Inspection on 08/08/06 for Cornerways, Paignton

This inspection was carried out on 8th August 2006.

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

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

Other inspections for this house

Cornerways, Paignton 20/06/07

Cornerways, Paignton 09/11/05

Cornerways, Paignton 21/06/05

Cornerways, Paignton 04/03/05

Cornerways, Paignton 30/06/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Cornerways Cornerways 14-16 Manor Road Paignton Devon TQ3 2HS Lead Inspector Michelle Finniear Unannounced Inspection 09:10 8 & 9 August 2006 th th 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 Cornerways DS0000049076.V296516.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. Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cornerways Address Cornerways 14-16 Manor Road Paignton Devon TQ3 2HS 01803 551207 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) www.peninsularcarehomes.co.uk Peninsula Care Homes Ltd Mrs Gillian Irene Plastow Care Home 50 Category(ies) of Dementia - over 65 years of age (50), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (50), Old age, not falling within any other category (50), Physical disability over 65 years of age (50) Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 09/11/05 Brief Description of the Service: Cornerways is a long established detached property, situated on the level to local facilities at Preston and Paignton. The home is a large building over three floors, and is registered to care for up to 50 service users who are older people with or without a physical or mental frailty or disability. The home has three shared rooms, with the others being for single occupancy, and with the majority having en-suite facilities. There is a shaft lift to all floors. There are several lounge areas and a large dining room where service users can choose to have individual tables. The home has limited outside space and no real garden area, but is close to the sea front at Preston beach and local facilities such as pubs, cafes and local shops, and there is seating available on the homes patio. There is limited parking at the home, but plenty of on street parking nearby, although some of this may be time limited in the summer due to the closeness of the sea front. Fees range from £289 to £510 per week. Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report reflects a summary of a cycle of Inspection activity at Cornerways since the last inspection visit to the home in November 2005. To help CSCI make decisions about the home the owner and manager gave us information in writing about how the home is run; documents submitted since the last inspection were examined along with the records of what was found at the last inspection; two site visits totalling 13 hours were carried out with no prior notice being given to the home as to the specific date and timing of the first visit; the CSCI pharmacy Inspector also visited the home and completed a full audit of the homes medication systems, storage and administration; discussions were held with the manager and staff on duty; various records were sampled, such as care plans and risk assessments; questionnaires were sent to staff who work at the home; a tour was made of the home and garden; time was spent with the people who live at the home both individually and in groups observing interactions and participating in an activity session; and discussions were held with visitors and a district nurse met on the site visit. In addition a sample group of service users were selected and their experience of care was ‘tracked’ and followed through records and discussions with staff and management from the early days of their admission to the current date – looking at how well the home understands and meets their needs, and the opportunities and lifestyle they experience. Time was then spent with these service users, and questionnaires were sent to their relatives, general practitioners and care managers where appropriate. This approach hopes to gather as much information about what the experience of living at the home is really like, and make sure that service users views of the home forms the basis of this report. What the service does well: The home provides comfortable accommodation, which is currently going through a programme of redecoration and renovation. Most rooms have ensuite facilities, and there is a choice of communal space for service user use in three lounges. An excellent menu is prepared with evidence of several choices for dessert, ensuring service users enjoy a varied and nutritious diet. The home is in an excellent location, level to local shops, facilities and the sea front. Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 6 Positive comments from service users, visiting professionals and relatives included that staff were “Polite, welcoming and friendly”, that they made appropriate referrals to community medical staff when their expertise was needed and that the staff were all very kind and considerate. The home is beginning to compile life histories for service users. This information is important as it helps staff understand the whole person they are caring for, their life experiences interests and relationships to people and places. It can also help in placing particular behaviours in context if the service user is no longer able to verbalise their needs or wishes. Currently the home undertakes a falls audit, which is good practice. This looks at every accident on a monthly basis attempting to identify patterns in order to prevent future incidents. Staff seen were well qualified and very knowledgeable about the service users in their care. What has improved since the last inspection? What they could do better: Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 7 The home manager must write to each prospective service user prior to admission confirming that the home can meet the service users needs as identified in the homes pre-admission assessment. This is so that the service user and the home are aware of any agreements made prior to moving into the home. Full Supervision systems must be