Inspection on 05/10/07 for Hadley Place Residential Home

This inspection was carried out on 5th October 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hadley Place Residential Home 03/10/08

Hadley Place Residential Home 27/09/06

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

CARE HOMES FOR OLDER PEOPLE Hadley Place Residential Home 301-305 Anlaby Road Hull East Yorkshire HU3 2SB Lead Inspector Beverly Hill Key Unannounced Inspection 5th October 2007 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 DS0000068362.V352501.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000068362.V352501.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hadley Place Residential Home Address 301-305 Anlaby Road Hull East Yorkshire HU3 2SB 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) 01482 212444 F/P 01482 212444 Hadley Place Limited Mrs Gaynor Louise Laing Care Home 29 Category(ies) of Dementia - over 65 years of age (29), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (6), Old age, not falling within any other category (29) DS0000068362.V352501.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Care to be provided for 6 named service users (names on CSCI files) in category MD who are under 65 years of age. One named service user under pensionable age can be cared for at the home . 27th September 2006 Date of last inspection Brief Description of the Service: Hadley Place is situated on Anlaby Road approximately a mile from Kingston upon Hull City centre, offering residential accommodation for a maximum of twenty-nine people including six people with a mental disorder who may be under the age of 65years. Accommodation is available over four floors and a passenger lift accesses three of these. The forth floor is accessed by stairs and is for more ambulant people. The home has twenty-one single bedrooms and four shared rooms. A number of the single rooms are en-suite. Communal rooms consist of three lounges, two of which are situated on the first floor, and a dining room. There is also a small kitchen leading from the dining room that service users or visitors can access to make hot drinks. The home has a walk–in shower room and two unassisted bathrooms. There are sufficient toilets throughout, which are close to communal areas. To the rear of the home there is a small patio garden area with garden furniture and a ramp for wheel chair access to the back door. There is car parking for approximately nine cars. The current scale of charges is between £298.50 and £361 per week. Additional charges include hairdressing, chiropody, toiletries, newspapers/magazines and trips out. Information about the home is included in the statement of purpose and service user guide, which are located in the home and distributed to potential service users. DS0000068362.V352501.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key inspection of the home on 27th and 28th September 2006 and includes information gathered during a site visit to the home, which took place over one day on 5th October 2007. Throughout the day we spoke to people to gain a picture of what life was like for them to live at Hadley Place and analysed the surveys returned from them. We also had discussions with the registered manager and care staff members. Information was also obtained from surveys received from staff members, relatives and visiting professionals. Comments from the surveys have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. We would like to thank the service users, staff and management for their hospitality during the visit and also thank the people who completed surveys. What the service does well: Everyone admitted to the home had an assessment to make sure staff were clear about whether they could meet the persons needs. People can have trial visits and respite stays before making a final decision about permanent residency. The staff team clearly enjoyed their jobs and spoke to people in a nice way, providing care that respected peoples’ privacy and dignity. There is a low staff turnover, which means that there is consistency of care and staff get to know the people who live there very well. DS0000068362.V352501.R01.S.doc Version 5.2 Page 6 There were plenty of activities provided for people and staff ensured they were given choices about their lives. Staff showed good understanding of how to make sure people remained as independent as possible. Visitors were welcomed at any time of the day. People who lived at the home stated they liked the meals and drinks provided. Alternatives were available and the staff organised theme nights for people to get together and enjoy special meals. The manager ensured that any niggles or complaints were resolved quickly. The manager made sure that staff received training in how to protect vulnerable adults from abuse. Staff members had obviously taken this training seriously and were able to give comprehensive answers to questions about safeguarding adults. The home provided a pleasant environment for people to live and work in. It had a friendly and homely feel, and was clean with no unpleasant odours. People were encouraged to bring in their own personal items. One person stated, ‘the staff keep it clean and tidy’. The manager and proprietors were very visible in the home and made sure the people that lived there and members of staff could talk to them about things. The staff supported people to budget their finances. What has improved since the last inspection? What they could do better: Some care plans were thorough but others needed more information especially when the person had dementia. Also care plans must be completed quickly after the persons’ admission so that members of staff have clear guidance on how to support them straight away. DS0000068362.V352501.R01.S.doc Version 5.2 Page 7 When staff checked whether the care plans were still meeting needs they must check information found in other parts of the care file and document the evaluation accurately. Generally the staff completed risk assessments for particular activities for people who lived at the home and put in place steps to minimise the risks. They