Inspection on 03/05/06 for Glynn Court

This inspection was carried out on 3rd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Glynn Court 11/06/07

Glynn Court 14/11/05

Glynn Court 04/05/05

Glynn Court 21/12/04

Glynn Court 30/06/04

Glynn Court 04/02/04

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

CARE HOMES FOR OLDER PEOPLE Glynn Court Fryern Court Road Tinkers Cross Fordingbridge Hampshire SP6 1NG Lead Inspector Tim Inkson Unannounced Inspection 3rd May 2006 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 Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 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. Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Glynn Court Address Fryern Court Road Tinkers Cross Fordingbridge Hampshire SP6 1NG 01425 652 349 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) Glynn Court Limited Mrs Sally Crook Care Home 31 Category(ies) of Dementia (31), Dementia - over 65 years of age registration, with number (31), Mental disorder, excluding learning of places disability or dementia (31), Mental Disorder, excluding learning disability or dementia - over 65 years of age (31), Old age, not falling within any other category (31) Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the category MD and DE referred to above are not to be admitted under the age of 55 years. 14th November 2005 Date of last inspection Brief Description of the Service: Glynn Court is a care home providing personal care and accommodation for up to 31 service users who require support due to old age, dementia or a mental health need. The home is owned by Glynn Court Ltd; Mrs Sally Crook is the registered manager and one of the directors. Glynn Court is located in a rural area on the outskirts of Fordingbridge in the New Forest. The accommodation is in two separate buildings. The main building accommodates 23 service users on two floors, in both single and shared bedrooms, none of which have en-suite facilities. The second floor can be accessed using stairs or a stair lift. There is a communal sitting room, dining room and conservatory. The second building can accommodate eight service users; one bedroom has an en-suite bathroom. The second floor is accessed using a stair lift. The building also contains a kitchen with seating for four and a sitting room. There is a bathroom upstairs. Day and night staff are based in the main building. The home has a large garden, which is used by the service users in the summer. Potential residents are given a brochure and a copy of the home’s “Service Users Guide” that provide information about the services and facilities provided by the home. There is a notice on display in the home informing anyone who may be interested of the availability of the Commission for Social Care most recent report about the home. At the time of the fieldwork visit to the home on 3rd May 2006, the home’s fees ranged from £327.04 to £520 per week. The fees did not include the cost of hairdressing; newspapers; chiropody and dry cleaning. Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This fieldwork visit was unannounced and took place on 3rd May 2006, starting at 08:50 and finishing at 15:55 hours. The process included viewing all bedrooms, communal/shared areas and the home’s kitchen and laundry. Also an examination of documents and records, observation of staff practices where this was possible without being intrusive and discussion with residents, staff and some visiting relatives. At the time of the inspection the home was accommodating 28 residents and of these 5 were male and 23 were female and their ages ranged from 75 to 98 years. No resident was from a minority ethnic group. The home’s registered manager was present throughout the visit and was available to provide assistance and information when required. Other information that influenced this report included information that the Commission for Social Care inspection had received since the last fieldwork visit made to the home on 14th November, such as statutory monthly reports made to the home for the owner and notices received about incidents that had occurred. What the service does well: What has improved since the last inspection? Care plans were being reviewed every month and they were usually updated to include new information about the help an individual required. The potential for residents to suffer some harm from things such as falling was identified, when individuals moved into the home. This should enable such risks to be reduced or eliminated. Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 6 Many staff had taken the opportunity to attend training in the subject of adult protection ensuring that they knew what action to take if they suspected abuse was occurring in the home. Staff recruitment procedures were more robust ensuring that individuals considered unsuitable to work with vulnerable adults were not employed. Staff were meeting regularly with a member of the home’s management team to have their performance appraised. The Commission for Social Care Inspection was being notified of important events that occurred in the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was a system in place for identifying most of the needs of potential residents. EVIDENCE: The records of 4 residents were examined and in some cases these included copies of assessments that the home had arranged in order to identify the help that an individual needed. The home had a pre-admission form/document that was completed and covered certain areas where a person was likely to need some help and support e.g. medication, mobility, personal care and activities. In two cases the home had