Inspection on 22/05/07 for Hernes Nest House

This inspection was carried out on 22nd May 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 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

Hernes Nest House 21/12/05

Hernes Nest House 26/04/05

Hernes Nest House 28/10/04

Hernes Nest House 27/04/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hernes Nest House Hernes Nest Off Park Lane Bewdley Worcs DY12 2ET Lead Inspector Nic Andrews Key Unannounced Inspection 22 and 23 May 2007 09:45 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 Hernes Nest House DS0000018464.V338934.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. Hernes Nest House DS0000018464.V338934.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hernes Nest House Address Hernes Nest Off Park Lane Bewdley Worcs DY12 2ET 01299 402136 01299 403750 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) Community World Limited Mrs Stella Ann Gurney Care Home 21 Category(ies) of Dementia - over 65 years of age (21), Old age, registration, with number not falling within any other category (21), of places Physical disability over 65 years of age (21) Hernes Nest House DS0000018464.V338934.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home may accommodate a named person under the age of 65 years with a physical disability. 21st December 2005 Date of last inspection Brief Description of the Service: Hernes Nest House is a large, detached Georgian building located in a quiet residential area a short distance from Bewdley town centre. The premises occupy an elevated position with a pleasant rear garden and sitting areas that provide attractive views over the surrounding countryside. The registered provider is Community World Ltd. The managing director of the company is also the registered manager. The building has been adapted and extended for its present use and is registered as a residential care home for a maximum of 21 older people who are frail and unable to live independently. The service users may also have a physical disability and/or a dementia illness. Short-term placements can be provided in the form of respite care. The home and the rear gardens are accessible to people in wheelchairs. There are car-parking facilities at the front of the premises. The service users are accommodated on the ground and first floor of the premises in thirteen single and four double bedrooms. The home does not have a passenger lift. However, a stair lift has been installed to enable the service users accommodated on the first floor to have easier access to their bedrooms. The second floor of the premises is designated as an area solely for staff use. The purpose of the home is to provide a quality service by caring, competent and well-trained staff in a supportive environment where service users are enabled and encouraged to live a full, interesting and independent lifestyle as far as they are able. The fees ranged from £410.06 per week to £440.02 per week. Hernes Nest House DS0000018464.V338934.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place over the course of two days. The home was inspected against the key National Minimum Standards with the assistance of the registered manager and care supervisor. Various records and a number of policies and procedures that the home is required to maintain were inspected. Parts of the home were also inspected. The care of service users was case tracked. Individual discussions were held with three service users, a relative of one of the service users and two members of staff. What the service does well: What has improved since the last inspection? Hernes Nest House DS0000018464.V338934.R01.S.doc Version 5.2 Page 6 Since the previous inspection various improvements had been made. These included the introduction of Skills for Care knowledge sets for medication and dementia and new manual handling risk assessments. A review of the medication procedure had been carried out and a new policy on homely remedies had been implemented. Staff had been issued with health and safety handbooks and ‘Inspecting for Better Lives’ and ‘Putting Service Users First’ had been introduced. The Hernes Nest shop had been introduced. Various items had been purchased including a gazebo, pharmaceutical bin, new blinds for the conservatory, new bedroom furniture, curtains and a new DVD player. Two bedrooms had been redecorated. The staff had undertaken various training and some staff had been enrolled on NVQ training courses. 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. Hernes Nest House DS0000018464.V338934.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 Hernes Nest House DS0000018464.V338934.