Inspection on 09/01/08 for Hadrian House

This inspection was carried out on 9th January 2008.

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

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

Hadrian House 25/11/09

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

CARE HOMES FOR OLDER PEOPLE Hadrian House Garden Street Blaydon on Tyne Gateshead Tyne and Wear NE21 4AG Lead Inspector Elsie Allnutt Unannounced Inspection 09:30 9 and 24th January 2008 th 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 Hadrian House DS0000070537.V356897.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. Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hadrian House Address Garden Street Blaydon on Tyne Gateshead Tyne and Wear NE21 4AG 0191 414 3330 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) Southern Cross OPCO Ltd Care Home 63 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (43) of places Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 43 Dementia, over 65 years of age - Code DE(E), maximum number of places: 20 The maximum number of service users who can be accommodated is: 63 12th and 13th April 2007 2. Date of last inspection Brief Description of the Service: Hadrian House is a modern, purpose built care home that is situated in the Blaydon area of Gateshead. The home is registered to provide care for up to 63 older people, including 20 places for people who have dementia. The home can provide personal care but cannot provide nursing care. Bedrooms and communal facilities are situated over 4 floors. The 1st floor is an 8 bedded residential unit, the second floor can accommodate up to 20 people with dementia, the 3rd and 4th floors offer 19 and 16 residential places respectively. All bedrooms have en suite toilet and shower facilities. Throughout the home there are six lounges and four dining rooms. A lift is provided to take people to each floor of the home and an emergency call bell system is fitted in all bedrooms and communal areas. The entrance has level access and the well laid out garden has a paved walkway that residents may use. There is a car park to the side of the building offering parking facilities for visitors to the home. The home is situated close to a number of local facilities and amenities such as shops, GP surgeries, Health Centres and pubs and the public transport system runs nearby. Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 5 A new company, Southern Cross has recently taken over the home. A Service User Guide has been developed and this informs residents and other interested parties about the services the home offers and a copy of the most recent inspection report is available to read. Fees charged by the home range from £390 to £484:64 per week. Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Before the visit: We looked at: • Information we have received since the last visit. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff & other professionals. The Visit: Two unannounced visits were made on 9th and 24th January. During the visits we: • • • • • • Talked with people who use the service, relatives, staff, the manager & visitors. Looked at information about the people who use the service & how well their needs are met, Looked at other records which must be kept, Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, Looked around the building/parts of the building to make sure it was clean, safe & comfortable, Checked what improvements had been made since the last visit. We told the manager/provider what we found. What the service does well: The home has developed good information about the service that they deliver, to help people to make an informed decision about moving there. People are encouraged to visit the home so that they can see the facilities available and experience life inside the home prior to making their decision and any special equipment that might be needed is put in place prior to the moving in date. The manager makes sure that the home can effectively meet the resident’s needs and receives important information about them from the referring agency, as well as carrying out her own assessment of their needs. Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 7 The staff are very good at making sure the residents receive the health and personal care they need. Some comments made by residents include: “The care here is very good.” “They look after us very well.” “The girls are very kind and gentle.” And some compliments recorded include: “We are particularly grateful for the support we received from your staff during the final hours of X.” “You and your staff are not only thanked but also congratulated on the quality of care which you provide for the residents of Hadrian House”. There are good procedures in place to make sure people get their medicines at the right time. Staff are friendly and courteous and very respectful towards the residents. The home provides a good range of activities for residents to choose from. People with dementia are able to independently use the garden in good weather and some personal rooms lead out on to paved areas where residents can also access independently. There is good contact maintained with family and friends and relatives said they could visit anytime. The quality of meals is very good and residents are also offered drinks and snacks throughout the day. Residents and relatives said they would have no hesitation in making a complaint as the staff, manager and deputy manager were very approachable. Staff receive training so that they know what to do should they witness or suspect abuse. They have also been provided with lots of other training so they can carry out their jobs well. The building is very clean, homely, light and airy, with extensive views from the lounges and majority of bedrooms over to Newcastle. As well as making sure the views of relatives and residents are obtained there are good internal quality assurance systems in place. For example: the deputy manager regularly checks the medication to make sure that people have been given their tablets at the right time. The manager is new and very enthusiastic about maintaining the good standards already achieved in the home, while at the same time she hopes to develop the service further. Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 8 She values her staff and is working hard to develop good relationships with them and the service users. All of this will ensure that residents continue to receive the sort of service they have been used to and to live a fulfilling lifestyle. Some comments made by relatives in letters and cards showing their appreciation for the care given by the home are as follows: “You and your staff are not only thanked but also congratulated for the quality of care which you provide for the residents of Hadrian House.” “We are particularly grateful for the support we received from your staff during final hours.” What has improved since the last inspection? What they could do better: So that residents moving into the home can confirm that they understand the home’s terms and conditions they should be given their contract to sign at the point of moving into the home. The range of fees charged by the home must be included in the Service User Guide so that anyone interested in the home has this information. Advice given by healthcare professionals must be recorded in the care plans, so that staff have guidelines to follow regarding clinical issues. This will mean that residents receive appropriate care in a consistent way. So that residents’ assessed needs are met appropriately staff must receive training regarding different conditions and illnesses related to old age, in particular dementia care and Parkinson’s disease. The manager was advised how to access a copy of the local authority’s Safeguarding Adults procedures. She was also advised of the importance, as manager, to become familiar with these and to attend training in relation to them as soon as possible. This means that any report from residents or others in relation to abusive practice, is dealt with in the appropriate manner. So that residents feel included and effort is made to stimulate conversation staff should not forget to interact with residents as they go about their duties. Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 9 The amount of staff needed throughout the home must be reviewed so that current residents are supported safely and their needs addressed appropriately. Although this is relevant throughout the home, it is particularly urgent to address this in relation to the dementia care unit. It is also important to note that the home has current vacancies and the needs of the any resident due to move in must be taken into consideration in relation to the current staffing levels. There should be clearer guidelines for staff to follow so that they know how to address concerns and complaints and when and how they should be recorded. This will make it clearer to the residents and their representatives that their concerns are taken seriously. So that residents have the aids available to promote their independence and safety grab rails must be fitted to the shower areas. 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. Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 10 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 Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 11 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): 1, 2, 3, 4, 5 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with good information about the service including a contract. This helps people to make an informed decision about where to live, while at the same time they are informed of the home’s terms and conditions. Preadmission assessments demonstrate residents’ needs and assists the home to make informed judgements as to whether they can meet them. This ensures that the service user receives the appropriate sort of care and support. EVIDENCE: The home has developed a Statement of Purpose and a Service User Guide. Both documents have recently been reviewed and updated to reflect a new company taking over the home and to ensure that the information included is Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 12 current. However the Service User Guide does not inform service users or interested parties of the range of fees charged by the home. Signed contracts that describe the home’s terms and conditions and include the cost of the fees to be paid by the resident are included in individual care files. However one relative commented that it took five to six months before their family member received a contract from the home. It was not clear whether this was the residency agreement from the contracting agency, or the terms and conditions of the home. One resident described how their family assisted them to visit the home and make their choice where to live. They added: “I knew I had made the right decision right from the start.” Although residents were happy with the decision to move into Hadrian House some felt that their choice had been limited due to the urgency of needing care at the time. The home has a six-month trial period at the end of which residents are given the opportunity to confirm whether they are happy to remain at the home. Residents’ files include comprehensive information about them from the referring agency and other people involved in their care. For example, a Hospital Discharge Plan and an assessment from the Community Resource Team for Older People (The CROP Team) were included with the Care Manager’s assessment and care plan for one person who had recently moved into the home. The home had also carried out a full assessment of need that includes addressing risks. The home’s comprehensive assessment process includes gathering information about the person’s life history, but it is disappointing to note that this area was not fully completed. This profile could be used as an important piece of information for carers to refer to when working with individual residents and when assisting them to make decisions and choices about their lives. The manager is aware of this and confirmed that plans are in place to develop this area further. The care needs assessment is kept at the back of the care file so that it can be reviewed and adjusted when needs change. When the decision is made that the home can meet a prospective resident’s needs a letter is sent out to the person to confirm this and a copy is kept in the individual care file. Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 13 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, 10 & 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although care practices are good and in practice residents’ healthcare needs are well met, the care plans do not always include the amount of information needed to guide staff to support residents in a consistent way and appropriate to their individual healthcare needs. This high standard of care previously achieved by this home could be compromised. Medication arrangements are appropriate and they are managed safely and appropriately, ensuring that the welfare of residents is safeguarded. EVIDENCE: A new care plan document is now in place to reflect the corporate image of the owner. It is used with the assessment document to ensure that identified care needs and risks, where relevant, are addressed. Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 14 The manager and staff expressed the view that improvements could be made to the new document so that it has a more person centre focus and guides more directly towards social and healthcare needs. The care plans are written clearly and include good information about the residents’ basic needs. However residents’ preferences regarding the way they prefer to be supported and information regarding how healthcare specialists are involved in residents’ individual care could be promoted further. Following a referral from a resident’s GP, a Parkinson’s Disease Specialist Nurse visited the home and discussed important aspects of the resident’s behaviours and medication needs with the senior carer on duty. Although advice from healthcare specialists is considered important and is reflected in staffs’ care practices, the information given is currently recorded in the daily notes and not in the actual care plan. Senior staff agreed that if clear guidelines regarding the advice given by healthcare specialists is in the care plans, it is more likely that staff will follow the advice in a consistent way. Although there is an area in the care plan document where healthcare professionals visits are recorded, the new document does not lend itself to the information being recorded separately and prominently. It was agreed that separate pages including such important information would be included with the relevant parts of the care plan. Although some staff have attended training related to old age, that includes dementia awareness, they have not attended training related to Parkinson’s disease. Staff, including the manager were receptive to this, recognising the benefits from further dementia care training, so that they are updated with current good practice, as well as attending training regarding Parkinson’s disease. Risk assessments that are signed by the resident, are in place and also relate to any specialist equipment used and clear risk strategies guide staff to minimise the identified risk. There have been a high number of falls recorded throughout the year, the highest number occurring since the end of November 07. Six resulted in fractures to limbs. All have been appropriately reported and some investigated by the Health and Safety Executive. An analysis of the falls indicates that staffing numbers need to be reviewed and consideration needs to be given to the deployment of staff. Staff support and interact with residents in a respectful way encouraging and supporting them to maintain and develop their independence and autonomy, while at the same time promoting exercise as much as possible. To achieve this residents are sensitively encouraged to move around the home at their Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 15 individual pace, some supported with walking frames, one in a self-propelling and another in an electric wheelchair, the diverse needs being well accommodated in the wide spacious hallways. Some surveys received stated that: “I think staff are always available if there is a specific need.” “I think staff could interact more with the residents.” “During the time X has been at Hadrian House they were admitted to hospital twice. I have always been kept informed of the situation by the staff on duty.” Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 16 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff actively encourage residents to exercise and maintain choice and control over their lives, while also maintaining contact with family and friends. This means that residents are provided with different opportunities to lead fulfilling lifestyles and do not become socially isolated. Furthermore meals are healthy, nutritious and attractive, and are prepared to meet residents’ individual dietary needs. EVIDENCE: An activity organiser is employed to arrange and coordinate activities throughout the home. However as a result of recent staff shortages this person has been allocated to work as a carer therefore not as much emphasis has been given to the organising of activities over recent weeks. The manager is currently addressing this so that the activities organiser will soon return to her employed role. Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 17 A resident commented: “There hasn’t been much going on recently.” And a relative commented: “This has been a very disappointing situation, activities were promised and these have not materialised. Recently there have been no activities that I have seen on my visits.” Staff were observed interacting positively and sensitively with residents giving physical contact and chatting as they worked. They also interacted warmly with relatives and friends as they came and went throughout the day. One relative commented: “We are always made to feel welcome here, the staff are very nice.” The activity organiser is enthusiastic, offering a range of different activities and described how she uses a range of different approaches to encourage residents to try new things. Notices in the home informed residents of different planned activities. Different churches come to the home and coffee mornings are arranged to encourage family and friends to visit. Residents and relatives commented that visiting singers have provided good entertainment and summer and Christmas fetes have been good fun. Throughout the home many of the residents were engaged in individual activities, some chatting, some watching TV and others individually involved in personal hobbies. One person sat knitting and listening to their personal stereo through ear phones; another person sat reading the newspaper and chatting to their pet budgerigar in the privacy of their room and another two people sat in one of their bedrooms enjoying a private conversation while exchanging magazines. There is a general view from all staff that communication and activity with residents forms a very important part of life in the home. The environment is thoughtfully set out and offers facilities that encourage communication between residents in small groups. There are plenty of areas other than personal rooms where residents can meet with each other, families and friends for personal chats. The large windows all around the home offer interesting and lively views of the local area. Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 18 There are plans to develop more personal information about residents’ lives in the form of Personal Journals. This will fit in well with the personal profile to be completed in the assessment process and will be a vital resource when assisting residents to choose activities they are interested in or have enjoyed in their former years. This process will be especially helpful for those residents with dementia type illnesses, who will be more positively motivated when offered an activity that they have particularly enjoyed at an earlier time of their life. A variety of ideas were discussed regarding how residents with dementia could be more motivated and supported in activity. However to accomplish such ideas safely along with supporting residents with personal tasks, it was also recognised that the staffing numbers needed must be reviewed. A midday meal was taken with residents. The tables were attractively set and small dining areas offered residents the opportunity to dine in small numbers, with enough staff to assist and support individuals in a sensitive and discreet way, when necessary. The food served is nutritious and varied to suit individual dietary needs. Residents said: “ The food is always good and we get a choice.” “I like the food.” “We have a good chef.” Menus on each table informed residents of the choice of food available for each meal. Residents are asked to make their choice prior to different mealtimes but there is some flexibility for people who change their minds or may forget what they have ordered. Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 19 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 & 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Arrangements are in place to help protect residents from abuse and to address complaints and concerns about the service. However due to the lack of clear guidance there is a risk that concerns/complaints from residents and their representatives are not seen to be taken seriously. EVIDENCE: There are plans in place to review the home’s current complaints procedure to ensure that it is accessible and comprehensible to residents, their families and staff. Residents and their representatives confirmed that they know how to make a complaint and to whom they would report this, however one person felt that their concerns were not listened to. One complaint has been recorded in the “Complaints Book” since the last inspection. This was taken seriously and addressed in an appropriate way, following the home’s procedures. Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 20 When daily concerns are made these are addressed directly and not always recorded. However if they are of a more serious nature some are recorded in the daily notes but not in the complaints book. The manager confirmed that this would be addressed when reviewing the complaints policy. It was good to note that fourteen compliment letters are on file about the services care practices. The home follows the local authority’s policy and procedures regarding Safeguarding Adults and staff receive training regarding these. However a copy of the procedures is not available in the home for staff to refer to if needed. Service users are encouraged to look after their own finances when appropriate. For those who need support with this comprehensive procedures are in place for staff to follow and these help safeguard service users from the possibility of financial abuse. The records are kept by the home’s administrator and monitored by the manager. A monthly reconciliation report is carried out and submitted to the company’s head office. Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 21 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, warm and well maintained, offering service users a homely environment in which to live. However some safety issues must be addressed in order to further safeguard the welfare of residents. EVIDENCE: Hadrian House offers residents 63 single bedrooms all with en-suite facilities. The building is situated over four floors. Each floor operates as an independent unit with its own lounge, dining area toilet and bathing facilities. Three of the communal lounges have wide views over to Newcastle and residents commented positively about this. Decoration throughout the home is of an excellent standard. Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 22 The environment has not been specifically designed to meet the needs of people with dementia, for example, some of the signs on toilet and bathroom doors could be more prominent. However, the home is aware of current good practise and has developed a “memory wall”. This is a distinguishing feature in the corridor, with photographs of the local area in years gone by. It is not only a talking point with residents and relatives but helps with reminiscing and will also help people find their way around the unit. The activities co-ordinator has also supported some residents with dementia to make signs for their bedroom doors. Residents have chosen something familiar to them to put on their sign so that that they can easily find their way back to their bedroom, however more residents could benefit from this. It is good that residents with dementia have access to other parts of the building and to the outside garden area, however the staffing numbers need to be improved so that residents’ independence can be promoted safely. All the bedrooms are nicely decorated and furnished and residents can personalise their rooms and use their own furniture if they wish. Residents have a choice of taking a bath with specialised aids if needed or a shower. Although a seat is available for residents’ use in the shower areas there are no grab rails around the walls that would be an additional safety mechanism as well as support for both residents and staff. During a recent visit to the service, the Health and Safety Executive also advised on this. A competent maintenance person is employed to deal with issues around the home and in addition, is responsible for monitoring health and safety issues including fire safety. The well-kept, safe and comfortable environment reflects a comprehensive maintenance programme. The home is decorated and furnished to a very high standard and the cleanliness throughout reflects effective cleaning routines, that are discreetly and safely carried out by the domestic staff team. Although one relative commented that on occasions unpleasant smells were evident in the home, this was not evident during this unannounced two-day visit. All staff have completed a comprehensive infection control course and these have been effectively put into practice. The entrance to the home is via a level ramp made out of decking materials and in the wet and frosty weather this is proving to be a hazardous area. Although the maintenance person works hard to sort this out by putting down salt and leaving notices to warn people entering the building, four members of staff and one visitor have fallen in this area. Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 23 The home’s risk assessment does not include a risk assessment for this area. The HSE during their visit also highlighted this issue. The manager agreed to address this as a priority. Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 24 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home employs a qualified staff team who competently meet the residents’ needs. However the widely dispersed residents at times present challenges on how effective the care can be with the number of staff available. Residents’ care and support therefore is at these times jeopardised. The robust recruitment procedures ensure that the welfare and interests of the service users are protected. EVIDENCE: There is an established staff team who work well together. Most have been with the service since it opened in 2006 and a high percentage are qualified in NVQ. Staff work well together, following the home’s policies and procedures and demonstrate an understanding of the aims and objectives of the home. They show an interest in the residents “as people” and an understanding of how to address their needs. They work hard to maintain a caring and friendly atmosphere in the home and this is particularly commended considering the challenging circumstances staff Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 25 have been faced with over the past month. A new company has taken over and a new manager has been employed. One resident commented: “I’m very satisfied with the home and staff. All the staff are caring, helpful and pleasant but I feel they are under pressure and very busy at the moment.” The present number of staff available is not always effective and sufficient to safely give the support needed to residents. For example, given the number of falls by residents, there would appear to be a need for a review of the circumstances. The manager discussed the need to review staffing numbers and in addition has ideas in relation to how staff can be flexibly allocated at different times of the day to address different activities and needs throughout the building. Staff files are well organised and easy to follow and they include all the necessary information to confirm good recruitment procedures. Clear and detailed application forms are in place plus two appropriate references. These clearly show the individual’s past and current work history, as well as their suitability for the job. Criminal Record Bureau clearance and Protection of Vulnerable Adults (POVA) First Checks are obtained for all staff. Almost 100 of staff have completed NVQ level 2 in care. The company supports a varied training programme, as well as a two-week induction, that includes dementia awareness, customer relations, first aid, fire safety, fire warden and moving and handling. The manager is now reviewing all training needs and organising training courses as needed and is also developing Personal Development Plans for staff. Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 26 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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A competent well-qualified senior care team and administrator support the manager to maintain good management systems. This has meant that during the transition stage of a new provider and new manager taking over, the best interests of the residents have been protected and promoted. EVIDENCE: The manager had been in post for only seven days when this inspection began. The manager, who still needs to register with the CSCI, is well qualified and experienced. Among many qualifications she has the Registered Managers Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 27 Award, NVQ 4 in Care, a Diploma in Management Services and is a Member of the Charters Management Institute (MCMI). She worked for a local authority for twelve years, during which time she was a manager of a care home. The manager also has experience in working in administration and is a qualified Life Coach. She hopes that her interests in the sociological and psychological approaches to understanding and motivating staff will promote her role as manager. As well as her professional training the manager has also attended mandatory training and plans to up date this with the training opportunities she has organised for the staff team. Policies and procedures are currently being reviewed and plans are in place to ensure staff are aware of any changes. A comprehensive quality assurance system is in place that monitors systems in the home and these are developed and carried out in the best interests of the residents. A residents survey is to be distributed so that residents’ views about the service are known and used to promote improvements in the care. Health and safety systems are in place, however there are areas that could be improved further and these have been identified in the main body of this report. Good health and safety practices take place and these are recorded appropriately. The fire log and accident books are in order and up to date. Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 28 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 2 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 3 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 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 30 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 OP1 Regulation 5(1)(b) Requirement Timescale for action 31/03/08 2 OP4 3 OP7 4 OP19 5 OP19 6 OP27 7 OP31 The manager must ensure that the Service User Guide includes the range of fees charged by the home and the method by which they can be paid. 12(1)(a)( So that the home is able to meet b) residents’ assessed needs the manager must ensure that staff attend training regarding the residents’ particular healthcare needs. 13(4)(b) The manager must ensure that the clinical advice given by healthcare professionals is used in individual care plans as guidelines for staff to follow. 23(2)(n) Grab rails must be fitted to the walls of the shower areas to provide additional safety mechanisms for both residents and staff. 13(4)(a)(c The manager must review the ) home’s risk assessment and include an assessment in relation to the ramp entrance into the home. Risk strategies must show how the evident risks are to be minimised. 18(1)(a) There must be sufficient staff on duty to support and address residents assessed needs so that the risk of falls and injury to residents is minimised 9(1)(2) The manager must submit an DS0000070537.V356897.R01.S.doc 31/05/08 29/02/08 29/02/08 29/02/08 29/02/08 29/02/08 Page 31 Hadrian House Version 5.2 8 OP38 12(1)&4 application form to CSCI so that she can be considered as a fit person to manage the home. The manager must ensure that the health and safety issues relating to: • The entrance ramp. • Staffing ratios • Residents’ falls • Rails in the showers Are addressed appropriately. 29/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP2 Good Practice Recommendations Residents should be given their contract to sign at the point of moving into the home, so that they are aware of the home’s terms and conditions from the beginning of their residency. The manager should ensure that the plans to complete a person’s Life History when completing the assessment document should go ahead. Consideration should be given to how the care plan document can be improved to include the amount of information needed to guide staff to assist residents appropriately. There should be clearer guidelines for staff to follow in relation to when residents and their representatives make a concern or complaint. Residents and their representatives should feel that their concerns/complaints are taken seriously. Copies of the local authorities Safeguarding Procedures to which the home contracts should be available in the home for staff to refer to and staff should update training regarding these regularly including the manager. 2 3 OP3 OP4 4 OP16 5 OP18 Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hadrian House DS0000070537.V356897.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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