Inspection on 30/07/07 for College House

This inspection was carried out on 30th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

College House 15/07/08

College House 31/07/06

College House 24/01/06

College House 07/09/05

College House 08/03/05

College House 19/10/04

College House 11/02/04

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE College House 87 College Street Cleethorpes North East Lincs DN35 8BN Lead Inspector Ms Matun Wawryk Key Unannounced Inspection 30th July 2007 09:00 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 College House DS0000002897.V346031.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. College House DS0000002897.V346031.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service College House Address 87 College Street Cleethorpes North East Lincs DN35 8BN 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) 01472 693957 01472 351749 Maria.Gatt@ntlworld.com Mrs Maria Gatt Mrs Maria Gatt Care Home 19 Category(ies) of Dementia (4), Dementia - over 65 years of age registration, with number (19), Old age, not falling within any other of places category (19) College House DS0000002897.V346031.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 day care place for under 65 with presenile dementia Date of last inspection 31st July 2006 Brief Description of the Service: College House is a well established home situated in a pleasant residential area in the sea - side resort of Cleethorpes; it has good access to local amenities and public transport. The home is registered to accommodate 19 service users with residential care needs. Accommodation is provided on two floors; there is stair and chair lift access to the first floor. There are eleven single rooms and four shared rooms; three of the single rooms have en-suite facilities. The home has two lounges and one dining room; all rooms are decorated and furnished to a good standard. There are bathroom and WC facilities located on each floor. There is a pleasant courtyard area where service users can sit out. The home is well maintained and provides a pleasant, homely inclusive atmosphere. The home is owned and managed by Mrs Maria Gatt. Information about the home and its services can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home. A copy of the latest inspection report for the home can also be obtained from the manager. Information given by the manager in the pre inspection questionnaire states the home charges £329 per week. People are not expected to pay for chiropody treatments and toiletries. More up to date information on fees and charges can be obtained from the manager of the home. College House DS0000002897.V346031.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Mrs Matun Wawryk, regulation inspector carried out this unannounced site visit in July 2007. The visit lasted eight hours. Prior to visiting the home the inspector gathered information from a number of different sources. Questionnaires were sent to a selection of relatives, people using the service, staff and professional people for example district nurses and social services staff. Seven people living in the home, six relatives, eight staff, and one professional returned a questionnaire. Some of the comments received by these people have been included in this report. The manager completed and returned an Annual Quality Assurance Assessment within the given timescale, this questionnaire gave lots of information about the home. Information received by the Commission since the last visit in July 2006 was also considered in forming a judgement about the overall standards of care within the home. During the visit the inspector spoke to eight, two relatives, a friend of one person, the manager, and four care workers to find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. The inspector spoke with people to check that their privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. The inspector also looked around the home and looked at lots of records, for example; assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there, daily records, supervision schedules, menus, and other records relating to the running of the home. Information received by the Commission over the last few months was also considered in forming a judgement about the overall standards of care within the home. What the service does well: People living in the home who returned a questionnaire and those spoken to who were able to give an opinion said they were satisfied with the overall care provided by the home. People were complimentary about the staff team stating they were kind and caring and supported them well. Some staff had been at the home for many years and they provided consistent care. College House DS0000002897.V346031.R01.S.doc Version 5.2 Page 6 The home is welcoming and has a relaxed atmosphere. People living there said they were happy with their bedrooms and they can bring in their own possessions, making it feel more like home. People said they were offered a good choice of meals and they enjoyed the quality of food. Specific wishes were catered for and people said they had plenty to eat and drink throughout the day. Comments included ‘excellent food’, the food is lovely’. All the relatives who returned a questionnaire were complementary about the food. Relatives spoken to during the visit said they were made to feel welcome by staff when they visit and that they can visit when they please. One relative said the ‘staff are very good and helpful, they always acknowledge me when I come into the home’, another relative said ‘the staff are very friendly and polite’, one person said ‘the staff are too laid back’. What has improved since the last inspection? What they could do better: Individual care plans and risk assessments giving staff information about how to care for the person properly were available, however these were not always kept up to date. Failure to keep complete and accurate information on peoples health and personal care needs, taking into account any incidents or changes means staff may not have all the information they need to support people appropriately and this could have an on