Inspection on 18/06/08 for Glengariff Residential Home

This inspection was carried out on 18th June 2008.

CSCI found this care home to be providing an Adequate service.

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

Glengariff Residential Home 04/06/09

Glengariff Residential Home 05/06/07

Glengariff Residential Home 06/06/06

Glengariff Residential Home 02/02/06

Glengariff Residential Home 17/03/05

Glengariff Residential Home 24/11/04

Glengariff Residential Home 10/12/03

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Glengariff Residential Home 45 Freeland Road Clacton On Sea Essex CO15 1LX Lead Inspector Sara Naylor-Wild Unannounced Inspection 18th June 2008 09:30 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 Glengariff Residential Home DS0000017831.V366549.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. Glengariff Residential Home DS0000017831.V366549.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Glengariff Residential Home Address 45 Freeland Road Clacton On Sea Essex CO15 1LX 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) 01255 220397 01255 220880 Glengariff Company Limited Mrs Tina Amanda Smyth Care Home 55 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (55) of places Glengariff Residential Home DS0000017831.V366549.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 55 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 15 persons) The total number of service users accommodated in the home must not exceed 55 persons 5th June 2007 Date of last inspection Brief Description of the Service: Glengariff is a care home for older people accommodating a maximum of 56 service users. The property is a three-storey converted hotel close to the town centre and seafront. The upper floors are accessed via a passenger lift. Most bedrooms are single occupancy and all have en-suite facilities. There is a choice of communal areas and a large garden at the rear of the building. The home provides written information about the service to prospective service users. Inspection reports are displayed on notice boards and in the manager’s office. Fees for this home, at the time of the inspection, ranged from £365.00 - £460.00 per week. Hairdressing, chiropody, personal items and outings are an additional cost. Glengariff Residential Home DS0000017831.V366549.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection was carried out on the 18th June 2008. As part of the inspection we checked information received by Commission for Social Care Inspection (CSCI) since the last inspection in 5th June 2007, looking at records and documents at the care home and talking to the manager, Tina Smyth, care staff, the people living at the home and their supporters and undertaking a tour of the home. The manager and the deputy manager assisted the inspector at the site visit. Feedback on findings was given during the visit with the opportunity for discussion or clarification. We would like to thank the manager, the staff team, and people living at the service and their relatives for their help throughout the inspection process. What the service does well: The service carries out a full assessment of peoples needs prior to any agreement that they will move to the home. They provide information about the service and people who had recently moved there felt they had been well informed about what to expect. People living at the service felt the staff knew them and understood their care needs. One person said “ they know how I like my tea and what time is best for me” and another said “I have heard them telling each other when they change over about how I have been and what help I needed, I think that shows that they know me”. There are activities programmed regularly that include both indoors activities such as games and music as well as outings to local amenities. People spoken with enjoyed this aspect of the home and particularly the opportunity to go out if they wanted. The people living at the home enjoyed the meal provision and felt that they would be able to make choices either from the planned menu or an alternative if they wanted. Glengariff Residential Home DS0000017831.V366549.R01.S.doc Version 5.2 Page 6 The service supports people to make complaints and people living there felt confident that they would be listened to. The service understands its responsibilities in safeguarding people living at the service from abuse. There are robust systems for recruitment of staff that supports the service’s protection of people living at the service from abuse. There is an annual training programme for staff that equips them to carry out their duties and gain the knowledge to meet the majority of people needs. The number of staff qualified has passed 50 of the total staff group. The service carries out a quality assurance process that aims to gain the views of people living at the service and their supporters. Some of this information is used to improve the way in which the service is delivered. People who live in the service speak highly of the manager and their team. They felt that the manager was available and approachable. The way in which people’s monies are managed is safe and provides a good audit trail of expenditure. What has improved since the last inspection? What they could do better: Care planning requires further development to ensure that all the known needs of the people living at the service and the way that staff have developed to meet these are included in the plans. The service must develop risk assessments to support their understanding of how they can best support people to take reasonable risks in their daily lives. Glengariff Residential Home DS0000017831.V366549.R01.S.doc Version 5.2 Page 7 The record of peoples nutrtional intake and the support provided to them in this area of their care required greater consideration to ensure that the service is monitoring this element of their health and wellbeing. The activities on offer tend to be group based and are not tailored to meet the individuals abilties and expectations. This means that some people do not particpate in activiites very often. The way in which the premises are kept clean and tidy requires some consideration within the quality assurance process of the service to ensure they support peoples dignity and expectations. The use of POVAfirst checks as a standard element of the recruitment process should only be used in very exceptional circumstances. Such as where there is a real danger that staffing levels will otherwise fall below numbers required to meet people’s assessed needs. The staff do not receive regular supervision sessions with their line manager. This does not support them in their development and understanding of their performance. 