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are provided with the opportunity to visit the home prior to admission and are given relevant information about the service to enable them to make an informed choice. The service users’ needs are assessed and they are given a contract that contains the terms and conditions of their residency. EVIDENCE: A copy of the home’s statement of purpose was made available for inspection. The information in the statement of purpose was relevant and comprehensive. The copy that was made available for inspection also included additional information taken from the service users’ guide. The registered manager confirmed that the home provided two separate documents i.e. a statement of purpose and a service users’ guide. The registered manager also confirmed that all of the service users had been issued with a copy of the service users’ guide. The statement of purpose should include, as part of the associated emergency fire procedures, the arrangements made for the care and accommodation of the service users in the event of a temporary closure of the home. It should also include a reference to the registered manager’s NVQ level 4 qualification. The out of date reference to the National Care Standards Hernes Nest House DS0000018464.V338934.R01.S.doc Version 5.2 Page 9 Commission should be changed to the Commission for Social Care Inspection. The registered manager confirmed that a copy of the service users’ guide and the statement of purpose contained a complete copy of the most recent inspection report. It was also confirmed that a copy of the most recent inspection report was kept in the home available for perusal on request. The registered manager confirmed that all of the service users had been issued with a statement of their terms and conditions of residence (contract). A copy of the contract was held on the service users’ individual files. The contents of the contracts were satisfactory. The registered manager confirmed that all prospective service users were assessed prior to admission. The service users’ files contained copies of the completed assessment forms. Usually, the registered manager or the care supervisor carried out the assessments. The assessments were undertaken in the prospective service user’s own home or in hospital using a commercially produced assessment form. The assessment form contained a reference to all of the aspects of care referred to in Standard 3.3. The home had a satisfactory admission procedure. The registered manager recognised the importance of ensuring that prospective service users were given an opportunity to visit the home prior to admission. Pre-admission visits included the opportunity to meet the existing service users, to have a meal and to view the vacant room. The home had a four-week trial period that could be extended if necessary. A reference to the trial period was included in the service users’ contract. The registered manager confirmed that the home did not admit people in an emergency. Hernes Nest House DS0000018464.V338934.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The staff work closely with other professionals to ensure that the healthcare needs of the service users are met. The staff adhere to the home’s procedures for the safe administration of medication. The service users feel that they are treated with respect and that their right to privacy is upheld. Some improvements in the care planning were needed to ensure that all of the service users’ personal care needs are met. EVIDENCE: All of the service users had a care plan that was based on an assessment of their needs. The care plans were commercially produced and consisted of several pre-printed forms. The space for recording details of the care needs was limited. The care plans did not include a specific reference to some of the aspects of care referred to in Standard 3.3 including social interests, hobbies, religious and cultural needs and carer and family involvement. The care plans were supplemented by additional information including key worker entries, doctor’s notes, risk assessments, personal cleansing, elimination and daily recordings. However, the recordings made in the care plans regarding the interventions by staff needed to state in greater detail the action to be taken to ensure that all aspects of the service users’ needs were met. Hernes Nest House DS0000018464.V338934.R01.S.doc Version 5.2 Page 11 It was confirmed that all of the service users were registered with a local GP. There was evidence to show that the service users were also receiving support from other healthcare professionals including the district nurse, chiropodist and psychiatrist. None of the service users had any pressure sores. However, the home had pressure relieving mattresses and cushions. The registered manager stated that the district nurse provided any additional pressure relieving equipment that was required. Nutritional screening is carried out in respect of each new service user commencing with a discussion about dietary needs and preferences. However, no formal nutritional assessment tool is used at the present time. The registered manager confirmed that the service users’ weight was recorded each month and that food and fluid intake charts were maintained when necessary. The home had made suitable arrangements to ensure that the service users’ received appropriate dental and ophthalmic care. The service users also received treatment at the local auditory clinic as and when necessary. Risk assessments had been carried out on the use of bedrails used by three service users. The registered manager confirmed that the home’s medication policy and procedures were based on the guidelines produced by the Royal Pharmaceutical Society of Great Britain and other relevant documents. The policy was dated 9 August 2006 and was signed by the registered manager. The policies included a homely remedies policy for residential homes. The home used the Boots monitored dosage system. The staff enjoyed a positive relationship with the local pharmacist