Inspection on 12/12/07 for Hampton Court Care Home

This inspection was carried out on 12th December 2007.

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

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

Other inspections for this house

Hampton Court Care Home 05/04/07

Hampton Court Care Home 10/06/06

Hampton Court Care Home 12/01/06

Hampton Court Care Home 11/05/05

Hampton Court Care Home 20/12/04

Hampton Court Care Home 22/06/04

Hampton Court Care Home 09/03/04

Hampton Court Care Home 06/10/03

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

CARE HOMES FOR OLDER PEOPLE Hampton Court Care Home Wrottesley Park Road Perton Nr Wolverhampton West Midlands WV8 2HE Lead Inspector Keith Jones Key Unannounced Inspection 09:00 12th December 2007 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 Hampton Court Care Home DS0000022329.V354303.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. Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hampton Court Care Home Address Wrottesley Park Road Perton Nr Wolverhampton West Midlands WV8 2HE 01902 840242 01902 844200 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) Mrs Gurdip Kaur Sahota Mr Resham Singh Sahota, Mrs Kamaldip Gill Maria Guest Care Home 52 Category(ies) of Physical disability (22), Physical disability over registration, with number 65 years of age (32) of places Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. PD 30 Nursing Minimum Age 60 on admission OP - 22 (PC only) minimum age 60yrs on admission Date of last inspection 5th April 2007 Brief Description of the Service: Hampton Court is a care home located in Perton near to Wolverhampton. The home was purpose built, with residents all accommodated on the ground floor level. The home is registered to accommodate up to 52 residents over the age of 60 years with physical disabilities, requiring nursing care or personal care only. The home can also take up to 5-day care residents who require personal care only. There are 42 single rooms and 5 double rooms all with en suite facilities, some with their own shower area. The corridor areas are wide and allow easy access for mobility and moving/handling aids. There are two large communal day rooms, each with a comfortable dining area. There is also a large reception area and a peaceful garden lounge where visitors can be received in private. The home is directly accessed from the main road and there is ample car parking facilities at the front. The home was built in open countryside backing onto farmland and there are rural areas all around the home, which are accessible to residents including wheelchair users. Amenities can be reached easily by transport, but are not within walking distance. Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted with the Registered Provider, Care Manager, an ‘expert by experience’ (assessor), and senior nursing staff. The Inspector acknowledged receipt of the hand written Annual Quality Assurance Assessment (AQAA). The last inspection report was discussed, and it was noted that there were no outstanding requirements or recommendations. CSCI are trying to improve the way we engage with people who use services, so we gain a real understanding of their views and experiences of social care services. We are using a method of working where ‘experts by experience’ are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service. The term ‘experts by experience’ (assessor) used in this report describes people whose knowledge about social care services comes directly from using them. On the day of inspection there were 42 Service Users in residence, 15 with nursing care needs and 27 with residential needs. A full case tracking of five residents yielded a valuable insight of policies in action. Records and a sample review of the administrative arrangements confirmed effective management. A tour of the Home allowed free and open access to all areas for inspection. The opportunity was taken to speak with a number of residents, relatives and members of staff. Service users and staff took an active role in the inspection process and contributed to the subsequent report. The assessor was able to speak to most residents and some family members, offering a valuable insight into daily living standards. Throughout the entire inspection a sense of familiar confidence pervaded into all aspects of daily activity expressed by those people met. A review of the administrative arrangements confirmed good practice and management. A full verbal report was offered at the end of the inspection to the Provider and Care Manager. The expert assessor presented her findings to the Inspector directly before leaving the inspection. The Inspector thanked all concerned for their contribution to a pleasing and constructive inspection. What the service does well: The Home offers a genuine commitment to care, with an open and personable approach, which reflects a degree of homeliness and a confident relationship between carer and resident. Emphasis goes into involving the residents and their families in the process of care, ensuring a personal approach to meeting Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 6 individual needs. Throughout the inspection a sense of familiar confidence pervaded into all aspects of daily activity expressed by those people met. The establishment of accountability towards effective assessment, care planning and review of resident’s needs are meaningful in formulating a satisfactory standard of care. This personable attitude and approach to care is appreciated and welcome by residents and visitors alike. The housekeeping, administrative and support services have all contribute to the team approach, and are recognised by the management for their efforts. What has improved since the last inspection? What they could do better: More effort and emphasis is required to organise suitable and varied activities and stimulation, both in and out of the Home. Continuing need to tighten up on security of medicine stores, and disposal of medicines. The disquiet over long-term catering service must be addressed, and immediate improvements are expected in areas of cleanliness and maintenance in the kitchen. Some comments from residents and families over long delays in receiving care attention should be recognised and discussed at team level. Nevertheless the achievements have been recognised, the areas of detail in requirement and recommendation will continue to play a part in the ongoing development and maintenance of an honest, meaningful and homely service. Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 7 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. Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,and 5 The quality in this outcome area is good. The Statement of Purpose has been, and continues in addressing the major issues and reflecting changes. The Home ensures that the admission process is recognition of a joint understanding that residents are aware, and that staff are able to meet expectations, to realise a comfortable transition. The Home ensures that prospective residents have the necessary information to enable an informed choice to be made. Residents have suitable contracts of terms and conditions of residence at the home a copy of which is on resident’s files. There had been a comment made in a survey return that a contract had not been issued, although recognised as an oversight and not the general case. EVIDENCE: Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 10 The Statement of Purpose continues to represent a description of the Home’s aims and objectives, philosophy of care and terms and conditions. The statement is frequently reviewed and updated to meet the contemporary situation, and to allow residents, and their relatives the opportunity to make an informed choice about where to live. A separate service user’s guide serves as an easily readable summary of the Statement of Purpose and supporting information, widely used and distributed to inform all interested parties. Case tracking of five individual residents identified that the Care Manager, Home Manager or her deputy, at the point of reference, conducts the preadmission assessment. The documentation was examined and found to be comprehensive, providing a solid foundation for progressive care planning. This assessment is produced with the full involvement of residents and family, allowing them to influence the direction of care. The assessment initiates the process of care, each individual having a plan of care, which includes a daily living plan and longer-term goals and outcomes. A comment of “I was made welcome and felt involved at all times” was noted. Following an assessment the assessor determines the suitability of the application in view of the facilities available, and at the capacity of the home, to manage the individual and any special needs. Likewise the applicants are informed in writing of those facilities and are encouraged to seek clarification concerning the general and specific services available for the prospective service user. Any special needs of the individual were discussed fully and documented, ensuring their individual needs would be met. Case tracking confirmed that a valuable exchange between resident and assessor took place and resources made available. These resources were seen to be an appraisal of staffing skills, equipment and general environment. From discussions it was evident that prospective residents and their relatives are able to visit and assess the quality, facilities and suitability of the Home at any reasonable time, to meet with staff and management. At all times relatives were seen to be involved in the process. Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11 The quality in this outcome area is good. This judgement is based on the examination of five care plans, discussions with residents, staff, managers, with general observations and inspection of the Home’s medication system. The care assessment, planning and review system is an organised, yet personalised process offering meaningful and valid documentation of care administered. A broad vision of needs is addressed through the care planning process, meeting personal and health needs. It is recognised that this reflects an individual profile of needs, discussed fully with family. The provision of medicines administration is managed efficiently, although reinforcement to improve storage and administrative procedures was advised. The Inspector was impressed with the confidence and closeness within the Home of staff, residents and visitors, and the mutual respect that prevailed. Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 12 EVIDENCE: Care records and case tracking clearly showed that this standard is well met, maintaining a high quality process of assessment. The pre-admission assessment represented the foundation for a well-considered and detailed care planning process. A profile of the residents’ social, physical and psychological status offered an individual plan of care, based upon activities of daily living, to be implemented and frequently reviewed. Each residents’ health, personal and social care needs are carefully assessed in an individual plan of care that is reviewed monthly, including residents’ and relatives views, to reflect their changing needs. That review is more frequent, dependant upon the individual’s needs and clinical condition. The strength of purposeful planned care lies within the frequency of the review process in monitoring and adapting care profiles. As is appropriate, a checking chart ensures that constant monitoring of high dependency residents is carried out. Evidence of fluid balance management controlled by the Care Manager was noted. A daily report is maintained to control monitoring, and