the persons health and welfare if not addressed. People working in the home must make sure the way they record and give out medication gets better. Some of the things staff were doing was not good practice and could put people at risk if not properly addressed. Examination of a sample of records showed limited take-up of activities by some people. There was limited evidence to show how the social and emotional needs of more dependent people were being met. The manager said plans College House DS0000002897.V346031.R01.S.doc Version 5.2 Page 7 were in place to review the activity programme. It is important that this happens and that a broader programme is developed with people taking into account their interests and abilities so that everyone living in the home have the opportunity to be involved in meaningful activities of their choice and within their capabilities. Relatives spoken to during the visit said the home notified them when their relative’s needs had changed or following accidents and injuries. In contrast two relatives who returned a questionnaire said they were not always notified of changes. The inspector advises that relatives be spoken to ascertain their wishes about this and that a record of their wishes be recorded in the person’s care records. This will ensure staff have a clear understanding about when and why they should contact a relative. 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. College House DS0000002897.V346031.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 College House DS0000002897.V346031.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 and 5 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wanting to use the service undergo a full needs assessment, which tells staff about them and the support they need. People can decide whether the home is right for them because clear information is available about the home and the services provided. EVIDENCE: A Statement of Purpose and Service User Guide is available to people considering moving into the home and their relatives and friends. Both documents give lots of information about the home. Information in the service user guide (brochure) needs updating to include the price of fees. College House DS0000002897.V346031.R01.S.doc Version 5.2 Page 10 The majority of people spoken to said they had received sufficient information about the home to help them make an informed choice about the service before accepting the placement offer. Two people spoken to said they had not seen or been issued with a copy of the service user guide. The manger is advised to ensure people considering moving into the be given a copy of this or have it explained to them. People living in the home are provided with a statement of terms and conditions/contract, which tells people what they are paying for. Each person has their own individual file and four of those looked at had a needs assessment completed by the funding authority or the home before a placement was offered. Evidence from records showed staff develop care plans from the assessments, identifying the person’s needs and care requirements using information gathered from the individual and their family. There was no evidence in the files to show that the manager formally wrote to people or their representatives following an assessment to confirm the home was able to meet the needs of the person, this should now happen for new admissions. Several people were spoken to about their experience of moving into the home, one person said ‘ I was brought here to see the home and talk to the staff before I made the decision to stay’, another person said ‘this is the best home I’ve been in’. One visiting relative said ‘they had chosen the home for reasons such as: the friendly atmosphere, the location and the friendliness shown by the staff. Another relative said a healthcare professional had recommended the home to her. This person said her father had ‘settled into the home very well’, she visits the home regularly and said she always found the staff to be polite and friendly’. Staff in interview confirmed that they understood the admission process and were aware of the importance of ensuring people moving into the home are made to feel welcome. Staff members on duty were knowledgeable about the needs of each person they looked after and had an understanding of their specific problems/abilities and the care given on a daily basis. Discussion with people showed that they were satisfied with the care they received and all those who were able to express an opinion said they had a good relationship with the staff. People are able to make a limited choice of staff gender when deciding whom they would like to deliver their care, as the home had one male carer as well as female carers. The manager said this matter was discussed with people during the assessment and care planning process. College House DS0000002897.V346031.R01.S.doc Version 5.2 Page 11 Information in the Annual Quality Assurance Assessment questionnaire returned prior to the visit and discussion with the staff and observation on the day indicates that all the people living in the home are white/British. The manager said staff would be able to support individuals with specific cultural or diverse needs following a needs assessment being completed. And where necessary additional training and guidance would be provided to staff to enable them to be responsive to the person’s needs. The home does not accept intermediate care placements so standard six does not apply to this home. College House DS0000002897.V346031.R01.S.doc Version 5.2 Page 12 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 and 9 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s health and personal needs are met but failure to ensure care plans clearly describe all areas of need and some medication practices could put people’s health and welfare at risk if not fully addressed EVIDENCE: Case tracking took place for four people. The methodology used was a physical examination of care plans; written surveys to people living in the home, relatives, health and social care professionals and direct observation on the