who had visited the home three times during 2006. The last visit was on 8 November 2006. The medicine was kept in a lockable trolley in a lockable store (medical room) with restricted access. The Medication Administration Record (MAR) charts were inspected and these had been completed correctly. Two members of staff had signed the MAR charts when the details of the medication were being written on to the MAR charts by hand. The date of opening was recorded on the outside of the medicine packets. The home had a controlled drug cabinet that complied with the Misuse of Drugs (Safe Custody) Regulations 1973. The controlled drug register was up to date and correctly maintained. There was an appropriate system for recording the receipt and return of medication. The home had a dedicated fridge in which medicines that required cold storage were kept. A daily record was maintained of the temperature of the fridge. The registered manager stated that all the staff had undertaken the Skills for Care medication training and some staff had undertaken intermediate training with Warwick University. The registered manager also stated that some staff were due to undertake accredited distance learning training with Solihull College and other staff were due to undertake accredited training in July 2007. All the staff that are involved in the administration of medication should undertake such accredited training. The staff with whom discussions were held understood the importance of upholding the service users’ privacy and dignity. The responses that were Hernes Nest House DS0000018464.V338934.R01.S.doc Version 5.2 Page 12 given to the questions they were asked about personal care giving reflected good practice. It was confirmed that examinations and treatment provided by visiting professionals were carried out in private. The service users were able to make and receive telephone calls in private by use of a mobile ‘phone. Two service users had their own telephones. Mail was given to service users unopened. The service users wore their own clothes and their clothes were appropriately labelled. The staff received instruction during their induction on how to treat the service users with respect. Curtain screening was provided in the four double bedrooms. The service users with whom discussions were held confirmed that they were treated with respect and that their right to privacy was maintained. Hernes Nest House DS0000018464.V338934.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The service users are helped and encouraged to lead active and interesting lives. They are also enabled to maintain contact with their relatives and friends and their links with the wider community. The home offers a balanced and nutritious diet. EVIDENCE: The home employed an activities coordinator who worked in the home five mornings a week Monday to Friday. There was a planned programme of social and leisure activities that covered a wide range of individual and group topics. A record of the activities in which each service user had been involved was maintained including a monthly pie chart indicating the level of participation by the service users. The activities included leisure pursuits and religious observance. Service user meetings were held each month and information about activities and special events was reported in a monthly newsletter. The service users with whom discussions were held spoke positively about the range of activities that were available. One service users said, ‘There’s plenty to do if you so desire. The manager doesn’t coerce people. She let’s people try things out and show some individuality’. The same service user expressed her pleasure with the supply of books provided by the home and with the visits to the garden centre. Hernes Nest House DS0000018464.V338934.R01.S.doc Version 5.2 Page 14 There were no unreasonable or unnecessary restrictions on the visiting arrangements. The service users with whom discussions were held confirmed that that they were able to receive their visitors in private and that their visitors were always made welcome and offered a cup of tea. A relative of one of the service users also confirmed that she was always made welcome. A choral group and a group of Brownies visited the home twice a year. Three volunteers visited the home once a month to talk to the service users. The registered manager confirmed that the volunteers had undergone a thorough selection process. It was confirmed that the service users enjoyed and benefited from the contact they had with all of the visitors. The service users with whom discussions were held confirmed that they were enabled to exercise choice and were encouraged to be involved in decisions affecting their care. They were consulted about the food they ate, the clothes they wore, the activities in which they were involved, their accommodation and their personal care. The service users that were able to take part in their care planning were encouraged to do so. The service users’ bedrooms had been personalised. The registered manager said that the service users had participated in ‘Having your say’. The home held information about the local advocacy service and the registered manager stated that the help of advocates had been enlisted in the past. The home operated a weekly menu. The menus were changed frequently. The record of the food