Inspection on 03/05/07 for Close House

This inspection was carried out on 3rd May 2007.

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 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

Close House 27/10/05

Close House 07/06/05

Close House 26/11/04

Close House 07/06/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Close House Hexham Northumberland NE46 1ST Lead Inspector Glynis Gaffney Key Unannounced Inspection 3, 4 and 8 May 2007 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 Close House DS0000000536.V337012.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. Close House DS0000000536.V337012.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Close House Address Hexham Northumberland NE46 1ST 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) 01434-602866 01434 603552 nursing@hexhamshire.com www.hexhamshire.com Mr D W Robson Mr J R Robson Ms Sylvia Margaret Robinson Care Home 22 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (21) of places Close House DS0000000536.V337012.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th October 2005 Brief Description of the Service: Close House is an adapted, extended building located in a rural setting on the outskirts of Hexham. It is a family owned and managed business. There are 18 single rooms and two doubles, one of which is used as a single room. Six bedrooms have en-suite facilities. All parts of the building are accessible by way of a passenger lift. A range of communal space is available as follows: four lounges; one dining room; a kitchen and laundry; five toilets and three bathrooms. There are extensive gardens surrounding the property, which have been attractively landscaped. Parking spaces are available at the main entrance. Close House can accommodate up to 22 older people, most of who require nursing care. The current fee for a place at the home is charged at the standard rate set by Northumberland County Council and the local Health Care Trust. The charge paid by each resident varies according to their individual financial circumstances. There is a top-up charge for three of the home’s largest bedrooms with en-suite facilities. Extra charges are made for hairdressing, private physiotherapy services, newspapers and toiletries. The most recent inspection report was available on request to residents, visitors and staff. Details of the fees to be paid are set out in the home’s individual contract with each resident. Close House DS0000000536.V337012.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. How the inspection was carried out: Before the visit: We looked at: • • • • • Information we have received since the last visit on the 25 October 2005; How the service dealt with any complaints & concerns since the last visit; Any changes to how the home is run; The manager’s view of how well they care for people; The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on the 3 May 2007. undertaken on the 4 and 8 May 2007. During the visit we: • • • • • • Talked with people who use the service, some of the staff and the manager; Looked at information about the people who use the service & how well their needs are met; Looked at other records which must be kept; Checked that staff had the knowledge, skills & training to meet the needs of the people they care for; Looked around the building to make sure it was clean, safe & comfortable; Checked what improvements had been made since the last visit. Two other visits were We told the manager and provider what we found. What the service does well: Staff at the home had: • Assessed peoples’ needs to ensure that they could be well cared for at Close House; Close House DS0000000536.V337012.R01.S.doc Version 5.2 Page 6 • • • Assessed each person’s level of dependency so that they could judge any future deterioration in their health and well-being; Completed an in-depth personal profile for each person covering such areas as significant life events and past social interests and hobbies; Completed an assessment of each person’s continence care needs. The home’s gardens were attractively landscaped, well maintained and could be easily accessed by people living at the home. Close House had its own gardener who cultivated a large vegetable plot providing the home with supplies of fresh vegetables and fruit. There was a range of communal areas that could be used by people wanting to socialise or have private time to themselves. Staff were kind, respectful, considerate and had developed warm and caring relationships with the people in their care. People living at the home were very satisfied with the care and support provided. Staff communicated with people in a positive manner, building upon their strengths and abilities. It was evident that staff were very proud of the standard of care they provided. People living at the home said that the quality of meals served was always of a very high quality. The inspector attended the lunchtime meal and found it to be appetising, tasty and nutritious. It was also very nicely served by the staff on duty despite the kitchen being out of operation for two days whilst it was being refurbished. There was a pleasant atmosphere at the home. A visitor to the home said that staff were always friendly and offered refreshments. Each member of staff is provided with a written summary of the outcome of each staff