CARE HOMES FOR OLDER PEOPLE
Highview Residential Home 42 Foxholes Road Southbourne Bournemouth Dorset BH6 3AT Lead Inspector
Marjorie Richards Key Unannounced Inspection 8th August 2006 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 DS0000064372.V304576.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. DS0000064372.V304576.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Highview Residential Home Address 42 Foxholes Road Southbourne Bournemouth Dorset BH6 3AT 01202 428799 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) rhodescarehomeltd@aol.com Rhodes Care Home Ltd Mrs Clair Maxine Rhodes Care Home 10 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (10) DS0000064372.V304576.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. One named person (as known to CSCI) under the age of 65 may be accommodated to receive care. Mrs Rhodes must obtain an NVQ level 4 in management and care by January 2007 and evidence of successful completion must be forwarded to the Commission for Social Care Inspection. 1st December 2005 Date of last inspection Brief Description of the Service: Highview Residential Home is a care home registered to provide personal care for 10 older people who have dementia or a mental disorder. Two beds are booked by Bournemouth Borough Council social services directorate for the provision of short-term and respite care. The home is situated in a quiet residential road, half a mile from local shops, the cliff top and coastal walks and approximately one mile from the main centre of Southbourne. Southbourne offers a number of amenities, such as post office, shops, a park and bowling greens, places of worship, GP surgeries and a library. There is limited off-road car parking available at the front of the home, with further parking on the road outside. Buses are available nearby, running to and from Southbourne, Bournemouth, Christchurch and beyond. Highview is a large detached house that has been converted for use as a care home. Residents are accommodated in ten single bedrooms on the ground and first floors, with two rooms having ensuite facilities. The home has sufficient communal bathroom/shower/WC provision to meet the needs of residents. The ground floor lounge and separate dining room are situated to the rear of the home, with the lounge having patio doors to the rear garden. There is also a spacious porch area where some residents like to sit and watch the comings and goings. The accommodation is comfortable and homely. The area at the front of the home is used mainly to provide car-parking facilities. The small rear garden is laid mainly to lawn with a paved patio area, with surrounding shrubs and tree. 24-hour personal care is provided. Laundering of personal clothing etc is carried out on the premises. All meals are prepared and cooked within the home. Although a choice of menu is not offered for the lunchtime meal, a variety of alternatives are available to suit individual taste and preference. DS0000064372.V304576.R01.S.doc Version 5.2 Page 5 An activities programme is being developed to provide stimulation and interest for residents. The current fees are as follows: £461 per week for all permanent residents. £470 per week for all respite/short term care residents. Rhodes Care Home Ltd also owns two other care homes in Dorset. DS0000064372.V304576.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 8 hours on the 8th August 2006. The purpose of this year’s first key unannounced inspection was to review all of the key National Minimum Standards, review progress in meeting the requirement and recommendations that had been made at the previous inspection and to ensure that the residents living at Highview Residential Home were safe and properly cared for. A tour of the premises took place and records and related documentation were examined, including the care records for three residents. Time was spent observing the interaction between residents and staff, as well as talking with eight residents. The daily routine was also observed during the inspection. Discussion also took place with Mrs Claire Rhodes, the registered manager, Mr Rhodes, on behalf of Rhodes Care Home Ltd., and all members of staff on duty. The Inspector was made to feel welcome in the home throughout the visit. What the service does well:
Mr or Mrs Rhodes always assess any residents coming to stay permanently in the home, even where they have sight of a Local Authority care plan. Confirmation of the outcome of such assessments is given in writing, so prospective residents are fully assured that their care needs will be met. Records demonstrate that residents have access to health care services, with evidence of visiting health professionals e.g. GPs, district nurses, community psychiatric nurses, chiropodists, etc as necessary. This was also confirmed in discussion with residents and staff. The arrangements for storing and handling medicines in the home ensure residents’ safety. All bedrooms at Highview Residential Home are for single occupancy, giving residents opportunities for privacy if they wish. Staff were seen to knock at bedroom doors and to deliver personal care discreetly. Staff interacted with residents in a friendly and caring manner. Staff were seen throughout the inspection to be treating residents with courtesy, kindness and respect. Residents commented, It is nice here, the people are good to me. It is alright here and I am alright too.” DS0000064372.V304576.R01.S.doc Version 5.2 Page 7 Residents are encouraged to maintain contact with family, friends and the wider community and to choose their own lifestyle within the home, where their individual preferences and routines are respected. They are able to bring their own possessions into the home to