need to make sure all identified risks are dealt with in this way. The way the home managed people’s medication must be improved so that people do not run out of medication and also that records are clearer. The home could look at the needs of people with dementia and tailor specific activities more fully to their needs. The home could provide paper towels in communal toilets instead of linen towels to assist in the prevention of the spread of infection. The way that staff members were recruited must improve so that references were available for all staff. This is really important to ensure only appropriately checked people care and support vulnerable people. The manager needs to plan staff-training needs by looking at supervision and appraisals. A plan will assist her to make sure staff have the right skills and knowledge to complete their jobs and to ensure refresher training is completed. Care staff supervision must be re-started for all staff to make sure they are supported in their jobs. Staff induction needs to meets Skills for Care standards, and documentation needs to evidence assessed competence in basic skills. This will ensure that when new members of care staff start in their caring roles they progress through nationally recognised standards at a pace suited to their learning needs. The home used to send out questionnaires to people to obtain their views about the service but this had not been completed this year. It is important people are fully consulted about how the home is managed so changes can be made. The home needs to improve the way it monitors the health and safety of service users within the home, as there were some areas identified in the report that could affect people’s wellbeing. All notifications of incidents or accidents that affect the wellbeing of service users need to be forwarded to the Commission. 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. DS0000068362.V352501.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000068362.V352501.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 5 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People had assessments of need completed prior to admission, which assisted the home in decision-making about whether needs could be met there. The home offered visits and trial stays so people could assess the services provided by the home. EVIDENCE: We examined four care files during the visit. Two of the files had assessments completed by care management and three also had care plans. All four care files had full assessments completed by the home manager prior to admission. She confirmed they visited people at home or in hospital to complete the assessment. This enabled the manager and deputy to discuss peoples’ needs and decide if they could be fully met in the home. DS0000068362.V352501.R01.S.doc Version 5.2 Page 10 The home produced care plans from information gathered at the assessment stage. The manager confirmed that people were encouraged to visit the home and look around, and the home provided them with information about services. The first four to six weeks of any admission were seen as a trial period, at which point a review was held to discuss the stay and whether permanent residency was required. Documentation confirmed this. The home had the capacity to provide respite care, which gave people the opportunity to try the home and get to know staff and the home’s way of working before making any final decision about permanent residency. The home has produced a formal letter to use when writing to people following the assessment stating their capacity to meet the identified needs. The home does not provide intermediate care services. DS0000068362.V352501.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Generally the home produced clear care plans, however the lack of a care plan in one instance means that staff do not have full guidance on how to meet needs and care could be missed. Running out of medication means that two service users have not received medication as prescribed for them, which could place their health at risk. Service users receive care and support that promotes their privacy and dignity. EVIDENCE: Four care files were examined on the day of the visit. They contained lots of information to use when planning care to meet the service users assessed needs. Two of the care plans examined contained thorough information and guidance to staff on how to meet assessed needs. One care plan required more DS0000068362.V352501.R01.S.doc Version 5.2 Page 12 detailed information on how to meet the persons’ needs especially in relation to their dementia. One person, admitted over seven weeks before did not have a care plan or risk assessments in place despite some risk identified in the care management care plan. The manager stated they were still gathering information. However it was essential the home completed plans of care quickly in order that staff had clear guidance on how to support the persons’ needs. There was evidence that service users signed their care plans and they were updated when needs changed. Reviews were held initially after six weeks then annually. There was a care plan evaluation form that was completed and dated monthly but in some instances seen these had been photocopied from previous months and had incorrect information on them. For example in June the evaluation talked about the service user enjoying Christmas celebrations. The evaluations need to be a true reflection of how the care plan continues to meet needs or whether changes in the care plan are required as a result of changing needs or circumstances. Care plans, surveys received and discussions with service users and staff indicated that health and social care needs were met in ways that promoted privacy, dignity, choice and independence. In discussions staff were aware of individual needs and people spoken with commented their needs were met, ‘they always knock on my door and they look after me very well’. People’s general health was monitored and there was evidence of referral to appropriate health professionals for advice and treatment, ‘I went to the dentist six months