Inspection on 17/04/08 for Herewards House

This inspection was carried out on 17th April 2008.

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 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

Herewards House 24/04/07

Herewards House 08/06/06

Herewards House 23/01/06

Herewards House 10/05/05

Herewards House 05/10/04

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Herewards House 15 Ray Park Avenue Maidenhead Berkshire SL6 8DP Lead Inspector Helen Dickens Unannounced Inspection 17th April 2008 10:30 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 Herewards House DS0000060965.V362209.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. Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Herewards House Address 15 Ray Park Avenue Maidenhead Berkshire SL6 8DP 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) 01628 629038 Mr Bedanan Guru Seegoolam Mrs Dhanwantee Seegoolam, Mrs Sangeeta Rukunny, Mr Bolah Rukunny Mr Bolah Rukunny Mr Bedanan Guru Seegoolam Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th April 2007 Brief Description of the Service: Herewards House is situated in a quiet residential area of Maidenhead. There is a parade of shops in walking distance with the River Thames close by. The building has been converted and extended to provide residential accommodation for 27 elderly persons. The home has a conservatory with access to the garden, a dining room and separate lounge. Some bedrooms have en-suite facilities. Since July 2004 the home has been under new ownership, and is managed by the proprietors. The current scale of charges is £400-£500 per week. Additional items include sweets, cigarettes, hairdressing, chiropody and newspapers. Herewards House DS0000060965.V362209.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 people who use this service experience adequate quality outcomes. This key inspection was unannounced and took place over 7.5 hours. The inspection was carried out by Mrs. Helen Dickens, Regulation Inspector. Mr. Bolah Rukunny, known as Jeet, the Registered Manager, represented the establishment. A partial tour of the premises took place and a number of files and documents, including two resident’s assessments and care plans, two staff recruitment files, quality assurance information, and the annual quality assurance assessment (AQAA) were examined as part of the inspection process. Twelve questionnaires returned to CSCI from residents, staff and healthcare professionals, were used in writing this report. The inspector met most residents and five residents were interviewed in more detail on the day of the inspection. Some residents and relatives returned questionnaires to the home as part of the homes own quality assurance processes and these were also considered in writing this report. The inspector would like to thank the residents, staff and manager for their time, assistance and hospitality. What the service does well: Herewards House Murdoch House offers a homely and comfortable environment, which is well maintained with a rolling programme of refurbishment. Residents were pleased with their rooms and the facilities on offer. The home was clean and fresh throughout, with no unpleasant odours. There are a number of activities for those residents who choose to take part and family and friends are made welcome and speak well of the home. Relatives commented positively on the home and the staff. One wrote that their mother was happy and content at Herewards House and ‘… she tells me she is treated like the Queen.’ Relatives said the manager was approachable and helpful, and that they were always made welcome. There is a settled and conscientious staff team at this home, five of whom completed CSCI surveys. They commented particularly on the good management of this home. They also said they had good training and supervision. Residents appreciated the support they received from staff, one Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 6 resident, when asked what it was like living at Herewards House said ‘It’s like heaven.’ The meals at Herewards House were the subject of many compliments and no complaints were received on this subject. The dining room is very pleasant and residents are offered a choice of mainly home made food. One resident described the food as ‘perfect’ and another said ‘We’ve got a chef and a half.’ There is a rolling programme of training for staff and more than half of the care workers have an NVQ qualification. Staff were pleased with the training opportunities on offer and five staff questionnaires confirmed they had ‘ongoing training’, ‘regular supervision and ‘always received support and assistance.’ This home does well on respecting people’s individuality and each resident has their own key worker. There were many examples of the home supporting residents to be more independent. For example, one resident who had wanted to leave the home and return to their own home was encouraged by staff and eventually did move back home. Herewards House and garden is accessible to those with mobility impairments, with a variety of aids and adaptations to enable residents to be more independent. Assessments and care plans sampled took into account each resident’s religious and cultural needs. What has improved since the last inspection? The Annual Quality Assurance Assessment sent to CSCI prior to the inspection was very well completed by the manager, and gave a good overview of the improvements made at this home since the last inspection. A larger print Statement of Purpose