personalise their bedrooms. The menu shows that residents enjoy a healthy, well-balanced diet. Fresh fruit and vegetables are used wherever possible. Some residents prefer easily managed finger foods, such as sandwiches, crisps, prepared fresh fruit, sausage rolls, fish fingers and chips and these were offered during the day and for the evening meal. Residents commented, The dinner was my favourite, I enjoyed it. I like the food most of the time. A system is in place for dealing with any complaints. Residents are confident that complaints would be listened to and dealt with appropriately. The home has an Adult Protection policy and procedure in place and staff have received Adult Protection training to ensure a proper response to any suspicion or allegation of abuse. Highview Residential Home provides a well-maintained and comfortable environment for residents. Both the lounge and dining room are homely and comfortable rooms. There is also a small garden to the rear of the property, which can be accessed through patio doors from the lounge. Patio tables and chairs are available and one resident said, “I sit in the garden when it is warm and sunny. I had tea outside the other day.” Bedrooms are comfortably furnished and individually personalised to suit their occupants. Clothing in wardrobes and drawers is clean and neatly stored. Residents commented, “I have a very nice room.” “I can stay in my room as much as I like. The home employs sufficient staff to meet the needs of residents and to ensure their safety and comfort. Residents are assured of sound management of their financial interests. What has improved since the last inspection?
A new exterior storage area has been created to accommodate freezers and to provide storage for wheelchairs and equipment when not in use. Since the last inspection, a covered patio area has been laid. New garden furniture and a barbecue have been purchased, creating a pleasant area for residents to sit outside whenever they wish. New flooring has been laid in the first floor bathroom. In bedrooms, new headboards, bedcovers, bedding and towels have been provided. Four of the nine requirements from the last inspection report have been met.
DS0000064372.V304576.R01.S.doc Version 5.2 Page 8 What they could do better:
Some of the care plans make general statements, for example, “Needs stimulation” or “Needs assistance with eating,” without being very specific about the interventions needed from staff. Care must be taken to ensure that significant information is always transferred to the care plan. At the last inspection, it was required that care plans be agreed and signed by the resident or their representative wherever possible, but this has not yet been achieved. At present, care plans contain only limited information about residents background, social history, previous hobbies and interests etc. This was highlighted at the last inspection and Mrs Rhodes says she is still gathering information to create life histories. The home is clean but there is an unpleasant smell in one bedroom. Mrs Rhodes is currently considering appropriate action to deal with this. An infection control policy is in place but not all staff have yet received infection control training. The home has a recruitment procedure in place, based on equal opportunities. Two staff files were examined. One of these revealed serious gaps in the recruitment process and the documentation obtained. For example, there was no reference from the last employer and only one reference on file, instead of the two written references required. This matter is of particular concern as issues around recruitment were identified during the last inspection. Mrs Rhodes said she was now implementing the Skills for Care induction programme for all new staff. However, this could only be evidenced in one of the staff files examined. There was no induction training record for the most recent employee. Individual staff files demonstrate there are shortfalls in the completion of mandatory training in the home, for example first aid, moving and handling, infection control, health and safety and food hygiene. At the last inspection it was identified that staff needed to receive training appropriate to the work they are to perform, for example dealing with dementia, mental disorders and challenging behaviour. Four staff had received dementia awareness training and Mrs Rhodes said further training was being arranged. Mrs Rhodes now says a total of five staff have completed dementia awareness training and the staff on duty confirmed this. At the last inspection it was recommended that an audit of training be carried out to ensure that all staff received the training they needed for the work they had to do and that this was updated wherever necessary. Where training needs were identified, arrangements should be made to meet these needs as soon as possible. This has not yet been achieved. Progress must now be