not identified these matters themselves but had relied on either someone else to obtain the information or their own previous knowledge of the person. One record examined only included a hospital transfer note with some information about the individual concerned. The registered manager said: Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 9 “The nurse talked to me at length, but with the best will in the world we can’t trot off to places like Poole to do assessments - When a resident lives close, assessment is no problem, but if they are at some distance, then I discuss their needs with hospital staff or a relative. I am honest and I expect them to be”. She said of another resident where there was also no detailed pre-admission documentation concerning her needs • “She has been here for respite care before so we knew about her”. Although some important details could be missing without full information being obtained about potential residents, it was apparent that the manager did try to get as much information as possible from sources she regarded as helpful. Discussion with one resident indicated that he visited the home before he moved in and the manager was able to ascertain what help he needed when that visit took place. There was documentary evidence that assessments of residents needs were reviewed regularly and revised as necessary when an individual’s circumstances had changed. The documentation used by the home omitted to refer to some specific areas of potential need that a person might have e.g. oral hygiene and foot care. It was suggested that the home devise a pre-admission document based directly on the matters set out in the National Minimum Standards for Care Homes for Older People at standard 3.3. The home does not provide Intermediate Care. • Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. 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. The home had systems in place to ensure the personal and healthcare needs of residents were met. The safety of the home’s system for the management of medication could be improved with written guidance. Staff working practice ensured that residents’ privacy and dignity was promoted. EVIDENCE: A sample of written records of 4 residents that included plans setting out the care that residents needed were examined. The documents set out the actions that staff had to take and what specialist equipment was needed to provide the support and assistance each person required. Observation and discussion with residents confirmed that individuals received the help they required and that the equipment (e.g. walking frame/aid) was in place as set out in their plans of care. All care staff spoken to were fully aware of the contents of the care plans that were sampled and of the assistance that the individuals concerned required. The care plan documents included recorded assessments of some of the potential risks to a resident e.g. falls. Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 11 One assessment indicated that the individual risk of falling was high but there was no plan corresponding to that, setting out how falls would be prevented or the risk of injury reduced e.g. the use hip protectors. At the last fieldwork visit to the home on 14th November 2005, it was suggested that consideration be given to using nationally recognised assessment tools for nutritional need and skin integrity/pressure sores. This recommendation was reiterated on this occasion. The documents examined included dates entered each month on an “Individual Care Plan Outcome Sheet”, indicating that the care plans had been reviewed. In addition some new plans had been produced where the needs of the person had changed. The plan for one individual had not however been changed despite the fact that her appetite had improved and nutritional needs had consequently changed. This omission was brought to the attention of the registered manager. The care plans were supplemented by entries in a daily diary of matters considered “worth” recording such as visits from health care professionals or to clinics. There was evidence from another record that the welfare of every resident was monitored during the night. A record of bathing was also kept in which the weight of each resident was recorded regularly. It was noted that care plans referred to some of the fundamental principles/values that underpin social and health care e.g. encouragement of independence and choice, etc. Comments from residents and visiting relatives about the care and support the home provided included: • “I walk with this (frame). I wash and dress myself – I am eating much better now – but I find it difficult to swallow – the district nurse looks in at me – I saw a doctor about itchy skin (reference to that problem was seen in an old care plan). • “We have everything we need and get attended to- if you want the doctor they will call him for you – I see a chiropodist regularly”. (Group of 3 residents) • “I am fortunate as I can more or less look after myself. They help me with my bath because if I get in I can’t get out - They check at night to see if I am all right - The district nurse gave me a flu injection”. • “They check up on me and they are on call when I have a bath- If I am not well they will call the doctor”. • “My Aunt came about a year ago and I visit her regularly - I think that she is well cared for - The girls are bright and cheerful. They know all about her, she is comfortable and they respond to her needs. She had cellulitis and they got the doctor quickly and he got her into hospital. She had sore heels and the district nurse came to see her - I come here at all times to suit me, sometimes