Inspection on 11/07/07 for Friars Hall Nursing Home

This inspection was carried out on 11th July 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

Friars Hall Nursing Home 19/07/06

Friars Hall Nursing Home 27/02/06

Friars Hall Nursing Home 12/05/05

Friars Hall Nursing Home 07/01/05

Friars Hall Nursing Home 02/06/04

Friars Hall Nursing Home 16/02/04

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

CARE HOMES FOR OLDER PEOPLE Friars Hall Nursing Home Friars Road Hadleigh Suffolk IP7 6DF Lead Inspector Marion Angold Key Unannounced Inspection 11th July 2007 10:25 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 DS0000024393.V348128.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. DS0000024393.V348128.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Friars Hall Nursing Home Address Friars Road Hadleigh Suffolk IP7 6DF 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) 01473 822159 01473 822682 friarshallnursinghome@yahoo.co.uk Mrs Lalitha Samuel Mrs Laura A Hampson Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places DS0000024393.V348128.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th July 2006 Brief Description of the Service: Friar’s Hall is a privately owned care home providing both nursing and personal care to a maximum of 42 older people. The home is located on the outskirts of the small market town of Hadleigh, where amenities such as shops, pubs, church and post office are available. Buses run from the town centre to Ipswich, Colchester and Sudbury towns. The home stands in it’s own grounds at the end of a long gravel drive. It has a car parking area, a garden with some seating for service users and a staff residence where nurses from overseas can be accommodated while they complete adaptation courses to allow them to practice in the United Kingdom. The building is a converted and extended Victorian house, dating back to 1858, with a shaft lift giving access to both floors. There were 30 single bedrooms, 26 with en suite toilet facilities, and 6 double bedrooms (1 with en suite toilet). The premises have been under the current ownership for the last eighteen years. The Service User Guide does not provide full information about fees or charges. DS0000024393.V348128.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection, covering the key National Minimum Standards, took into consideration all recent records and contacts relating to the service, including 23 surveys completed by people living at the home, relatives and representatives and others connected with the home by profession. The inspection also included a visit to the home on 11/07/07, lasting 8 hours. This visit involved speaking with residents, a relative, the manager, owner/provider and staff, as well as a partial tour of premises, observation of care practice and the sampling of records. Of the 23 Standards inspected, 15 were met. The remaining 8 Standards were nearly met. What the service does well: • • • People moving into the home would have a full assessment of their needs and could expect their care to be given according to an individual plan. People’s personal hygiene and presentation was well attended to, in a manner that respected their privacy and dignity. People were offered a choice of menu, with food prepared on the premises, which they enjoyed. Those living at the home or their representatives described the food as ‘varied’, ‘nourishing’, ‘to a high standard’ and ‘very good’. People living at the home benefited from clean and well-presented surroundings, suitable for their needs. People at the home were generally well served by staffing levels. They thought that staff were usually available when they needed them. Management and staff listened to people’s views and acted on them. One person said, ‘I feel the nursing staff will always listen to me and will act upon any concern I may have.’ People could be expected to be well treated and respected. A relative said, ‘The matron and her staff have infinite patience. In over 18 months I have never heard an irritable word or sound in the nursing home’. People used words to describe staff such as ‘caring’, ‘helpful’, ‘friendly’, ‘smiling’, ‘pleasant’ and ‘kind’. • • • • DS0000024393.V348128.R01.S.doc Version 5.2 Page 6 • The management ethos and style fostered positive working relationships and good outcomes for people living at the home. People commented on the home being ‘well run’. What has improved since the last inspection? • • Recommendations made at the last inspection in respect of care planning had been followed. A large porch had been added to the main entrance to protect visitors waiting for the door to be opened. The installation of a telephone entry system allowed the door to be opened remotely and reduce the time visitors were kept waiting. Necessary repairs and refurbishment identified at the last inspection had been carried out and a number of items of worn furniture replaced. Routine fire safety checks were taking place to protect everyone in the home. The home was notifying the Commission of significant events affecting people living at the home (such as serious illness or death), as the Care Homes Regulations 2001 require. Regular meetings were being held to hear the views of people living at the home and their representatives. • • • • What they could do better: • Information about the cost of living at Friars Hall Nursing Home and any additional charges must be included in the Service User Guide as people need these details when