Inspection on 30/04/08 for Hafod Residential Home

This inspection was carried out on 30th April 2008.

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

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

Other inspections for this house

Hafod Residential Home 08/10/09

Hafod Residential Home 20/04/09

Hafod Residential Home 03/05/07

Hafod Residential Home 19/09/06

Hafod Residential Home 23/01/06

Hafod Residential Home 27/09/05

Hafod Residential Home 01/03/05

Hafod Residential Home 28/09/04

Hafod Residential Home 24/02/04

Hafod Residential Home 16/10/03

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

CARE HOMES FOR OLDER PEOPLE Hafod Residential Home 14 Anchorage Road Sutton Coldfield West Midlands B74 2PR Lead Inspector Ann Farrell Key Unannounced Inspection 30th April 2008 08:30 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 Hafod Residential Home DS0000016917.V362629.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. Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hafod Residential Home Address 14 Anchorage Road Sutton Coldfield West Midlands B74 2PR 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) 0121 355 6639 0121 355 5688 Hafodlimited@aol.com Mr Alan Pearce Janet Lillian Taylor Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd May 2007 Brief Description of the Service: Hafod Residential Home is registered to provide personal care for sixteen people aged 65 years and above for reasons of old age. The Home does not provide nursing care and does not have a category to care for people with dementia. The Home does not accommodate people who require the use of wheelchairs and hoisting equipment is not available for general use. Accommodation is provided in a large and sympathetically adapted Victorian building situated at the junction of Anchorage Road and Lichfield Road approximately one mile from the centre of Sutton Coldfield. There are good bus links from Birmingham and Lichfield. There are 14 bedrooms, two of which are shared rooms however the Home utilises these as single rooms, and the majority have en-suite facilities. There is a call bell facility in each bedroom to summon assistance when required. Bedrooms are located on the ground and first floors and a passenger lift gives access to these areas. Communal areas are available on both floors, these were spacious, attractive, well appointed and in keeping with the age of the property. A conservatory leads of the dining room looking out on to a well-maintained garden. Assisted bathing facilities are located on each floor offering a choice of bath or shower facilities and staff are available to provide assistance in these areas as required. The Home has a large enclosed and attractive garden to the rear of the building. There is limited off road parking at the front of the premises. There are notice boards located throughout the Home displaying forthcoming events and other information of interest to people who live there and their visitors in a large print format. A copy of the our report was available on entering the home. Information relating to the services and facilities provided were available in individual bedrooms, but these gave varying information, some of which was out of date and did not include the range of fees and the items not covered by the fees. Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Two inspectors undertook this fieldwork visit over one day. The registered manager and one of the proprietors were present and assisted us throughout. The home did not know that we were visiting on that day. There were thirteen people living at the home on the day of the visit. Information was gathered from speaking to and observing people who lived at the home. Four people were “case tracked” and this involves discovering their experiences of living at the home by meeting or observing them, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. A further two care files were partly reviewed. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety files were also reviewed. Random questionnaires were sent out to staff, people who live at the home, relatives and health professionals before the inspection in order to gain their views about the service. Four questionnaires have been returned to date and their comments about the service provided are included within this report. On the day of inspection approximately eight people who live in the home and three visitors were spoken with in order to gain feedback. The feedback was positive with visitors stating; “ There is a good level of care” “The staff are very kind and caring”. “The care staff are extremely supportive, caring and patient”. “There is a friendly and homely environment”. People who live in the home stated the staff were very good, especially if they felt ill, they enjoyed the food and if they had any concerns they felt confident the manager would deal with them. Prior to the inspection the Registered Manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us some information about the home, staff and people who live there and developments since the last inspection, which was taken into consideration. Regulation 37 reports about accidents and incidents in the home were reviewed in the planning of this visit. Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 6 What the service does well: People are able to visit the home before moving in enabling them to view the facilities, meet staff etc. and make an informed decision about moving in. People are cared for in a respectful manner by staff working at the Home and this ensures that their self-esteem and dignity are maintained. Feedback was very positive about staff and one person stated, “ Staff are attentive and flexible, especially when people are ill”. Residents have access to a range of Health and Social Care Professionals, so ensuring health care needs are met. One person stated, “they call the doctor immediately if I want one”. People are able to exercise control over their daily lives and are involved in decisions about the home, giving them control over their lives. Staff encourage them to maintain their independence and there is a good range of activities available, so providing adequate stimulation. People are supported to continue to practice their chosen religions and this ensures that their beliefs and individuality are