offer a satisfactory account of care and service given. Relatives’ involvement in the process was evident. Risk assessments were carried out on an individual basis and frequently reviewed. Included in the care records were applications of established monitoring systems following a process of goals, care and evaluation. Case tracking confirmed the extent that the preparation, and recorded care plans were appreciated by residents and relatives alike. Tissue viability, continence, psychological and special needs are assessed and documented, along with nutritional screening, hearing and sight tests as appropriate. The GP service is supportive on request; through this service, arrangements are made to provide professional support. Continence is assessed on admission and promoted within the plan of care, and there was evidence that service users nutritional needs, and residents’ weights were frequently reviewed. Care staff maintain all aspects of service users personal care, overseen by trained nurses on a daily basis. The administration of medicines generally adhered to procedures to maximise protection to service users. The active storage was secure, with satisfactory added security for controlled drugs. A controlled drug register was examined and found to be up to date. There is b a continuing need to review the reception and secure storage of newly received supplies. The disposal arrangements have to be appraised due to poorly secured, overflowing stocks for disposal. The continued use of a ‘Homely Remedy’ process would require updating. Oxygen storage arrangements are by chain to the wall. There was no Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 13 resident self-medicating at the time of inspection. Each service user has the opportunity of their own lockable facility in their bedrooms on request. The Statement of Purpose, admission assessment and care plans are geared to engender a sense of individuality and privacy. These policies are reinforced with a staff induction programme and supervised practice. Case tracking confirmed that the policies were implemented, with all service users spoken with being complimentary of the degree of respect given, by each and every member of staff. The inspector observed the free, courteous interaction between service users and staff based on a level of confidence of mutual trust and respect. There was also an observed knowledgeable, and positive attitude towards residents and feedback from the residents: “Spotlessly clean” and “ The Home is excellent, the staff are really friendly” also - “staff are not always available”. Visitors revealed: “Excellent working relationships”, “We are made very welcome”. Relatives have freedom of visiting, emphasising on the importance of maintaining social contact. Adequate privacy policies exist for all toilet/bathroom areas and bedrooms. Individual spiritual persuasions were documented and individual diversity respected at all times. Relatives are welcome to stay as long as they liked in times of stress, including overnight stay. The Inspector and assessor were impressed with the confidence and closeness within the Home of staff, residents and visitors, and the mutual respect that prevailed. Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 14 The quality in this outcome area is adequate Generally service users’ life-styles and interests are recognised, discussed with their relatives prior to admission, and documented as far as possible to enhance a position of supported independence. Those who wish to bring in personal possessions are encouraged to do so. That routine is seen as flexible; to acknowledge individuality, yet maintain a focal point for service users to latch on to without dictating events. Residents were able to see their relatives and friends in private and decide whom they see and do not see. Service users were offered a varied and nutritious choice of meals from a 4week rotating menu. Special diets were accommodated with, although the cook fails to engage with residents to discuss personal preferences. EVIDENCE: The daily routine was discussed with staff and several residents, and was Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 15 agreed that there have been significant improvements in ensuring a more sensitive approach, and to be seen to be flexible to acknowledge individuality, without dictating a regime, yet present a focal point for residents to offer the security of consistency. Through case tracking, resident’s life-styles and interests were recognised, discussed with their relatives prior to admission, and documented as far as possible to enhance a position of supported independence. This will be enhanced by a closer application of a social record to match regular care plans. Those who wish to bring in personal possessions are encouraged to do so; there was ample evidence to show that has been followed through, presenting a sense of familiarity. Family and friends have freedom of visiting, those spoken to remarking on the importance of maintaining social contact. Relatives are engaged at all levels in the progress of care and its ongoing review. Residents spoken to were generally complementary with the relaxed environment, and the standards of care. During the inspection several residents and staff were seen to be engaged in social activities and discourse. Staff were observed to hold a friendly and sympathetic interaction with residents in their own bedrooms, and at mealtime in helping those who required assistance. The home had a part time activity vacancy at this time, with care staff filling in. On the day several residents had gone to a local school for the annual carol concert and lunch. A hairdresser visited the home every week. The home provided an Anglican service on a monthly basis. Residents were offered a varied and nutritious choice of meals from a 4-week rotating menu. It was discouraging that the cook did not get involved in the daily nutritional affairs of the residents, including accommodation of special diets and regimes. There was no evidence however, to indicate that a poor service was offered. Staff were seen to offer discreet assistance to those who required it. The choice of dining room, lounge or bedroom was at the discretion of service users. The assessor enjoyed a lunch with several residents and visitors. Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 The quality in this outcome area is good The home had a meaningful complaints policy in place to ensure the protection of resident’s legal rights, identifying the CSCI as a resource to approach with a complaint or grievance. On discussions it was evident that small matters were handled immediately, discretely and to the satisfaction of all concerned. The home has systems and procedures and to protect residents from abuse. EVIDENCE: Residents’ legal rights are protected by the systems in place in the home to safeguard them, including their contract, the ongoing assessment of care planning and policies in place i.e. the complaints procedure. The complaints policy was seen and records examined. There had been two formal complaints handled by CSCI since the last inspection, one of which was investigated by 2 external inspectors. This enquiry showed areas of concern regarding administrative arrangements, to which requirements and recommendations were made, and since complied with. One allegation made regarding care provisions, had not been supported by a multi-disciplinary strategy team. There were six other recent complaints, which had been dealt with satisfactorily. The Provider was advised to establish a formal ‘record of concerns’, to record residents and families concerns in a meaningful and Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 17 effective manner. A three monthly analysis of all complaints, concerns and allegations is to be reinforced by the Care Manager. On discussions it was evident that small matters were handled immediately, discretely and to the satisfaction of all concerned, by direct intervention of the care management. The overall policy of openness and transparency was acknowledged to have been a major improvement, requiring continual address. Discussion confirmed that there is a protocol and response, to anyone reporting any form of abuse, to ensure effective handling of such an incident. Staff induction and in-house training programmes clarified and reinforce the responsibilities of all staff in their daily contact with service users, especially their privileged position in protecting service users from abuse, of all natures. The practical training requires a formal annual approach for all staff. Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,23,24,25,26 The quality in this outcome area is good. This judgement was based on discussions with residents, staff, and a tour of the premises by the assessor and inspector. The home is well appointed to meet the needs of an elderly population of service users in providing a safe and comfortable environment. There are two sections to the Home, the East wing predominately residential care, the west wing to nursing care, although there is an increasing flexibility of use. The west wing is presently undergoing extensive refurbishment. On inspection, bedrooms were personalised with most displaying service user’s own furniture, and with personal belongings. All communal areas are of a good standard, offering social as well as private reflection, as the mood takes. The overall environment was found to be safe for service user’s comfort within risk assessed limits. The domestic services in the home were seen to be of a good standard, with no evidence of unpleasant smells or unsightly debris anywhere throughout the inspection. Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 19 EVIDENCE: A tour of the Home verified that the premises were fit for purpose, clean warm and tidy, and being well maintained. The surrounding garden areas were maintained to a basic standard, with evidence of dumping certain items no longer of any use, or awaiting disposal. The surrounding countryside provided a pleasant vista for relaxation in warmer months. Internal access was facilitated with suitable fittings of hand and grab rails, in adequate, well-lit and airy corridors. Wheelchair access was satisfactory throughout all areas of the home. On admission the Provider or Care Manager assesses each individual service users’ needs for equipment and necessary adaptations. Efforts had been made to provide a homely atmosphere and the décor in most areas of home was found to be of a high standard. The assessor likened the Home to a hotel standard. The Home provided two lounge areas that were pleasantly decorated for the Christmas festivities, providing essential furnishings and items to offer comfortable areas where residents were able to interact, or to entertain their guests. The west wing lounge is large and has had furniture moved to facilitate small group areas, which has proved to be acceptable, but would be enhanced further with floral display dividers. It was noted that few residents took advantage of the lounge areas during the morning, although it was noted that several residents had gone on to a school play that morning. The central conservatory provided a tranquil area where service users could experience the views of the surrounding grounds. The Provider indicated her plans to convert an office space with a quiet room to create another bedroom. There were spacious dining areas at each wing where service users were able to dine in comfort. It was noted that there are plans to wood-floor the areas in the near future. Toilets and bathrooms were located on both floors and were in close proximity to bedrooms and communal areas. One bath was damaged and the Arjo hoist mechanism non-functional. There