day of the visit. There was no indication during the visit that people’s health and personal care were not being met. However information recorded in some care plans and College House DS0000002897.V346031.R01.S.doc Version 5.2 Page 13 daily records did not reflect some of the care being provided and changes in people’s health or behaviour was not always identified in the person’s individual plan(s). For example, one person was having ‘fits’, staff were recording when these occurred in daily notes and had consulted the person’s GP, but this information had not been taken into account in the persons care plan and risk assessments. Failure to record information in people care plan/risk assessment may mean that over time the information/care instructions could go unnoticed and may put the person at risk of needs not being met. One person had a care plan for diabetes but again this plan gave very little guidance to staff about how to help the person manage their diabetes. The person’s care plan indicated blood glucose levels should be recorded twice daily. Records showed several gaps in the staff’s recording of this. The plan also advised staff to record the persons blood glucose levels twice daily, in practice staff were doing this three times a day. Records did not give staff guidance about what action they should take if the persons blood glucose levels fell or rose above a certain level. It is important that records accurately detail people’s health and care needs and any health monitoring arrangements; failure to do this may put people health and welfare at risk. Some people or their representative had signed the care plans to show they agree with the content, however there was little evidence to show how people with memory related problems were consulted on a regular basis about their care, especially when staff were completing monthly evaluations. Staff commented that individuals with memory problems were unable to contribute to their care plans. The manager should look at how staff could use a variety of different and creative methods to help people using the service to contribute to their own care plan Risks were identified in relation to nutrition, pressure sores, moving and handling and in most cases care plans had been put in place to address any identified risks. Records for one person identified they were at risk of developing pressures sores because of reduced mobility and continence issues, a detailed care plan for this had not been put in place and advice had not been sought from a` health care professional. Staff were advised to speak to a district nurse about this. Moving and handling risk assessments for two people had not been updated to reflect deterioration in their mobility, which meant they were more reliant on staff support. The manager is advised to ensure moving and handling assessments are updated, as people’s needs change. The inspector observed two incidents of poor moving and handling techniques, this matter was referred back to the manager for her to address with staff. There was evidence of professional input from dieticians, community psychiatric nurses and district nurses and everyone was registered with a GP. There was evidence that people were weighed regularly. People who were able to give an opinion said that they have good access to their GP’s, chiropody, College House DS0000002897.V346031.R01.S.doc Version 5.2 Page 14 dentist and optician services, with records of their visits being written into their care plans. People had access to outpatient appointments and records and staff feedback showed they have an escort from the home if wished. Responses to the surveys indicated that most people and their relatives were satisfied with the level of medical support given to people living at the home. However one relative wrote in their questionnaire ‘‘Communication between home and family needs to improve, some medical conditions need to be treated more speedily or reported to a doctor or nurse, The staff seem to accept the deterioration of my mum and every symptom as ‘part of the illness’ and are reluctant to seek medical advice for things such as dry eyes, sore lips, water infections; these are virtually ignored.” The AQAA states that procedures giving staff guidance about a range of matters relating medication practice are in place and that staff responsible for administering medication have received appropriator training. Medication systems were examined at this visit. Generally medication was being managed appropriately however there were a number of areas where improvement was needed. Staff were secondary dispensing medication, this means the person administering the medication was not the worker who signed the medication record. The manager was advised to ensure that the worker who gives the medication also signs the record confirming administration. There were some omissions of signatures or codes in the administration records and this raised questions about whether medication has been administered or not Staff were sometimes handwriting medication (transcribing) on to the medication administration record (MAR), a second member of staff was not witnessing the entry to confirm the information was correct. In order to ensure proper safeguards are in place a second member of staff should witness all hand written annotations on the MAR. Staff were not always signing the MAR to confirm quantities of medication received together with balances of medication stored in the home, this makes auditing supplies difficult. There was not a list of the names of staff authorised to administer medication, together with specimen signatures. The manger was advised to put such a list in place. As a matter of good practice the inspector also advises that patient information leaflets of medication supplied be obtained from the dispensing chemist and that these be kept in the medication cupboard. This will provide staff with up to date information on medication prescribed for each person. College House DS0000002897.V346031.R01.S.doc Version 5.2 Page 15 Comments from people and relatives showed that most were satisfied with the care and support offered by the staff. Discussion with people using the service revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. One person said ‘ I feel safe here’, another person said ‘the staff do a good job’. One relative said ‘ the staff are very good, they care for people properly’. One relative wrote in their questionnaire ‘the care home looks after my mum well she has plenty to eat and she is safe’, another wrote ‘She is being fed ok, but her personal cleanliness is not always acceptable, her clothes are not regularly changed’, another wrote ‘I feel the carers feel they are doing their best for my mum, however I feel its just the basic care, she is fed, bathed 1 or 2 a week, dressed and that’s about it’. College House DS0000002897.V346031.