Inspection on 06/05/08 for Cleeve Lodge

This inspection was carried out on 6th May 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cleeve Lodge 20/07/07

Cleeve Lodge 22/02/07

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Cleeve Lodge Cleeve Lodge Close Downend South Glos BS16 6AQ Lead Inspector Grace Agu Key Unannounced Inspection 6th May 2008 09:15 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 DS0000068293.V362836.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. DS0000068293.V362836.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cleeve Lodge Address Cleeve Lodge Close Downend South Glos BS16 6AQ 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) 0117 970 2273 0117 956 6027 cleevelodge@shieldscare.com Shields Care Ltd Marie Rochester Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33), Physical disability (3) of places DS0000068293.V362836.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th July 2007 Brief Description of the Service: Cleeve Lodge opened in 1993 to provide care and accommodation for 30 older people and 3 people with disabilities aged 45 and over. The property is a listed building, dating back to the 18th Century, which has been carefully restored and maintained in keeping with the period of the house. The home is located in the residential area of Downend, South Gloucestershire, close to the border of the City of Bristol. Local shops and other community facilities are close to the home and it is within easy reach of motorway connections. The homes 30 bedrooms (3 of double size) are situated on three floors and are equipped with TVs, emergency call systems and en-suite facilities. There are gardens and lawns to the front and side of the property. The philosophy of the home is to promote independence in all aspects of home care life and it aims to offer the ideal environment to improve health and general wellbeing as well as opportunity to make new friends. It stated in its Service Users Guide that it encouraged all staff, residents and visitors to help to offer an environment that is non-discriminatory, maintains people’s dignity and is respectful at all times. The home has a range of staff with various skills to cover the home 24 hours a day. Training undertaken by staff includes NVQ 2, manual Handling and medicine administration at level 2. Fees range from £385-£510 weekly DS0000068293.V362836.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced visit that was undertaken by two inspectors over nine hours to review medication and other requirements made at the last inspection and also to review the care practice to ensure that it is in line with the legislation and that best practice is followed at the home. The pharmacy inspector reviewed the home’s medication and her report can be found in the body of the report under Standard 9. In addition to the above, the inspection was undertaken in response to the complaint raised by an individual in relation to the standard of care given to their relative at the home. We met with the manager and the Head of Care. To enable us to form judgement about the quality of care provided at the home we toured the building and viewed a number of records. Four service users, three staff members and two relatives were spoken with on the day. What the service does well: Evidence from records and speaking to the service users indicate that the home creates a safe, and caring environment in which residents feel content and their needs fulfilled. Generally the home was found clean and warm. Residents were found relaxed and some residents were seen accessing the communal area without restriction. Staff were noted interacting with individuals living in the home in informal and sensitive manner. The manager stated in the Annual Quality Assurance Assessment sent to the Commission for Social Care Inspection that the home offers quality care and that the proprietor is committed to investing in making Cleeve Lodge a home with high standards. Evidence from the visitors book shows that families, friends, relatives and other visitors are encouraged to visit the home to ensure that regular contact is maintained. Relatives spoken with stated that they are able to visit the home at any time without restrictions. DS0000068293.V362836.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: To minimise accidents to identified individuals, accidents must be followed up and the risk assessments and care plans completed/reviewed. Individuals living in the home would receive appropriate care if comprehensive personalised care plans were in place for all identified needs. To ensure that the nutritional needs of the residents are met at the Home it would be better if individuals living in the home are provided with choice of meals and that the service users are able to select the meals from the menu on a daily basis as stated on the ‘Residents Charter of Rights’ provided by Cleeve Lodge. Robust recruitment procedures must be followed at all times and all new staff must be fully vetted before starting work. This must include the following: Written application form/CV Gaps in employment history should be explored Two written references that have been verified as true CRB and POVA First checks (the latter must be received prior to employment starting). The general cleanliness of the home must improve by ensuring adequate numbers of domestic and laundry staff to ensure that service users are provided with a clean environment where they are happy to live in. It could be better if arrangements around fire safety are improved in regard to fire drills and action taken to address the concern raised by the fire safety officer. Furthermore individuals living in the home would be protected is all staff attend statutory training in relation to fire safety