Inspection on 13/11/07 for Everley Care Home

This inspection was carried out on 13th November 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Everley Care Home 05/11/08

Everley Care Home 16/04/07

Everley Care Home 30/10/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Everley Care Home 15 Lyde Green Halesowen West Midlands B63 2PQ Lead Inspector Mrs Cathy Moore Unannounced Inspection 13th November 2007 06:55 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 Everley Care Home DS0000067211.V349864.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. Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Everley Care Home Address 15 Lyde Green Halesowen West Midlands B63 2PQ 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) Shilpa Odedra Mr Devshi Jethwa, Mrs Mani Jethwa vacant post Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Three service users in the category of DE(E). This condition will revert back to OP when the placements are terminated. Five service users in the category of PD(E). This condition will revert back to OP when the placements are terminated. 16th April 2007 Date of last inspection Brief Description of the Service: Everley Care Home is a detached property located in a residential area between Halesowen and Cradley Heath. The home was extended and converted by previous owners to its present form; a care home providing personal care to a maximum of 16 service users’. The home offers a lounge, dining room, kitchen, laundry and a choice of personal care facilities as it has both a shower and an assisted bath. There are gardens to the rear and car parking space at the front of the property. The home is not located close to shops or other amenities. Since the last inspection the home has been purchased by new owners. The registered owner told us that the fees range from £349-£360. We did note that the fees were not included in the statement of purpose as they should be. Additional charges include; hairdressing, clothing, private chiropody. Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We carried out this unannounced inspection on one day. One inspector and one pharmacy inspector were involved in the inspection. The inspection was carried out between 06.55 and 14.55 hours. Prior to the inspection we asked the owner to complete our questionnaire called an Annual Quality Assurance Assessment (AQQA) so that we had up to date information about the home. We sent questionnaires to staff, residents and relatives to find out what the home does well and areas that need to be improved. Unfortunately, the response rate was poor we only received the following number back; relatives 3, staff 4 and residents 1. We carried out the inspection in living areas of the home where we could observe daily routines and involvement between staff and residents. Three residents were case tracked. This process involves us looking at their care in detail and speaking to them to find out what their experience of living at Everley is like. During the inspection we spoke to six residents’ and two staff. The registered owner and the manager were involved with the inspection during the day. We looked at three staff files to find out how safe recruitment practices are and how much training and supervision they receive. We randomly looked at the premises which included; the living and dining room, five bedrooms, laundry, kitchen and toilets on the ground floor. We looked at records concerning health and safety and maintenance . Our pharmacist carried out an inspection of the medications and medication safety. We partially observed breakfast and lunch times to see what choices were offered and the quality of food. Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 6 What the service does well: We found the premises to be homely and comfortable. The atmosphere was positive, friendly and welcoming. The registered owner is totally involved in the running of the home and its operation on a daily basis. The registered owner and manager are pro-active and are motivated to continue to make improvements in all areas within the home. They listen to what we say and try to put into practice what has been asked of them. As with the last inspection there was a lot of conversation between the residents at meal and other times, joking and laughter. The residents are very much encouraged to maintain contact with family and friends. Staff observed during the inspection worked hard. They were friendly and polite to the people in their care. We observed positive interaction between staff and residents. Residents were given choices about what they wanted to eat and what they wanted to do. We observed comprehensive handovers between the night and day shift and morning and afternoon shift. This means that all staff have daily, up- dates on any changes in the care of the residents or any appointments for that day. The owner and manager make sure that only residents who have needs, which fall within the homes category of registration, are accepted to ensure that their needs can be met. Comments from residents included; “ I like it, they look after me”. “ I am settled and happy”. “ Lovely here. Only place that I have got that I like”. “ Nice, yes good, I am looked after”. “ Staff, are lovely and very kind”. “ The staff are lovely, they’ve always got time for you and are polite”. One staff member said; “ The home is good. I would not work here if it was not. They all get the care they need. I would not settle for anything else. Treat them as though they were my own grandparents”. A relative commented; “ We are happy in the way the care home takes care of mother in all aspects”. Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? Improvements continue to be made in all areas. The owner and manager have maintained their drive and commitment to ensure that standards continue to rise. The manager has commenced training to achieve her Registered Managers Award. All but two bedrooms have been provided with new hand wash- basins and vanity units. A number of bedrooms have been redecorated and have been provided with new furniture. The hall way has been painted. Work has been undertaken on the roof area that was prone to leakage. New fridges and freezers have been purchased for the kitchen. New toilets have been provided on the ground floor and one toilet room re-tiled. The owner and manager continue to try and improve catering arrangements. This includes menus and encouraging the residents to eat more healthily. One action that has been taken to achieve this is the offering of fresh fruit, carrot or cucumber as snacks between lunch and tea. A complaints procedure has been produced in part pictorial format to aid the understanding of residents. One staff member made the following comment; “ Everley has come a long way and things are improving. The home has done a lot. The service and support are better than before. Also the manager will be on the floor to check that things are right”. Another staff member made the following comment; “I feel that the home has done a lot of changes. For example staff training, meetings for all staff and relatives, activities are better. Staff have more responsibility to the residents and the paperwork. I know that the home is not perfect but Everley has come a long way and things are improving”. The following comment was received from a relative; “ Are better now at meeting mothers needs and requirements”. Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Everley Care Home DS0000067211.V349864.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 Everley Care Home DS0000067211.V349864.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): 1,3,4. Quality in this outcome area is adequate. Not all information is made available to residents before their admission to enable them to make an informed decision about the homes suitability for them. No resident moves into the home without having had their needs’ assessed. The home only offers places to those residents whose needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw written information including the last inspection report and Statement of Purpose on display by both exit doors on the ground floor. We did not see a service user guide. We did not see that the range of fees were available in the statement of purpose as they should be to ensure that prospective residents know the full cost a placement of the home will be. We Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 11 asked the owner SO about this and she confirmed that the range of fees is not available in the statement of purpose but would address this. Our questionnaire asked relatives if they received enough information about the home before (relative) moved in, 1 said always, 1 usually and 1 sometimes. This evidence shows that there are some minor shortfalls about information available to prospective residents’ which, need to be addressed. We looked at the files of three residents. One had been at the home for some time. The other two EH and LD admitted since July 2007. We saw a signed and dated form on these two residents files giving the home permission to carry out an assessment on them. We saw that a written assessment of need had been carried out for both residents. However, there was little evidence to show that they or their relatives had been involved in this process. We saw that both had a signed terms and conditions document on file. We saw a letter relating to EH to confirm that the home could meet her needs. We were concerned to see an entry on LD file dated 29.8.07 saying that she had been assessed by a Dr G, who felt that the environment was not right for her. We asked the manager about this who told us; “ No-one would confirm that L did not have dementia so until I was sure about this I would not accept her permanently as we are not registered to take people with dementia. I discussed this with the GP who told me the only way to conform would be to have her assessed by Dr G. L has a blood disorder and that was what he was referring to as it may have meant that she needed barrier care to prevent infection. Obviously, I followed this up and went to see her specialist nurse at the hospital who assured me that the environment is no problem. They know where she lives and from records you can see she attends the hospital regularly. Dr G confirmed on this day no dementia. I was then happy to make her permanent”. We looked at the daily records for 29.8.07 which read ‘ Dr G said no depression or dementia identified’. We observed the residents throughout the day and apart the ones where conditions were detailed on the registration certificate there was no evidence to suggest that any other had illness or conditions other than relating to old age. This evidence shows that the manager is very aware of the homes legal responsibility in terms of who they can offer a placement to and who they can not. Everley Care Home DS0000067211.V349864.