they are considering whether the home would be suitable for them. Bedrails should only be used where an actual risk to the person’s safety has been assessed and the use of rails identified as the best way to meet their risk. Care plans should be developed in respect of people’s interests and how they would like to spend each day. One person suggested they had more entertainment and background music. The home must not employ staff or volunteers until all the required checks have been carried out to ensure they are suitable to work in a care setting. DS0000024393.V348128.R01.S.doc Version 5.2 Page 7 • • • • • • Arrangements for mealtimes should be reviewed so that no one who needs support with eating has to wait for help. Staff must have the training they need for their work of supporting people and keeping them safe. The home should consider how to address the difficulty that individuals have experienced communicating with some of the staff, whose first language is not English. 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. DS0000024393.V348128.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 DS0000024393.V348128.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People moving into Friars Hall Nursing Home could expect to do so on the basis of a full assessment of their needs but not to have full information about fees and charges set out in the Service User Guide. EVIDENCE: 10 out of 11 residents who responded to the Commission’s survey said that they received enough information about the home to decide if it was the right place for them. The information provided by the home in the form of a combined Statement of Purpose and Service User Guide covers all key aspects of the service but some details in respect of fees and extra charges that are required by regulation are not included. Such information helps prospective residents decide whether the home is suitable for them. Although the DS0000024393.V348128.R01.S.doc Version 5.2 Page 10 brochure refers to nurses on the staff, it does not make clear under the sections headed Admissions Criteria and Short-Term Care that nursing care is provided. It also does not explain under the section on the qualifications and experience of staff that some people working in the home will be there to complete adaptation courses to allow them to practice in the United Kingdom. Records sampled for three people living at the home showed that a full assessment of their needs had been undertaken. In two cases this was before their admission, for one person, the day after. People professionally involved with the home indicated that the home’s assessment arrangements ensured that accurate information was gathered and that the right service was planned and given to individuals. One assessment and medical history inspected closely matched information given to the inspector by the person concerned, and their relative. More than 6 out of 11 residents, who responded to the Commission’s survey, were not aware of having contracts relating to the terms and conditions of their stay at Friars Hall Nursing Home. However, information provided by the home indicated that everyone had a contract but, in situations, where relatives had taken responsibility for the agreement, residents might not know about it. NMS 6 did not apply to the home at the time of inspection. DS0000024393.V348128.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): 7, 8, 9 and 10. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People could expect their care to be given according to an individual plan, although they were not always fully consulted about how their care was given. Sometimes the dignity and independence of people living at the home is compromised through inappropriate use of equipment or deployment of staff. EVIDENCE: Records sampled for three people included appropriate individual care and risk management plans, monthly evaluations of these plans and daily progress records. Care plans sampled identified individual preferences in respect of daily routines although people spoken with during the inspection did not think they had been involved in formulating or developing their care plan or, in one case, the care plan of their relative. One person’s care plan did not adequately cover their lack of speech or guidance to staff about how to promote good DS0000024393.V348128.R01.S.doc Version 5.2 Page 12 communication. This is an area that management recognised needed further development. Care staff said that key workers had read only access to care plans; it was the role of staff nurses to maintain and update them. They indicated that the main responsibility of key workers was to ensure that people’s wardrobes were tidy and that they had sufficient toiletries. The sample of care plans showed how individual health needs were attended to and monitored, for example, in relation to pressure areas, turning in bed, catheter care, fluid intake, nutrition, weight and wound care. The home’s Annual Quality Assurance Assessment (AQAA) indicated that the home was well served by regular visits from the GP surgery. Professionals involved with the service indicated that the home appropriately monitored and attended to people’s health care needs, seeking and acting upon advice to manage and improve individual health, where this was warranted. Residents, responding to the Commission’s survey, also felt that they received the medical support they needed. A visitor attributed their relative’s improvement since admission to the care