Inspection on 23/01/08 for Eventide Residential Home

This inspection was carried out on 23rd January 2008.

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

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

Eventide Residential Home 22/01/09

Eventide Residential Home 16/05/06

Eventide Residential Home 18/10/05

Eventide Residential Home 11/05/05

Eventide Residential Home 17/01/05

Eventide Residential Home 02/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Eventide Residential Home 22 Downs View Bude Cornwall EX23 8RQ Lead Inspector Susan Taylor Unannounced Inspection 11:00 23 January 2008 rd 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 Eventide Residential Home DS0000009173.V350351.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. Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eventide Residential Home Address 22 Downs View Bude Cornwall EX23 8RQ 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) 01288 352602 Eventide Residential Home Limited Mrs Ann Georgina Cousins Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th May 2006 Brief Description of the Service: Eventide is an older property offering care and accommodation to 18 older people. A committee of local people in conjunction runs it with the registered manager. The home is near the beach and overlooks the golf course at the front. Accommodation is provided on three floors connected by a shaft lift, although a few rooms on the first and second floor have two additional steps to reach them. Nine rooms are en suite. There are handrails and a variety of pieces of equipment to aid independence throughout the home. There is an assisted bath on the ground floor and a large shower on the first floor. Externally seating is provided in front of the home. This is a popular venue where residents sit in good weather and watch people, holidaymakers and golfers passing by. There is also a small paved rear garden for peoples use. As at January2008, the fees ranged between £308.09 and £350 per week for personal care. Extra charges are made for chiropody, hairdressing, newspapers and magazines and toiletries and these vary. Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 stars. This means the people who use this service experience adequate quality outcomes. This was the first key inspection of Eventide under the ‘Inspecting for better lives’ arrangements. We were at the home with people for 7.5 hours for one day. The purpose for the inspection was to look at key standards covering: choice of home; individual needs and choices; lifestyle; personal and healthcare support; concerns, complaints and protection; environment; staffing and conduct and management of the home. We looked at records, policies and procedures in the office. A tour of the home took place. We tracked the care of three people and met some of their relatives. We also spoke to a group of four people that live in the home about their experiences there. We sent surveys to all of the people living in the home and received 14 back. The comments of these people and our observations are in the report. We sent surveys to three GPs and other healtcare professionals and received none back. We also sent surveys to 15 staff and received 14 back. The results of this are included in the report. As at January2008, the fees ranged between £308.09 and £350 per week for personal care. Extra charges are made for chiropody, hairdressing, newspapers and magazines and toiletries and these vary. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk People living there described Eventide as being a “homely” and “comfortable” home. In a survey, staff wrote comments like ‘The service users all seem very happy with the service we provide for all their individual needs. There is always ongoing training for the staff to ensure they are all aware of the current up to date regulations which enables them to carry out their duties correctly and provide a very good standard of care.’ And [the home] ‘Relates very well to service users needs and aims’. Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The manager has created a questionnaire that will be done with new people just before and when they first move into the home. This will ensure that all of the staff know what needs a person has and how they should be met. Since the last inspection, medication procedures have been tightened up with regard to checking medicines into the home and this ensures that ensure that people receive the right medication, as prescribed, at the right time. The number of staff that holds an NVQ award in care has increased (2008- 78 ) and another 12.5 are in the process of doing the award. This means that more staff has the appropriate experience, skills and knowledge to care for older people living in the home. Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 7 What they could do better: The assessment process using the new questionnaire needs to be followed consistently, immediately before and after a person moves into the home. This will ensure that the staff have all of the information needed to meet the individual’s needs. People living in the home should be involved reviewing their care regularly to ensure that it meets their needs. This is repeated from the last inspection. We agreed to extend the timescale so that this could be met. Risk assessments need to be comprehensive (covering falls, tissue viability, nutrition) and reviewed regularly. Risks should be managed positively to help people lead the life they want. Any limitations on freedom, choice or facilities must always be in the person’s best interests and agreed with them and/or their advocates. Protect people that live in the home and staff that work there further from the risk of infection by using the Department of Health guide ‘Essential Steps’ to audit current infection control management. People living at the home must be protected by ensuring that appropriate checks are done before staff are allowed to work. We made an immediate legal requirement to stop a member of staff working until these checks had been carried out. The manager has since written to the Commission to tell us that this has been done. Quality assurance processes need to be implemented across all aspects of the home to ensure that people consistently receive a good service and are actively involved in decisions about their lives there. For example, people need to be able to discuss what they would like to do for activities and outings so that they feel valued as people themselves. People that use the service must be confident that they are being cared for by experienced and competent staff. As part of the quality assurance processes, supervision of staff provides an important means to ensuring that staff get the right level of support and guidance they need to do their job well. This is repeated from the last inspection. We agreed to extend the timescale so that this could be met. Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 8 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. Eventide Residential Home DS0000009173.V350351.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 Eventide Residential Home DS0000009173.V350351.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 & 6 Quality in this outcome area is adequate. People’s needs are not consistently known or shared with the staff that have to deliver care to them. Therefore, there is a lack of continuity of care for people living in the home. Information that people rely upon when deciding whether to use the service is not up to date. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 77 of people living in the home responded to a survey and verified that they received enough information before they moved in so that they could decide if it was the right place for them. Similarly, they all had a contract of residency. Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 11 The manager told us that people are assessed initially by her either at their home or in hospital, using a ‘lifestyle assessment form, to establish whether their needs can be met at Eventide. We used information sent to us to look at how specific needs of people were assessed and planned. We examined three care files for people with short term memory loss, physical frailty and mental health needs. The manager had obtained information about the individuals had been obtained from social services if the care package had been commissioned by them. A thorough assessment of needs had been completed for 66 or for two out of three people. Where these had been done there was evidence that relatives had been involved in the process when they moved into the home and a ‘pen picture’ had been written. People told us that the manager and staff had asked them and their relative for a lot of information about their health and needs when they first moved in. However, the current picture we were given by the individual’s concerned or observed when we met them did not match up with that seen in two out of the files examined. We also spoke to key staff to verify the needs we had identified. For example one person’s assessment was incomplete and made was no mention of the fact that they were in pain and needed regular strong analgesia. In another person’s file the lifestyle assessment had not been filled in. That person had significant mental health needs and the staff were managing these despite not having up to date information about the individual’s needs. In surveys received from staff, 78 verified that they ‘usually’ or ‘sometimes’ received up to date information about the needs of people that they care for. This indicates that information about peoples’ needs is not always up to date. We read committee minutes and saw that intermediate care had been provided for one person. The manager verified that the individual concerned had stayed for a brief period at the home and had a lot of input from healthcare professionals, such as physiotherapists, during that time. We were told that the person had returned home after a short stay. We read the statement of purpose, which made no mention that the home provided intermediate care. Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. Although improving, the variable practice regarding the planning and delivery of care means that all the people living in the home cannot be sure that their health and personal care needs will be fully met. Improvements are needed to ensure that a person centred approach is used that takes account of and makes plans that enable people to take risks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We tracked the outcomes for a person with complex mental health needs and focussed on one aspect of the care they received. Staff told us that on admission to the home the individual had arrived in a neglected state having Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 13 not fed them properly. The individual was very underweight. We observed staff prompting the individual at mealtimes and offering extra snacks and meal supplements to them. We read the individual’s care file, which was incomplete. No risk assessments had been done about the person’s nutritional state and needs. Similarly, no care plan had been written so staff delivering the care to that person did not have clear goals to work towards with them. The manager and staff we spoke to all verified that the individual had gained weight in the short time they had been at the home and this was recorded in the daily records. In a survey 78 of the staff verified that they ‘sometimes’ or ‘usually’ had up to date information about the people they were caring for. We spoke to a person who told us that they were at risk of falling due to a health condition. The individual’s limited mobility was highlighted in their care plan but there was no clear guidance to staff about the steps that should be taken to minimise the risks of falls for that person. There was a handling plan that had been written and was incomplete with regard to the safety of the person when staff need to help them change their position. We followed the outcomes for a person who told us that they experienced pain and needed regular pain relief. The person told us that they were regularly offered medication for this and that when it was given to them two people did this. They told us that the medication “really takes the edge off the pain” and that they “couldn’t do without it”. Additonally, they said that they were “very satisfied with the care and attention” they received from “kind and caring staff”. We looked at medication records and established that the staff were following procedures for controlled medication. A register had been kept as is required by law. We looked at the individual’s care plan, which omitted to mention that this person suffered chronic pain and was receiving regular treatment for this as prescribed by their doctor. 