ago and go to the Brocklehurst (diabetic clinic) regularly’. Generally risk assessments were produced for a range of issues such as, smoking, medical conditions, pressure sores, mental health concerns, making hot drinks, diet and general environment. However some issues identified in daily records required greater attention and risk management. For example one service user was seen offering some of her bowel medication to another person. The manager had addressed this with the service user but clearly staff need to follow medication policies and procedures regarding observing administration of medication. Three people had bed rails in place, two of which were integrated with hospital beds and supplied by the primary care trusts. The manager had completed basic risk assessments regarding the need for bed rails but they need to include new guidance produced by the health and safety executive and the medicines and health care products regulatory agency. Medication was stored well and signed on admission to the home and on administration, however there were some areas of management that needed improvements. DS0000068362.V352501.R01.S.doc Version 5.2 Page 13 • Two service users had run out of important medication. The manager explained this was an ongoing concern. This was not acceptable and must be resolved with the practice manager. • Staff members need to follow policies and procedures regarding observing administration of medication. • Codes used on the medication administration record need to be consistent. • One person had the dose of medication, ‘as directed’. Staff had been administering it four times a day but there was no evidence that this was the dose the GP requested. Instructions must be clarified with the GP. • When transcribing information onto the medication administration record, the full manufacturers’ instructions were not consistently written down with two signatures. • Information regarding the changes to anti-coagulant dosage should be in writing and maintained with the medication administration record. DS0000068362.V352501.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home had flexible routines, promoted choice and individual decisionmaking and provided well-balanced meals, which met peoples’ nutritional needs. EVIDENCE: People spoken with stated their visitors could come at anytime and could be seen in private. This was confirmed in discussion with staff. The survey received from a relative commented that they were always kept informed of important matters. The home organised daily activities and weekly trips out to offer social stimulation. These included, bingo, visiting entertainers, weekly theme nights, for example Chinese food and a movie, shopping into the town and visits to Bridlington and Hornsea, the Humber Bridge and local pubs. One person explained how they had visited the race course at Beverley three times this year and another talked about their recent weekend away with four other DS0000068362.V352501.R01.S.doc Version 5.2 Page 15 people and staff to Bridlington. One person still attends a local club monthly and stated, ‘If I want to do it there are things for me to do’. The home had three newspapers delivered daily and two to three at weekends. The proprietor had also installed Sky television to communal rooms and all bedrooms. People stated they really enjoyed watching Sky sports on TV and made requests if there was a particular film or programme they wanted to see. The home could look at the needs of people with dementia and tailor specific activities more fully to their needs. There was evidence through observation and discussion that people could make choices and decisions about aspects of their lives. Staff spoken with had an understanding of how to promote independence and choice, ‘we ask people if they want to get up or what clothes they want to wear’, ‘some people go to the shops on their own’ and ‘we can advise what is best but it is their decision’. People spoken with confirmed this, ‘I go to bed whenever, I suffer with headaches so they make me a cup of tea, then I go back to bed’, ‘you can make your own drinks’, ‘you can please yourself what you want to do’, ‘one person doesn’t like fish and chips so they have a jacket potato and eggs’ and ‘you are not pressured into joining in, I like to read and watch television, and keep myself occupied’. The manager spoke about assisting some people to budget their finances and manage their supply of cigarettes safely to ensure they had sufficient to last throughout the day. Bedrooms were personalised and people stated they could bring in their own items of furniture. Some people had installed their own telephones and small fridges. People managed their own money and one person was able to safely manage a part of their medication with staff support. People spoken with enjoyed the meals provided by the home. Some comments were, ‘I like the food, its quite nice, if you want something different they will give you it’, ‘the food is great, we have a fantastic cook’, ‘we get plenty to eat and drink’, ‘my favourite is fish and chips, the best meal of the week’ and ‘the food and the staff are good’. We observed one choice at lunchtime and the meals were well proportioned and presented. People did confirm that alternatives were provided as required and described times when this had happened. The dining room was set out with individual tables and chairs. Some people chose to eat their meals in their bedrooms. Special diets were catered for and the staff checked with people if they had enjoyed their lunch or if they required anymore. Menus were rotated and included local produce and fresh fruit and vegetables. The home had achieved DS0000068362.V352501.R01.S.doc Version 5.2 Page 16 a score of ‘B’ from environmental health in the, ‘Scores on the doors’ scheme. The home was working towards the ‘healthy heartbeat award’, which related to menu planning and preparation of healthy alternatives. DS0000068362.V352501.