and health and safety. To adequately protect the residents it could be better if portable (electrical) appliance testing is updated. To further provide appropriate care to the service users it could be better if staff receive training on behaviour that challenges. DS0000068293.V362836.R01.S.doc Version 5.2 Page 7 Domestic and laundry staff would perform their duties more effectively if they attend training on infection control and Control of substances Hazardous to Health (COSHH). To ensure that people living in the home are adequately protected it would be better if the generic risk assessment includes individual service users bedrooms, lounges kitchen and other arrears that service users have access to following recent falls. Ensuring that there is a policy on dignity and respect would enable staff to make entries in resident’s care file without compromising their dignity and ensure that this is appended in the home’s ‘Statement of Purpose’. At this inspection, it was noted whilst touring the building that one resident was in the dining room in an undignified condition. The home must ensure that better strategies are in place to meet residents’ personal care needs in order to uphold and respect their dignity. Handling of medication has greatly improved since the last key inspection, however some further action is needed to ensure that residents’ health is protected. Accurate records must be kept of the disposal of all medicines from the home. This refers to: Return of unused Controlled Drugs to the pharmacy and Return of medicines to residents who leave the home. Action should be taken to allow staff to audit medicines supplied in standard packs so that they can check the balance in the pack to see if the correct dose has been given. Handwritten additions to the medicines administration record sheet should always be signed and dated by the person making the addition and checked by a second member of staff. This is to reduce the risks of mistakes being made which could lead to someone being given medicines incorrectly. Records of disposal of medicines should be kept in a bound book so that individual sheets cannot be lost. A second member of staff should check and sign the disposal record. This is to reduce the risk of mistakes leading to the discrepancies seen with some medicines. The home should ensure its induction and foundation programme is Skills for Care accredited to ensure that new staff are well equipped with knowledge of the responsibilities of meeting needs before working with service users. 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. The summary of this inspection report can be made available in other formats on request. DS0000068293.V362836.R01.S.doc Version 5.2 Page 8 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 DS0000068293.V362836.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The process of admission of prospective residents is detailed and planned to enable the residents to make an informed choice of moving to the home with the assurance that their needs will be met. EVIDENCE: The Home has a Service Users’ Guide, which is given to the prospective resident or their representative when they visit the Home to enable them to make an informed choice of moving to the Home. The manager stated that the Statement of Purpose is to be reviewed to include the statutory requirements stated in Schedule 1 of the Care Homes Regulations 2001. DS0000068293.V362836.R01.S.doc Version 5.2 Page 10 The manager stated in the Annual Quality Assurance Assessment that when a prospective resident visits the Home for a day, they are invited to join and have lunch and interact with existing residents and receive more information about the services provided at the Home. Residents are informed on the initial visit or on admission of the one-month trial period during which she/he can change their mind. The care file of a recently admitted resident contained pre-assessment information about activities of daily living, social activities, likes and dislikes, medical history and medication. The above information is looked at and care plans are expected to be written on how the assessed needs are to be met. The care file reviewed contained information detailing the terms and conditions of stay at the Home. DS0000068293.V362836.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home offers care and support to residents throughout their lives and towards the end however, it fails to protect residents by reviewing their health needs and appropriate care planning. Handling of medication has greatly improved since the last key inspection, however some further action is needed to ensure that residents’ health is protected. EVIDENCE: We looked at four service users care records. A care assessment of the needs of the service users had been completed for each service user on admission. The assessment information addressed the service users’ physical, and psychological needs. The assessments had been regularly reviewed. This included a detailed life history of the person and what was important to them. DS0000068293.V362836.R01.S.doc Version 5.2 Page 12 The assessment information addressed the service users physical, and psychological needs. The assessments had been regularly reviewed. There was a medical record for each of the service users whose records were reviewed. This recorded when the person had seen the doctor, the reason for the referral and any outcomes from this, such as what treatment may be required. The service users accident records were reviewed. This showed the Home follow up and monitor service users after having an accident. However, it was advised that an easier format be put in place, for the recording of accidents. Currently accidents are recorded in a general record about service users