Inspection on 30/10/07 for Glebelands

This inspection was carried out on 30th October 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Glebelands 13/02/07

Glebelands 06/02/06

Glebelands 13/09/05

Glebelands 28/02/05

Glebelands 08/06/04

Glebelands 20/02/04

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

CARE HOMES FOR OLDER PEOPLE Glebelands Woolf Drive Glebelands Road Wokingham Berkshire RG40 1DU Lead Inspector Mike Murphy Unannounced Inspection 30th October 2007 11:00 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 Glebelands DS0000011356.V348743.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. Glebelands DS0000011356.V348743.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Glebelands Address Woolf Drive Glebelands Road Wokingham Berkshire RG40 1DU 0118 979 0669 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) glebelands@ctbf.co.uk Cinema & Television Benevolent Fund Mr Stephen William Harold Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Glebelands DS0000011356.V348743.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - (OP) The maximum number of service users to be accommodated is 26. Date of last inspection 13th February 2007 Brief Description of the Service: Glebelands is a care home providing personal care and accommodation for up to twenty-six older people, the majority of whom have worked in the cinema and television business. It has been in operation since 1936, and is owned by the Cinema and Television Benevolent Fund. Glebelands is a large converted house dating from 1897, and is located within the remaining eight acres of a previously larger estate. The house has been extended over the years and is within a short distance of the shops and other amenities of Wokingham town centre. The house did not meet the environmental national minimum standards; work on redeveloping and modernising Glebelands has continued through 2007, and it is anticipated that on completion the home will provide 15 additional places and exceed the standards. While that work was in progress the home relocated to temporary accommodation in an adjacent building (to be a supported living complex). At the time of this inspection modernisation of the former home was near to completion and it was expected that residents would move back into the improved and enlarged accommodation in November 2007. The current fees for the service are £465 per week. Glebelands DS0000011356.V348743.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector in October 2007. The inspection included a whole day unannounced visit to the service, discussion with residents, staff, managers and a visitor, examination of documents (including care plans and personnel files), perusal of the organisation’s website, consideration of information supplied by the registered manager in advance of the inspection, a tour of the building, and consideration of views of the service communicated by residents, relatives and staff through questionnaires returned to CSCI. The inspection was carried out towards the end of a year of considerable change for the home. The registered manager and matron had not yet been in post for a year, a number of new staff had been appointed over the course of 2007, the home was about to move back to its former - and now much improved and enlarged - accommodation, and it was in discussion with the CSCI Registration office with regard to its intention to provide care with nursing for residents in the near future. The inspection finds that residents report a very good level of satisfaction with the service provided, that visitors find the home welcoming, and that a good level of job satisfaction is experienced by staff. The home has systems in place for assessing the needs of prospective residents. In some cases these are supplemented by the care management processes of Wokingham Council. Residents who accept the offer of a place have the opportunity of a short admission to assess whether they feel the home will meet their needs. A registered nurse acts as a key worker for each resident and is responsible for the formulation of a care plan to meet the resident’s needs. The home liaises with local healthcare services as required. Three activity co-ordinators organise an ongoing programme of activities and outings – a particular strength of the service which supports residents psychological and social well being. Staffing levels have improved throughout 2007. However, an oversight in the recruitment process reflects a weakness in systems which needs to be addressed. The home’s approach to staff training is positive and should support staff to develop in line with the planned direction of the service when it moves to its improved and larger premises. Overall, this home is providing a good quality service which is valued by residents and their families. What the service does well: Glebelands DS0000011356.V348743.R01.S.doc Version 5.2 Page 6 Prospective residents are provided with information about the home. The home only admits residents if it can meet their needs. Residents health and social care needs are identified and met. There were no particular religious or cultural needs provided for at the time of this inspection but the service would endeavour to accommodate any if needed. The home was said to have a real “family” feel. Visitors are made to feel welcome in the home. Residents benefit from an active programme of activities and outings which reflect the value the home places on this aspect of its service and contributes towards the well being of residents. The home is well staffed to meet residents needs. Staff receive appropriate training to carry out their duties in meeting residents needs. Residents views are sought on a regular basis to inform the development of the service. What has improved since the last inspection? What they could do better: Ensure that staff appointments, without exception, conform to fully to the Regulations. This will protect residents from the appointment of staff unsuited to work in such a setting. It was suggested that the home should update its website so that prospective residents are informed of the facilities at the home. Please contact the provider for advice of actions taken in response to this Glebelands DS0000011356.V348743.R01.S.doc Version 5.2 Page 7 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. Glebelands DS0000011356.V348743.