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. Diabetes care is not included in care plans as it should be for residents who have this diagnosis. Some improvements are needed to ensure that all healthcare needs are fully met and that this is evidenced. Some further improvement is needed concerning medication management to prevent risk to residents. Residents are treated with respect and dignity is promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at care plans concerning three residents LD, NW and EH. We saw that although care plans contained limited information there was a clear process of identifying what needs to be done and by whom. We did not see a Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 13 care plan in place for diabetes for EH which should be in place for staff to be informed of signs and symptoms they need to be alert for concerning this condition. However, we did see a large diabetes information pack on file, which had been given by the district nurses. This information pack gave full details of blood sugars, diet and other implications. The visiting district nurse confirmed that the home is managing the diabetes. We heard her say to the senior J; “ You are doing what you should. Blood sugar has come down and is what it should be”. The manager told us that staff have not to date had training in diabetes awareness but she is trying to secure this. She named the known diabetic nurse specialist in Dudley (SB) who she had approached for this training. She told us that she had been told that there would be no training until after Jan 08. We saw that there were weight recordings for all three residents whose care we looked at. We were concerned however, to see from records that NW had lost a staggering 11 KG in 8 months. We heard NW say to staff member SN “ My clothes are loose I have lost weight”. She seemed concerned about this. We asked the manager about the weight loss and what she was doing about it. The manager told us the doctor is aware and is not concerned. There were records on file to show that NW had been in hospital recently but nothing to confirm that the GP had actually been alerted to this weight loss or precisely how much as there should have been to confirm that the situation was being dealt with. We were concerned to see bruising on LD’s face . Records showed us that she had a number of falls 26.9.07 fell out of bed. 27.9.07 found on floor by bed said rolled out. 3.10.07 fell when getting on commode. 26.10.07 found on floor 999 called. 10.11.07 paramedics checked over-refused hospital, bruise to right eye. The manager told us, we have been in contact with the doctor about this. We read the professional visit form on file, which confirmed this; 12.11.07 Dr M is involved and is reviewing medication. The manager also told us that the problem might be due to the fact that all LD’s life she has slept in a double bed and they were looking at getting a double bed to see if this would stop her falling. We told the manager that further, action is needed to prevent serious injury and suggested that they look at alarm systems and other equipment for on-going monitoring during the night. The manager phoned someone the same day asking for information. We saw evidence on all three resident files to confirm that a range of healthcare services are being accessed either regularly or when needed which included the Dentist, Dr and District Nurse for treatments and the flu vaccine. We saw on all files regularly reviewed risk assessments concerning for example; tissue viability and nutrition. We visually looked at residents such as RR, RU, NW and saw that they were well presented. Female residents were nicely dressed. Males were shaven. All Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 14 teeth, glasses and nails looked clean. We saw that better records are being maintained regarding personal care. Comments received about health and personal care included; “ We are happy in the way the care home takes care of mother in all aspects”. “ Are better now at meeting mothers needs and requirements”. “ Not always informed if Drs visits have been requested, usually informed after the event”. Pharmacist Inspector (Morag Ross) undertook inspection of the control and management of medication within the service. There had been some improvements in the general control and management of residents’ medication since the previous inspection, which was commended. Staff had undertaken an accredited medication training course in August 2007 on the safe handling of medication. A medication procedure was available to staff, which means that safe procedures to protect residents from harm could be followed, however the medication procedure for administration of medication was brief and would benefit from a review and updating. Medication was seen stored in a locked medicine trolley, which was transported around the home to ensure that residents received their medication safely. A new lockable refrigerator was available for the safe storage of medication requiring cold storage. The temperatures were recorded and monitored daily and were within a safe range. This was safe practice and protected the residents from potential harm. Safe systems were not in place to ensure the safe storage of creams and ointments. They were sometimes stored directly next to liquid medicines and inhalers, which means that there was an increased risk of a cream or ointment contaminating medication that a resident would place in their mouth. The storage arrangements for ‘controlled drug’ medication did not meet the required safe storage arrangements. The cupboard was not secured safely to a solid wall, which means that medication with special storage arrangements would not be protected by safe and secure procedures within the home. This had been discussed at a previous inspection with the manager. It was agreed that the cupboard would be made secure following this inspection. The majority of the medicine records seen were accurately recorded with a signature for administration or a code to explain why medication had not been administered. This was good practice and an improvement since the previous inspection. Random medication audits undertaken were accurate, and showed evidence that medication was being administered correctly although it would be helpful if staff carried balances of medicines over onto new medicine charts to ensure accuracy. Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 15 Some of the medicine records were hand written by a member of staff, however there was no system in place to ensure that the written information was accurate. This had been discussed at a previous inspection with the manager who agreed that the home’s procedure to ensure accurate information was recorded onto the medicine charts had not been followed. Three residents care plans were seen, which recorded the current medication requirements of the residents. However, one care plan did not contain sufficient information for medication, which was to be given when required for anxiety or agitation. There was no written information available to inform staff under what circumstances this medicine should be administered. The daily notes seen for the resident did not reflect the reason why the medicine had been administered on three separate occasions. This means that due to a lack of specific information the resident was at risk of being given the medication incorrectly and not as the doctor prescribed. We saw that the residents concerning their preferences in who provides their personal care relating to gender had signed a form. J the senior told us;” Residents are not keen on male carers. We have no male carers and if we have agency we always ask for females”. Observations during the day showed that staff were friendly and polite. They gave residents choices about food and after meals what they wanted to do. Whilst looking around the premises we saw that bathroom and toilet doors were shut when in use to promote privacy and dignity. One resident told us; “ Staff are polite”. This evidence indicates that staff do treat residents with respect and try to maintain privacy and dignity at all times. Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is adequate. Daily routines meet the expectations of the residents. Further improvement is needed to ensure that meaningful activities and adequate stimulation is provided for all residents regularly. The home encourages residents to maintain contact with family and friends. Although food provision has improved further developments are needed to ensure a balanced and nutritious diet at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When we arrived at the home early two residents were up and dressed. These were the same ones that were seen up early during the previous inspection. One of whom confirmed that she always liked to get up early. We spoke to a night staff member J who told us; “ We saw records on Ld and EH file to confirm that the home is determining and documenting not only preferred rising and retiring times, but how residents like to spend the rest of the day as well. Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 17 Activity provision is in the process of being developed. The owner told us; “ We have a carer who we will be giving extra hours to, to undertake activities. She is really good”. We heard a resident asking J ( the staff member the owner has in mind for activities) if they would be doing dancing that day. The staff member told her dancing is on Thursday. We saw that a schedule of weekly activities was displayed by the front door. We also looked at photos of a recent old times evening where the residents were dressed up and clearly enjoying themselves. We heard a staff member SN asking two male residents if they would like to play dominoes that afternoon and we saw two residents doing printed word searches during the afternoon. A staff member told us; “ Activities are improving but sometimes it is difficult to motivate them. When they do join in they really enjoy it”. Activity records we looked at, although improved, lacked everyday recording or entry saying activity offered but refused. Evidence overall shows that although activity sessions are available the regularity is questionable. This was confirmed by a comment made by a relative regarding what could be improved; More activities and more discussion. We did see one male resident reading a daily newspaper. We asked the owner if residents have to pay for their own. The owner told us, no we pay for that newspaper everyday which is positive. There have never been any concerns or negative comments made about visiting or restricted visiting times. During this inspection a number of residents’ told us that they have regular visits from family members. We looked at a number of bedrooms all held a range of residents’ belongings making them feel personalised and homely. We saw information on files to show that action is taken to ensure that those residents who want to can vote during elections. We received an anonymous complaint in July 2007, which we recorded as a concern to look into during the next inspection. The complaint told us; ‘ Food menu consists of cheap meats and not food that the elderly enjoy. No qualified cook or chef’. We received a comment from a relative saying’ food could be a little more imaginative, better menu. We looked into this concern during this inspection. We discussed the complaint and comment with the owner who told us; “ We have had problems with cooks. One was good but did not stay long. We now have K and are starting someone to cover at weekends so things should get better. We looked at the food stocks in the home, which were adequate. We saw for example; meat, cheese, yogurts, some pre-packed meals, cereals, tinned foods, bread, cooking ingredients, salad, fresh fruit and vegetables. There was no evidence to suggest that food purchased was cheap or not enjoyed by the residents. Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 18 We discussed training for a cook- although it is not many homes that do have ‘ qualified’ cooks we expect them to have food hygiene training. We looked at the file of the cook for the day K and saw that valid food hygiene certificate was available. We did suggest to the owner SO that when the cooks are both in post it would be advantageous for the health of the residents for them to at least receive training in nutrition for the elderly. We asked residents about the food and they told us; “I’m satisfied with the food. I don’t like rice pudding for example, they know this and always offer me something else”. “ The food is nice”. “ Food is nice. Can choose. Always tastes nice”. One resident asked us what was for lunch when we told her fagots she said; “ Oh fagots I love them. I used to make hundreds of them when I worked in the kitchen”. We saw that menus were on display in the dining room for both everyday and diabetic meals. We have seen during both, the last inspection and this that fresh fruit and vegetable availability in the home has increased. Fresh fruit is offered as a snack between meals. Cucumber portions were offered during the inspection and the owner told us that recently carrot sticks were offered and enjoyed. Main meals for the day of the inspection were fish in batter or fagots with potatoes and peas. The breakfast consisted of a range of cereals and hot options to a full cooked breakfast for those who wanted this. The meals we saw were well presented, ample in portion size and smelt appetising. This evidence shows that although there is some work to be done regarding food the complaint is not upheld. Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is adequate. Processes are in place for residents and their relatives to raise concerns or dissatisfaction. Processes have been improved to ensure adequate safeguarding within the home. Five staff however, to date have not received abuse awareness training which would increase safeguarding within the home further. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As detailed above we have received one concern since the last inspection, which we discussed with the manager and owner and looked into during the course of the inspection. The owner SO told us in her completed AQAA that no complaints have been received by the home. SO told us that some informal minor issues have been raised and dealt with. Questionnaires completed by relatives confirmed that three of three know how to make a complaint and two of three confirmed that the home has always responded appropriately to concerns raised, one commented usually to this. Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 20 We asked residents during the inspection what they would do if they had a complaint and received the following answers; “ I have no complaints if I did I would speak to D”. “ If anything I would tell my daughter”. We asked a staff member what she would do if a relative or resident complained to them and were given the following answer;” Deal with if I could, if not report to manager and document”. We saw that the complaints procedure is on display by the main door and included in the statement of purpose. We were pleased to see that a part pictorial complaints procedure has been produced and was on display by the main doorway, which is good as this could increase understanding and make easier reading for residents who have poor eyesight or dementia. We were concerned during the previous inspection carried out in April 2007 to see evidence to suggest that a resident had been abused. This allegation had not been reported as it should have been. Since this inspection the home has made us aware of one incident of aggression which involved two residents. We did not identify any unreported incidents during this inspection. Staff and residents spoken to further confirmed that there have been no incidents; “ I would not tolerate any form of abuse to the residents, if I had a concern I would not hesitate to report it”. “ Abuse nothing. If there was I would report it straight away. I had abuse awareness training last week”. We were told by one person “ Initially some of the attitudes of some staff was poor at times, set in their ways, but believe me that has been addressed and things are better now”. “ No nothing horrible here”. We did note from the training matrix that although the majority of staff have received abuse awareness training five have not. This needs to be addressed. Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,25,26. Quality in this outcome area is adequate. Residents live in a comfortable and homely environment. Some refurbishment work has been undertaken but further refurbishment work and monitoring of heating is needed to further increase comfort and safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We found the atmosphere of the home to be welcoming and friendly. Communication between staff and residents’ and the residents’ themselves made the atmosphere feel very positive. The new owners have undertaken refurbishment work, which was confirmed in the completed AQAA and by our observations. Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 22 All but two bedrooms have been fitted with new vanity and sink units. A number of bedrooms have been provided with new furniture. Toilets on the ground floor have been replaced and the toilet nearest to the kitchen has been retiled. One resident NC told us; “ They’ve put me a new wardrobe and carpet, it’s lovely”. Work has been undertaken on the roof and the garden has had some work undertaken to make it safer and more attractive. Walls in corridors have been repainted to make them look nice and fresh. The new owner has further plans to enhance the premises to increase resident comfort for the coming year. We received a comment from a relative saying that her mother’s bedroom was not always warm enough. During the inspection we noted that the large single bedroom on the ground floor, situated second away from the front door was not very warm. The occupant had a blanket around her. We asked if she was cold and she told us “ I was cold this morning, not too bad now”. We discussed this with the owner, advising that it is her responsibility to ensure that the home is warm enough at all times. In the first instance temperature recordings of rooms must be monitored then action to be taken where needed. We were pleased to see that all radiators were suitably guarded which prevents burns. We did note however, that a lot of hot pipe work in the home in corridors, the dining room and toilets is exposed and therefore presents as a burning risk to the residents. We advised that suitable foam cover in purchased and put around the pipes to prevent accidents. We saw that a cleaner was on duty during the inspection. We saw from the written rota that a cleaner is provided every day. We saw that the home was clean and did not detect any offensive odour. We were pleased to see that liquid soap, paper towels, disposable gloves and aprons were available to prevent and transmission of infection. The laundry is small. It has a washing machine and dryer. We saw that the laundry was clean and orderly. We asked the owner if there had been any infectious diseases in the home such as scabies and she replied “ No”. Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good. Adequate staffing numbers meets residents’ needs. 50 of the staff team have achieved NVQ. Although further development is needed, staff recruitment has improved increasing resident safety and protection. Training within the home is generally up to date. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A concern was received about staffing in the home. We were told that there is a shortage and some staff work long hours. We discussed this with the owner who told us; “ It does happen occasionally when we are desperate, that staff work a night and then an evening but not often”. We looked at staff rotas and determined that only occasionally do staff work night and then an evening. However, we did advise the owner that this should not happen at all. There were two carers and a senior on duty on the morning of the inspection and the same in the afternoon. We looked at rotas and saw that three staff are Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 24 provided per daytime shift and two at night which is good as these are adequate levels. To confirm we asked staff their views who told us; “ There are three staff per shift and two at night. Staffing levels are ok”. “ Yes. I think there are enough staff”. One resident told us; “ Sometimes we could do with more”. Staff we observed during the inspection were polite and friendly and worked hard. We asked residents about the staff and they told us; “ The staff are nice, I play them up!”. “ I love D and J. The rest are lovely, very kind”. “ The staff are lovely”. We determined from the AQAA and by talking to staff that 50 of the staff team have NVQ which is good as this means that half of the staff team have been assessed as competent to do their work. We looked at the files of five staff. We saw that recruitment practices have very much improved since the last inspection. For two of three new staff the owner had waited to receive the full enhanced disclosure before allowing them to commence work. For the third, written references had been obtained and a clear POVA first document. Written risk assessments had been undertaken weekly and a supervisor allocated. We spoke to the owner about this staff member and told her that further improvements should be made in that the name of the supervisor should be detailed on the written staff rota and staff on POVA first should not be night workers as there may be restricted supervision time, in that there are only two staff available and it may not be possible for the staff member to be supervised at all times. The owner SO told us; “ I will take her off night until we get her full Criminal Records Bureau disclosure back”. Training has improved. We looked at the files of three established staff members and saw certificates to evidence adequate training. We saw evidence of induction training on new staff files. Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,25,36,38. Quality in this outcome area is adequate. Management arrangements within the home adequate and give assurance that residents are safe. Quality assurance and monitoring processes continue to be developed in the best interests of the residents. Safekeeping processes regarding residents’ money need further attention, but are adequate. Evidence was available to confirm that staff receives supervision. Some further attention is needed concerning health and safety aspects. This judgement has been made using available evidence including a visit to this service. Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 26 EVIDENCE: As previously stated in other sections of this report we received a concern. An element of the concern was about the management of the home as follows; ‘ Manager no relevant qualifications to be in a management position, proprietor no relevant qualifications of how a care home should be run’. We were surprised to be informed of this concern as there had been no other concerns brought to our attention from anywhere about any aspects of the running of this home or the management arrangements. The manager and new owner have been in position for over 12 months now and all evidence shows that the home continues to improve. We do not ask that registered owners have any particular qualifications. The manager has recently commenced on the training we expect. Therefore we do not up-hold this element of the concern. The owner told us that within the next few weeks the manager will be applying for registration this is a very positive move forward. Staff have different views about the owner and the management of the home. Comments we received indicated that two staff feel that the owner should ‘value them more’. One commented; “ I think the only thing letting the service down is the owner. Although she has in some ways improved things and she is determined to make the home a success I feel she doesn’t always treat the staff with the respect they deserve”. Other staff told us “ I love my new job”. “ I can see there have been changes. Things are ok, I’ve no concerns, the residents are looked after”. “ Compared to my other home it’s a lot better”. One staff member commented;” I