they had been receiving. The sample of care plans showed that decisions for people to be supported with medication had been based on a risk assessment. Although, as reported to the inspector, none of the existing residents administered their own medication, management confirmed the practice of maintaining, wherever possible, people’s independence in this area. The experience of professional people working with the home was that the home managed people’s medication correctly, where it was not possible for them to self-administer. One resident, commenting on this aspect of the service, said that they had always been satisfied with the manner in which the home had handled their medication and were content for the home to take responsibility for it. New Medication Administration Records had been introduced since the last inspection. They did not include individual photographs, which help to avoid mistakes of identity. (Care plans also lacked photographic identity.) Sample signatures of the people administering medication were kept separately from the Medication Administration Records, which meant it was not possible to determine at a glance, who had endorsed the records. Staff said that responsibility for medication administration was only given to staff nurses with the appropriate training. Inspection of the medication trolley and discussion of procedures with the person responsible for the administration of lunch time medication, showed good labelling and stock control. The home’s medication policy, reviewed this year, covered the handling of spoiled and refused medication, which had been identified as an issue at the last inspection. DS0000024393.V348128.R01.S.doc Version 5.2 Page 13 It was observed during a tour of premises that most beds were fitted with rails. Risk assessments were in place for these, as evidenced by all three care plans sampled. One member of staff confirmed that nearly everyone had bed rails; they stated that rails were only used on one side in some cases and that they always introduced bumpers to minimise the associated risks. They expressed the view that people would be at risk if they did not have rails because they were not able to manoeuvre themselves when they turned. Management should ensure that bedrails are essential for individual safety and are not used routinely as suggested by the number of people who have them in place. Unnecessary use of bedrails is a form of restraint, which infringes people’s rights and undermines their dignity. Although people in the main dining room were well supported at lunchtime, those in armchairs at individual tables in the conservatory did not have anyone on hand, overseeing their needs. One person had slipped down in their chair and had part of their meal in their lap. (The inspector, who conducted the previous site visit to the home, recorded a similar situation.) The person concerned on this occasion thanked the inspector for alerting staff, who came to move them into a more suitable position for eating. They also washed off the worst of the spills and brought an apron. Instructions to ensure that this person was properly supported at mealtimes were not included in their care plan and the situation they experienced in a communal area did not promote their dignity. The person was still eating their main meal an hour later and the inspector was advised that this was because they would not accept help. Comments from people living at the home and various surveys showed that people’s personal hygiene and presentation were well attended to, in a manner that respected their privacy and dignity. This was confirmed by observation. People living at the home indicated that staff were available to give assistance when needed and that two staff were involved if they were hoisted. People said that they had regular showers but had not been consulted about the timing of these. The home identified in their Annual Quality Assurance Assessment that residents could be more involved in determining how their personal care was given. This would increase their choice and independence. DS0000024393.V348128.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): 12, 13, 14 and 15. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at Friars Hall Nursing Home were able to exercise choice in relation to some key aspects of daily living, including meals, but some lacked the stimulation they would derive from suitable activities or support they needed at mealtimes. EVIDENCE: People professionally involved with Friars Hall, indicated that the nursing home usually supported individuals to live the life they chose, wherever possible; one person stated, (the manager) ‘tries to give individuals care appropriate to their needs’. 