was also a shower room inoperative which needs to be closed off until repaired. Bedrooms were maintained to meet residents’ personal preferences. On inspection, most bedrooms were personalised, with some displaying residents’ own furniture, and most with personal belongings. It is the policy that on bedrooms becoming vacant that each room is reappraised for redecoration, as confirmed during the Inspection. There was evidence of an ongoing upgrading of bedrooms, with 10 rooms completed. There is throughout a satisfactory Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 20 standard of furnishing. Those residents spoken to expressed a sense of belonging and satisfaction in the quality and presentation of their living areas. An effective call system is installed; care staff reacted readily to tests. The care manager expressed a willingness to meet any reasonable demand for special needs. A locked facility and lockable bedroom doors are made available on request, following suitable risk assessment. The evidence seen on inspection of residents’ rooms, and on discussion with the individual service users and family, assured that this standard was well met. The kitchen area was poorly presented with equipment needing cleaning, store areas disorganised and inadequate attention to detail. The cleaning schedule and fridge freezer checks not being kept up to date. Essential maintenance had not been attended to. The Provider was in agreement to review kitchen management as a matter of some urgency. The laundry was disorganised and in need of a clean up, although equipped to a good standard. Red Alginate linen bags are available and widely used. Notices regarding chemical handling in the areas that store chemicals were displayed. The external and internal environment was generally well maintained and secure. The Registered Provider and Care Manager are to provide the Inspector with a development plan for 2008/09. Heating and ventilation were found to be satisfactory and lighting was domestic in style. Aids, adaptations and equipment were available throughout the Home. Fire equipment was inspected and seen to be serviced and up to date. The home presented a clean and pleasant, odour-free atmosphere, much to the credit of staff. Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The quality in this outcome area is adequate. Staffing levels were seen to be good to meet an expected demand, the daily care staffing rota showed adequate balance between skills and qualifications. Bed occupancy is low and plays a part in the defining of staffing levels. Care agencies are occasionally used, with agreed overtime and flexible rostering to accommodate shortfalls. The management have established a satisfactory procedure for interview, selection and appointment of staff. The thoroughness of staff selection has a significant effect upon the provision of cares to ensure protection of service users. Staff training records need review to complement the effort placed into staff training. EVIDENCE: Three weeks of off-duty were examined, and showed adequate balance between skills, qualifications and numbers to provide a foundation for a good standard of care. Staffing levels exceed the expected number to meet the needs of 42 residents, including 15 residents requiring nursing care. Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 22 The staffing establishments were examined and found to be satisfactory in meeting the CSCI staffing notice. An average coverage was seen to be: a.m shift – 2 trained 5 carers p.m shift – 1 trained 5 carers n.d. shift – 1 trained 3 carers It was agreed that there were some genuine concerns expressed regarding adequate numbers of staff to respond to needs, and that a re-establishing of 2 trained and 6 carers in the morning is advised. Several comments via surveys and discussions with the assessor confirmed this situation. The Home has an agreement to deploy a student nurse from Wolverhampton University. There are sufficient laundry and domestic staff over a seven-day period. There is a cook and 2 assistants in the kitchen daily. There is an administrator/receptionist for the home who works full time, and two handymen/gardeners available. The provision for a 10 hour activity coordinator are deemed inadequate, and should be increased to 20 hours per week. The overall staffing compliment on the day of the inspection was found to be satisfactory. The care manager emphasised the home’s commitment to training and to achieving targets for NVQ level 2. There are presently 9 staff with NVQ level 2 and 3, with 7 seeking qualification. The Registered Providers and Care Manager have established a satisfactory procedure for interview, selection and appointment of staff. This involves a standard application form to assess and profile, two references taken and CRB (enhanced) checks gathered before a contract is offered to successful candidates. The thoroughness of staff selection has a significant effect upon the provision of cares to ensure protection of service users. Service users are supported and protected by these practises and all new staff goes through an induction process that will ensure that they are going to be the right person for the home. All staff interviewed had a statement of terms and conditions. It is a declared policy that recruitment is based on equal opportunity. Four staff files were sampled and found to be well organised and up to date. Personal and training records were kept secure in accordance of the Data Protection Act 1998. Policy clearly states an equal opportunity position. The management are steadfastly committed to a learning environment. Staff induction programmes are comprehensive and well established; forming the base upon which in-service supervision and training are planned. Overall the Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 23 evidence, demonstrated an account of a meaningful and important schedule of training to meet internal and external demand. Supervision is inconsistent, and conducted by the Care Manager, which would be better maintained with delegated responsibilities, cascaded throughout the staff, to include all staff, on a two-monthly basis. Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37 and 38 The quality in this outcome area is good. The Care Manager Maria Guest is a very experience qualified General Nurse with a track record of good standards and professionalism. Arrangements are in hand to ensure early Registration with CSCI. The style of management was seen as by direct observation, and by discussion with residents, relatives and staff, and that a very open and positive attitude prevails, enhancing the Home’s ‘family feel’ and homeliness. There was evidence of openness, inclusion and honesty in speaking with residents, relatives and staff in which day to day events and episodes were freely discussed. On-site inspections offered evidence of a management increasingly in control. There is a renewed confidence apparent in the interaction of staff and the Home’s management that demonstrated an increasingly positive relationship that pervades throughout the Home. Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 25 EVIDENCE: The Care Manager has demonstrated competence in establishing a solid Statement of Purpose and policy portfolio that continues to be implemented, to achieve a good standard of set aims and objectives. A qualified general nurse with a professional portfolio of practical and managerial experience, supported by senior Nurses and experienced carers, who represent an effective care management team Staff meetings are held regularly in which staff are encouraged to participate fully in the management and direction within the home. The inspector observed at first hand through interviewing staff, the confident interrelationship that exist, not only between management and staff, but also between staff and residents. There was strong evidence of openness and honesty in speaking with service users, relatives and staff, in which day to day events and episodes are freely discussed. Evidence was secured to confirm a quality monitoring system has been introduced, based upon audit of standards; care plans and feed back from residents and relatives. Family forum is organised and hoped to be established as a permanent arrangement. Standards are discussed at staff meetings, daily reports, direct observation involvement and one to one staff meetings. The procedures manual was randomly examined, and found to offer a very comprehensive reference. Abuse management, grievance, pressure care and infection control procedures were examined and found to be informative and up to date. The Provider was advised over the implications of the Mental Capacity Act 2007, including the urgent need to cascade information and training throughout the Home. Fire safety remains high priority for all staff evidenced in routine maintenance checks, regular fire drills and frequent staff training sessions organised by the training officer. Discussion with the Care Manager indicated that supervision sessions and individual training programmes are areas that with continuing improvements, will enhance the desired impact on quality of service. A sample of administrative, maintenance and care records were examined and found to offer an accurate reflection of a service committed to providing a safe and comfortable environment for elderly service users. This was confirmed by inspection of service agreements for electric supply, gas, PAT and water supply. Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 26 Accidents were seen to be addressed, risk assessed, actioned and recorded in an effective way, with access to Riddor if needed. No serious accidents have been recently reported. The administration and management of the home continues to show improvements and are responsive and sensitive to the needs of the residents and their families. Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 3 3 2 3 4 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 2 3 3 Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP9 OP9 Regulation 13 (2) 13 (2) Requirement That a review of storage space for security of medicines. A Review of medicines disposal arrangements to ensure security at all times. Ensure that the kitchen is clean, maintained and organised at all times. That a schedule of cleaning and fridge/freezer temperature recordings be re-established. Timescale for action 12/12/07 12/12/07 3 OP38 16 (2) (g) 12/12/07 4 OP38 16 2 (g) 12/12/07 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 OP36 Good Practice Recommendations Ensure all staff are appropriately supervised every two months. DS0000022329.V354303.R01.S.doc Version 5.2 Page 29 Hampton Court Care Home 2 3 4 5 6 7 8 9 10 11 OP30 A training plan for 2008/09 was recommended to easily identify individual team member training needs. A re-furbishment plan be drawn for 2008/09 OP19 OP19 OP27 OP19 OP16 OP30 OP30 OP32 The registered person shall ensure that the garden area of the home is kept in a good state of repair. That a full unit risk assessment programme be updated. That consideration be given to the provision of activity coordination. All bathrooms and toilets be upgraded. A complaints book be established to categorise concerns, complaint and allegation for easy reference. Ensure the training of staff to address the Mental Capacity Act 2007. That the cook maintains a link in the relationships with residents and staff teamwork. That consideration be given to re-establishing care staffing levels in the morning period. Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Hampton Court Care Home DS0000022329.V354303.R01.S.doc Version 5.2 Page 31 - 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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