Inspection on 06/11/07 for Fessey House

This inspection was carried out on 6th 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

Fessey House 01/05/07

Fessey House 13/11/06

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 Pauline Lintern Key Unannounced Inspection 10:00 6th November 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 Fessey House DS0000035422.V346365.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.V346365.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 Vacant Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places Fessey House DS0000035422.V346365.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 any one 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. 1st May 2007 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 into 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 bring their own furniture. Typically there are seven or eight care staff on duty plus a shift leader or manager. At night three 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. Fees charged at Fessey house are £377 per week. Fessey House DS0000035422.V346365.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Following the last unannounced random inspection of the service in September 2007, we received an action plan from Swindon Borough Council outlining their plans to improve the service offered at Fessey House. This new inspection was to assess the effectiveness of these improvements. Before the visit, all information held by the Commission relating to Fessey House was reviewed. Survey forms were sent out to relatives, staff and to people using the service. Fifteen people living at the home, nine relatives and two staff members returned comments. These are included in this report. The registered manager was not available on either day of the inspection; however the team leader was able to assist us. We carried out the unannounced inspection over the course of two days. The pharmacist inspector carried out her inspection on the first morning. Overall the inspection took place over 11 hours. Both inspectors spent time talking with the people who use the service individually and in groups. We also spoke to staff on duty. The inspection included a tour of the building, concentrating on the standard of décor and cleanliness and health and safety issues. Other areas examined included care plans, risk assessments, medication practices, staff recruitment, induction and training. At the end of the inspection we discussed our findings with the Area Manager (who was visiting the home on the second day of the inspection) and the team leader. Overall the home has worked hard to comply with the requirements set at the last inspection and taken on board the good practice recommendations. The management are aware that the home is in need of the planned refurbishment, which in turn should improve overall staff morale. The home needs to continue to develop to ensure the health, safety and welfare of the people using the service and to provide them with the best outcomes. What the service does well: Staff pay close attention to ensure that the people living at the home receive the medical attention they require. People living at the home told us that the staff members listen and act on what they say. The home has provided a copy of the service user guide in Urdu and a menu to meet one person’s ethnic needs. Relatives who visit the service said that they were made to feel welcome by the friendly staff team. People can choose whether they eat their meals in the privacy of their room or join others in the communal dining room. There is a choice of food and people confirmed that there was always plenty to eat. Fessey House DS0000035422.V346365.R01.S.doc Version 5.2 Page 6 The majority of people who use the service and their relatives know how to make a complaint or raise a concern if needed. People who use this service are able to join the ‘residents committee’, which enables them to share their ideas and voice any concerns. What has improved since the last inspection? What they could do better: Care plans could be further developed to provide more information regarding the management of risks. The monthly weighing of people using the service had ceased due to the home waiting to purchase new weighing scales, however this was addressed at the time of the inspection. People’s dignity and health and safety may be compromised by the wedging open of fire doors. One door was wedged open to provide the occupant with a flow of air as the thermostat on the radiator was broken and the room was Fessey House DS0000035422.V346365.R01.S.doc Version 5.2 Page 7 extremely hot and uncomfortable. An immediate requirement was issued to rectify this problem within 48 hours. This was completed in the set timescale. It was noted that some hot water outlets were in excess of the recommended 43°. When this was reported to the team leader it was again dealt with immediately. Generally the whole building is in need of the planned refurbishment although staff do their best to keep the home clean. Two cupboards, which were holding cleaning materials, were found to be unlocked and a small fridge had a mouldy plate with potions of butter on it inside, due to the fridge having been turned off by mistake. People told us the call bells are not answered as soon as they would like. The home does have a record of any complaints received, however it was noted that some entries did not have a timescale, or an outcome of the investigation. This was addressed at the time of the second visit to the home. The home must ensure that any safeguarding adult referrals are immediately made to the Vulnerable Adults unit before any internal investigation is commenced. Evidence shows that some staff members are not receiving regular formal supervision from their line manager. The storage temperatures for all medicines must be checked for suitability. All controlled drugs must be stored in a cupboard that meets the current storage regulations. Oxygen cylinders must be moved and stored safely in residents’ rooms. 