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 Glebelands DS0000011356.V348743.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of prospective residents are assessed by experienced staff prior to admission on a permanent basis. This process aims to ensure that the home is able to meet the person’s needs and that the prospective resident and their family are comfortable in accepting the offer of a place. The home does not offer intermediate care, therefore standard 6 does not apply. EVIDENCE: The home has recently revised its statement of purpose, before returning to its former, now modernised and enlarged, accommodation. The home accepts referrals from, or on behalf of, people who qualify for a place in accordance with the organisation’s aims as a registered charity, and Glebelands DS0000011356.V348743.R01.S.doc Version 5.2 Page 10 through Wokingham Borough Council Social Services department. Applications are made through the organisation’s Welfare Department offices in Central London. Papers to be completed at the time of application include an application form, a care report and a medical report. Supplementary information is also required. In the case of referrals from the local authority this will include a copy of the community care plan for the person. Consideration of the application will usually include a meeting between the registered manager and the matron and the prospective resident and his or her family. Where possible, this will include a visit to the home by the person or their representative. The referral and assessment process may also include a visit to the person at their current place of residence (such as a hospital) by the registered manager or matron. Where the referral is progressed arrangements are made for the admission of the person for a two-week “respite care” stay. During this time a comprehensive assessment of needs is carried out by staff. At the end of the time both parties meet and decide whether the home can meet the person’s needs. In the case of local authority referrals a review is held after six weeks. Where an offer of a place is made and accepted then permanent admission is agreed. All residents are registered with a local GP practice and specialist NHS services are accessed through the GP. The statement of purpose includes references to ‘independence’, ‘civil rights’, ‘choice’, ‘daily life’ and ‘staffing’, aimed at ensuring that the equality and diversity needs of residents are respected and taken account of. The home’s arrangements for staff recruitment, training and development aim to ensure that residents are cared for by appropriately selected, trained and supervised staff. This inspection visit included discussion with a resident who had recently been admitted and with the resident’s son who happened to be visiting at the time. Both were complimentary about the quality of the service, had no reservations about the decision to accept the offer of a place, and were confident that the service could meet the resident’s needs. The relevant paperwork was said by the registered manager to be with the organisation’s London office for processing. The registered manager said that this situation was likely to change in the future with improved IT systems which should obviate the need for referral, assessment and admission papers to be separated from the resident’s files. Glebelands DS0000011356.V348743.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comprehensive care plan is in place for each resident. Care plans include risk assessments and evidence of liaison with other healthcare professionals. Care plans aim to ensure that peoples’ needs are met and that their independence is supported as far as possible. Arrangements for maintaining the privacy and dignity of residents are satisfactory. EVIDENCE: A care plan is in place for each resident. Care plans comprise two sets of documents. A folder for storing care records which are not current and correspondence, and the current care plan. Papers in the former are loose filed and it would be advisable to consider some form of binding to avoid misfiling or loss of such documents. A key worker is responsible for the co-ordination of care. This role is carried out by registered nurses supported by healthcare assistants. Glebelands DS0000011356.V348743.R01.S.doc Version 5.2 Page 12 The four care plans examined on this inspection were comprehensive. The structure and content of care plans was being reviewed and those examined included documents from different versions. Each version had its strengths and weaknesses in terms of its structure, and the quantity and quality of the information recorded. It was felt that some of the newer documents had a nursing and clinical bias. While that may be necessary in a service which is intending to provide nursing care it is important that it does not displace without replacement those documents currently in place for recording psychosocial aspects of care – an area in which the home is currently strong. This concern was discussed with managers towards the end of the inspection. Care plans include basic information on the person. They include an assessment of needs including those relating to the activities of daily living (such matters as nutrition, mobility, sleep, elimination, sight, hearing (among others)), condition of skin, prostheses, and