100 people responding in a survey verified that they ‘always’ received the medical support they needed. Their comments included ‘prescribed medication is always administered correctly. They also told us that if there is a need for a nurse or doctor the staff act ‘promptly’. Medication record charts are in use and no gaps in the records were seen. Whilst tracking the needs for three people, we observed that medicines had been given as prescribed. Medicines were seen to be stored in a locked cupboard and a bristol maid trolley, both of which were securely affixed to the wall. Training records demonstrated that key staff involved in administering medication had received appropriate training. Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. Generally people living at the home have some say about how they occupy their time. However, the views of people need to be sought to enable people to enjoy as full and stimulating lifestyle as they are able to. The food in the home is of good quality, well presented and meets the dietary and cultural needs of people who use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 42 of people responding in a survey verified that activities were arranged in the home ‘sometimes’. One person commented further, ‘if on the odd occasion the residents and staff could go out for the odd trip…I feel this would benefit the residents in a great way’. During the inspection we asked people how much say that they had in deciding how to spend their time. Opportunities such as outings came up in the discussion and we were told the committee decides when and where people go. We read minutes of Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 15 committee meetings documenting discussions that had taken place about arranging two outings for people to a garden centre and museum. People felt that it would be nice for them to have more say about this and that it was “important to have something to look forward to”. We asked people whether meetings were held with them to discuss issues such as activities and were told that no meetings had been held with them. We discussed this with the manager who told us that committee members visited every month and talked to people as they toured the building. The majority of people we spoke to did not recognise this as a way of influencing the decision making in the home. As highlighted under the sections entitled ‘choice of home’ and ‘health and social care’, the manager showed us a lifestyle assessment that they had developed. However, this had not been consistently applied for the people whose care we tracked. Therefore, the staff did not have comprehensive information about each individual’s social networks, hobbies and interests that would highlight the person’s goals and desires and from which a care plan could be drawn up and regularly reviewed. The manager provided information to verify that 100 of people living at Eventide are of christian faith. Three service users we spoke to told us that communion is held every two weeks in the home. Additionally, one person who lives in the home is actively involved with a local church and attends services there every Sunday with a relative. We observed that most people were occupied with individual pursuits such as reading, doing puzzles and crosswords or knitting. A person living in the home told us that they liked making dolls clothes as a hobby and they showed us a lot of their work, which was lovely. The person went on to tell us that they did this for charity and that they enjoyed this immensely. Another person said that they enjoyed “poetry and playing with words” and did “a lot of crosswords”. The manager verified that mealtimes are seen as a social event and therefore people living in the home are encouraged to join everyone in the dining room at mealtimes. In a survey 100 of people that responded felt that meals were ‘always’ and ‘usually’ to their liking. People we spoke to made comments like (the meals are) lovely, really lovely, they come round the day before and ask is what we want for the following day. Lunch was served during the inspection, which was well balanced and appetising. Information that the manager had sent us did not specifically outline what improvements had been made since the last inspection. We saw at least two different choices being served. The catering staff explained that they have written details of individuals’ likes and dislikes and can plan menus around these. We were told that special diets such as low fat/sugar had been made for people with diabetes Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. The arrangements at Eventide ensure that people are both protected and able to voice their concerns. This judgement has been made using available evidence including a visit to this service. EVIDENCE: With regard to complaints, 100 of people that responded in a survey verified that they ‘always’ knew who to speak to if they were not happy and knew how to make a complaint. Similarly 100 of staff responding in a survey also knew how to deal with concerns and complaints and who to refer these to. We read the complaints procedure that was displayed on the notice board. The contact information for the Commission for Social Care Inspection was out of date and this was highlighted to the Manager. We looked at records and saw that the home last received a complaint in 2005, which had been properly investigated. During the inspection no formal complaints were made to us. We spent time in the lounges observing how staff interacted with the people living there. During the period of observation, staff engaged with people continuously at the right speed and demonstrated genuine warmth and attention, which people appeared to respond to and enjoy. In a survey, Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 17 people wrote comments like the ‘Staff are always very attentive and act on what is needed’ and ‘the staff always listen’ and ‘the staff are very friendly and helpful’. We spoke to three staff who were all aware of adult protection procedures. The manager showed us a training pack that had been purchased told us that in house training about adult protection was being rolled out to staff. She went on to tell us that he had been given more supernumery hours to enable her to do this. We saw a copy of the ‘Alerters guide’ in the office. The home also had a whistleblowing policy, which all of the staff we spoke to understood. Two out of four staff whose files we looked at had also attended recognised training about safeguarding people. 