respected. Visiting times are flexible enabling people to maintain contact. Visitors stated staff made them feel welcome and they were offered a drink or were able to use a facility to make their own drinks. There was a choice of wholesome meals, which met the dietary needs for reasons of health, taste, culture or religion. People spoken with all stated the meals were of a good standard and they enjoyed them. People who live in the home felt safe and were confident that if they had any concerns the manager would address them. The home was warm, clean and comfortable, so providing a homely environment for people to live. People are encouraged to bring their own items into their bedrooms, so providing a homely environment and reflecting their personal tastes. Aids and adaptations are provided so that the independence, choice and dignity of people living in the home is promoted whilst maintaining their safety. Regular maintenance checks of this equipment ensure that they are safe to use. Residents have the option of using the Home’s facility for the safekeeping of small amounts of money and systems were in place to ensure they were safely maintained at all times. Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 7 There are staff supervision and staff meetings, so enhancing communication and support for staff. What has improved since the last inspection? What they could do better: The service user guide, statement of purpose and contract of residence must be reviewed, ensure they are up to date and made accessible o all people living in the home and their representatives, so they are aware of the services, facilities and conditions of stay. The pre admission assessment process and records need improving to ensure staff have comprehensive information about people’s needs before they move into the home to determine if their needs can be met. Care plans need improving so that they contain up to date and relevant information, so that staff have the relevant information to ensure people’s needs are met. Risk assessments need to be developed further to include areas such as tissue viability, nutrition etc. in order that risks to people living in the home are identified and appropriate action taken to reduce the risk. The system of referring to health professionals should be reviewed to ensure all referrals are timely and records of all visits or interventions by health professionals should be clearly maintained to demonstrate people’s health needs are being addressed effectively. Improvements are required in respect of the administration and recording of medication to ensure people receive their medication in a safe manner as prescribed. All policies and procedures need to be reviewed and updated ensuring they are compliant with the Mental Capacity Act to ensure staff have the relevant information to undertake their roles and protect people who live in the home. Systems should be in place to ensure all signs and notices around the home provide people with up to date information. Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 8 Systems must be in place to ensure all staff are trained effectively to undertake their role, so peoples’ needs are being met. The system for formally reviewing the quality of service provided should be further developed in order to continually improve the service for people who live there. 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. Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 9 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 Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 10 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): 1,2,3,6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Information about services and facilities was out of date and needs updating to ensure people have the information available to make an informed choice before moving into the home. Inadequate pre admission assessments may result in individual care needs not being met whilst living at the Home. EVIDENCE: On entering there home there was a copy of a recent report from the Commission, but no information was available from the organisation about the services, facilities, fees etc. so that people living in the home or prospective clients do not have all the information they need. It was noted that service user guides were available in individual bedrooms and different versions of the document were seen in two bedrooms visited. Some pf the information was out of date; they did not include information about the range of fees. There was some lack of clarity about the terms and conditions/ contract of residence Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 11 and on discussion with people living in the home they were not aware of the arrangements for fees etc. The service user guide will need updating and arrangements for contracts clarifying to ensure that anyone moving into the home is fully aware of the arrangements. The home generally provides care for people who require long term or respite care. People who are interested in moving into the home are encouraged to spend time at the Home in order to sample what life would be like to live there. During this time staff are able to undertake an assessment of the persons needs to determine if the home can meet them effectively. On inspection of the records for some people who had recently moved into the home it contained basic information about the persons name, address, next of kin, the GP, medication and in some cases there was basic information about peoples requirements in respect of assistance with washing/bathing, but did not provide a comprehensive record of the persons needs. There was no evidence of an assessment from social workers and there was no further assessment on admission to the home. The pre-admission assessments seen were not dated or dated the day of admission to the home. Without a comprehensive assessment it cannot be guaranteed that peoples need will be met effectively as identified in respect of one persons nutritional needs (see Health and personal care). Three people who had recently moved into the home stated their families had made arrangements for admission; they had not visited before moving in, but were happy with the home. The manager confirmed that that assessment seen was the standard form used for pre admission assessment. The manager stated they did not write to people following assessment advising them if the home could meet their needs as required under the Care Homes Regulations and it would provide confidence to people planning to move into the home that their needs will be met. The pre admission process will need to be reviewed and developed further to ensure staff have relevant information to determine if peoples needs can be met when they move into the home and provide assurance to anyone moving in. Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health provision and care delivery are generally good however; some delays in referral to health professionals and poor recording in care plans may result in people’s needs not being met in a timely manner. Medication practices need improving to ensure people receive the medication as prescribed. Residents are cared for in a respectful manner by staff working at the Home and this ensures that their self-esteem and dignity are maintained. EVIDENCE: Each person living in the home had a written care plan. This is an individualised plan about what the person is able to do independently and states what assistance is required from staff in order that their needs are met. We looked at four peoples care plans in detail and partially looked at a further two plans. It was found that core care plans are used, which are pre printed documents about various aspects of care. However, the statements used lacked detail Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 13 and were generalised and the documents had not been personalised to reflect the assistance/support required by individual people. The comments included areas such as - needs help of one carer for a bath; uses a Zimmer frame, sometimes needs the help of one carer; encourage independence at all times; assist in establishing an elimination pattern. Since the last inspection the staff have also developed a summary of care, but again statements were vague and lacking in detail e.g. needs a lot of encouragement, likes soup if he refuses a meal – offer soup or something else. Where clear directions are not given to staff it cannot be guaranteed that people’s needs will be met appropriately and in a consistent manner. In some cases a risk assessment had been completed in respect of tissue viability, but this was not consistent and it was noted that one person who was at risk and did not have one in place. Falls risk assessments had been completed, but were not specific e.g. dizzy spells – to encourage the use of a buzzer, but no indication as to the cause of dizziness or if it had been investigated. There was no evidence of nutritional risk assessments and it was identified that one person had a poor dietary intake, had lost weight and no action had been taken. On discussion with the manager about this she had not contacted any health professionals since the persons admission. On discussion with staff they gave a different account to the manager as to how the persons nutritional needs were being addressed. The manager telephoned the Macmillan nurse following the conversation who stated she would contact the GP and arrange some treatment. Without comprehensive care plans, risk assessments and other documents the delivery of care may be compromised and people’s needs not met consistently. Care plans were reviewed by staff monthly and the care manager was undertaking an annual review with relatives, which was confirmed on discussion with some relatives who were visiting at the time of inspection. Daily records were maintained about the care provided and people’s general condition. However, there were vague comments such as “ is fine, no concerns”. This does not provide information about peoples general condition and should be developed further. Some written feedback was received stating that communication could be improved between staff and from staff to relatives. It is recommended that this area be reviewed. During the inspection it was noted that the rubbers were worn on two people’s Zimmer frames. This could put people who live in the home at risk of accident and they should be regularly checked and maintained to reduce the risks. All people were registered with a local GP who visits the home and there was evidence of people receiving visits from chiropodists. One person stated “They get the doctor immediately if I want one”. There was no evidence of visits by other health professionals such as an optician and dentist. The manager stated that a number of people went out to visit the optician and dentist and it has been stated that records of these visits are kept separately. On discussion Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 14 with a person living at the home they stated they had seen a dentist and optician, but could not confirm when the visits occurred. On discussion with others they stated they were happy with the care they received and found the staff very helpful, especially when they felt ill. Feedback from relatives indicated there was a good level of care. They stated “We are happy with the care given to all of us not just mum”. “The care staff is extremely supportive, caring and patient”. The records did not consistently indicate peoples medical history, treatments and if there was any monitoring of chronic diseases such as diabetes, high blood pressure etc. These areas will need to be followed up and records maintained of all appointments/interventions with heath professionals to ensure that people’s health is being maintained to optimum levels. Feedback from health professionals indicated that staff usually met people’s health care needs; they usually sought and acted upon advice given. Staff encourage people who live in the home to maintain their independence and mobility, so they maintain their abilities and promote well-being. People appeared to be well supported by staff to choose clothing appropriate for the time of year, which reflected individual culture, gender and personal preferences. Staff were described as attentive and flexible especially when people were ill. The homes medication system consisted of a blister and box system with printed Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. The home had copies of the original prescription (FP10’s) for repeat medication, so they were able to check the prescribed medication against the MAR chart when it entered the