Inspection on 13/11/06 for Fessey House

This inspection was carried out on 13th November 2006.

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

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

Other inspections for this house

Fessey House 06/11/07

Fessey House 01/05/07

Fessey House 06/12/05

Fessey House 05/09/05

Fessey House 14/12/04

Fessey House 28/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Fessey House Brookdene Haydon Wick Swindon Wiltshire SN25 1RY Lead Inspector Bernard McDonald Key Unannounced Inspection 09:20 13th November 2006 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 Fessey House DS0000035422.V304771.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. Fessey House DS0000035422.V304771.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fessey House Address Brookdene Haydon Wick Swindon Wiltshire SN25 1RY 01793 725844 01793 706104 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) Swindon Borough Council Mrs Doreen Ann Nicholls Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places Fessey House DS0000035422.V304771.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may also admit not more than 2 adults at anyone time who are aged over 55 years but under 65 years so long as these people are accommodated in the short term care unit and their period of stay does not exceed 8 consecutive weeks in any one care episode. 6th December 2005 Date of last inspection Brief Description of the Service: Fessey House is a large care home owned and managed by Swindon Borough Council. It is located in a quiet cul de sac in the Haydon Wick area of Swindon the local shops and a community centre are nearby. The home is on 2 floors and is sub divided in to 4 living areas. Three of these living areas provide long term social care and accommodation. The other area provides respite and crisis care on a short term basis. Each living area has its own separate lounge and dining room with a kitchenette where drinks and snacks can be prepared. The main meals (typically lunch and tea) are cooked in a central kitchen. Other meals are prepared in the living units. All bedrooms are single rooms and can be decorated to the occupants choice. Service users are encouraged to personalise their rooms and may furnish them with their own furniture. Typically there are 7 or 8 care staff on duty plus a shift leader or manager. At night 3 care staff work in the home. Additionally the home deploys a housekeeper in the mornings at busy times in each living area as well as providing cleaning staff. Designated staff are employed to carry out administrative and cooking duties. If the home is short of permanent staff it relies on staff working extra hours or agency staff. On the same site there is a local day centre that is run by Age Concern. Some service users can attend the day centre if there is a vacancy and they meet the criteria. The Commission does not inspect the day centre, as it has no powers to do so. The fees charged for the service are £94 to £376 per week. Fessey House DS0000035422.V304771.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit of this key inspection was completed in fifteen and a half hours over two days. The first day of the visit was unannounced and the second day was by appointment with the manager. The pharmacist inspector examined the medication records and procedures. There was opportunity to meet with all service users to obtain their views on the care they receive. Service users were interviewed in private and in small groups. As part of our inspection, comment cards were sent to a random sample of service users, their representative’s, health care professionals and placing authorities. Six care plans were examined in detail. In addition medication records, staff recruitment files, training records, health and safety documents and a sample of risk assessments were also examined. A tour of the building was made and the majority of service users bedrooms were viewed. Seven members of staff were interviewed in private. The relatives of five service users who were visiting the home at the time of the site visit shared their views on the care provided to their relative. Comments received were positive and complimentary. On the first day of our site visit we issued one immediate requirement to ensure the safety of one service user. The requirement was met by 12.00pm the following day. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: Service users or their representatives are invited to visit the home prior to moving. This enables service users to view their room and meet with staff and service users before making a decision to move. One service confirmed they had visited with their family before moving. Another service user stated a family member had visited the home on their behalf. Service users religious and cultural needs are being addressed at the home. A religious service is being held every week and service users are visited by their clergy or priest if they wish. One service user has specific times they wish to pray and staff were aware of these times and ensure the service user is left undisturbed. Service users commented favourably on the care they receive. Relatives spoken to during the site visits confirmed they could visit at anytime and were satisfied with the care being provided. Service users are able to personalise their room with small items of furnishings and personal items such as photographs and ornaments. The system for safely managing service users money and personal belongings is good. More than 50 of staff are trained at National Vocation Qualification level 2 or above. Fessey House DS0000035422.V304771.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Fessey House DS0000035422.V304771.R01.S.doc Version 5.2 Page 7 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 Fessey House DS0000035422.V304771.