and it was difficult to review if/how the accident was followed up. The manager stated that the Home would consider using the format currently used for recording staff accidents. In relation to the four residents’ care files checked. The files contained evidence of assessed needs however lacked clear information and direction to enable staff to deliver appropriate care according to the individuals’ needs. For example one resident’s care file reviewed evidenced that there was no care plan in relation to a medical condition and how this is being managed at the home. Furthermore, another resident had different entries on ‘wandering’, aggression and challenging behaviour from the beginning of September 2007 and had no care plans on how these conditions were being managed. Because of lack of care plans and subsequent reviews following this individual’s deterioration, and failure of timely action an incident occurred that threatened the health and safety of other people living in the home. We noted that there was evidence that the General Practitioner (GP) and other health professionals are involved in the management of the health needs of the person. The manager stated that this person has been reassessed and is awaiting placement to a more appropriate home for better management of the individual’s needs. We have made a requirement for care plans to be put in place for all the needs identified while the person is living at the home. In addition we noted that the entries made on 22/03/08 and 21/04/08 suggest that respect and dignity of the individual is compromised. For example ‘X has been really weird’. DS0000068293.V362836.R01.S.doc Version 5.2 Page 13 This did not reflect the aims and objectives of the home as written in the Statement of Purpose and the Service Users Guide. The manager stated that this would be discussed at staff meetings, handovers and would be strongly emphasised at the induction of new staff members. We have asked the home to ensure that there is a policy on dignity and respect to enable staff to make entries in resident’s care files without compromising their dignity and ensure that this is appended in the home’s ‘Statement of Purpose’. We have issued a requirement to ensure that this happens. We observed care staff knocking before they entered service users’ bedrooms. Care staff were seen to speak with service users as they entered their bedrooms in a friendly and warm manner. One resident spoken with stated that staff respected them and provided them with good care. One relative stated in the survey returned to us“ mum is happy and this is all that matters”. One Staff member spoken with was aware of measures to be taken if a resident became terminally ill and in the event of death. Evidence of residents’ wishes in the event of death was noted in the care files. The pharmacist inspected the handling of medication in the home. The pharmacy supplies medication for residents using a monthly blister pack system. Several people living at the home are able to look after their own medicines. Risk assessments have been completed for the people who permanently live in the home, to make sure that this is safe. We spoke to two of the people looking after their own medicines and both said they were happy to have their medicines in blister packs, although one person said that they had not been given a choice when the home switched from a weekly box system to a monthly blister pack system. Lockable storage is available so that people can keep their medicines securely Staff keep a record of medicines that they order and pass on to the residents. This means that there is an audit trail for these medicines. The home does not have a homely remedies policy, for treating minor ailments. All medicines given by staff are supplied on prescription. This has resulted in several blister packs of Paracetamol for occasional use being kept longer than is recommended. Staff need to discuss with their pharmacist how best to keep Paracetamol that is only used occasionally. DS0000068293.V362836.R01.S.doc Version 5.2 Page 14 Secure storage is available so that medicines are kept safely. A medicine fridge is available and staff record the temperature every day. A Controlled Drugs cupboard is available for medicines that need more secure storage. A register is used to make sure that these have been looked after safely. When we checked the recent records made in the register, we found that some records were unclear and the return of some medicines for disposal had not been recorded. In some cases there were discrepancies between the records of returns made in the register and those made for the pharmacy. This means that staff cannot show these medicines have been looked after safely and a requirement has been made concerning this. A medication policy is available for staff so that they have information about safe procedures to be used. We saw staff giving medicines out at lunchtime in an appropriate way. The pharmacy provides printed medicines administration record sheets for staff to complete when they give out medicines. New sheets and blister packs had been started just before this inspection. We looked at several records that had been made the previous month and saw that records had been completed fully. This shows that staff are recording that they have given the medicines correctly. However we saw two records on the new charts where it was not clear if the correct dose of medicine had been given. Clear information about the dose of medicine given should always be on the medicines administration record sheet. Action should be taken to allow staff to audit medicines supplied in standard packs so that they can check the balance in the pack and see if the correct dose has been given. Staff have made some handwritten additions