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. Glengariff Residential Home DS0000017831.V366549.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 Glengariff Residential Home DS0000017831.V366549.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): 3, Standard 6 is not applicable to this service Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who consider moving to the service can be assured that the service will consider how it can meet their needs prior to agreeing to their admission. EVIDENCE: The service has an assessment format that is used to determine the range of needs a prospective resident may have and how the home can meet those needs. Samples of assessments were considered at this visit. The file belonging to the person who has most recently moved to the home was seen and this demonstrated that an assessment was completed with a full consideration of the range of daily living needs a person may need support with. Discussions with the person and their family members identified that they had been provided with information about the home prior to moving in and also Glengariff Residential Home DS0000017831.V366549.R01.S.doc Version 5.2 Page 10 had an opportunity to visit and ask questions about the service. They had participated in an assessment of their needs and felt that the service had sought to understand them before they agreed to the admission. The service does not provide intermediate care. Glengariff Residential Home DS0000017831.V366549.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 adequate. This judgement has been made using available evidence including a visit to this service. People living at the service are confident in the way staff support their needs. They cannot be assured that their identified needs will be consistently delivered according to their plan of care. EVIDENCE: The care plans of five people living at the home were read to determine how the service supports the needs identified in the person’s initial assessments. All the plans seen were completed and followed a format that provided information about the person’s abilities and how staff should support these. They varied in how informative the information was as in some instances a more general instruction was given. Examples of this include under the section on getting dressed the person’s plan states “requires help to choose clothes for the day”, but does not tell the reader how much interaction that the person requires to make those choices. Similarly under continence the plans advises staff to use the continence products assigned to the person, and to ensure that Glengariff Residential Home DS0000017831.V366549.R01.S.doc Version 5.2 Page 12 person is offered the toilet regularly, but not detail of what equipment and how. This information would help staff to understand how the person’s abilities can best be supported to promote their independence and develop an understanding of them as an individual. Some plans did not contain all the information found in other documents such as the initial assessment or the daily records used by staff to record the person’s needs on a day-to-day basis. In one case there were issues relating to a person’s behaviour and the affect of this upon other people living at the home, which were not included in the care planning document. The care plan of the person most recently admitted to the service was not completed in any part. Although from discussion with staff and the person themselves it was clear that information gathered at the initial assessment and from staffs ongoing support was being used. Overall the plans do give instruction to staff in meeting the majority of peoples needs, and from observation and discussions with people living at the home and the staff group there was evidence of knowledge of the individuals and their needs. However if the information in care plans was more detailed and responded to all the information staff demonstrated that they knew about the person, it would provide an increased level of consistency in the delivery of the staff support and improve the outcomes of people living at the home. The files also contained risk assessments relating to the moving and handling needs of people living at the home. These gave an indication of the person’s strengths and weaknesses that affect the outcome of their movements. The conclusion of these are incorporated into the mobility element of the person’s care plan and inform staff in the safe way to support someone when moving them around the home. There were not risk assessments in place for other issues raised in initial assessments or daily records. These included falls assessments, nutritional screening, the inappropriate behaviour of one person and use of bed rails to prevent another person falling from bed. Following discussion with the manager they presented a form they felt fulfilled the purpose of a risk assessment in relation to the use of bedrails. The document was in fact an agreement signed between the service and the person living at the home or their family that bedrails were required to protect the person from falls. It did not however give the information required of a risk assessment, primarily how the risk is assessed and what other means of managing the issue have been considered and disregarded. Risk assessments identify and support the service in determining a proportionate response to risks presented in people’s daily living whilst recognising their rights to live their life in as independent a way as possible. Glengariff Residential Home DS0000017831.V366549.R01.S.doc Version 5.2 Page 13 Without the process of risk assessment the service is unable to ensure these rights are supported. The service maintains some records that monitor people’s health and wellbeing such as regular checks on their weight and fluid intake. This provides tools that give indications of changes in the person’s