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 and 15 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not everyone living in the home was seem to experience a full life with opportunities to take part in varied activities according to their assessed needs and preferences. People are enabled to keep in contact with family and friends and people receive a nutritious and varied diet that meets their assessed needs and choices. EVIDENCE: The home did not employ an activity coordinator; care staff are responsible for planning and arranging activities. The activities on offer ranged from games to one to one sessions, film afternoons and occasional outside entertainers and singers People who returned a questionnaire said they were happy with the level of activities available to them. Four people spoken to said there was not enough College House DS0000002897.V346031.R01.S.doc Version 5.2 Page 17 to do in the home, two people said ‘I have never taken part in any activities since I’ve been here, another person said ‘there is nothing to do except watch TV’, another person said ‘I sometimes get bored’. One relative wrote in their questionnaire, ‘I am sure they are doing their best under the circumstances but I feel my mum and other residents have very little stimulation other than TV and radio’, another wrote ‘more encouragement could be given to people to keep them mentally stimulated’. These comments indicate staff may need to look more closely at people’s social and recreational needs. This matter was discussed with the manager who gave an assurance that activities provision was regularly discussed with people living in the home, but acknowledged more could be done particularly for those with more significant care and support needs and for people with memory related problems. People spoken to who were able to express an opinion said they felt staff listened to them. People said they were able to exercise choice in aspects of their life and daily routines regarding times of rising and retiring, preferences with bathing arrangements, personalising their bedrooms and general choices about meals and gender of carer In discussion staff displayed a good knowledge of individual resident’s needs, likes/ dislikes, family support and records contained information about people’s religious observances. One person said she regularly attended a church service in the local community. Staff spoken to had an understanding of how to promote peoples privacy, dignity, independence and choice, staff said things `like ‘we try and get to know what people like as soon as they come in’, ‘we always make sure doors and curtains are closed’, ‘we don’t have any set routines’. One relative wrote in their survey ‘staff always seems a cheerful bunch, which I think is important’, ‘they appear to care for the people they look after’, another wrote ‘ in response to a question about how the service can improve ‘by paying more attention to residents, they sit in a separate room and they don’t check on them enough’. People spoken to said visitors could come at anytime and could be seen in conservatory, dinning or sitting room. The home does not have a private area where people can see visitors in private other than their bedroom. The home provides three meals a day and a light supper. The manager said there were no restrictions on what food could be ordered and this was confirmed in discussion with other staff. Menus indicated that a choice of food was provided. A second choice of main meal is not provided, said staff said an alternative would be provided if the person did not like what was on the menu. Time was spent observing the lunchtime meal and staff were observed to sit next to people who needed support to eat their meal and support was provided in a sensitive manner. College House DS0000002897.V346031.R01.S.doc Version 5.2 Page 18 People spoken to and those who returned a survey confirmed that the home provides a good standard of meals, which people enjoyed. Comments included ‘ the food is excellent’; another person said ‘meals are plentiful and good variety served’. Three of the relatives who returned a questionnaire all comment that the food as ‘very good/nice’. The home caters for people needing diabetic diets. The manager said other specific dietary needs would be accommodated where this was needed. College House DS0000002897.V346031.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 and 18 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A satisfactory complaints system was in place and people living in the home, staff and others are assured complaints and concerns will be listened to any allegations acted upon. Failure to operate robust recruitment practice could put people at risk if not addressed. EVIDENCE: No complaints about the home had been referred to the Commission since the last inspection carried out in July 2006. Records indicated that internal complaints made to home had been appropriately dealt with. A complaints procedure was in place and staff spoken to said they had no complaints about the home and felt confident to raise issues of concern if they arose with the manager. Most people spoken to said they knew who to report concerns or complaints to. Three residents who had memory impairment problems were unable to say whom they would speak to if they had any concerns. One visiting relative said they were aware of the complaints process