68 percent of care staff held the national vocational qualification in care and a further 12.5 are in the process of doing it. A component module is about abuse and adult protection therefore the staff doing this will be more aware of how to protect the people living in the home. Information sent to the Commission hightlighted that no referrals had been made to POVA (Protection of Vulnerable Adults List). No referrals had been made to the local authority to safeguard the interests of a person living in the home. Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. People live in a well-maintained, comfortable and clean environment. Eventide has infection control procedures that reduce the risk of infection to people living in the home. This might be further improved by auditing practice using a recognised tool such as the Department of Health guide ‘Essential Steps’ and encouraging all of the staff to attend training about the prevention of infection and management of infection control to develop knowledge of best practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the people responding in a survey felt that the home was ‘always’ clean and fresh. Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 19 In a survey relatives told us that they were ‘very impressed with the lovely clean bedding’. We spoke to people in the home about their experiences of bathing. One person said that they had had a lovely bath, real top to toe and they tested the water temperature before I got in to make sure that I didnt get scalded. Information that the manager had sent to us highlighted that since the last inspection the kitchen had been refurbished. We toured the premises. Most parts of the home were well maintained. We saw that improvements had been made to the accommodation as discussed previously. Fire exits were clear and accessible. The external fire escape had corroded due to the close proximity to the sea, and is in need of maintenance to preserve it. All the bedrooms were inspected and found to be clean, individualised and comfortably furnished. People living in the home told us that there is always a housekeeper on duty. All of the wcs and bathrooms had locks on the doors. Communal areas were comfortable and homely. Maintenance certificates were seen for the lift, assisted baths, electrical installation, and fire alarm systems. On entering the home we saw a poster displayed reminding visitors not to enter if they had any sort of infection to prevent the people living in the home from contracting an infection. Additionally, alcohol gel was in the entrance hall and all visitors asked to use it before entering the home. The manager had verified in information sent to the Commission that an audit using the department of health guidance had not been carried out. Additional information provided verified that 7 out of 15 staff (46 ) had received training about the prevention of infection and management of infection control. Hand towels and soap dispensers were seen in wcs, bathrooms and bedrooms. Good hand washing practices were observed as staff were seen to deliver care to residents. The laundry was clean and well organised. We observed good infection control measures being followed when staff were dealing with soiled linen. Sluices were clean and fully operational. People in the home told us that there had been little illness amongst the group through the winter and that everyone had been offered the opportunity to have the influenza vaccination Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 20 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 poor. People’s needs are generally well met, though greater stability of staffing levels at weekends would improve this further for them. Recruitment practices at Eventide do not fully protect the people living there. The home has improved the level of training for staff to ensure that competent and knowledgeable staff care for the people that live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In a survey about the availability of staff, people living in the home wrote that they ‘sometimes have to wait a long time’. The same issue arose when we asked people the same question at the inspection. People felt that normally staff responded quickly and promptly to their needs. However, people told us that there was sometimes a problem at weekends. We inspected on a weekday and observed that people’s needs were attended to promptly. Therefore, staffing levels were sufficient. However, we wanted to establish whether this was the case at weekends. Staff we spoke to told us that weekends could be a problem since the majority of staff did not want to work then. We looked at the information that the manager had sent to us, which Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 21 did not highlight this to be an issue that needed to be improved. We looked at the duty roster for the weeks starting 20th and 26th January 2008. We saw that on Saturday 26th January, staffing levels was down by one member of staff when compared to weekday levels. We discussed this with the manager who verified that weekend cover was always difficult. We advised the manager that other services tend to have one of two systems, weekend and weekday staff or a system whereby every member of staff works one in two or three weekends a month. This is an area that needs improvement to provide continuity of care for people living in the home. In a survey, two of the staff that responded told us that criminal records bureau checks had not been taken up for them prior to employment at the home. We examined 4 staff files. 