Inspection on 04/08/07 for Glebefields Resource Centre

This inspection was carried out on 4th August 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Glebefields Resource Centre 19/09/06

Glebefields Resource Centre 14/12/05

Glebefields Resource Centre 14/12/04

Glebefields Resource Centre 06/07/04

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

CARE HOMES FOR OLDER PEOPLE Glebefields Resource Centre Strathmore Road Tipton West Midlands DY4 0TD Lead Inspector Mrs Cathy Moore Unannounced Inspection 4 August 2007 08:30 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 Glebefields Resource Centre DS0000035175.V347870.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. Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Glebefields Resource Centre Address Strathmore Road Tipton West Midlands DY4 0TD 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) 0121 569 5940 0121 557 7438 Sandwell Metropolitan Borough Council Ms Avril Nott Care Home 19 Category(ies) of Dementia - over 65 years of age (19) registration, with number of places Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. All requirements contained within the registration report of 22 January 2003 are met within the timescales contained within the action plan agreed between Sandwell Metropolitan Borough Council and the National Care Standards Day care provision must not encroach on the facilities, staffing and services provided to residential service users. 19th September 2006 2. Date of last inspection Brief Description of the Service: Glebefields is owned and managed by Sandwell Council. It is registered to provide care to a maximum of nineteen older people who have been diagnosed as having dementia. Glebefields is located in a residential area of Tipton. Local amenities are close by which include; a fish and chip shop, small shops and a library. Adjacent to the home are playing fields. The home has gardens to the front and the rear. Car parking space is available at the front of the home. The home comprises of two floors. Both floors are accessible via stairs or the passenger lift. Communal areas, offices, the laundry, kitchen, and toilets are located on the ground floor. All bedrooms are single occupancy and are situated on the first floor. The senior in charge at the time of the inspection did not know what they weekly charges are for this home. Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on one day by one inspector between 08.30 and 18.30 hours. I carried out a large proportion of the inspection in communal areas where I could observe daily routines and involvement between staff and service users’. During the inspection I spoke to one relative, four service users’ and seven staff. The manager was not on site during the inspection. The inspection took place on a Saturday. I looked at service user records to assess admission processes and care planning. I looked at staff files to assess recruitment and training processes. I looked at medication systems to assess their safety. I looked at service and other records to make sure that equipment is being maintained. I observed breakfast and lunch-time. I looked randomly at the premises, which included; the garden, living areas, dining room, toilets, laundry, kitchen and four bedrooms. What the service does well: The home is owned and managed by Sandwell Council, which means that the home has access to a wide range of support mechanisms. All bedrooms are single occupancy enhancing privacy and dignity. The Home offers a range of different living and day rooms so that service users’ have a choice of where they spend their time. The layout of the home and garden gives the service users’ freedom to wander in an environment that is safe. The rear garden is attractive with plants and trees. It can be easily accessed by a ramp. Visiting times are open and flexible. Service users’ are encouraged to maintain contact with family and friends. Well over 50 of the staff team have achieved NVQ level 2 or above in care, which means these staff, have all been assessed as being competent to undertake their work. I spoke to one relative who wanted me to highlight his views on the home. He told me; “ I go to a number of different homes’ every week as part of my job. This is one of the nicest places I have been in and I have seen a few”. Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 6 Service users’ I spoke to told me the following; “ I’m very contented. Very happy here and satisfied and that’s the truth”. “ Its alright here, good. They really do care for us”. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 Quality in this outcome area is adequate. Not all service users’ have a terms and conditions document that details the correct fee. There has been a recent incidence when a service user was admitted to the home without staff assessing her needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The senior in charge of the home was not able when asked to provide me with the current fee scales for the home. A requirement was made following the last inspection for the home to ‘ ensure that all resident contracts detail the correct fee’. I looked at three service user files and saw that one ( RC) did not have a contract. One (JS) had an unsigned contract which detailed the fee of £467 but the SAC8 on file detailed the fee of £485. The third (JM’s) contract dated 1.6.06 detailed the fee of £447.22. This evidence shows that the requirement made following the previous inspection has not been met. Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 9 I was concerned to discover that one service user (JS) had been admitted to the home without the staff undertaking an assessment to ensure that her needs could be met. A staff member told me; “ She came from another home”. I pointed out that this was not correct as she had been in hospital between being discharged from the other home and being admitted to this one in which time needs could change considerably. It was positive however, to be told by a staff member, even if it was done quite quickly, that another service user had been brought to the home by his son for his assessment to be carried out. This was confirmed in the diary; 31/7/07 “ RC son will be bringing him for assessment”. Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is adequate. Care plans have recently all been produced using a new improved format. However, the home must make sure that all needs are included to keep service users’ safe. There was ample evidence to show that a range of health care professional input is secured. Processes however, do need to be put in place to address incidences where Doctors refuse to visit, which potentially places service users’ at risk Service users’ are treated with respect by the staff and the maintenance of independence is encouraged. This judgement has been made using available evidence including a visit to this service. EVIDENCE: I looked at service user care plans, which have been reproduced recently. Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 11 A lot of time and effort has gone into producing these care plans. The home missed the opportunity however, when producing the care plans to obtain signatures to confirm that they were produced after discussion with the service user or their representative. The front page of the care plan and the ‘Life Map’ have a pictorial theme, the rest of the pages do not. Staff told me about a situation which occurred within the last few days whereby a service users’ skin became sore. As this issue has potential for rapid deterioration I asked if I could have a look at the care plan or written records relating to this soreness. Staff could not provide me with any. I was told that it had been written on a ‘scrap of paper’ but was going to be addressed within the next few days. The ‘next few days delay’ would mean that there was a lack of instruction telling staff what to look for, or what to do, which could place the service user at greater risk. The type of dementia diagnosed for each is not included the service users’ care plan which’ would increase staff understanding of their condition, signs, symptoms and management. I saw evidence to confirm that the service users’ have access to a range of health care services. One service user’s record told me she had been seen by the following; 13.7.07 GP about behaviour, 17.7.07 chiropodist, 18.7.07 Admitted to Edward Street. She had been weighed on 8.6.07, 29.6.07 and 17.7.07 her weights were up or down by a few kilograms. Another file I looked at told me the following had seen the service user; 19.1.07 general surgeon, 19.2.07 continence nurse. I did note that one service user (WW) had refused to be weighed since November 2006. I suggested that a visual tool for weight monitoring should be obtained and used. Staff and service users alike confirmed that the home accesses healthcare services regularly they told me; “ The doctor comes to see me and I have my feet done. “ See the doctor”. “ There are no delays in getting the doctor. All services come”. “ No delays or anything in calling the doctor. The rest of the services come in fairly regularly”. One relative told me; “ I know they see the dentist because they got her some dentures as others were lost when she was in hospital”. I did identify one concern relating to health care access. I saw written on one service users’ medication record ‘ homely remedy’. I asked why a homely remedy was needed and was told; “ We are waiting for the prescription”. I asked why there was a need to wait for a prescription and was told; “ The doctor would not come. The service user was sore so we brought some cream”. I explained that staff may not know what cream was needed and if the wrong cream was used could cause more damage to this persons skin. I discussed this situation with the staff and suggested if there is a problem with a doctor then this should be recorded and reported to the relevant agency. Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 12 This service user whose notes said; “ terminal”, would have gone throughout the weekend without seeing a doctor or at least being referred to a district nurse for assessment and their skin could have deteriorated further. The doctor was contacted regarding this service user before I left the home. Staff told me of a similar incident that occurred whereby a service user had pain. The doctor was requested, would not come to the home and told the staff to give this person a Paracetomol. Although rightly so, the staff challenged the doctor about this he still refused to visit. I discussed this situation with the staff highlighting that in future all incidents should be logged and referred to the appropriate agency to deal with. At the time of the inspection there was no oxygen on the premises and no controlled drugs were prescribed. I looked at medication systems and found some really good practice, which is positive, as this increases service user safety. Equipment is available on site for taking photographs to put on medication records as soon as service users’ are admitted to enhance identification and decrease the chance of giving the wrong person the wrong medication. Medication boxes are all date labelled when first opened to aid audit processes. I carried out three medication audits, all of which were correct. The home has a dedicated medication room where the medication is stored in an approved