wellbeing that may require action by the service. During observation of a mealtime it was observed that some people with cognitive impairments either did not eat at all during the mealtime or ate only small amounts. When staff were asked to identify how individual’s nutrition is monitored and recorded they indicated that there were not specific records, but that entries would be made in the daily handover, although no entries could be found for that day or any days immediately prior to the inspection date. The regular monitoring of peoples nutritional intake are part of the records that support the service in ensuring appropriate action is taken in promoting peoples wellbeing. Visits made by medical professionals such as GP’s or District Nurses were maintained on people’s files, and included the reason and outcome of the visit. Changes made as a result of these visits to the individual’s support or medication were transferred to their care plan and medication records. This helps staff understand how the person changing medical needs are to be met. The management of medication administration was considered during the inspection visit. This included the observation of staff administering the lunchtime round, checks on documentation and discussions with staff. The way in which the medication was administered met with good practice and the person responsible for the administration was able to give a good account of their understanding of the safe administration of medication. The storage and receipt and disposal of medication including controlled drugs were also good. A system that supported staff dispensing medication had been introduced by providing staff with coloured tabards. The accompanying instruction to other staff is that a member wearing the tabard is carrying out a medication round and must not be interrupted at this time. This supports the safe administration of medication and ensures staff are not distracted whilst carrying out this important role. Glengariff Residential Home DS0000017831.V366549.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 adequate. This judgement has been made using available evidence including a visit to this service. Some people living at the service can expect there to be opportunities for activity and occupation that meets their needs and wishes. However there are not the same opportunities for all residents. EVIDENCE: The service employs two people for 24 hours and 12 hours a week as activities coordinators who are responsible for organisation of the activities programme. The opportunities on offer are posted on the main notice board and include local outings either by foot or in the mini bus, skittles, basketball, soft darts, ring game and entertainers. At the time of the inspection an outing to the Beth Chatto gardens had taken just place and people spoke of how much they had enjoyed it and their appreciation of being able to go out of the home. The files of the same five people were considered in relation to the way their social and emotional needs are supported by the service. Their initial assessments included some reference to their previous interests and hobbies as well as their emotional state. Some gave indications of knitting as an Glengariff Residential Home DS0000017831.V366549.R01.S.doc Version 5.2 Page 15 interest and one assessment noted that the person had been actively social in their life previously. Although there were care plans relating to the social needs of people there were not specific details of how the assessed needs and abilities of people shaped their choices and how staff should support these. Care plans contained an activity sheet used by staff to record the activities people had participated in. The record of a person with assessed cognitive impairments noted only four instances where they had participated in the activity in the previous 6 months, all of which were large-scale group activities. The record relating to a person with greater cognitive awareness had frequent dates for participation and the range of activity was also greater. Discussions with the manager and staff indicated that the provision of activities was not based on an individual assessment of people’s needs and abilities in this area of their lives. Staff responds to peoples behaviour and their reactions to activities they provide which are mainly organised for groups of people. The service benefits from a large lounge with kitchen facilities and washable floors that provide a separate area for activity if required as well as a place for families to use when visiting. The manager reported that there was not a specific budget in place for activities, however she had confidence in the proprietors willingness to give financial support to any activity project. Visitors spoken with during the visit said they were made to feel very comfortable during their visit and welcomed at any reasonable time. People who live at the home said that they felt they were given opportunities to exercise choices during their day. One person spoke about how they enjoyed spending time in their room and actively chose not to take part in activities provided or outings. They felt that this was respected although staff never forgot to offer the opportunity to take part. Another person spoke about the choice of meals and felt confident that if they chose something else from the offered menu this would be not be a problem, they said ” they are very good in the kitchen, it’s never too much trouble”. There was one person who told us that they felt the opportunities for choice were more limited, and that there was an expectation that people should be up for the day by a set time rather than making a choice to stay in bed. The manager said that people chose when to get up but records did not demonstrate how these choices were supported. The menu is planned in advance and people are asked for their choice for the following days meals. The menu includes at least two choices at each meal and provides a nutritious and balanced diet. The observation of the lunchtime meal indicated that there was generally a congenial atmosphere where people were given time to eat in a relaxed Glengariff Residential Home DS0000017831.V366549.R01.S.doc Version 5.2 Page 16 manner. The staff moved around the dining room serving the meal, encouraging people to eat and offering assistance if required. The way in which people were assisted did not however always provide the best outcomes for people. Staff tended to assist people from a standing position in short bursts of attention, rather than sitting down with them and supporting them throughout the meal. For one particular person who was agitated during the meal time, the way in which staff responded did not reduce their anxiety and resulted in them not eating their meal. Whilst staff were not unhelpful they need to understand how their support impacts on the person receiving it to ensure they gain the best outcomes. Glengariff Residential Home DS0000017831.V366549.