6 out of 11 representatives thought the home responded to the different needs of individual people. Care plans sampled identified individual preferences in respect of daily routines and it was evident from discussion with people living and working at the home that people had choice about such things as when they got up or whether they remained in their rooms. DS0000024393.V348128.R01.S.doc Version 5.2 Page 15 During the inspection people in communal areas mainly rested. A number of people remained all day in the same chairs, without a change of location, but management said this was from choice. The television was on in both of the occupied lounges but only a few people were in a position where they might see it clearly. Individuals were observed with a newspaper or knitting or seated where they could look out at the grounds. Although the Statement of Purpose and Service User Guide identified the benefits of 3 acres of grounds, people told the inspector that they were not taken outside. Management said this was not the case but acknowledged that people may not have been out much this year due to very bad weather and a lot of rain. A relative newcomer to the staff team said they had been impressed by the way staff spent time talking with residents and this was confirmed by observation throughout the inspection. People who remained in their rooms showed that they valued their contact with staff on a social as well as a practical level. In consideration of people’s need for stimulation and interest, the home made available a variety of newspapers and had arranged a visiting manicurist and exercise and movement sessions (both fortnightly); aromatherapy and massage, live entertainment and a church service on the premises, all on a monthly basis. The perception of this provision by people living at the home varied considerably. Only 2 residents, who responded to the Commission’s survey, were fully satisfied with arrangements for activities. Two thought the home usually arranged activities they could take part in, 4 thought it sometimes did and 2 said it never did. One person suggested they have more entertainment and background music. Management acknowledged in their Annual Quality Assurance Assessment that there was potential to develop more stimulating activities and they are advised to take a person-centred approach to this to ensure that people can be occupied in ways that suit their personal preferences and needs. The home’s Statement of Purpose and Service User Guide encourages people to visit and stay in contact with their relatives and friends in the home. Since the last inspection a porch had been built onto the main entrance to protect visitors and a telephone entry system installed so that the door could be opened remotely and reduce the time they waited to be let in. All 11 representatives responding to the survey felt they were kept up to date with important issues affecting their friend/relative and those who thought it was applicable to their situation, said the home helped their friend/relative to stay in touch with them. 6 out of 11 residents indicated by survey that they always liked the meals at the home; 3 said they usually did, 2 said sometimes. Care plans sampled DS0000024393.V348128.R01.S.doc Version 5.2 Page 16 lacked information about individual food preferences and dislikes. However, apart from one person expressing a view that the quality and presentation of meals were not quite as good as they used to be, comments received about food were positive. People spoke about a varied menu and being able to have something cooked at every meal. They referred to the chef coming round with the next day’s menu, offering a choice of two dishes with an alternative if neither option were suitable. A relative said how much they had appreciated the home marking residents’ birthdays with a special cake. Information given to new residents, supported by observation, showed that drinks and snacks were available to supplement main meals. Not everyone sat at a dining table for lunch, some people remaining in their armchairs with small tables in front of them. This meant they did not have a change of scene or the movement involved in changing location. However, one resident referred positively to the fact that people were allowed to stay in their rooms for meals, even though this meant more work for staff. A number of staff were on hand at lunchtime supporting people in the main dining area but there was no one to see that a person in the conservatory area had slipped down in their chair and lost much of the contents of their plate in their lap. DS0000024393.V348128.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): 16 and 18. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s complaints and allegations were taken seriously and appropriately handled by the home but not all staff had up to date training on safeguarding adults. EVIDENCE: The procedure for making a complaint was displayed in the home and the Statement of Purpose and Service User Guide emphasised that the home’s operations were open to scrutiny and people would not be disadvantaged for making a complaint. Complaints had been logged in January, February and April this year. Records showed the detail of these complaints, what action the home had taken in response and the outcome of any investigation. One complaint known to CSCI was dealt with in satisfactory manner and not upheld. People completing surveys indicated that they knew how to make a complaint and had been satisfied with the way the home responded to any concerns they or people using the service might have raised. All 11 residents in the survey said that staff listened and acted on what they said. A person professionally involved with the home said, ‘Matron is supportive in listening to any concerns and acting on these with a plan of action’. . DS0000024393.V348128.R01.S.doc Version 5.2 Page 18 Comments and surveys showed that people in the home felt well treated. People used words to describe staff such as ‘caring’, ‘helpful’, ‘friendly’, ‘smiling’, ‘pleasant’ and ‘kind’. One person said, ‘I have no complaints about any member of staff. When I visit, I only see good caring. When I am with (resident) and a member of staff goes by, (resident) always says’ ‘I