provided showed that the service users received a balanced and nutritious diet. A record was kept of the service users’ dietary needs and preferences. Mealtimes were appropriately spaced throughout the day. Birthdays and other occasions were celebrated with special meals. One main meal was served at lunchtime and an alternative meal was provided if any of the service users did not like the meal that was offered. The cook said that she consulted the service users twice a week about the food and made changes to the menu as necessary. The service users with whom discussions were held spoke positively about the food. One service user said, ‘The food is excellent and always presented well’. Another service user described the food as ‘good’. Another service user said, ‘The food is very good up to a point. There are things that I don’t like but there’s always a choice to have something else and there’s always enough. We can always have a drink or snack at any time of the day’. The home had embarked on the ‘Safer Food Batter Business’ programme. The kitchen was clean and well equipped and the cook confirmed that all of the equipment was in satisfactory working order. Food was labelled and records of the temperature of the cooked food, fridge and freezers were maintained. Hernes Nest House DS0000018464.V338934.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The home has a clear complaints procedure and other relevant policies and procedures to help ensure that the service users are protected from abuse. The staff receive instruction about the protection of service users from abuse and the service users feel confident about making a complaint. EVIDENCE: The home had a clear complaints procedure. A copy of the complaints procedure was included in the information pack that was issued to service users at the point of admission. A record was maintained of the complaints that had been made against the home. Since the previous inspection three separate complaints had been received by the home in respect of one service user. The complaints had been investigated by the home and responded to appropriately. No other complaints against the home had been received by the CSCI. The home maintained a folder in which numerous cards and letters were kept from the relatives of former service users. These were expressions of thanks and appreciation for the help and kindness that had been shown by the manager and staff. The service users with whom discussions were held felt confident about making a complaint. They also felt that any complaint would be dealt with quickly and appropriately. One service user said, ‘If you want to make a comment you’ll be listened to and not ignored. You get the feeling that things are done for the benefit of the residents. The staff fall over backwards for you’. The home had a policy and procedure for the protection of vulnerable adults from abuse and a ‘whistle blowing’ procedure. These had been obtained from Hernes Nest House DS0000018464.V338934.R01.S.doc Version 5.2 Page 16 the National Care Homes Association and included a reference to the main issues that needed to be included in such documents. However, the documents were not regarded as ‘user friendly’ and had not been adapted to reflect the particular circumstances of the home. The care supervisor stated that the policies and procedures for the protection of vulnerable adults from abuse were in the process of being updated. As part of this process the out of date reference to the National Care Standards Commission should be replaced with a correct reference to the Commission for Social Care Inspection (CSCI). The policy and procedure should also state clearly that all suspected or alleged incidents of abuse should be referred to the CSCI without delay in accordance with Regulation 37. The documents should also include the name and telephone number of the Adult Protection Coordinator. The home had a copy of the Department of Health guidance ‘No Secrets’. It was confirmed that, as part of their induction, the staff were instructed about the home’s procedures and were issued with a copy of the leaflet ‘Adult Abuse’ produced by the Worcestershire Vulnerable Adults Protection Committee. The home also had policies on ‘Management of Aggressive Behaviour’, ‘Putting Service Users First’ and ‘Gifts, Wills and Bequests’. The staff were required to confirm in writing that they had read and understood the policies and procedures and these records were kept in their individual staff development files. All the staff had undertaken the home’s ‘in-house’ training on abuse as part of their induction. Some staff had also undertaken training in abuse awareness provided by an external training organisation in February 2004 and March 2007. However, eight members of staff had not undertaken the formal external training on the protection of vulnerable adults from abuse. It was confirmed that no suspected or alleged incidents of abuse had occurred within the home or had been reported since the previous inspection. The registered manager had had no reason to refer the names of any of the staff for possible inclusion on the POVA register. Hernes Nest House DS0000018464.V338934.