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home can expect to be protected by the home’s policies and procedures. They can be assured that their concerns and complaints are responded to appropriately. EVIDENCE: The way in which the service responds to complaints was assessed through examination of the documents relating to complaints and discussions with the manager and staff. The service has a complaints policy that is publicised both in the home and through the service user guide given to people thinking about moving into the home. People spoken to during the inspection were confident about their right to complain and clear that they would approach the manager or deputy manager to speak about their concerns. The service records the complaints they receive in a complaints record. The entries indicate the nature of complaint, the investigation and outcomes and action taken in response. The record is open to inspection and gives indications of the services positive attention to complaints. The service does not maintain an audit of the frequency, type and common indicators of complaints received. This would be a helpful tool in understanding if there were repeated complaints and possible patterns. Glengariff Residential Home DS0000017831.V366549.R01.S.doc Version 5.2 Page 18 The service has a policy and procedure relating to the safeguarding of adults. The policy sets out the nature of abuse and the services response to such allegations. The procedure requires a review and updating, as it does not reflect the current guidance provided by the local authority responsible for leading in safeguarding referrals. Staff were due to take refresher safeguarding training within two weeks of the inspection date. Discussions with staff at all levels demonstrated a clear understanding of their responsibilities in reporting signs of abuse and how the service should respond to these. There have been two reported safeguarding referrals made by the home in the previous 6 months. These referrals were appropriately made to the local authority that was coordinating the response. The first issue was passed to the service to investigate and an outcome was awaited at the time of the inspection. The second referral had been made just prior to the inspection and a full outcome was not available. The Commission monitors the outcomes of safeguarding referrals and considers how the findings of any investigation indicate the services compliance with the Care Homes Regulations 2001. Glengariff Residential Home DS0000017831.V366549.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 adequate. This judgement has been made using available evidence including a visit to this service. People living at the service can expect the premises to meet their needs and provide a comfortable place in which to live. However the cleanliness of some areas could be improved upon. EVIDENCE: The premises were generally clean and tidy with no noticeable odours in any part of the home. New furnishings and flooring for communal rooms had been purchased over the previous 12 months and the dining rooms and lounges were attractive bright rooms. People’s bedrooms were pleasantly decorated and they were encouraged to bring in their personal items to enhance their rooms. People told us that the housekeeping staff work hard to keep the home tidy and one person mentioned that they had asked for their ‘nets’ to be cleaned Glengariff Residential Home DS0000017831.V366549.R01.S.doc Version 5.2 Page 20 and staff had immediately done so. Some areas of the cleaning routine of the home appeared to require further consideration. This included the corridor carpets that had been heavily stained by the constant traffic of people and wheelchairs moving through the home. The manager reported that despite the use of carpet cleaners there was no improvement in the state of the carpets and the proprietor was very disappointed in the product. They were advised to consider professional advice about the cleaning products the home uses or inform the manufacturer of the carpet of the failure of their product. Other areas such as the arms of chairs in lounges were also stained from use and required attention. During the inspection the carpet in the lounge where people were sitting midmorning was covered in crumbs from a previous meal. The housekeeping staff came to hoover the room shortly after, but people had been moved into the room following the breakfast meal before this was done. The organisation of cleaning of areas of the home and the standards of cleanliness maintained could be addressed within the home’s quality monitoring. The service employs a maintenance man who attends to minor repairs and refurbishment of the building. There was not a maintenance plan committed to paper although the manager gave indications of the plans for renewal of areas of the home in the coming months. The bathroom on the top floor of the home was out of order at the time of the inspection due to the hoist seat on the assisted bath being broken. The manager stated that this has been reported about a month ago and a part was waited for. People whose bedrooms were on this floor were able to use bathrooms and shower rooms on the other two floors, and the manager stated that people do not spend time in the day on that floor so this was not a major inconvenience. People living at the home spoken with during the inspection did not always understand where the bathrooms were located in regards to their personal accommodation and stated that generally staff supported them in accessing the bathroom so this was not an issue for them. The service benefits from a large garden lounge that is no longer in full time use by people living at the service. This area contains a kitchen area and washable flooring that provides an excellent space for activities to take place as well as an alternative place for people to use when they don’t wish to sit in the main lounges or are receiving visitors. People living the home have access to extensive and well-maintained gardens that are an excellent resource and enjoyed by people living at the home. Glengariff Residential Home DS0000017831.V366549.