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. Fessey House DS0000035422.V346365.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 Fessey House DS0000035422.V346365.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): NMS 3,6. Quality in this outcome area is adequate. Prospective new people have an assessment carried out before they are admitted to the home and this is reflected in their care plan. The manager needs to confirm in writing to each person confirming that their needs can be met by the home. People are provided with information about the home to enable them to decide if they wish to move in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Comments received from our surveys indicate that a few people using the service did not receive a contract as they had transferred from another unit. The remaining people confirmed that they have a signed contract of the terms and conditions of the home. Where people have been admitted as an emergency they report that the staff or the manager have taken time to provide them with information about the home. The home has a statement of purpose and a service user guide. The home has translated the statement of Fessey House DS0000035422.V346365.R01.S.doc Version 5.2 Page 10 purpose and the service user guide into a format suitable for one person’s cultural needs. The manager reports that all service users have an assessment prior to admission to the home and are given the opportunity to visit the home. One person told us that their family had visited the home on their behalf and another person said that they had left it to their daughter to arrange. One relative told us “ everything they (the home) have promised they have delivered so far”. Three case files were examined and demonstrated that an assessment of needs has been completed. The manager has not confirmed in writing that the home is able to meet each person’s needs. The home has a designated area for respite care. People told us they enjoy their stays at Fessey House. Fessey House DS0000035422.V346365.R01.S.doc Version 5.2 Page 11 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): NMS 7,8,9,10. Quality in this outcome area is adequate. Care plans and their contents have now improved and all care plans have been reviewed and linked with the initial assessment. Providing more information relating to risks could further develop care plans. Medication requirements have been met. Residents are protected by the home’s procedures for the safe handling of medication and are supported to manage their own medicines when they wish to do so. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Efforts have been made to improve care plans since the last key inspection, although providing more information within the ‘risk’ section could further develop them. This was discussed with the team leader during the inspection. Making them more person centred by involving people who use the service could also develop the plans further. Fessey House DS0000035422.V346365.R01.S.doc Version 5.2 Page 12 Any people who may be at risk of falls are referred to the falls clinic following an assessment. Where possible care plans are agreed and signed by the person using the service or their representative. The plan is kept under monthly review. The team leader explained that they have now introduced reviewing care plans as part of staff supervision with the designated key worker. It was noted that manual handling assessments were not being reviewed at the same time as the care plans however the team leader explained that this would be the procedure for the future. People told us that they feel their health care needs are being met. Case files demonstrate that people have access to healthcare professionals such as doctors, opticians, audiologist, dentist, district nurse, podiatrist and the continence nurse. The home is fitted with a call bell system and some people felt that they were answered as soon as was possible. However a few people gave us the following comments, 1. Staff are not answering bells as quick as they could, however I appreciate shortages of staff and some people take much longer to see to. 2. I have been told about the call system. 3. Due to staff shortages we sometimes have to wait for assistance. If more staff were available services could improve. 4. Staff are always available and ready to help when needed. 5. The person is happy to wait providing she is informed. Care plans state that people using the service should be weighed monthly to ensure they maintain a healthy weight. However care plans sampled showed that they had not been weighed for several months. The team leader reported that they were waiting to purchase new weighing scales. By the second day of the inspection this had been addressed and people had been weighed. Records also showed that manual handling risk assessments are not being completed monthly in conjunction with the care plans. The team leader stated that she would ensure this happens in the future. One person’s care plan stated that their key worker would arrange for weekly showers/baths for them when they wish. Daily notes show that when they take place they are recorded. People who spoke to us told us that they are treated with dignity and care by the staff when they are supporting them with their personal care. Aspects of promoting dignity and privacy have generally improved, with the reduced practice of wedging fire doors open. One family member reported that their relative had to wedge open their bedroom door to allow some air into the bedroom both during the day and at night. On inspection we found the room to be uncomfortably hot due to a broken thermostat on the radiator. An immediate requirement was issued during the visit to repair or replace the Fessey House DS0000035422.V346365.R01.S.doc Version 5.2 Page 13 thermostat to ensure the dignity, privacy and health and welfare of the person using the service. This was complied with within the given timescale. The