Inspection on 19/11/07 for Four Seasons Care Centre

This inspection was carried out on 19th November 2007.

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

Four Seasons Care Centre 05/02/09

Four Seasons Care Centre 15/09/06

Four Seasons Care Centre 18/11/05

Four Seasons Care Centre 27/06/05

Similar services:

Ashlea Mews Residential Home

Eastwood

West Lodge

Arran House

Avenue Community Nursing Home

Cosin Lodge

Farmborough Court

Connolly House

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

CARE HOMES FOR OLDER PEOPLE Four Seasons Care Centre Ox Close Saltburn-by-Sea TS12 1NR Lead Inspector Jackie Herring Unannounced Inspection 09:30 19 November 2007 th 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 Four Seasons Care Centre DS0000063463.V351068.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. Four Seasons Care Centre DS0000063463.V351068.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Four Seasons Care Centre Address Ox Close Saltburn-by-Sea TS12 1NR 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) 01287 624516 01287 624008 fs@keyhealthcare.co.uk Key Healthcare (Operations) Limited Bridget Anne Logan Care Home 53 Category(ies) of Dementia - over 65 years of age (53), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (12) Four Seasons Care Centre DS0000063463.V351068.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two of the twelve MD(E) beds can be used for two existing service users between the age of 55 - 64 years until they are no longer required. They will then need to be removed from the registration certificate. The twelve beds MD(E) can be used for the twelve existing service users until they are no longer required . They will then need to be removed from the registration certificate. The existing 29 bedded unit will provide Nursing Care and the new 24 bedded unit will provide Personal Care. 15th September 2006 2. 3. Date of last inspection Brief Description of the Service: Four Seasons Care Centre has been operational as a Care Home since 1989. In April 2005 Key Healthcare Ltd became the Registered Provider. The home operates two separate units, a 29 bedded EMI nursing unit and a 24 bedded EMI residential unit. All rooms are single rooms and the rooms within the EMI residential unit also have ensuite facilities. The home is situation on the outskirts of Saltburn and within close proximity of local shops, church and public transport. The weekly charge at Four Season’s is £453 - £597 per week. Four Seasons Care Centre DS0000063463.V351068.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection at Four Season’s Care Centre was an unannounced key inspection; as such all of the key standards relating to older people were looked at. This was to check that the home meets the standards that the Commission for Social Care Inspection say are the most important for the people who use services, and that it does what the Care Standards regulations say it must. The visit to the home was conducted in one inspection day and was unannounced. During the visit to the home, a number of records were looked at, including resident’s records; along with medication records, staff records and training records as well as maintenance information. Time was spent talking to residents, relatives and staff and also walking around the home, observing interactions and generally finding out what Four Seasons Care Centre was like for residents and staff. Discussions also took place with the manager and company area manager. The manager had completed the Annual Quality Assurance Assessment (AQAA) prior to the inspection and contained detailed information, which is reflected within the report and to support the judgements made. This document had been very well completed and clearly identified a number of improvements and plans and developments for the future. This was a very positive inspection with clear developments and progress having been made since the last inspection. What the service does well: The outcome of the unannounced inspection is that Four Season’s Care Centre has delivered good performance and has managed a number of improvements. Where areas for improvement have been identified, the service recognises them and manages them well. Management and staff are enthusiastic and try hard so that residents benefit from good quality care service. Four Season’s Care Centre provides a warm and friendly home for people to live. There is an enthusiastic staff team who are clearly aware of the job roles. One member of staff said, “We encourage the residents to be as independent as possible, we give choices and are aware of their likes and dislikes”. “Staff are made aware that you don’t just walk into their room and put the light on, you go in quietly and leave them if they are still asleep”. Another staff member said, “We treat the residents as we would like to be treated, most definitely with respect and we are aware of their rights”. Four Seasons Care Centre DS0000063463.V351068.R01.S.doc Version 5.2 Page 6 A relative stated in a survey, “We as a family are glad we chose Four Season’s because the standard of care received is second to none”. During discussion with a relative, they said, “My father used to be in another home, he has settled here, the atmosphere is different, it is much calmer and quieter”. Another relative who had previous care home experience said, “It is marvellous here, much more organised with higher standards”. Activities