to the medicines administration record sheet and these should always be signed and dated by the person making the addition and checked by a second member of staff. This is to reduce the risks of mistakes being made which could lead to someone being given medicines incorrectly. Records are kept of the receipt of all medicines into the home. Records are kept of unwanted medicines returned to the pharmacy. During the inspection it appeared that one record sheet might be missing. Action is needed to make sure that these records are not lost. A second member of staff should check and sign the returns record. This is to reduce the risk of errors leading to the discrepancies seen with some medicines. Records had not been made of the medicines returned to people who move from the home. DS0000068293.V362836.R01.S.doc Version 5.2 Page 15 Action must be taken to make sure that records are kept of all medicines leaving the home, including those returned to people who move from the home. This is to make sure that there is a clear audit trail of medicines throughout the home to show that they have been looked after safely. DS0000068293.V362836.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home enables residents to maintain contact with family, friends and the Community. Meaningful activities are available. However, it fails to provide choice in respect of meals. EVIDENCE: Discussions with residents and staff and entries in the visitors’ book showed that the home actively supports the residents to maintain contact with families and representatives. During the visit relatives and friends were noted visiting the home. One relative spoken with stated stated that the staff are welcoming and that they are satisfied with the care provided for their person. One comment card from a relative stated, “Staff are friendly and quite welcoming.” Another comment card stated, “I visit my relative quite regularly and there is a warm atmosphere at the home”. DS0000068293.V362836.R01.S.doc Version 5.2 Page 17 The home’s activities programme was reviewed. The Manager said in the Annual Quality Assessment Assurance (AQAA) that the home has employed more staff enabling one carer to be allocated for activities every afternoon. They do armchair exercise, games, puzzles or sit and chat with residents. The staff member is trying different activities aimed to provide better and more stimulation to all the residents and particularly those residents who prefer to stay in their rooms. The manager also stated that the home has introduced an aromatherapist who comes in once a month to offer hand, feet, leg and body massage. Additional outside entertainment has been arranged. Other activities provided include, flower arranging, cake decorating. There is holy-communion service once a month for service users who wish to exercise their faith in that manner. One comment card from a relative stated, “Staff are friendly. They are trying to introduce more activities. Food seems good, plentiful and well presented. Gradually services are being brought up to date and modernised to meet current standards”. Activities for the week were displayed on the board. The Activities Book showed names of residents that participated so that the home can aim to include all residents to ensure that no resident feels isolated. The menu was reviewed and it has one choice of meal at lunch time and a limited alternative. Residents that we spoke with stated that are not provided with menu to enable them to make a choice of what to have. One individual stated “I don’t even know what I am having for lunch. We discussed this concern with the manager and we were informed that the home has a new chef and that a new menu was being developed in consultation with the residents. Residents would be shown the menu a day before to enable them to choose the their prefered meal for lunch. We have made a requirement to ensure that this is implemented. Comments made by residents confirmed that they felt able to choose what time that they get up, and go to bed. This was also observed during the visit, with residents getting up at differing times during the morning, and helps demonstrate residents exercise choices in their lives. The kitchen was found satisfactory in relation to cleanliness. There was evidence that staff working in the kitchen have attended basic food hygiene training. It was noted that the fridge and freezer temperature recordings were regularly undertaken to monitor the risk of food poisioning. DS0000068293.V362836.R01.S.doc Version 5.2 Page 18 DS0000068293.V362836.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are enabled to complain and are confident that their complaint will be listened to. Practices at the Home ensure protection of residents from harm and abuse. EVIDENCE: There were three-recorded complaints since the last inspection. These complaints include a complaint by a relative in relation to care provided for an individual at the home. We had a discussion about the complaint with the individual and a family member and it was agreed that if they were not satisfied with the response from the home to inform the Commission. We also discussed the complaint with the manager. She informs us that in addition to the response that she sent to the Commission about this complaint that she would discuss the issues raised in the complaint and take action where required. We noted that this complaint was not recorded. We noted that two complaints in relation to care of another service user were adequately recorded. DS0000068293.V362836.R01.S.doc Version 5.2 Page 20 Records indicated that appropriate procedure was followed and that the complaints were satisfactorily resolved. A copy of the complaints procedure is on display in the reception area, which includes the name of