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provided an environment where people and their relatives felt able to complain. The home protected service users from abuse by staff training and adherence to policies and procedures. EVIDENCE: The home had a complaints policy and procedure that was on display. It stated timescales for resolution of the complaint and there were complaint forms for people to fill in and give to staff members or the manager if people wished to make a formal complaint. The manager confirmed that any complaints were generally minor in nature and resolved straight away. There had been no formal complaints since the last inspection. People spoken with stated they felt able to complain if they were unhappy and mentioned the manager, staff members or the proprietor by name as the people they would go to. ‘You can go to her for anything’, ‘I’ve never had to complain’, ‘I have no complaints at all’ and ‘we are very well looked after – definitely’. A survey from a relative had ticked that they were not aware of the complaints process but stated, ‘I would complain to the person in charge’. DS0000068362.V352501.R01.S.doc Version 5.2 Page 18 There was evidence that all care staff had completed training with the local authority in how to protect vulnerable people from abuse. Those care staff spoken with were able to give very comprehensive answers to questions about safeguarding adults and were clear about the alerting process. Some ancillary staff were still required to complete the course. The home used the multi-agency policy and procedure regarding safeguarding vulnerable adults from abuse and the manager and deputy manager were aware of their responbsibilities in referring any allegations of abuse to the local authority or police for investigation. DS0000068362.V352501.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provided a clean, homely and safe environment for people to live and work in. EVIDENCE: Accommodation was available over four floors and a passenger lift accessed three of these. The forth floor was accessed by stairs and was for more ambulant people. Generally the house was well maintained and maintenance personnel dealt with health and safety or repair issues quickly. Records were kept of when an item or job was reported as needing attention and also when it had been completed. DS0000068362.V352501.R01.S.doc Version 5.2 Page 20 The home had twenty-one single bedrooms and four shared rooms, although two of these were currently used as single bedrooms. One of the people who shared a bedroom was spoken with and they confirmed they had made their own decision to share, ‘I used to have a single bedroom but I asked to share with my friend’. A number of the single rooms were en-suite. Those bedrooms examined were personalised to varying degrees. Some people had installed their own fridges and telephones and all bedrooms had privacy locks. As an addition all bedrooms as well as communal lounges had the full package of Sky television installed. People spoken with were happy with their bedrooms, ‘I have a nice bedroom’, ‘I used to share a room but now I have one of the single en-suite rooms’ and ‘the staff keep it clean and tidy’. Surveys received from people were positive about the homes cleanliness and tidiness. Communal rooms consisted of three lounges, one on the ground floor and two situated on the first floor, and a dining room. There was also a small kitchen leading from the dining room that service users or visitors could access to make hot drinks. The manager confirmed that a grant from the local authority was to be used to refurbish and re-decorate the dining room and extend it at both ends. The small kitchen will then become part of the dining room. The dining room was nicely set out with individual tables and chairs with tablecloths and place settings. The home had a walk–in shower room and two unassisted bathrooms. There were sufficient toilets throughout, which were close to communal areas. Some of the toilets although serviceable were rather dated and in need of refreshing and in some cases, replacement of the floor covering. All bathrooms and toilets had privacy locks. To the rear of the home there was a small patio garden area with garden furniture and a ramp for wheel chair access to the back door. There was car parking for approximately nine cars. All parts of the home were clean and tidy. The home had a separate laundry room with two commercial washing machines and driers. The room also included an open sluice system. Most of the communal bathing and toilet facilities had towelling hand towels instead of paper towels. This was a potential risk of infection and the manager needs to take steps to address it. The primary care trust infection control nurse has had contact with the home and was to provide infection control training for a nominated staff member who will then be able to cascade the training to other staff members. DS0000068362.V352501.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although there were gaps in induction and training plans, the training the home provided generally gave staff the skills they required, to care for older people, and those with mental health needs. The recruitment processes lacked a robustness that was required to ensure the safety of people that lived in the home. EVIDENCE: There had been an improvement in staffing levels since the last inspection. Discussion with the manager and staff and examination of staff rotas evidenced that there were four care staff on duty during the morning shift, three or four in the afternoon/evening shift and two at night. There was a management on-call system at night for emergencies. Care staff spoken with explained how tasks were allocated during the morning and although they were busy they felt it was manageable. The manager advised that they had two care staff vacancies that had occurred recently and recruitment was to commence. Existing members of staff were filling in gaps. DS0000068362.V352501.R01.S.doc Version 5.2 Page 22 People spoken with were complimentary about the care staff, ‘the staff support me with my cigarettes, I’m happy here, they look after me’, ‘they’re lovely, I get on well with them’, ‘yes, the staff do listen to you’, ‘the staff are good’, ‘you can do more or less what