Inspection on 23/04/08 for Glenmar

This inspection was carried out on 23rd April 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Glenmar 02/03/09

Glenmar 29/05/07

Glenmar 08/05/06

Glenmar 21/11/05

Glenmar 21/06/05

Glenmar 10/02/05

Glenmar 16/09/04

Glenmar 16/09/02

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

CARE HOME ADULTS 18-65 Glenmar 2-3 Charles Road St Leonards-on-sea East Sussex TN38 0QA Lead Inspector Michele Etherton Unannounced Inspection 23rd April 2008 09:30 Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 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 Glenmar DS0000021113.V361083.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 Adults 18-65. 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. Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Glenmar Address 2-3 Charles Road St Leonards-on-sea East Sussex TN38 0QA 01424 436864 01424 446425 glenmarjulia@aol.com 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) Grovestead Limited Mrs Julia Couzens Care Home 25 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (25) of places Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is twentyfive (25) Service users must be aged between eighteen (18) and sixty-five (65) years on admission Service users with a past or present mental illness only to be accommodated 29th May 2007 Date of last inspection Brief Description of the Service: Glenmar provides a service for up to twenty-five adults with or recovering from mental health issues. The home caters for people with low to medium dependency needs. Residents are provided with opportunities for personal, emotional and social development and are supported towards improving their living skills. The home, owned by Grovestead Limited, is located in a quiet residential street, close to the town centre of St. Leonard’s, within easy reach of the usual town amenities and public transport. The building was originally two terraced properties. All bedrooms are for single occupancy, with the exception of two. Some rooms contain ensuite facilities. As the accommodation is arranged over three floors and there is no passenger lift, the home is best suited to those with no mobility problems. Residents have the use of two separate lounge areas on the ground floor (one of which is currently non-smoking) and there are two dining rooms in the basement. The home has gardens to the rear with a seating and lawn area. In addition, Glenmar is situated opposite Gensing Gardens. Kerb side parking is available in the road to the front of the property. The home has an organisational structure, which includes the Manager, the Head of Care and support workers, who operating a roster, provide twentyfour-hour cover. Ancillary staff undertake catering, domestic and maintenance duties. Current fees for the home range between £335.30 and £348.00 per week. Full information about the fees payable, the service provided, the home’s Statement of Purpose and the latest inspection report by the CSCI are available from the Manager. Glenmar DS0000021113.V361083.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. A key unannounced inspection of this service has been undertaken that has taken account of information received from the service and about the serviced since the last inspection, including an Annual quality assurance assessment (AQAA). The AQAA has been completed to a reasonable standard but contains areas where more supporting evidence would have been useful to illustrate the activities of the service and future planning. The inspection has also included an unannounced site visit to the care home on 23/4/08 between the hours of 9:30 am and 4:30 pm. During this visit a tour of the premises was undertaken, time was spent with residents, and discussions held with two staff of the home in some depth in addition to an examination of a range of records including, care plans, risk assessments, Medication administration records, staff recruitment, training and supervision records. All key inspection standards have been assessed. The homes progress in addressing shortfalls identified previously has also been taken into consideration. Survey information has not been returned in order to inform this inspection however, Staff and residents were co operative and helpful during the site visit speaking positively of their experiences of the home and their input has been influential in the compilation of this report. What the service does well: The premises are large but offer spacious, comfortable and homely accommodation in a relaxed and friendly atmosphere. Systems are in place to ensure prospective residents are assessed and can visit and test-drive the home before moving in. Residents benefit from having enough staff available to support them, that staff turnover is low and consequently stable, providing a trained and committed staff team who understand their needs and routines. Residents feel listened to by staff and consulted about changes. The home is supportive and enabling of residents to lead the life they would wish where this does not impact adversely on others. Residents are encouraged to make choices and decisions in their daily lives. The home is welcoming to visitors. Residents enjoy a varied diet and are able to choose what they eat. Residents enjoy living in the home and their comments are: Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 6 “I find it has everything I need” “Staff are hardworking and conscientious” “life is pleasant and happy” “I can’t think of anything bad about it” What has improved since the last inspection? What they could do better: The home has not addressed two previous requirements ensuring that the staff recruitment procedure is sufficiently robust to safeguard residents, or that CSCI are notified promptly of significant events that occur in the home and impact on residents. There is little evidence that the home has responded to good practice recommendations made at the