implemented for all care staff, including the manager. Supervision is a system of staff development and performance management, which ensures that staff are working consistently to support service users and receive the training and support they need to do their job. The home must review the lighting levels in the interior bathrooms to ensure they are safe to work in and provide a comfortable environment for service users to bathe in. The registered person must expand upon the current questionnaires to provide a full system for reviewing and improving the quality of care at the home. The responsible individual must discuss the stair gate to the second floor fire escape with the fire officer. This is to ensure that the fire escape is still safe to use in an emergency. The home manager is recommended to increase the amount of information gathered on service users life histories. This information is important as it helps staff understand the whole person they are caring for, their life experiences, interests and relationships to people and places. It can also help in placing particular behaviours in context if the service user is no longer able to verbalise their needs or wishes. The home manager should ensure that the homes policy on restraint includes all areas including the ‘baffle’ device on the front door, and ensures that it’s use is minimised. This is so that service users access is only restricted under particular circumstances. The home manager is advised to review the programme of activities with the specific needs of service users with memory loss in mind. This is to ensure that the social needs of all residents are assessed and met. A copy of the homes service user guide should be given to each service user. This should ensure service users have access to up to date information about the home. Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 8 The home manager should consider whether the homes service user guide could be made available in additional formats to meet the needs of the service user group. Service user care plans should be reviewed monthly. This is to ensure that up to date information on service users care needs is available and that their needs are kept under review. A falls risk assessment should be undertaken for all service users with a more detailed assessment based upon best practice undertaken for those service users most at risk. The home manager should complete a first aid risk assessment for the home. this helps to ensure that the right level of first aid cover is always available. It is recommended that when additions need to be made to the printed medication administration record chart that these are hand written, the person making the entry signs and dates it and then gets it checked and signed by a second person. This is to ensure that medication records are completed in a way that changes to ensures service users medication are safely recorded. It is recommended that the staff signature lists be reviewed to ensure that they only contain the names of those persons currently authorised and assessed to administer the medication. this is to protect service users from having medication administered by people who are not trained to do so. The registered person shall make arrangements for the safekeeping of medicines received into the care home. This refers to the need to ensure that all medication is stored securely and within the temperature range as stated by the manufacturer. The registered person shall make arrangements for the recording and safe administration of all medicines received into the care home. This refers to the need to ensure that record is made of the receipt of all medicines: it also refers to the need to record the supply of medicines to those service users looking after any of their own medicines 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. Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 9 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 Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, 6 Quality in this outcome area is good. Service users receive good information about the home prior to moving into enable them to make a decision about whether the home is the right place for them. EVIDENCE: On the day of the inspection site visit the files for eight service users were selected at random. Files contained details of their admissions, and the process followed for those most recently admitted. For some service users this information was not in the files, but this was because they were admitted many years ago under previous management when pre-admission assessments were not always undertaken. Discussion was held with the manager on the processes followed for the most recent two admissions, which confirmed the written information in the file about how they had come to be at the home. Discussion was also held with relatives visiting the home who explained how they had chosen the home for Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 11 their relative from a list given them by Social services, and had visited before they made a final decision. The home has a statement of purpose and service user guide which gives service users and prospective service users information about the running of the home and any rules or restrictions as well as services available. A copy of this is available in the homes hallway, and should be given to each service user currently resident as well as prospective new service users. This may need to be provided in alternate formats to meet the needs of the service user group, for example it may be appropriate to put this information on audio tape for service users with visual impairments. This is so that service users are all able to access the information despite their disability or impairment. The homes admissions policy and procedure indicates that service users wherever possible are offered trial visits. It is important that the home is aware of all the needs of service users prior to any admission as the home needs to know they will be able to care for the service user appropriately. Trial visits are also important as they enable the service