meeting. What has improved since the last inspection? Areas of the home had been redecorated. New guttering had been fitted and a new bins store built. New carpets had been fitted in some bedrooms. The following items had been purchased: • • • • Dining chairs; A new mattress for each bedroom; An industrial carpet cleaner; A washing machine; DS0000000536.V337012.R01.S.doc Version 5.2 Page 7 Close House • • • • • • • • • • A dishwasher; Sixteen commodes; A freestanding cooker; New kitchen equipment and crockery; A new office photocopier; New bed linen and continence care bedding; A central heating boiler; Ground floor corridor and stair carpets; 20 comfortable armchairs; A blood pressure machine. The kitchen had been refurbished and re-painted. Wall tiles had been cleaned and re-grouted. Three new extractor hoods and a fan had been installed. Department of Health infection control guidance had been implemented and improvements made. 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. The summary of this inspection report can be made available in other formats on request. Close House DS0000000536.V337012.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 Close House DS0000000536.V337012.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): 3. Standard 6 is not applicable. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Satisfactory arrangements were in place for assessing the needs of people before they are admitted into the home. But, suitable arrangements were not in place to ensure that the home obtained the required social services information. This meant that the manager might not have all of the information required to reach a decision as to whether the home could meet a person’s needs. EVIDENCE: The care records of three people were examined. For each person, there was written evidence that the home had completed its own pre-admission Close House DS0000000536.V337012.R01.S.doc Version 5.2 Page 10 assessment. Qualified and experienced staff had carried out these assessments. The home’s pre-admission assessment form covered the required areas apart from prompts to ensure that the needs of people from different cultural and ethnic backgrounds were fully addressed. Mrs Robinson indicated that there was a place on the form where this information could be added if necessary. A social services assessment and care plan were not available in any of the care records examined. However, the manager said that this information was not available for two people because they were privately funded and there had been no social services involvement. Mrs Robinson said that although she knew she could access social services assessments and care plans, care managers often did not provide this information without a prompt from the home. Mrs Robinson stressed that, in the absence of other professionals’ written assessments, if she was unsure about any aspects of the care required, either herself, or the deputy manager, would laise with other relevant professionals to obtain the necessary information. Mrs Robinson said that she had not been aware that the home should obtain copies of relevant care management information before agreeing to provide a place at Close House. Close House DS0000000536.V337012.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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans checked were of a good quality and were well written. But, they did not cover all of the areas referred to in the National Minimum Standards. This might result in staff not being clear about how to meet each person’s care needs. The health care needs of people living at the home had been satisfactorily met enabling them to lead healthy and comfortable lives. The systems in place to support the safe administration, storage and disposal of medication were satisfactory and promoted the good health of people living at the home. Staff respected the needs and wishes of people living at the home. This meant that people using the service felt valued and able to retain control over the way they wanted to live their lives, in as far as they were capable of doing so. Close House DS0000000536.V337012.R01.S.doc Version 5.2 Page 12 EVIDENCE: The care records of three people living at the home were examined. On admission, staff had completed an assessment of each person’s needs. A recognised tool had been used to assess their level of dependency. The nursing care needs of some of the people living at the home had been clearly identified and detailed plans of care put into place to meet those needs. Care plans addressing peoples’ need for support with general hygiene and personal care had also been devised. But, care plans covering the following areas had not always been put in place for each person: - management of medication and general health care needs; religious, sensory and foot care needs. Generally, the care plans checked had been reviewed on a monthly basis. The non-nursing care plans were easy to understand and had been written in plain English. Only one person had signed their care record to confirm their agreement with the contents. Peoples’ care records included an identification photo. There was evidence in two of the care records examined that the manager had carried out checks to ensure that care records contained the required information and were up to date. A key worker