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. People living at the service can expect to be supported by staff in suitable numbers to meet their needs. They can also be confident that that staffs have been subject to satisfactory recruitment practices. Although they cannot be assured that the staff hold all the knowledge and skills required to meet their assessed needs. EVIDENCE: The home’s staffing rota demonstrated that a staffing level of 9 care staff in the morning and 8 care staff in the evening are maintained with 4 waking staff on duty overnight. In addition there are catering, housekeeping and activities staff on duty in the waking day. The manager stated that the numbers of staff required are arrived at by a calculation of individuals needs, discussions with staff about how they work with people living at the home and an allowance of time for the tasks to be undertaken. The rota was also arranged to provide increased staffing levels for the periods where people living at the home require the most support from staff such as early in the morning when people wanted to get up and late in the day when people wanted to go to bed. Glengariff Residential Home DS0000017831.V366549.R01.S.doc Version 5.2 Page 22 The recruitment records of the three most recently appointed staff contained documents that supported the employment of people who were suitable to work with vulnerable adults. This included full application forms, references, proof of their identify and CRB checks. In each case the staff had commenced their employment with a POVA first request while the full CRB report was waited for. The guidance in relation to the use of POVA first checks from the Criminal Records Bureau is “POVAfirst checks are available in only very exceptional circumstances. For England these are described in Department of Health (DH) guidance as, where a care worker may be allowed to start work in a care home… before a CRB check has been issued. ….Such cases are permissible only where it is necessary to take such action because of a real danger that staffing levels will otherwise fall below numbers required to meet statutory obligations. The Commission for Social Care Inspection and the Care Standards Inspectorate for Wales, will monitor applications for POVAfirst checks to ensure compliance with this criteria (SIC)”The manager reported that the time taken to return CRB’s had been too long and they felt it was not in the services best interests to wait. Discussions with staff verified that they undertook a robust recruitment process and were asked to provide supporting documents before they were offered a post. The six monthly staff training programme included items such as health and safety, Safeguarding, dementia care, supervision, care planning and bereavement. Staff spoken with said they had enjoyed the training they participated in and felt that there was plenty of training on offer. They were not aware of how they contributed to the programme choices, but felt that the manager would consider anything they suggested. There was not a direct link to the training programme and staff performance identified through supervision The training subjects are chosen by the manager and relate to the requirements of health and safety legislation and some identified needs of people living at the home. The assessments and care plans of people living at the home suggest that training in other issues could also be provided in a training programme and this was discussed with the manager at the inspection. These included risk assessing, falls management, challenging behaviours and nutritional needs. Including the subjects that relate to the needs of people ensures that staff have the knowledge and skills to meet those needs. The service has 13 staff that had completed their NVQ 2 with 6 holding NVQ 3 as well. One person was undertaking their NVQ 3 at the time of the inspection. In addition there were 3 staff that had undertaken NVQ 2 in non-care subjects that related to their roles in the service. This takes the service to above the recommended 50 level of qualified staff working at the home and is Glengariff Residential Home DS0000017831.V366549.R01.S.doc Version 5.2 Page 23 commended as an indication of the commitment shared by the proprietors and staff to attain a formal qualification. Glengariff Residential Home DS0000017831.V366549.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, 32, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living at the service can be confident that they will be consulted about the way the service operates but not about how their views will influence the development of the service. EVIDENCE: The manager has been in post since 2005, and has previously worked in the care sector. She has undertaken her NVQ 2 and 3 and was completing the NVQ 4 Registered Managers award at the time of the inspection. Staff spoken with during the inspection spoke highly of the manager and the deputy manager. They said they felt supported by the management team and Glengariff Residential Home DS0000017831.V366549.R01.S.doc Version 5.2 Page 25 knew that they could speak to them at any time. This was endorsed by the people who live at the service, who said that they thought the home was well run and that they knew they could speak to the manager or deputy manager at any time. The manager reported that the consistent provision of staff supervision had not yet been achieved although all staff were going through their annual appraisal at the time of the inspection. The manager was aware of the shortfall and although all the staff have taken part in supervision training the consistent application of carrying out the sessions had proved difficult to fit into work arrangements. Although there are some similarities between the topics covered