3 of the staff had been employed since April 2007. Written references [two] had not been obtained prior to employment by the home for the individual’s concerned. However, these had since been received for 2 of the individuals concerned. Duty rosters verified that the newest member of staff had worked at the home since 10th January 2008, there was no evidence on file to demonstrate that references, including CRB or POVA checks had been carried out. These shortfalls were discussed with the registered manager who verified that references including a CRB and POVA check had yet to be undertaken for this person. We issued an immediate requirement that required the manager to take up references, CRB and POVA check for the individual concerned and instructed the manager not to allow the person to work until satisfactory references including a POVA check had been obtained. We showed the manager the Commission’s publication ‘Safe and sound?Checking the suitability of new care staff in regulated social care services’ [available at http:/www.csci.org.uk/pdf/safe_sound_tagged.pdf] and clarified what constituted good practice in relation to recruitment procedures. The registered manager told us they would address the shortfalls as a priority. We spoke to a disabled worker who told us that ‘reasonable adjustments’ had been made, which enabled them to become an effective and valued member of the team. 85 of staff in a survey told us they had received training relevant to their role and helped them understand and meet the individual needs of people living in the home. The manager verified in information sent to the Commission that 78 of the staff holds the NVQ award in care. Additionally, a further 12.5 are in the process of doing the award. Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 22 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 adequate. An experienced, qualified person manages the home with support from a Committee. The views of people living and visiting the home are respected. However, this is an area that needs further development to ensure that quality assurance is implemented across all areas of the home for the benefit of the people living there. Financial procedures safeguard peoples interests. People living in the home are aware of safety arrangements and have confidence in the safe working practices of staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 23 The Registered Manager has been in charge of the establishment since 2003. She holds the Registered Managers Award and NVQ Level 4 in Care Management. She told us that she keeps up to date by using an in house training system and has “good links” with the local college. Throughout the inspection we found the manager to have a fair understanding of her role. We were disappointed that two out of three requirements made at the last inspection (16th May 2006) had not been fully met, namely those relating to care plans and supervision of staff. We agreed to extend the timescale with regard to these to facilitate this. Similarly, we had to make an immediate requirement with regard to recruitment practices to safeguard the people living in the home. We advised the manager to negotiate more administrative time with the committee to enable them to address these shortfalls. The manager gave the Commission a reasonable picture of the current situation in the service, in a document entitled AQAA (Annual Quality Assurance Assessment). However, there were areas when more supporting evidence would have been useful to illustrate what the service has done in the last year, and/or explicitly how it is planning to improve. The certificate of registration was displayed in the hallway, which was out of date and showed the incorrect title for the provider. This matter was discussed with the manager, who told us that there had been ongoing correspondence with the Commission in the past about the registration of the home. We advised the manager that we would look into this and would confirm what action they needed to take about this in due course. People responding in a survey told us ‘..they always try to make the home happy and friendly with plenty of laughter’ and ‘the manager and her staff do an excellent job very well’ and that they were ‘very happy here’. In a survey relatives told us ‘it is a lovely home and the staff are very lovely and caring’. The manager verified in information sent to the Commission that the trustees visited the home regularly to meet the people that live there and staff working there. According to our records, we have regularly received a report of such visits from the Committee although this is no longer a legal requirement. The manager verified that the home does not formally conduct surveys to seek the views of other stakeholders, relatives or the people living in the home. The manager went on to tell us that most of the quality assurance was done “informally” and that more formal routes such as meetings and surveys needed to be implemented to consistently obtain the views of people living in the home, staff and visitors. People we spoke to verified that they “have not bee asked to do a questionnaires” to rate the service that they receive. The Cook told us that waste was monitored and we observed her asking for feedback from people during and after lunch. As previously highlighted, people told us that they did not tend to have house meetings to discuss issues. Whilst committee members do meet people during the monthly visits, the Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 24 majority of people we spoke to did not recognise this as a way of influencing improvement of the service they receive. 