lockable trolley. Staff spoken to about medications all had good knowledge of what was held in the home. Some improvement is needed however, to increase medication safety further. Care plans are needed where medication is prescribed on an ‘ as needed’ basis such as Promazine and Salbutomol to instruct staff when these medications should be given. There have been occasions lately when handwritten medication records have not be verified as being correct by two staff. A requirement was made concerning this issue following the last inspection. Although improved I saw that there were initial gaps on creams charts that should have been initialled or a code used to confirm administration or other. A requirement was made regarding this issue following the last inspection. Although the majority did have, a number of medication records did not highlight any allergies or no allergies as they should. I observed staff and service user involvement throughout the day. I heard staff giving service users choices where possible examples being; where to spend their time and what they wanted to do and eat. I saw that bathroom and toilet doors were shut when in use to enhance privacy and dignity. I heard staff using service users’ preferred forms of address. Staff were polite to the service users’ and gave them time. Staff told me that they encourage service users’ at all times to maintain independence wherever possible. “ We always encourage that they do what they can for their selves such as choosing clothing and toiletries”. “ Even with feeding, if it takes longer then that is still better”. Glebefields Resource Centre DS0000035175.V347870.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): 12,13,14,15. Quality in this outcome area is good. Daily routines experienced by service users’ matches their expectations. Service users’ are very much encouraged to maintain contact with family and friends. Meals are satisfactory and food is plentiful. This judgement has been made using available evidence including a visit to this service. EVIDENCE: I observed routines during the morning. I saw service users’ appearing in the dining room and lounges at different times. I asked service users’ and staff about daily routines, in particular rising and retiring times and was told the following; “ No one is made to get up if they don’t want to”. “It’s their choice. No-one gets up unless they want to. Some do get up about 4 or 5 but this is because they want to”. “ They don’t get us up, we get up when we want to”. “ Can get up when we want to”. This evidence shows that rising times and breakfast time is flexible around the needs of the service users’. Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 14 I asked service users’ if they had any religious needs or religious needs that were not being met. They told me the following; “ I have no religious needs. I have been to church a couple of times years ago but don’t make a habit if it. If I had to, I would go but I’m not bothered”. “ I do not have any religious needs”. A staff member told me; “ There is a church service once a month. I think that is enough. No one really expresses any religious needs when asked”. A relative said; “ No religious needs. If she ever did she does not now”. During the previous inspection I was told about activity groups that were being planned. These were started and were successful. One project undertaken by service users’ involved art and painting. A high standard of work was produced. The senior on duty showed me a selection of the paintings that had been produced by the service users’. These have recently been enlarged and framed. It is planned that they will be displayed in the dining room. Unfortunately the activity groups have not continued. Staff told me; A group started but has stopped. We would like to see more trips and outings. We do things with them such as videos and dominoes” “ We are hoping to start up the activity groups again soon”. From observation and general conversation it is clear that the staff do try and do activities with the service users’. On the day of the inspection the home had a fete. A number of service users’ were involved in this and made some purchases. One staff member told me; “ We are hoping that some of the proceeds from the fete will be used to take the service users’ to Blackpool”. During the inspection I saw two service users’ doing a ‘table top’ task. Service users told me; “ We have some nice evenings and we always have a good time at Christmas”. “ We have some enjoyable evenings here, singing and things”. “ I love sitting in the garden. I love the garden”. I saw on records that one service user enjoys art work. Review notes read; “ I like the way in which his sudden artistic needs are met”. This service users daily records read; 27.7.07 doing art work’. 22.7.07’ Enjoyed doing some art work’. A dedicated activities person may however, ensure activities are provided more consistently. The home has an open visiting policy. Service users’ are encouraged to maintain contact with family and friends. One service user told me; “ Sundays I go out with my son to Cannock. We have a drink”. A relative told me; “ I am always greeted when I come and am offered a drink”. Service user bedrooms that I looked at held a range of belongings such as pictures and ornaments making them feel homely and personalised. I saw written evidence in one service users’ records to confirm that the home deals with council to ensure that service users’ have the opportunity to vote if they want to. The home has achieved a gold award for food provision and ‘five for life’ recognition, which is very positive. Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 15 The dining room is a large, but pleasant room, which is nicely decorated. I noticed that the ceiling has been repainted since the last inspection and looks clean and bright. The tables were nicely laid with cloths and mats. Menus are available which have been produced in writing. Pictures may enhance the understanding of service users’. A menu board in the dining room displayed the meals for the day this too, was in writing. I sat in the dining room and observed the breakfast time I saw many good practices. I heard staff asking service users’ what they would like to eat and giving them a choice. I saw two staff sitting and feeding service users’ their cereal. Their bread and butter was cut into small pieces to enable them to eat independently. Staff encouraged service users’ to eat and drink. I heard a lot of conversation between service users’ during breakfast, which was nice. Breakfast consisted of a range of cereals including porridge. Hot options were available. One service user had tomatoes and fried bread. Because of the fete the menus for the day had been changed. The senior on duty assured me that service users’ had been consulted with about this. Sandwiches’ were provided at lunch- time and chicken and chips at tea time. When in the lounge I saw that fresh fruit and crisps were available for service users’ to help themselves. Staff told me at the present time no service users’ had any medical conditions that required special diets. Comments made about food included the following; “ The meals could be better. In the afternoons not very varied, sandwiches and soup”. “ Problems with meals at tea time lack of choice”. “ The meals are perfect, lovely. All of the residents like it. It is fresh”. “ No problems, pretty ordinary. Day to day, nothing special”. “ I love my food. If you don’t like something they give you something else”. “ Meals are not too bad”. “ Meals are good we can have different things”. Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 16 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): 16,18. Quality in this outcome area is adequate. The home has written processes for staff to follow concerning complaints and compliments. Complaints procedures have not to date been produced in formats other than writing, which could enhance understanding. A number of incidents have occurred between service users’, involving physical and verbal aggressions, which have not been reported as per Multi-agency procedures or to the Commission as they should have been. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure, which is available within the home. To date this has not been produced in a format other than writing to help increase understanding. I looked at the homes’ complaint recording system. No complaints have been recorded since the last inspection. This evidenced further by information provided by the manager in the homes’ ‘annual quality assurance assessment’. The Commission has received no complaints about this home. I asked service users and staff about complaints and they told me the following; “ I’d see the person in charge”. “ No complaints I would tell them if I did”. “ If it was something I could sort out myself I would, then report to senior”. A relative told me; “ I would go to Avril”. Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 17 I did note when looking at records that the home has received a number of compliments which include; 17.5.07 “ .. thanked Avril and staff who looked after her sister whilst at Glebefields”. 26.7.07 “ To all staff how kind you are looking after my Nan”. These compliments are positive. No allegations have been reported since before the last inspection. I did however, gain evidence from different sources to confirm that a number of incidents have occurred between service users’. It is concerning that the Commission has not been informed of these. I was told that one male service user had episodes of aggression and he had been physical to one female service user (JM) . Although the home referred the male service user to the psychiatrist there was no evidence to confirm that the Commission was made aware of this incident, as they should have been. It must be highlighted that this male service user no longer lives at the home. When looking at records I identified other incidents as follows; 9.10.06 ‘J shout he punched me whilst pointing at S. No marks or injury present’. 3.5.07 ‘ Struck fork in J arm piercing the skin. But no serious injury’. 16.7.07 ‘ J was walking behind another SU when she swung her back and hit other SU in the lower back’. I did not find any evidence to confirm that staff have received challenging behaviour training. The physical intervention policy has to date not been finalised. As incidents are occurring in the home these issues must be addressed to reduce the risk of harm to service users’. Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 18 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): 19,20,24,25,26. Quality in this outcome area is good. Although the home still has some decorating and replacement needs in general it is well maintained, comfortable, homely and clean. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection a lot of maintenance work has been carried out in the home. A number of bedrooms have been redecorated and have been provided with laminate style flooring. Hallways and landings have been redecorated and new chairs have been purchased. This work and these purchases have enhanced the comfort of the home. I did observe however, that lounge chairs are quite low and some service users’ had some difficulty getting out of them. Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 19 I saw that most toilets on the ground floor were lacking toilet seats. When I asked about this the person in charge told me; “ They keep breaking. The manager has ordered some new raised seats complete with frames. These should be stronger and will increase safety as well. The home still has some maintenance needs the toilets and bathrooms in the home still need to be redecorated. The carpet on the landing has seen better days. I was told by the senior on duty that these issues are being addressed bit by bit. The home has very generous living areas. It offers a dining room and four separate lounges on the ground floor as well as additional quite, seating areas in different locations. On the first floor there are two other lounges. One of which is being considered to use as a bar. All of the living areas are nicely decorated, comfortable and homely. The living areas enable full freedom to service users.’ They can walk around all parts including the garden. The home also has a good-sized fully equipped hair dressing salon, on the ground floor. The home has a good size rear garden, which is accessible and safe. I looked at four bedrooms, whilst these were all comfortable and safe in that they were well decorated and three of the four nice laminate style flooring, radiators were guarded and wardrobes were secure. I did not that there was no wardrobe in one bedroom. The persons clothes were stacked on a surface. I was told that this is in hand and the family are fully informed. I asked service users’ what they thought about their bedrooms and was told; “ Pretty average”. “ I like my bedroom”. I noted that the radiator in the kitchenette area on the first floor has still not been guarded. It is however, protected as there is a bolt on the door. However, the door can-not always be shut so to prevent any risk the radiator should be guarded. The home employs dedicated domestic and laundry staff. I saw that the home clean. I did not identify any unpleasant odour. One relative told me; “ There is never any smell in here like some places”. Toilets and bathrooms were provided with protective clothing to reduce the risk of infection spread. The laundry is separated into two areas to segregate clean and dirty washing. It has commercial style washing machines and tumble dryers. Red disposable bags are provided for soiled laundry to minimise handling and prevent infection spread. Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 20 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): 27,28,29,30. Quality in this outcome area is adequate. The home has experienced problems with staffing over recent months due to sickness and vacancies, which has had an impact on the home. Well over 50 of the care staff team have achieved NVQ level 2 or above. Recruitment processes are satisfactory, processes are in place for the induction of new staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has experienced problems recently due to staff vacancies and sickness the manager highlighted this shortfall in her annual quality assurance assessment. To cover staffing in the home some staff have worked extra shifts, casual and agency staff have been used. It is appreciated when three staff are off sick and there are a number of vacancies that this situation may be difficult to manage. The home has tried to use agency staff and casuals that have worked at the home for some time and are familiar. However, at times the cover is not suitable as follows; on one occasion one permanent staff member was on shift with two new agency staff, which would make meeting the service users’ complex needs difficult. That agency staff are not always adequate is evidence by the following which was written in the communication book; ‘. sent off premises last night due to reluctance to assist residents with personal hygiene. Watching TV and using mobile phone’. Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 21 Obviously the home dealt with this situation but at that time the meeting of service user needs may have been compromised. Some staff are working double shifts which may present health and safety implications. It must be highlighted that two new staff have been appointed. Both of these are ‘casuals’ at the present time and know the service users’ well. Morale amongst staff seems quite low at the present time. One factor could be the present staffing situation. Positive comments were received about the staff in general as follows; “ The staff are always polite”. “ Staff are nice”. “ The staff are very good”. The home has a good NVQ attainment levels. Information provided shows that 9 of the 13 care staff have achieved NVQ level 2 or above. This means that 62.9 of the care staff team have been assessed as being competent to carry out their work. I looked at two staff files and found these to be satisfactory each held a photo, application form, references and evidence of a Criminal Records Bureau check. The Council has it’s own in-house induction programme which staff attend over a two week period. Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 22 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): 31,33,35,38. Quality in this outcome area is good. The Commission as a fit person to be in charge of the home has approved the manager. Service users money is safeguarded by the homes procedures. Some development concerning health and safety health is needed to increase safety in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for a number of years. The Commission as a fit person to run and be in charge of the home has approved her. One relative told me; “ Avril is very good”. Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 23 The home has been accredited to ISO 9002. This quality award is externally accredited. In general the homes internal audits are mostly up-to-date. I was told than a few audits are a bit behind but this is being addressed. The home has good processes in place to ensure that service user money is safeguarded. Money is held in a safe. All money is held in individual envelopes, which are signed by two persons and then sealed. The contents of the safe are checked at the start and end of each shift. I checked three service user monies. All were correct against balances. Two signatures verified all transactions. Receipts for expenditure were also available. I checked a number of certificates and records to make sure that appliances and equipment is being tested as it should be and found the following: Fire risk assessment dated 22.5.07. Fire alarm tests 7.6.07, 21.6.07, 10 and 13 .7.07 Emergency lighting test 11.7.07. The fire extinguishers were tested on 22.6.07. I looked at service records and other checks and saw fire drills had been carried out on 2.4.07. Another fire drill is probably due now Fire training was carried out in March 07, which 13 staff attended. This probably needs to be carried out again as more than 13 staff are employed by the home. The manager confirmed in her annual quality assurance assessment that training is difficult to secure. Names are put forward but places are not being offered. This situation needs to be addressed. Staff I spoke to confirmed that all of their mandatory training was up to date they must have been ones that have been accepted for training. Kitchen: The kitchen was less organised than usual this may be due to the fact that different staff are covering some kitchen shifts or additional workload due to the fete. I was pleased to see that temperatures of freezers, fridges and hot food are being taken and recorded. I did see that some of the ingredients such as flour have been removed from their original packaging and put into steel containers without the use by date being transferred. Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 24 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 2 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 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 2 17 x 18 2 3 4 x x x 3 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 25 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(2) Requirement The registered person and manager must ensure that where medication records are handwritten two staff sign to verify that the information written is correct. Timescale of 01/10/06 not fully met. 2 OP9 13(2) 15/08/07 The registered person and manager must ensure that each medication record is signed immediately after medication has been administered. Timescale of 01/10/06 not fully met. Mainly regarding prescribed creams. 3 OP9 13(2) Care plans must be in place for all medications prescribed on an ‘ As required’ required basis. This requirement has been made to reduce the risk of harm to service users’. 10/08/07 Timescale for action 15/08/07 Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 26 4 OP18 13(6) All untoward incidents involving service users’ must be reported to the CSCI and to the appropriate person identified by the Local Authority as being responsible for safeguarding processes. This requirement has been made to reduce the risk of harm to service users’ and keep them safe. This was highlighted during the inspection to the senior on duty to inform the manager. 10/08/07 5 OP25 13(4)(c) The registered provider and manager must ensure that the radiator in the first floor kitchenette is guarded. Previous timescales of 01/02/06 and 01/11/06 not met. Adequate staffing must be provided at all times to prevent risk to service users. This requirement has been made to reduce the risk of harm to service users’ and keep them safe. This was highlighted during the inspection to the senior on duty to inform the manager. 01/09/07 6 OP27 13(4)(c) 10/08/07 Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 27 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 2 Refer to Standard OP1 OP2 Good Practice Recommendations Service user guide should be produced in formats appropriate to the service users’ to aid understanding. The up to date fee range for any given year should be available within the home. All service user contracts should detail the correct fee for any given year. All service users should be assessed before they are offered a placement at the home. Evidence should be available to confirm that service users’ and their relatives were involved in care plan production. All needs must be contained in care plans including recent physical changes and more emphasis on specific dementia types. Where service users’ continually refuse to be weighed an alternative means of weight monitoring should be identified. All staff should receive accredited medication training. Menus should be produced in formats appropriate to the service users’. Complaints procedures should be produced and displayed in formats appropriate to the service users’. All staff should receive violence and aggression training. The exterior of the building, toilets and bathrooms are in need of redecoration. Consideration should be made to providing a walk in shower in the home. Quality audits must be all up to date. 3 4 5 6 7 8 9 10 11 12 13 OP3 OP7 OP7 OP8 OP9 OP15 OP16 OP18 OP19 OP21 OP33 Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Halesowen Office West Point Mucklow Trading Estate Mucklow Hill Halesowen B62 8DA 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 Glebefields Resource Centre DS0000035175.V347870.R01.S.doc Version 5.2 Page 29 - 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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