system was in operation and this allowed staff to work more closely with some people whilst also contributing to the care of all those living at the home. Each person also had a qualified nurse to oversee the delivery of their care. In each person’s care records there was evidence that health care related risk assessments had been carried out. For example, a pressure area care assessment had been carried out for each person. A nutritional risk assessment had been completed for one person. The assessments had generally been reviewed on a monthly basis. People had had their weights checked each month. A continence care programme had been completed for two people and reviewed on a regular basis. The risks posed to people as they went about their daily lives had also been assessed and plans put in place to minimise the risks identified. There was evidence that the home made arrangements to ensure that the health care needs of new people admitted into the home were met. For example, medical advice had been sought to ensure that one person had the right type and level of pain control. Systems had been put in place ensuring that this person’s diabetic care needs were met and reviewed on a regular basis. This person told the inspector that his life had greatly improved since coming to the home as staff monitored his health and ensured that he had a good diet. He said ‘I feel the best that I have for a long time.’ Written records completed by staff confirmed that people had access to regular optical and chiropody care. Dental care is provided as and when needed. The manager said that no limitations had been placed on the rights of people living at the home to make decisions and choices about how they lived their lives. Close House DS0000000536.V337012.R01.S.doc Version 5.2 Page 13 The home had a medication policy that was available in the main office/nurses station. All medication was stored either in a locked trolley or cupboard to which only qualified nursing staff had access. The medicines trolley was clean, tidy and it was easy to identify what medication belonged to which person. Only limited stocks of medication were kept at the home. Photos to identify each person were available in their medication records. Lockable facilities for the safe storage of medication were available in all bedrooms. There were records covering the receipt, administration and disposal of medication within the home. Only nursing staff administered medication. All nursing staff had received extra training in the use of the home’s monitored dosage system from a local pharmacist. No incidents involving the mis-administration of medication had been reported to the Commission. The home’s medication arrangements had last been subject to a pharmacy audit carried out by a qualified pharmacist in 2006. An anti-bacterial hand wash was available in the nurses’ station. Three staff were interviewed. It was evident that they were fully committed to helping people living at the home to live fulfilling lives as independently as possible. During the inspection, there was evidence that the people using the service made their own decisions about how they lived their lives. For example, one person told the inspector that she made choices regarding whether she wanted to stay in bed and rest or, get up and sit downstairs. Another resident said that staff respected his privacy. He said that he had been given a choice about whether he wanted a male carer to meet his intimate care needs. A number of bedroom, toilet and bathroom doors had frosted glass fronts. Lace curtains had been fitted to these doors to provide privacy. These doors had been in place since the home was first registered by the local authority. One of the people interviewed was asked about this and he said that he had no concerns and did not feel that his privacy had been compromised. The last inspector was told that the views and opinions of people living at the home, as well as those of their relatives, had been obtained and no concerns were expressed. Close House DS0000000536.V337012.R01.S.doc Version 5.2 Page 14 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory arrangements were in place for providing people living at the home with opportunities to participate in a range of stimulating social activities and events. Suitable arrangements were in place to support people living at the home to maintain contact with their families and friends. Food served at the home was of a good quality, nutritious and well presented. Mealtimes were relaxed and staff were patient and helpful, giving people the time they needed to finish their meal comfortably. EVIDENCE: There was evidence that people living at the home were able to lead full, stimulating and fulfilling lifestyles. For example, one had person had participated in the following social events in April – went out walking with staff Close House DS0000000536.V337012.R01.S.doc Version 5.2 Page 15 support, helped to make paste eggs for Easter, received visitors from Scotland, attended a birthday tea and joined in an art class. Although social care plans were not in place in any of the records checked, staff had completed a social profile of each person covering such areas as their favourite pastimes and hobbies. A member of the care team was responsible for managing the provision of activities within the