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The service users live in a clean, comfortable and well-maintained environment. EVIDENCE: The premises, including the rear garden, were accessible to people in wheelchairs. There was a permanent ramp at the side of the premises and a portable ramp was available for use at the main front entrance. A bell had been provided at the front of the premises to enable people in wheelchairs to alert staff and gain access. The service users were accommodated on the ground and first floor in thirteen single bedrooms and four double bedrooms. Keys to bedroom doors had been provided to the service users that had expressed a wish to have one. There was no passenger lift. However, a stair lift had been installed to enable the service users to access the accommodation on the first floor more easily. The communal areas included a dining room, two attractive lounges and a sun lounge (conservatory). A staff training room and staff offices were located on the second floor. The home was well maintained and decorated to a satisfactory standard. The service users bedrooms were personalised and homely. The home had a programme of Hernes Nest House DS0000018464.V338934.R01.S.doc Version 5.2 Page 18 routine maintenance and renewal of the fabric and decoration of the premises. However, there were no handrails on some parts of the walls in the corridor on the ground floor and a paper towel dispenser had not been installed in all of the communal toilets. The gardens were maintained to a satisfactory standard and provided attractive sitting areas with pleasant views of the surrounding countryside. A gardener was employed for 25 hours per week to help maintain the gardens. Consideration was being given to the provision of a workshop, potting area and a quiet room in the cellar. The Environmental Health Officer had carried out an inspection of the home on 30 October 2006. The registered manager confirmed that the two issues identified for action as a result of the visit had been addressed. The Fire Safety Officer had not visited the home since 3 November 2003. However, the registered manager said that there were no outstanding fire safety issues. The premises were clean and tidy and there were no unpleasant odours. The home operated a ‘no smoking’ policy. The staff that smoked were required to smoke outside the premises. The laundry was appropriately sited and equipped. There were two washing machines and a tumble dryer. The washing machines had a sluicing facility. The laundry also had a wash hand facility. The floor finishes were impermeable and these and the wall finishes were readily cleanable. The staff cleaned manually the commode pots that were used. The home did not have appropriate facilities to carry out this task and manual cleaning is not the recommended method of decontamination. Disposable commode pots should be used. The home had a commercially produced infection control policy that had been obtained in August 2006. The policy should be reviewed in accordance with the Infection Control Guidance for Care Homes (dated June 2006) produced by the Department of Health and the Guidelines for Infection Control in Care Homes (dated 2003) produced by the Herefordshire and Worcestershire Local Health Protection Unit. The registered manager, care supervisor and a designated member of staff had special responsibilities for infection control and other health and safety issues within the home. It was pleasing to note that all the staff had been issued with an ‘Employee Safety Handbook’. The service users with whom discussions were held confirmed that their bedrooms were always kept clean. They also expressed their satisfaction with the standard of laundering of their clothes. Hernes Nest House DS0000018464.V338934.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The staffing levels and the arrangements for staff training are sufficient to meet the needs of the service users. The staff are supported and enabled to understand their roles and responsibilities and the staff recruitment procedures help to ensure that the service users are protected from abuse. EVIDENCE: A copy of the staff duty rota and details of the staffing arrangements were made available for inspection. These indicated that the staffing levels and deployment of staff were sufficient to meet the needs of the service users. The staffing establishment included the registered manager, care supervisor, three senior care assistants, three lead carers, nine care assistants (days), activities coordinator, cook, assistant cook, kitchen assistants, domestic staff, housekeeper and gardener/handyman. Administrative staff were also employed to support the work of the home. It was confirmed that there were always two care staff on waking duty at night. The service users with whom discussions were held spoke positively about the staff. Two service users described the staff as ‘very good’. One service user said, ‘If there’s anything they can do for you, they’ll do it. There’s nothing I can fault here’. Another service user said, ‘The staff are very friendly and very kind. They do what they can for you as far as they can. The staff are approachable. You never see people in tears or if you did you’d see someone going up to them and asking them if they were alright’. The relative of one service user with whom a discussion was held expressed her satisfaction with the standard of care provided and described it as ‘phenomenal’. She said that she was kept Hernes Nest House DS0000018464.V338934.R01.S.doc