CARE HOMES FOR OLDER PEOPLE
Glow Rest Home 58 Villiers Avenue Surbiton Surrey KT5 8BD
Lead Inspector Barry Khabbazi Unannounced Inspection 5 April 2005 09:10 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 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. Glow Rest Home Version 1.10 Page 3 SERVICE INFORMATION
Name of service Glow Rest Home Address 58 Villiers Avenue, Surbiton, Surrey, KT5 8BD Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8399 2614 Mrs Aloma Glowacki Mrs Aloma Glowacki Care Home 3 Category(ies) of Dementia - over 65 years of age(3) registration, with number Old age, not falling within any other category(3) of places Glow Rest Home Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: none Date of last inspection 23 November 2004 Brief Description of the Service: Glow Rest Home is registered with the Commission for the provision of residential care to a maximum of three service users. The home is situated within easy reach by car or public transport of both Surbiton and Kingston town centres. On-street parking outside the property is limited, but the home has sufficient hard standing to provide parking for up to four vehicles.All service users’ bedrooms are on the first floor of the property. The building does not have an elevator or stair lift. To the rear of the property, a mature garden. Glow Rest Home Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 9.00 a.m. This early unannounced inspection was prompted following difficulty contacting the home in the mornings since February. The main aim was to assess staff cover during the manager’s absence. The potential staffing and management concerns during the manager’s absence were allayed following investigation. See Standard 31 for details. The inspection took place over one hour early in the morning. The inspector was able to speak to all the residents and one relative/visitor on this occasion. During this inspection the manager was interviewed. Records, and care plans and the building were examined, as were all the residents’ bedrooms. What the service does well: What has improved since the last inspection?
The initial assessment now covers all the elements of Standard 3. This will result in more detailed and relevant assessments of a residents individual needs and a better understanding of needs by staff. Glow Rest Home Version 1.10 Page 6 Care plans now not only cover the physical and medical needs of the residents but also cover social care needs social interests, religious and cultural needs and carer and family involvement and other social contacts. This should improve how well staff, particularly new staff, know and respond to a resident’s need. The home has purchased an induction and foundation training package from the National Training Organisation which has been used on the most recent recruited member of staff. This should contribute to creating a more highly trained workforce. The way in which staff are recruited is now much improved and should help protect the residents from employing undesirable staff. What they could do better: The contracts need some improvement. The contract should make clear which room has been given to the resident in order that they can feel secure that the room will not be changed by the home without a valid reason. Further work needs to be done to improve safety and security for the residents by fitting window restrictors where required. This will protect residents from intruders and where appropriate protect residents from falling. Further work needs to be done to confirm the water quality in the cold water storage tanks. This will protect residents from many infections for example legionella and e-coli. Residents’ bedrooms did not contain all the furniture the home should provide. For example it is normal to have two chairs in the bedrooms so that residents can sit in privacy and talk with their guests. Residents should be able to decide what furniture they want around them however it is important that these decisions are recorded and supported by risk assessments. This will ensure that the residents have all the furniture they are entitled to supplied by the home, unless they do not want a particular item. Only limited progress has been made with regards to the home implementing a quality assurance system and an annual development plan. It is extremely important that residents and their relatives are consulted as part of this process as they have commented positively about being involved. Only limited progress has been made with regards to the frequency of staff supervision. Although staff are supervised on a day to day basis a more in depth regular meeting to discuss what they do well and what they do better will help to maintain the quality of the work. Until this occurs this area therefore remains unsatisfactory. Glow Rest Home Version 1.10 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Glow Rest Home Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Glow Rest Home Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 The contracts need some improvement. The contract should contain the room to be occupied so that the room occupied by a resident cannot be changed by the home without a valid reason. The initial assessment now covers all the elements of Standard 3. This will result in more detailed and relevant assessments of a residents individual needs and a better understanding of their needs by staff. EVIDENCE: The home does have contracts with the placing authority and separate contracts between the home and the service user. The last inspection