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Inspection on 24/08/06 for Cleeve Hill Nursing Home

Also see our care home review for Cleeve Hill Nursing Home for more information

This inspection was carried out on 24th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has excellent activities facilities with very motivated staff and a very imaginatively planned weekly programme, provided for all service users and their families to see. Service users and satisfaction surveys seen also praised the quality and the choice of food provided and this was further confirmed by most of the residents whose records were seen, having gained weight since admission. Care is provided by well-trained, enthusiastic and motivated staff and on the whole the standard of care received was confirmed as high. Staff training and supervision is also well organised with staff having access to regular mandatory training updates and a variety of other specialist training such as palliative care.

What has improved since the last inspection?

There is an improvement in the assessment and care planning system in the home. In most of the records seen, the care plans reflected the current needs of the service users and there was evidence of regular reviews completed with service users and/or their families. Risk assessments were also completed and kept under review. Recruitment procedures have improved but there is still room for more improvement particularly with overseas recruitment (detailed below) to ensure that service users are protected.

What the care home could do better:

Staff are still being recruited from overseas with inadequate references, for example written in a foreign language, with insufficient career histories and are commencing work before POVA first has been completed. This is putting service users at risk and could be considered discriminatory when staff recruited in this country have to have all these checks in place before appointment. It is also a concern that a number of overseas staff employed as carers or domestic workers have a poor understanding of English. Not only is this detrimental in providing good communications with service users but is also a concern as to their understanding of the induction, and health and safety training they are given, as well as implications for the care of service users.

CARE HOMES FOR OLDER PEOPLE Cleeve Hill Nursing Home Cleeve Hill Cheltenham Glos GL52 3PW Lead Inspector Mrs Janet Griffiths Key Unannounced Inspection 24th August 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cleeve Hill Nursing Home Address Cleeve Hill Cheltenham Glos GL52 3PW Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01242 672022 Cleeve Hill Healthcare Limited Mary Ann Gangoso Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42), Physical disability (2) of places Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To accommodate two (2) services users under 65 years of age with physical disabilities on a respite care programme. To accommodate one (1) named service user under 65 years of age. This condition will be removed when the named service user reaches the age of 65 or no longer resides at the home. 8th December 2005 Date of last inspection Brief Description of the Service: Cleeve Hill Nursing Home is situated on the slopes of Cleeve Hill about three miles from Cheltenham. The home has its own grounds of two and a half acres. The premises consist of the original building and purpose built extensions. The accommodation is on two floors accessed by a shaft lift and a stair lift. A ramp from the main corridor to the entrance provides access for wheelchairs. The home provides two communal lounges and dining rooms all overlooking the well maintained gardens with beautiful views of the surrounding countryside. At the front of the home there is an accessible patio area. Major building work is currently underway to enlarge and improve on catering facilities and to build an extension to accommodate a further eight residents. The garden at the front of the building is also being landscaped and further parking facilities are being planned. Information about the service to include CSCI reports is made available by the provider to prospective service users through the homes’ Statement of Purpose and Service Users Guide. At the time of inspection the fees are £625 per week for personal care and £700 per week for nursing care. Additional charges are made for hairdressing and toiletries (list of charges provided), chiropody and beautician £10.00, newspapers at cost and telephone according to BT rates. Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This unannounced key inspection commenced on one day in August 2006, with the site visit that took place over 8.20 hours and was carried out by one inspector. During this time the inspector spoke with some of the residents who had been admitted since the last inspection and staff working in the home, to include several key workers who introduced or spoke about the residents they were responsible for. The manager was present throughout the day. Four residents’ files were looked at in detail. Surveys were left with some service users, and with a senior carer and the manager to hand out to relatives and to be completed with the residents where possible. No relatives were spoken with on this occasion although one was seen, having brought in her mother on that day for respite care. Another came in for a review meeting with the manager in the afternoon. Once returned, the results of the surveys will be collated and the information used in this or a later report. What the service does well: What has improved since the last inspection? Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 6 There is an improvement in the assessment and care planning system in the home. In most of the records seen, the care plans reflected the current needs of the service users and there was evidence of regular reviews completed with service users and/or their families. Risk assessments were also completed and kept under review. Recruitment procedures have improved but there is still room for more improvement particularly with overseas recruitment (detailed below) to ensure that service users are protected. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3; 6 not applicable Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. The admission process is well managed and with full pre-admission assessments the home ensures that it is able to meet the needs of each service user. EVIDENCE: Copies of the Statement of Purpose and Service Users Guide were seen both in service users rooms and in reception, with a copy of the last CSCI report in the one in reception. Five service users who had been admitted since the last inspection were spoken with. All had settled into the home. Several had been admitted for respite care initially but then decided on remaining at the home for full time care. One is hoping to return home when arrangements can be made but all were generally satisfied with the standards of care received. Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 9 None had visited the home prior to admission. One had visited it a few years ago when it was under different management, and several said their families had been to look round and recommended the home to them. Four records of these service users were examined and all had a pre-admission assessment completed to ensure that their needs could be met, and all confirmed this. There is no intermediate care provided at this home. Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. The care planning systems in place provides the staff with the information they require to care for all the residents’ needs. Service users are protected by the home’s policies and procedures for dealing with medicines. Service users health needs are fully met. Residents are treated with courtesy and respect. EVIDENCE: Four records were examined in detail. All had an assessment completed in addition to a number of risk assessments and all showed evidence of regular review. From the assessment, care is planned and the care plans reflected the current needs of the service users, for example when a nutritional assessment indicates someone at risk, they are weighed regularly and a care plan instigated to ensure that steps are taken to improve this situation. Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 11 Daily records are completed and a record is also kept of doctors and other professionals’ visits, for example the physiotherapist or speech and language therapist, indicating that the health needs of the service users are being met through multi disciplinary liaison. Records of relatives’ reviews were also seen and were very informative. One was taking place on the day of inspection. A number of staff were spoken with to include one new member of staff, two senior carers, one of whom also organised activity sessions and two other carers. All were able to give accurate information about the service users they were responsible for and how to meet their needs. They were observed carrying out their work efficiently and in a professional manner, respecting the service users privacy and dignity. Service Users spoken with confirmed the good standards of care, although some said communication was not always easy. However, one said, they all come into the room with a smile and are all willing to help, which is most important. The home has a robust medication procedure in place. Records were seen of the service users who were case tracked and were well maintained. Storage arrangements were in place and satisfactory. The dispensing pharmacy carries out 6-monthly audits and at the last inspection put plans in place for the qualified staff to have further training on medications from the National Pharmaceutical Association. They also send pharmacy information leaflets every three months and with all new medicines. The manager also carries out her own medication record audits and sends a copy of the results of these to all the trained staff. Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality is this outcome is excellent. This judgement has been made using available evidence including a visit to this service. Residents continue to experience a very stimulating and varied life at the home should they choose to participate in the programme available and all are helped to exercise choice and control over their lives. Visitors and community links are always encouraged. Service users receive a wholesome, appealing and balanced diet with plenty of choice, in pleasing surroundings. EVIDENCE: The home employs three activities co-ordinators who between them organise an extremely varied and imaginative activities programme which is posted on the notice boards around the home and a copy given to each resident. Activities for August included word games, flower arranging, poetry readings, craft, memory games, exercises, musical entertainers and a falconry display. A ‘map of life’ is completed for each resident in consultation with them and their relatives and these give a picture of each residents’ past life, work and interests and from this meaningful activities are planned. Not all residents chose to participate but all are offered the choice to join in with which ever activities, social events or outings they choose, or the activities co-ordinators ensure that they receive one to one social interaction. Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 13 Records are kept of what activities each resident participates in and also a colour- coded chart where staff can see at a glance what social interaction each resident is receiving and how successful and popular each activity has been, which helps the planning of future events. One activities co-ordinator was spoken with about her role, which she thoroughly enjoys. She talked about the one to one sessions she has, reading and discussing subjects that individuals have interests in, such as sports and nature. Other particularly enjoyable sessions included kneading dough for bread and later eating the finished article and sweet making. She also said that a number of residents enjoy having items from the local papers read to them. Exercise sessions and word games were taking place during the inspection. Several of the residents spoken with related outings they had been on and enjoyed, to include going out for a ride and then calling back by a local pub for a drink and some food. Visitors are welcomes to the home and it was noted that they often joined the residents for a meal. Beverages are available for visitors in the main hall and again are a very welcomed facility. No relatives were spoken with on this occasion but a number of relative reviews were seen within care records examined. Residents spoken with all confirmed that they were able to exercise choice and control over their lives, particularly with how they spent their days, the times they got up and retired to bed, and whether they participated in the activities on offer. There were several examples seen of where residents were offered assistance washing and dressing later in the morning, as they liked to ‘lie in’. There were several comments made in reviews about lack of specific personal care such as shaving and making sure glasses were put on, and elsewhere regarding sitting someone on a dining chair rather than in a wheelchair for meals, but it was reported that these issues had already been dealt with. Staff were observed maintaining privacy and respect by knocking on doors prior to entering rooms and addressing residents by their preferred form of address. Part of the current major building project is to improve on the existing catering facilities and whilst this is underway staff are using temporary but well equipped kitchen facilities. Residents confirmed that this had in no way affected the excellent quality and choice of the food provided. The two dining rooms are still operational and Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 14 residents have the choice of dining in one of these, in one of the lounges or in their own rooms. Menus are displayed on the notice board in the corridor by the dining rooms and are also replaced daily on each dining room table. Lunch choices on the day of inspection were sausage and apple pie with onion gravy, poached chicken salad or macaroni cheese, followed by blueberry apple cake and whipped cream, or Greek yoghurt with honey and walnuts. Special dietary needs are also catered for and discreet assistance offered where necessary. It was also noted that fluids are readily available to each resident and fluid balance charts in place where necessary. Most of the residents spoken with confirmed their satisfaction of the meals provided, with several saying they had put on weight since moving into the home. One resident said there was nothing at all wrong with the food but it just didn’t suit him. Staff were aware of his preferences and tried to accommodate them. There were one or two comments related to food in the homes’ satisfaction surveys. One related to undiluted orange juice being given, others said they weren’t given a drink or a drinking glass, another no food. These all related to specific occasions at weekends when the person completing the survey felt care needs were not always met so fully. All the findings of the surveys have already been discussed and action taken. The only other negative comments regarding food related to food service and problems with communications. One service user said it was frustrating at times to be handed two spoons and a fork to eat a meal, but no knife and then on another occasion to have all the meal cut up into small pieces when they were quite capable of cutting it up themselves. Another frustration was saying they didn’t want sugar in their drinks and it being given. This was all fed-back to the manager for action to be taken. Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse. EVIDENCE: It was reported that there had been three complaints since the last inspection. All had been substantiated, recorded and appropriate action taken. The manager and provider both ensure that they are accessible to residents and their relatives and generally any concerns are dealt with immediately, and avoid becoming formal complaints. A copy of the complaints procedure is available in the reception area, as is a ‘thank you’ file. One minor adjustment is required to change the reference to National Care Standards Commission (NCSC) to Commission for Social Care Inspection (CSCI). Service users spoken with confirmed that they knew how to complain and who to complain to and were confident that their complaints would be dealt with. Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 16 A Whistle blowing Policy, Prevention of Abuse and the Department of Health Guidance ‘No Secrets’ were all seen and are available to staff. All new staff are expected to read these documents as part of their induction and those undertaking NVQ are also required to refer to these policies as part of their training. Training on Protection of Vulnerable Adults has been arranged for all staff to attend in October. Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within this home is good providing residents with an attractive and homely place to live. Despite major building work ongoing the home remains clean, pleasant and hygienic. EVIDENCE: Major building work was in progress during the inspection. The kitchen is being enlarged and refitted. An extension is being built on to the end of the current purpose built building to create a further eight rooms, and a new sitting room is being built at mid level. The front garden is being landscaped and additional car parking created. Construction Bulletins are sent out regularly to residents and their families to keep them informed of the work in progress and before the building work Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 18 commenced a presentation evening was given, again for residents and their relatives. On the whole this is all being managed extremely well in an attempt to cause the least disruption for the service users but inevitably some service users spoken with said that it was very noisy at times, and had been extremely hot during the heat wave when windows were often kept shut to reduce noise and dust. However, others find the whole experience interesting to watch from their bedroom windows. It is anticipated that the new kitchen will be operational before Christmas after which both dining rooms are to be redecorated and refurbished. There are also plans in place to enlarge the ground floor bathroom and fit a hydro-bath on 18th September. Not all areas of the home were inspected on this occasion but rooms visited appeared to be clean, in good decorative order and well maintained. There were one or two comments in the homes’ last satisfaction surveys related to the environment. One stated that the standard of room furnishings could be much improved; another felt there was lack of storage space and another wanted small handles on their wardrobe. It was reported that all of this has been addressed. Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is judged to be poor. This judgement has been made using available evidence including a visit to this service. Staff at the home are well trained and supported and employed in sufficient numbers to meet the residents needs. There are concerns regarding recruitment procedures which although they show some improvement are still less than robust for all staff recruited from overseas putting service users at risk. EVIDENCE: The manager and another qualified nurse were on duty during the inspection together with six care staff during the morning and four on the late shift. In addition to care staff, the home has cleaning, catering and laundry staff onduty. Other staff include an administrator, maintenance staff and drivers. Details are sent to CSCI each month of the dependency of each service user and the calculation of how many staff are required and provided. Several staff were spoken with during the day to include two senior carers and three care staff, one of which had worked at the home for 3 months, but had had previous care experience. Two staff from overseas were approached. One a carer and another a domestic but both stated their English was poor and indicated it was difficult to communicate. Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 20 The one senior carer has NVQ 3, having done NVQ 2 previously; the second has NVQ 2 and is currently doing 3; none of the three care staff spoken with have NVQ although one completed the care practice foundation but had to give it up for personal reasons and the newest member of staff is hoping to do her training and confirmed that she was completing a TOPSS induction programme which all new staff complete with the principal or senior care staff. All indicated that they were up to date with mandatory training and some had also completed a variety of specialist training (training matrix provided). Plans for training over the next two months include first-aid, continence and POVA training for all staff, and ear irrigation and venepuncture for qualified nurses. All also confirmed that they had received an annual appraisal and regular supervision sessions, which were later confirmed by the records seen. The newest member of staff had not yet had a supervision but expected to have one soon as she was coming to the end of her probationary period. The one senior carer had also not had her last appraisal, which is usually in March, although she had completed the prepatory paperwork. It was later reported that the qualified nurse assigned to complete her assessment had been on extended leave and had not completed all her appraisals yet. All the qualified staff are assigned a number of staff and are responsible for their appraisals and supervisions; senior carers also appraise and supervise care staff. From conversations it appeared that some senior carers do find it difficult to fit in these additional responsibilities in their normal working day and also felt communications were sometimes difficult with some overseas staff who needed a lot longer induction period before being counted in the numbers assigned to each floor to work each day. One carer also felt that communication generally in the home could improve. They felt that there were not enough staff meetings and if they were part time and reported something about a resident on one day and then were off for several they did not get to hear what action had been taken. It was suggested that they ask at handover periods or read the daily care records. Generally the morale at the home appears good and the staff were very enthusiastic about their work and were very informative about the service users and how to meet their needs. Five staff files were checked in detail of all new staff appointed since the last inspection. All had an application form completed. Some of these were brief but the home now also requests a CV so that a more detailed career history can be completed. A written explanation of any gaps in career history must be produced. Only one interview record and job description was seen. All had confirmation of being mentally and physically fit. Two of the files were complete and had all the necessary checks completed, but the records of the two overseas staff were unsatisfactory. One gave details of a career history from 1984 to March 2006 with the last employment being in England, but this employer was not given as a referee. Two employers from overseas names were given and one reference (presumably) written in Slovakian with no Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 21 translation was on file. The start date for this employee was given as 1/4/06 but POVA first was not obtained until 3.5.06 and CRB disclosure was received on 17.5.06. The second gave a brief career history stating past employment such as chef, shop assistant, waitress but no details of where this employment was or names of employers and no reasons given for leaving these positions. There were two handwritten references on file, which both presumably came from abroad and looked very similar but as no names of referees were given on the application form it is uncertain whether these were actually from past employers. Ensuring that each potential employee has two written references, one being from the last employer has been a requirement for the last two inspections. Again this employee began work with the domiciliary agency attached to this business on 15.1.06 and began in the nursing home on 18.2.06 but