Version 5.2 Page 20 informed of any changes and that her mother’s appetite had improved since being admitted to the home. She said that there was ‘good personal and emotional care’. She felt that her mother was ‘better than she’s been for years’. The home employed a sufficient number of care staff who had completed the NVQ level 2 training to meet the minimum ratio of 50 trained members of staff required by the National Minimum Standards. It was pleasing to note that the NVQ training was ongoing and that four members of staff had completed the NVQ level 3 training. The care supervisor was also undertaking the Registered Managers’ Award training. The staff files that were inspected contained relevant information including a photograph and proof of the person’s identity. There was also evidence to show that two written references, a POVAfirst check and a disclosure check from the CRB were obtained in respect of the staff prior to their appointment. It was also confirmed that staff were issued with a statement of their terms and conditions of employment (contract) and a copy of the code of conduct and practice set by the General Social Care Council. The home provided a staff induction programme based on ‘Skill for Care’ training material. New staff were also issued with relevant information that included staff handbooks and leaflets on the protection of vulnerable adults from abuse. The induction training covered six main areas including understanding the principles of care, understanding the organisation, maintaining safety at work, communicating effectively, recognising and responding to abuse and neglect and developing as a worker. The registered manager confirmed that three members of staff were currently undergoing the induction training. Hernes Nest House DS0000018464.V338934.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 The quality outcome in this area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well managed and there is a positive and open approach to the management of the service. The quality assurance systems help to ensure that the home is safe, the standard of care is monitored and that the service continues to develop in response to the service users’ needs. EVIDENCE: The registered manager was competent and had relevant experience. She had been the registered manager of the home for nine years. She had a background in registered general nursing and had also completed the NVQ level 4 training and Registered Managers’ Award training in 2002. She had also undertaken more recent relevant training. This training included accredited training in the administration of medication in December 2004, first aid at work in January 2006, a management course at Worcester on ‘Managing Staff Effectively’ in June 2006 and the protection of vulnerable adults from abuse in March 2007. The registered manager was a manual handling trainer Hernes Nest House DS0000018464.V338934.R01.S.doc Version 5.2 Page 22 and she had also completed a distance-learning course on equality and diversity at Solihull College. The registered manager displayed an open and transparent approach in her management of the home. She was service user focussed and supported a strong staff team who were committed to their work and cooperative and helpful during the inspection. The registered manager recognised the importance of individualised care and to ensuring that the service users made the best of what they were able to achieve. One service user said, ‘She’s a cheerful person and that makes a big difference’. The care supervisor had undertaken nurse training in the past. She was an NVQ assessor and was undertaking the Registered Managers’ Award training. The three senior care assistants had completed the NVQ level 2 training and one of the senior care staff had also completed the NVQ level 3 training. The home had been using three quality assurance systems including a commercially produced quality assurance system, the Cared 4 Quality Management System and another system produced by the National Care Homes Association (NCHA). The registered manager said that the home had been using the NCHA quality assurance system for the past four years. Monthly internal audits were carried out that covered all of the National Minimum Standards. The home’s policies and procedures were reviewed as part of the quality assurance system. The registered manager produced an annual report on the quality of the service provided by the home based on the outcomes of the quality assurance systems. The contents of the report were shared with the staff, the service users and their relatives. The registered manager confirmed that the quality assurance systems that were currently used by the home would be amalgamated into one comprehensive system by the end of June 2007. It was also intended that staff would become more involved in the process of monitoring the quality of the service and that surveys would be used involving staff, service users and visitors. Each month a questionnaire was issued to visitors and also to a different service user. Questionnaires had not been issued to any visiting professionals. The registered manager confirmed that no one connected with the running of the home acted as an agent or as an appointee on behalf of any of the service users. Money was held in safekeeping by the home on behalf of seven service users. Individual