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5, 6. The home is failing to ensure service users are fully informed of the terms and conditions of their stay or have sufficient information to make an informed decision about their move. While service users needs are assessed prior to moving, the in house assessment tools are poor. Care plans are not reflecting needs and fail to ensure service users needs are being safely met. The Quality rating in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The case files of two service users recently admitted to the home were examined in detail. One service user confirmed they did not visit the home prior to moving in but a member of staff did come to visit them. As part of the admission procedure a full assessment of need had been obtained for both service users. In addition the home had completed their own assessment to determine whether they could meet the needs of the service users. These in house assessments had not been signed or dated. The tool being used by the home to determine whether they can safely meet the needs of service was a number based assessment that scored each area of need and gave a final overall total. This document did not lead the reader to what action to take or Fessey House DS0000035422.V304771.R01.S.doc Version 5.2 Page 9 what the scores related to in terms of need. One service user had a score of 40 and a second service user had a score of 80. The manager was unable to give an explanation of what the number meant in terms of the needs of service users or the care they required. A care plan had been developed for each service user but consisted of one page that was split into sections covering morning, afternoon, evening and overnight. Areas where the service user needed assistance is highlighted in marker pen. A copy is also on display on each service users bedroom wall. One service users preadmission assessment highlighted they were insulin dependent diabetic. There was no care plan around the specific medical needs of the service user and examination of the daily notes showed the service user had two hypo glycaemic attacks in one month. One of these attacks was attributed to the service user not having anything to eat after receiving their insulin injection and the emergency services had to be called. The care plan was highlighted in marker that the service user must receive their breakfast after their insulin. The manager stated this was added after the hypo glycaemic attack and that they were aware the service user had a history of such attacks. However no other guidelines were in place to ensure the safety of the service user or direct staff on the action they need to take to reduce the risk of further attacks occurring. The lack of any guidelines or a comprehensive plan of care puts the service user at risk and the manager was informed of the urgent need to address this matter during the inspection. The second service user confirmed they did visit with their family prior to moving in. The service user stated they had not received a copy of the terms and conditions of their stay or a copy of the service user guide. One service user whose first language was not English had received no information in their first language. The service user did state, the staff are very good and respectful to her needs. In discussion with other service users it is apparent that they did not receive a copy of the service user guide. One service user who had been living at the home for a number of months was not aware of the cost of their stay. A sample of contracts examined showed that some service users had a contract while others did not. The home does not offer intermediate care. Fessey House DS0000035422.V304771.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. The absence of any meaningful care plans means the home cannot ensure it is meeting the holistic needs of service users. The absence of individualised risk assessments is a serious concern and could put service users at unnecessary risk. Health care needs are not clearly recorded. Poor practice, lack of appropriate procedures and inadequate recording mean that the residents are at risk from the home’s medication systems. The Quality rating in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: A total of six service users care plans were examined in detail. This included the two care plans of service users recently admitted to the home. Information contained in the care plans was poor and did not direct the carer on how the needs of service users should be met. For example a service user informed us that they were registered blind. Although the community care assessment detailed the service users condition there was no reference to this in the care plan. Risks associated with the service users mobility had not been addressed and the absence of individualised risk assessment puts service users at risk. A number of care plans had not been reviewed. Statements made in the care Fessey House DS0000035422.V304771.R01.S.doc Version 5.2 Page 11 plans are not clear. For example, terms like “needs close supervision” or, “needs assistance” were common but there was no direction for staff on how the supervision or assistance should be provided. A more detailed care plan booklet was found on service users records. However the booklet was not being completed and one service user who had been living at the home for over six months had only their name on the booklet and nothing documented inside. The records of one service user had four different allergies separately documented in various parts of the file. The manager did not know if the service users records were accurate or whether the service user had any of these allergies. There were no risk assessments in place. An immediate requirement notice was issued to ensure the safety of the service user and ensure the home contacted their GP for confirmation on their allergies. We received written confirmation by 12.00pm the following day that the immediate requirement notice had been met and the home had confirmation from the GP on the service users known allergies. Comments were sought from health care professionals as part of the inspection methodology. Three service users identified during our site visit had no care plan regarding the management of diabetes. One