last inspection. Two further requirements have been issued from this inspection, one relates to the absence of a means to record visitors to the home, this breaches fire regulations and Care home regulations 2001 on what documentation must be kept within a care home. The home is also required to develop a system to review the quality of care provided at the home and this should involve systems for consulting with service users. There is a need for the home to improve the content and quality of documentation recording as this fails to demonstrate where good practice is occurring, or that systems are sufficiently robust to safeguard residents or reflect the support offered to them, including how judgements have been reached in respect of risks. Whilst the home has clearly had successes in the work it undertakes with some residents, and provides a settled and stable environment, there is little evidence of progression, promotion of independence skills, goal setting or achievement of aspirations that would enhance the quality of life experienced by residents. Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 7 Good practice recommendations have been made in respect of improved recording in assessment, care planning, residents health, risk assessment, and staff records, recommendations have also been made in respect of medication storage and the home have been asked to seek guidance from their community pharmacist in respect of this. 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. Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,5 People who receive this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Information about the home and the terms and conditions of their stay is made available to Prospective residents to inform their decision making in addition to opportunities to visit and ‘test drive’ the service. Information is gathered about prospective residents to inform the needs assessment process prior to admission, however, this would benefit from improved clarity and detail. EVIDENCE: A brief examination of Statement of Purpose and terms and conditions information confirmed that the home has amended this information to take account of previously identified shortfalls, some inaccuracies to this information noted during the site visit have also been addressed. Discussion with the home’ “care” manager indicated that a comprehensive assessment of prospective residents is undertaken and professional assessment and background information is gathered to support this in addition to a phased introduction to the home, a review of a sample of resident assessment information highlighted that this information is not always Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 10 sufficiently robust or detailed to indicate clearly the needs the home are being asked to meet, and ways in which this could be improved upon were discussed during the site visit, it is a recommendation that assessment information makes clear the needs the home is asked to support, and informs their decision to admit on the basis that these needs can be met. In view of the fact that a phased introduction allows for the home to observe prospective residents and test out assessment information consideration should be given to ensuring the admission process for individuals is fully documented to support overall assessment. Residents of the home who were happy to speak about their admission confirmed they had been given a choice to visit the home and had opportunities to stay before a final admission decision was made. They reported that: “I came and had a look at this place before I moved in” “My home was closing and I needed to move out within the month” “Yes, I was asked whether I wanted to come and visit” Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 People who receive this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans lack clarity to inform staff how they are to support needs, promote independence and the achievement of goals and aspirations. Residents are enabled and supported to make choices and decisions about their daily routines and lifestyle, management of risk is positive and discussed with individual residents however shortfalls in recording and content fails to evidence how judgements have been arrived at and ensure the risk assessment process is sufficiently robust to safeguard residents. EVIDENCE: A sample of three care plans were examined, these contain a range of information including basic risk assessments. Residents spoken with reported that they were involved in the review of their care plans, they commented positively about staff support and spoke with their key worker about their daily Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 12 routines, the “Care” manager advised that no residents have suffered mental health breakdowns since the last inspection and they have clearly done well to achieve such stability, the low turnover of staff and their familiarity with residents and their routines is an important factor in the maintenance of good mental health and early interventions where needed. Care plans viewed do not reflect however, the support provided by staff and the preferences of individual residents in how this is delivered and would benefit from improved clarity. Currently care plans provide little evidence of progression, goal setting, personal aspirations or promotion of independence, whilst it is accepted that motivation is a significant issue for many residents their quality of life would be enhanced by the introduction of personal goals. The home uses a dual system to record resident information and there is evidence on a cardex system of changes to daily routines being recorded, this is not always transferred until sometime later to the main care plan, therefore this is not always accurate. Only two residents now share a bedroom discussion with them confirmed they are both very happy with this arrangement and it is suggested this arrangement