the Commission for Social Care Inspection, for anyone who wishes to contact us. The contact details of the owners are included in the service users guide and with residents’ contracts, if residents or representatives wish to contact the owners directly to make a complaint. Many residents also said that they felt able to speak to the manager, or the deputy manager if they had any concerns and wished to complain. Staff are aware of the Whistle Blowing policy and would report any bad practices to the Manager without fear of reprisal. All staff are provided with training to ensure they are up to date in their understanding of the principle of the protection of vulnerable adults from abuse. There is a policy in place relating to the issue of protection of vulnerable adults from abuse. The manager is aware of the protocol to follow if abuse occurs or is suspected. Referral made in relation to safeguarding a service user was satisfactorily resolved. DS0000068293.V362836.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents enjoy a pleasant, safe and homely environment however review of the domestic staff needs to happen to ensure a satisfactory standard of cleanliness of the home. EVIDENCE: The home is located in the residential area of Downend, South Gloucestershire, close to the border of the City of Bristol. Local shops and other community facilities are close to the home and it is within easy reach of motorway connections. The homes 30 bedrooms (3 of double size) are situated on three floors and are equipped with TVs, emergency call systems and en-suite facilities. There are gardens and lawns to the front and side of the property. DS0000068293.V362836.R01.S.doc Version 5.2 Page 22 All areas of the home both indoors and outside are fully accessible to residents. There is level access to all rooms and corridors and a passenger lift provides access to the three floors. Handrails have been fitted as required throughout the home with adaptations in bathrooms and toilets such as specialist baths and raised toilets. Call systems are in place in all bedrooms and bathrooms and toilets. A loop system has been installed to assist communication with residents who have a hearing impairment. In addition, the home has fitted a ramp to provide residents with level access from the home’s garden to an adjacent park. Residents stated that everyone is able to get around the home. No residents currently use a wheelchair to assist mobility in the home. The Home had recently installed stair-lift to enhance the service users mobility and comfort. The home is centrally heated. Risk assessments should now be undertaken on all the bedrooms following recent falls. The home was found to be clean with no offensive odour. However some residents commented upon the lack of consistent standard of cleanliness on a daily basis. One service user stated that there are not enough domestic staff to undertake cleaning duties at the home. The individual stated that sometimes their room is not cleaned for a whole day. One relative spoken with told us “I have just dusted my relative’s room because there are not enough domestic staff.” Policies and procedures were seen to be in place for control of infection and in respect of Control of Substances Hazardous to Health (COSHH). The home’s laundry is sited away from food preparation areas and was clean, well-organised and included 4 washing machines including a commercial type washer with a sluicing facility and 3 dryers. A requirement has been issued for the laundry and domestic staff to undertake training on infection control and COSHH training to enable them to perform their duties effectively. DS0000068293.V362836.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recruitment policy of the home offers protection to the residents at the home. However, the home fails to follow the procedure to ensure that residents are protected. There is adequate numbers of staff that are competent to meet the needs of the residents. EVIDENCE: On the day of inspection, there was an adequate number of staff members on duty to meet the needs of the residents. The home’s duty rota showed five staff members on duty during the week between 8.00am and 1.00pm and three staff members on duty between 1.00pm and 10.00pm. Two staff members are on waking duty in each night. The manager stated that the Head of Care has been allocated supernumerary hours each week to assist with administrative work and to cover staff shortage in an emergency. DS0000068293.V362836.R01.S.doc Version 5.2 Page 24 We received a complaint in relation to frequent use of agency staff. The manager stated that the use of agency staff has reduced due to recent staff recruitment. Staff members that we spoke with confirmed that the general standards of care have improved due to continuity of care. Staff told us that there still room for improvement and that this could be achieved by ensuring that care staff are not allocated to do domestic duty for example cleaning, this they told us takes them away from providing quality care to the service users. The manager stated that she would review the staffing level with the provider in relation to care and domestic staff to ensure that care staff hours are strictly allocated to providing care to the service users. We agreed that reviewing the staffing level would provide better supervision for the service users in the dining rooms at meal times and especially at lunchtime. The manager would also review the staff allocation at meal times in response to the complaints received at the Commission. Review of the training record showed that some staff members have achieved National Vocational Qualification (NVQ) at level 2 and 3. Three staff members are currently undertaking NVQ level 3 and 5 staff members are currently