risk assessments. An appropriate nutritional screening tool has yet to be agreed. Residents are weighed regularly. Some care plans included a very useful form for noting the person’s likes and dislikes. Risk assessments include moving and handling, falls, pressure sores, managing medication, negotiating obstacles, and in some cases, any risks associated with the person’s participation in activities. It was reported that no resident had pressure sores at the time of this inspection. The information above forms the basis of the plan of care. This includes identification of the problem (the area in which the person requires assistance), the care objective, the ‘nursing intervention’ required towards attaining that objective, and review. Progress notes are made daily and care plans are reviewed monthly. All residents are registered with a GP. The GP carries out a routine visit every Wednesday. At the time of this inspection visit all residents were said to be independent. This will change when the home’s registration status is reviewed and it is able to provide nursing care. The new home is reported to be well equipped to meet the needs of more dependent residents. NHS specialist services are accessed through the person’s GP. There is a “drop-in” hearing clinic at the Royal Berkshire Hospital in Reading. Opticians and dentists are available in Wokingham. A chiropodist will be available three days a week. A visiting district nurse expressed confidence in the new managers and said that there had been real improvements in the home over the last six to nine months. Medicines are prescribed by the resident’s GP and are dispensed by Boots chemists in Bracknell. Staff practice is governed by the organisation’s policy which was reviewed in 2006. Staff training is provided through Boots chemists and through Wokingham Council’s ‘STRIVE’ training project. Only registered nurses administer medicines. Arrangements are in place for residents to Glebelands DS0000011356.V348743.R01.S.doc Version 5.2 Page 13 administer their own medicines if desired. Facilities for the control and storage of medicines appear satisfactory and include a portable metal trolley and a refrigerator for medicines requiring cool storage. The home’s arrangements were audited by a pharmacist in October 2007. A written report with recommendations was made and a senior nurse said those were being addressed. The medicines administration records (‘MAR’ charts) of four residents were examined on this inspection. Each had a photograph of the resident. No gaps were noted. Handwritten entries are countersigned by a GP on their next visit. It may be advisable in the meantime, for two staff to countersign such entries. Arrangements for maintaining the privacy and dignity of residents are satisfactory. All rooms are single. Medical examinations are carried out in the person’s own room. Personal care is carried out in the person’s room or in a bathroom. Glebelands DS0000011356.V348743.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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides care and support to residents with a wide range of needs. Residents’ wishes are respected and daily activities promote choice and independence and a diverse and stimulating environment. Menus offer a varied choice of meals and meals are taken in a social atmosphere. EVIDENCE: Residents were in touch with their families. Residents are not obliged to participate in activities. A list of ‘likes and dislikes’ are recorded in some care plans. This is a useful document but it was unclear whether it would be retained as care plan documentation is changed to meet the more detailed requirements of a care service which provides nursing. The home has a part-time activity co-ordinator and two part-time assistant coordinators. These are excellent levels of staffing which reflect the value placed on social activity and the benefits of this for residents. The activity coordinators organise a range of activities, details of which are listed in the diary Glebelands DS0000011356.V348743.R01.S.doc Version 5.2 Page 15 for the month. This is supplemented by pictures and posters on notice boards. An album of photographs of a range of events was on display in the home. The activities include events in the home and outings to places of interest. In September and October 2007 the diary included quizzes, hairdressing, ‘manicures, nails and facials’, a ‘cinema club’, PAT dog visits, walks out, mobility classes, a poetry reading, and trips to a garden centre and a shopping village. Residents may have visitors at any time and are able to see their visitors in private if they wish. One visitor commented on the friendly and welcoming atmosphere of the home. The home’s statement of purpose states that the home will aim to ‘Provide meals which contribute a wholesome, appealing and balanced diet in pleasant surroundings and at times convenient to the residents’. In response to a question on the subject during the course of this inspection residents described the food as “All Right” with two adding that it must be difficult to please such a large number of people at all times. In answer to the question ‘Do you like the meals at the home?’ in the CSCI survey a resident ticked ‘Sometimes’. Residents may influence the menus at the quarterly meetings. However, some reservations appear to have been expressed on this inspection and it might be advisable for managers to seek residents’ views of meals at other times as well. Catering staff have prepared meals from a temporary kitchen while the main home has been refurbished. It is noted that appreciation of the work of the catering staff in maintaining the service while the lift was recently out of order was expressed at the October 2007 residents meeting. At the time of this inspection visit residents had meals in the dining room. This seemed to