report recorded that the contract between the home and the service user covers almost all of the elements required in Standard 2 except specifying the room to be occupied. The manager confirmed that contracts had not been amended by the time of this inspection. The existing requirement remains in force. Glow Rest Home Version 1.10 Page 10 The last inspection report recorded that the home uses ‘Standex’ medical assessment forms, which while being comprehensive from a clinical perspective, do not cover any social needs. By the time of this inspection the care plans had been amended to cover all the elements of Standard 3.3, and in particular a history falls, oral health, mobility, social interests, religious and cultural needs and carer and family involvement and other social contacts. Glow Rest Home Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 Care plans are much improved and are now more holistic and also cover social care needs. This should improve how well staff, particularly new staff, know a resident’s needs. EVIDENCE: The last inspection report contained the following requirement: Care Plans must cover all the elements of Standard 3.3. By the time of this inspection new Care Plans had been created that covered all the elements required. Glow Rest Home Version 1.10 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) NA These standards were not assessed on this occasion. These standards were all assessed as met at the last inspection. See the last inspection report for details. EVIDENCE: Glow Rest Home Version 1.10 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) na These standards were not assessed on this occasion. These standards were all assessed as met at the last inspection. See the last inspection report for details. EVIDENCE: Glow Rest Home Version 1.10 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 24 and 25 Further work needs to be done to improve safety and security for the residents by fitting window restrictors where required. This will protect residents from intruders and where appropriate protect residents from falling. Residents’ rooms need to contain all the furniture required under the National Minimum Standards unless recorded choice or risk assessment shows otherwise. This will ensure that the residents have all the furniture they are entitled to supplied by the home, unless they do not want a particular item. Further work needs to be done to confirm the water quality in the cold water storage tanks. This will protect residents from many infections for example legionella and e-coli. The home is particularly hygienic and clean and cleanliness is maintained to a high standard. EVIDENCE: Glow Rest Home Version 1.10 Page 15 The home appeared to be in good condition externally and was well decorated in a homely fashion inside. This home is very well maintained. The 2003 inspection report contained the following requirement: All windows from which there is a risk of falling must be fitted with appropriate restrictors. This had not happened due to uncertainty about the appropriate fittings and completion of risk assessments therefore the requirement remains in force. All the service users’ bedrooms were seen at this and the announced inspection. Bedrooms were decorated to a high standard. The bedrooms were highly personalised and reflected the individual tastes and preferences of their occupants. Service users spoken to during the inspection confirmed that they had been able to bring items with them on admission, including photographs, ornaments and, in some cases, items of furniture. Service users also confirmed that they liked their rooms. Most of the items required in 24.2 were present in service users’ bedrooms, except for example, 2 chairs in each room to enable the reception of visitors, and a table to sit at. However it seemed to the inspector that this might be due to choice as service users had a lot of their own furniture instead. The following new requirement was made to reflect this identified shortfall: Service users’ rooms must contain all of the items listed in Standard 24.2 unless the service user has made a positive choice not to and this is evidenced in their files or recorded risk assessments show otherwise. This had not occurred by the time of this inspection and the requirement therefore remains in force. The last inspection report contained the following recommendation: Give consideration to commissioning a water analysis check on the water storage system. This had occurred and water-testing equipment was present at the home by the time of this inspection. However the tests had not been executed and results of these tests were not available. The following new requirement is therefore now set. The ‘certificate of bacterial analysis’ testing results are to be sent in to the Commission. At this unannounced inspection, it was reassuring to see that the home was particularly clean and hygienic, as it was at the announced inspection. Glow Rest Home Version 1.10 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29 and 30 Induction and foundation training to National Training Organisation’s specifications is now in place. This should create a more highly trained workforce. The staff vetting procedure is now much improved and now meets the National Minimum Standards fully. This should help protect the residents from undesirable staff. EVIDENCE: The last inspection report recorded that most staff members’ files contained: enhanced Criminal Record Bureau checks for both new and existing staff, the staff member’s full name and