Inspection on 19/02/07 for Coniston

This inspection was carried out on 19th February 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

Coniston 16/02/09

Coniston 06/03/06

Coniston 12/10/05

Coniston 21/03/05

Coniston 28/09/04

Coniston 25/02/04

Similar services:

Claremont House

Chesham House

Oak Ridge

Argyll House

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

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

CARE HOMES FOR OLDER PEOPLE Coniston Garfield Road Felixstowe Suffolk IP11 7PU Lead Inspector Julie Small Key Unannounced Inspection 19th February 2007 10:50 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 Coniston DS0000024363.V315165.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. Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Coniston Address Garfield Road Felixstowe Suffolk IP11 7PU 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) 01394 278484 01394 274441 Mr Colin Robert Bentley Mrs Leanne Marjoram Care Home 21 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (1), Old age, not falling within any of places other category (21) Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Number of Service Users The number of service users is not to exceed 21 (OP 21, MD 1) Designated Double Room All bedrooms to be single accommodation except Room 7 which is designated as a double room if required. Care Staff on Duty There will be a minimum of 3 (three) care staff on duty at all times between 08.00 and 22.00, and 2 (two) carers on duty at all times between 22.00 and 08.00. 6th March 2006 Date of last inspection Brief Description of the Service: Coniston is situated in a residential area of Felixstowe, a busy seaside town with a good selection of shops and sea front facilities. The building is believed to be approximately 100 years old and is built into the cliff side. A new extension was completed in 2004, which adds a first floor level to the building. This has increased the number of places to 21. The new rooms considerably exceed the basic space requirement, had en-suite facilities including a shower, and all doorways are wide enough to allow the easy passage of wheelchairs. One of the new rooms has been designated a double room, all other rooms being single. The new entrance to the home is on this first floor, leading off the driveway across a footbridge, and provides level access to the home. The lounge and Dining Room have very pleasant views with the new bedrooms upstairs to the front of the building have views out over the sea. The Home has a pleasant, well-tended garden with shrubs and pots, which are looked after by the more able service users. A large area of wooden decking has been built to the rear of the house, and there is a summerhouse at the end of the garden that service users are able to use. The PIQ stated that the current scale of charges was £331 to £505, with additional charges for chiropody services, hairdressing, public transport and requested newspapers. Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on Monday 19th February 2007 from 10.50am to 17.30pm. The inspection was a key inspection which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. This report has been written using accumulated evidence gained prior to and during the inspection. The homes manager, Mrs Leanne Marjoram and the homes proprietor Mr Colin Bentley facilitated the inspection, and they were receptive to the process and the inspector. The manager had been registered manager since October 2006. All information requested was provided promptly and in an open manner. The inspector was informed that service users were referred to as residents; this term will be used throughout this report. During the inspection four staff members, three visitors to the home and six residents were spoken with. A tour of the building and observation of work practice was undertaken. A range of records were viewed which included residents care plans, staff recruitment records, training records, medication records and health and safety records. Further records viewed are identified in the main body of the report. Prior to the inspection (November 2006) a PIQ (pre-inspection questionnaire), residents ‘have your say about…’ questionnaires, staff comment cards and relatives/visitors comment cards were sent to the home. The PIQ, eight relatives/visitors comment cards, twelve staff comment cards and sixteen residents ‘have your say about…’ questionnaires were returned. A visitor to the home in error had completed one staff comment card and one resident questionnaire was returned and not completed. Residents and staff made the inspector welcome in the home. It was noted that the home provided some areas which were very good, however, there were areas for improvement, which are identified in the section below ‘what they could do better’. Through discussion with the homes manager and proprietor that they were committed to providing a safe environment to residents at the home and assured that all points would be corrected immediately. What the service does well: The staff at the home were welcoming and both residents and staff appeared happy. The home was clean, well maintained, comfortable and homely. Resident’s bedrooms were attractively furnished and all contained their personal belongings which reflected their individuality. Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 6 During discussions with residents it was clear that Coniston is their home and they were consulted with about the care they receive. Residents and visitors were complimentary about the staff and the home in the returned questionnaires and discussions. Comments in questionnaires included; • • • • • • • • ‘Atmosphere in the home is very friendly creating a happy home feel. Carers all conscientious towards residents and all are extremely well cared for’. (Visitor) ‘Standard of care by staff absolutely first rate’. (Visitor) ‘An excellent care home – all staff are very attentive to peoples needs. Always welcoming. A credit and a model to others to aspire to’ (visitor) ‘This is a wonderful home with lovely proprietors and staff. …. Is very happy and well looked after’. (Visitor) ‘This place is lovely, the owners are, so are the staff. I wish I had been here 20 years ago, I cannot fault anything or anyone’. (Staff) ‘The staff are very helpful’. (Resident) ‘I am satisfied with the home and am lucky to be here’. (Resident) ‘I am quite content living here’. (Resident) Interaction between staff and residents was observed to be very good and respectful. The culture at the home was positive and Coniston was clearly the resident’s home. Records viewed evidenced that care provided at the home is person centred and catered for each individual living at the home. Residents records identified residents likes, dislikes and choices with regards to the care they received and included their preferences to what form of address they wished to be called. What has improved since the last inspection? What they could do better: Service users signed terms and conditions referred to the previous inspection commission, these should be amended to provided details of the current CSCI (Commission for Social Care Inspection). There were four gaps in the medication administration records (MAR) for February 2007. Insulin was stored in a refrigerator on the ground floor, which also stored food stocks. The area was not accessible to residents. The insulin must be securely stored and regular temperatures checks should be recorded. Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 7 There was a cook who prepared the main lunch, however, the lighter evening meal was prepared, served and cleaned up by the care staff. There were two care staff and one senior working in the evening. The manager said that staff were also required to provide personal care when needed. It is recommended that there be dedicated staff available to provide the evening meal. There was evidence that staff had attended POVA (protection of vulnerable adults) training, however it may be beneficial to record it more clearly in the staff training records. Three staff recruitment records viewed contained CRB (criminal records bureau) checks, their application form, two written references, however one provided proof of the individual identity and two did not. Staff recruitment records must include the required information as set down in Schedule 2. 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. Coniston DS0000024363.V315165.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 Coniston DS0000024363.V315165.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): 2, 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect that they have a written statement of terms and conditions in the home and that they have their needs assessed prior to moving into the home. The home does not provide an intermediate care service. EVIDENCE: Four residents records were viewed, each held an assessment undertaken prior to them moving into the home. Two of the records viewed were of residents who had recently moved into the home, the homes manager had undertaken their assessments. The manager said that the assessments were completed prior to the resident moving into the home, that they were completed to identify their needs and to determine if the home could meet their needs. They Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 10 were undertaken by the manager or by the homes proprietor. The assessments included details of the next of kin, medical history, accommodation required, and medication. There were documents called ‘indicator of dependency assessments’ which included details about the resident’s needs including with communication, mobility, personal care, mental state, district nurse needs, waterflow assessments and continence. The records contained care plans which identified how their needs were to be met while living at the home. Each resident’s records included a written statement of terms and condition at the home. They included details about the fees, termination of agreement, care staff and the service that they could expect from the home. The document held information about how residents could make a complaint, which included contact details of the Commission and that the home was registered with the Commission. However, the Commission was referred to as the previous inspection commission, which was NCSC (National Care Standards Commission) and not the current service, which is CSCI. The resident and the homes manager had signed the terms and conditions. Sixteen residents questionnaires were received, one of which was blank. Fifteen stated that they had a contract, fourteen said that they received enough information about the home before they moved in and one said that they did not and a comment was made ‘…. thought the information was great’. The home did not provide an intermediate care service. Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect that their health, personal and social care needs are set out in an individual plan of care, that their health care needs are fully met and that they are treated with respect. The medication procedures have areas for improvement, however, it was noted that risks to residents were minimal and the inspector was assured that actions would be taken. EVIDENCE: Four residents records were viewed each held a detailed care plan which identified the care they should be provided with on a daily basis. The care plans included their personal details, a medical and personal history, funeral arrangements, allergies, daily living needs, communication, mobility, falls, personal care, diet, dental needs, continence and religious observance. There were details of what the residents likes and dislikes were and what they wished Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 12 to be called by the staff, such as a different name from their first name. There was a care plan agreement which residents had signed. There were records which identified residents health needs, any medical appointments attended, medication, a record of weight, dietary requirements and a water flow assessment. There were clear details of support required and received from a district nurse in one resident’s records. The home also maintained a separate record of GP and district nurse visits. Each resident had risk assessments in place, which identified the risks and actions which should be taken to prevent the risks in their daily living. There were risk assessments on manual handling, which detailed how staff should assist residents if they had fallen and with transfers from one place to another. There was evidence that care plans and risk assessments were regularly updated with the residents changing needs and preferences. There was one resident whose first language was not English, their care plan clearly explained how to communicate with them when using English. Which included allowing time for understanding and being patient when they replied. The manager explained how they had used an interpreter for discussions about their care plan and decisions they had to make. Residents spoken with said that they were consulted with regarding the care that they received at the home. Staff spoken with confirmed that they referred to the care plans when working with individual residents and that they were provided with regular updates on their well being and any changes in their needs during daily staff shift hand over meetings. During the inspection one resident had received a doctor visit in the privacy of their bedroom. A staff member was observed to ask a resident if they wanted them to check their hearing aid as they were having trouble hearing what was said. The manager provided information to a visitor who had asked about when a dressing needed changing for their parent. The manager said that the residents were provided with weekly exercise activities. A resident and visitor confirmed this. Seven visitors/relatives visitors comment cards said that they if their relative/friend was not able to make decisions that they were consulted with about their care, one had answered N/A. One visitor/relative questionnaire commented that their family member had not had a weekend bath because of staff shortage. The proprietor said that this might have been the case that the resident had not taken a bath, but that they would have been offered it and may have refused it. They said that at no time would a resident be denied having a bath. Residents spoken with confirmed that they bathed when they chose to. Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 13 Resident’s questionnaires asked: • • • • ‘Do you receive the care and support you need?’ eleven answered always and four answered usually. ‘Do the staff listen and act upon what you say?’ fifteen answered yes, one comment was ‘the staff are very helpful’. ‘Are the staff available when you need them?’ eight answered always and seven answered usually. ‘Do you receive the medical support you need?’ thirteen answered always and two answered usually. The home had a medication procedure, which included residents who self medicated. Medication was stored in resident’s bedrooms in a metal locked cabinet which was attached to the wall. There were alternative arrangements for controlled medicines which were stored in locked metal tins in a secure cupboard in the office. The office cupboard also stored a stock of medication. Insulin was stored in boxes in a fridge on the ground floor with a stock of foodstuffs. The boxes or the fridge were not secured and the required temperatures for the insulin were not maintained and monitored. The room where the fridge was stored was not accessible to residents. The home maintained a clear record of controlled medicines, which was viewed. The records which identified the receipt and return of medicines to the pharmacist. The lunchtime medication administration was observed. Medication was administered to each resident in their own bedroom, from the dossett box stored in the medication cabinet in their room. The manager tipped medication from the dossett box into a pot and gave the pot to the resident. They then signed the MAR chart, which the manager had taken on the round from the office. The MAR charts were viewed and it was noted that there were four omissions for February 2007, which were not accounted for. The manager explained that they were in the process of changing the pharmacy, to a pharmacy that provided MDS (medication dosage system). They said that this system would provide the ability to audit control medications. The current arrangements weekly dossett boxes were returned to the pharmacy. Staff spoken with confirmed that the administration of medication was a senior staff responsibility. Training records