are well planned and managed, both on an individual basis and group basis. Staff said, “The activities co-ordinator is marvellous, there is plenty going on for the residents”. A relative who was spoken to said, “It is incredible what she does, there is always something going on, there are fundraising events, concerts are arranged, I have absolute admiration”. A very good percentage of care staff have achieved their National Vocational Level 2 in care, that being 78 with a number of other staff having NVQ Level 3. A number of the staff have now also completed dementia care training. What has improved since the last inspection? What they could do better: There are areas that could be improved and make some areas within Four Season’s Care Centre better and some that are needed to ensure ongoing safety and protection. Portable heaters are not to be used within the care home and there is the need to ensure that the central heating is satisfactory within all of the rooms. Bath and shower temperatures are to be recorded weekly rather than monthly as recommended by the Health and Safety Executive. Toilet doors are to be fitted Four Seasons Care Centre DS0000063463.V351068.R01.S.doc Version 5.2 Page 7 with lock to promote privacy and dignity of the residents. Areas within the nursing unit are in need of further improvement, particularly in the bathrooms, shower rooms and toilets. Whilst the care records were in the main good, there is the need to ensure that detailed assessments are in place with supporting care plans for more complex and challenging needs of residents. The medication systems whilst generally good, needed some additional attention to strengthen the systems. If staff are employed prior to Criminal Record Bureau checks then a POVA First is to be obtained and detail contained within the staff members file about the supervision arrangements. Staffing skill mix is to remain under review to ensure that there is an appropriate level of skill and experience to meet the needs of the residents. This particularly relates to the qualified nurse team. The induction for new staff who have not completed NVQ level 2 must be in line with the Skills for Care Induction. The complaints procedure needs some slight amendment to the contact details of people. 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. Four Seasons Care Centre DS0000063463.V351068.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 Four Seasons Care Centre DS0000063463.V351068.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): Standards assessed 2 People who use this service experience good quality outcomes in this area. People have their needs fully assessed prior to being admitted to the service, ensuring their needs are met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Three sets of residents records were looked at, one residential resident, one nursing resident and one for a newly admitted resident. All contained pre admission information and there were also copies of care management assessments available. There was evidence of post admission reviews taking place; these were well recorded within the records looked at. There was some discussion about the pre admission assessment documentation and the manager said that this was being looked at with a view to expanding the level of detail and also to include more mental health information. Four Seasons Care Centre DS0000063463.V351068.R01.S.doc Version 5.2 Page 10 Discussions with relative said that they had looked around the home prior to deciding whether their loved one should move in. One relative said, “Me and my daughter looked at a few and we decided we liked this one best”. It was confirmed through discussion that information about the home was given at point of admission. There had been some recent referrals for people with perceived complex needs. The pre admission assessment and planning that was carried out was comprehensive and allowed for staff from the home and previous placement to spend time together with the potential resident making the transition as smooth for the person as possible. This also enabled staff to be more aware of the person’s needs and the care that was needed for them. A copy of the Statement of Purpose and Service User Guide was on display on the notice boards within the home. Four Seasons Care Centre DS0000063463.V351068.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): Standards assessed 7, 8, 9, 10 People who use this service experience good quality outcomes in this area. Whist the majority of resident’s health, personal and social care needs are assessed and detailed within care plans some additional information would enhance these further. Residents were generally protected by the home’s policies and procedures for dealing with medicines. Residents were treated with respect and their right to privacy was upheld. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The same three residents records were looked at in more detail. The actual documentation in terms of layout, information flow and assessment tools are very good. They generally contained very nice person centred information. The completion of the assessments, risk assessments and the development of needs specific care plans was in the main good, however there was room for further development to ensure that needs are clearly identified and all appropriate care plans are in place. This particularly related to residents who had more complex mental health needs or needs associated with some Four Seasons Care Centre DS0000063463.V351068.R01.S.doc Version 5.2 Page 12 challenges in behaviour that was associated with their dementia. Examples of this included, a number of incidents that had been recorded but there was nothing in place to show what action had been taken and no care plan in place to give staff clear direction in terms of interventions. A range of risk assessment tools are being used included moving and handling, risk of falls and nutrition. These were completed in all of the files looked at and were being updated on a regular basis. Care plans were being evaluated on a monthly basis, with a good level of detail. There was evidence of relative’s involvement with the assessments and care records and they also confirmed in discussion that they were involved in the care planning process. In all of the files looked at there was clear evidence of other disciplines being involved such as GP’s, district nurses, chiropodist and optician. These were well recorded within the files and relatives said they were kept informed of any changes to their loved ones. A relative said, “They had the GP out last week and nursed him/her in bed, I am kept well informed and he/she is very well cared for”. The medication systems in both the nursing and residential unit was looked at and there was discussion with key staff involved in the procedure for the safe handling, ordering and storage of medication. In the main, there are good systems in place, however there are some areas that required further attention to detail and some amendment. These included, the need to implement an audit of the medication systems, which will assist in exploring any gaps in records. It was agreed that a systems for ongoing competency assessment for all staff involved in the administration of medication is being developed. Medication fridge temperatures were on the whole being recorded daily, with the odd day being missed. The inspector was satisfied that a system was in place for this and just needed a little more attention. The way in which some of the controlled drugs within the residential unit needs to be looked at as, the full level of details was not always being recorded. The manager agreed to address this. It is also recommended that the temperatures within the medications rooms be recorded. Staff spoke with knowledge about the residents and spoke of the encouragement that is given to residents to make choices and how they are treated with dignity and respect. One member of staff said, “We encourage the residents to be as independent as possible, we give choices and are aware of their likes and dislikes”. “Staff are made aware that you don’t just walk into their room and put the light on, you go in quietly and leave them if they are still asleep”. Another staff member said, “We treat the residents as we would like to be treated, most definitely with respect and we are aware of their rights”. Four Seasons Care Centre DS0000063463.V351068.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards assessed 12, 13, 14, 15 People who use this service experience good quality outcomes in this area. Residents are provided with a very good programme of activities, which they can choose to join in with. Residents enjoy visits from families and friends. Residents are offered a balanced and varied menu, with individual preferences and diets being catered for. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Social assessment are completed for all residents at Four Season’s Care Centre and are available within the residents files that were looked at. There is a range of social and recreation activities available for residents and a very committed, creative and enthusiastic activities co-ordinator. The AQAA detailed that, “the activities co-ordinator tailors specific activities to the needs of the individual based on their level of cognitive impairment, previous preferences and hobbies and the service users wishes”. On the day of the inspection a number of residents were going to another local care home to join in events being held there. A number of photographs are on display throughout the home showing the variety of activities residents have been Four Seasons Care Centre DS0000063463.V351068.R01.S.doc Version 5.2 Page 14 involved in. Details of activities are also recorded within the resident’s notes. An activity file was made available and contained evaluations of all of the activities, these included computer course, as currently three of the residents are doing this; Indian Head Massage; Quiz Night; Turkish Night, including Belly Dancers, Fireworks and Pottery Painting. Through discussion with staff, they all without exception spoke extremely highly of the work that was done with the residents to involve them in as many activities and social outlets as possible. Staff said, “The activities coordinator is marvellous, there is plenty going on for the residents”. A relative who was spoken to said, “It is incredible what she does, there is always something going on, there are fundraising events, concerts are arranged, I have absolute admiration”. Staff confirmed that residents spiritual needs are being met, with visiting clergy and with residents attending church services if they so wished. One of the sister homes has a consecrated chapel within it and residents from Four Season’s had recently attended a church service there. It was also confirmed that there were plans to continue to offer this to residents. The menu has been reviewed since the last inspection and there is now clearly a choice available at every mealtime for the residents. The dining rooms are suitable for purpose and the use of tablecloths and table settings certainly improved the environment and mealtime experience for the residents. Relative said, “A member of staff goes around and asks what people want, they are well fed have things like homemade scones, I wish I could have it myself”. Staff also said that the meals were good. One member of staff said, “The residents have a choice, they are always asked, it is a good bit of dinner”. Four Seasons Care Centre DS0000063463.V351068.