I come at lunch time and help to feed her, which is something that they normally do”. The home had a monitored dosage system in place for the administration of medication. Prescribed medicines were provided by a local pharmacist and most were delivered in blister packs holding 28 days supply of each medicine Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 12 and from which they were dispensed to the individuals concerned. Medicines that could not be supplied in these packs such as creams, liquids and those that would deteriorate/spoil quickly outside their protective packaging were administered from their original containers. The blister packs and most medication in use was stored securely in a locked trolley that was secured to a wall when it was not in use. In addition medication was stored in a locked cupboard that contained a locked cabinet secured on a wall in which controlled drugs could be stored if they were prescribed. Most care staff had recently attended a course in medicines administration. The home’s deputy manager explained how the procedures for the ordering, receipt and disposal of any unused or unwanted medicines worked. Medication administration records (MAR sheets) were examined and they were accurate and up to date. Good practice concerning the management of medication that was noted consisted of: Written permission from residents doctors for the use of homely remedies such as simple linctus and analgesia; dating of containers of certain medicines when they were opened; and the use of a special container for any medication requiring refrigeration. There was no written procedure about the management of medication although there was a written policy about residents’ self-medicating. The registered manager was required to produce written medication procedures concerned with the safe recording, handling, safekeeping, administration and disposal of medicines received into the home. This is to ensure that if in an emergency the home had to rely on staff unfamiliar with the home’s procedures there is written guidance readily available. During a tour of the premises it was noted that in shared bedrooms screens were available to provide privacy. As on previous fieldwork visits to the home, on this occasion staff working practice that was observed indicated that residents’ privacy and dignity was promoted e.g. knocking on bedroom doors and polite forms of address. Residents confirmed that staff were respectful, and one said, “… and they are always polite”. One visiting relative said, “On the whole the atmosphere seems good and the attitude of the staff towards the folks -I have not witnessed anything that has bothered me”. Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents preferred lifestyles, expectations and choices were generally promoted and supported by the home but some residents would benefit from having more organized activities in which to participate. They were able to maintain contact with their friends and families and they were provided with a nutritious diet. EVIDENCE: A sample of residents records examined (see page 11 above) included some details about individuals’ leisure interests. There were some organised activities but apart from a busy time around Christmas these normally consisted of a visiting entertainer/singer about once a month and also a monthly communion service. Other activities were reliant on the availability and confidence of staff to chat with residents and as the manager stated “do passive exercises”. Some residents spoken to said that they preferred their own company and pursued their own interests, but some residents, staff and visitors commented about the lack of organised social events/activities. An entry in the care plan of a person who clearly needed support to enable her to socialise and benefit from stimulation stated, “make sure she is brought over to the main building each day to mix with other residents”. Comments about these matters included: Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 14 • • • • • • • “I have been here about a year. It is pretty grim. It is very boring. You just sit for hours on end waiting for the food to come - They said that I was going to bed too early so they make me come to the lounge”. “There is nothing organised here so we sit and chat – I read”. (Group of residents) “There is a religious service here on Wednesdays. They have entertainment but having listened I prefer to read in my room. My daughter brings me books”. “I am not very sociable – I mostly sit and read or do some knitting”. “I would like to see more activities. At Christmas we had singers and we have one about once a month - We would need more staff if we did more activities such as trips in wheelchairs - A nice group of residents meet in the lounge and have a cackle and a chat”. (Staff member) “Depending on how busy we are I try and spend some time talking with residents and try to interact with them”. (Staff member) “They don’t organise too many activities which suits my Aunt as she would not like to be jollied along”. (Visiting relative) There was evidence from discussion with both residents and their visitors that the latter could call at the home any time and there were no restrictions. One resident said, “I get visitors in spades, one reason I moved here is because my daughter lives nearby”. The home had a written policy concerned with the rights of residents i.e. Residents Charter. It referred to the right of residents to make their own choices, act independently and enjoy the same rights and freedoms as any person living in the community. The home’s manager said that no resident managed their own financial affairs, although