like her/him’. Well, that’s good enough for me. Another relative said, ‘The matron and her staff have infinite patience. In over 18 months I have never heard an irritable word or sound in the nursing home’. An adult protection referral, made in May 2007, related to a person being strapped in their chair and two people being left unattended and unable to reach their call bells. The person from the Social Services Safeguarding Adults Team that investigated this alert was satisfied that the manager had dealt appropriately with the situation and had been open and constructive in her response. They established that the short-term arrangement to restrain the person had been agreed with their family for their safety, not as a matter of expedience. It was concluded that the circumstances could be explained and the allegation was not upheld. Another professional person indicated that the home had always responded appropriately if they, or a person using the service, had raised any concerns. The manager said that staff covered safeguarding adults in their induction and foundation training, which included reading the home’s related policies and procedures. Among these was a policy on the appropriate use of restraint and the locally agreed Safeguarding Adults procedures. Staff were aware of the requirement to read policies and procedures but they said they had not attended safeguarding adults training and records confirmed this. DS0000024393.V348128.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): 19 and 26. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People, living at Friars Hall Nursing Home benefited from clean and wellpresented surroundings, suitable for their needs. EVIDENCE: Since the last inspection a porch had been built to protect visitors waiting to be let in. A telephone entry system had also been installed so that the door could be opened remotely to improve the response to visitors and reduce their waiting times. Part of the grounds were being landscaped with paths suitable for wheelchair users and seating. The stone paths surrounding the house presented some difficulty for people with poor mobility or in wheelchairs. DS0000024393.V348128.R01.S.doc Version 5.2 Page 20 A person employed to maintain the house and grounds said they were one of a team of 3 full time maintenance personnel. Their work included small decorating jobs but larger projects were contracted out. The home was generally well maintained in the areas inspected, the old and the new sections of the building retaining their distinctive character. Shortfalls identified at the last inspection had been addressed, with new floors laid in the upper floor bathroom and passenger lift, to remove trip hazards. The upper bathroom had also been refurbished and worn furniture repaired or replaced. New armchairs had been provided for the conservatory and the inspector was advised that armchairs in the ‘green lounge’ would be replaced next. During the inspection people living at the home did not use the green lounge. It was not as attractively presented as the other lounge or conservatory and lacked the aspect of the grounds that these rooms offered; it was therefore easy to see why people were said to prefer sitting in the other communal areas. It was noted that televisions were on in both the lounge and the conservatory and people did not have the option of a quiet area unless they sat in the dining room, which did not have comfortable chairs. The green lounge should be upgraded to make it a real alternative to the other communal locations. There was no evidence of doorways being obstructed as at the last inspection. The manager stated that a second visit from the fire safety officer confirmed that they had carried out work necessary to comply with requirements. The maintenance person said they checked fire extinguishers and emergency lighting monthly and sorted out any problems arising from the weekly testing of the alarms by the housekeeper. Bedrooms sampled during this inspection were individually appointed and reflected the personality and interests of the occupants. People commented positively about their rooms. The extensive use of bed rails has been addressed in this report under the heading, Health and Personal Care. Hot water sampled in two bedrooms was at a safe temperature. The home was clean and fresh in the areas inspected. People living at the home confirmed that this was the case either in their surveys or comments to the inspector. Observation, and discussion with people living and working at the home, showed that staff took adequate steps to maintain hygiene and avoid the spread of infection. This included appropriate use of plastic gloves and aprons and hand hygiene. One person said staff usually used an antibacterial preparation on their hands, but the supply in their room had run out. DS0000024393.V348128.