and people who were able to College House DS0000002897.V346031.R01.S.doc Version 5.2 Page 20 express an opinion said they were aware of the complaints procedure. Six relatives returned a questionnaire in response to the following question ‘do you know how to make a complaint about the care provided by the home’ two relatives said yes, four said no. This indicates a shortfall of information about the complaints process and the manager is advised to address this with relatives. Information from the Annual Quality Assurance Assessment and discussion with the manager indicates the home has policies and procedures to cover adult protection and prevention of abuse and whistle blowing. People spoken to said they felt ‘safe’ in the home. When asked about abuse, what it was and what they would do if they suspected or saw or suspected any abuse staff stated that they would report it to the manager or senior care worker. Examination of a sample of individual staff training records showed staff had been provided with training in safeguarding adults. Staff interviewed also had a good knowledge of whistle blowing procedures. No safeguarding referrals had been made to the local authority since the last inspection. Although the police were still investigation an allegation of theft brought against a member of staff dismissed from the home. The manager was not always following good practice when recruiting new staff this could adversely affect the welfare of people living in the home if not addressed. Please refer to comments on page 25 of this report. College House DS0000002897.V346031.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 and 26. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a clean, comfortable and hygienic home that is well maintained. EVIDENCE: The home provides and maintains comfortable and clean facilities. All areas of the home were generally decorated and furbished to a good standard. Information in the Annual Quality Assurance Assessment indicated the home complies with the requirements of the local fire and environmental health College House DS0000002897.V346031.R01.S.doc Version 5.2 Page 22 department. During a tour of the home the inspector noted that two fire doors did not close properly and action must be taken to address this. The communal areas were all well utilised during the visit; people spoken to commented on how happy and settled they were at the home. The conservatory was noted to be very hot on the day of the visit; the inspector advises that the room temperature is checked on a regular basis and where necessary remedial action is taken to reduce high temperatures. A down stairs bathroom and had been refurbished, the bath had been taken out and a shower unit with seat had been put in. The home did not have a bath hoist to enable people with restricted mobility to have a bath, although the manager said she intended to have a hoist fitted in an upstairs bathroom. All bedrooms seen were clean and tidy and were furnished and decorated in a homely style. Many people had furnished their bedrooms with a range of personal items, some bringing in items of furniture to reflect their own individual choice and taste. People spoken who were able to express an opinion said they were happy with their rooms. Two people said their rooms were small but sufficient for their needs. There are steps leading into the dinning room. Mobile ramps are used to enable wheelchair users to access this area. There are also steps leading off this room to three bedrooms, a stair lift in available for people who restricted mobility. Access to the first floor bedrooms is by use of a staircase and stair lift. Corridors are wide enough to accommodate wheelchairs although the positioning of stairs means people with restricted mobility would be reliant on staff support to move freely in some areas of the home. Policies and procedures for the control of infection were in place and staff in interview confirmed a good understanding of infection control measures and confirmed adequate supplies of protective clothing. Equipment provision was also discussed with the staff. Staff said the home was generally well equipped. The location of laundry facilities is suitable and ensures that dirty laundry is not carried through food storage, preparation or dinning areas. People spoken to and their relatives said they had not experienced any particular problems with their laundry, and all said cloths were washed and ironed appropriately. College House DS0000002897.V346031.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 and 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are trained and competent to carry out their work and there are enough staff on duty at all times to enable peoples needs to be met. Failure to ensure all necessary employment records and checks are obtained before people start working in the home could put people at risk if not addressed. EVIDENCE: The roles and responsibilities of staff are clearly defined and in discussion with the inspector staff demonstrated understanding of the management and reporting structures for the home. At the time of this visit there were 19 people living in the home. The manager said three care staff are normally on duty up to 11am, this increased to four between 11am and 6pm and reduced back to three between 6pm and 10pm. Two staff are on duty through the night. College House DS0000002897.V346031.R01.S.doc Version 5.2 Page 24 Information from the Annual Quality Assurance Assessment about the number of staffing hours provided, and information gathered during the visit about the dependency levels of the people using the home, was used with the Residential Staffing Forum Guidance and showed that the home is meeting the recommended guidelines. Staff spoken to said there was generally enough staff on duty at any one time to enable peoples needs to be met. Eight staff returned a survey. In response to the question ‘are there sufficient numbers of staff on duty to enable residents needs to be met’ all said yes. Evidence from questionnaires and discussions with people during the visit confirmed that they were generally satisfied with the