viewed evidenced that staff had received training on the safe handling of medicines. The PIQ stated that a visiting community pharmacist attended the home on a yearly basis to assess the resident’s medication. All bedrooms were of single occupancy during the inspection. Some residents spoken with had a telephone in their bedroom and all received their mail Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 14 unopened. They confirmed that they were addressed with respect by staff at the home and they had been asked what their preferences were with regards to what they were called. This was confirmed in resident’s records, which were viewed. Care plans viewed clearly identified resident’s preferences and needs with regards to their personal care. Records were viewed of the safe keeping of resident’s finances, which included checks and signatures of their representatives of the balance of monies and clear records of expenditure for those who were unable to manage their own finances. Residents and visitors spoken with were complimentary about the respectfulness of the staff toward them. Residents confirmed that staff always knocked doors and asked to be invited in before entering. This was confirmed by observation of staff during the inspection. The manager escorted the inspector on a tour of the building and introduced the inspector asked residents permission to enter the room. Interaction between staff and residents was observed to be positive, friendly, respectful and professional. A staff member knocked the bedroom door of a resident while they were talking to the inspector, they apologised to the resident and asked if they would prefer for them to return at a later time, which was agreed. A visitor and a resident spoken with explained that the resident took great care with their appearance and liked to be colour coordinated. They said that staff supported them in this and ensured that the resident was happy with their appearance. The PIQ stated that a chiropodist visited the home every two months, that an optician visited the home if required by residents. Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect that they are provided with the opportunity to participate in activities which met with their expectations and preferences, that they maintain contact with family and friends, that they are supported to exercise choice and control in their lives and that they receive a nutritious and appealing diet. EVIDENCE: There was a range of pots which had plants in outside the building. The manager said that residents looked after them if they wished to. A resident was observed tending to the bird table on the patio area of the home. There were notices around the home which advertised activities that were available in the home and in the local community. The manager explained that the home did not have an activities coordinator and were looking into getting one in the future, they said that staff took responsibility for facilitating activities if they had particular interests. The manager said that one staff member enjoyed art and that they were planning on providing arts and crafts activities. Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 16 The manager and proprietor said that there were regular services held at the home, of several religious denominations such as Methodist and Catholic Holy Communion, and that residents could attend if they wished to. They said that one resident had regular visits from members of their chosen religious community. Resident’s records viewed identified residents interests and activities they had participated in. Residents spoken with said that they did exercises, quizzes and chatted with each other. During a tour of the building it was noted that there was a good range of books and music CD’s available which residents could use. A resident was observed walking around the home and the manager and they spoke about their daily exercise regime. The residents questionnaire asked ‘are there activities arranged by the home that you can take part in?’ one said always, nine said usually and five said sometimes. There was a comment which was ‘We all have our own activities – reading, writing, letters, going shopping etc. also gardening’. There was a comment that they would like more regular armchair exercises. The manager confirmed that residents had shown an interest in this and it was now provided on a weekly basis. The PIQ stated that activities were available including using the library, bingo, visiting entertainments, embroidery, visits to local amenities and going for a walk. Three visitors were spoken with and confirmed that they were welcomed in the home by staff. One visitor said that they were often invited to share a meal with their family member. All visitors said that they were offered drinks when they visited. A visitor said that they could visit in the privacy of the resident’s bedroom or could use the communal areas of the home. Relatives/visitors comment cards asked: • • • ‘Do staff welcome you into the home?’ eight answered yes ‘Can you visit your relative/friend in private?’ seven answered yes, one did not respond ‘Are you kept informed of important matters affecting your relative/friend?’ eight answered yes. Resident’s bedrooms seen during a tour of the building held their personal memorabilia and decorations, which reflected their individuality. Residents spoken with confirmed that they had bought in items of furniture from their home such as easy chairs and shelves. Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 17 Care plans viewed identified residents likes, dislikes and preferences regarding the care that they received. The records identified that their choices and preferences were sought and supported in their provision of care. Residents spoken with said that they were consulted with regarding their care. Fifteen residents questionnaires said that staff listened and acted on what they said. Records were viewed which evidenced that the residents finances were safeguarded in the home. For those who were unable to manage their own finances, their representatives/family had control of their finances. There were records of when they had provided money to be securely stored at the home, records of checks by the representatives were present and records of expenditure such as receipts were maintained. The home had procedures on access to files. During a tour of the building it was noted that the dining area was attractively decorated and furnished and residents were observed to be enjoying their lunch. The homes menus were viewed and evidenced that there was a balanced and healthy diet provided to residents. Residents were observed to be provided with drinks throughout the day and there was a cold water fountain. Residents confirmed that they were provided with a choice of meals and could choose an alternative to the menu if they did not like what was offered. Before entering the kitchen the inspector was provided with a disposable apron to wear. In the kitchen there was a list of drinks which residents preferred, which included the amount of milk and sugar they liked. There was a good range of drinks available which included squash, fruit juices, tea, coffee and bedtime drinks. There was a good range of fresh fruit and vegetables which supported the residents healthy eating. The cook was spoken with, who was preparing lunch and confirmed that they had attended food and hygiene training. They said that they worked five days each week and there was a part time cook who covered their days off. Staff said that they prepared, served and cleaned up the lighter evening meal, which would consist of for example sandwiches or various foods on toast. This was done in addition to their care duties. There was a concern raised in a residents questionnaire ‘often the excellent carers are involved in domestic tasks which makes their job harder e.g. washing up, vegetable preparation…’ The residents questionnaire asked ‘do you like the meals at the home?’ ten answered always, three answered usually and two answered sometimes. One commented ‘few choices at teatime as carers do the preparation, with little Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 18 time to do it’. Residents spoken with said that the food was very good at the home and that there was enough. The PIQ stated that breakfast was served 6.00 to 8.30, if it is requested at a later time, this would be accommodated. Lunch was served at 12.00, the evening meal at 17.00 and supper at 20.00. Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect that their complaints will be listened to and acted upon and that they are protected from abuse. EVIDENCE: The home had a comprehensive complaints policy and procedure, which was viewed. A summary was included in the written terms and conditions, which was provided to each resident, signed by the resident and was present in their records. The complaints records were viewed and there were no complaints made since the last inspection. Seven relatives/visitors questionnaires said that they were aware of the homes complaints procedure and one said that they were not. Eight stated that they had never had to make a complaint. The resident’s questionnaire asked ‘do you know who to speak to if you are not happy?’ Ten answered always, four answered usually and one answered sometimes. Another question was ‘do you know how to make a complaint?’ Eleven answered always, three usually and one answered never. Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 20 Residents and visitors spoken with confirmed that they knew how to make a complaint. They said that they had not had the need to make complaints and that any issues or requests were dealt with straight away by the homes manager and proprietor. Eleven staff comment cards said that they were aware of the complaints procedure and one did not answer. Ten staff comment cards stated that they had received training in the home’s abuse policy, one did not answer and one said no, however a visitor to the home had completed this. One staff member had recorded that they had not responded to the above questions as they were not care staff and worked on a part time basis. Staff spoken with confirmed that they had received POVA training and provided explanations of actions they would take if they had concerns about the safety of any residents, which demonstrated a good knowledge of the homes reporting procedures. Training records viewed and certificates evidenced that staff had attended POVA training within their foundation training. However, documents which identified individual staff training had identified that they had attended foundation training and POVA was not identified. It is recommended that POVA training be individually identified in the training records. The home had local authority POVA guidance that was stored in the office. The homes policies and procedures were viewed and included POVA, aggression towards staff, missing persons, gifts to staff, resident’s finances, racial harassment and whistle blowing. Coniston DS0000024363.V315165.