should routinely be reviewed with the affected residents and their representatives at annual reviews so that the homes decision to maintain this arrangement is fully supported by all parties. The home is supportive and empowering of residents being in control of their lives and this is reflected to some degree within the statement of purpose and terms and conditions documentation where there are clear expectations those residents will be responsible in most cases for their finances personal care, medication. Capacity issues that may impact on personal decision making and risk taking are not made clear within care plans. Discussion with residents indicated that they have lots of opportunities to make day-to-day decisions and choices about their daily routines and in most cases take responsibility for themselves seeking staff support where necessary. The management of risk within the home is positive with a focus on capacity rather than incapacity, good outcomes are achieved in that residents are encouraged to go out and make use of community facilities if they are able to travel independently, however, recording of judgements on how risks have been assessed lacks content, and where limitations exist this is not clearly recorded. Current risk information fails to evidence that risk has been sufficiently explored to safeguard residents and staff and minimise overall risk of harm. A previous recommendation for improvement in this area has not been implemented, it is recommended that risk assessments clearly indicate the risk highlighted and the strategies in place to minimise risk that there is sufficient detail to ensure residents changing needs and guidance for staff are fully reflected. Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 People who receive this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are enabled to live the lifestyle they choose making use of the community and leisure facilities to pursue their interests, hobbies and social life. Residents are supported to maintain links with relatives and friends who are made welcome. Residents enjoy a varied diet that takes into consideration their personal preferences. EVIDENCE: Observations of residents during the site visit and discussions with individual’s residents indicated that many are able to come and go from the home as they choose; making use of local facilities and enjoying a lifestyle they wish. The home provides some activities but there is no organised programme of activities and residents spoken with indicated they preferred this flexible arrangement and being asked what they wanted to do. From discussion with staff there is evidence that where necessary some residents are provided with escort whilst in the community and for attendance at appointments. Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 14 Residents and staff indicated trips out are arranged on occasion with transport provided and this was confirmed in an examination of staff meeting minutes, Discussions with residents highlighted links with voluntary groups, or regular commitments to family and friends that keep them busy, it was also clear that some make use of community facilities at night. Home staff reported that whilst they try to encourage and motivate residents to make use of the community and activities inside and outside the home, they respect the right of residents not to do so. “ I find it has everything I need” “ I can’t think of anything bad about it” “Life is pleasant and happy here” Residents reported that they enjoy the garden in good weather and make use of the park opposite. Whilst none of the residents spoken with during the site visit indicated a desire for additional recreational activities, a review of some early surveys undertaken after admission highlighted some expressed personal wishes about what individual residents would like, care plans viewed in conjunction with this information failed to evidence that such aspirations and wishes had been taken account of or that these had been used to influence overall service development. Staff reported that it is sometimes frustrating when residents cannot be motivated so when they do show an interest the home staff try to support them to access a service or interest but sustained motivation is a problem for many of the residents. Residents indicated that they have visits from friends and family and in most cases this is flexible with the home being supportive of maintaining relationships with partners and accommodating this where possible, providing opportunities for visitors to participate in meals and could give examples where in the past they have supported couples to maintain their relationship by offering an overnight stay facility, it became clear however, that in some instances the home has for reasons of health and safety of staff and other residents imposed restrictions on some visitors and this is made clear to all staff and the resident themselves. Such restrictions need to be clearly stated within the individual resident care plan with evidence that this decision has been discussed and reviewed within a wider forum i.e. CPA review and not made in isolation by the home (see standard 23). Residents were complimentary of food, reporting that they are consulted about menus and made clear that they can request something different and feel comfortable doing so, they were very happy with portion sizes and overall quality and variety of food. Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 15 “The boss asks what changes we want at the residents meeting” “You can ask for something different for example I have an omelette instead of sausages you can ask for a salad or shepherds pie” “She’s a very good cook” Residents confirmed they are able to have a cooked breakfast if they wish on a Sunday but this is served early there being two breakfast sittings, most of those spoken with indicated that they made the effort to make the earlier sitting and this was confirmed by staff. All meals are served within the two dining areas on the basement floor of the home. The home could evidence that it takes account of changing needs of individual residents and offers soft or pureed diets and food supplements where necessary. Discussion with staff indicated that there may be a lack of awareness around best practice in the presentation of pureed food and consideration should be given to providing the cook with additional training in this area. Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 People who receive this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are happy with the way staff deliver support around personal care needs, and are supported to access routine and specialist healthcare, there is a need for improved recording to reflect support offered or where this is refused. More attention needs to be paid to changing mobility needs of residents. Medication management arrangements are generally satisfactory but would benefit from suggested improvements particularly around evidencing incapacity, risk assessment, and medication storage. EVIDENCE: Discussion with residents indicated that most are able to undertaker their own personal care routines, but where there is some element of staff support residents reported that this is undertaken in an acceptable manner that makes them feel comfortable and that their privacy and dignity is maintained they are supported to maintain a good personal presentation. Residents reported they find staff friendly and helpful, there is now only one shared bedroom and screening is provided, residents of the shared room independently confirmed their satisfaction with the present arrangements. Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 17 Discussion with individual residents confirmed that they are supported to access health care appointments and are encouraged to attend routine check ups, there is a resistance from some to this and staff reported attendance if at all is on the residents terms and they respect this, whilst there is supporting evidence within the cardex records of people attending appointments or having contact with health professionals, this information is not easily accessible for monitoring purposes, the home have been asked to consider recording health contacts in one place so that attendance and access to health care checks can be more easily monitored by home managers and staff. The home is without a lift, a few residents have mobility issues that if they progress will impact on their ability to make full use of the house or to go out consideration must be given to their needs and quality of life with a view to assessing the likelihood of installing stair lifts. Some people need a steadying hand from staff getting in and out of a bath, moving and handling assessments should be developed for these residents to ensure support offered is correct and consistently delivered. Discussion with the care manager indicated that the home where possible tries to support access to specialist healthcare treatment but refusal of treatment by residents is sometimes an issue, the home need to ensure where any refusals of treatment exist these are recorded clearly with the resident records and that this is discussed and recorded within CPA meetings for a multi disciplinary view of this problem, this is a recommendation of this report. The home understands the rights and respects the views of residents in respect of their healthcare and medication, support is provided for those who lack capacity, although evidence of incapacity needs to be more clearly evidenced. The home has responded to previous highlighted shortfalls with some improvements in recording of administration, and has instituted a system of changes to medication by prescribers only being actioned upon receipt of a fax. MAR charts examined indicated handwritten changes are initialled; these should also be dated on the day of the change. The home is supportive and empowering of self-administration of medication, but should evidence clearly that risks for this activity have been appropriately assessed; equally incapacity judgements in regard to medication should be clearly recorded with review dates. Some residents are in receipt of PRN medication, where this not self administered they and staff would benefit from individual guidelines to ensure this medication is administered consistently by staff. The “Care” manager expressed concerns that medication storage had been viewed as previously as inadequate, as this is routinely viewed by the community pharmacist who undertakes 3 monthly visits, it is therefore recommended that storage is discussed at their next visit specifically with reference to the guidance issued from the Royal Pharmaceutical society regarding storage, and the outcome notified to CSCI, the home is recommended to address the other identified shortfalls also. Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 18 All administering staff have received training in medication however, routine competency assessments could not be evidenced within staff records. Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 People who receive this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents feel listened to by staff and are confident about raising issues of concern. Systems are in place to safeguard residents but these would benefit from improved recording to evidence actions taken to minimise risk of harm. EVIDENCE: Discussions with residents during the site visit indicated that they find staff approachable and feel confident about raising issues on an individual basis and in resident meetings and that these will be dealt with. The manager and “care “ manager have open door policy and residents were observed making use of this to approach the “care” manager with queries. The complaints procedure viewed on terms and conditions documentation is very basic and not compliant with regulation 22 of the Care Homes Regulations 2001 the home must ensure that all versions of the complaints procedure provided to residents are fully compliant, and whilst the present format is suitable for the resident group, alternative formats may need to be developed should residents with communication or visual impairment difficulties be admitted. A complaints record is maintained, there are no outstanding complaints currently. Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 20 Staff understand the need for safeguarding residents and have received adult safeguarding training, there is a low level of referrals to AP because of a lack of incidents not because of a lack of awareness on the part of the service. The home has reported a recent concern to social services adult safeguarding staff who may raise an alert as a consequence. Whilst staff did not report any specific behaviour issues from residents that caused or needed a consistent response from staff, best practice would suggest that the home develops strategies and guidelines for staff to adhere to and thereby respond to behaviour in a consistent manner. Residents are afforded increased protection by ongoing improvements in the staff recruitment procedure. Residents are encouraged where possible to manage their own finances, small cash amounts are held on some residents behalf and systems are in place to ensure this is managed safely and responsibly with appropriate signing for cash withdrawals, the maintenance of balance sheets and appropriate auditing annually. A sample of cash balances held has not been checked on this occasion. Whilst there has been a minimal reported occurrence of incidents and accidents involving residents risk assessment information currently in place lacks sufficient content to evidence that this has been carried out thoroughly. Discussion with the “care” manager indicates that where the home has cause for concern regarding the welfare of residents, they can evidence that appropriate referral is made to social services representatives to seek interventions where necessary. The home is generally welcoming of visitors but in some instances restrictions are in place to safeguard other residents and staff, where such restrictions either on visitors or on individual residents are in place, these should be recorded clearly within care plans, and be subject to review, where possible and to demonstrate transparency, fairness and accountability restrictions should be agreed within a multidisciplinary meeting involving the resident and not established in isolation by the home and this is a recommendation of this report Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,28,29,30 People who receive this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a spacious, clean and comfortable environment where they are enabled to express their own tastes and have their own things about them. The premises benefit from a gradual and rolling programme of upgrading. Improvements are still needed to ensure that residents are encouraged to maintain good hand washing, and that fire regulations are fully complied with EVIDENCE: The home is large and spread over three floors. Stairwells and communal halls show signs of wear and tear and the age of the building means that regular and ongoing maintenance is needed. A rolling programme of upgrading is in place but the rewiring of the entire house during 2006/2007 has caused some set back in progressing this. Bedrooms viewed with the permission of the residents are spacious in most cases, care maintained to a good standard of cleanliness and enable residents to imprint their own tastes on the décor and furnishing of the room. Residents have keys to their bedrooms and were observed locking and unlocking their rooms throughout the site visit. Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 22 The home have identified within AQAA information that there is a need to establish a visitors to comply with fire regulations, this was not in place on the day of the visit and is also a requirement under schedule 4 of the Care Homes regulations 2001 that the home maintains a record of all visitors to the home and their departure. There is now only one shared room, this has fixed screening in place, and both current residents of the shared room expressed their satisfaction with the arrangement independently. This arrangement should be clearly recorded within care plan and terms and conditions information and subject to regular review. Residents spoken with said they liked their rooms and had what they needed; they indicated that where it had been decorated they had been consulted with about the colour etc. Residents reported that repairs and maintenance are undertaken quickly and they only have to ask. Residents make good use of communal areas especially the smoking lounge and have made strong representation to the local EHO at the prescriptive manner in the new smoking regulations have been interpreted by that local authority department, and have been supported in their cause by the manager, this has not resulted in the outcome they seek and they remain disappointed at this. The home should ensure that residents displaying changes in mobility receive a moving and handling assessment where some intervention by staff is needed, this should take account of any identified needs in respect of equipment to support their stay within the home and enable them full access of its facilities, this is addressed elsewhere in the report The home has responded to a previous required action and has implemented hand wash facilities in toilets identified at the previous inspection, during the site visit it was noted however, that hand towels were not available to promote good hand washing and drying, discussion with the care manager indicated that the home had tried using paper towels but found toilets became blocked by these being incorrectly flushed down the toilet, if the home considers that residents are unable to comply with instructions to dispose of paper towels appropriately they are advised provide a facility that enables residents to dry their hands, if this is not to be paper towels consideration should be given to ensuring a system for the replacement of cotton towels at regular intervals to minimise the possibility of cross infection and this is a recommendation . Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36 People who receive this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Further improvements are needed to the recruitment procedure to ensure that this is sufficiently robust to safeguard residents. Systems are in place to ensure that staff’ are appropriately trained and their performance monitored. EVIDENCE: Discussion with members of staff indicated that they enjoy working at the home, turnover is low with most staff having worked at the home for a number of years. Residents commented positively about staff attitudes and the support they offer to residents, residents reported that staff’ are helpful and friendly. “Staff’ are hardworking and conscientious” A staff member commented that the manager is keen to ensure staff spend time with residents and not each other. The home has achieved a high number of NVQ2 qualified staff exceeding the 50 by quite a percentage, feedback from residents and discussion with staff Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 24 indicated that staff are implementing the good practice they have learned in working with residents. A sample of three files of staff recruited within the last two years were examined these evidence that some improvements highlighted at the last inspection have been implemented and that Criminal records checks (CRB’s) and references are in place, the “Care” manager was reminded that staff should not be commencing work prior to receipt of a CRB and references except in exceptional circumstances that can be evidenced, an examination of CRB information held in the home indicates that one has been transported from another employer, this is no longer acceptable and an updated check must be provided. None of the staff files viewed provided any evidence of interview notes or those gaps in employment and reasons for leaving previous caring roles had been explored. The home has added a health statement question to the application form but should consider whether this is sufficient to make a judgement as to the overall fitness of new staff to fulfil all the obligations and responsibilities of the role. There is indication of induction booklets within staff files examined and the home will need to ensure these are compliant with the common induction standards established by “skills for care”. Staff’ reported that they had access to training on a regular basis and this was confirmed in training certificates noted for individual staff, a rolling programme of mandatory and specialist training is provided to ensure staff remain updated. Staff’ confirmed that they have opportunities to meet alone with their manager and supervision records noted indicate that these meetings occur within expected frequencies. Staff meetings take place a minimum of 3 monthly and these are minuted. Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,40,41,42 People who receive this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is generally well run to a reasonable standard and takes into account the interests of residents. Shortfalls exist in some areas of work practice that could compromise the overall safety of residents and staff. EVIDENCE: The manager and owner of the home was not present on the day of the site visit, there has been no change in the management arrangements of the home since the last visit. Staff on duty during the site visit participated well in the inspection process contributing to an understanding of work practices in the home. Staff demonstrate a commitment to the home and speak positively of the managers who they view as firm but supportive and approachable. Staff reported that the Registered manager was someone who “really cares about Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 26 the welfare of the residents” and has an expectation of staff that they will interact with residents rather than each other whilst on duty. Residents reported that they feel listened to and consulted with through resident meetings and an open door policy, however, no formal system currently exists for the home to capture and analyse feedback from residents and to evidence how this is used to influence change and service development, goals and aspirations highlighted in surveys completed by residents following admission have not been reflected in care planning for those individuals. We asked the home to complete and annual quality assurance assessment to inform the inspection process and this was returned to us within the expected timescale, this was completed to a reasonable standard, there are some areas where additional supporting evidence would have been useful. The AQAA indicates that some policies are not routinely reviewed on an annual basis, and may not therefore be keeping up to date with changes in legislation or best practice that impact on the work staff do with residents. Discussion with staff highlighted a lack of awareness around important legislation such as the mental capacity Act 2006 and the impact this has on residents in promoting their right. Improvements are needed to the content of documentation and records to ensure clarity and that staff’ have a full understanding of client needs and support, the risks attached to this and the changes that occur. The home has identified within AQAA information that it needs to implement a visitors record book to comply with fire regulation, on the day of the site visit this was not in evidence, the home is required under schedule 4 of the Care Homes regulations 2001 to maintain a record of visitors to the home, this is also a requirement of