home. Activities are planned in advance and a monthly list of activities is drawn up. A record had been kept of what activities had been provided and who had attended. A hairdresser visited the home every fortnight and a Church of England service is held each month. A Catholic priest also visits his parishioners. A group from the local Mothers Union visit once a month and holds a christian prayer service. People living at the home were able to access Talking Newspapers and a mobile library visited the home regularly. The home also has an extensive library of large print books. A trip out to a local fruit farm had just taken place and a trip to Wallington Hall was due to take place in the next couple of months. People spoken with confirmed that the manager and her staff always made families and friends feel welcome. People living at the home said that visitors could be seen in private or meet with their relatives in the lounges or dining areas. Nobody spoken with could recall the home placing any restrictions upon their visitors. People living at the home said that they had been supported to bring their own personal possessions with them when they moved into Close House. Staff were observed providing people with opportunities to make everyday decisions. Information about peoples’ preferences regarding how they lived their lives was available in their care records. A four-week rotating menu had been drawn up. The provider confirmed that changes were made to the core menus to take account of seasonal supplies of fruit and vegetables. There were regular deliveries of fresh food to the home complemented by fruit and vegetables from the home’s own garden. Following each person’s admission into the home, kitchen staff are supplied with dietary information including details of any special diets required and food preferences. The food served at the lunchtime meal was of a good quality, well presented and met peoples’ dietary needs. Regular drinks and snacks were available throughout the day. The dining area was pleasant and had views over the garden area. People living at the home said that this always provided a good talking point. The tables were attractively set. For those individuals who needed support during mealtimes, this was carried out in a helpful and sensitive manner. Staff gave individuals the time they needed to finish their meal comfortably. People living at the home said that the meals served were always of a good standard offering both choice and variety. They also said that they received enough to eat and drink and alternatives were available to the main menu meals. The mealtime was relaxed and staff provided mealtime support in a caring and sensitive manner. Close House DS0000000536.V337012.R01.S.doc Version 5.2 Page 16 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements in place for handling complaints were satisfactory and people were confident that their complaints or concerns would be listened to, taken seriously and acted upon. Satisfactory arrangements were in place to protect people living at the home from harm or abuse. This meant that people could feel safe and protected in their own home. EVIDENCE: The complaints procedure provided staff with clear guidance about how to handle complaints. People living at the home said that they would be happy to raise any concerns they might have with the manager or a member of the staff team. The home had received one complaint since the last inspection. The provider had notified the home’s inspector and acted upon advice given by the Commission about this matter. The complaint was under investigation by the local authority at the time of the inspection. The safeguarding policy provided staff with guidance about how to handle adult protection concerns. There had been no concerns raised with either the home, Close House DS0000000536.V337012.R01.S.doc Version 5.2 Page 17 or the Commission, since the last inspection. All staff had received training in the protection of vulnerable adults. People living at the home said that they felt safe and secure. Staff were able to satisfactorily describe the action they would take to protect people from potential harm or abuse. Close House DS0000000536.V337012.R01.S.doc Version 5.2 Page 18 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, 20, 21, 22, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory arrangements were in place to maintain, replace and improve the home’s decoration, furnishings and fittings. This meant that people living at the home were provided with comfortable accommodation that was well maintained and which satisfactorily met their needs. The bedrooms had been attractively decorated and nicely furnished. This provided people living at the home with a comfortable and well-maintained private space where they could relax in and, receive visitors. The home was clean and hygienic. This meant that people using the service were protected from contracting illnesses that might result in poor health. Close House DS0000000536.V337012.R01.S.doc Version 5.2 Page 19 EVIDENCE: On the day of the inspection, Close House was clean, safe, comfortable and generally well maintained. The home was located in a rural setting outside of Hexham. Transport would be required to access local community facilities and services. There was an ongoing programme of refurbishment