DS0000064372.V304576.R01.S.doc Version 5.2 Page 9 made on the implementation of a structured staff training and development programme, which ensures that all staff receive the training they need for their work. Copies of all training certificates should be retained to provide evidence that staff receive a minimum of three paid days training per year. The registered manager demonstrated a good knowledge of the operation of the service and the needs of its residents. However, Mrs Rhodes must demonstrate more effective management skills, for example in meeting the requirements of the last inspection, and ensuring the safety of residents. One of the conditions of registration for Highview Residential Home is that Mrs Rhodes must obtain an NVQ level 4 in management and care by January 2007. Mrs Rhodes admits that she has made little progress towards meeting this condition to date but hopes to make more time available in the near future. Five requirements and three recommendations from the last inspection report have still not been met. The home has commenced reviews of its performance to ensure Highview Residential Home is run in the best interests of residents, but has had little response so far. The home should now consider a more pro-active approach with regard to quality assurance. Care staff should receive formal supervision at least six times a year, as a means of ensuring good practice, emphasising the philosophy of care within the home and looking at individual career development needs etc. Not all staff are currently being supervised. Where formal supervision is taking place, this is not always at the recommended intervals. The home works to ensure the health, safety and welfare of residents. However failure to evidence that staff fire training and fire drills are taking place at the appropriate intervals, has the potential to place vulnerable residents at risk in the event of fire. 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. DS0000064372.V304576.R01.S.doc Version 5.2 Page 10 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 DS0000064372.V304576.R01.S.doc Version 5.2 Page 11 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standard 6 is not applicable to Highview Residential Home Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Highview Residential Home. Pre-admission assessments are carried out so residents are assured their care needs can be met. EVIDENCE: Individual care records are kept for each resident and three of these were examined. All showed that, prior to moving to the home, care needs had been assessed; some by care managers from the Local Authority who then provided care plans to the home, and also by Mr or Mrs Rhodes. Mr or Mrs Rhodes say they always assess any residents coming to stay permanently in the home, even where they have received a Local Authority care plan. (Care must be taken to ensure that such assessments are always signed and dated.) Mr and Mrs Rhodes then confirm the outcome of such assessments in writing, so prospective residents are fully assured that their care needs will be met.
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The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Highview Residential Home. Highview Residential Home has a comprehensive care planning system in place. However, this does not always ensure that staff have access to all the information they need to meet the care needs of residents. There is still little information available about social care needs so it is difficult to assess if these are being fully met. Health needs are well met, with evidence of good support from community health professionals. The arrangements for storing and handling medicines in the home ensure residents’ safety. Residents are treated respectfully and care is offered in a way that protects their right to privacy and dignity. DS0000064372.V304576.R01.S.doc Version 5.2 Page 13 EVIDENCE: All three of the care plans examined were based upon information provided prior to admission by care managers from the Local Authority and from preadmission assessments undertaken by Mr or Mrs Rhodes. The home then draws up its own care plan identifying the needs of each resident and how staff are to meet these needs. Some of the care plans make general statements, for example, “Needs stimulation” or “Needs assistance with eating,” without being very specific about the interventions needed from staff. One preadmission assessment identified seven specific foods, which the resident disliked but this information had not been transferred to the care plan. Discussions with staff demonstrated that they had knowledge of residents’ individual care needs. Care plans are regularly reviewed at least monthly and updated as necessary to reflect any changing needs. Good daily records are written by both day and night staff to evidence the care being provided. At the last inspection it was required that care plans be agreed and signed by the resident or their representative wherever possible. Mrs Rhodes said that she did discuss the care plans with residents and/or relatives but did not ask them to sign. This requirement is therefore repeated at the end of this report. It was also recommended that more information be recorded about social care needs. Mrs Rhodes said that life histories had been completed for each resident, but these could not be evidenced on the files examined. Mrs Rhodes later explained that work has been commenced, but was not yet in place for all residents. (See also Standard 12.) Records demonstrate that residents have access to health care services. There was evidence of visiting health professionals e.g. GPs, district nurses, community psychiatric nurses, chiropodists, etc as necessary. This was also confirmed in discussion with residents and staff. The home has systems in place for managing medicines. Observation of the staff administering medication and examination of the records indicate that medicines are given as prescribed, to ensure the protection of residents. All bedrooms at Highview Residential Home are for single occupancy, giving residents opportunities for privacy if they wish. Staff were seen to knock at bedroom doors and to offer personal care discreetly. Staff interacted with residents in a friendly and caring manner. It was clear from the time spent with residents that they felt comfortable and at ease with staff and appreciated their gentle approach. Staff were seen throughout the inspection to be treating service users with courtesy, kindness and respect. Residents commented, It is nice here, the people are good to me.