fire regulations to ensure an accurate reflection of numbers of people within the building in the event of a fire. Systems are in place for the recording of accidents and incidents but the home has not routinely notified CSCI through Regulation 37 notifications where these are significant and notifiable, after further clarity regarding appropriate events that warrant notification using this method the “care “ manager is confident that this outstanding requirement will be met fully in future. There are some shortfalls within the systems that protect and promote the safety and welfare of residents in that the recruitment procedure needs strengthening, risk assessments lack detail and clarity, moving and handling assessment are not in place. It is clear that some residents are becoming dependent on staff to help them in and out of baths, and soon may need aids to support them. The service needs to plan for these changes rather than react to them when they become a problem. Some key health and safety checks appear not to have been undertaken for more than 12 months. Glenmar DS0000021113.V361083.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 Adults 18-65 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 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X 2 2 X Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 28 Yes Are there any outstanding requirements from the last inspection? 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 YA24 Regulation Schedule 4 (17) Requirement Schedule 4 (17) Care Homes regulations 2001 Other records to be kept in a care home In that the home must maintain: A record of all visitors to the care Home including the names of visitors 2. YA34 19(1)(b) The registered person shall not employ a person to work at the care home unless…(they have) obtained…the information and documents specified in…Schedule 2. In that, in order to evidence a robust staff recruitment procedure, the home must be able to show that all the necessary pre-employment checks detailed in Schedule 2 have been undertaken. Not met within previous timescale of 6/7/07 (1)The Registered person shall establish and maintain a system DS0000021113.V361083.R01.S.doc Timescale for action 30/05/08 06/09/08 3. YA39 24 30/09/08 Glenmar Version 5.2 Page 29 for evaluating the quality of the services provided at the care home (2) At the request of the Commission the registered person shall supply to it a report based upon a system referred to in paragraph (1), which describes the extent to which, in the reasonable opinion of the registered person, the care home – (a) Provides good quality services for service users; (b) Takes the views of service users and their representatives into account in deciding (i) What services to offer them and (ii) The manner in which such services are to be provided; and In that they must evidence that systems are in place to consult with residents, collate and analyse feedback and evidence how this is used to influence change and service development. The registered person shall give notice to the Commission without delay of the occurrence of the death of any service user…the outbreak…of any infectious disease…any serious injury to…(or) serious illness of a service user, any event…which adversely affects the well-being or safety of any service user, any theft, burglary or accident…any allegation of misconduct… 4. YA41 37 30/05/08 Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 30 In that, the home must notify the Commission of all significant events, including serious illness or injury and those adversely affecting the well being or safety of residents. (Not met within previous timescale of 30/5/07) 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 YA2 Good Practice Recommendations It is recommended that a review should be undertaken to ensure that the home’s recorded pre-admission assessments are completed with sufficient detail on which to base a plan of care. It is strongly recommended that a review should be undertaken to ensure that residents’ care plans are up to date, completed with sufficient detail to reflect residents’ changing needs and provide adequate guidelines for staff. It is strongly recommended that a review should be undertaken to ensure that residents’ risk assessments are completed with sufficient detail to reflect residents’ changing needs and provide adequate guidelines for staff. It is recommended that, with regard to medication: The ability of self-administrating residents to do so should be more clearly evidenced within care plans and supported by risk assessments. Capacity assessments should be in place for residents who are administered medication by staff. Hand written changes to the MAR should be dated for the day of the change as well as signed. Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 31 2. YA6 3. YA9 4. YA20 A review of medication storage including refrigerated medication is to be discussed with the community Pharmacist with reference to the RPS guidance on this matter. PRN guidelines should be established to ensure staff administer this medication consistently. Refusals to access health appointments and treatment should be more clearly recorded within care plan information and made known to other relevant professionals through the review process Restrictions placed on residents should be clearly recorded within care plan information with a clear rationale for the restriction, the restriction should be subject to discussion within a wider forum of other professionals and the resident Moving and handling assessments should be developed where staff are providing physical support to some residents, a trained moving and handling assessor to ensure a safe practice of work should undertake these. 5 YA23 6 YA42 Glenmar DS0000021113.V361083.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office 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. 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