you want, we’re well looked after’, ‘I have no complaint about the staff’. One person did state, ‘the staff are mixed, some are alright’. A survey from a relative was equally complimentary, ‘the staff genuinely care about the residents, they do their best for them’ and surveys from service users had all ticked positive that staff listened to them and acted on what they said. We observed that the manager and staff team had built up good relationships with people. The staff office was located on the main corridor and people were observed popping in and out to speak to the manager or to receive support from them. Staff induction tends to be an orientation to the home, working alongside other staff members and observation by the manager. Members of the care staff team need to complete Skills for Care induction standards and evidence their competence before induction is signed off by the manager or senior staff. The manager needs to complete a staff-training plan based on information gained in staff supervision and appraisals. Given the lack of these it was difficult for the manager to plan sufficiently and some refresher timescales had passed. However there was evidence that staff had access to a range of mandatory training mainly provided by the local authority. Each staff member had a file with an individual training log and copies of training certificates. District nurses conducted some service specific training when service users had individual needs that required staff training, for example, ileostomy care and diabetes. The local infection control nurse is to provide training for one designated member of staff and they will then become a trainer within the home for infection control measures. Some staff had completed training in mental health needs with the local authority, although this should be a requirement for all care staff as the home provided support for a number of people with mental health needs. Six staff had completed a distance learning modular training course in medication with the local authority. From information obtained during the day the home had 40 of care staff trained to National Vocational Qualification (NVQ) level 2 and 3 in care. A further four staff were progressing through the course and when completed this will mean the home will have exceeded the target of 50 of care staff trained to this level. Catering staff had commenced NVQ level 2 in catering. Food hygiene certificates for catering staff had recently expired and updates were required. DS0000068362.V352501.R01.S.doc Version 5.2 Page 23 Four staff files were examined for recruitment documentation. Each staff member completed an application form and generally references were obtained. However one file did not have any references in place although the manager felt sure they had received them and another did not have a reference from a previous employer. The manager said the employer had returned the reference request stating it was their policy not to provide references but the manager could have followed this up with a phone call. Criminal record bureau checks had been completed. When there are instances of previous cautions or convictions on criminal record bureau checks these must be discussed with the staff member and the reasons for continued employment documented. DS0000068362.V352501.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The current quality assurance system does not allow for full service user consultation. This could mean that views of people are not obtained and used. Re-starting formal staff supervision for all care staff and implementing specific health and safety checks will promote good practice, ensure staff are supported and improve further the health, safety and welfare of people. EVIDENCE: The registered manager had completed a national vocational qualification in care at level 4 and had two units to complete of the management section. She DS0000068362.V352501.R01.S.doc Version 5.2 Page 25 has had many years experience working in care homes and in a managerial role. She has completed various training courses in the last year including employment law, computer studies, first aid, bowel care, and mandatory training such as fire, moving and handling and safeguarding adults. She had an infection control course and equality and diversity for managers planned. Staff spoken with felt supported by the manager and surveys commented on her supportive and approachable manner, ‘she’s fair’, ‘you can always go to her’, ‘things were dealt with immediately’ and ‘it’s a nice place to work’. There was evidence that not all staff members received formal supervision. Of the four staff files examined one person had received five sessions in the last year, one person had received one session, whilst the remaining two staff had not received any formal documented supervision. Only one of the four staff had received an annual appraisal and the date of this was December 2004. The national minimum standard is that all care staff members have access to at least six formal supervision sessions a year, which covered care practices, the philosophy of the home and training and development needs. The manager confirmed that they were always available for staff and observed their practice. The home had a system for assessing quality of care that included themed monthly audits, which followed a timetable for the year. There were some daily checklists to be followed and these contributed to the monthly themed audits. Although audits had been completed in the last year surveys to service users, their relatives, staff and visiting professionals had not been sent out. Service users views had been obtained from general day-to-day discussions and some meetings held throughout the year. Results of audits were analysed so shortfalls could be addressed. However surveys need to be sent out and action plans need to be produced that addresses issues highlighted in both audits and questionnaires. The home had achieved both parts of the quality development scheme awarded by the local authority and reassessed in 2006. There are policies, procedures and guidelines on handling finances, assisting