be a pleasant social occasion. Staff provided assistance to residents where required. Choices from the lunch menus included: (Friday) Carrot and Coriander soup or Avocado Vinaigrette, followed by Deep Fried Haddock or Cottage Pie accompanied by vegetables, with a dessert choice of Apricot Crumble, Fresh Fruit Salad or Cheese and Biscuits ; (Wednesday) Celery Soup or Garlic Mushrooms, followed by Pork and Sage Pie or Plaice and Basil Tomato Sauce accompanied by vegetables, with a dessert choice of Crème Brulee, Fresh Fruit Salad, Ice Cream or Cheese and Biscuits. A roast is usually available on Sunday (there is a fish dish as an alternative). Water is available on the table as required. Tea and Coffee is available at all meals. Residents appeared happy living in the home and confirmed that there were always activities available and that they were not obliged to participate if they did not want to. A number of people said it was a friendly place, one resident described the staff as “wonderful” and said that they would try to accommodate residents wishes wherever possible. Residents were Glebelands DS0000011356.V348743.R01.S.doc Version 5.2 Page 16 complimentary about the manager and the matron and two people contrasted the home favourably with other homes in the area. Two respondents to the CSCI survey carried out in connection with this inspection mentioned problems in communication with families on occasions. Glebelands DS0000011356.V348743.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, 17 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a policy and procedure for investigating complaints. It has a framework of policy, reporting arrangements and staff training with regard to the protection of vulnerable adults (POVA). Together, these aim to protect people from abuse and to ensure that complaints are properly investigated. EVIDENCE: The statement of purpose in its section on ‘Complaints and Protection’ states that procedures are in place to ‘Prove and when necessary operate a simple clear and accessible procedure’ (it is assumed that it means to ‘provide’), ‘Take all necessary action to protect residents’ legal rights’, and ‘Make all possible efforts to protect residents from every sort of abise and from the various possible abusers’. The complaints procedure is outlined on page 4 of the ‘Residents’ Guide’. The procedure states that complaints may be made orally or in writing to the manager of the home. It promises a prompt investigation and an outcome within 28 days. It says that if the complainant remains dissatisfied then they may complain to the Executive Director of the Fund and provides contact details. Glebelands DS0000011356.V348743.R01.S.doc Version 5.2 Page 18 Slightly misleadingly it says that ‘External avenues for a complaint if no satisfaction achieved at previous levels are….’ And goes on to provide contact details for CSCI in Oxford and Age Concern in Wokingham. In fact a complainant may refer their complaint to CSCI at any stage should they wish to do so. The same would apply to a person who seeks independent advice or support from an advocate. Neither necessarily come into play until the internal processes of an organisation have been exhausted. For residents sponsored by a local authority the contact details for the relevant department in that authority would also be helpful. CSCI has not received any complaints about this service since the last inspection. Residents names are included in the annual return to the Electoral Registration office to ensure that they do not lose the right to vote in an election. Managers said that no resident had recently had cause to contact an advocacy service because all were in touch with their family. If advocacy were required then the resident would be given contacts details for Age Concern in Wokingham. As stated above this information is included in the service users’ guide. Staff spoken to during the course of this inspection were aware of the need to report concerns to managers and expressed confidence in managers to investigate any such reports. 12 of 30 staff had attended local external training on safeguarding vulnerable adults. Managers said that more staff will attend further training events as they arise. The organisation has a policy on the subject of safeguarding vulnerable adults and has an informative folder in the staff office which includes relevant guidance on the subject, including the Berkshire joint agency policy. Glebelands DS0000011356.V348743.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides an accessible, clean and well-maintained environment which offers residents a comfortable and safe place to live. EVIDENCE: The home is located in a quiet residential area, a short distance from Wokingham town centre. There is plenty of parking in the grounds. The nearest rail station is Wokingham (just over one mile distant) and the town is served by buses. The home forms part of a larger complex of accommodation run by the Charity. This includes housing, flats for supported living and the care home. The home is located in extensive grounds which according to the Charity comprise ‘…a rose garden, 8 acres of rolling lawns, mature trees…’. All this Glebelands DS0000011356.V348743.R01.S.doc Version 5.2 Page 20 was not visible at the time of the inspection because of the work associated with the development of the complex and in particular of the main home. At the time of this inspection at the end of October 2007 the home had been in its temporary accommodation for about one year. During the course of that time the main home had been completely refurbished. When completed, the modernised accommodation is expected to fully meet the standards and to provide a standard of accommodation and equipment which meets the needs of residents requiring nursing care. The move was expected to take place in November 2007 – a few weeks after the inspection visit. For that reason, therefore, this inspection did not include a detailed assessment of the accommodation. The temporary accommodation consists of a number of self-contained flats. The flats were built to provide a supported living complex and will revert to that use when the care home moves back into its own accommodation. A corridor will link the two blocks of accommodation. The accommodation is located over three floors and the flats have been adapted for temporary use as a care home and staff offices. All areas of the home are accessible to a person in a wheelchair. There is a lift and stairs to all floors. Each flat includes a bedroom, kitchen, living room and bathroom/WC. There are communal rooms on each floor and other areas of seating in the lobby and other areas on each floor. The accommodation is relatively new and is of a good standard. It is pleasantly decorated and all areas were noted to be clean and tidy on the day of the inspection visit. Bedrooms seen were of a good size and comfortably furnished. The building appeared to accommodate the needs of the current residents quite well. Meals are taken in the dining room. Residents relax in their own rooms or in the lounge. The building accommodated a range of activity throughout the day. The current temporary building does not have any specialist adaptations for the needs of more dependant residents. These were not required at the time of this inspection. The registered manager and matron said that the modernised accommodation has been planned with the needs of resident’s requiring nursing care in mind and is well equipped. Adequate laundry facilities are in place and according to the registered manager the number of housekeeping staff has doubled since April 2007. Glebelands DS0000011356.V348743.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels and skill mix are good. Procedures for the recruitment of new staff are generally thorough and staff have access to a range of training and development opportunities. These aim to ensure that there are sufficient numbers of appropriately trained and supervised staff to meet residents needs. However, weaknesses noted in staff recruitment procedures could pose a risk to residents. EVIDENCE: Current staffing includes: the administrator, the registered manager, the matron, three part-time activities co-ordinators, a chef manager, a cook and six catering assistants, two maintenance staff, registered nurses and care staff, a house keeper, laundry assistant and domestic assistants. In terms of direct care to residents, this provides for 2 RGNs and 6 care staff in the morning, 1 RGN and 4 care staff in the afternoon and evening, and 3 care staff at night. A copy of the duty rotas for two weeks (February 2007 and October 2007) were provided for this inspection. Glebelands DS0000011356.V348743.R01.S.doc Version 5.2 Page 22 The registered manager, the matron and a senior RGN provide an out of hours on-call service on a rotational basis. A number of care staff are currently registered on NVQ courses at L2 an L3 at Thames Valley University. The home had not quite met the 50 target required under standard 28 but expects to do so by March 2008. Staff recruitment is managed from the home. Vacancies are advertised in local newspapers. Enquirers are sent an information pack, Applicants are required to complete an application form, provide details of previous employment and two referees and those short-listed are required to attend an interview. Successful candidates are required to provide an Enhanced CRB certificate. Offers are subject to satisfactory references and an Enhanced CRB certificate. The home does not employ volunteers. Four personnel files were examined in the presence of the registered manager and checked for conformance to Schedule 2 of Regulation 19. In administrative terms the files were in very good order. However, none of the four files contained a recent photograph. All four contained an application form and two references. Three of the four contained either an Enhanced CRB certificate or ‘POVA First’ obtained prior to the person taking up post. In one case the person appeared to have taken up post three weeks before a POVA First was received. The manager acknowledged the oversight and its significance in this case. Files of RGNs included a photocopy of the nurses Nursing and Midwifery Council (NMC) ‘PIN’ (Personal Identification Number) but did not have a dated and signed note stating that these had been confirmed with the NMC with regard to current registration status. The manager said that the home would routinely carry out such checks. Skills2Care had carried out a training needs analysis earlier in 2007. The results were provided on an individual basis and in aggregate form for the home as a whole. This identified strengths and weaknesses in staff training and gaps where action is needed. A summary report was provided to managers and forms the basis for the homes training programme for the next twelve to eighteen months. The matron said that Skills2Care were of the view that the home’s induction programme for care staff meets the Skills for Care Common Foundation Standards. This is supplemented by a more general induction programme. The home expects to continue to support care staff on NVQ programmes. Training attended by staff between June and October 2007 included: ‘Introduction to Dementia’, ‘Common Infection Control’, ‘Medication’, ‘Safeguarding Vulnerable Adults’, ‘Food Hygiene’, ‘Manual Handling’, ‘Fire Glebelands DS0000011356.V348743.R01.S.doc Version 5.2 Page 23 Safety’, ‘Emergency Treatment’, ‘Epilepsy Awareness’, and, ‘Mental Capacity Act (2005)’. Details of training events in ‘Infection Control and Health Protection’ run in 2007 by the Berkshire Health Protection Team were supplied. A senior RGN has been nominated the lead nurse for infection control within the home and acts as liaison between the home and other agencies on matters relating to infection control. Staff were positive in their views of the home and acknowledged the work of the registered manager and matron in improving teamwork and investing in staff development. The home was described as a friendly and caring place to work with good standards of practice. Glebelands DS0000011356.V348743.