DS0000064372.V304576.R01.S.doc Version 5.2 Page 14 It is alright here and I am alright too.” DS0000064372.V304576.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Highview Residential Home. The information recorded about individual resident’s social, cultural, religious and recreational needs is still limited, making it difficult to assess if their needs and expectations are fully met. Residents are encouraged to maintain contact with family, friends and the wider community and to choose their own lifestyle within the home, where their individual preferences and routines are respected. Highview Residential Home serves a balanced and varied selection of food that meets residents’ tastes and dietary needs within pleasant surroundings. EVIDENCE: Activities available at Highview Residential Home include board games and puzzles, manicures, a weekly exercise to music session and regular monthly entertainment. Occasional activities, such as cooking and knitting are also arranged. Some reminiscence materials are available and daily newspapers are provided.
DS0000064372.V304576.R01.S.doc Version 5.2 Page 16 At present, care plans contain only limited information about residents background, social history, previous hobbies and interests etc. This was highlighted at the last inspection and Mrs Rhodes says she is still gathering information to create life histories. However, delays had been caused in some cases where it was difficult to obtain information from residents themselves. Staff are now making contact with relatives to see if they can assist. Completion of this information will help to ensure that the activities on offer at Highview will be person centred, meeting the individual needs, preferences and expectations of residents. It is hoped to see this in action at the next inspection. Although there is no religious service available in the home, arrangements can be made for clergy to visit individual residents on request. Residents and staff confirm that visiting times at Highview are unrestricted. Relatives are encouraged to participate in the care process if they so wish. Residents records and the visitors book demonstrate contact with family and friends as well as visits by professionals. Some residents are able to go out of the home with their visitors or with staff. Mrs Rhodes says she tries to ensure occasional car trips are arranged to local places of interest for a couple of residents at a time. A telephone is always available to residents. As far as possible, residents are encouraged to choose their own lifestyle within the home and make choices about how they wish to live. One resident confirmed that the decision to spend most of the time in their bedroom was respected by staff. Staff confirmed that another resident sometimes refuses cereals and/or toast and marmalade and requests cheese on toast for breakfast, so this is provided. Residents are able to bring their own possessions into the home to personalise their bedrooms. Lunch on the day of inspection was chicken curry with rice. One resident chose to have scrambled eggs on toast. This was followed by fruit flan with evaporated milk. The cook has information available about individual likes/dislikes and alternatives are always provided to suit individual taste and preference. Mealtimes can be flexible to fit in with care needs, appointments etc. The menu shows that residents enjoy a healthy, well-balanced diet. Fresh fruit and vegetables are used wherever possible. Some residents prefer easily managed finger foods, such as sandwiches, crisps, prepared fresh fruit, sausage rolls, fish fingers and chips and these were offered during the day and for the evening meal. Mrs Rhodes says night staff also ensure that snacks and drinks are available whenever needed or requested. Residents commented, The dinner was my favourite, I enjoyed it. I like the food most of the time. I liked the dinner. I don’t know what it was, but it tasted very nice. DS0000064372.V304576.