undertaking NVQ level 2. Other training attended included Manual Handling, Protection of vulnerable Adults from abuse and First Aid. The manager stated that some staff members are currently undertaking a course on safe handling of medication through distant learning. The manager told us that basic food hygiene update has been booked for all staff on 12/05/08 and that staff would undertake training on dementia awareness as soon as the medication training is completed. The manager is to ensure that all staff attend training in relation to health and safety to ensure that the service users are adequately protected. We have issued a requirement for staff to undertake training on challenging behaviour to enable staff to care for service users with behaviour that challenges. The home is also required to provide training for domestic and laundry staff on infection control and COSSH. There is a recruitment policy and procedure at the home to ensure that only appropriate, suitable and experienced staff are recruited at the home. Whilst reviewing the recruitment documentation of two newly appointed staff members the inspector noted that one staff member recruited had appropriate recruitment documentation before commencement of employment however a DS0000068293.V362836.R01.S.doc Version 5.2 Page 25 Criminal Records Bureau (CRB) disclosure was from a different organisation that was issued three years ago. The manager stated that Criminal Record Bureau checks for all staff members had been applied for. The other staff member employed on 14/04/08 had no references and no CRB disclosure to ensure that this person is able to work in a vulnerable adult setting. We have issued a requirement to ensure that this situation is remedied. This standard requires the home to keep all records listed in Schedules 2 and 4 in respect of staff employed at the home. Whilst the home provides induction training for new staff members, it is recommended that the home ensures its induction and foundation programme is Skills for Care accredited to ensure that new staff are well equipped with knowledge of the responsibilities of meeting needs before working with service users in an older peoples’ setting. One staff member spoken with confirmed that she had attended training courses to enable her to perform her duties effectively. Individuals living at the home stated that staff are very kind and are sensitive to their needs. Some of the comments we received from the people who live at the home and their relatives and visitors include: “Staff are friendly and seem happier than they were few months ago”. “Staff are always helpful and approachable”. “Staff listen to me more than my last home”. DS0000068293.V362836.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,35,36,37,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home benefits from good leadership and management, however its practices do not fully protect the health and safety of the residents. EVIDENCE: Ms Marie Rochester was recently registered as the home manager of Cleeve Lodge following a successful Fit Person’s Interview with the Commission for Social Care Inspection. Marie is well qualified and has experience in the care of older people. Evidence from records and observation on the day of the visit indicate that Marie has work hard to make improvements in various areas of service provision for better outcomes for the people living at the home. DS0000068293.V362836.R01.S.doc Version 5.2 Page 27 The staff members and two relatives spoken with told us that Marie was an approachable manager and was ready to support and give advice if needed. It was demonstrated by staff through their interaction that there is an understanding in the team of the manager’s enthusiasm to raise and maintain a satisfactory level of care for the people living in the home. Evidence from observation led us to believe that the team are supportive to each other. There were recent records of annual gas safety inspection, testing of fire equipment and call bells system The manager stated and there is evidence of this that the Five Yearly Electrical Installation Safety inspection had been undertaken in 2006. It was agreed that the testing of all the portable electrical appliances should be undertaken as the last test was done in 2006. This is to ensure that the service users are adequately protected. The home’s quality assurance system was reviewed. During a discussion the Manager stated that the service users plans are regularly reviewed and discussed at staff team meetings. Other ways used to monitor the quality of service is through informal discussion with family and friends; residents’ care plan reviews and the statutory monthly visits by the provider. Questionnaires are also sent by the home to relatives, General Practitioners and District Nurses to give feedback on how the home is performing. The home’s policies and procedures reviewed included whistle blowing, Missing persons Medication, Protection of Vulnerable Adults from Abuse, Quality Assurance, Death and Dying and Health and safety. The manager stated that the home would purchase a different accident book to enable staff to record and review accidents. There was evidence that individual risk assessments were reviewed to minimise incidences of falls. The fire logbook was reviewed and was well maintained, however it was noted that only five staff attended a fire drill on the 17/03/08 since the last inspection. A requirement was made for this to happen regularly to enable staff to become familiar with measures to be taken in actual fire emergency. In addition we also made a requirement for all staff to attend fire awareness training to enhance their knowledge of fire hazards in order to protect the service users, staff and the visitors. A comprehensive fire