accounts were maintained in respect of each service user and the money was kept in individual packets in a safe. The money and accounts were checked at random and these were correct. The registered manager checked the records every month. The home held valuable possessions on behalf of six service users. Appropriate records and property indemnity return forms were maintained. The registered manager provided moving and handling training annually for all the staff. Fire safety training is provided as part of the staff induction programme and is then provided annually using a video. First aid training was provided in January and March 2006 and in February 2007. However, four members of staff did not have a valid three-year certificate. All of the senior Hernes Nest House DS0000018464.V338934.R01.S.doc Version 5.2 Page 23 staff and the majority of the care staff had undertaken food hygiene training. Food hygiene training was provided as part of the staff induction. However, four members of staff had not completed the training. Infection control training was also covered during staff induction and arrangements had been made for staff to receive formal training in August 2007. Training in the care of people with dementia was provided and further training was due to take place on 14 June 2007. However, the staff-training matrix was not up to date and was not made available for inspection. A risk assessment on fire safety had been carried out in April 2006 and was currently being updated. The home had COSHH data sheets and risk assessments. However, a risk assessment had not been carried out on the security of the premises. The records of the tests carried out on all of the home’s fire safety installations and equipment were up to date. Similarly, the records of the tests and servicing certificates in respect of boilers, gas equipment, PAT testing, water samples, the stair lift, bath hoist, Arjo bath and the home’s electrical safety were valid and/or within the specified period. The registered manager confirmed that thermostatically controlled mixer valves had been fitted to all hot water outlets used by service users. It was also confirmed that opening restrictors had been fitted to all of the windows. A requirement was made as a result of the previous inspection that notification must be made to the Commission of the occurrence of all accidents, injuries, illness and incidents in accordance with Regulation 37 and Standard 38. The requirement had been implemented. The incidents that may arise which would necessitate the CSCI being notified were discussed with the registered manager and advice was given. Hernes Nest House DS0000018464.V338934.R01.S.doc Version 5.2 Page 24 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 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 2 Hernes Nest House DS0000018464.V338934.R01.S.doc Version 5.2 Page 25 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 OP19 Regulation 13 (4) Requirement Timescale for action 30/06/07 2 OP19 13 (3) Risk assessments must be carried out regarding the provision of handrails in all of the corridors and any necessary action taken to ensure the safety of the service users. Risk assessments must be 30/06/07 carried out regarding the handdrying facilities in all of the communal toilets and bathrooms and any necessary action taken to reduce the risk of cross infection. 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 Refer to Standard OP1 OP7 Good Practice Recommendations The statement of purpose and service users’ guide should be amended in accordance with the guidance given in this report. The care plans should set out in detail the action that DS0000018464.V338934.R01.S.doc Version 5.2 Page 26 Hernes Nest House 3 4 5 6 7 8 OP8 OP18 OP18 OP26 OP26 OP33 9 10 11 OP38 OP38 OP38 needs to be taken by the staff to ensure that all aspects of the service users’ needs are met. (Refer to Standards 7.2 and 3.3 for guidance). Nutritional screening should be undertaken on admission and subsequently on a periodic basis using a recognised monitoring form. The home’s policy and procedure for the protection of vulnerable adults from abuse should be amended in accordance with the guidance given in this report. All staff should undertake formal, external training on the protection of vulnerable adults from abuse. Disposable commode pots should be used. The policy and procedure on the control of infection should be reviewed in accordance with relevant guidance. The home should provide one comprehensive quality assurance system that includes feedback from staff, service users and their family and friends and the views of stakeholders in the community (e.g. GPs and other visiting professionals), should be sought on how the home is achieving goals for service users. All the staff that are involved in food preparation should receive training in food hygiene. The staff training records should be kept up to date. All of the home’s risk assessments should be reviewed in order to ensure that they cover all the safe working practice topics referred to in Standards 38 2 and 38.3. Hernes Nest House DS0000018464.V338934.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Hernes Nest House DS0000018464.V338934.R01.S.doc Version 5.2 Page 28 - 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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