has been completed for those who may suffer from sight impairment. Arrangements for meals have been reviewed and more choices are now on offer. Soup is now available each evening as is fresh fruit when residents request it. There has been a great deal of refurbishment over the last year including the path around the garden being resurfaced and now offering an even and secure environment for residents to enjoy; new garden furniture has been purchased; some bedrooms have been redecorated and another is being refurbished to include en-suite facilities. The laundry now has a washable floor covering which makes it easier to keep clean, and a new water boiler has been installed. The manager has completed the Registered Manager’s Award since the last inspection, and more staff have completed their NVQ qualification. More staff have been on the home’s mandatory training courses. Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 7 The majority of Requirements made at the last inspection have been met in full including all staff completing moving and handling training, and more staff have now done first aid training which means there is always at least one person on duty who is a qualified first aider. Infection control policies have been reviewed in line with Department of Health Guidance and the second floor bathroom has been refurbished. 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. The summary of this inspection report can be made available in other formats on request. Herewards House DS0000060965.V362209.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 Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. No resident moves into Herewards House without having his/her needs assessed and being assured these will be met. EVIDENCE: Two resident’s files were sampled and found to contain sufficient information regarding the needs of these residents. The manager carries out an assessment of each person’s needs and information is sought from health and social care professionals and is kept on file. Care plans were drawn up from these initial assessments and kept under review. The AQAA states that prospective residents are encouraged to visit the home and meet with residents and staff and have lunch before a decision is made about moving in. Of the 5 surveys returned to CSCI from residents prior to the inspection, all 5 said they had been given a contract, and three said they were given enough information prior to moving in. Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 10 One resident who was interviewed on the day of the inspection said they had been unwell and not capable of making all the admission arrangements – this had been done on their behalf. However, this person was very happy with the move to Herewards House and told the inspector that they were grateful for the way the home had taken them in and looked after them at that difficult time – they added that they would “Always be indebted to Jeet” (the Manager), for the “care and attention” given. Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s care needs are set out in an individual plan of care and their health needs are met. Arrangements for the administration of medication are satisfactory and residents are treated with dignity and respect. EVIDENCE: Two care plans were looked at in detail and found to contain information about residents needs including how they would like their support to be delivered. One staff survey returned to CSCI commented that care plans are up-dated every month and staff always go through the care plan before attending to a resident for the first time. The inspector noted on the day of the inspection that care plans are indeed properly reviewed each month and any changes noted. Care plans contained risk assessments, for example where one resident had had past falls, their care plan contained a falls risk assessment. Care plans also contained goals which residents were working towards for example some Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 12 residents had been trying to stop smoking and two had been successful so far. One resident was hoping to get more exercise and this had been set out as a goal at their last Review. Since then the manager had supported the resident to join an exercise class. Resident’s spoken with confirmed that they got the care and support they needed. On the surveys returned to CSCI from residents, all 5 ticked ‘Always’ to the question about whether they got the care and support they needed at Herewards House. Resident’s health needs are noted on their care plans and any assessments or visits by health professionals are clearly documented. One survey returned from a health professional ticked that staff ‘usually’ had the skills and experience to support individual’s social and health care needs, and that the service has ‘always’ responded appropriately if the health professional has raised concerns about their care. They added that ‘the residents always appear clean and happy.’ The home promotes healthy lifestyles for residents and have supported some to give up smoking, and enabled others to take part in community exercise classes. Residents have access to a spacious garden, which has level paths and is therefore suitable even for residents with mobility problems who like to take a walk. On the day of the inspection several residents were using the garden independently, whilst others were being supported to have a walk with two members of staff. Residents who were interviewed confirmed they got help with any health problems they had, with one describing how staff supported them with their diabetes. The medication at this home is well managed and both health professionals who returned questionnaires to CSCI confirmed this. The local pharmacist commented that the home always ordered repeat prescriptions on time, informed the pharmacy about any changes to medication, and rotated the stock properly. This respondent also confirmed that the manager had used the pharmacy’s smoking cessation service to help some residents who wanted to give up smoking. The inspector looked at the medication trolley and three medication administration records. The trolley was clean and tidy and kept securely, and there were no unexplained gaps on the records. The local pharmacist noted that the temperature in the room where the trolley is kept is often warmer than the 25C recommended on most medicines and the manager’s own temperature monitoring record shows this to be the case. The manager is therefore reviewing the current arrangements and said he will find somewhere which is cooler to store the trolley from now on. Residents raised no concerns about their privacy and dignity being respected and those resident’s interviewed on the day of the inspection were complimentary about the staff in this regard. Staff were seen to knock on resident’s bedroom doors before entering, and all personal care was delivered in private. There were numerous examples of resident’s dignity being protected for example those resident’s who needed assistance at lunchtime Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 13 were supported in a sensitive way with a member of staff sitting beside them in a relaxed manner. Another example was when the manager was observed to discreetly close the bathroom door for one resident who was using the bathroom independently and had forgotten to close the door on the way in. Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents have opportunities for social and leisure activities, and community and family links are encouraged. There are also opportunities to exercise some choice and control over their lives, and mealtimes offer a pleasant dining experience and a healthy diet. EVIDENCE: Residents are given some opportunities for recreation and the manager continues to improve on this Standard. Regular activities include fortnightly bingo, daily sing-a-longs or exercises to music, and board games. On the day of the inspection there was a sing-a-long session in the lounge and some residents went out for a walk in the garden with staff. A musical entertainer visits monthly and he has been coming to the home for many years – the manager said he is popular with residents. Two care staff have done activities training courses and the manager said he is working towards allocating extra hours dedicated to activities co-ordination for these two staff. Not all residents join group activities, and some go out independently, including those who smoke and go out into the garden fairly regularly. Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 15 Residents have been supported to attend local lunch clubs in the past but none of the current residents do this. One resident has been supported to join a borough council facility called SMILE (So much improvement with a little exercise) and said they were enjoying taking more exercise. The AQAA highlights that the home has also enrolled with ‘People to Places’, which provides transport for group outings. It was pointed out to the manager that 2 of the 5 service user questionnaires returned to CSCI said there were ‘sometimes’ activities on offer, whilst the other three said there were ‘usually’ activities on offer. The manager was asked to think about and consult with residents on how he might promote the current range of activities and perhaps extend these to ensure all residents feel there are stimulating activities on offer. Family and community links are encouraged at Herewards House and those residents spoken with who received visitors said they were always made welcome. One resident said their relative visited and had lunch at Herewards House every fortnight; another said their relative who lived a long way away and couldn’t visit often had a long chat with the manager on their last visit. One member of staff takes a resident to visit their relative on a regular basis, and the home provides a packed lunch for the resident to take with them. Some residents use the local facilities for example a café on the river nearby. Residents at Herewards House are given some opportunities to exercise choice and control over their lives and staff support them in their choices, for example some residents have given up smoking. Those who have chosen to continue to smoke are supported to buy their cigarettes and they are able to smoke in the garden. Residents are encouraged to manage their own financial affairs and some choose to use the office facility to keep small amounts of money for their personal use. The manager said one resident is being supported to open a new bank account and will then be able to use the local cash machine. Residents are allowed to bring personal possessions with them and there was evidence from visiting resident’s rooms that pictures, photographs and personal memorabilia had been brought in by residents and their relatives. One resident who said he was happy at Herewards House outlined how their day went at the home and said they had their own room, all meals were provided, and they could stay up in the evening watching television in the conservatory. This resident said the move to Herewards House has “…changed my life.” Mealtimes are a pleasant experience at Herewards House. The chef was complimented by many residents, one describing the food as “Tremendous….we’ve got a chef and a half.” On the day of the inspection the main course was sausages, home-made ratatouille and fresh vegetables. The alternative was fish. The chef made home-made bread and butter pudding as a sweet. He said most of the food was home made with fresh vegetables and meat. The weekly menu for the week of the inspection featured two roast dinners, (chicken and pork), liver and bacon, fish and chips, chilli con carne and chicken breast with tomato sauce. Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 16 The weekly menu is displayed in the dining room and the daily menu is written in a larger print onto a board each morning so it is clearer for residents. Of the five questionnaires returned to CSCI from residents, three said they usually like the food on offer, and two said they always liked it. The manager keeps a ‘verbal complaints’ book where he records minor issues which residents raise, often relating to the food. For example one resident wanted to give up eating meat, and this was arranged with the chef – some others didn’t want peas, and again the manager arranged this with the chef. Special diets can be catered for, for example one resident said he was diabetic. It was also noted that some residents needed either special cutlery or plates in order to enable them to be more independent at the table and these had been obtained by the home; and those who needed support from staff with eating were assisted in a sensitive way. Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents and their relatives are confident that their complaints will be listened to, taken seriously and acted upon. Improvements have been made in relation to safeguarding vulnerable people but more work is needed to meet this Standard (18) in full. EVIDENCE: The home has a complaints procedure and this is displayed throughout the home. A log is kept of complaints though the home has not received any since the last inspection, nor have any complaints been reported directly to CSCI. All five residents who completed surveys for CSCI said they would know who to speak to if they had a complaint, and that staff listened to them and acted on what they said. The manager keeps a ‘minor complaints’ book which details any issues raised by residents and how they have been dealt with – this is discussed earlier in the report under ‘Mealtimes’ as a number of comments related to food. The home has a copy of the local Safeguarding Adults policy and the manager has recently attended the launch of the up-dated version of these procedures. No safeguarding issues have been reported in relation to this home since the last inspection. A Requirement was made at the last inspection that all staff should have protection of vulnerable adults training and the manager could demonstrate exactly which staff had now completed this. However, three staff Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 18 had still not done the course. The mitigating circumstances were taken into account and the manager provided evidence that two of the three staff were booked on the course for next month. In addition, some shortfalls in recruitment which could have an impact on the safety of residents still need to be rectified, and an arrangement was made with the manager to do this within one week. Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Herewards House offers a homely environment, which is clean and hygienic throughout. EVIDENCE: Herewards House offers a homely environment with a pleasant conservatory and a garden for residents to enjoy. The outer gate to the car park is kept locked with a door entry system, providing a safe environment for residents. Those residents who wish to go out independently are able to do so. The home is undergoing continual refurbishment and up-grading and a number of improvements have been carried out since the last inspection as listed at the beginning of this report. Three resident’s rooms were visited and found to be comfortable and personalised with their own possessions. All the communal areas were visited including the dining room, laundry and some bathrooms – Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 20 these were clean and well kept. Residents interviewed said they were happy with their rooms and the home itself – one describing it as ‘Very comfortable.’ One downstairs bathroom needed attention as there were decorative shortfalls including cracks on the ceiling and peeling paint behind the basin and on the pipe cover. A shelf in this room was overfull and bowed in the middle, weighed down with pads, aprons and clean dressings. There were toiletries under the sink which shouldn’t have been stored there. The overall impression was that this room was institutional and uncared for, and detracted somewhat from the otherwise homely ambience within this home. This was discussed with the manager who made some suggestions about improving this room in the near future. There were wheelchairs being stored in a downstairs corridor and the manager was asked to find more suitable storage space. There were also some health and safety matters highlighted during the inspection, and these are outlined under Standard 38 at the end of this report. This home is clean and pleasant throughout. There were no unpleasant odours on the premises on the day of the inspection. Residents who returned surveys to CSCI all said that the home was ‘Always’ fresh and clean. Visitors too remarked on the cleanliness with one writing ‘The cleaners are excellent. Mum’s room is always clean and dust free, as are the communal rooms.’ There are individually dispensed soap bottles and paper towels in all communal hand washing areas and there are lidded containers for carrying linen etc down to the laundry room. The laundry room itself now has a washable floor covering, the manager has up-dated infection control policies and the second floor bathroom has been refurbished – these were all highlighted as shortfalls at the previous inspection. The manager was asked to take advice from the environmental health officer about the suitability of having clean clothes drying in the sluice room. Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s needs are met by the numbers and skill mix of staff and this home exceeds the Standard on NVQ qualifications for care staff. Recruitment arrangements need further work in order to fully protect residents. Staff training continues to improve and resident’s benefit by the current arrangements though more work needs to be done to ensure all staff have completed the annual mandatory training courses. EVIDENCE: On the day of the inspection there were sufficient numbers of staff on duty to meet resident’s needs. There is a written rota in place and senior staff are on duty when the manager is absent. There is a key-working system at the home and staff are organised into teams, which the manager said ensures better and more personalised care for residents. There are sufficient domestic staff to maintain the home in a clean and hygienic state. Residents and relatives commented positively on the care at the home, one relative noting that their relative who was resident at the home ‘….is happy, so I am happy knowing she is looked after 24/7.’ One resident told the inspector ‘Service all round here is very good. I think we are very fortunate.’ The home keeps a compliments folder and one relative who had been visiting the home over many years had written to the manager and said: ‘It was a great relief to have people around Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 22 to care for him. Please pass on our thanks to all staff…….you could not have done more.’ The AQAA returned to the service prior to the inspection stated that 65 of staff at this home are trained to at least NVQ Level 2 which exceeds the National Minimum Standard of at least 50 having this qualification. Recruitment arrangements were checked during the inspection and two staff files were sampled. Each contained an application form, written references, CRB and POVA checks, and details of induction and training. However, the Requirement at the last inspection regarding ensuring that all staff had a documented full employment history had not been fully met. This was discussed with the manager and there were mitigating factors which were taken into account, including the fact that most staff have been working at the home since before this Schedule (specifying a ‘full employment history’) came into force, and therefore this applies to very few staff at Herewards House. The manager undertook to get a full employment history for all staff within the next week and to follow up on any unexplained gaps. There is a staff training matrix in place which enables the manager to see at a glance which staff have done which training courses, and when refreshers are due. All staff have now done moving and handling training which was a Requirement from the last inspection. A Requirement had also been made to ensure there was a qualified first aider on duty at all times – this Requirement has been met as most staff now have this qualification. However, two further Requirements from the last inspection have not been fully met, namely ensuring all staff have had protection of vulnerable adults training, and those who deal with food should have food handling and hygiene training. A Requirement will be made to review all staff training to ensure all the mandatory courses are up to date for all staff. Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 23 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): 31,32,33,35 and 38 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Herewards House is well managed with staff, residents and relatives benefiting from the leadership and management approach of the current manager and owners. Residents benefit by the quality assurance measures in place at this home, and by the financial procedures for supporting them with budgeting. The health and safety of residents and staff is taken seriously at this home but residents would benefit by the manager reviewing current monitoring arrangements to ensure any health and safety shortfalls are identified and dealt with in a timely fashion. EVIDENCE: The manager has been in post at this home since 2004 but now works full time. He is a qualified nurse (RNMH) and has completed the Registered Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 24 Manager’s Award since the last inspection. The manager is also one of the registered owners of the home and is therefore in a good position to take responsibility within the home. There are clear lines of accountability within the home and with external management. The registered manager creates an open, positive and inclusive atmosphere within the home. Residents, relatives and staff all commented on this. Comments such as ‘The manager is very approachable.’, ‘Herewards House is first class.’, and ‘Staff get good support from the manager.’ were typical. As mentioned earlier, one resident said they would “Always be indebted to Jeet” (the manager), for the care and attention they had been given. The home continues to improve arrangements for looking at the quality of the service they provide. There are a number of ways in which the home gets feedback from residents and other stakeholders including regular meetings for residents and separate staff meetings, and sending questionnaires out. Some of these questionnaires were returned in April and were sampled during the inspection. The home scored mainly ‘good’ or ‘excellent’ on all areas from both residents and relatives. There are quality audits of the standard of care and the environment, and regular reviews of care plans. The manager keeps a minor complaints book which clearly documents any issues raised by residents and how the home has dealt with these. There is a plan for refurbishing the home, and an annual development plan in place. This was not available on the day of the inspection as the manager had been working on this at home but it was clear from the ongoing improvements that the service was being kept under review and changes being made. Several residents have support with their finances from the manager and staff, and small amounts of money for these resident’s are kept in the safe. The manager and key workers help residents with budgeting for example regarding their hairdressing, buying cigarettes and sweets, and one resident is being assisted to set up a new bank account so that he can go and get his own cash out. Staff do not manage any resident’s finances, and residents who cannot manage their own affairs have this done for them by relatives or advocates. There are a number of measures in place to ensure the health and safety of residents and staff at this home. Staff training has improved and now all staff have had moving and handling training. There is always at least one trained first aider on each shift, and all staff have done fire safety training. The home has employers liability insurance and the current certificate, together with their CSCI registration certificate, were displayed in the hallway. There are risk assessments in place and any hazards identified by these assessments have been dealt with, for example covers have been fitted to radiators, hoists and special showers have been fitted, and the hazardous substances used within the home were in a padlocked cupboard. The environmental health officer visited the home on the day before the inspection to check whether Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 25 requirements had been met from the previous inspection and found the home to be satisfactory, with no new requirements being made. However, a number of shortfalls were identified on the day of the inspection including: • Risk assessments to do with the premises appeared to be general and not very relevant to this home – they were not dated or signed • The risk assessment for the laundry did not cover the fact that the door was unlocked and there was washing powder and conditioner left out • There were liquids left out in the sluice and in the downstairs bathroom and these were immediately moved by staff • There was no written risk assessment for the step going down to the toilet on the ground floor which could be hazardous – a handrail had been fitted but the step was unexpected for visitors not familiar with the home The manager was asked to review arrangements for monitoring health and safety within the home and a Requirement will be made in this regard. Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 26 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 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 2 Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 27 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 OP30 Regulation 18(c )(i) Requirement Training arrangements must be reviewed to ensure that all staff have completed all the mandatory training courses as set out in the home’s training matrix. Arrangements for carrying out risk assessments must be reviewed to ensure these are completed for all identified areas of risk and are specific to this home. Risk assessments must be dated and signed and a date set for each to be reviewed. Health and safety monitoring arrangements must be reviewed to ensure that any shortfalls are identified and dealt with in a timely fashion – see page 25 of this report. Timescale for action 17/05/08 2. OP38 13(4)(a) (b)(c) 17/05/08 3. OP38 13(4)(a) (b)(c) 17/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 28 No. 1. Refer to Standard OP12 Good Practice Recommendations The manager was asked to think about and consult with residents on how he might promote the current range of activities and perhaps extend these to ensure all residents feel there are stimulating activities on offer. The manager should follow up with the member of staff who is not yet booked on Safeguarding Adults training to ensure they are fully conversant with the recently updated local safeguarding arrangements. The manager should check the CRB website for guidance regarding the correct storage and destruction of CRB certificates. 2. OP18 3. OP29 Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Herewards House DS0000060965.V362209.R01.S.doc Version 5.2 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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