person confirmed that their room was now much more comfortable for them. One person using the service told us that there is an ongoing problem with the shower. They reported that they had raised this as a concern in the past but it still presents a problem even though the shower has been replaced. One staff member explained that they felt the restricted drainage may be the cause of the problem and added that at times the whole shower room is flooded. On examination the shower base was found to have residual water left in it where it could not drain away. This was discussed with the team leader who confirmed that it only happens if the shower has had a lot of continual use. The area manager reported that there are plans to have another shower upstairs when the refurbishments take place. He confirmed that they would be asking the people who live there for their views on this first. During the inspection it was noted that the team leader was making arrangements to ensure that a particularly poorly person would have a staff member sit with them through the night. She confirmed that she was assessing the situation daily and would ensure that the person and their family had all the support they needed. The area manager confirmed that the Borough has had a work party developing end of life protocols to be implemented to ensure people and their families are treated with sensitivity and their wishes are respected. We noted that the final draft was in accordance with the Mental Capacity Act. The Pharmacist Inspector looked at arrangements for the handling of medicines. A new storage room for medicines is now in use, which improves the facilities. This room can be warm and the temperature should be regularly checked to ensure that it does not exceed safe limits for the storage of medication. A fridge is in use and the temperature of this is monitored. Medication records were completed accurately and changes to medication were evidenced in doctors’ letters. Residents were well supported to self medicate where they were able and wanted to do so. Separate charts for the use of external preparations were in use, but care must be take to record exactly what has been applied and any that have been refused by the resident. Controlled drugs are stored separately but the cupboard does not comply with recent changes in legislation. Records of one controlled drug were found to be inaccurate due to accounting errors, which were corrected at the time of the inspection. Staff showed knowledge of medication and residents were seen regularly by the GP and reviewed when appropriate. The positioning of oxygen cylinders in residents’ rooms must be made safe as they can be very hazardous. Fessey House DS0000035422.V346365.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12,13,14,15. Quality in this outcome area is good. An activities programme has now been developed and appears to meet the needs of the people living at the home. Links with families and friends are welcomed. Efforts have been made to ensure everybody’s dietary needs are being met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is now an activity programme, which is displayed for people to see in the dining room. Copies are also placed on the tables when there are planned events such as the firework display and wine tasting. People told us they were looking forward to the firework display taking place in the grounds that evening, with hot dogs and beef burgers being provided. The activities co-ordinator now keeps a log of all activities which have taken place and records who attended. The team leader explained that they ensure extra staff are on duty when special events take place to support the people living at the home. The activities co-ordinator reported that they try to have two or three activities each day including skittles, board games, quizzes, bingo and gentle exercise. There is now a designated arts and craft room where it Fessey House DS0000035422.V346365.R01.S.doc Version 5.2 Page 15 was observed that Christmas Yule logs were being made. A display of hand made Christmas cards were on display and could be purchased by relatives or visitors. At the entrance to the home there were three tables full of raffle prizes, which had been donated ready for the Christmas celebrations. People told us that the home made great efforts to celebrate individual birthdays and always provides them with a birthday cake. The activities co-ordinator told us that there are plans for a Remembrance Day service and they are hoping the local choir will come in to entertain the people living there at Christmas with carol singing. The home has made improvements to the communal areas by making areas where people can listen to music or sit and chat without the television being on if they choose. The team leader reported that all changes were made in consultation with the ‘resident’s committee’. People’s religious needs are recorded in their care plan. One person living at the home from an ethnic minority group has been provided with a television and DVD player. Although the television does not show Asian programmes the home have provided Asian DVDs for them to watch and their care plan records how their cultural needs should be met. The cook has developed a menu to suit this person’s needs but reported that the person will often refuse the food on offer as they do not believe it is true Halal, preferring to rely on food bought in by relatives. When food is refused this is recorded in the person’s daily notes. Survey forms received from relatives indicate that people are made to feel welcome when they visit the home. There is also provision now for people to meet in private in one of the smaller communal rooms, where there are tea and coffee making facilities. These rooms need monitoring to ensure the f fridges do not get turned off by mistake causing them to defrost as was the case on the day of the inspection, which resulted in a mouldy plate being found. Consideration also needs to be given to ensure the