one signed a cheque for his fees but his daughter “looked after his things”. All residents were assisted to manage their finances by their families or representatives. The home had details of a local advocacy service available should a resident or relatives want to obtain independent advice about matters that may concern them. The home permitted residents to furnish their own bedroom accommodation if they wanted to do so and during a tour of the premises most bedrooms were seen with items of furniture that belonged to the occupants e.g. display cabinets. Comments from residents about their ability to exercise control over their daily lives included the following: • “My solicitor pays my bills - I go to bed after supper – it’s my choice. I get up pretty late – they let me lie in for some time”. • “I decide what time I get up and I go to bed about 9: 00 p.m. It is reasonably free and easy nobody gets rebuked”. • “I do what I like – if I am going to watch soccer at night I tell them otherwise they see the light and they keep coming in - They have entertainment but having listened I prefer to read in my room”. Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 15 • “……..I prefer to eat in my room”. The home had a three-week rotating menu that included choices of main dish and it was prominently displayed in the main dining room. A list of individual residents food preferences and any need for special diets e.g. diabetic, was on display on a board in the kitchen. There use of fresh ingredients e.g. vegetables, in meals was observed as well as the ready availability of fluids in residents rooms and communal areas, also the provision of fresh fruit. A homemade cake was provided with midafternoon tea on the day of the fieldwork visit. The main meal of the day was observed and it was attractively presented. There was some discussion about the appearance of the soft diets that were provided and the registered manager said. ““We used to prepare all the ingredients separately but they mix it up so we don’t bother”. One resident spoken to said, “The food is quite good, I have pureed food, but it is the same day after day, it all tastes the same”. Comments from residents about the food were generally positive: • “The food is good”. • “The food is very good – I am fussy so not for me- sometimes there is too much” (Group of residents) • “The food, I have no complaints about, there is a good selection and there is plenty. I prefer to eat in my room”. • “Food is not too bad – some days it is better than others and there is choice to a certain extent. There is always plenty”. One resident summed up all the matters referred to in this section in the following statement: • “I think that I made the right move. Food is good, plentiful and good quality, my laundry is done and I really appreciate that”. Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was a system in place to address residents concerns but it needed updating. The home’s procedures to ensure that residents were protected from harm could be improved with the addition of further guidelines. EVIDENCE: The home’s complaints procedure was readily available and a copy was displayed on the back of every bedroom door. The registered manager said that there had been complaints since the last fieldwork visit to the home on 14th November 2005. The complaints procedure was however out of date as it referred to legislation concerning care homes that had been repealed by the implementation of the Care Standards Act 2000. It also erroneously included a reference to the local authority as the body for dealing with any complaints a person may have about the way the Commission for Social Care Inspection investigated a complaint concerning the home. The registered manager was required to produce an up to date/amended procedure. The home had a written procedure concerned with the protection of vulnerable adults and at least one other related procedure i.e. restraint. Most care staff had attended recent training in adult protection matters and staff spoken to had a good understanding of the different types of abuse and what action to take if they knew or suspected abuse had taken place. Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 17 Following the last fieldwork visit to the home the registered manager was required to obtain a copy of the local authority’s adult protection guidelines. A pamphlet referring to these had been obtained. This was not however the comprehensive guidelines that would inform the staff in the home of the steps that they must take and the details of the external agencies with whom to liaise if abuse of residents in the home was suspected. Consequently this requirement is repeated in this report. Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has arrangements and procedures in place to ensure that the environment is well maintained safe, clean and hygienic. EVIDENCE: The home employed a handy person to undertake maintenance and repairs and there were records of regular audits of the condition of the bedroom and other accommodation and decoration was undertaken as required. During a tour of the two buildings in which residents were accommodate it was noted that they were both well maintained. Furniture and décor and fittings were all in good repair. There were no offensive odours throughout. Residents and visitors spoken to said that the bedroom accommodation was “nice”. The home had dedicated cleaning staff and there was a written procedure concerned with infection control. Staff were observed using protective clothing that was readily available. Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 19 The home’s laundry was located in a building separate from the living accommodation and the washing machine had a sluice programme. Comments from residents and visiting relatives about these matters included: • • “It is always clean here. Her room is clean and never smells - The whole place smells good. It is clean and tidy. I have seen the cleaners and they are always cheerful and talk to the residents”. (Visiting relative) “They keep the place very clean” (Resident) Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home deployed staff in numbers and with the abilities to meet the needs of residents. Staff induction and on-going training was a priority but there were insufficient care staff with a relevant/appropriate qualification There was a robust staff recruitment procedure in place that ensured the protection of vulnerable adults. EVIDENCE: The basic for the deployment of care staff was: Time Number 8-9 4 9-1 7 1-8 3 8-8 2 In addition the home employed 4 staff dedicated to cleaning tasks, a cook and a kitchen domestic. The registered manager was supernumerary and worked Monday to Friday from 08:00 to 17:00 Residents and staff spoken to all were of the view that the staffing levels were sufficient. Residents and visitors were also confident that the staff had the competence to provide the help and support that residents needed (see page 12 above). Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 21 The number of care staff working in the home was 27 and of these, 1 had a National Vocational Qualification (NVQ) at level 3 in care, 1 was a State Enrolled Nurse. The expectation set out in the National Minimum Standards for Care Homes for Older People is that a minimum of 50 of care staff are trained NVQ level 2 or equivalent. The ratio of care staff meeting this standard was 7 . At the time of the fieldwork visit 2 care staff had started working towards obtaining an NVQ. As the ratio of staff with NVQ was so low the registered manager was required to provide an action plan setting how and when the home intend to meet the level of 50 . The registered manager explained that there was considerable difficulty persuading staff to take up training opportunities. She said: “It is difficult getting staff to do NVQ and attend training generally – I have looked at ways of encouraging them to do it we have a “shame board” in the staff room. The problem is because of their age some staff don’t want to do it and also the cost”. Despite the problems that the manager described it was apparent from the “shame board” that the vast majority of care staff had attended a programme of monthly training events that was taking place over 6 months and provided by an external training organisation in the following subjects relevant to their roles: Moving and handling; risk assessment; abuse; and administration of medicines Staff spoken to referred to the training they had received including their induction and said that they were still to attend training in dementia and workplace health and safety before the end of June 2006. • “I was allocated to a member of staff for one month who went through everything and gave me feedback. I have been on all the courses. I have been enrolled on NVQ 3”. • “I did my induction with someone who had NVQ 3 but she has left now. She stayed with me constantly and I was shown things like using gloves, lifting, emptying catheter bags, which people needed which sort of help. We have had training about medication, fire safety, moving and handling and abuse”. • “I worked alongside shadowed another care assistant who told me what to do. I have done lots of care work and through Learn Direct had a day course about induction into care. I have completed my TOPSS training. Here in the home we have done fire safety, administration of drugs, risk assessment, abuse and we due to do dementia and work place health and safety”. A more experienced member of staff said, “I have done some of the training the others are doing already – I did risk assessments elsewhere and a 2 day course on dementia care”. Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 22 The records of 2 staff who had started work in the home since the last fieldwork visit on 14th November were examined and all the necessary preemployment checks to ensure that they were suitable to work with vulnerable adults had been completed. In addition both individuals had completed fire safety training organised by the home before they started their employment. There was evidence from discussion with care staff and records that all new care staff received induction training that met the specifications of the National Training Organisation (NTO). The manager however was not aware that the NTO had changed from the Training Organisation for Personal Social Services (TOPSS) to “Skills for Care” and that induction and foundation training had been combined and that the period of time for a new member of care staff to complete this had been extended. Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager had the experience and knowledge to run the home effectively. There were systems and procedures in place for; monitoring the quality of the service provided by the home and ensure that it was run in the best interests of service users; and for ensuring that the living and working environment was safe for residents and staff. EVIDENCE: The registered manager had trained as a State Registered Nurse but was no longer on the register of the Nursing and Midwifery Council. She had managed Glynn Court for some for 28 years. In discussion about maintaining her knowledge and skills the registered manager said that she had not done any training for some time, but she did Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 24 attend meetings and seminars organised by the local care homes’ association in order to attempt to keep up to date with developments. Some staff spoken to said that in many circumstances and on a day-to-day basis they would seek advice from the home’s deputy manager when they were uncertain about things. However the following comments were made by residents’ and staff about the manager’s abilities and approach: • “I see the matron every day and I would go to her if I wanted advice”. (Member of staff then described an incident where a resident needed some cream on her neck for a limited period of time and the advice she was given by the manager). “We have a handover every day and discuss every resident. The matron is in every day but we tend to go to the deputy for everyday things”. (Member of staff) “I ask the deputy matron for advice when she is on the floor or the matron who is in Monday to Friday”. (Staff member) “The manager is a very nice lady”. (Resident) “The matron is capable”. (Resident) “The matron seems to be all right but I don’t see much of her”. (Resident) • • • • • The home had a quality monitoring system. A consumer satisfaction survey had been carried out, and the registered manager said that the responses to questionnaires had been collated and sent to the Commission for Social Care Inspection. She also said that another survey would be done in June 2006. A record of regular audits made of the condition of bedrooms and other areas was seen. Monthly visits to the home were carried out for the registered provider and copies of the reports of these visits were provided to the Commission for Social Care Inspection. The home had a range of written policies and procedures to provide guidance for staff and they included the following. • Abuse • Care of dying • Complaints • Infection control • Restraint • Self medication • Charter of rights • Accidents • Missing persons Staff said that they were given copies of the procedures when they first started work in the home. There was evidence that the registered persons (i.e. the manager and provider/owner) had addressed or had attempted to address all requirements Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 25 arising from previous fieldwork visits. The following matters were noted concerning the requirements: • There was evidence that care plans were formally reviewed every month. • Risk assessments were completed as part of the home’s admission process. • Staff had undertaken training in the subject of adult protection. • A pamphlet had been obtained about the local authority’s adult protection guidelines (but not a copy of the actual guidelines as required). • Staff employed since the last inspection had not started work until necessary pre-employment checks had been done. • Care staff confirmed that they were meeting regularly with a member of the home’s management team for appraisal. • The home’s deputy manager was booked on a training course in September 2006 that would equip with the necessary skills to provided formal staff supervision and appraisals. • Notices of incidents and event were sent to the Commission for Social Care Inspection. The home did not look after the finances or keep any money on behalf of any of the residents. There was evidence from both discussions and records that all staff working in the home had received regular training fire safety and other in health and safety subjects that were relevant to their roles in the home. These included, “food hygiene” and “moving and handling”. One of the subjects that was included in a training programme that had been arranged for the home’s staff was “work place health and safety” (see also page 22 above). Records were seen of accidents that occurred in the home. A fire risk assessment had been completed for the home. Product data/information was available for hazardous chemicals used in the home and these were stored securely. Other records examined indicated that systems and equipment in the home were tested and serviced at intervals and with the frequencies either required according to relevant regulations or good practice. These included: • • • • • • Fire extinguishers – March 2006 Call-bell/emergency lights/smoke detectors/fire panel – May 2005 Stair lift –March 2006 Mixer valves on taps to control hot water temperature 3March 2006 Weekly test of fire alarm Electrical wiring 2003 Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 26 Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 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 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 1 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 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 OP9 Regulation 13(2) Requirement The registered persons must produce written procedures concerned with the recording, handling, safekeeping, safe administration and disposal of medicines received into the home. The registered persons must update the home’s complaints procedure. The registered persons must obtain copies of the “Hampshire” Adult Protection Procedures /Guidelines. (Timescale of 28/02/06 not met) The registered person must submit an action plan about how and when a minimum of 50 of the care staff will be trained to NVQ level 2 or equivalent. Timescale for action 31/08/06 2 3. OP16 OP18 22 13(6) 31/08/06 31/08/06 4 OP28 18(1) 31/08/06 Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 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 Glynn Court DS0000012344.V292654.R01.S.doc Version 5.1 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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