Inspection on 08/05/07 for Excelsior

This inspection was carried out on 8th May 2007.

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

Excelsior 10/11/05

Excelsior 20/06/05

Excelsior 10/02/05

Excelsior 22/07/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Excelsior 74/76 Mitchell Avenue Ventnor Isle of Wight PO38 1DS Lead Inspector Neil Kingman Unannounced Inspection 10:15 8th May 2007 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 Excelsior DS0000041267.V335903.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. Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Excelsior Address 74/76 Mitchell Avenue Ventnor Isle of Wight PO38 1DS 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) 01983 854737 Excelsior@wightbiz.com Mr Arthur Leighton Lawrence Mrs Shushma Lawrence Mrs Shushma Lawrence Care Home 19 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (19), of places Physical disability over 65 years of age (1) Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10 November 2005 Brief Description of the Service: Excelsior is a residential home providing care and accommodation for up to 19 older people, with capacity for people in the dementia and physical disability care category. Mrs Lawrence manages the home and jointly owns it with her husband. Both live with their family on the premises. The single room accommodation is arranged over two floors, with access to the first floor via a stair-lift. All rooms have an en-suite facility. Communal areas consist of two lounges, one being a sunroom, and a separate dining room. The home is located in Mitchell Avenue, Ventnor and is less than a quarter mile from the shops and amenities of the town. The building itself is a period town house, with off-road parking to the front, and ramped access into the home. Outside at the rear is a large decking area with seating for the residents, affording views over the English Channel. Rooms at the front have countryside views. Day placements are available by arrangement (up to 2 places daily). The home provides 24 hours staffing. Weekly fees range between £369.25 and £504. The manager states that a copy of the home’s service user’s guide is provided to all residents or their representatives where applicable. Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report details the results of an evaluation of the quality of the service provided by Excelsior and brings together accumulated evidence of activity in the home since the last key inspection on 10 November 2005. Part of the process has been to consult with people who use the service; including a GP and Community Nurse who regularly visit the home. There were eight responses to the visitors/relatives survey and one from a person who uses the service. Included in the inspection was an unannounced site visit to the home by an inspector on 8 May 2007. The registered manager Mrs Lawrence was on duty and available throughout the day, her husband was also present during most of the day. At the visit we had an opportunity to speak with staff on duty, several residents as a group and a minority in the privacy of their rooms. We also looked at a selection of records. Prior to the site visit the providers sent to the Commission a detailed selection of information about the service including an Annual Quality Assurance Assessment (referred to as the assessment during the report), which has been used with other information to inform the various judgements made about the service. What the service does well: The home’s assessment highlights many aspects of the service, which the management consider they do well, key areas being: • • • • Planning care for people and promoting and maintaining their health. Comments from a visiting community nurse and relatives strongly support this. Providing choice over daily routines and the consistent quality and standard of food. Attention to the continued upkeep and development of the environment. An ongoing training programme for staff with consistent support for them to achieve the NVQ at levels 2 and 3. Comments from visiting relatives about what they consider the home does well include: “They are very helpful and kind and nothing is too much trouble. They look after my relative well and never hesitate to call me in an emergency.” Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 6 “All the staff I have met, including the owners are always kindness itself, very caring, and Excelsior is home from home. It is a place I would be happy to go to when the time comes.” “The care home tries to make it home from home and gives the residents individual attention.” “Gives individual attention – concern shown for each resident’s needs – pleasant and well furnished décor – warm, friendly and open attitude – lively approach with welcome to visitors.” What has improved since the last inspection? The home’s assessment outlines the many improvements that have taken place since the last inspection, key areas being: • • • • An improvement in palliative care through a greater understanding of the ‘Liverpool Pathways’ programme. Improvements in the medication system and methodology – requirement from the last inspection met. Introduction of regularly updated personal routines, ensuring individuals maintain the routine that they wish to follow. Implemention of mandatory Safeguarding Adults awareness training for all staff. All new staff have Safeguarding Adults Training in their induction. A range of improvements to the environment including: replacement carpets, outside decking and garden furniture, the external façade of the building and car park and machines in the laundry upgraded. Ongoing recruitment and staff training. Improved communication with outside agencies to provide better specialist care for people. • • • What they could do better: There were no requirements or recommendations identified during the inspection. However, the home has identified its own areas for improvement and included them in its assessment. Of the many initiatives planned (some following consultation with people who use the service) key areas are: • • • • • • Excelsior To achieve the Investors in People Award. New dining and lounge furniture. The installation of a passenger lift. A training programme for residents who may wish to use the internet. Water features to be installed on the outside decking. Redevelop the laundry area. DS0000041267.V335903.R01.S.doc Version 5.2 Page 7 • Provide information about the service in Braille format. 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. Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 - People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives have the information needed to choose a home, which will meet their needs. The manager ensures that their care needs will be met by undertaking a proper assessment prior to them moving into the home. The home does not provide dedicated accommodation for short-term intermediate care or specialised facilities for rehabilitation. EVIDENCE: Information The providers’ assessment confirms that all prospective residents and/or their families receive a comprehensive information pack, which includes such items as sample contracts, terms of business and recent inspection reports. They are also provided with details of an advocacy service, which may be able to Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 10 offer further assistance in areas that the home is unable to do so. At the site visit we noted the information pack includes a comprehensive service user’s guide containing all the information about the home as recommneded in the relevant standard. A copy of the service user’s guide is located in each bedroom. Residents spoken with in the privacy of their rooms were aware of the document. Pre-admission assessment People should know that their needs will be met when they move into a home. An important part of ensuring this happens is the pre-admission assessment process. It had been noted at previous inspections of Excelsior that this standard had been met. During this site visit the manager described the home’s admissions process: • • • • • Each prospective resident is invited to visit the home before they decide if it is right for them. They are encouraged to tour the building, look at the room available and meet other people who use the service. They are given information about other rooms, which may be more suitable to their needs, and may become available in the future, e.g., a ground floor room if one is not immediately available. Prospective residents are offered an overnight stay to help them make a decision about moving in. A pre-admission assessment questionnaire is given to the prospective resident and/or their representative. Following the pre-admission visit if the individual decides that the home is right for them an appointment is made for the manager and a senior member of the care staff to visit them to carry out a needs assessment. At the site visit we looked at how they managed the admission of the newest resident, who moved into the home during January 2007. Records showed, and the manager confirmed that she undertook a full pre-admission assessment of the individual’s needs and recorded the information on an assessment form, which was then used to form the basis of their personal care plan. A copy of the assessment was available on the resident’s file. The home’s policy is not to accept unplanned or emergency admissions. Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 11 Intermediate care Residents at Excelsior tend to be long term. The home does not provide dedicated accommodation for short-term intermediate care or specialised facilities for rehabilitation. However, respite care is provided, if there is a room available. There was no evidence that this arrangement had any negative impact on the existing residents. Excelsior DS0000041267.V335903.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 and 10 - People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Care planning – The home has a system of care planning with an individual personal plan for each resident. At the site visit we looked at a sample of three plans. The intention was to look at the outcomes for residents in general by assessing all areas of care for those sampled. The sample included the newest admission to the home, a resident with an illness associated with dementia and a resident with mobility difficulties, and sight and hearing impairment. Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 13 Plans are clear, simple and person centred, with guidance for staff on how residents’ needs and wants are to be met. Each resident’s plan includes key information: • • • • • • • General admission information about the resident. Service user handling risk assessment. Care plan, which includes problems/needs, expected goals/outcomes. Risk assessments. Continence assessments. Daily recording of relevant information. Regular reviews. Care plans have the action plan written in a very person centred way so that staff know how residents prefer the various tasks to be carried out. The manager said that they were in the process of developing a more person centred approach to the recording of daily routines. The home uses a computerised system of recording daily information about residents’ needs. This promotes ease of understanding and retrieval of information. Staff spoken with felt it was a good system once they were used to using it. There was a mixed reaction from residents when asked about their individual care plans. Responses varied from those who were confused about the existence of such a document to those who were well aware of their care plan. A community nurse visiting on the day of the site visit said that feedback from the nursing team was that care records in the home were very good. Health and access to care services The manager confirmed, and records evidenced the regular contact with GPs, optician, dentist, chiropodist and community nursing team. People spoken with said that the home looked after their health needs very well. One commented, “You only have to say you need a doctor and they get straight onto it.” Records showed and discussions with staff confirmed that a minority of people were currently vulnerable to pressure sores. However, the manager and care staff were very clear about what was required to ensure that pressure sores did not develop, i.e., suitable equipment and care practices. The community nurse confirmed that the standard of care in the home was good and a holistic approach to the management of pressure areas prevented the occurrence of sores. Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 14 A visiting GP on the day of the site visit made the comment, “They do a good job here.” The providers assessment showed that both the manager and the deputy have a good overview in the management of palliative care (the Liverpool Pathway programme) and staff have an understanding, through specific training, of what is needed for these residents and their families. The manager said, and care records confirmed that while people who use the service have a choice about their GP wherever possible, the reality is that there are two local health clinics, each with several GPs who serve the home well. Other healthcare professionals visit the home on a regular basis and more specialist ones e.g., speech therapist, infection control nurse, private physiotherapist and community psychiatric nurse are called upon as and when required. All nine responses to the visitors/relatives survey were very positive with views about: receiving enough information about the person they visit, the ability of the home to meet their needs, the care and support provided and the skills and experience of the staff. One commented, “I cannot fault their support. It goes far beyond the care my relative received in other homes.” Another commented, “The staff I have met always seem most professional.” Medication Medication is dispensed by means of a monitored dosage (blister pack) system by staff who have completed training in ‘medicines administration in care settings’, and deemed competent by the manager or the deputy. The home has a policy and system to ensure residents’ medication is stored, administered and recorded safely. There is a lockable medication room in which there are facilities for the safe storage of medicines. In addition, there is a lockable metal medicines trolley on each floor. We noted that all medication records were well maintained. The home had met the requirement identified at the last inspection in respect of recording the administration of controlled drugs. All rooms have a lockable metal cabinet ready for use by those who wish, and are assessed as safe to self medicate. Privacy, dignity and respect The home has a policy for respecting people’s dignity and privacy and the subject is covered in the Common Induction Standards for new staff. Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 15 On the day of the site visit the inspector spent time with residents in the communal areas and observed the staff at work. Staff were noted at all times to be respectful, very attentive and kind towards residents, calling them by their preferred names and knocking on doors before entering rooms. All residents spoken with during the site visit were full of praise for the staff and their approach to care, and no concerns were raised. All rooms are able to have telephones, which are connected to the home’s telephone system. A pay phone is provided in the hall and people can use the home’s phone if privacy is required. Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 - People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use service are able to make choices about their life style and activities are offered to suit their individual needs and expectations. Friends and family are made to feel welcome and can visit at any time. Residents’ nutritional needs are satisfied with a varied and balanced diet of good quality food. EVIDENCE: Routines and activities – The home’s assessment shows and the manager confirmed that routines for residents are kept as flexible as possible, e.g., they have choice over where and when they have their food served, what time they like to be woken and the time they like to retire, where and when they like their breakfast served etc. The home has introduced person centred routines to ensure that people retain the routines they wish to follow. This extends to choices about activities, which are offered to residents every afternoon. An activities co-ordinator is employed run them. The manager explained that the introduction of some Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 17 activities and entertainments had not been popular and that daily quizzes and reminiscence have had the most appeal. Residents have formed a quiz team, which has so far competed against a team in one other home. It is hoped to expand competition with other homes during the year. One visiting relative commented about the activities, “They have quizzes in the afternoon which the resident enjoys and it keeps their brain active, and regular outings when we, as a family are invited, and a good time is had by all.” A comment in the visitors/relatives survey illustrates the person centred approach to helping people, “Our friend is deaf/blind and the home have a ‘pocket talker’ from ‘Sound Advice’ so that others can communicate with them one-to-one, which they find so very useful.” Another popular activity is a trip to a place of interest/entertainment in the minibus. Trips are more frequent during the summer months. The home has introduced a trolley for residents to purchase incidental items they have expressed an interest in having access to. The home receives a regular visit from the local parish clergy and those who wish can take communion in the privacy of their rooms. Visiting arrangements – Friends and relatives are encouraged to visit the residents with their permission. Details of visiting arrangements can be found in the information pack and are generally at all reasonable times, i.e., respect for mealtimes and times that people want to retire in the evenings. People can receive visitors in their own rooms or any of the communal areas. Personal autonomy and choice – Residents were spoken with in small groups and some individually in the privacy of their rooms. Due to some cognitive impairment it was not possible to obtain informed views from everyone. However, the consensus from others was that they were given choices regarding routines in the home, e.g., times of rising, going to bed, activities, meals, personal care etc. The manager confirmed that most people have either a family member or Power of Attorney able to support them independently of the home. At the point of admission all residents/families are given information on how to access ‘Care Aware’ the advocacy service and some have taken advantage of this. They are encouraged to bring with them pictures, ornaments and personal items for their room. During the tour of the building it was noted that some rooms were well personalised, and reflected the residents’ individual tastes and preferences. Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 18 The management of residents’ finances is covered later in the report but in a general sense they are encouraged to handle their own financial affairs for as long as they are able. The home provides a facility for safeguarding residents’ monies or valuables on request. Meals and mealtimes – The inspector had an opportunity to sit with the residents over lunch. The atmosphere in the dining room was sociable and friendly and staff were available to assist residents as and when required. It was noted that staff in one instance showed patience and understanding while encouraging and assisting one person experiencing some difficulty in eating. Food served looked appetising and was well presented, with a choice of two hot meals available. All residents spoken with made very complimentary remarks about the lunch and confirmed that the standard of food was consistently high. People take their meals together in the dining room, or individually in their own rooms, the lounge or the sunroom, according to choice. Menus are arranged over a four-week cycle and show food to be varied and appealing. The cook said that she uses fresh produce and meals are freshly prepared on a daily basis. She has a good understanding of their likes, dislikes and special dietary needs. Records are maintained of what residents are actually served on a daily basis. The inspector noted that drinks and light snacks were offered through the day between meals. Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 - People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and have access to a robust, effective complaints procedure. They are protected from abuse, and have their rights protected. EVIDENCE: Complaints The home has a complaints policy and procedure, summarised in the service user’s guide, which is given with the information packs to all residents or their representatives. The manager ensures that a copy is located in each bedroom. She confirmed that no complaints had been made about the service since the last inspection. People spoken with on the day of the site visit were not familiar with the detail of the complaints procedure, but were very confident about raising any concerns with the manager. One commented (about the manager), “She always wants to know if you are happy and needs to know if you are not.” All responses to the care homes and visiting relatives surveys showed people who use the service always knew how to make a complaint. One was very specific; “Excelsior’s ‘Terms and Conditions of Business’ explains this on page 4.” Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 20 Safeguarding Adults The home has well defined policies and training in place for staff to recognise and act upon signs of abuse. The Isle of Wight Social Services Policy Guidance is also in place. In discussions the providers were very clear about the locally agreed multi-agency protocols as regards the reporting of incidents. This is important as it reflects the position of social services as the lead agency in all adult protection referrals. Staff spoken with showed an understanding about how to recognise abuse, what to do, and the importance of reporting issues of concern without delay. They confirmed that training was given and that they were aware of the home’s ‘whistle blowing’ policy. Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 - People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. All areas of the home are kept clean, hygienic and there are no unpleasant odours. EVIDENCE: Environment Excelsior has been a residential care home for older people in Ventnor for many years and while not purpose built has been developed and adapted over the years to be suitable for its stated purpose of providing a safe, manageable and comfortable environment for the people who live there. The home is located in Mitchell Avenue, and is only a short distance from the town shops and seafront. Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 22 The current providers in their assessment state what they do well: • • • • • • • The property is well maintained by dedicated staff. Rooms are renewed/refurbished/redecorated every three years or when vacant, or when needed. External aspects of the home are a key issue, with dedicated gardening services and continued development. All worn furniture is replaced All rooms have en-suite facilities Stand Aid, Portable Hoist, Portable Ceiling Track & Fixed Ceiling Track hoists are installed and available for use when and where needed. Although the majority of the rooms are large - rooms are not shared unless there is a request by a husband & wife, brothers, and sisters. This would only be at their request. All areas of the building are accessible to the people who use the service, including a large decked area at the rear where residents can sit when the weather is fine. The home is generally comfortable, well furnished and decorated. There was evidence of continued improvements with plans for the next twelve months: • • • • • • • Redevelop the laundry facilities. Finish the external façade of the building. Investigate the possibilities of an extension. Further work on the grounds of the home. Introduction of water features on the decked area. Replace the kitchen units and work tops of the ground floor kitchen. Install CCTV to the entrance & car park and areas where building security needs improvement without intruding on the daily life of the residents. The home employs a maintenance/handy man who deals with all maintenance issues as and when they occur. When residents’ rooms are vacated, they are redecorated and new carpets laid where required. The building consists of four storeys including the basement, with resident accommodation on the ground and first floors. Communal space comprises a lounge, dining room and sunroom, all comfortable, well decorated and furnished. There is a shower/wet room and three assisted bathrooms. Three bedrooms are equipped with ceiling track hoists to meet peoples’ specific identified needs. All bathrooms have toilet and wash hand facilities and there is a separate toilet near to the lounge. Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 23 People spoken with during the inspection made very positive comments about the environment, especially their own rooms. Cleanliness During the tour of the building with the manager it was noted that all areas were very clean, hygienic and free from unpleasant odours. The home employs two domestic staff to ensure the standard of hygiene is maintained. The laundry room is located at the side of the building and is accessible only via the front door and around the front outside. It was noted the laundry houses two newly purchased commercial grade machines and is included in future plans for development. This is important as the current laundry room does not have an impermeable floor covering or wipe clean wall finishes. The home’s assessment confirms it has policies and procedures for the control of infection and safe handling and disposal of clinical waste. Staff have received training in the prevention of infection and management of infection control. Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 - People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are deployed in sufficient numbers, are trained and given the necessary skills and experience to meet the needs of the people who live there and support the smooth running of the service. EVIDENCE: Staffing levelsThe home employs fifteen care staff, domestic, maintenance and catering staff. There are several care shifts throughout the day with between two and four staff on duty at different times according to the needs of the residents. For the most part a minimum of three staff are deployed. Additional staff are brought in to arrange exercises and entertainment for the residents. The manager works in a supernumerary capacity. On the day of the site visit there were seventeen people resident in the home with three care staff including the deputy manager who works on the floor, and the manager on duty. Overnight there is one waking carer and one sleeping in on call. These staffing levels are considered adequate for the current needs and numbers of residents in the home. Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 25 Seven of the nine responses to the visiting relatives survey indicated staff always have the right skills and experience to look after the people properly and 2 indicated usually. NVQ training – The manager confirmed and staff training records showed that currently 40 of care staff have achieved the NVQ at levels 2 or above and a further 40 are currently working towards achieving the qualification. The home’s training programme continues to ensure that this standard will be met. Recruitment The one and only negative comment about the home came from one of the responses to the visiting relatives survey, which highlighted a problem with a constant turnover of staff. The providers recognised that there had been a period some months ago when staff turnover was high, but the situation had stabilised recently. Individual staff recruitment files were available for inspection and showed that the home’s recruitment procedure includes: • • • • • • Application form Job description Contract of employment Two written references Criminal record and Protection of Vulnerable Adults (POVA) checks on all staff. Receipt for staff and health and safety handbooks. During the inspection the recruitment records of three new members of staff were randomly dip-sampled and found to be in good order. Staff Training – The home operates an induction programme for new staff, which follows the Common Induction Standards recommended by ‘Skills for Care’. All staff have personal development plans. The manager and staff spoken with were clear that the home provides a very good training programme using distance learning packages and some external training providers. Training needs are identified on the home’s computer, which shows dates when qualifications have been achieved and when refresher training is due. This was demonstrated during the site visit and backed up with qualification certificates. Staff training includes, amongst other subjects: Manual handling Excelsior Fire safety Basic first aid Version 5.2 Page 26 DS0000041267.V335903.R01.S.doc Adult protection Challenging behaviour Food hygiene Dementia care Infection control Health & safety Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 27 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 and 38 - People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. EVIDENCE: Management – The registered manager Mrs Shushma Lawrence is joint proprietor of the home. She has been in post as registered manager since September 2005. She is fully qualified having achieved the NVQ at level 4 in care and the Registered Managers Award (RMA). In addition, she updates her knowledge, skills and competence with periodic training in care related subjects specific to the service provided by the home. Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 28 Staff spoken with during the site visit confirmed that regular staff meetings and formal supervision sessions were taking place. They felt the home was well managed; staff morale was high and communication was good. Quality assurance – There was evidence in the form of survey results seen during the site visit that the home carries out an internal quality assurance survey amongst the people who use the service, which covers in clear and simple terms: • • • • • All elements of the admissions process Peoples’ experience of moving into the home The accommodation Complaints A tick box satisfaction survey of food, care support, daily living, the premises and the management. Other areas that inform the home’s quality assurance are: • • • • Regular in-house care plan reviews. Regular staff meetings and supervision sessions. Family input to residents’ surveys, especially in respect of those who cannot give informed views. One-to-one communications with the residents and their visiting relatives. The manager said that they had in the past arranged residents meetings and produced a newsletter, neither of which had proved a success. The home’s assessment confirms it has plans to improve the service over the next twelve months and sets out in detail the areas for improvement. One area is to continue to enhance its quality assurance surveys by extending them to families and outside agencies. Residents’ monies – As outlined earlier in the report residents have a family member, Power of Attorney or a ‘Care Aware’ advocate to support them. The home provides a facility to safeguard monies or valuables on request. Currently several residents use the facility, whereby the home makes incidental purchases on their behalf. The system was checked and found to be in good order, with receipts for purchases kept. Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 29 Health and safety – The home’s pre-inspection information sent to the Commission by the providers confirmed that policies and procedures were in place to ensure safe working practices in the home. A sample of records was viewed including accident records, fire alarm tests and risk assessments, public liability insurance, and gas and electrical tests, all of which were in good order. Staff training records showed, and staff confirmed that statutory training is scheduled and updated in manual handling, first aid, fire training, infection control and food hygiene. Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 30 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 4 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 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 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 31 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Excelsior DS0000041267.V335903.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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