user to have a choice about whether they feel the home is the right place for them, however it is accepted that this is not always possible for every service user. In the last few admissions discussed with the manager the relatives had visited the home, and then the home manager or deputy had been and assessed the prospective new admission either in their own home or in hospital to ensure that the home was able to meet their needs. Evidence of this assessment could be seen on file. The home manager does not write to each service user before their admission confirming that the home is able to meet their needs, and confirming any special arrangements that have been discussed. This is important as it means everyone is aware of what has been agreed. Each file also has a copy of a statement of terms and conditions which is a contract detailing the fees to be paid and what the service user can expect to receive in return. The home does not provide intermediate care. This means they do not provide intensive programs of rehabilitation as a specialist function within the home. Cornerways DS0000049076.V296516.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area was adequate. Cornerways has systems for the planning and monitoring of care needs. The management and storage of medication in the home has the potential to place the service users at risk of harm, as all medication is not stored securely. EVIDENCE: Each service user at Cornerways has a service user plan of care, based on an assessment, which was seen on the site visit. The care records sampled for seven service users were written in an accessible way and included details on how identified care needs were to be met. Reviews had recently taken place, but this has not been happening monthly as a minimum. Updating and reviewing of plans is important as it ensures that up to date information is always available. One file seen contained information on the past social and life history of the service user which is a positive development that could be continued throughout the care plans. This information is important as it helps staff understand the whole person they are caring for, their life experiences interests and relationships to people and places. It can also help in placing particular behaviours in context if the service user is no longer able to verbalise their needs or wishes. Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 13 Plans would benefit from more person centred information on care needs being included. This might for example include specific information on how the service user wishes their care to be delivered. One relative commented that additional care was sometimes needed with the cleaning of teeth and the limited number of showers or baths made available to service users. Others spoken to or seen were satisfied with the level of care given. Many of the service users at Cornerways are very frail, both physically and mentally. Service user files contained specific risk assessments related to the individual such as the use of wheelchair lap belts or bed sides. Risk assessments are a tool for regulating and reducing risks to service users with the minimum of restrictions to their lives and choices. The falls risk assessments seen in some files should be expanded across all service users. Specific detailed assessments must be provided for those most at risk, following the advice of the falls prevention team at the local hospital. Falls assessments are important as they ensure every effort has been made to reduce the risk of falls to people most at risk through frailty or poor mobility. The assessment may for example indicate that hip protectors are appropriate or that better lighting should be provided. Currently the home undertakes a falls audit, which is good practice. This looks at every accident on a monthly basis attempting to identify patterns in order to prevent future incidents. Further evidence could be seen on file in relation to the accessing of healthcare facilities, hospital appointments and the involvement of local general practitioners and district nurses. One district nurse seen on the visit confirmed that the home were responsive to peoples changing needs and made appropriate referrals to them, for example to look at small abrasions or potential pressure areas. They also confirmed that specialist equipment was being accessed for one service user who needed a specially built chair. However other comments from district nursing staff indicated there were still issues regarding the securing of service user leg bags for service users with catheters and that sometimes staff needed to give service users more warning when trying to carry out care tasks. Evidence was seen of regular blood tests being carried out to monitor levels of certain medications, and regular eyesight, hearing and podiatry appointments are made. These help to demonstrate that service users needs for healthcare are being met. Visitors confirmed they were kept up to date with changes in their relatives condition. Medication requiring refrigeration is stored in an unlocked refrigerator to which all persons have access. There is no record made of the temperature range of this fridge to ensure that all medication is stored within the manufacturers recommended temperature range. Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 14 The medication trolleys are kept locked whilst not in use but were not secured to the wall at this time. Also one of the medication cupboards was not affixed to the wall in the appropriate manner. Service users are encouraged to look after their own medication where appropriate, however no risk assessments for this were found in the service user care plans and also no record was found to be made to indicate the supply of medication to these service users. It was seen that the receipt of some medicines had been recorded. This record was not found to be complete. The home had a list of all members of staff who had been trained and assessed as competent to administer medication, however this list also contained the names of people in the longer working at the home. The medication administration record charts are supplied printed by the pharmacy, however for supplies made during the month an additional dispensing label is stuck onto the chart, which is not recommended as good practice. Cornerways DS0000049076.V296516.