cupboards in these room containing cleaning materials are either emptied or locked to safeguard people living at the home. The dining room at the home provides a pleasant environment for people. The cook reported that quite a few people prefer to have their meals in their bedroom on a tray and this is catered for. People spoke favourably about the meals provided at the home. Each person is offered a choice of menu for the day. One person expressed their unhappiness at the new policy of only having cooked breakfast twice a week now instead of their usual ‘fry up’ every day. The cook explained that all meals are cooked to ensure they are suitable for anyone with diabetes. The menus were sampled and looked to be varied and nutritious. People told us during the inspection they were enjoying their main meal of steak and kidney pudding or the fish alternative. Feedback from our surveys from people using the service includes: Fessey House DS0000035422.V346365.R01.S.doc Version 5.2 Page 16 1. The menu was varied and meals and service was excellent. 2. Would like more gravy dinners, and more fruit, nuts, oranges, satsumas and more of a variety. 3. Prefers simple plain cooking, gravy meals and feels menu needs to reflect meals that residents of senior years prefer. 4. Food and variety of menus are marvellous. 5. Good food choices. 6. Enjoys the menu. 7. Teatime menu needs more variety, staff will accommodate with choices. 8. I am diabetic and I feel that they do cater for my needs. Fessey House DS0000035422.V346365.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16,18 Quality in this outcome area is adequate. There is a procedure in place to enable people to make a complaint if the wish. People could be placed at risk if the local protocols for alerting suspected abuse are not adhered to. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been four complaints made in the last twelve months. They are recorded within the home’s complaints log. Two entries do not state the timescale and outcome of the investigation although the Annual Quality Assurance Assessment (AQAA) returned to us reports that all were resolved within 28 days. The team leader completed the information before the end of the inspection. There have also been two referrals made to the Protection of Vulnerable adults List (POVA). We had concerns that one of these referrals was investigated by the home prior to informing the Vulnerable Adults unit in line with the local guidance ‘No Secrets’. This has been discussed with Swindon Borough Council. A recent notification regarding a theft was responded to by the home following the local protocols. The majority of people who use the service confirm that they know who to speak to if they were not happy and know the procedure for making a Fessey House DS0000035422.V346365.R01.S.doc Version 5.2 Page 18 complaint. One person said that they would probably discuss any concerns with their family in the first instance. Staff members told us they receive training in safeguarding adults. Discussion with staff confirms that they know the local procedure to follow for raising any concerns regarding suspected abuse. Fessey House DS0000035422.V346365.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19,26. Quality in this outcome area is adequate. The health and safety of service users is being compromised by doors still being wedged open. There is still no date for the planned refurbishment, which means people are still living in home showing considerable signs of wear and tear. Staff do their best to try to maintain a clean and tidy environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The standard of cleanliness in the home has improved since the last inspection. People told us that they were happy with their bedrooms and had everything they wanted in their room. People are able to bring in their own pieces of furniture and personal belongings to make them feel at home. Unfortunately the need for refurbishment detracts from the overall rating of the home. The home employs a handy man who carries out the health and safety checks and small general maintenance jobs. However due to the deteriorating condition of Fessey House DS0000035422.V346365.R01.S.doc Version 5.2 Page 20 the home much of the required work would be beyond his skills. As mentioned earlier in the report the wedging open of fire doors has greatly improved, however a couple of people living at the home have expressed that they do not like to feel claustrophobic and prefer their doors to be left open. The area manager confirmed that arrangements had been made for these particular doors to be fitted with automatic closure devices. On the first day of the inspection one hot water outlet was producing water in excess of 43°C. This was fed back at the end of the day and had been rectified by the second day. Records demonstrated that all hot water outlets had now been checked and showed that they were within the recommended setting. Nine new thermostats have been ordered to replace the faulty ones. It was noted how staff have made the communal rooms as homely and pleasant as possible, with pictures, ornaments, books an other items. As mentioned earlier in this report the people using the service have welcomed the new dining room. Discussion took place with the area manager regarding the proposed date for the planned refurbishment. He confirmed that they were hoping for this to take place next summer. He agreed that certain areas of the home would benefit from a coat of paint to brighten them up such as the hallways and confirmed that this could be arranged. He also agreed that some areas were poorly lit and again he confirmed this would also be addressed. Ten out of fifteen surveys returned to us from people living at the home confirm that the home is always clean and tidy. The remaining five report it is either usually or sometimes clean. One relative told us that they had to clean the bedroom window and remove cobwebs from their family member’s bedroom when they visited. It was noted