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Highview Residential Home. A system is in place for dealing with any complaints. Residents appear confident that complaints would be listened to and dealt with appropriately. The home has an Adult Protection policy and procedure in place and staff have received Adult Protection training to ensure a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a complaints procedure and this is displayed in the entrance area and is also available in the Service Users Guide. All residents and/or their relative are given a copy of the Service Users Guide on admission to the home. A complaints record is maintained. Since the last inspection, one complaint has been received which is currently being investigated. Some residents were not able to comment about the complaints procedure, but others commented, If I want something, I ask the staff. If I was upset or worried they would sort it out, they always do. If something was wrong, I would tell the lady over there, (indicating Mrs Rhodes.) She is very nice to me. DS0000064372.V304576.R01.S.doc Version 5.2 Page 18 Highview Residential Home has an Adult Protection policy in place. Mrs Rhodes says that, since the last inspection, all staff have received Adult Protection training to ensure a proper response to any suspicion or allegation of abuse. The staff on duty confirmed that they had received training in the Protection Of Vulnerable Adults. DS0000064372.V304576.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Highview Residential Home. Highview Residential Home provides a comfortable environment for residents. Maintenance records need improvement to be able to demonstrate appropriate servicing of equipment. Residents have access to pleasant communal areas, including a garden. Bedrooms are comfortably furnished and individually personalised to suit their occupants. The home is clean but there is an unpleasant odour in one bedroom. Appropriate action is currently being considered to deal with this, so that all residents live in a pleasant environment. DS0000064372.V304576.R01.S.doc Version 5.2 Page 20 EVIDENCE: Maintenance records show that continual work is carried out to keep the home and garden in good condition. Care staff confirm that prompt attention is always paid to any defects. Mrs Rhodes says the home employs a qualified maintenance person, who is responsible for the regular servicing of all wheelchairs, the hydraulic bath seat, alarm call system and hoist. Unfortunately, there are no records available to evidence such in-house maintenance is taking place. Mrs Rhodes agreed to instigate the necessary records straight away. Servicing of equipment, such as gas appliances, is carried out regularly under contract and a record maintained. Since the last inspection, a new exterior storage area has been created to accommodate freezers and to provide storage for wheelchairs and equipment not in use. New garden furniture and a barbecue have been purchased. New flooring has been laid in the first floor bathroom. In bedrooms, new headboards, bedcovers, bedding and towels have been provided. Both the lounge and dining room are homely and comfortable rooms. Additional communal space is available in the entrance porch, where some residents like to sit and watch the comings and goings. There is also a small, garden to the rear of the property, which can be accessed through patio doors from the lounge. This garden is laid mainly to grass, enclosed with mature trees and shrubs. Since the last inspection, a covered patio area has been created. Patio tables and chairs are available and one resident said, “I sit in the garden when it is warm and sunny. I had tea outside the other day.” A tour of the building confirms that residents’ bedrooms are comfortably furnished and personalised to varying degrees. Clothing in wardrobes and drawers is clean and neatly stored. Residents commented, “I have a very nice room.” “I can stay in my room as much as I like. The laundry facilities are sited outside of the main building and include a commercial washing machine and tumble dryer. The walls of the laundry have been painted and new floor covering laid, to ensure surfaces are readily cleanable. Disposable gloves and aprons are available for staff. Anti-bacterial handwash is available around the home as a means of minimising any possible risk of cross-infection. An infection control policy is in place but not all staff have yet received infection control training. The home is clean but there is an unpleasant odour in one bedroom.