and replacement for the home. Improvements planned included replacing the remaining wooden windows, which were showing signs of wear and tear. The home’s gardens were attractively landscaped and well maintained. People living at the home had access to a range of communal areas such as a variety of lounge areas, a dining room and a conservatory at the front of the building. There were a number of bedrooms measuring well over the minimum of 10 square metres. There were two bedrooms measuring below this size. The home’s furnishings and fittings were satisfactory and all areas visited were comfortable and homely. The provider had ensured that the home’s physical environment met the individual requirements of the people who lived there. A range of specialist equipment and adaptations to meet individual needs was in place. For example, hoisting equipment had been fitted in each bathroom. Grab rails had been fitted besides toilets. Height adjustable beds had been provided for those people who needed them. One person had access to a mobile hoist that fitted under their bed when not in use. A second mobile hoist was also available. The bathrooms visited were clean and hygienic. A thermometer was available in each bathroom to enable staff to test hot water temperatures. The home was fully accessible to people with physical disabilities. For example, a lift had been provided to the first floor. A ramped entrance gave access to one of the lounge areas. A stepped path had recently been removed and in its place a gentle sloped path had been laid giving access to the rear of the home. The home had an infection control policy. Anti-bacterial gel hand wash was available at all washbasin sinks and at the nurses’ station. A self-assessment infection control checklist compiled by the Department of Health had been completed and action had already been taken to implement some of the findings. For example, basic infection control awareness training had been incorporated into the home’s induction. Also, two staff had completed more indepth infection control training. The laundry was clean and tidy. The home’s washing machines had a pre-wash or sluice cycle wash. The home also had a sluice disinfector machine. All light pull chords had been fitted with plastic tubing to ensure that they could be kept clean and hygienic. All waste bins had been fitted with lids and liners. Close House DS0000000536.V337012.R01.S.doc Version 5.2 Page 20 Mostly single room accommodation was available and some bedrooms had an en-suite facility. A small number of bedrooms were visited and were found to be clean, tidy, nicely decorated and attractively furnished. Each room had been personalised in line with the occupant’s preferences. Some of the bedrooms visited contained furniture that people had brought in with them. Close House DS0000000536.V337012.R01.S.doc Version 5.2 Page 21 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were sufficient staff rostered on duty to meet the needs of people living at the home. This meant that people could be sure that they would get the help and assistance they required to live as independently and comfortably as possible. The arrangements for ensuring that staff regularly updated their training in key areas were satisfactory. This meant that staff had the skills and knowledge required to meet the needs of people living at the home in a safe and professional manner. Satisfactory arrangements were in place to ensure that staff were able to complete a relevant qualification in care. This meant that people living at the home could feel confident that staff were trained and competent to do their jobs. There was evidence that suitable arrangements were in place to carry out preemployment checks on new staff before they started work at the home. This is an important step in ensuring that people who maybe unsuitable to work with vulnerable adults are not employed at Close House. But, the arrangements for ensuring that documentary evidence was available for inspection were not fully adequate. Close House DS0000000536.V337012.R01.S.doc Version 5.2 Page 22 EVIDENCE: A sample of the home’s rotas were checked as part of the inspection and it was confirmed that previously agreed levels of staffing were in place as follows: 9am to 6pm Four care staff 1 registered nurse 6pm and 8pm Three care staff 1 registered nurse 8pm to 9am One care staff 1 registered nurse Although the manager covered shifts on the rota as the nurse in charge, the provider had also given her hours off the rota, which allowed her to carry out the management tasks associated with her role. People living at Close House felt that there were enough staff on duty to meet their needs. Staff interviewed felt that sufficient numbers of staff were rostered on duty to meet the needs of the people living at the home. The home had no vacancies and there had been a low turnover of staff since the last inspection. There had been no use of agency staff. Staff interviewed said that a high level of importance was attached to them undertaking the training they needed to do their job well. For example, all staff whose records were checked had completed recent training in the following areas – moving and handling, first aid, food hygiene, health and safety and fire prevention. The home employed eight qualified nursing staff and ten of