Inspection on 12/09/06 for Hambleton Court Residential Home

This inspection was carried out on 12th September 2006.

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

The inspector 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

Hambleton Court Residential Home 09/12/09

Hambleton Court Residential Home 10/09/07

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

CARE HOMES FOR OLDER PEOPLE Hambleton Court Residential Home Station Road Hambleton Selby North Yorkshire YO8 9HS Lead Inspector Anne Prankitt Key Unannounced Inspection 12th September 2006 09:10 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 Hambleton Court Residential Home DS0000066900.V305225.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. Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hambleton Court Residential Home Address Station Road Hambleton Selby North Yorkshire YO8 9HS 01757 228117 F/P 01757 228117 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) Mr Stuart Churm Mrs Sandra Churm Mrs Kathleen Welford Care Home 12 Category(ies) of Old age, not falling within any other category registration, with number (12) of places Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection N/A Brief Description of the Service: Hambleton Court, formerly known as Rose Villa, provides personal care and accommodation for up to twelve older people. The home, which is a large detached building, is situated off the main road in the village of Hambleton, next to the village hall and local church. There are ample parking facilities. The village offers a range of facilities, including shops, pubs and restaurant, and is on the main bus route to the market town of Selby, which is approximately four miles away. The accommodation is provided on two floors. All rooms excepting one provide single accommodation. The second floor is accessed by a chair lift. Mr and Mrs Churm became registered providers in March of this year, when they purchased the home from the previous owners. Before being admitted, prospective service users are given information about the home within a service users’ guide. The register providers confirmed on 12 September 2006 that the current weekly fees range from £342 to £395. Items not included within the fees include hairdressing, toiletries, magazines, papers, transport, chiropody dentist and optician. Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior the site visit, the registered manager, Kath Welford, provided certain information about the home within a ‘pre inspection questionnaire’. In addition, information about what has been happening at the home since the new owners took over, has been collected by the inspector as part of an ‘Inspection Record’. All of the information, including that which was gathered at the site visit, was used as part of the key inspection. Comment cards were sent to General Practitioners who visit the home, and one was returned. The inspection lasted for seven and a half hours. Four hours preparation took place beforehand. The registered manager and registered providers were available throughout the day, and for feedback at the end. The site visit consisted of an inspection of the communal areas, and a sample of private bedrooms. Kitchen and laundry services were also looked at. A selection of documentation was looked at, including a sample of care plans, health and safety records, staff records and residents’ monies. Quality assurance was discussed. Some staff, residents and relatives/visitors were spoken with, and general observations of the activity at the home were made. What the service does well: Staff are kind to residents, and they have enough time to care for them without having to rush. Residents said that staff understand their needs, and that they are met. The owners are available at the home each weekday, and residents appreciate their input, and also that of the registered manager. Residents have the opportunity to spend time at the home before they decide whether they want to live there, and staff meet them to assess their needs before they are admitted. Residents feel happy that they could complain to staff if they had any grumbles, which they are satisfied would be dealt with. All residents thought that the food at the home is good. The owners make sure that there are fresh vegetables available, and the cook provides home baking. Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. Service users’ needs are assessed prior to admission so that they can be assured that their current needs can be met. The judgement is made using available evidence and a site visit to the service. EVIDENCE: Before service users are admitted, they are provided with information about the home in a service users’ guide. There have been two admissions made to the home since the new owners and registered manager took over. The written assessment completed by the home was missing in one case, but the registered manager explained that the service user was visited in hospital prior to admission, and the hospital had provided information about current needs. The information gathered had been used when deciding whether the service user’s needs could be met at the home. Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 9 In the case of the second service user, there was a pre admission assessment that had been completed by the home, and a care management care plan. Following admission, the staff at the home had used this information when developing a care plan. From discussion with the service user, it appeared that they were happy with their placement, and pleased that they were near to their family. The registered manager confirmed that a full days visit took place prior to the admission. The home does not provide intermediate care. Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. More proactive management of risk would further enhance the care that is provided to service users. The judgement is made using available evidence and a site visit to the service. EVIDENCE: The registered manager explained that all of the care plans have recently been updated. This had happened within the last month. They were in the process of being developed, and had not yet been reviewed. An assessment of need is made following admission. From this assessment, the care plans are developed. They are based on the activities of daily living, and are personalised to recognise the needs of individual service users. Service users who were spoken with said that they were able to have access to their General Practitioner whenever they needed medical help. The district nursing team meets their nursing needs, and details about visits made were documented within the care plans. Record was made of family contact, and of social activities that each service user had enjoyed. Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 11 The way in which risk is assessed and subsequently recorded within the care plan could be improved upon, to include: • • how risk could be minimised, and a trigger to inform staff when a referral to a specialist was needed. It would be good practice for this to take place for all service users upon admission, so that a baseline is achieved, and reviewed periodically thereafter. However, attention should first be given to the care plans belonging to those service users where there have already been risks identified, which are associated with their care needs. For instance: • • A falls risk assessment should be completed where service users are identified as at risk from falling. A recognised risk assessment, such as Waterlow, should be completed where a service user has been identified as being vulnerable to the risk from pressure sores. Service users who are at risk nutritionally should have a nutritional assessment completed. The risk assessment for those service users who self medicate should be reviewed regularly as part of the care plan review, to check that the arrangements in place are still safe. A manual handling risk assessment should be completed where risk to service user and staff has been identified. A risk assessment must be completed for the safe use of bed rails, to include a record that the rails have been checked on a regular basis to ensure that they are safe and fit for use. • • • • However, service users were extremely satisfied with the care that is provided by staff. Without exception, they thought that they were very good. Service users looked well cared for, and were spoken to with respect and dignity. They thought that staff understood their needs. There was evidence that equipment is sought, such as pressure relieving equipment where required, and the registered manager explained that there were now no service users with pressure sores. The registered provider has also ordered weighing scales, as there is currently no way that staff can weigh service users. The registered manager has made changes to the medication system since the last inspection. The medication is no longer stored in the kitchen; a dedicated storage cupboard has been provided. Medication is now provided in blister Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 12 packs, and the supplying chemist has provided equipment for safe storage, including a trolley and a medication fridge. The registered manager awaits delivery of a controlled drugs (CD) cupboard. The controlled drugs were being stored in a separate plastic box, which was secured to the wall. This had not been locked after being accessed by staff. This is not safe practice, and the registered manager agreed to change the storage arrangements to one more suitable pending delivery of the CD cupboard. The balance of controlled drugs could be reconciled with the records kept, although the date had been recorded wrongly in one case. On discovering that there were some omissions in the administration records, a random audit of the general medication was made. It could be established that the medication had been given, but the records had not been signed. Discussion took place with the registered manager about the need to carry out regular audits of the medication system. She confirmed that all staff that are responsible for the administration of medication have undergone training in the safe handling of medication, and distance learning in this area of competence is now being accessed to complement the training provided by Boots the Chemist, who provide a service to the home. The arrangements in place to assist service users who part self medicate are mainly satisfactory. The registered manager explained that a record is kept of the medication that is prescribed in the care plan. However, the following areas of risk were discussed: • • The risk assessment for people who self medicate must be reviewed regularly Within the risk assessment, staff should consider whether it is possible, appropriate and safe for the service user to keep all of their medication other than the medication, which staff administer and keep record of. Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. Service users’ daily living needs and wishes are considered, and their preferences listened to and acted upon. The judgement is made using available evidence and a site visit to the service. EVIDENCE: There is an organised plan of activities, which is provided by the staff at the home, or by Mrs Churm, registered provider. The programme was varied, and included both group activities and one to one activities. On the day of the site visit, a service user was assisting a small group of service users making hand made greetings cards. One service user accesses town independently, and enjoys gardening, whilst another was looking forward to visiting the local church, so that they could re-establish their connections with the church community. However, they explained that the local curate does come to the home to provide communion on a regular basis. Service users thought that the programme of activities was satisfactory, although some were clear that they did not wish to be involved, and that their wish was respected. Service users thought that they were able to make decisions about their day to day lives, such as when they go to bed and when they get up. Their bedrooms Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 14 were individualised, and contained personal belongings. Personal telephones were seen in bedroom areas, and one service user has access to the Internet. Visitors are welcomed to the home at any time. Service users spoken with appreciated this, and observations of interactions between staff and visitors confirmed the view of the service users that they are made welcome by staff. One visitor stated ‘I stay for all of the afternoon when I come, and I always get a cup of tea’. Another stated ‘I am always made welcome. I come and go as I please’. Service users spoken with were unanimous in their view that the food provided at the home is of good quality. The dining area, which has been recently refurbished, was nicely set out, and displayed a copy of the menu. There is no choice at lunchtime, but service users were confident that they could request an alternative if they wished to. The cook thought that she was given sufficient information about special diets, and she explained how these were provided. Fresh fruit was available in the dining area, and the cook explained that the registered provider ensures that there is always a good supply of fresh vegetables available. The care staff prepare the teatime meal, for which the cook provides home baking. Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. Service users are protected by care staff who understand the need to report matters of abuse, and a manager who will take steps to protect them should abuse be suspected. However, the lack of management knowledge about the role of the local authority could result in a delay in proper investigation taking place. The judgement is made using available evidence and a site visit to the service. EVIDENCE: There have been no complaints made either to the home or to the Commission for Social Care Inspection during the period since the last inspection. However, there is a clear complaints procedure, and service users spoken with were confident that they would be able to raise any issues of concern with the staff, and that they would be dealt with. Staff consulted were clear that they would direct all complaints to the manager. Should they suspect that a service user was being abused, staff also understood their responsibility in reporting their concerns directly to the management. They understood that they could not keep secrets where the vulnerability of service users was in question. The registered manager knew that she would be responsible for making the immediate situation at the home safe, and would consider suspending the member of staff in question. However, she was not clear as to whom she should report the matter, believing the point of referral to be RIDDOR. The abuse policy did not make Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 16 mention of the local authority as lead investigators to whom vulnerable adult issues should be referred. It stated that the home would investigate. Staff have not received training in abuse awareness. The manager has agreed to obtain a copy of the local authority vulnerable adults procedure, to update the policy at the home, and to ensure that she and the staff update their knowledge of the correct procedure. Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26 Quality in this outcome area is adequate. Service users live in a clean and homely environment, and the registered provider has agreed to take prompt action where shortfalls have been identified. The judgement is made using available evidence and a site visit to the service. EVIDENCE: All areas of the home seen were spotlessly clean, and were a credit to the cleaning staff. There were no malodours. The majority of bedroom areas are situated on the first floor of the building, which is accessible by stairs, or a stair lift, which has recently been replaced. There was an assisted bath on each floor, and a step into shower, which two service users are able to enjoy. Since the new registered providers took ownership of the home, there has been a conservatory built onto the sitting area, which has increased the amount of communal space available for service users. They have commenced a programme of redecoration, which has so far included the sitting Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 18 and dining areas, to include some new seating and dining furniture. Two bedrooms have also been redecorated, and this programme will continue as rooms become vacant. The fire crew made a scheduled visit to the home in April 2006, with no problems reported. The registered provider has not yet completed a fire safety risk assessment, but has agreed to contact the local fire safety officer for advice. As part of this assessment, he has been asked to check that the fire safety officer is satisfied with the current system whereby final fire exit doors are fitted with Yale or mortise type locks, and the key left in the door, or in close proximity. All bedroom doors are fitted with a locking device that require the use of a key should they need to be opened from the outside. The registered manager explained that the staff have a master key for use in emergencies. When in bed, one service user who occupies the shared room is unable to attract the attention of staff by means of the call bell, which is not accessible to them. The registered manager stated that the service user does not need the call bell during the nighttime. However, the registered provider has agreed that they will devise a system whereby the service user is able to summon the assistance of staff should they need to do so. The temperatures of the two immersion baths measured 39.6°C and 45.1°C. Whilst there are thermometers available in each of the bathrooms so that staff can check the temperature of the bath water prior to immersion, a system must be introduced for checking and recording all hot water outlets accessible to service users on a regular basis, to ensure that they are maintained close to 43°C. Work had been carried out to the hot water cylinder in the first floor bathroom, and the cover had been removed, exposing a hot water tank. The registered provider agreed to make this safe so that service users are not at risk from burns. The laundry facilities are located separate to the main part of the building, behind the kitchen. Within the laundry, there was guidance about how to deal with spillage of hazardous chemicals. The registered provider has agreed to ensure that there are no vegetables stored in the laundry forthwith. The environmental health officer has made a scheduled visit to the home in order to inspect the kitchen services. They have provided the registered manager with a copy of the ‘Safer Food, Better Business’, which they have been asked to implement. It was also recommended that the cook receive training. This is currently being sourced. Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. The current systems in place for ensuring service users are protected by suitably trained and vetted staff need to be improved upon, but the registered provider is taking active steps to mitigate these issues. The judgement is made using available evidence and a site visit to the service. EVIDENCE: There are two care staff available over a twenty four hour period. At night, one of these staff is asleep, but on call within the building. The registered manager confirmed that all waking night staff are above the age of 21. The manager and registered providers are available during the daytime. There is a cook available until lunchtime each day, and cleaning staff. Service users spoken with thought that there were always sufficient staff to meet their needs. They and the staff consulted agreed that they had sufficient time to complete tasks without being rushed. There are some areas where statutory training has lapsed, and the registered providers and manager have been looking at the training schedule available at the home in order to address this issue. Whilst the registered provider stated that all staff have been trained in how to use the new fire alarm system, it was of concern that fire safety training was not being provided at regular intervals. This requires priority attention, so that all staff know what to do should a fire Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 20 break out at the home. He has completed a training matrix, which identifies who requires statutory training, and has contacted the local college so that this can be delivered as soon as possible. This must include provision of training in: • • • • • Food hygiene Infection control First aid, to ensure that there is a trained first aider available on each shift Fire safety Moving and Handling Newly recruited staff undergo a period of induction. One member of staff explained that they were being mentored by the registered manager and a senior carer as part of this process, and that she was provided with suitable training before she was expected to carry out tasks alone. NVQ training is being provided as part of a rolling programme, and the registered manager confirmed that three care staff have already completed NVQ level 2, and contact has been made with the local college so that a further three care staff can be enrolled to complete this training. The deputy manager is also undertaking NVQ 4 in management, and has recently completed ‘train the trainer’ training so that she is suitably qualified to train staff in fire safety. The registered manager stated that suitable training for the cook is currently being sourced following recommendations made by the environmental health officer. It is the aim of the registered providers that all staff will be qualified to at least NVQ level 2 in care. The home relies on an umbrella body when obtaining Criminal Record Bureau (CRB) checks. From the records available, it was difficult to assess the point at which the umbrella body had confirmed to the home that the CRB had been returned, as this was not properly recorded. In one case, the registered manager gave assurance that it had been returned, but this information was not available. Within two files seen of staff recruited since the new owners have acquired the home, there was only one written reference obtained. Whilst there had been a POVAFirst completed, the information received prior to deployment, and on which a judgement could be made that the worker was suitable was insufficient, and must be improved upon. In addition to this, the registered providers have no evidence that staff employed prior to their acquisition of the home had a CRB completed by the previous employers. However, staff consulted stated that they have an applicants copy from when these checks were obtained by the previous owners, and previous inspection concluded that the recruitment procedures were robust. It would be good practice for the registered provider to make a record on each individual file where this problem has occurred. Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. The management of the home understands the need to comply with legislation, and accepts that shortfalls identified need to be addressed in order that the health and safety of service users is protected. The judgement is made using available evidence and a site visit to the service. EVIDENCE: The home has gone through significant changes during the last six months, during which time Mr and Mrs Churm have become the new owners, and Kath Welford the new registered manager. One service user stated ‘Kath is wonderful’. A member of staff stated ‘Kath and the management are very approachable’. Another stated ‘Kath has made positive differences to the home’. The changes appear to have been handled sensitively, with care taken to ensure that the impact on the service users was not detrimental. Service Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 22 users spoken with confirmed that this was the case. They appreciated the input of the registered manager, whom they described as ‘very kind’, and they referred to the registered providers, who are available at the home throughout the week, on first name terms. Observations made suggested that they were closely involved in the day to day running of the home. The registered manager has made the decision to retire from her position. The decision had been shared with staff and service users. The registered provider has plans in place so that the management arrangements following her departure are handled smoothly. The quality assurance systems are in the early stages of development. The registered manager and providers explained that they have developed a questionnaire to be handed out to relatives in the near future. However, they agreed that seeking the views of service users about the service would give them good information about areas of current good practice, and where further improvements could be made. Discussion was also had about seeking the views of visiting professionals when measuring the quality of the service. There are no service users for whom the home acts as appointee. All service users’ finances are dealt with by family members, who provide them with personal allowance as and when needed. A small float is kept securely at the home where personal monies are kept on behalf of a small number of service users. This is kept pooled. Whilst clear records are kept of individual balances, it would be good practice to separate monies out individually. The registered provider pays for hairdressing and toiletries in advance, and invoices the families concerned. The registered provider explained that they are currently looking at the maintenance of the home, and updating systems as necessary. They have replaced the fire alarm system and stair lift. The nurse call and emergency lighting systems have been serviced, and all portable electrical appliances have been tested. Service of the oil-heating boiler is planned. The companies concerned have not yet provided the relevant certificates. However there was no current fixed wiring certificate available. The registered provider stated that he would make enquiries to establish whether this was obtained by the previous owner, and, if not, will ensure that this work is completed. Whilst the registered manager has not yet implemented the recently provided ‘Safer Food Better Business’ records in the kitchen area, the records evidenced that the staff complete daily cleaning tasks, record is kept of hot food temperatures, and food stored within the refrigerator was covered and dated. However, the chopping boards were badly scored, and in need of replacement. The upstairs windows were not fitted with restrictors. The registered manager had already identified this issue, and did not believe that there were any individual service users who were currently at risk. However, the registered provider has agreed to complete a risk assessment to formalise this. Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 17 X 18 1 1 X X 2 X X X 2 STAFFING Standard No Score 27 3 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 1 Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 OP8 Regulation 13,14,15 Requirement Risk assessments must include: • • how risk could be minimised, and a trigger to inform staff when a referral to a specialist was needed. Timescale for action 31/10/06 In addition: • A falls risk assessment must be completed where service users are identified as at risk from falling. A recognised risk assessment, such as Waterlow, should be completed where a service user has been identified as being vulnerable to the risk from pressure sores. Service users who are at risk nutritionally must have a nutritional assessment completed. The risk assessment for those service users who self medicate should be reviewed regularly as part of the care plan review, to Version 5.2 Page 25 • • • Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc 2 OP9 13 check that the arrangements in place are still safe. • A manual handling risk assessment must be completed where risk to service user and staff has been identified. • A risk assessment must be completed for the safe use of bed rails, to include a record that the rails have been checked on a regular basis to ensure that they are safe and fit for use. Controlled drugs must be kept locked away securely in dedicated secure facilities which meet the requirements of the Misuse of Drugs (Safe Custody) Regulation 1973. Staff must ensure that the controlled drugs register is completed correctly. Medication must be signed for at the point of administration to ensure that omissions in the records do not occur. The registered person must: • Obtain a copy of the local authority multi agency adult protection policy and procedure Update the abuse policy at the home to incorporate the role of the local authority Provide training in abuse awareness, and ensure that the staff and management understand the system of referral to the local authority where abuse is alleged or suspected 12/09/06 3 OP18 13 31/10/06 • • Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 26 4 OP19 13,23 The registered person must seek advice from the fire safety officer with regards to: • • Completion of a fire safety risk assessment Checking that the current arrangement whereby final fire exit doors are kept locked, and the key kept in the lock, or hung next to the door, is acceptable to the fire authority 28/09/06 5 OP22 16 6 OP30 18 A system must be devised whereby hot water outlets accessible to service users are checked on a regular basis, to ensure that they are maintained close to 43°C. A record must be kept. Arrangements must be put into place whereby those service users who do not have access to their call bell when in bed, are able to summons the assistance of staff. The registered person must ensure that all staff have up to date training in fire safety within two weeks. In addition, arrangements planned with the training body must be expedited in the following areas: • • • Food hygiene Infection control First aid, to ensure that there is a trained first aider available on each shift Moving and Handling 13/09/06 28/09/06 • In line with the recommendation made by the Environmental Health Officer, the cook must be Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 27 7 OP29 19 provided with suitable training appropriate to the work that they perform. In all future recruitment, the 12/09/06 registered person must ensure that, prior to deployment, they have obtained: • • Two satisfactory written references A Criminal Records Bureau disclosure applied for by the home In extreme circumstances, where the staff member is deployed prior to the return of the CRB, a POVAFirst must be obtained. The staff member must be supervised at all times until such time that the CRB is returned, but not before two satisfactory references have been received. A second written reference must be obtained for those staff recently recruited, and for whom this has not been received. Clear record must be kept of the date on which the umbrella body informs the registered person that a satisfactory CRB has been returned. Upon receipt, the registered person must supply the Commission with a copy of the following service certificates: • • • • Portable appliance test Fire alarm, call bell and emergency lighting Fire fighting appliances Oil heating system 8 OP38 13,23 31/10/06 The registered person must obtain a current periodic electrical fixed wiring certificate Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 28 for the building. The chopping boards in the kitchen must be replaced. The registered person must carry out a risk assessment to ensure the there are no service users at risk from the windows to the first floor of the home, which are not fitted with restrictors. Where risk is identified, discussion should take place with the fire safety officer to ensure that it is safe for them to be fitted. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP9 OP26 OP33 OP35 Good Practice Recommendations It is recommended that the registered person carry out a regular audit of the medication system. It is recommended that the ‘Safer Food Better Business’ guidelines be implemented at the home. The registered person should further develop the quality assurance systems at the home, by seeking the views of service users, relatives, and visiting professionals. It would be good practice for service users’ personal allowances held by the home to be kept separately. Hambleton Court Residential Home DS0000066900.V305225.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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