GP highlighted poor communication between staff and there is not always a member of staff to accompany them to see their patients. None of the service users records examined had a risk assessment for nutrition, pressure damage and falls despite assessments highlighting risks. In particular one service user who was at a high risk of falls due to their medical condition had no risk assessment completed. The service users care plan stated they were to have hourly checks but there was no record to show if these were being carried out and the manager could not confirm what checks if any were being made. There was no evidence to show the service user care plan had been reviewed after a fall. There was opportunity to meet the majority of service users in private. Service users were complimentary about the staff and the care they provide. Observation made during our visit showed there were good relationships between service users and their carers. Staff were observed speaking to service users in a respectful way and taking time to explained the task they were performing. Relatives that were interviewed during our site visit were also complimentary about the care their relatives received. However more attention needs to be given to ensure service users are treated at all times with dignity and respect. For example one support worker was observed to pull up a service users underwear while the bedroom door was open. Another service user was observed sat on the commode with their bedroom door open. One service user stated they did not always get a bath when they wanted. Their care plan stated they should have a bath every week but records showed this was not happening. Their key worker stated the service user does not always want another carer to assist them with bathing, but there was no Fessey House DS0000035422.V304771.R01.S.doc Version 5.2 Page 12 record to support the statement or record to demonstrate a bath had been offered and refused by the service user. On the second day of the site visit the manager had started to make some improvements to service users care plans and risk assessments. The pharmacist inspector has provided the following report; Medication is stored securely, photographs aid identification of service users when the medicines are being given. A policy is available and staff receive training from Swindon Borough Council. Medication administration records were incomplete. There were gaps in administration records for more than one service user, even though a second check had been signed for. It was not possible to ascertain if these medicines had been given. Two medication errors had been reported in the previous year and management had highlighted the need for more care. This was not evident in the records. Some service users had varying degrees of self-medication, either for all or some of their medicines. A new resident had a form in their notes signed for self-medication, but no risk assessments were seen for any of them. Service users with particular medical needs (for example diabetes) do not have care plans to help the management of their condition. In one instance a service user was not given food at the correct time after the medication and became unwell. There were no instructions to the carers about this in the records. Another service user was concerned that frequent medication was not given regularly. The home should explore ways of ensuring that medication given outside normal times is given correctly. External preparations are often kept in service users’ rooms. In one room were some medicated creams that were prescribed in 2004 and were unused. There was no care plan for the use of these products. A separate respite unit in the home takes service users for varying lengths of time. The service users bring in their own medicine, which is administered by staff or the service user themselves. Risk assessments for self medication were not completed. Some service users bring in unlabelled medicines, which cannot be identified. This causes great risk to the service user. The home must have a policy of accepting only containers labelled by the pharmacist or GP and potential service users and their carers must be made aware of this. One medication was incorrectly written on the medication administration record, this was amended at the time of the inspection. Fessey House DS0000035422.V304771.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. The home is making every effort to ensure service users social and cultural needs are being met but more attention needs to be given to ensure service users choices and preferences are known to staff. Visitors are made to feel welcome. The Quality rating in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: There was a mixed response from service users when they were asked about things they liked to do during the day. One service user said there was “lots to do” while another service user said there was “never anything to do”. Discussion with staff confirmed service users have been consulted about what they would like to do but the records relating to service users activities had been mislaid in the recent office move. On the second day of the site visit staff had organised a morning quiz, which was well attended. In addition a notice was on display to inform service users of a Christmas shopping trip. Outside entertainment is also brought into the home but the loss of the home’s large dining room to an outside day care service means not all service users could participate in activities or listen to outside entertainment as this room is used five and half days a week by another service. The manager reported that there are plans to relocate the service to another site in the near future. In the Fessey House DS0000035422.V304771.R01.S.doc Version 5.2 Page 14 interim service users can, if they wish, join in the day care activities in the dining room, though in reality only a small number have taken up the offer of a place. Service users religious needs were being met and staff were aware of the times one service user wished to pray. In