the eighteen staff had obtained a recognised qualification in care. Four care staff were in the process of obtaining such a qualification. The files of two staff appointed during the last two years were examined. There was evidence that an in-house induction had been provided. Although it was clear that the home had taken the time to develop a robust in-house induction programme, the provider confirmed that it had not been updated to take account of the ‘Skills for Care’ common induction standards. A profile of the training received by each staff member had been reviewed as part of their performance appraisal. There was evidence in the files examined that all staff had had an annual appraisal. The home was able to access training courses provided by the local health care authority. A sample of staff personnel records was examined and it was identified that: an application form had been completed by each member of staff, with the exception of one carer who was appointed in 1990; although Criminal Records Bureau checks had been carried out, information forwarded to the home by the ‘umbrella’ organisation responsible for carrying out these checks, had been destroyed; a contract of employment was available on each file as was confirmation of physical and mental health. Recently appointed staff had confirmed on their application form whether they had any convictions or Close House DS0000000536.V337012.R01.S.doc Version 5.2 Page 23 cautions. Two written references had been obtained for each applicant. The inspector was unable to verify that the home had obtained a full employment history for each person as its application form only asked for periods of employment relating to the last 10 years. There was no verification of identity on any of the files examined. Close House DS0000000536.V337012.R01.S.doc Version 5.2 Page 24 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, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager provided a clear sense of leadership, involved staff and people living at the home in the management of Close House, and demonstrated a commitment to providing people with good quality care. This meant that people lived in a home which was run and managed by a person who was fit to be in charge, was of good character and able to discharge her responsibilities fully. Steps had been taken to promote the health and well being of people living at the home and to protect them from potential hazards. This meant that people lived in a home where health and safety concerns were taken seriously and where concerns were promptly addressed to prevent them suffering harm. Close House DS0000000536.V337012.R01.S.doc Version 5.2 Page 25 There was a satisfactory programme of regular and structured staff supervision. This meant that staff were properly supervised, received support and guidance in meeting the needs of people living at the home, and had their performance regularly appraised. EVIDENCE: The manager had obtained relevant qualifications, including the Registered Manager’s Award. Mrs Robinson was also a Registered General Nurse and had worked at the home for approximately 22 years. She displayed the professional competence required to manage such a home. The manager was ably supported by the provider and an experienced senior management team. There was evidence that the provider, Mrs Robinson and her team worked very hard to improve the lives of the people living at the home. Staff also said they were clear about the standards of care to which they were expected to achieve. The home had not taken on any responsibilities for managing the day-to-day finances of people living at Close House. The home was not acting as a legal ‘appointee’ for any of the people accommodated at the home. The quality of care and services provided at the home are monitored at a number of different levels. For example, at the beginning of each shift the nurse in charge visits every person and checks on their well-being and establishes whether they have any concerns. The provider described how one person had commented that it would be nice for the home to hold exercise classes. This now happens once a fortnight. Each year, a Quality of Services Questionnaire is given to people living at the home and their relatives. The annual survey was last completed in November 2006 and a summary report was prepared and given to people using the service and their families. Following a comment made in one of the surveys returned, a monthly events calendar was placed in one of lounges. The provider said that quality surveys had not been issued to staff and other professionals involved with the home. All staff had received supervision at the recommended frequency during the last 12 months. Supervision sessions were used to provide staff with feedback on their performance. Records had been kept of the supervision sessions held. • A sample of health and safety records was examined and found to be generally up to date. A tour of the premises identified no health and safety concerns. An audit of the home’s fire records confirmed that the required fire prevention checks had been completed. For example, the fire alarm system had been tested each week. An up to date fire risk assessment was in place. Staff had received fire instruction and DS0000000536.V337012.R01.S.doc Version 5.2 Page 26 Close House