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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is a well managed home which has arrangements in place for consulting residents. Residents should benefit by having their views taken into account and through having some influence on the service provided. Arrangements for health and safety are satisfactory and aim to ensure the safety of residents, staff and visitors. EVIDENCE: At the time of this inspection the registered manager has not been in his current post for a year. The registered manager has previous experience of Glebelands DS0000011356.V348743.R01.S.doc Version 5.2 Page 25 managing a care home. He has acquired an NVQ4 in care and the registered managers award (RMA). The matron had been in post since April 2007. The matron is an RGN and has had many years experience in NHS services. Line of accountability within the organisation are clear. The home has been in its temporary accommodation for the past year or so and there have been significant changes in management and staffing during this time. The Welfare Team at head office are normally responsible for conducting resident surveys. An annual survey had not been carried out over the past year but it is expected that this activity will be resumed once the home settles back into the main home. Quarterly meetings are held between residents, relatives and Trustees. The manager said that the chief executive is often around the home for chats with residents. The head of welfare who is based in London holds a monthly meeting to discuss welfare and benefits matters with individual residents. The notes of a meeting with residents held in October 2007 were made available for this inspection. There has been a significant investment in extending and improving the quality of the accommodation and staff levels over the past year and residents will benefit from this when they move back there in November 2007. Policies and procedures are regularly updated. The home looks after some monies for around seven residents. This process is managed by the administrator. All transactions are recorded. The arrangements include provision for the home to purchase items for residents from petty cash and reclaim the money spent from relatives. Details for two residents - including cash balances – were checked on this inspection and found to be correct. It is expected that the number of people using this service will increase in line with the planned number and dependency level of residents. While the present arrangement work well for a small number of residents they may need to be reviewed as the service develops over the next year or so. Nurses and care staff have personal supervision quarterly. The home aims to increase this to six times a year once things settle down after the move. Arrangements for health and safety appear satisfactory. There is a health and safety policy (reviewed in 2007) and a health and safety committee. The registered manager is a moving and handling trainer. Staff have received fire training. Staff attend training in first aid provided by Wokingham Council. Training in food hygiene is provided at two levels: external training for catering Glebelands DS0000011356.V348743.R01.S.doc Version 5.2 Page 26 staff and training through an interactive DVD for other staff. The home is developing a ‘link nurse’ arrangement for training on infection control. All staff attend training on safeguarding vulnerable adults. The home has a contract for the disposal of clinical waste. Its arrangements for clinical waste disposal will be reviewed when it moves back to the main home. The arrangements for the disposal of unused medicines will be revised when it acquires nursing home registration because it will then need to make separate arrangements. Risk assessments are included in care planning. Responsibility for COSHH risk assessments and the provision of relevant data sheets is delegated to the housekeeper. A recent meeting included details of new security arrangements for access to the home out of hours. CCTV will be operational on the site. The temporary home is a new building and electricity and gas appliances were reported to be still under warranty. It is expected that the refurbishment of the main home will include new appliances and systems that will meet all current standards. Glebelands DS0000011356.V348743.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 X X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Glebelands DS0000011356.V348743.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP29 Regulation 19 Requirement The registered manager must ensure that staff files include the documents required under Schedule 2 and that practice in staff recruitment conforms fully to the Regulations Timescale for action 30/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP16 Good Practice Recommendations It is recommended that the registered manager amend the home’s complaints procedure so that residents are informed that they may refer a complaint to CSCI at any stage of the process. It is recommended that the registered manager seek the views of residents on meals on a more frequent basis. 2 OP15 Glebelands DS0000011356.V348743.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Glebelands DS0000011356.V348743.R01.S.doc Version 5.2 Page 30 - 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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