addition a religious service is also held in one of the communal lounges every week. On service user confirmed they had been asked if they wished to attend but had declined. A total of five visitors to the home were interviewed in private. They confirmed they could visit at anytime and were always made to feel welcome. There was a general opinion that their relatives were well cared for and this was further endorsed by the comment cards that relatives had returned as part of our pre inspection methodology. Service users or their representative are responsible for handling their financial arrangements. There are also secure facilities available at the home to keep service users small items of jewellery or personal documents. There was a clear record being kept of all items held on behalf of service users. The cook confirmed she had just developed a new menu in consultation with service users. A choice is offered at each meal. Service users were generally satisfied with the quantity and quality of meals provided. The cook confirmed they are informed about service users likes and dislikes but no written record has been kept. This needs to be reviewed as one service user commented they did not like mashed potatoes and would like boiled. This preference was recorded in the service users records yet the cook was unaware of the service users preference. Fessey House DS0000035422.V304771.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. The home is making every effort to ensure service users views are listened to and they are protected from abuse. The Quality rating in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The home has a detailed complaints procedure provided by Swindon Borough Council. Information about how to make a complaint is signposted throughout the home on various notice boards. Discussion with service users confirmed they would speak to the manager, staff or one of their relatives if they were unhappy or had a complaint. It was recommended at our last inspection that the home keep a register of all complaints, concerns and compliments. The records examined showed 7 complaints had been received since July 2006. The outcome of the complaints was clearly recorded. Staff training records showed that the majority of staff have completed abuse awareness training. Policies for the protection and safeguarding of adults were available at the home. Discussion with staff confirmed they had received abuse awareness training. When asked what action they would take if they witnessed any practice that they considered was abusive staff confirmed they would have no hesitation in reporting it directly to the manager. Fessey House DS0000035422.V304771.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24,25, 26. The home is clean and tidy but the delay to commencing the refurbishment programme means some areas are showing signs of wear and service users safety is put at risk. The Quality rating in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: A tour of the building was made and the majority of service users bedrooms were viewed. The home was clean and tidy and free from odour. There is a plan to refurbish part of the home but the implementation of the plan has been delayed leaving a building that is showing signs of wear and tear. For example wallpaper in communal corridors was torn in places and coming away from the wall. Paintwork was damaged and chipped and lighting in the communal corridors was poor. We found hot water temperatures in excess of 50c and a number of fire doors wedged open. This was discussed with the manager at the time of our site visit. The manager reported that as part of the refurbishment it is planned that doors will have magnetic hold open devices or similar equipment on doors. Some service users bedroom sinks had been fitted Fessey House DS0000035422.V304771.R01.S.doc Version 5.2 Page 17 with thermostatic valves to reduce the hot water temperature close to 43c while others had not. There were no risk assessments to support this decision. Where these valves were not installed a notice was placed on the wall warning of hot water. This is not sufficient to ensure the safety of service users some of whom are confused, from extreme hot water temperatures. The majority of service users were spoken to and they confirmed they liked their accommodation. One service user commented they had been able to bring some personal items with them when they moved. A number of rooms had also been personalised with small ornaments and personal effects such as family photographs. Service users are able to have a private telephone line installed in their room, which enables them to maintain contact with family and friends. The home has been split into four units and each unit has a small communal lounge/dining area. Each unit has a bathroom, which had been refurbished to a high standard. However no suitable lock had been fitted to the bathroom doors to ensure service users privacy when they bathe. This deficit was identified at our last site visit and action must be taken to meet the requirement within the revised timescale. The laundry room is situated off a corridor away from food preparation areas. There are two commercial washing machines and a large commercial dryer. Walls and floors were easily cleanable to reduce the risk of infection. Service users commented that their laundry was promptly returned after it had been washed. Fessey House DS0000035422.V304771.