participated in fire drills at the required frequencies. A record had been kept of accidents occurring within the home. . The home’s lift, hoisting equipment and hospital beds had been serviced twice during the last 12 months. There was no gas supply to the home. The provider confirmed that a check of the electrical appliances used within the home had taken place in October 2006. But, Mr Robson said that he had not been supplied with a written schedule of the tests completed. A maintenance book was used to record jobs and repairs that required attention. Following completion of a job or repair, the maintenance book is updated. A range of workplace risk assessments had been completed covering such areas as window restrictors and the risks to people of slipping and falling in the garden. Although there was evidence that staff had completed risk assessments as and when hazards had been identified, assessments covering the following areas were not in place:use of bedside rail; prevention of falls from first floor windows; prevention of Legionella; lone working and hot surfaces. The provider confirmed that there was a programme of maintenance in place to ensure that the thermostatic valves fitted to baths continued to work in line with the manufacturer’s guidelines. Mr Robson also said that the home’s window restrictors were checked on a regular basis. But, there were no written records to confirm that these checks had taken place. Close House DS0000000536.V337012.R01.S.doc Version 5.2 Page 27 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 X X 2 x X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X N/A 3 X 2 Close House DS0000000536.V337012.R01.S.doc Version 5.2 Page 28 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 OP3 Regulation 14 & 15 Requirement Ensure that: • Timescale for action 01/06/07 2. OP7 15 Where applicable, a Care Management assessment and care plan are obtained prior to the offer of a placement; • Where it has not been possible to obtain the above information, the care records of the person concerned contain documentary evidence to demonstrate that the home has given a high priority to obtaining the required information. Ensure that care plans covering 01/12/07 the following areas are put in place for each person living at the home: • • • • • • • Social care; Religious care; Management of medication and finances; Health care; Sensory care; Mobility; Foot care. Version 5.2 Page 29 Close House DS0000000536.V337012.R01.S.doc 3. OP30 18 Ensure that the home’s in-house 01/09/07 induction programme covers the good practice areas referred to in the ‘Skills for Care’ common induction standards. Ensure that the umbrella 01/06/07 organisation used by the home to obtain Criminal Records Bureau disclosure certificates issues the home with a letter stating: • • • • • • • The name of the person; The date of disclosure; The level of the disclosure; Information about the POCA check (if requested); Information about the POVA check (if requested); The disclosure reference number; The date the POVAFirst check was received (if this was sought) and the POVAFirst Reference number. 4. OP29 Schedule 2 7, 9 &19 Ensure that a copy of the letter is kept on the file of the staff member concerned. 5. OP29 Schedule 2 7, 9 &19 Ensure that the home’s 01/06/09 application form requires prospective staff to provide a full employment history, including the month and year each period of employment commenced and ended. Ensure that each staff member’s file contains verification of their identity. Ensure that written risk 01/09/07 assessments are completed in the following areas: • Close House 4. OP38 13(4) Use of bedside rails; Version 5.2 Page 30 DS0000000536.V337012.R01.S.doc • • • • Prevention of falls from first floor windows; Prevention of Legionella; Lone working; Hot surfaces. (Guidance on these areas can be found at the following web sites:www.hse.gov.uk www.mhra.gov.uk) 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 OP3 Good Practice Recommendations Ensure that the home’s pre-admission assessment document covers the needs of people with different ethnic and cultural backgrounds. Ensure that: • People living at the home, or their representative, are encouraged to sign the care records held about them to confirm their agreement with the contents. • Nutritional risk assessments are carried out for each person living at the home. Ensure that: • A log is kept of the electrical appliances that need to be periodically examined to establish standards of electrical safety. Ensure that the log identifies how regularly electrical appliances will be checked. Check with the Health and Safety Executive that you are fully discharging your responsibilities with regards to testing the electrical items that people living at Close House have brought in with them; • A programme of maintenance is put in place to ensure that the thermostatic valves fitted to baths DS0000000536.V337012.R01.S.doc Version 5.2 Page 31 2. OP7 3. OP38 Close House • continue to work in line with the manufacturer’s guidelines; The home’s window restrictors are checked on a regular basis. A written record should be kept. Close House DS0000000536.V337012.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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. 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