address, date of starting, qualifications, application form, copies of the qualification certificates, job descriptions, copies of identification checks in the form of a passport and a driving licence, or other documentation, two written references, and staff photographs. One file sampled contained some omissions including two references. This had been rectified by the time of the last inspection and the new member of staff’s file contained all the elements required. This was also the case at this inspection. The 2003 inspection report contained the following requirement: Develop a programme of training available to staff at the home. At the last inspection the registered manager was reminded that this training would need to meet National Training Organisation standards and specifications. The registered manager had recruited a new staff member at the time of the last inspection. The home had acquired the ‘Training Of Personal Social
Glow Rest Home Version 1.10 Page 17 Services’ induction packs and the new member of staff has started this induction system. This meets the requirement set and this standard. Glow Rest Home Version 1.10 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 36 The home is managed well and run efficiently providing a safe and stable environment for the people living there. Only limited progress has been made with regards to the home implementing a quality assurance questionnaire and an annual development plan. If residents are not involved in this process their views about how the home can better meet their needs will not be taken into account. This will be an opportunity missed as both residents and relatives have commented about being involved. Only limited progress has been made with regards to the frequency of staff Supervision. This area therefore remains unsatisfactory. This could affect the quality of the work that the staff do. EVIDENCE: Glow Rest Home Version 1.10 Page 19 This early unannounced inspection was prompted following difficulty contacting the home since February. The main aim was to assess staff cover during the manager’s absence. The potential staffing and management concerns during the manager’s absence were allayed following investigation. A home owner who has a home in the adjacent road covered management issues, two additional staff were put on call and records showed that the staffing levels were maintained during the manager’s unplanned absence. As this is a small home of 3 residents the staffing needs are lower than a larger home. This would account for difficulties making contact during the period identified as the staff on shift would be addressing the residents’ care needs at the times contact was attempted. Quality assurance tools currently include service user meetings and a complaints system. These quality assurance tools have been pulled together into an internal quality assurance system, which includes this information in the home’s annual plan where appropriate, and then provides a system of feedback and review involving the service users in the form of resident meetings. This should allow open measuring of achievement in improving quality. However, a minor shortfall was identified at the last inspection in gathering information from service users and relatives. The following requirement was then set to address this minor shortfall: The views of the service users must be obtained in the form of service users questionnaires. {For the quality assurance systems and also inclusion in the Service Users Guide.} This had not occurred and the requirement therefore remains in place. The last inspection report recorded that supervision is occurring but this is not being recorded as required under this standard. The following requirement was then set to address this shortfall: Formal supervision sessions must occur at least six times a year and must be recorded and cover all the elements of Standard 36.3. This had not occurred yet and the requirement remains in force. Glow Rest Home Version 1.10 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 2 x x x x 2 2 x STAFFING Standard No Score 27 x 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x 2 x x 3 x x Glow Rest Home Version 1.10 Page 21 no 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. 2. Standard 19 24 Regulation 12(1)(a)1 3(4)(a)(b) &(c) 16[2]c m Requirement All windows from which there is a risk of falling must be fitted with appropriate restrictors. Service users’ rooms must contain all of the items listed in Standard 24.2, unless the service user has made a positive choice not to and this is evidenced in their files or recorded risk assessments show otherwise. The ‘certificate of bacterial analysis’ testing results are to be sent in to the Commission The views of the service users must be obtained in the form of service users questionnaires. {For the quality assurance systems and also inclusion in the Service Users Guide.} Formal supervision sessions must occur at least six times a year and must be recorded and cover all the elements of Standard 36.3. Timescale for action Timescale extended to 1/12/04 1/12/2004 3. 4. 25 33 13[3][4] 12[3] 1/3/2005 1/12/2004 5. 36 17[2]b 1 8[2] 1/12/2004 6. Glow Rest Home Version 1.10 Page 22 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 2 Good Practice Recommendations The room to be occupied needs to be added to the service users’ contracts. Glow Rest Home Version 1.10 Page 23 Commission for Social Care Inspection 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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