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, 20, 24, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect that they live in a safe, well maintained, hygienic, safe and comfortable environment. EVIDENCE: The home was clean, warm, well lit, well maintained, comfortable and attractively furnished. The lounge, dining room and bedrooms at the upstairs bedrooms to the front of the house had attractive views of the sea and residents were observed enjoying the views during the inspection. The front of the home had decking, seating, a bird table and flowerpots. The proprietor said that this area caught the sun and that residents had seating areas at the back of the house, which was in the shade. Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 22 The communal areas of the home such as the lounge and the dining room were well lit, warm and attractively furnished. Residents were observed watching television and reading newspapers in the lounge. Some residents who had lived at the home prior to being extended explained to the inspector areas of the home which had been changed. Residents spoken with said that the home was comfortable and homely. Residents bedrooms viewed were attractively and appropriately furnished and decorated. Residents confirmed that they had bought their own belongings to the home such as memorabilia, chairs, television and shelving. All residents spoken with said that they were happy with their bedroom. Residents were provided with keys to their bedroom and each room had a metal, lockable cabinet attached to the wall where their medication was stored. At the time of the inspection all bedrooms were single occupancy. There were no offensive odours in the home. There was a procedure on infection control. The laundry was viewed and the washing machine had a programme which met disinfection standards and to input detergents into the machine. There was a store of disposable gloves and hand washing facilities, which included hand wash gel and disposable paper towels. The resident’s questionnaire asked ‘is the home fresh and clean?’ Fourteen answered always and one answered usually. Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect that their needs are met by sufficient staff who are trained and competent to do their jobs. Not all staff recruitment records held staff identification. EVIDENCE: Three staff recruitment records were viewed and each contained a satisfactory CRB check, application form and two written references. One held identification, which was a photocopy of a birth certificate and passport and two, who were employed before the registered manager was employed at the home, did not contain identification. The PIQ listed all staff working at the home and included the dates for the application date and return of their CRB check. This included all carers, domestic staff, kitchen staff and the handyman/gardener. The staff rotas were viewed, which included clear information about staffing times, leave and which staff was the key holder for that shift. There was a rota for domestic and kitchen staff. The proprietor said that the home did not use agency staff, which ensured that residents were supported by staff who were Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 24 known to them. The PIQ stated that the appropriate staffing levels met the needs of residents. The relatives/visitors comment card asked ‘in your opinion are there always sufficient numbers of staff on duty?’ Seven said yes and one said ‘unsure’. One had raised a concern about staff shortage affecting their family members bath times. The manager and proprietor stated that there were no staff shortage, however, they could not foresee if there was staff sickness at short notice. They confirmed that staff cover was achieved during times of sickness. Visitors and residents spoken with said that they thought that there was sufficient staff at the home. At the time of the inspection there was two care staff and one senior staff working the morning and afternoon shift, two domestic and one cook on an early shift and the manager and proprietor were present. The resident’s questionnaire asked ‘are the staff available when you need them?’ Eight answered always and seven answered usually. The home had met the target of 50 of staff to have achieved a minimum of NVQ level 2 care, which was evidenced in training records. The PIQ stated that 56 of staff had achieved their award, this has since increased with staff who were working on their award had completed. Staff training records were viewed and evidenced that staff were provided with a good training programme, on issues such as POVA, first aid, fire safety, manual handling, dispelling myths of funerals, continence, bereavement, grief and mourning and food hygiene. Staff were provided with TOPSS (now Skills for Care) induction. The proprietor said that they used the induction training provided by the Local Authority. Twelve staff comment cards said that they felt that the home had a good training programme to support staff and that they had received sufficient training to undertake their role. The PIQ stated that future planned training was one staff to attend a moving and handling trainers course, the manager to attend NVQ assessor training, dementia care to all staff, first aid to night staff and POVA updates for all staff. Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 25 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, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect that the home is managed by a person who is fit to be in charge, that the home is run in their best interests, that their financial interests are safeguarded, that staff are appropriately supervised and that their health, safety and welfare is promoted and protected. EVIDENCE: The manager was interviewed by the inspector September 2006 and was registered October 2006. They were found to have the qualities, experience and qualifications required for the registered manager role. The manager has NVQ level 4 in management and care, a diploma in dementia awareness and Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 26 evidenced that they had attended training to update their knowledge. Training records were viewed at the home which evidenced that the manager had attended fire safety training since working at the home. Twelve staff comment cards answered yes to the question ‘do you feel the home is well run?’ Twelve staff comment cards said that they received regular formal supervision. Records viewed and discussions with staff confirmed this. There had been a recent quality assurance exercise, which included satisfaction questionnaires about the home and the service it provided to residents, their family and visiting professionals such as a chiropodist and a district nurse. The results were published and were displayed in the entrance hall to the home, along with the homes previous inspection record. The manager said that if there was concerns raised in the questionnaires, that they would be resolved as soon as possible. The manager and proprietor were spoken with and were committed to the continuing improvement of services provided by the home, and were receptive to and interested in the inspection process. Relatives/visitors comment cards asked ‘do you have access to a copy of the inspection reports in the home?’ Seven answered yes and one answered no. Resident’s records viewed included details of the management of their finances, which identified if they managed their own finances or if members of their family managed them. Residents finance records were viewed and the manager explained how they were used. The family member or resident’s representative signed the records to agree the incoming amount to the home for safe keeping and to agree the balance of the finances. The spending was clearly listed and receipts were included. The homes procedure for resident’s finances was viewed. During a tour of the building it was noted that the home had a good stock of first aid materials and suitable COSHH (control of substances hazardous to health) storage. The accident records were viewed and were appropriately completed, there were no excessive or major accidents at the home. Staff training records viewed evidenced that staff had received training on health and safety issues such as first aid, medication, infection control, manual handling and food hygiene. The home’s policies and procedures were viewed and included accidents, quality assurance, missing persons, infection control, COSHH, emergency and crisis, fire safety, food safety and nutrition, first aid, health and safety at work, moving and handling, residents finances, pressure relief, smoking and the use of alcohol and substances and clinical waste. There was evidence that they Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 27 were regularly updated and reviewed. Each staff member was provided with a health and safety manual, which identified the health and safety requirements in the home. The home had a fire risk assessment which was viewed and fire safety checks were regularly undertaken. The fire procedure was displayed in areas around the home. There were certificates which evidenced that regular fire equipment was serviced and inspected. There was evidence that electrical items were checked. Documentation was viewed regarding the maintenance and servicing of the lift, hoists, stair lift, washing machine and dryer. There was a gas safety record. The home’s environmental risk assessments were viewed, and included all areas of the home which may pose a risk. The home had a legionella risk assessment. Evidence that the fridge and freezer temperatures in the kitchen were routinely maintained was viewed. The PIQ stated that the last fire officer’s visit was March 2006 and that there were no recommendations. Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 28 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 4 X X X 4 X 3 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 3 X 3 3 X 3 Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 29 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 OP29 Regulation 19(1)(b) (i) Sch. 2 13(2) 13(2) Requirement The registered person must ensure that staff records contain proof of their identity, including a photograph. The registered person must ensure that insulin must be securely stored The registered person must ensure that all medicines are accounted for and recorded on MAR charts Timescale for action 31/03/07 2. 3. OP9 OP9 31/03/07 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Coniston Refer to Standard OP15 OP9 OP9 Good Practice Recommendations It is recommended that a dedicated staff member, such as a cook be available for the preparation of the evening meal It is recommended that fridge temperatures are regularly checked and recorded, to meet with the storage of insulin guidance It is recommended that regular medication audits are DS0000024363.V315165.R01.S.doc Version 5.2 Page 30 undertaken to ensure that there are no discrepancies between MAR charts and medication Coniston DS0000024363.V315165.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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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