home. On inspection of the medication for the current month it was found that the majority of the medication in blister packs had been administered satisfactorily. However, there were some discrepancies in the boxed medication and in some cases the home had run out of a persons medication, so they were not able to receive it. Some eye drops and cream had not been dated when opened, which is required, as they should be discarded after specific timescales to reduce the risk of infection. A fridge was used for the storage of some medication and temperatures were recorded daily. However the minimum and maximum temperature should be recorded to ensure all medication is stored correctly and is suitable for use. The manager was advised of the findings and the need to undertake regular staff audits in order to minimise shortcomings in the way medication is administered. She stated that audits had been undertaken previously, but there was only evidence of one audit in 2007, which does not demonstrate that they have been undertaken regularly to ensure good practice. The home has a hands free telephone and it was stated that people living in the home could use it wherever they wished, so ensuring their privacy. In addition, some people have telephones fitted in their bedrooms so that they can maintain contact with family and friends. Bedrooms are provided with locks on doors and lockable facilities, so enhancing the arrangements for Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 15 privacy. During the visit staff were caring for residents in a respectful manner and this ensures that their dignity and self-esteem are maintained. Hafod Residential Home DS0000016917.V362629.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. People who live in the home are able to make decisions so they are able to exercise some control over their lives. The activities meet the needs and interests of people using the home so that they experience a meaningful lifestyle. People have a choice of healthy meals that meets any dietary requirements. EVIDENCE: There was no evidence of any rigid rules or routines in the home and people who live there can go outside with their friends and family as they choose. One person stated they went to a coffee morning at her church regularly. Visiting was flexible and this was confirmed on discussion with people who were visiting the home. They stated, “ the home was always clean and warm and staff were welcoming”. Another stated, “ the home was good, they get a drink when they visited and activities have started in the afternoons. Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 17 People living in the home confirmed they could choose the times they get up and go to bed and it was noted that the people arrived for breakfast at different times. People are able to bring personal items of furnishings etc. into the home so providing a home from home atmosphere. They are also consulted about aspects of redecoration and refurbishment enabling them to have some control over their environment. Opportunities for worship of all faiths could be arranged and Holy Communion is held at the Home each month. There was a range of in house activities including beanbags, balls, bingo, skittles, darts, exercises, quiz, pat a pet and an aquarium. There was a firework party last year and a visit to the garden centre in April, which was talked about enthusiastically by people who went on the trip. It was stated that there is the opportunity to go on holiday to Weston super Mare each year. The home has recently purchased a Wii console for use by people living in the home. The library service visit exchanging books on a regular basis and a beauty therapist visits regularly providing a range of treatments, so enhancing people’s self esteem. There were posters on notice boards advising that a 100th birthday party was to be celebrated in the near future and it was stated that many invitations had been sent out. Surveys from Relatives stated, “ It was a friendly and homely environment”. “There is a lovely garden and my mother likes to sit outside”. There was evidence of regular meetings with the people living in the home demonstrating their involvement in making decisions about various aspects of the home. This enables them to have some control over their lives. Three main meals are provided each day and breakfast is prepared and served in the home. Lunch and evening meals are prepared at the organisations nursing home, which is near by and transported in heated trolleys. There is a four-week rotating menu with a choice of meals, which are ordered on a weekly basis. The menus reflected a choice of nutritious food that reflected the cultural preferences of people living in the home. Special diets could be catered for reasons of health, religion or taste and alternatives to the main meal options were available. Mealtime was calm, and music was played in the background. Staff were observed to be respectful, interacting with people to offer choice. The atmosphere created felt as if it was a hotel. The menu board indicated there was a choice of lamb or cauliflower cheese. Lunch was sampled and the inspector shared a table in the dining room with two people who had recently Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 18 moved into the home. Some food was put on the table to enable the inspector to help themselves. Others were served food, although some were able to help themselves. There was a choice of vegetables and pudding (semolina or yogurt) evident and offered, which people choose from. The food was hot, wholesome, and tasty and both people sitting with the inspector stated the food was good. Hafod Residential Home DS0000016917.V362629.