feel the support is there and if we need any information regarding our job role then the manager or provider will provide the information. We spoke to the owner SO about the staff views and was told; “ I do value my staff. However, if they do anything wrong they are told. We have had a battle to improve things, but are getting there now”. We saw evidence to prove that where possible residents and relatives are given the opportunity to be involved in the running of the home. Meetings are held and relatives invited to events that are planned. Quality monitoring of the home has begun in areas for example such as; medications and meals. We discussed quality monitoring with the owner and manager who confirmed that further development and improvements are needed to ensure that all National Minimum Standards for older people are included. We checked the money held in safe keeping for three residents. For two, records tallied with money left and receipts available. For the third there was a discrepancy as there was £5.01 more than there should have been thus, Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 27 indicating that some money had been spent but not recorded. The manager and owner told us that they would look at this deficit within the next day. We looked at the files of two established staff members and saw written evidence to confirm that they are receiving formal one to one supervision on a regular basis. There was also evidence to confirm that they had a full appraisal carried out in Jan 07. We looked at a range of service certificates concerning fire fighting and other appliances all of these were in order except two. The gas landlords safety certificate had expired 15.8.07. Further there was no instruction when the checking of the fixed electrical wiring should commence. The last letter 2006 from the electrician said; “. It is recommended that the installation undergo periodic inspection and test at five year intervals next Sept 07. The owner SO started to address both of these issues before the inspection ended. We were please to see that a long standing issue has been addressed regarding ML and the previous lack of foot rests on the wheelchair. We saw three brand new wheelchairs have been purchased. ML, using a wheelchair complete with footrests, which makes her transportation safer. We did find some concerns in the kitchen. Just before lunch the cook was still washing up cups and mugs. We told the owner SO that she should consider purchasing a dish washer. We saw that there were no food temperatures recorded the previous day and the cleaning schedule had not been completed since before the weekend. We discussed this with the owner SO and advised that she contact Dudley Environmental Health Food safety Department and request a food safety diary. That may improve temperature and record keeping. The manager told us that from now on more frequent in-house audits would be carried out to improve this situation. Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 2 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x x x x x 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 3 x 2 Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement Controlled Drug storage must meet the Misuse of Drugs ( Safe Custody) requirements 1973 in order to ensure that medication is stored securely and safely. This requirement has been made to ensure that medication is safe and that there are no risks to residents. Timescale for action 12/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP8 Good Practice Recommendations Care place should be in place related specifically to diabetes for those residents who have this diagnosis. All possible solutions must be explored and put into action to prevent LD having falls. Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 30 3 OP9 It is strongly recommended that any hand written medication charts are double- checked and signed by a second member of staff to agree that the medication details recorded are correct. The medicine policy should be reviewed and updated in order to ensure that the health and welfare of residents taking medication are safeguarded. Documentation should be available which describes the care to be given to residents who become agitated or aggressive and to include details for the administration of medication prescribed ‘ when required’ for behaviour management. This is in order to ensure that medication is given as prescribed by a doctor. A safe system should be introduced to ensure the safe storage of creams and ointments in order to prevent possible cross contamination with other medicines. A system should be introduced to ensure that balances of medicines are carried over onto a new medicine chart in order to ensure accurate medicine audits can be done. Where it is felt that certain bedrooms are prone to being cold thermometers must be provided and twice daily temperatures taken and recorded. Action must be taken if it is identified that temperatures are lower than they should be. It is strongly recommended that the name of the supervisor for persons starting on POVA first is highlighted on the staff rota. It is strongly recommended that the full CRB is received before staff work nights. It is strongly recommended that the registered owner approaches Dudley Environmental Health Food Safety section and asks for a safe food handling folder/diary from them. Consideration should be given about purchasing a dish washer for the kitchen. It is strongly recommended that the area where residents smoke is reviewed and risk assessed to ensure that the main environment is smoke free at all times. 4 OP9 5 OP9 6 7 8 OP9 OP9 OP25 9 OP29 10 11 OP29 OP38 12 13 OP38 OP38 Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Everley Care Home DS0000067211.V349864.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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