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards assessed 16 and 18 People who use this service experience good quality outcomes in this area. Relatives on behalf of residents were generally confident their complaints would be listened to, taken seriously and acted upon. Residents were protected from abuse by the home’s policies and procedures. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The AQAA detailed that since the last inspection there has been one complaint and three Protection of Vulnerable Adult referrals. A complaint was still in the process of being investigated by the manager and the complainant was informed of this during the inspection and it was agreed that once the investigation was completed feedback would be given. The company have demonstrated that where serious concerns have been raised, they have dealt with them robustly and taken the action they consider appropriate. The complaints procedure was on display within the home, this needs some additional contact information, which the manager agreed to action. A relatives comment in a survey said, “Any concerns we have are quickly dealt with and I feel we are kept informed of any developments as they occur”. A relative who was spoken to said, “I have no concerns or complaints, I am confidents about talking to Bridget and I just have to mention things and they are addressed”. Four Seasons Care Centre DS0000063463.V351068.R01.S.doc Version 5.2 Page 16 The training programme detailed that staff had received training in respect of protection of vulnerable adults and staff who were spoken to confirmed this. The training programme was looked at and showed that this training is regularly delivered. It was however identified that when new staff are employed, they do not always cover this subject in a timely way. It is however recommended that new staff should be made aware of the procedures to be followed through their induction process and within a short time of commencing employment. Four Seasons Care Centre DS0000063463.V351068.R01.S.doc Version 5.2 Page 17 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): Standards assessed 19, 21, 22, 26 People who use this service experience adequate quality outcomes in this area. Resident’s benefit from a clean and well-maintained home. Further redecoration and refurbishment would enhance this further. Some additional checks would also enhance the safety of residents within the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The environment at Four Season’s Care Centre is a mix of a more longer standing care home, which provides nursing care, which has been operating for a number of years and a newer residential unit. A number of environmental improvements were evidenced within the nursing unit during the inspection. These included the redecoration of a number of areas within the nursing unit and some new carpets had also been laid. The dining room had been improved with redecoration and a new non-slip floor Four Seasons Care Centre DS0000063463.V351068.R01.S.doc Version 5.2 Page 18 being laid. The refurbishment that has taken place has enhanced the environment for the residents. Locks had been fitted to bathroom and shower rooms doors, however toilet doors did not have locks fitted and this continues to be a matter that needs to be addressed to meet dignity and privacy needs of the residents. Bath seats within the nursing unit also need some attention as they potentially present a risk to some residents, the holes in the seats need to have bungs fitted to prevent any potential injury. The residential unit was very tastefully decorated, with a good amount of communal space and nicely appointed bedrooms. All of these rooms are single rooms with ensuite facilities. The home itself was generally clean and was odour free on both days of the inspection. A relative did raise concerns about the cleanliness of one of the baths and the manager agreed to address this issue. Housekeeping staff were observed going about their duties had the appropriate equipment such as carpet cleaners to effectively keep the home clean and odour free. There continues to the need to improve a number of areas within the nursing unit at Four Season’s. This include the update of bathrooms, showers and toilets which should be refurbished, made more homely and would enhance the environment for the residents. The central heating systems also needs to be looked at as a portable heater was observed within one of the residents bedrooms and staff confirmed that it was used as the room got cold. The manager took steps to remove the heater from use and to issue staff with instructions that they were not to be used. A sample of maintenance records were looked at and it was noted