service users to make purchases and on staff receiving gifts etc. to protect service users from financial harm. Relatives or people themselves manage finances including personal allowances. People can have lockable facilities in their bedrooms to store items should they choose to. Records for money held in safekeeping within the home are maintained, though these were not inspected. Generally the home was a safe place for people to live in and staff to work in. Documentation indicated that moving and handling equipment was serviced regularly and fire drills and alarm tests completed. Staff had policies and procedures to guide their practice and completed health and safety, moving and handling, fire and first aid training. Safety posters were on display in the home. DS0000068362.V352501.R01.S.doc Version 5.2 Page 26 Some areas of health and safety need to be addressed: •The laundry room needs to be inaccessible to service users. •There needs to be a hot water sign for staff in the laundry room. •Bed rail safety checks need to be part of regular maintenance checks. •Notifications for all incidents affecting the safety and wellbeing of service users must be forwarded to the Commission. •The manager needs to discuss with an electrician any safety issues in the current use of multiple plugs in extension leads. •The manager must seek advice from the fire safety officer regarding the current use of wedges to secure some bedroom doors. Fire doors must have appropriate doorstop closers if they are to remain open. DS0000068362.V352501.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 1 X 2 DS0000068362.V352501.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The registered person must ensure that interim care plans are formulated quickly for people if time is needed to gather information for a more comprehensive plan. This will ensure that care staff have basic information about service users needs and guidance in how to meet them. The registered person must ensure that care plans for people with dementia contain full information on how their needs are to be met. Care plans must be evaluated effectively taking into consideration information found in other parts of the care file. The registered person must ensure that risk assessments are completed for all areas of risk and risk assessments for bed rail use must refer to updated guidance. The registered person must ensure that: •Medication policies and procedures are adhered to DS0000068362.V352501.R01.S.doc Timescale for action 09/11/07 2 OP7 14 & 15 09/11/07 3 OP8 13 (4) 09/11/07 4 OP9 13 (2) 09/11/07 Version 5.2 Page 29 5 OP26 13(3) 6 OP29 19 7 OP30 18 8 OP30 18 9 OP33 24 regarding observing administration. •Reordering of prescriptions is addressed so service users do not run out of medication. • Transcribing has full instructions and two signatures to avoid mistakes. •Codes are used consistently when describing why medication has been omitted. •Medication must have clear administering directions for staff and not have, ‘as directed’ on the package. The registered person must ensure that paper towels are provided in communal toilets instead of linen towels to assist in the prevention of the spread of infection. The registered person must review recruitment practices to ensure: • Two references are obtained, at least one from the previous employer. •Negative comments on criminal record bureau checks to be discussed with the staff member and decisions to continue employment clearly documented. The registered person must ensure that staff induction meets Skills for Care standards where evidence of competency is assessed and documented The registered person must ensure that a training plan is produced based on information gathered during staff supervision and appraisals. Training logs to be audited to capture any shortfalls in mandatory training. Shortfalls to be included in the training plan. The registered person must ensure that the system for DS0000068362.V352501.R01.S.doc 30/11/07 09/11/07 30/11/07 31/12/07 31/12/07 Page 30 Version 5.2 10 OP36 18(2) monitoring the quality of the service is used fully to allow consultation with service users, staff and visitors to the home. The registered person must ensure that care staff are supervised appropriately in line with national minimum standards i.e. supervision covers all aspects of practice, philosophy of care in the home and career development needs. All care staff to have one supervision session covering these points by timescale for action date. The registered person must ensure that the home forwards to the Commission notifications of incidents or accidents that affect the wellbeing of service users. The registered person must attend to the following health and safety issues: • The laundry room needs to be inaccessible to service users. •There needs to be a hot water sign for staff in the laundry room. • Bed rail safety checks need to be part of regular maintenance checks. •The manager needs to discuss with an electrician any safety issues in the current use of multiple plugs in extensions leads. •The manager must seek advice from the fire safety officer regarding the current use of wedges to secure some bedroom DS0000068362.V352501.R01.S.doc 31/12/07 11 OP38 37 09/11/07 12 OP38 13(4), 23(4) 09/11/07 Version 5.2 Page 31 doors. Fire doors must have appropriate doorstops if they are to remain open. 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 2 3 4 Refer to Standard OP9 OP12 OP28 OP31 Good Practice Recommendations Information regarding the changes to anti-coagulant dosage should be in writing and maintained with the medication administration record. The home should look at the needs of people with dementia and tailor specific activities more fully to their needs. The home should continue to work towards 50 care staff trained to national vocational qualification level 2 and 3. The manager should continue to work towards completion of the Registered Managers Award. DS0000068362.V352501.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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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