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Page 21 Rhodes is currently considering appropriate action to deal with this. Suitable procedures are in place for the disposal of clinical waste. DS0000064372.V304576.R01.S.doc Version 5.2 Page 22 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to Highview Residential Home. The home employs sufficient staff to meet the current needs of residents and to ensure their safety and comfort. The home is working towards the recommended ratio of 50 NVQ level 2 trained staff, to help ensure residents are in safe hands. Employment and recruiting procedures need improvement to ensure the protection of residents. Both the induction and all aspects of staff training (including mandatory training) must be updated, to ensure that all staff have the necessary skills to carry out their work. EVIDENCE: Staffing rosters are in place, showing which members of staff are on duty and when. Care staff are responsible for carrying out all personal care tasks for residents, as well as domestic duties such as cleaning and laundry. On the day of inspection, staffing was as follows: DS0000064372.V304576.R01.S.doc Version 5.2 Page 23 8 8 9 8 a.m. p.m. a.m. p.m. ----- 8 2 1 8 p.m. p.m. p.m. a.m. 2 1 1 1 Care Assistants Care Assistant Cook wakeful Care Assistant and 1 sleeping in, on call. From 8 p.m. until 8 a.m., one night Care Assistant is on wakeful duty and one works evenings and then sleeps on the premises and is on call if needed. A total of six care staff are currently employed and the home is actively seeking to recruit further staff. At present, one member of night staff is supplied by an Agency. The Agency supplies the same person each time, to ensure continuity of care. Two further part-time members of staff are also employed, one to carry out maintenance tasks and one to assist with administration. There are sufficient staff to meet the current needs of residents, but should these change, additional staffing may be required. Residents commented, “Everyone here is very kind to me.” “This is a nice place. There is a lady who helps me all the time. I dont know her name but she is always there when I need her.” Standard 28 recommends that a minimum ratio of 50 per cent trained members of care staff at National Vocational Qualification (NVQ) level 2 or equivalent is achieved, to help ensure that residents are in safe hands. Mrs Rhodes is working towards meeting this standard. One member of staff has achieved NVQ level 3 and one is currently undertaking NVQ level 3 training. Two staff commenced NVQ level 2 training in January 2006. Mrs Rhodes is employing one member of staff from overseas whom she believes has the equivalent of NVQ level 3 training, but this has yet to be evidenced. The home has a recruitment procedure in place, based on equal opportunities. Two staff files were examined. One of these revealed serious gaps in the recruitment process. For example, appropriate information had been gathered about the right to work in the UK, but examination of this documentation showed the work permit had expired. There was no reference from the last employer and only one reference obtained, instead of the two written references required. The importance of ensuring that a proper recruitment procedure is in place was discussed with Mrs Rhodes. This matter is of particular concern as issues around recruitment were identified during the last inspection. Any further failure to implement a robust recruitment procedure and ensure the protection of residents will result in enforcement action. Mrs Rhodes said she is now implementing the Skills for Care induction programme for all new staff. However, this could only be evidenced in one of the staff files examined. There was no induction training record for the most recent employee. DS0000064372.V304576.R01.S.doc Version 5.2 Page 24 Individual staff files demonstrate there are shortfalls in the completion of mandatory training in the home, for example first aid, moving and handling, infection control, health and safety and food hygiene. At the last inspection it was identified that staff needed to receive training appropriate to the work they are to perform, for example dealing with dementia, mental disorders and challenging behaviour. Four staff had received dementia awareness training and Mrs Rhodes said further training was being arranged. Mrs Rhodes now says a total of five staff have completed dementia awareness training and the staff on duty confirmed this. At the last inspection it was also recommended that an audit of training be carried out, to ensure that all staff received the training they needed for the work they had to do and that this was updated wherever necessary. Where training needs were identified, arrangements should be made to meet these needs as soon as possible. Disappointingly, Mrs Rhodes said she had not yet carried out such an audit, but was planning to do so. Progress must now be made on the implementation of a structured staff training and development programme, which ensures that all staff receive the training they need for their work. Copies of all training certificates should be retained to provide evidence that staff receive a minimum of three paid days training per year. Further