that water temperatures are being recorded monthly rather than weekly. It is recommended that the baths and shower be checked weekly rather than monthly in accordance with the recommendations made by the Health and Safety Executive. It was confirmed with the manager that the providers have plans to significantly update the nursing unit, improve the bathrooms, showers and toilets and improve the laundry and the kitchen. A copy of the refurbishment programme and associated timescales was not however available during the inspection. Four Seasons Care Centre DS0000063463.V351068.R01.S.doc Version 5.2 Page 19 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): Standards assessed 27, 28, 29 and 30 People who use this service experience adequate quality outcomes in this area. Resident’s benefit from a well-trained staff who are sufficient in numbers. The recruitment and selection of staff is not quite good enough and does not fully ensure that resident’s are protected. Staff receive a rolling programme of mandatory training, however steps must be taken to that the appropriate induction is fully delivered. Staffing skill mix needs to continue to be reviewed to ensure that the required skill and experience is in place to fully meet the needs of the residents. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager has completed a course in Dementia Care at Teeside University to enhance her knowledge and skill in this area. It is planned for more staff to complete this course, which is necessary particularly within the nursing unit as there is a very limited number of Registered Mental Health Nurses in post. The duty rota for both the residential and nursing unit was looked at. Whilst the numbers of staff on duty was seen to be sufficient by people spoken to, the skill mix in relation to the appropriate qualification of nursing staff is of some concern. The week prior to the inspection rota were looked at and showed that there was Registered Mental Health cover for one and a half day shifts and three night shifts although there was a Registered General Nurse on duty the remainder of the time. There is the need to ensure that there is an Four Seasons Care Centre DS0000063463.V351068.R01.S.doc Version 5.2 Page 20 appropriate amount of skill and experience and that qualified nurses have demonstrable specialist qualifications. The nursing residents needs should be prescribed and directed by a qualified nurse who has the required knowledge and skill. The AQAA states that 78 of care staff are trained to NVQ Level 2, which is good and a number of care staff also have NVQ Level 3. It also details that 100 of catering staff have been trained in safe food handling. Dementia care courses were clearly evident within the training programme and staff confirmed they had received this training. Three staff files were looked at, two relatively new members of care staff and one longer serving qualified nurse. The actual staff files were well set out with a good flow of information. It was identified that the two new care staff had commenced employment prior to the return of the Criminal Records Check and without a POVA First, although the manager had thought this had been obtained through the company’s own in-house procedures. It was agreed that the correct procedure would be followed and the manager agreed to take immediate steps to address this. The in-house induction for new staff was looked at and found to be very comprehensive. There is however the need for care staff who have not achieved a National Vocational Qualification to complete the induction as described by Skills for Care within 12 weeks of commencement of employment. The current in house induction although very good did not cover all of the areas needed. Relatives said in one of the surveys, “I consider the staff at this care centre to be very good indeed. We are all only human and minor errors of judgement are inevitable. However, cleanliness, kindness and competence seem to be the order of the day and I have never seen any signs of abuse”. Another relative said during discussion, “The staff are very good, they are very caring and friendly. I think there is sufficient staff, they are always in and out and they always bring me a cup of tea”. A member of staff said, “I love it here, it is my first care job but something I have always wanted to do and the residents are well cared for”. Four Seasons Care Centre DS0000063463.V351068.R01.S.doc Version 5.2 Page 21 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): Standards: 31, 33, 35 & 38 People who use the service experience good quality outcomes in this area. The home was well managed by an enthusiastic manager and run in the best interests of the residents. Resident’s personal monies are generally safeguarded by the home’s procedures. The health, safety and welfare of residents and staff was promoted and protected. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The registered manager is a Registered General Nurse who is now undertaking the RMA. She has also completed a Dementia Course at the local university, which enhances her knowledge and skill for the category of people living at Four Season’s. Staff spoke very highly of the manager and commented that the home was well run, well managed and better now that it had been. Staff said that they were able to express their opinions and believed what they had to say was important and that they were listened to. One member of staff Four Seasons Care Centre DS0000063463.V351068.R01.S.doc Version 5.2 Page 22 said, “There has been a lot of improvement, the manager deals with matters, she listens and I feel much more valued”. The manager although present at this inspection has recently been moved to oversee the running of one of the sister homes within the company and currently the deputy manager is managing the home, this needs to be confirmed in writing to CSCI. A relative stated in a survey, “We as a family are glad we chose Four Season’s because the standard of care received is second to none”. During discussion with a relative, they said, “My father used to be in another home, he has settled here, the atmosphere is different, it is much calmer and quieter”. Another relative who had previous care home experience said, “It is marvellous here, much more organised with higher standards”. The system for managing resident personal allowances was looked at. There is a centralised bank account for this with individual records contained within the computer system. There was a clear system for the in-house management, showing debits and credits and receipts were kept. This system should be looked at as currently it pays a very small amount of charges and also earns a small amount of interest. This system needs to be reviewed. There are very good management systems in place, supported by good documentation. Regular audits take place throughout all departments within the home. The provider carries out regular 26 visits, copies of their reports are available with the home. Relative questionnaires are also available within the home and tend to be dealt with on an individual basis rather than a quality assurance report being produced. The service and maintenance systems were sampled during the inspection. It was evident that regular audits take place within all of the different departments within Four Season’s Care Centre and there is very good supporting records. Weekly fire checks and regular fire drills take place. Staff also confirmed that mandatory training such as fire, health and safety and moving and handling was on a rolling programme. A copy of this programme was made available and detailed the training and attendance of staff at the training. A full range of policies and procedures are in place and were detailed within the AQAA. Four Seasons Care Centre DS0000063463.V351068.R01.S.doc Version 5.2 Page 23 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 2 X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Four Seasons Care Centre DS0000063463.V351068.R01.S.doc Version 5.2 Page 24 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 OP9 Regulation 13 Requirement Additional measure must be put into place in regard to the medication systems. Regular audits must take place, enabling gaps in recording to be explored and to ensure that CD records are written properly. Regular ongoing competency assessments are also to be introduced. All of this will enhance the safe handling of medication procedures ensuring residents are protected. The use of portable radiators must not be used as these present as a potential risk to resident’s safety. Timescale for action 31/12/07 2. OP19 13 20/11/07 3. OP21 12 (4) a 23 Bath and shower water temperatures must be checked and recorded in line with the Health and Safety Executives recommendations ensuring more safety in these areas for residents. The toilet doors must have locks 31/12/07 fitted, which will promote privacy and dignity for the residents. Four Seasons Care Centre DS0000063463.V351068.R01.S.doc Version 5.2 Page 25 4. OP22 23 Bath seats must have plugs fitted to prevent injury to the resident. This remains outstanding from the last inspection. New staff must not commenced employment until a CRB check has been completed unless there are extenuating circumstances. In these situation staff must have a POVA First check and must work fully supervised. This ensures the protection to residents. 31/12/07 5. OP29 19 30/11/07 Four Seasons Care Centre DS0000063463.V351068.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 OP7 Good Practice Recommendations Residents care plans should be developed further to ensure that appropriate risk assessments and care plans are in place and meet the needs of more complex and challenging residents. The complaints procedure needs some additional information and should include the contact details of the local contracting units and Primary Care Trusts. An up to date refurbishment programme detailing timescales should be available. This should include the refurbishment of bathrooms, shower rooms and toilets within the nursing unit. The skill mix of staff should remain under review to ensure that the appropriate qualification, experience and skill mix of staff are on duty and available to meet the category of care provided at Four Season’s. All new staff who are not qualified to NVQ Level 2 should complete the Induction programme that covers all of the areas as specified within the Skills for Care Induction. The system for managing resident’s personal allowances should be looked at in line with Regulation 20 Care Home Regulations 2001. 2. 3. OP16 OP19 4. OP27 5. 6. OP30 OP35 Four Seasons Care Centre DS0000063463.V351068.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Four Seasons Care Centre DS0000063463.V351068.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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