during annual appraisals and supervision, it is the regular attention to staffs performance and understanding of how their role contributes to the service aims and objectives that is provided by consistent provision of one to one time with their line manager. There have been arrangements made to set up a spread of line management supervision responsibilities across the senior staff in each area of the home and the service needs to consider how it will support these staff to monitor and meet their supervision programme. Some staff had received more consistent supervision and the records of these sessions demonstrated a good quality of discussions that would help the individuals to understand how their performance in the service was rated as well as identify any shortfalls in skills that required further input. The service does manage some people’s monies on their behalf. The system in place for management of monies includes individual finance sheets detailing all withdrawals and deposits of monies and the reasons for the action. The record includes receipts for monies that are spent and the staff countersigns the withdrawal. The cash is kept in individually named plastic wallets, in the homes safe only accessible by the manager, the deputy and the homes administrator. This provides a robust and safe account of people’s monies. The service has a quality assurance system in operation that consists of the consultation of people who live at the home and their families through the distribution of surveys at the end of the calendar year. The outcomes from the survey were audited and converted into percentages in each response category in each question group. The manager had drawn up an action plan as a response to the findings of the survey for 2006/07 that gave an indication of how the home intended to address any possible shortfalls identified in the feedback. The action plan referred to the outcomes in the most dissatisfied percentage, but there had not been a response to the comments in the less than satisfied outcomes. The manager advised that the report and the action plan was not published so that people who had contributed to it understood how their comments influenced the planning of the service. Glengariff Residential Home DS0000017831.V366549.R01.S.doc Version 5.2 Page 26 The audit of 2007/08 had not been done and the manager reported that this had been because there was a very poor response to the survey (only 14 returned) and that the last of these had been received in February. An action plan had not yet been drawn up in relation to this round of consultation. The manager was covering quality assurance in the Registered Managers Award and hoped that this would provide her with some fresh thinking on the subject. The service held certificates in relation to the safe operation and maintenance of equipment according their legislative responsibilities. The certificates that demonstrated this were considered at this inspection and included Electrical installation, gas safety soundness test, Lift maintenance, moving and handling hoists, water regulations, portable appliance testing, fire extinguishers and emergency lights and fire alarms. The service carries out monthly visual check of the fire safety systems and there was a fire risk assessment in place. The records included the monitoring of staff attendance at fire drills, although there was some staff that had not attended training in the previous 6 months. Glengariff Residential Home DS0000017831.V366549.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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 2 X 3 Glengariff Residential Home DS0000017831.V366549.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 OP7 Regulation 15 Requirement Care plans must be detailed, to ensure they cover all aspects of people’s identified care needs. The previous timescale set was not met. 2. OP8 13(4)(c), Risks that are presented in 31/08/08 individual’s assessments must be considered using a risk assessment tool to support the service in determining the most appropriate steps to manage the risk proportionately. Areas of individual’s lives that are identified as a risk must be monitored and records maintained to ensure that changes in their well-being are charted and responded to. Staff must receive training that supports them in meeting the assessed needs of people living at the home, and their personal development needs. 31/08/08 Timescale for action 31/08/08 3. OP8 17(1), Schedules 3 and 4 4. OP30 18(1) (c) 30/09/08 5. OP36 18(2) Staff must receive consistent line 31/08/08 DS0000017831.V366549.R01.S.doc Version 5.2 Page 29 Glengariff Residential Home management supervision that supports them in their personal development. 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 OP12 Good Practice Recommendations The People who live at the service should be provided with activity that suits their abilities and personal preferences. Specifically staff should provide opportunities for people to enjoy individual activity as well as in groups. Equipment required to meet the assessed needs of people living at the home should be kept in good order, and repairs carried out in a timely manner. Specifically this refers to the bathroom on the second floor of the home. People should be able to live in a clean and tidy environment. Specifically staff should ensure that areas used by people living at the home are clean before people are moved into them. Further advice should be sought if the current cleaning products and equipment cannot achieve a good standard. Staff should only be recruited to the service on the basis of a full CRB check and the application for POVAFirst checks should be only made in circumstances set out in the Criminal Records Bureau guidance. A quality assurance system whose findings are audited and an action plan produced in response should be developed This will assist the proprietors in understanding what is important to people involved with the service and how they can improve their experience. 2. OP19 3. OP26 4. OP29 5. OP33 Glengariff Residential Home DS0000017831.V366549.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Glengariff Residential Home DS0000017831.V366549.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. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!