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. The complaints procedure is accessible to people living in the home and visitors so that people using the service were generally confident that their views were listened to. The lack of staff knowledge and up to date policies and procedures means people in the home cannot be confident they are adequately protected from harm. EVIDENCE: The complaints procedure was on display in a large print format so that it was easily accessible to residents and their visitors. There was also a suggestions box in reception area so that people who live in the home and their visitors could put forward their views about the service provided. There was evidence of “thank you” letters on notice boards. People living in the home stated they felt safe in the home and had no complaints. They stated, “If I had any concerns I would go to Janet and she would sort it out”. We have not received any complaints about the home and staff had recorded one complaint. The home has policies and procedures in respect of safeguarding and whistle blowing, which need updating. The manager stated that an organisation had visited the home and were in the process of updating all policies and procedures. The senior staff in the home had made two safeguarding referrals to Birmingham City Council, but were not aware of any outcomes. They were Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 20 advised to contact the relevant person at the City Council to determine the progress and outcome of the investigations. According to the training records provided only two care staff had received training via a video in this area. However the AQAA stated all staff had received this training. Hafod Residential Home DS0000016917.V362629.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): 19,20,21,24,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a homely, clean and comfortable environment in which people feel safe and secure and their privacy is maintained. EVIDENCE: The home is a detached three-storey building with off road parking for a small number of cars in a residential area. It was generally well maintained, clean and odour free with a homely atmosphere. The garden was spacious, well maintained and was split over two levels with ramped access to the lawn area, but people had to negotiate a small step into the garden area. Accommodation is provided for sixteen people over the ground and first floor. Communal accommodation consists of a lounge/dining on ground and first floor plus a conservatory, which was homely and domestic in character. However, it was noted that there was no call bell facility in the conservatory and observations during the inspection were that people were not supervised by Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 22 staff at all times. Consideration should be given to providing a means whereby assistance can be summoned if required in an emergency. There was one assisted bathing facility on each floor and the majority of bedrooms had ensuite facilities consisting of a toilet and wash hand basin. They were decorated in a homely style so that people using the facility could do so in comfort. However, it was noted that some toiletries were being used communally. This is not considered good practice due to the risk of infection and this practice should be reviewed. All bedrooms had a call bell system to enable assistance to be summoned when required. Bedroom doors had locks and lockable facilities were in place, so enhancing the arrangements for privacy. Bedrooms were individually and naturally ventilated and windows were provided with restrainers for safety and security reasons. Radiators and the temperature of water from hot water taps were controlled to reduce the risk of scalding to people who live in the home. People are encouraged to personalise their bedrooms and can take their own belongings in to their bedrooms to reflect their individual tastes, age, gender and culture so meeting their needs and providing a more homely environment. One person was very happy with their bedroom stating they had a lovely view over the garden. Since the last inspection carpets have been replaced in the first floor lounge, stairs and landing area, one bedroom had been refurbished and they were in the process of refurbishing another bedroom, so improving the environment and providing a pleasant and safe place to live. There were a number of aids and adaptations provided that were fit for purpose and suitable for the needs of the people living in the home. A number of people had been assessed for walking aids, so that their independence was promoted whilst maintaining their safety. Raised toilet seats, grab rails near to toilets and handrails in corridors were provided. There was an assisted bath and shower facility, so that people with physical disabilities could use these facilities safely and in comfort. Access to the first floor is by a passenger lift enabling everyone to access all areas of the home. Two residents had been assessed as being at risk of developing sore skin and appropriate pressure relieving mattresses had been obtained for them. The Home chooses not to accommodate people that require a hoist to transfer. An exception to this is that there is one person living at the Home who requires the use of a hoist. This person’s care needs have not changed for a long period of time and the management team stated that her care needs are being met at the Home. This hoist is not used for other people and staff had received training in this area, so that they are competent to use it safely. The second floor is used as offices and domiciliary carers were seen to use the office, which may impact on people’s privacy. The proprietor stated that they Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 23 were planning to have an extension to the nursing home in the future and offices would be moved there. Hafod Residential Home DS0000016917.V362629.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 adequate. This judgement has been made using available evidence including a visit to this service. There was an adequate number of staff who had been recruited effectively; so people who live in the home were supported by staff who were suitable to work with elderly clients. Further staff training is required to ensure staff have the skills and knowledge to meet people’s needs consistently. EVIDENCE: The duty rota indicated there was two care staff on each shift during the day with a manager on duty in the morning from Monday to Friday and they are on call at other times. The housekeeper also works in the afternoon during the week and is responsible for activities. Overnight there is one awake and one sleep in member of staff. The sleep in member of staff works between 8pm and 10pm and 7am and 8am. They can sleep on the premises the remainder of the night and are available if case of any emergencies. There is a fairly stable staff group and the information provided indicated that only two staff having left employment over the past year. This ensures people who live in the home are supported by staff who know them well and ensure consistency of care. Three staff files were inspected and there was found to be a satisfactory recruitment process with references and Criminal Record Bureau checks having been completed before staff commence employment, so protecting peop0le who live in the home. It was noted that one member of staff from overseas had a student visa and was working in excess of 20 hours. Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 25 On discussion with the manager she stated that the member of staff concerned had indicated that this is now acceptable. In future the manager must ensure that any future employment complies with the Home Office current guidance and evidence must be retained in the home. The record of training indicated that some staff had undertaken training in the majority of basic core training such as manual handling, food hygiene, infection control etc; so ensuring they had the basic knowledge and skills to care for people. However, some staff had only undertaken training in one or two areas and some were not fully conversant with the fire procedure, which could put people at risk in the event of a fire. Also there was no evidence of training in diabetes, tissue viability and other areas that affects people living in the home. A notice was available in the office indicating that a range of basic training was available in May, which included manual handling, health and safety, food hygiene, fire safety and infection control. The manager should also consider other areas such as diabetes, epilepsy, tissue viability etc. so that staff develop their knowledge and understanding of peoples health conditions etc. so leading to improved outcomes for people. The records indicated that only one member of staff had completed NVQ level 3 and there was no record of induction training in the files. Staff confirmed that they had received some training on commencing employment and at the time of inspection it was noted that a new member of care staff was supernumerary giving them the opportunity to work with more experienced staff and learn what was required to meet people’s needs. The manager showed the inspectors and new induction package, which meets the standards and stated all staff would be working through the package to ensure they had the appropriate knowledge and skills to meet people’s needs. Hafod Residential Home DS0000016917.V362629.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 adequate. This judgement has been made using available evidence including a visit to this service. The Home is generally run in the interests of the people using the service and they are consulted about changes, so they are able to influence changes and have some control of their lives. Health and safety arrangements generally protect people living at the Home. Some systems and records need developing to ensure people are fully protected and needs met in a timely manner. EVIDENCE: The manager and one of the proprietors were available at the time of inspection. There appeared to be a relaxed, homely atmosphere. People living in the home and visitors provided positive feedback about the staff. It appeared that people’s needs were being met in a number of areas, but there Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 27 were times when staff were slow to obtain advice from health professionals and this could put people at risk. On discussion with the staff they stated they enjoyed working in the home, they felt staff got on well and they worked well as a team. They confirmed that staff meetings and supervision sessions occurred with the manager, which they found useful and helpful. The home has a quality assurance system and the manager stated questionnaires had been sent out to relatives last year, but they were due to be sent out again. No evidence of the previous ones were seen or how the information was obtained was used. There was evidence of meetings with people who live in the home giving them the opportunity to be involved in decisions about the home and what they wanted. The quality assurance system enables monitoring of systems and feedback to be obtained, so that the home can ensure continuous development. It was recommended that feedback should also be sought from other stakeholders such as health professionals, social workers, staff and other visitors to the home to improve the system. Another area of the quality assurance system includes monthly visits from one of the owners to monitor progress and talk to people in the home. The director, who was present, stated she had not undertaken these visits over the past six months as she was away from work. However, in her absence arrangements should be made for someone else to undertake the visits and write a report on her behalf, so that she is aware of any issues or concerns in the home. The manager stated in the Annual Quality Assurance questionnaire that all policies and procedures had been reviewed and updated by a company. However, on inspection, they had not arrived and it was noted some of the other polices and procedures were not up to date. This will need to be followed up and ensure they are compliant with the mental capacity act, as they are required by staff to undertake their roles effectively. Whilst touring the home it was noted that a number of notices on boards were out of date and the manager was advised of the need to ensure up to date information is available for staff, people who work live and visit the home at all times. Prior to the inspection an Annual Quality Assurance Assessment was completed. The document gave only limited information about the home, staff and people who live there. It did not provide any information on any plans for the future or any areas that they had identified as needing development. The Staff do manage personal money for some people who live in the home. The manager stated they do not act as appointee for anyone. On inspection of the system it was found to be satisfactory with two signatures for all transactions and weekly checks were made, so ensuring a robust system Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 28 Health and safety maintenance checks had been undertaken in the home to ensure that the equipment was in safe and full working order. Maintenance checks were completed on the fire system and equipment, so that people are safe in the event of a fire occurring. Checks were made on hot water outlets to ensure it maintained at a satisfactory temperature to prevent scalding. Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 29 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 2 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 3 2 X 3 X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12 Requirement All people using the service must have an up to date care plan. This will ensure that people will receive person centred support that meets their needs. (Timescale of 16/11/06 and 1/8/07 not met) Risks to people living in the home must be identified and a risk assessment completed, which is subject to regular review so that individual’s health and safety is maintained. Zimmer frames must have effective rubbers on the feet at all times to prevent risks to people using them. When staff are transferring people in wheelchairs foot rests must be used unless a risk assessment demonstrates alternatively to reduce any risk of injury. People living in the home must receive health care in a timely manner according to their individual needs and their records completed to ensure that DS0000016917.V362629.R01.S.doc Timescale for action 30/08/08 2 OP7 13(4) 30/06/08 3 OP8 13(4) 10/06/08 4 OP8 13(4) 10/06/08 5 OP8 13(1)(b) 17(1)(a) 10/06/08 Hafod Residential Home Version 5.2 Page 31 6. OP9 13(2) adequate healthcare monitoring takes place. Robust system must be in place 10/06/08 to ensure medication is available and administered to people living in the home, so they receive the medication prescribed by health professionals. All staff must undertake training 30/07/08 in respect of safeguarding and whistle blowing procedures to ensure they have the knowledge to protect all people living in the home. The portable hoist should be 30/06/08 serviced on a regular basis to ensure it is fit for purpose. All staff should undertake fire 30/06/08 drills at least twice and year and records maintained, so they are aware of the action to take in the event of a fire. 7. OP18 13(6) 9 10 OP22 13(4) 23(4) 17(1) OP28 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 OP1 Good Practice Recommendations The service user guide and statement of purpose should be reviewed and updated to ensure that all people living in the home or those looking to move in have up to date information and can make an informed choice. Comprehensive pre admission assessment should be undertaken for anyone wishing to move into the home to determine if their needs can be met before moving in. Staff should write to all people following a pre- admission assessment confirming if their needs can be met in line with the regulations and to provide confidence to the person that their needs will be met upon moving in. It is recommended that advise be sought regarding monitoring of chronic diseases from G.P. practices and DS0000016917.V362629.R01.S.doc Version 5.2 Page 32 2 3 OP3 OP3 4 OP7 Hafod Residential Home 5 OP7 5 6 OP7 OP7 6 OP8 7 OP9 where this occurs clear records maintained, so ensuring people’s health is maintained to an optimum. Records of all health professionals’ visits/interventions should be maintained to demonstrate effective monitoring of peoples health. The impact of not doing this can be serious as staff are unable to follow up on concerns. It is recommended that daily records be reviewed and action taken to provide more detail about the care provided and the person’s day. Arrangements should be made for staff to undertake training in respect of care planning so t they have the opportunity to gain knowledge and understanding in this area. It is recommended that communication systems be reviewed to ensure all staff and relatives are kept informed of any changes or incidents in people’s conditions. Medication • The dates of opening eyes drops and creams should be recorded to ensure they are used within specific timescales to reduce the risk of infection. • The minimum and maximum temperatures of the fridge should be recorded to ensure medication is stored at the correct temperature. • Regular staff audits should be undertaken to determine any shortfalls in practice, so they can be addressed. Consideration should be given to people’s ability when serving meals in order to further enhance independence. Records of all complaints, investigation and findings must be kept in the home at all times so they are available for inspection. Follow up the outcome of the safeguarding referrals made earlier and inform us, so that we can ensure appropriate action has been taken. Policies and procedures in respect of safeguarding and whistle blowing should be updated to ensure staff have the appropriate information to refer to and use in the event of any incident. A call bell facility should be available in the conservatory so that assistance can be summoned if required. The portable hoist should be serviced on a regular basis to ensure it is fit for purpose. The practice of using communal toiletries should be reviewed to reduce the risk of cross infection. 8 9 10 11 OP15 OP16 OP18 OP18 12 13 14 OP22 OP22 OP26 Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 33 15 OP27 16 17 18 16 OP28 OP29 OP33 OP33 A review of the staffing rotas should be undertaken and action taken to ensure staff are not working several shifts consecutively in order to fall in line with the working time directive and the health and safety of people living in the home and staff. 50 of care staff should be trained to NVQ level 2, so that have the skills and knowledge to care for people living in the home. The manager will need to obtain evidence of the working permission for student visas, so that they are working within the legal requirements. The proprietor must ensure that monthly visits are undertaken and reports are written on the conduct of the home as required under the Care Homes Regulations. The quality assurance process should be further developed to identify areas for continuous improvement and implement appropriate plans. Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Hafod Residential Home DS0000016917.V362629.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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