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. The home is making every effort to ensure safe recruitment practices are being followed and that staff are trained for the work they perform. However the availability of staff at peak times should be reviewed. The Quality rating in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The home is split into four units with one member of care staff in each unit throughout the waking day. The exception is the respite unit, which has two care staff on duty at all times. In addition to the care staff, each unit has one housekeeper. The role of the housekeeper differs from that of care staff in that they do not provide personal care to service users. This leaves one member of care staff to provide personal care for 10-12 service users. Service users who may require the support of two staff would have to wait until the one floating member of staff is able to provide the extra support. In addition, two members of staff are responsible for the administration of medication. When the medication round is finished the two staff then provide extra support in the units. The manager stated that she feels this is sufficient to meet the needs of service users. While no service user said there were not enough staff comments like, “they [staff] are always busy” and as one relative put it “they are a bit thin at times” would indicate staffing levels should be reviewed. This was further endorsed by comments we received from one GP who indicated that they can’t always find a member of staff to accompany them to see their patient. Fessey House DS0000035422.V304771.R01.S.doc Version 5.2 Page 19 At the present time housekeepers do not work in the evening, though the manager reported this is currently under review and there are plans to extend their hours through the evening. At the present time there are four 15 hour vacant posts at the home. These hours are currently being covered by agency staff or by the current staff team working extra hours. More than 50 of the care staff have completed National Vocational Qualifications (NVQ) at level 2 or above or are working towards the award. It was difficult to fully evidence what training staff had successfully completed. There were no certificates held at the home but there was a training record showing what staff had achieved. In addition staff confirmed they had received training such as NVQ and dementia care, manual handling and abuse awareness. Samples of three staff recruitment records were examined. The home had confirmation that a criminal records Bureau check (CRB) and two written references are obtained for all staff appointed at the home. The home did have evidence that agency members of staff had also received a satisfactory CRB at enhanced level. One member of staff who commenced work on the second day of the inspection was shadowing one member of staff as part of their induction. The manager reported that all new starters are being put forward for the Skills for Care induction training, which is facilitated through the learning and development department of Swindon Borough Council. Fessey House DS0000035422.V304771.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38. The manager is qualified to run the care home but needs to put into practice the skills and experience she has to ensure service users are able to live in a safe environment suited to their needs. Quality assurance is progressing well but staff are not receiving formal supervision as often as they should. The Quality rating in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The manager has been in post since August 2006 and has made an application to become the registered manager. She has previous management experience and has completed both the NVQ 4 in care and the registered managers award. Discussion with staff confirmed the manager is approachable and no detrimental comments about her style of leadership were received. However the deficits found in service users care plans and risk assessments should have been identified by the manager. Although steps are now being taken to Fessey House DS0000035422.V304771.R01.S.doc Version 5.2 Page 21 address these issues it remains a concern that action had not been taken earlier to address these matters. Since our last site visit the views of service users, their families and friends and other health care professionals i.e. GP’s, district nurse, care managers and anyone else who the service user may have contact with had been obtained. In addition the responsible individual had commenced monthly quality monitoring visits as required by Regulation 26 of the Care Homes Regulation 2001. A report on the outcome of the quality audit was available in the home together with the action plan to address issues from the outcome of the audit. The manager has not provided any feedback to participants of the review and it is recommended that this be done to ensure participants are aware of the outcome of the quality audit and proposed action plan. The home was holding a small amount of money on behalf of service users. A random sample of the money being held was examined. This showed that money was being accurately recorded and the accounts reflected the money being held. Discussion with staff highlighted they were not receiving formal supervision. One member of staff stated they had only received supervision twice this year. Another member of staff stated they had not had supervision for “a while” and possibly only “twice this year”. The manager needs to address this issue and ensure staff are appropriately supervised for the role they perform. This is especially important when service users care plans and risk assessments are reviewed. Regular supervision should ensure staff understand the revised documentation and are fully aware of their role in meeting the needs of service users. Examination of staff training records show staff have received training in safe working practices. Documentation is in place to demonstrate regular servicing of the passenger lift, hoists and portable appliance testing. Control of Substances Hazardous to Health (COSHH) risk assessments were in place and the manager is slowly updating product risk assessments. Fire safety drills are taking place at the required intervals however one member of staff who had commenced work on the second day of our site visit had not received any instruction on what action to take in the event of a fire. This was brought to the attention of the manager who said she would ensure the staff member received the necessary fire safety instruction. Concerns regarding hot water temperatures and the wedging open of fire doors have been addressed earlier in the report. Fessey House DS0000035422.V304771.R01.S.doc Version 5.2 Page 22 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 1 2 1 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 1 X X 2 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Fessey House DS0000035422.V304771.