that on both days of the inspection the home was clean tidy and hygienic. One housekeeper told us that they have a checklist to follow to ensure all areas of cleaning are covered. One person living at the home told us “they are shampooing the carpets today”. At the time of the inspection one housekeeper told us that there was one part time post currently vacant and that another housekeeper had been recruited and was waiting for their police checks to be returned. Protective clothing such as aprons and gloves is provided. One staff member confirmed that there are sufficient supplies for their needs. Kitchen staff were observed wearing aprons and gloves whilst going about their duties. During the last key inspection it was noted that the washing machines were inadequate for the amount of washing at the home. The area manager confirmed that a new commercial washer has now been ordered for the home. Training records and discussion with the staff members and the training and development officer confirmed that training in infection control is provided Fessey House DS0000035422.V346365.R01.S.doc Version 5.2 Page 21 Fessey House DS0000035422.V346365.R01.S.doc Version 5.2 Page 22 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): NMS 27,28,29,30. Quality in this outcome area is good. The home runs a flexible rota to ensure the needs of the people who live there are met. Staff members are offered a good level of training both mandatory and specialist. The home has suitable recruitment practices, which help to safeguard people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Comments received from people living at the home and from their representatives indicate that that they do not always feel there are sufficient staff on duty. However the team leader confirmed that the rota is now more flexible to meet the needs of the people using the service. On the first day of the inspection extra staff were on duty to support the firework display and one extra member of staff to sit with one person who was ill. People living at the home and their representatives generally spoke well of the staff team. One relative commented; “While all the staff are quite simply ‘great’ as they constantly work under pressure I would like to say a) There seems to be a shortage of staff b) High turnover of staff means we are constantly seeing new faces, that in turn cannot be good for existing staff / residents inside”. As mentioned earlier in this report people commented that Fessey House DS0000035422.V346365.R01.S.doc Version 5.2 Page 23 their call bells are not always answered promptly. One person told us “No one calls when I pull the bell, I could be sat there for half an hour”. Staff meeting minutes demonstrated that the issue of responding to call bells had been raised at a ‘residents’ meeting on 18/5/07 by a person living at the home and the manager had explained the proposed changes to the rota to provide more staff on duty at peak times. One staff member told us that there “Is no problem with staffing levels or with responding to call bells”, another person commented “we need more staff per shift due to the increasing needs of the people living here, we always seem to be rushing and we are not doing efficient jobs and feel we may make mistakes”. The team leader confirmed that there were three staff vacancies at the time of the inspection. She explained that the Borough have now set up their own agency to provide staff cover and consistency. External agencies are still used. The same agencies are used regularly to provide consistency for the people who live there. One housekeeper told us that she would often work extra care shifts when there are staff shortages. She added that she has completed manual handling in care training and had a good understanding of care plans and therefore felt competent to carry out her duties. The training and development officer told us that five staff have achieved their National Vocational Qualification (NVQ) level 2 and the remaining staff have level 3 and above. She confirmed that she is also planning to set up NVQ for the housekeepers at the home. Part of her new role involves the induction of new staff, which is now in line with the Common Induction Standards as recommended by Skills for Care. The home currently has four First Aiders and there are plans to increase the numbers, although all staff attend basic first aid training as part of their induction along with health and safety, safeguarding people, medication, manual handling and fire awareness. Specialist training is available and courses have been run in dementia, boundary awareness, epilepsy, diabetes, stoma care and visual and hearing impairments. The trainer told us that they have arranged to offer training for staff in hand and foot massage. Two sessions have already been booked. The training and development officer has recently been accredited as a trainer for Alzheimer’s awareness, which will cover the Mental Capacity Act. She confirmed that staff members are keen to attend this course and that she plans that all staff will have the opportunity to attend. Staff spoke positively about the amount of training they receive. The home is accredited with the Investors in People Award for their commitment to staff development. A sample of recruitment records were examined and showed that staff had received a satisfactory Criminal Records Bureau (CRB) check and Protection of Vulnerable Adults (POVA) check before commencing work. Fessey House DS0000035422.V346365.R01.S.doc Version 5.2 Page 24 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): NMS 31,33,35,36,38 Quality in this outcome area is adequate. The manager must ensure that staff are regularly supervised. Quality Assurance systems have improved since the last inspection. Improved methods for safeguarding people’s money have been developed. The health, safety and welfare of people living at the home has improved however standards need to be maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The area manager