50 of staff responding in a survey had not received supervision from the manager. We spoke to three staff during the inspection, two of which had not had a 1:1 supervision session with the manager for more six months. In a survey, 92 of staff responding in a survey verified that they either usually or sometimes received support from the manager. We looked at four personnel files; one out of four had a record of recent supervision that had taken place. We looked at records showing how money is managed on behalf of three people that live in the home. All were accurate when crosschecked with the balance kept for safekeeping. Entries had been signed for. The manager told us that the records were regularly audited. Receipts corresponded with entries for items such as chiropody, hairdressing and newspapers. Secure facilities were being used to safeguard people’s money. Comprehensive Health & Safety policies and procedures were seen, including a poster displayed near to the office stating who was responsible for implementing and reviewing these. 100 of staff that responded in a survey verified that they ‘always’ or ‘usually’ received induction training. We spoke to a newly recruited member of staff that was in the process of doing induction training. We were shown the induction pack that they had received and were working through. This reflects ‘Skills for Care’ standards, and demonstrated that the home has improved the induction procedures for new staff ensuring that properly trained staff cares for people. We toured the building and observed that cleaning materials were stored securely. Data sheets were in place and staff spoken to understand the risks and strategies to minimise those risks from chemicals used in the building mainly for cleaning and infection control purposes. We observed hand sanitizer being used by staff to minimise the risk of cross infection. Records of accidents were kept and showed that appropriate action had been taken. The fire log was examined and demonstrated that fire drills, had taken place regularly. Similarly, the fire alarm had also been regularly checked. People living in the home, relatives and staff told the inspector that the alarm was regularly “checked once a week”. Three people told us that a fire drill had happened before we arrived at the home. They said that staff didnt evacuate people because it was a practice and went on to say that drills were done regularly. Certificated evidence verified that an engineer had checked the hoists. First aid equipment was clearly labelled. Three staff on duty verified that they held a current first aid qualification. Good manual handling practice was observed as carers transferred people from wheelchairs to chairs in the dining room at lunchtime. Maintenance certificates were seen for the lift, assisted baths and fire alarm systems. The manager had verified in Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 25 information sent to the Commission that a local electrician had inspected both the electrical system and appliances. Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 2 x x 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 2 x 3 Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 27 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 OP29 Regulation 19(4)b(i) Requirement People living are safeguarded by thorough pre-employment checks having been carried out on all new employees prior to commencement of duties at the home. An immediate requirement was issued on 23/1/08. The manager has since verified that action has been taken to resolve this matter. 2. OP3 14(1)a-d People living in the home are confident that their needs can be met and have been thoroughly assessed and regularly reviewed with them. People living in the home are fully involved in the planning of their care and this is regularly reviewed with them. Risk assessments must show that the safety, independence and choice has been considered and is regularly reviewed with people. DS0000009173.V350351.R01.S.doc Timescale for action 31/01/08 30/06/08 3. OP7 15(2)a-d 30/06/08 4 OP7 13(4)c 30/06/08 Eventide Residential Home Version 5.2 Page 28 5. OP33 24(1) 6. OP36 18(2)a Quality assurance processes need to be implemented across all functions of the home to ensure that people receive a consistently good service. This might include ensuring that people have a forum in which to discuss their preferences and interests in respect of activities and outings for example. All staff that provides care to people using the service must be supervised regularly in a structured way. This will ensure that the people that use the service are cared for properly by staff that are supported and receive appropriate training. This is repeated from the last report. We agreed to extend the timescale to facilitate this to be met. 31/08/08 31/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP3 OP7 OP7 Good Practice Recommendations People moving into the home should have a comprehensive assessment done with them to ensure that their needs can be met by the home. People living in the home should be involved reviewing their care regularly to ensure that it meets their needs. Risk assessments need to be comprehensive (covering falls, tissue viability, nutrition) and reviewed regularly. Risks should be managed positively to help people lead the life they want. Any limitations on freedom, choice or facilities must always be in the person’s best interests and agreed with them and/or their advocates. Use the Department of Health guide ‘Essential Steps’ to assess current infection control management to protect DS0000009173.V350351.R01.S.doc Version 5.2 Page 29 4. OP26 Eventide Residential Home 5. OP27 6. OP33 7. OP29 people that live in the home and staff that work there. Take steps to ensure that staff are sufficient in number every weekend, by reorganising working patterns, so that people living in the home receive good continuity of care as is reasonable to meet their needs. Quality assurance processes need to be implemented across all functions of the home to ensure that people receive a consistently good service. This might include ensuring that people have a forum in which to discuss their preferences and interests in respect of activities and outings for example. The manager should familiarise herself with good practice documents such as ‘Safe and sound? Checking the suitability of new care staff in regulated social care services’. CSCI June 2006. Additionally, guidance about criminal records bureau checks at: http:/www.csci.org.uk/professional Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Eventide Residential Home DS0000009173.V350351.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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