information about staff training can be obtained from the following websites: www.picbdp.co.uk This is the Partners in Care web site and provides lots of information about funding streams for training including NVQ, Life skills and Leadership & Management. www.skillsforcare.org.uk This is the Skills for Care web site and there are downloadable knowledge sets and learning logs for: Dementia, Infection Control, Medication and also Workers not involved in direct care. These knowledge sets are the first 4 of approximately 30 that are currently planned. They are designed to improve consistency in underpinning knowledge for the adult social care work force in England. They identify learning outcomes and are designed to be used alongside the Common Induction Standards, which are also available from this web site. They also count as underpinning knowledge towards NVQs and link to the Health & Social Care National Occupational Standards. www.traintogain.gov.uk This is a programme and funding stream supported by the Learning and Skills DS0000064372.V304576.R01.S.doc Version 5.2 Page 25 Council and Business Link, who provide a skills brokerage role. (This project takes off from 1st August in Dorset.) www.lsc.gov.uk/bdp/employer/eggt_intro.htm This is the Employer Guide to Training website, which is aimed at assisting employers to choose the most suitable training provider to meet their workforce needs by the use of a search facility. DS0000064372.V304576.R01.S.doc Version 5.2 Page 26 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to Highview Residential Home. The registered manager demonstrated a good knowledge of the operation of the service and the needs of its residents. However, Mrs Rhodes must demonstrate more effective management skills, for example in meeting the requirements of the last inspection, and ensuring the safety of residents. The home has commenced reviews of its performance to ensure Highview Residential Home is run in the best interests of residents, but has had little response so far. Residents are assured of sound management of their financial interests. Not all staff are being supervised to ensure good practice. Where formal supervision is taking place, this is not always at the recommended intervals. DS0000064372.V304576.R01.S.doc Version 5.2 Page 27 The home works to ensure the health, safety and welfare of residents. However failure to evidence that staff fire training and fire drills are taking place at the appropriate intervals has the potential to place vulnerable residents at risk in the event of fire. EVIDENCE: Mrs Rhodes has experience in caring for older persons and is currently undertaking the National Vocational Qualification (NVQ) level 4 in care and management. Mr and Mrs Rhodes and their staff have developed good relationships with the residents. This results in a supportive, caring and relaxed environment where residents feel comfortable and secure. Mrs Rhodes was seen to liaise well with residents and members of the staff team throughout the day. One of the conditions of registration for Highview Residential Home is that Mrs Rhodes must obtain an NVQ level 4 in management and care by January 2007 and evidence of successful completion must be forwarded to the Commission for Social Care Inspection. Mrs Rhodes admits that she has made little progress towards meeting this condition to date, but hopes to make more time available in the near future. At the last inspection, a total of nine requirements and four good practice recommendations were made. Five requirements and three recommendations have still not been met. These requirements include important issues around care planning, the need to operate a thorough recruitment procedure to ensure the protection of residents, ensuring that staff are appropriately supervised and carrying out staff fire training and fire drills to ensure the safety of all in the home. The home has now commenced a quality monitoring system based on seeking the views of residents, relatives, staff and other visitors to the home. Questionnaires are available in the entrance hall, but Mrs Rhodes said that so far, only two responses had been received. It may be necessary to consider taking a more pro-active role in dealing with quality assurance. In order to protect residents the home prefers wherever possible to have no involvement in personal finances. Therefore, all residents who are unable or have no wish to handle their own affairs, have a relative or other representative to deal with their finances. The home does look after the Personal Allowance of one resident. An account is kept showing all transactions and receipts retained, as necessary. This record was checked during the inspection and the balance found to be correct. All monies and related records are held securely. DS0000064372.V304576.R01.S.doc Version 5.2 Page 28 Care staff should receive formal supervision at least six times a year, as a means of ensuring good practice, emphasising the philosophy of care within the home and looking at individual career development needs etc. At the last inspection, records showed that supervision was not taking place on a regular basis and a few staff had not received any formal supervision. The two staff files examined evidenced that