confirmed that the manager has now submitted her application form to apply to be the registered manager of the home. Mechanisms for measuring quality assurance have improved. Recently returned questionnaires from people using the service and their Fessey House DS0000035422.V346365.R01.S.doc Version 5.2 Page 25 representatives were sampled and were mostly positive in their comments, although a few people spoke negatively about the lighting and general decoration in the home. The team leader reported that there are now plans for an external Commissioning team to visit the home independently to audit the service. A copy of the planned format for the visit was observed and showed that this will be in two sections. The first section will include observations of staff interactions with the people using the service and their health and happiness. The second section will cover staffing issues, recruitment, induction, training, quality, complaints and equal opportunities. Regular monthly management audits are completed and these are then submitted to the Commission. The home has recently experienced a theft from their safe. This was reported to the appropriate people including the police and is being fully investigated by the area manager. It has raised awareness to increase security regarding access to the safe. The administration officer showed us the new procedures for holding money for people living at the home. Financial transactions and records for two people using the service were examined and records, receipts and money in the safe balanced. Staff supervision remains a concern, as not all of the senior staff appear to be carrying out their supervisions regularly. Staff members told us that they do receive regular 1-1 supervision however not all records confirm this. One person commented, “I get on well with all the seniors and the management, they take on board things we say”. The home has regular team meetings, bank and agency meetings, resident meetings and senior staff meetings. There is evidence to show that following the last key inspection the findings were shared with the staff team to ensure they were aware of issues that were raised. Regular checks are carried out to ensure the health and safety of the people living at the home. All radiators are guarded to safeguard people. Fridge and freezer temperatures are recorded daily and hot food is regularly probed to ensure it is served at a safe temperature. The area manager explained that the copy of the Gas safety Certificate and the Portable appliance test (PAT) certificate are held at the head office, however there was evidence to confirm that these checks had taken place on 1st April 2007. The home has a reviewed fire risk assessment. . Fessey House DS0000035422.V346365.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X X X X X 2 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 2 X 3 X 2 2 X 2 Fessey House DS0000035422.V346365.R01.S.doc Version 5.2 Page 27 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 All controlled drugs must be stored in a cupboard that meets the current storage regulations (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007. Timescale for action 31/03/08 2. OP9 13(4)(a) Oxygen cylinders must be moved 31/12/07 and stored safely in residents’ rooms. The registered person must confirm in writing to each person using the service that the home can meet his or her assessed needs. The registered manager must ensure the radiator with the broken thermostat is repaired to ensure the privacy, dignity and health, safety and welfare of the person sleeping in the room. An immediate requirement was issued at the time of the inspection. The registered person must ensure that all hot water outlets are regularly monitored to ensure they do not exceed the DS0000035422.V346365.R01.S.doc 3. OP3 14(1)(d) 31/12/07 4. OP38 12(1)(a)( 4)(a) 07/11/07 5. OP38 13(4)( c) 06/11/07 Fessey House Version 5.2 Page 28 6. OP36 18(2) 7. OP18 13(6) recommended 43°C. The registered person must ensure that all staff receive regular formal supervision at least six times a year. The registered person must ensure that local protocols are complied with when making a safeguarding adults alert. 05/12/07 06/11/07 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. Refer to Standard OP9 Good Practice Recommendations The storage temperatures for all medicines should be checked for suitability and appropriate measures taken if necessary. Records of the use of creams should state when a cream or other external preparation has been refused. Care plans should provide the reader with more information relating to risk. It would be good practice to involve the people who use the service in the development of their care plans. It is recommended that manual handling risk assessments are reviewed monthly. It is recommended that each person living at the home is weighed monthly and this is recorded. It is recommended that the manager monitor the shower unit to ensure there is not a build up of water that cannot drain away. It is recommended that the manager ensure that any cupboards storing toxic materials are securely locked. It is recommended that the registered manager checks that the fridges upstairs do not get accidentally turned off. It is recommended that the registered manager ensure there is adequate lighting throughout the building. It is recommended that the registered manager ensure parts of the home are decorated. When complaints are logged timescales and outcomes DS0000035422.V346365.R01.S.doc Version 5.2 Page 29 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. OP9 OP7 OP7 OP7 OP7 OP38 OP38 OP38 OP19 OP19 OP16 Fessey House 13. OP28 should be recorded. It is recommended that the time it takes for call bells to be answered is monitored to ensure people are not being kept waiting too long. Fessey House DS0000035422.V346365.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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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