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People at the home were generally well served by the home’s staffing levels but were not fully protected by protected by recruitment and training practices. EVIDENCE: Rosters showed that morning shifts were usually covered by 6 care staff, 1 staff nurse and the manager or a deputy. This changed to 5 care staff and a staff nurse for the second shift, with the manager or deputy around for part of it. Two cleaners, a laundry assistant, chef and kitchen staff were employed daily as well as maintenance personnel. There were usually 5 staff on duty at night including a staff nurse. Staff indicated that there were sufficient numbers on duty to enable them to talk with people as they were supporting them and not feel under pressure. They indicated that good working relationships and communication amongst staff helped them make the most of their capacity. Discussion with people living at the home and their surveys showed that, on the whole, they felt that staff were available when they needed them. 5 out of 11 respondents to the survey said that this was always the case; 5 said it was DS0000024393.V348128.R01.S.doc Version 5.2 Page 22 usually so and only 1 said ‘sometimes’. One person said that staff came when they rang the bell; another said there were ‘plenty of staff’. People confirmed that staff checked on them intermittently through the night. The manager said that the nurse call system was sited near her office so that she could monitor how long people waited for help and address any delays. The adequacy of staffing ratios was confirmed by most observation. However, people in the conservatory did not have a member of staff on hand to oversee their lunch and the inspector had to call for help for someone who was struggling. There were a number of staff supporting people with meals in the dining room and one person, who rang from their room for assistance over this period, only waited a 2 or 3 minutes for staff to respond. At the last inspection it was suggested that the home have 2 sittings to ensure that everyone can eat together. The manager advised that 16 people currently need support to eat; it is therefore inevitable under the present arrangements that some will wait for assistance. Records were sampled for two new members of staff. One person had started with all the required checks and documentation in place. The other person’s application form and references post-dated their date of employment by up to a week, although the Criminal Record Bureau disclosure had been completed beforehand. Shortfalls in recruitment procedures for a person starting work in 2004 had not been addressed. Their records did not include an employment history (so that gaps could be explored) or written references. The inspector was advised that the home had carried out verbal checks in respect of a person on a placement from college, whereas police checks and references would be the minimum requirement in these circumstances. People living at the home were positive about the ability of the staff to meet their needs, and their representatives and professional people taking part in the survey, indicated that in the main staff had the right skills and experience to look after people properly. A number of responses to the Commission’s survey and comments received on the day of inspection showed that individuals experienced difficulty understanding and communicating with some of the staff. People said things like, ‘the language barrier is often quite difficult for the elderly to understand’. The home was recruiting nurses directly from abroad to complete their adaptation to work in this country. Training records and discussions with management and staff evidenced that the home was providing a suitable, extended programme of induction for new staff that required them to evidence their learning. New staff described their induction in positive terms and commented on the amount of support they had received from their colleagues and management as they worked through the units of the training. Information sent to the Commission showed that 5 out of 11 staff had achieved the recognised qualification in care (National Vocational DS0000024393.V348128.R01.S.doc Version 5.2 Page 23 Qualification in Care) NVQ Level 2, 1 person was nearing completion and 2 others waiting to commence training. 1 person had achieved Level 3 and 2 were working towards this and the 2 deputy managers had completed the Registered Manager’s Award and were awaiting their certificates. This meant that, discounting staff nurses and adaptation nurses, the home was close to exceeding the minimum ratio of 50 trained members of care staff. Records and information provided by management showed that in the last year 5 staff had completed training in first aid. 5 people had undertaken distance learning courses in infection control and 4 in health and safety. Other staff had not received formal training in these areas but management stated that people who had completed the distance learning training were responsible for training others in the home. Similarly, there was an expectation that the 50 care and catering staff, who had received training in safe food hygiene, would provide instruction to their colleagues. However, this training is given, it is necessary for the home to demonstrate, through evidence of individual learning and competencies, that all staff have received the required level of health and safety training. This also applies in respect of safeguarding adults. Although the topic may be covered by induction training, it was evident from discussion that people who had worked for some time at the home felt they had not covered it specifically. DS0000024393.V348128.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): 31, 33, 35, 36 and 38. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The management ethos and style fostered positive working relationships and good outcomes for people living at the home although their health and safety could be compromised by shortfalls in health and safety training. EVIDENCE: People professionally involved with the home gave positive feedback about management. For example, one person indicated that the home responded well to emergency situations and that the manager was ‘supportive in listening to any concerns and acting on these with a plan of action’. One member of DS0000024393.V348128.R01.S.doc Version 5.2 Page 25 staff commented specifically on the good organisation and smooth running of the home. The home had a robust management structure with the manager, suitably qualified and experienced, supported by 2 deputy managers, each undertaking the Registered Managers Award at the time of inspection. The owner and registered provider, Mrs Samuel also had a strong presence in the home, coming in several times a week, working closely with management and taking an active interest in the people living at the home. This was observed during the inspection. Since the last inspection the home has complied with the Care Homes Regulations 2001, Regulation 37 by notifying CSCI of significant incidents affecting the lives of people living there. Records and discussions evidenced that manager had also introduced regular meetings to hear the views of people living at the home and their representatives. She reported that they had made several changes as a result of listening to people at these meetings, including the new porch and entry system. All feedback received in the context of this inspection showed that people felt that what they said was taken seriously and acted on. Most of the requirements and recommendations arising from the last inspection have been addressed and, through completing the Annual Quality Assurance Assessment, the provider and manager have identified specific areas for improvement. The home held small amounts of people’s personal money deposited with them for safekeeping and to cover incidental expenses. Records, receipts and balances sampled for three people living at the home were in order with some minor discrepancies (additional cash) which management said related to the saving which accrued to people through the bulk ordering of toiletries. Although people were invoiced separately, according to what they had, the discount made on the total order was shared between them afterwards. The manager and provider were advised to ensure that this was always clearly accounted for. Records and discussions showed that staff were receiving appropriate supervision by regular appointment as well as annual appraisals of their work. Staff indicated that they felt well supported by these processes. Health and safety issues identified at the last inspection had been addressed, including matters relating to fire safety. No hazards were noted during the tour of premises. The home’s Annual Quality Assurance Assessment (AQAA) showed that various installations and equipment had been serviced or tested as recommended and this was confirmed with documentary evidence during the site visit. Records showed that, since the beginning of 2006, most staff had attended training in manual handling and fire safety, staff nurses had attended courses on health and safety and first aid, but no one had specifically covered food hygiene or infection control. According to information in the DS0000024393.V348128.R01.S.doc Version 5.2 Page 26 AQAA, only half the staff, including those working in the kitchen, had food hygiene training and only 5 staff had received training on the prevention of infection and management of infection control. DS0000024393.V348128.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 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 3 X 2 DS0000024393.V348128.R01.S.doc Version 5.2 Page 28 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 5A Requirement The Service User Guide must contain information about fees as set out under this Regulation, which people can take into account when making a decision about the suitability of the home. Timescale for action 30/09/07 2. OP29 17 Sched 4 19 Sched 2 13, 18 3. OP30 OP38 Staff and volunteers must not 17/08/07 commence employment until all the checks required by regulation have been completed to make sure they are suitable to work in the nursing home. Staff must have the training they 30/09/07 need to promote the health and safety of people living at the home. 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 Care plans should be developed in respect of people’s DS0000024393.V348128.R01.S.doc Version 5.2 Page 29 OP12 2. OP9 interests and how they would like to spend each day. Photographic identity of people receiving assistance with their medication, and sample signatures of staff authorised to administer medication, should be kept with the Medication Administration Records to safeguard people from mistakes. Bedrails should only be used where an actual risk to the person’s safety has been identified and not as a general safeguard. Staff should be available at meal times in sufficient numbers to ensure that, where necessary, residents are assisted and supported to eat their meals and maintain their dignity. Staff should have periodic training on safeguarding adults so they are fully prepared to protect people living in the home. The green lounge should be upgraded to make it a real alternative to the other communal areas and maximise people’s options. 3. 4. OP10 OP15 OP10 5. 6. OP18 OP19 OP20 DS0000024393.V348128.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 DS0000024393.V348128.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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