one member of staff had received supervision only twice in a period of eleven months and the other had not yet received any supervision in over five months. From touring the premises, looking at records and discussions with staff and residents, it is evident that measures are in place to promote the health and safety of residents, e.g. all substances that could be potentially hazardous to health are handled and stored safely and restrictors are fitted to windows. All radiators are guarded, to minimise the risks to residents from hot surfaces. Staff demonstrated an awareness of health and safety issues. Examination of the fire records shows that regular maintenance of the fire warning system, emergency lighting and fire fighting equipment is taking place. Routine checks of emergency lighting, fire fighting equipment and the fire warning system are carried out at appropriate intervals and staff confirm this. The issue of fire drills and staff fire training was the subject of an Immediate Requirement Notice at the last inspection, requiring urgent steps to be taken to ensure compliance. Notification was subsequently received by the Commission that satisfactory action had been taken to meet this requirement. However, at this inspection, it again proved impossible to evidence from records that fire training and fire drills are taking place at the required intervals and that all staff, including new/Agency staff have received appropriate training. Fire training for five members of staff took place on 10/06/06. Mr Rhodes said that further training had taken place with an outside agency and undertook to provide documentation to evidence this. The staff on duty confirmed that they had received training. However, Mrs Rhodes said that a fire drill had not yet taken place and undertook to arrange this as soon as possible. The importance of effective training and fire drills cannot be overstressed in ensuring that all staff know what to do in the event of fire, particularly where residents are more vulnerable because of their dementia or mental disorder. DS0000064372.V304576.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X X 3 X 2 STAFFING Standard No Score 27 3 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 1 X 1 DS0000064372.V304576.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 14 and 15 Requirement All aspects of each resident s health, personal and social care needs must be recorded and regularly reviewed. Care plans are to be agreed and signed by the resident or their representative wherever possible. (Previous timescale of 28/02/06 not met). The registered persons must operate a thorough recruitment procedure to ensure the protection of residents. All staff must be properly checked before being employed. (Previous timescale of 28/02/06 not met). The registered persons must ensure that staff receive training, including induction training, which is appropriate to the work they are to perform. Timescale for action 31/10/06 2 OP29 19(1) Schedule 2 31/10/06 3 OP30 18(1) 31/12/06 DS0000064372.V304576.R01.S.doc Version 5.2 Page 31 4 OP31 9(1) and (2)(b)(i) The registered manager must demonstrate that she has the qualifications, skills and experience necessary for managing the care home. Mrs Rhodes must obtain an NVQ level 4 in management and care. Evidence of successful completion must be forwarded to the Commission for Social Care Inspection. 31/01/07 5 OP33 24 The registered persons must 31/12/06 introduce effective quality assurance and quality monitoring systems. These should be in place to measure success in meeting the aims, objectives and Statement of Purpose of the home. (Previous timescale of 28/02/06 not met). The registered persons must ensure that staff are appropriately supervised at the recommended intervals. (Previous timescale of 28/02/06 not met). 31/10/06 6 OP36 18(2) 7 OP38 23(4)(e) 8 OP38 23(4)(d) The registered persons must 31/10/06 ensure, by means of fire drills and practices, that persons working in the home are aware of the procedure to be followed in the event of fire. (Previous timescale of 01/01/06 not met). All staff must receive fire training 31/10/06 at the appropriate intervals and a detailed record be maintained. (Information regarding previous staff fire training is to be forwarded to the Commission immediately.). (Previous timescale of 01/01/06 not met). DS0000064372.V304576.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations It is recommended that much more be recorded about each residents background, social history, hobbies and interests etc, so that activities in the home can be tailored to meet individual needs. Repeated. It is recommended that maintenance records be improved to evidence appropriate servicing of equipment. It is recommended that urgent steps be taken to eradicate the unpleasant odour in one bedroom. It is recommended that a minimum ratio of 50 per cent trained members of care staff at NVQ level 2, or equivalent be achieved. Repeated. It is recommended that an audit of staff training be carried out, to ensure all staff are receiving the training they need. Repeated. 2 3 4 OP19 OP26 OP28 5 OP30 DS0000064372.V304576.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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