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5(1)(a)(b) (ba) Requirement The registered person must ensure the service user guide includes the terms and conditions and details of the total fee payable and the arrangements for paying the fee. The registered person must ensure service users receive a copy of the service user guide. The registered person must ensure the needs of service users identified in the pre admission assessment are clearly reflected in the service user care plan. The registered person must ensure any service user who is an insulin dependent diabetic has a plan of care on how their specific health care needs are to be met. The registered person must ensure each service user has an individual care plan that clearly specifies how their needs must be met. The registered person must ensure each service user care plan is reviewed a minimum of DS0000035422.V304771.R01.S.doc Timescale for action 01/01/07 2. 3. OP1 OP3 5(1)(2) 15(1) 01/01/07 01/12/06 4. OP3 12(1)(a) (b) 01/12/06 5. OP7 15(1) 01/01/07 6. OP7 15(1) 01/01/07 Fessey House Version 5.2 Page 24 7. OP7 13(4)(c) 8. OP7 13(4)(c) 9. OP8 12(1)(a) (b) 13(2) 10 OP9 once every month or earlier if the needs of the service user changes. The registered person must ensure any service users at risk of falling have a risk assessment completed, which identifies steps to reduce the risk. The registered person must ensure any service users at risk of pressure damage have a risk assessment completed, which identifies steps to reduce the risk. The registered person must ensure service users specific health care needs are recorded in their care plan. The registered person must make arrangements for the recording and safe administration of medicines. • All administration records must be completed at the time of administration • Written additions to the medication administration record must be checked for accuracy • Risk assessments must be recorded for all self administration The registered person must make arrangements for the recording and safe administration of all medicines brought in to the home by respite residents under an additional procedure. The registered person must ensure that the arrangements for the disposal of medicines no longer required includes regular audits so that out-dated medicines are not available for use. The registered person must DS0000035422.V304771.R01.S.doc 01/01/07 01/01/07 01/01/07 22/12/06 11. OP9 13(2) 05/01/07 12. OP9 13(2) 22/12/06 13. OP10 12(4)(a) 01/12/06 Page 25 Fessey House Version 5.2 14. OP21 12(4)(a) 23(1)(a) 15. OP24 13(4)(a) (b)(c) 16. OP25 13(4)(a) (b)(c) ensure that where personal care is provided to a service user in their bedroom the door is kept shut to ensure their privacy and dignity is respected. The registered person must ensure a suitable locking mechanism, which can be overridden in an emergency, must be fitted to bathroom doors, which does not have a lock. This was a requirement at the last inspection. The timescale given was 01/02/06. The registered person must ensure the practice of wedging open fire doors and bedrooms doors stops. Where a service users door or fire door needs to be kept open advice must be obtained from the fire safety officer. The registered person must ensure any unnecessary risk to service users is eliminated and risk assess the hot water supplies in service users bedrooms. Where a risk is identified the registered person must take action to reduce the risk and ensure hot water is regulated close to 43c 01/02/07 01/01/07 01/02/07 Fessey House DS0000035422.V304771.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The registered person should ensure service users are provided with information in the form of a service user guide in their first language, or a format suited to their needs. The registered person should ensure each service user has a contract that clearly reflects the cost of their stay. The registered person should review the in house assessment tool or provide staff with guidance on how the assessment tools should be implemented to determine how the home can safely meet the needs of service users. The registered person should avoid the use of terminology such as “needs assistance” or “needs support” unless the care plan clearly specifies what action or support is required. The registered person should ensure that staff sign service users individual risk assessments to demonstrate they have read and understood the risk assessments. The registered person should consider a system, which records the exact time of frequently given medication to ensure it is given accurately. The registered person should ensure written additions to the medication administration records are signed, dated and checked by two members of staff. The registered person should ensure the poor lighting in the corridors is addressed as this could affect carers’ ability to select medication from the trolley. The registered persons should record service users involvement in daytime activities. The registered person should ensure service users likes and dislikes at meal times are know to staff. DS0000035422.V304771.R01.S.doc Version 5.2 Page 27 2. 3. OP2 OP3 4. OP7 5. 6. 7. 8. 9. 10. OP7 OP9 OP9 OP9 OP12 OP15 Fessey House 11. OP27 12. 13. 14. OP27 OP33 OP36 The registered person should review the number of care staff deployed on each living unit at peak times so as to ensure the number is adequate to meet the needs of the residents. The registered person should review the role and responsibilities of housekeepers. The registered person should ensure participants of the quality audit are made aware of the outcome of the review. The registered person should ensure staff are appropriately supervised. Fessey House DS0000035422.V304771.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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