care they received. People commented on how kind and supportive the staff were. One person said ‘ I am very pleased with the care at the home, another person said ‘I am very happy with the staff’. Comments from other people included ‘staff to busy to sit and talk’, ‘ staff always busy’. One relative wrote in their questionnaire ‘she is being fed okay but her personal hygiene is not always acceptable, her clothes are not regularly changed’, another wrote some of the carers are more understanding than others, some carers spoke to her like a naughty child’. The manger said the home had an equal opportunities policy and procedure, although the inspector did not examine this. Feedback from the manager, staff and information in personnel and training records showed the procedure is followed when employing new staff and throughout the homes working practices and staffs access to training. Employment records for four staff appointed since the last inspection were examined. Records were generally in good order although the inspector noted one person had two ‘to whom it may concern’ references, neither were dated. Records also indicated two people had started working in the home prior to receipt of a POVA first check. Other relevant documentation to comply with Schedule 2 of the Care Homes Regulations had been obtained. The manager who gave an assurance that no other person would start working in the home until all required checks and records had been obtained. New staff are provided with an induction and the manager had an induction programme, which meets Skills for Care Common Induction Standards specification and includes a competency assessment. The home had a training plan and examination of a sample of eight staff records evidenced that mandatory safe care had been provided. Specialist training in dementia care had been provided and staff gave examaples of how they had used learning on the course in their datyto day work. The manager now needs to develop a training plan which provides staff with training opportunites which reflect the needs of people living in the home for example, pressure area care, strokes, sensory imprairments and iother conditions College House DS0000002897.V346031.R01.S.doc Version 5.2 Page 25 common to older people. This is needed to help care workers deliver up to date care methods and to ensure have a better understanding of the varied conditions common to people living in the home. Failure to provide this training may mean staff do not have all the knowledge and skills they need to meet the needs of people and this could impact on the care they receive. The home had a good National Vocational Qualification training programme for staff. The pre inspection questionnaire indicated the home exceeded the target of 50 of care staff trained to level 2 or above, which is a very positive achievement and the home is to be commended for this. College House DS0000002897.V346031.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, 33, 36, 37 and 38 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. An experienced manager manages the home and systems are in place to ensure people are consulted about the running of the home. However some areas of management practice do not ensure people are safeguarded. EVIDENCE: An experienced registered manager runs the home. Staff confirmed that moral was good and commented that there was a good team approach to the care delivery at the home. Evidence from staff interviews and staff surveys College House DS0000002897.V346031.R01.S.doc Version 5.2 Page 27 indicated that staff consider the manager and senior staff to be approachable. Staff said they take issues raised seriously and take action to resolve matters where this is needed. Staff spoken to and returned staff questionnaires provided evidence that they were happy working at the home and with the support that they received to carry out their tasks. Information gathered from the Annual Quality Assurance Assessment (AQAA) indicated that there are a range of policies and procedures in place for health and safety. Safe working practices are maintained by the provision of training to staff in the form of moving and handling, basic food hygiene, basic first aid, infection control and fire safety. A sample of staff training records were examined these showed staff had received this training and further training was planned. Improvements had been made to the homes quality assurance programme following the last inspection. The new system includes bi monthly questionnaires to people, their carers, staff and other professional staff and audits. The manager now needs to produce an annual development plan, which identifies the quality areas of improvement from 2007/08 and clearly set out the standards to be achieved in this year and ensure this information is made available to residents, their relatives and relevant third parties. A summary of which should be included in the service user guide. The home does not help people with their finances therefore Standard 35 does not apply. Staff interviews and supervision records supported the evidence that the staff receive a minimum of six formal recorded supervision periods per year and their supervision includes the philosophy of care in the home, their actual practice and career development needs. The staff also stated that they are also regularly offered informal supervision as and when they require it. Not all records required by regulation were available and up to date for example, staff employment records and care records. Please refer to pages of this report. Information in AQAA indicated that maintenance certificates were in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. The manager had completed generic risk assessments for a safe environment within the home. Risk assessments were in place for fire, moving and handling and daily activities of living. As noted in another section of this report two fire doors did not close properly, please refer to comments on page 23 of this report. Bedrails wee in use in the College House DS0000002897.V346031.R01.S.doc Version 5.2 Page 28 home and risk assessments had been completed. The inspector advised the manager to review these using guidance issued by MRHA. There was no evidence to show how frequently bed rails were checked to ensure they were safe to use. Information given by the manager showed she was aware of these matters and was in the process of taking action because of this no requirements or good practice recommendations have been made. College House DS0000002897.V346031.