POVA first was not obtained until 28.2.06 and CRB until 8.3.06. A third employee who is English also had a start date of 1.6.06 and POVA first check 13.6.06 and CRB 24.7.06. All care staff applying to work in care positions working with adults in CSCI regulated settings are required by law to have received a satisfactory POVA check before they can take up employment. This includes all staff recruited from abroad. Failure to do this is a breach of regulations and puts service users at risk. The other concern regarding the recruitment of care staff from abroad is their understanding of English, both spoken and written. Information from the recruitment agency for one member of staff gives their assessment of English speaking and reading as basic. All staff go through in depth induction programmes to include mandatory health and safety training on commencement but if understanding of the language is basic then it is questionable as to how effective this training is. It is also very important in the role of a carer for the elderly that staff have good communication skills to recognise when a resident is unwell, or has concerns, and are able to offer reassurance. Again this is questionable as to whether this is achieved particularly with reference to residents quoted experiences. All staff for the duration of their induction training and for the period between POVA First and CRB checks being on file, must be adequately supervised by a named supervisor who is qualified to do so and as far as is practicable must be on duty at the same time as the new worker. Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. The manager is well supported by her senior staff in providing clear leadership throughout the home with all staff demonstrating awareness of their roles and responsibilities. The home is run in the best interests of service users and their financial interests are safeguarded. The systems for resident consultation in the home are good with evidence that indicates that residents’ views are both sought and acted upon. The health, safety and welfare of service users are promoted and protected. Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 23 EVIDENCE: Since the last inspection the manager has been approved as registered manager by CSCI. She is currently half way through the registered managers award- NVQ4. She appears to be managing the home well especially in this time of transition although not all staff feel communication systems are adequate (see standards 27-30 above). However, it was reported that specific staff meetings are held and all other communication is carried out during either daily handovers at each shift change or in one to one supervision sessions. The home holds small amounts of ‘pocket money’ securely for service users where necessary and requested. Individual records and receipts are kept of any financial transactions undertaken, and were seen. Monies for hairdressing, chiropody etc. is generally billed individually and sent out in a monthly invoice to each service user/their representative. Residents are able to purchase confectionary, toiletries and certain items of clothing from the home and price lists are included both in their information and were provided with the pre-inspection questionnaire. Again records are kept of all these transactions. The last satisfaction survey was sent out to service users/their families in February 2006. To date twenty have been returned. These looked at all aspects of the home and on the whole were quite positive although there were comments made that required action (some of which have been mentioned in the report). The results of these should now be collated and a report published as to what action has been taken. A copy should be included in the service users guide and one sent to the Commission. The provider ensures that the service users and staff are kept safe particularly during the building works. Staff spoken with and records seen confirmed that all staff receive mandatory training on induction and regular updates. Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 19 19(4)(c) Requirement Timescale for action 31/10/06 2. OP29 19 3. OP30 18 2(a & b) Two written references to be obtained for each new employee including a reference related to the person’s last period of employment, which involved working with vulnerable adults. This requirement has been repeated from the last two inspections. The registered person should also ensure that they are satisfied on reasonable grounds as to the authenticity of the references. The registered person must 31/10/06 obtain the following pre employment checks: 1) A full employment history, together with a satisfactory written explanation of any gaps in employment. 2) Criminal Records Disclosure (including where applicable a POVA check). The registered person must 31/10/06 ensure that persons working at the care home are appropriately supervised, and for the duration of a new workers induction DS0000016410.V309351.R01.S.doc Version 5.2 Cleeve Hill Nursing Home Page 26 4. OP33 24 training; 1) A member of staff (the staff member) who is appropriately qualified and experienced is appointed to supervise the new worker. 2) As far as is practicable, the staff member is on duty at the same time as the new worker; and 3) The new worker does not escort any service user away from the care home premises unless accompanied by the staff member. The registered person must supply to the Commission a report in respect of any quality assurance reviews undertaken and shall include details of the measures taken in order to improve the quality and delivery of the services provided in the home. 28/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP29 OP33 Good Practice Recommendations An interview record should be kept The results of service user surveys are published and made available to current and prospective service users, their representatives and other interested parties including CSCI. Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cleeve Hill Nursing Home DS0000016410.V309351.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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