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. Service users would benefit from an increase in person centred activities, and from opportunities to be more involved in the home. EVIDENCE: Many of the service users at Cornerways suffer from memory loss and physical frailty. Others may be more mentally alert but have physical disabilities which limit their ability to follow their chosen lifestyles. This means that many people are reliant on the home or relatives and friends to bring activities and stimulation to them rather than going out and seeking it for themselves. On the day of this visit two service users had been taken out by relatives and another had gone out for lunch. Others were receiving visitors, reading, watching television or socialising. In the afternoon of the second site visit there was an organised bingo session. This was quite well attended and the member of staff carrying out the activity had made adaptations to cater for the variety of strengths in the participants. However activities for those service users who are more frail or have memory loss would benefit from an increase in person centred activity and assessment. This reflects current best practice in Dementia care, the individual interests and needs of service users and sets activities to meet the level of retained skill Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 16 of the service user. For example some service users are able to carry out ‘complex’ activities, others may be batter suited by participating in activities that are simple creative tasks that do not require any decision making. Service users are able to welcome visitors at any time and visitors confirmed they are made welcome and offered refreshment on arrival. Service users are able to attend religious services of their choice as wished, although none of the service users spoken to expressed a wish to do so. The manager is about to re-circulate updated questionnaires to service users about the quality of life they experience at the home, and the home has recently held a small meeting with service users and relatives to discuss any issues. This helps service users have a say in how the home is operated and thus have more control over their lives. Questionnaires circulated to service users by CSCI indicated that service users felt there were usually activities available for them to take part in, and one commented “They do their best to help us enjoy ourselves”. The home provides a very good standard of catering and food for service users. Meals are home cooked with the use of fresh meat, fruit and vegetables and the menu plan demonstrated excellent choices and variety. The Manager is considering providing an option of a cooked breakfast if demand is there. The chef has also implemented afternoon ‘smoothies’ for more frail service users. These provide increased calories and vitamins in a palatable form, incorporating dairy products and fresh fruit, and were being greatly enjoyed on the second visit which was on a very hot day. Other service users had a choice of ice lollies or choc ices in the afternoon which were also well received. Discussion was held on specialist advice available on the nutritional needs of older people with memory loss. Comments from service users included “A good variety – very good always” and “the food is really good”. Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18 Quality in this outcome area is good. Service users and staff have access to a robust complaints process, including a whistle-blowing policy, which assists in identifying and addressing poor practice. Service users are further protected by the homes policies on prevention of abuse, but attention is required to the homes policy on restraint. EVIDENCE: The home has a complaints procedure which is detailed in the homes hallway and in the service user guide. Service users who completed questionnaires indicated that they were clear about the homes complaints process and about who they would go to with any concerns or worries. No formal complaints have been received since the last inspection, either by CSCI or by the home, other than minor issues that have been resolved by the home immediately they were raised. A concern was raised with the Health Authority about the removal of a syringe driver in a patient who had died, and this was investigated fully by the pharmacy inspector during the site visits who was satisfied with the outcome. The home also has policies on adult protection and the prevention of abuse. Staff spoken to had attended training in Adult protection and certificates to detail this were available in their files. The home has a policy on restraint, and this should be revised in the light of the baffle device which has been fitted to the front door. A policy on restraint is important as it clearly sets out for staff Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 18 and service users where and how any issues of restriction of service user choice may be instituted. This might for example include when and why the front door may be secured, and for what period for the protection of service users. This may need to be examined again soon in the light of forthcoming legislation. Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 Quality in this outcome area is adequate. Cornerways is undergoing a programme of renovation which once completed will provide a very attractive environment for service users. Some areas still awaiting renovation have suffered wear and tear. Discussion needs to be held with the fire officer concerning protection to a fire escape, and some lighting in communal toilets could be improved. EVIDENCE: Cornerways is a large building over three floors, with a shaft lift to access all floors. Lounges and the conservatory were being well used during the course of the inspection. There is limited car parking at the home, but parking is available on streets nearby, particularly during the winter months. The home has a newly fitted commercial laundry and clean clothes storage to the rear of the building. Service users spoken to commented favourably upon the laundry service and ironing, however a comment from a relative indicated that more care could be taken with some service users clothes. The new Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 20 system provides for excellent infection control and sluicing facilities, which means that service users clothes and bedding can be kept clean and reduce risks of cross infection. Any contaminated or soiled linen is taken to the laundry in a sealed bag that then dissolves in the washing machine, eliminating the need for staff to handle soiled bedding in the laundry area where cleaned clothing may be kept awaiting ironing. This also reduces risks for staff of any known cross infection. Service users bedrooms were individual and showed evidence of personal belongings and furnishings. Some rooms have access to a shared balcony and all rooms vary in size, shape and outlook. The majority are en-suite with at least a toilet, but many also have baths or showers. Some rooms were locked as the service users were out. This demonstrated that service users who are able can maintain their privacy if they choose. Some service user rooms had an odour problem, but this is being managed by the home’s staff. The home has a comprehensive infection control policy, which includes the use of disinfectant wipes, and hand sanitisers. Toilets have paper towels and soap dispensers which reduces the risk of cross contamination from hand towels. The home has a variety of bathroom and shower arrangements for service users which includes wheel-in showers and baths with hoists. Some lighting in these areas was not very bright, and would benefit from being increased. On the second floor a small half height gate has been fitted to stop service users from falling down or using the fire escape unaccompanied. This must be discussed with the fire officer as it affects an escape route. Considerable investment has been and is being made in the building to enhance facilities for service users. Much of the current investment is “invisible” to service users and visitors as it involves such areas as boilers and heating systems and an excellent new laundry area. Future development is planned which will actively enhance the direct environment for service users. Whilst this is awaited it is acknowledged that although some areas would benefit from redecoration, spending money doing this only to have to re-do it several months later would not be a good use of resources. In other areas rooms are being redecorated and refurbished if they fall vacant or if it is possible to do so without disrupting the service user concerned. Two comments were received that the home would benefit from additional cleaning in some areas. Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. Cornerways policies and practice on recruitment and training of staff ensures service users are cared for by people who are suitable to work with vulnerable people and who can meet their needs, however additional training is needed in the care of people with Dementia. EVIDENCE: Four staff files were selected at random and examined to ensure all of the required paperwork was in place. This included such documents as references, criminal records bureau checks and application forms. All the files seen were complete and demonstrated a full employment procedure is followed. This is important in determining that service users are cared for by people who are suitable to work with vulnerable people. The manager stated that staffing levels met the needs of service users and that staffing levels can be adjusted to meet alterations in need. The home has senior staff such as senior carers and/or deputy managers on at all times. Some of these senior staff are qualified nurses and others have completed national vocational qualifications in care. 4 more staff are due to commence level 3 NVQ training in the near future and 4 will undertake NVQ level 4, which is a management level qualification. The home has a developing programme for staff training, including the protection of vulnerable adults, food hygiene and handling, first aid, fire training and palliative care. Training such as moving and handling and fire training is also on a rolling programme for staff to repeat regularly. The home has provided an induction programme, which could be Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 22 seen being completed for two newly appointed staff. Induction programmes were not all available for staff who were appointed many years ago under previous management. Staff have access to policy and procedure manuals which are kept in the homes office, and have contracts of employment which could be seen in the sampled files. There are also job descriptions for all grades of staff seen. Staff have recently received a short course on working with people with dementia. The manager has also obtained copies of the Sector Skills Council standards for care staff working with people with dementia, which will provide a good basis for developing the training already received. Discussions were held individually with four members of staff, looking at training and work issues, privacy and dignity, equality of access, the complaints procedure and their employment. Discussions were also held with the group manager who attended the second day of the inspection, the chef, and the homes manager. Staff also completed questionnaires which indicated generally that the home staff were working well as a team, although comments included that the home would benefit from increased handovers between shifts and that more staff were needed, both by day and by night to ensure that service users needs can be met without staff being rushed, especially in the morning. Other comments from staff included that some routines would benefit from being reviewed and that sometimes more assessments on service users who were deteriorating would be helpful as sometimes not all staff are up to date with each service users condition. Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is adequate The home is being well managed, however attention is required to supervision systems and quality assurance within the home. EVIDENCE: The manager, Mrs Gill Plastow has worked at Cornerways for over 20 years and last year was registered to be the manager having completed the Registered managers award, which is a nationally recognised specialist qualification for managing a care home. She shortly intends to commence taking an NVQ 4 in care, which is another management level qualification. Staff at the home participate in supervision meetings and appraisals, but systems need to be developed further to ensure staff receive full supervision at a frequency of at least six times a year. Supervision is a system of staff development and performance management, which ensures that staff are Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 24 working consistently to support service users and receive the training and support they need to do their job. The manager is developing a new quality assurance system for the home. Questionnaires have been given to all service users and staff in the last year and are due to be re-issued. Questionnaires are to be developed for relatives and other stakeholders and information gathered from internal and external audit procedures, monitoring systems etc within the home. The next stage will be to produce a report that links to the homes annual development plan. Once completed, this system will ensure that service users and other stakeholders are able to formally be involved in the operation of the home, and affect how their care is delivered. The home has been awarded the Investors in people Award. Health and safety management systems seen were satisfactory, with servicing contracts in place for lift and hoist maintenance. Some minor attention was required to the homes health and safety at work policy, but the arrangements for the storage and safe keeping of chemicals, environmental risk assessments and assessments for safe working practices were satisfactory. The manager confirmed that a fire precautions workplace risk assessment had been completed and agreed with the fire officer. An assessment of the first aid risks at the home still needs to be completed to determine the level of first aid cover needed. The management of service user finances was examined. Some service users have a small cash float left with the home for safe keeping. Any expenditure made on service users behalf, for example paper bills, hairdressing and chiropody services are receipted. Each service users money is maintained independently, and the samples checked at random balanced correctly with the cash held. Receipts also balanced with the list of expenditure. The home has a small shop where such items as talc, stamps and sweets are available at cost price in case service users are unable to go out themselves to shop. Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 25 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 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 2 3 2 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 2 3 3 Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement Timescale for action 30/08/06 2 OP36 18 The home manager must write to each prospective service user prior to admission confirming that the home can meet the service users needs as identified in the homes pre-admission assessment. Full Supervision systems must 30/11/06 be implemented for all care staff, including the manager. Previous date for compliance 28/2/06 3 OP21 23 4 OP33 24 The home must review the lighting levels in the interior bathrooms to ensure they are safe to work in and provide a comfortable environment for service users to bathe in. The registered person must expand upon the current questionnaires to provide a full system for reviewing and improving the quality of care at the home. Previous date for compliance 28/2/06 30/09/06 30/11/06 Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 27 5 OP9 13 (2) 6 OP9 13 (2) 7 OP19 23 The registered person shall make arrangements for the safekeeping of medicines received into the care home. . The registered person shall make arrangements for the recording and safe administration of all medicines received into the care home. The responsible individual must discuss the stair gate to the second floor fire escape with the fire officer. 01/10/06 01/10/06 30/08/06 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 OP7 Good Practice Recommendations The home manager is recommended to increase the amount of information gathered on service users life histories. The home manager should ensure that the homes policy on restraint includes all areas including the ‘baffle’ device on the front door. The home manager is advised to review the programme of activities with the specific needs of service users with memory loss in mind. A copy of the homes service user guide should be given to each service user. The home manager should consider whether the homes service user guide could be made available in additional formats to meet the needs of the service user group. Service user care plans should be reviewed monthly. A falls risk assessment should be undertaken for all service users with a more detailed assessment based upon best practice for those service users most at risk. Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 28 2 OP18 3 OP16 4 OP1 5 OP7 6 7 OP38 OP9 8 OP9 The home manager should complete a first aid risk assessment for the home. It is recommended that when additions need to be made to the printed medication administration record chart that these are hand written, the person making the entry signs and dates it and then gets it checked and signed by a second person. It is recommended that the staff signature lists be reviewed to ensure that they only contain the names of those persons currently authorised and assessed to administer the medication. Cornerways DS0000049076.V296516.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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