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 2 2 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X N/A 3 2 2 College House DS0000002897.V346031.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 OP2 OP37 Regulation 5(b)(c) Requirement Timescale for action 30/09/07 Amended regulations 2006 2 OP7 OP37 15 3 OP7 13(4) The responsible person must ensure the homes statement of terms and service user guide meet the criteria of Regulation 5 of the Care Home Regulations and includes the information asked for in The Care Standards Act 2000 (Establishments and Agencies)(Miscellaneous Amendments) Regulations 2006 (for Regulation 5), which came into force on 1st September 2006. This is so people know how much they have to pay for their care, what they are getting for their money and the cost of any additional extra services they may wish to purchase. The registered person must 30/10/07 ensure that people’s individual plans are updated taking into account any incidents or changes to ensure timely and appropriate care interventions. The registered person must 30/10/07 ensure moving and handling assessments are updated as people needs change and that staff follow agreed moving and DS0000002897.V346031.R01.S.doc Version 5.2 College House Page 31 4 OP9 17 5 YA14 16(m) 6 OP29 19 7 YA42 23 handling techniques to ensure staff know how to move and handle people safely and to avoid inappropriate moving and handling of people. Accurate records must be kept of all medications, received, and administered to ensure there is no mishandling of medication. The responsible person must make sure that medications in the custody of the home are handled according to the requirements of the Medicines Act 1968, guidelines from the Royal Pharmaceutical Society, the requirements of the Misuse of Drugs Act 1971. To make sure people receive their medication correctly and to ensure their health and safety is not put at risk. The registered person must ensure residents have the opportunity to exercise their choice in relation to leisure and social activities; that these choices are recorded and they are offered a range of stimulating activities both inside and out of the home to ensure residents do not get bored and to ensure they are able to take part in meaningful activities. The registered person must ensure people do not start working in the home until two satisfactory written references have been obtained and a POVA first or satisfactory CRB. Ensuring robust recruitment and selection practice is one way the registered person can protect people living in the home from harm as far as practicable. The registered person must ensure action is taken to ensure all the fire doors in the home DS0000002897.V346031.R01.S.doc 30/08/07 31/12/07 30/09/07 31/08/07 College House Version 5.2 Page 32 8 OP16 22 close properly. It is important that all doors close properly to ensure the safety of residents in the event of a fire in the home. The registered person must ensure relatives of people who use the service are made aware of how to complaint about services provided by the home and of they must follow. This will ensure relatives have access to the information about the complaints process and will people feel confident to make a complaint should this be needed. 31/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP33 Good Practice Recommendations The registered person should make sure that the home has an effective quality assurance and monitoring system in position. This includes the implementation of the new system from September 2006. Staff should ensure that medication already held in the home when a new medication sheet is started is added to the supplies on the medication record sheets. This should be done so as to ensure a running total is available at all times and an audit of stock is easy to carry out. The manager should make sure that where staff are hand writing medication onto the sheets (transcribing), they include the amounts of medication received or brought forward, and have two staff sign the entry to indicate they have both witnessed that the information on the sheet is correct. The manager should consider how staff could use a variety of different and creative methods to help people using the service to contribute to their own care plan. DS0000002897.V346031.R01.S.doc Version 5.2 Page 33 2 OP9 3 OP9 4 OP7 College House 5 6 OP9 OP9 7 OP13 8 OP30 The registered person should put in place a staff signature list of staff authorised to administer medication together with specimen signatures. The registered person should obtain patient information leaflets of medication supplied be obtained from the dispensing chemist and that these be kept in the medication cupboard. This will provide staff with up to date information on medication prescribed for each person. The registered person should speak to relatives about what matters they wish to be notified about a record of the relatives wishes should be made in the persons care records. This will ensure staff have a clear understanding about when and why they should contact a relative. The registered person should produce a written training plan that specifically reflects the needs of older people and those with dementia. Providing staff with better training around the needs of people in the home will ensure they have all the knowledge and skills they need to meet the needs of residents and this will have a positive impact on the care they receive. College House DS0000002897.V346031.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road 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 College House DS0000002897.V346031.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. 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