risk assessment was noted at the home. DS0000068293.V362836.R01.S.doc Version 5.2 Page 28 We have asked the manager to tell us the action that the home has taken following the concerns raised by the fire safety officer when they visited on 28/3/08. The accident book was reviewed and it was noted that accidents are recorded, however it was difficult to audit due to the existing format. Regulation 37 Notifications of incidents affecting the well being of residents are sent to the Commission as appropriate. We noted from the records that the home had high incidents of accidents to service users between March and April 2008 and that most of the accidents happened in service users’bedrooms,lounges and bedrooms. We noted that the accidents although recorded, have not been reviewed regularly to minimise the frequency made a requirement to ensure that this happens in order to protect the service users. We noted that the home has undertaken a generic risk assessment of the home however this has not included the areas where some service users have fallen recently and other areas that the service users have access to. We have issued a requirement for the risk assessments to include, the bedrooms, hallways, dining rooms and kitchen. Staff records viewed evidenced that staff are receiving supervision however not regularly, manager stated that she is aware of the importance of regular staff supervision and would ensure that this isdertaken more regularly with the new arrangement of delegating some staff to be supervised by the Head of Care. DS0000068293.V362836.R01.S.doc Version 5.2 Page 29 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 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X X 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 2 3 2 DS0000068293.V362836.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13.2 Requirement Accurate records must be kept of the disposal of all medicines from the home. This refers to: Return of unused Controlled Drugs to the pharmacy and Return of medicines to residents who leave the home. Records made in the Controlled Drugs register must be clear and accurate. The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated Review all accidentsto residents. Ensure that risk assessment is in place following accident and it is reviewed regularly. Ensure that care plans are developed using a person centred approach with the person and /or their relatives following admission to the home. Timescale for action 01/06/08 2. OP38 13 30/06/08 3. OP7 15 30/06/08 DS0000068293.V362836.R01.S.doc Version 5.2 Page 31 4. OP38 23 All staff must attend fire drills at regular intervals to enable them to protect the residents in actual fire emergency. Ensure staff attend statutory training in relation to fire safety and health and safety. Ensure that staff are appropriately supervised to enable them to perform their duties effectively. Ensure that domestic and laundry staff attend training on infection control and Control of substances Hazardous to Health to ensure that the service users are adequately protected. A Privacy and Dignity policy must be formulated and appended onto the Statement of Purpose. Ensure that the service users are provided with a choice of meals and are enabled to choose the food they wish to have at meal times. Ensure that appropriate strategy is in place to support a service user with unpleasant smell in other to maintain their dignity. Ensure that all portable electrical appliances at the home are tested in order to protect the service users from potential harm or injury. Ensure that generic risk assessment includes residents’ bedrooms and other areas that the residents have access to minimise accidents. DS0000068293.V362836.R01.S.doc 30/06/08 5. OP38 18 30/06/08 6. OP36 18 30/06/08 7. OP30 18 30/06/08 8. OP10 4 (1) (c) Sch.1.18 30/06/08 9. OP15 12 30/06/08 10. OP10 12 30/06/08 11. OP38 13 30/06/08 12. OP38 13 30/06/08 Version 5.2 Page 32 13. OP30 18 14. OP29 7,9,19 Sch. 2 Ensure that staff receive training on behaviour that challenges to enable them to meet the needs of identified individuals. The manager must ensure compliance with the documentation to be sought and kept at the home for staff employed. Ensure that there are sufficient numbers of domestic staff in line with the size of the home and the dependency level of the service users living at the home. 30/06/08 30/06/08 15 OP27 18 30/06/08 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 Refer to Standard OP9 Good Practice Recommendations 1.Action should be taken to allow staff to audit medicines supplied in standard packs so that they can check the balance in the pack to see if the correct dose has been given. 2.Handwritten additions to the medicines administration record sheet should always be signed and dated by the person making the addition and checked by a second member of staff. This is to reduce the risks of mistakes being made which could lead to someone being given medicines incorrectly. 3.It is recommended that records of disposal of medicines be kept in a bound book so that individual sheets cannot be lost. A second member of staff should check and sign the disposal record. This is to reduce the risk of mistakes leading to the discrepancies seen with some medicines. DS0000068293.V362836.R01.S.doc Version 5.2 Page 33 2 OP30 It is recommended that the home ensures its induction and foundation programme is Skills for Care accredited to ensure that new staff are well equipped with knowledge of their responsibilities of meeting needs before working with service users. DS0000068293.V362836.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000068293.V362836.R01.S.doc Version 5.2 Page 35 - 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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