Inspection on 03/07/08 for Homeacre

This inspection was carried out on 3rd July 2008.

CSCI found this care home to be providing an Adequate service.

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

Other inspections for this house

Homeacre 30/06/09

Homeacre 24/07/07

Homeacre 03/08/06

Homeacre 10/11/05

Homeacre 14/12/04

Homeacre 04/05/04

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

CARE HOMES FOR OLDER PEOPLE Homeacre 28 Hayes Road Clacton On Sea Essex CO15 1TX Lead Inspector Helen Laker Unannounced Inspection 3rd July 2008 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Homeacre DS0000017853.V366155.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. Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Homeacre Address 28 Hayes Road Clacton On Sea Essex CO15 1TX 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) 01255 425365 F/P 01245 425365 homeacrecare@aol.com www.littlehomeacre.co.uk Mrs Kathleen Curtis Mrs Kathleen Curtis Care Home 5 Category(ies) of Dementia (5) registration, with number of places Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th July 2007 Brief Description of the Service: Homeacre is a care home providing personal care and accommodation for up to five older people with dementia. The home is situated close to the town centre of Clacton and within walking distance of the seafront. Homeacre is a family run establishment, which cares for people in a homely environment. The care and support of people living in the home is carried out by Mrs Curtis assisted by a small number of staff, most of who are family members or family friends. Facilities consist of five single rooms, lounge and dining room/conservatory. To the rear of the property there is a paved patio area and garden, which is fully accessible. There is a small parking area to the front of the property. The home charges £375.00 per week with additional charges for hairdressing services and for personal items such as newspapers and sweets. This information was provided to us in July 2008. Information about the home can be obtained by contacting the manager; inspection reports are available from the home and from the CSCI website www.csci.org.uk Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out as part of the annual inspection programme for this home. The registered manager was away on holiday on the day of the inspection. The inspection focused upon all of the key standards. A full tour of the premises was undertaken. Evidence was also taken from the Annual Quality Assurance Assessment (AQAA) completed by the management of the home and submitted to the CSCI. The AQAA provides an opportunity for the service to tell us what they do well and areas they are looking to improve and/or develop. It is anticipated that some improvement be noted as this contributes to the inspection process and indicates the home’s understanding of current requirements, legislation changes and own audited compliance. This document will be referred to as the AQAA throughout the report. Three residents and three staff were spoken with during the inspection. The CSCI sent feedback/comment surveys to the home for both residents and relatives for completion prior to the inspection. Four have been received from staff, three from relatives, four from service users and one from a care manager and the comments taken into account in the body of this report. A range of evidence was looked at when compiling this report. Documentary evidence was examined, such as staff rotas, care plans and staff files. Observations of how members of staff interact and communicate with people living there have also been taken into account. On the day the inspector visited the home, the atmosphere in the home was relaxed and welcoming and the inspector was given every assistance from all staff on duty. What the service does well: Relatives and other visitors are made welcome and confirmed in relative’s surveys that they are happy with the family atmosphere that Homeacre provides. There is good communication between staff and visitors and they confirm also in the surveys the high standard of care their relatives receive. Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 6 The home has a stable, committed staff team who know people well and treat them as individuals. As previously reported, the home’s greatest strength is the homely atmosphere and the person-centred way that people are treated. The small staff team work well together to ensure people living in the home receive continuity of care. Surveys received from service users stated, “Looked after very well” Homeacre provides traditional home-cooked food that is enjoyed by people living in the home and staff make sure that people’s likes and dislikes are taken into account when planning meals. What has improved since the last inspection? What they could do better: The management team should continue to audit the maintenance of the home and ensure any health and safety matters that would put service users at risk are addressed and appropriately risk assessed. People living in the home must be kept safe by ensuring window restrictors are in place or appropriate locks based on an assessment of their vulnerability and the potential risk. This applies to windows in communal areas such as the upstairs bathroom and individual’s rooms such as the bedroom with balcony doors. Hot water temperatures in sinks in service users bedrooms must be thermostatically controlled so people are kept safe from accidentally scalding themselves. The management team should continue to develop care plans and risk assessments. The storage facilities for medication should be reviewed to ensure that the home has appropriate facilities to store medications that may be prescribed for people living in the home, specifically controlled drugs. The registered manager should obtain a qualification of NVQ level 4 in management and care (or the equivalent). The home should implement an appropriate supervision and appraisal structure for all staff. Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and (standard 6 does not apply) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People considering moving into Homeacre, and their representatives will be provided with the information they need to make a decision if the home is suitable for them. They will have their needs assessed and will be provided with a contract, which clearly tells them about the service they will receive. EVIDENCE: The home has a published Statement of Purpose and Service User Guide, both of which are made available to existing and prospective residents at Homeacre. These documents have previously been assessed and contain all the relevant information as required by regulation. Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 10 The examination of care records showed that the majority of residents (one resident’s circumstances were of a interim transitional nature), living in the home had had their individual needs assessed prior to moving in and these assessments formed the basis of individual care plans. Records indicate there have been no new admissions to the home since the last inspection. The pre–admission assessment covers a wide range of areas including physical needs, dressing and undressing, pressure sores, falls, safe handling, mobility, mood, behaviour, memory, dietary preferences and the background history of the person. The format of the document is mostly a ‘tick box’ type assessment. However all staff spoken with are able to demonstrate a very good awareness and knowledge of people’s individual assessed needs. The AQAA and staff highlight that paperwork is to be updated and the process is underway. Discussions with staff and service users supported the evidence found in care records and indicated that these assessments gained views and insights from the individual, their families and professionals involved in the individual’s care. The home’s AQAA identifies that “Prospective service users are assessed prior to moving into the home to enable us to give them the care they need also we give them a service users guide a written contract and statement of terms and conditions of the home. We also have a web site that they can access”. Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals can be confident that their personal and healthcare needs will be met in Homeacre although to ensure service users healthcare needs and wellbeing are monitored accurate recording and storage of medication is required. People can be confident that they will be treated with respect and dignity. EVIDENCE: The AQAA states that care plans are in place and reviewed frequently. A sample of care plans examined show that they have been developed from the pre-admission assessments and were reviewed regularly. The morning routines are well documented with good details about how people living in the home like to have their personal care provided. Individual’s personal care routines for the whole day are displayed on the inside of the wardrobe in their bedroom so that all members of staff have the necessary information to ensure care is provided in a consistent manner. Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 12 Care plans could be improved if they are further developed to ensure all aspects of the person’s care including their likes and wishes around food, individual behaviours and daily activities are as well detailed as the weekly routines. Presently a daily recording system for care plans is not in place and the implementation of such was discussed at the inspection. The home’s AQAA acknowledges that they could improve care plans and plans to improve over the next twelve months include making existing care plans more user friendly. One out of three service user’s records reviewed did not make reference to any risk assessment processes for bedrails and the potential implications of such. It was noted that only one bumper was available and the bed was pushed against the wall with an uncovered bedrail on the opposite side. This is not considered safe practice and systems must be made safe. The senior staff spoken with are able to demonstrate a good awareness of people’s individual healthcare needs. Records examined confirm that people are supported to access healthcare professionals as required. One relative’s survey detailed that their relative was “ provided with all services” People’s individual files contain details of prescribed medication. One of the senior carers has compiled a record book containing details of each individual’s medication, what it is prescribed for and the side effects. As at the last inspection visit, no one has the capacity to manage their own medication. Storage of medication is in a locked kitchen cupboard, but this is neither metal nor fireproof. There are no controlled drugs in use at present, but current storage does not meet the requirements for storage of controlled drugs should any be prescribed. The senior staff present at the inspection were informed of the current legislation surrounding this and were asked to provide a metal cupboard as the Royal Pharmaceutical Society Guidelines advise without further delay. Items requiring controlled temperatures are stored in the kitchen fridge. The manager confirmed at the previous inspection that they have a small separate fridge that could be used for medication if required. The system in place for the storage of medication has not changed since the last inspection and still needs to be reviewed to look at more secure ways of storing medicines. Medicine Administration Record (MAR) sheets are completed appropriately and staff spoken with are able to demonstrate a good knowledge of medications prescribed for people living in the home. Staff spoken with all demonstrate good individual, person centred approaches to caring for the people living at Homeacre. Two service users spoken with were complimentary about how staff cared for them. Surveys stated “I am looked after well” and “although demanding is cared for very well and all needs Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 13 are met” Observations on the day of the inspection showed that people are treated with dignity and respect. Staff were observed to have a good rapport with service users and were respectful and polite to service users. Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Homeacre provides people who live there with variety and choice. People living in the home benefit from maintaining good contact with family and friends and they are provided with a varied diet that they enjoy. EVIDENCE: There have been continued improvements in the way people are supported to make choices around activities. The senior carers on duty discussed how they encourage and support people to make choices and have developed a folder containing laminated pictures to help with the process. The AQAA states that people living in the home are ‘happy and contented’ and this is confirmed by observations on the day of the inspection. One service user was observed chatting to the staff, making jokes and laughing and made a point of telling us “he wouldn’t want to change a thing now!” As previously reported at the last inspection, people enjoy watching DVDs and the home has a satellite receiver so that they can enjoy films and has purchased a new 42-inch television set. Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 15 The home is situated very close to the town and people are supported to access local facilities such as the library. The home uses modelling clay to help people exercise their hands and keep them supple. One person living in the home attends a club on a weekly basis. Another enjoys going out for dinner and another loves going to the pub and participating in karaoke. Feedback gained from relatives confirmed that they are made welcome in the home and the staff team have developed close, supportive relationships with relatives. Staff also confirm that service users are taken out on trips to the shops and beach or where they wish weather permitting. Observations on the day of the inspection confirm that staff are ‘good listeners’ and communicate well with people living in the home, supporting them to make choices. One service user who was undecided about going out was given the option of using a mobility scooter kept at the home to help him. There is very much a ‘home from home’ family atmosphere at Homeacre. Staff prepare home cooked food that people are seen to enjoy. Visiting relatives are welcome to stay for a meal and there is a homely atmosphere. Evidence was seen of fresh foods, fruit and vegetables that are used. Appetites are monitored via a portion control tool and a two-week rolling menu is currently being redeveloped. Service users commented that food is enjoyable and they were generally asked what they would like to eat which was taken into account when the shopping was done. No one at the home currently requires a special diet and only one service user required assistance and this was given in a timely manner. Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can access the complaints procedure and be confident their concerns will be taken seriously, listened to and followed up. They can be assured they will be protected from abuse as staff have appropriate training and procedures and plans are in place to safeguard people living and working in the home. EVIDENCE: As at the last inspection, the home has an appropriate policy and procedure around complaints. No complaints have been received in the last twelve months. The home at present has no formal recording system for complaints. The small size of the home and the family culture however ensures that any minor concerns are dealt with as they arise. Service users spoken with confirm that they are confident that any small concern would be sorted out. Documenting minor concerns as well as major complains and recording the outcome would demonstrate that people’s concerns are taken seriously and acted upon. Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 17 The AQAA states, “All staff have had POVA training and are CRB checked”. A sample of four staff files examined all contained evidence of Criminal Record Bureau (CRB) checks. Staff spoken with confirmed that they have received training around Protection of Vulnerable Adults (POVA). This was last held last July and August 2007 and review of records evidenced that updates are planned Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall, people living in Homeacre benefit from a homely environment that is clean and pleasant, although improvements need to be made around safety and maintenance if people are to remain safe. People may be confident that their bedrooms are comfortable and they are surrounded by their own possessions. EVIDENCE: The AQAA gives details of new furniture that has been purchased since the last inspection and units and ceiling repairs. A tour of the premises confirmed that there has been redecoration to doors and some bedrooms. Discussions with service users did not highlight any concerns about the environment. Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 19 The furnishings throughout the home remain homely and domestic. It was noted from the last inspection that some of the bedrooms were quite cluttered, this has now been addressed and clutter streamlined. On the day of inspection the front fence was being mended and the senior staff informed us that there are plans to repaint the house. Individual bedrooms contain domestic furnishings, beds, drawers and wardrobes and all have washbasins. Temperatures from hot taps in bedrooms exceeded the safe temperature of 43°C and no thermostatic monitoring valves were in place. This must be addressed, as a priority health and safety matter to ensure service users do not suffer a scalding incident. At the last inspection people did not have lockable storage space where they can keep medication, money or valuables. A lockable case has now been provided to each service user. It was noted that removable window restrictors had been fitted since the last inspection however this was not secure on one service user’s window and this was discussed on the day of inspection. A risk assessment had also not been undertaken for this. Risk assessments were also not in place for the other rooms. A tour of the premises confirmed that the home continues to be kept clean and free from offensive odours and staff were observed to demonstrate good practices around keeping the premises clean. Staff were observed to be cleaning and airing rooms on the day of inspection. Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in Homeacre benefit from a competent staff team, who receive the training they need to meet the needs of the residents. The home’s recruitment procedure generally provides the safeguards to ensure that appropriate staff are employed. EVIDENCE: As highlighted at previous inspections and confirmed via observation at this inspection, the small staff team work closely together in a flexible manner so that they can respond to the needs of people living in the home. The commitment of the management team and care staff ensure that there are always sufficient staff on duty. The development of a clearly documented duty rota was discussed and its implementation is a best practice recommendation. The current duty rota was confusing and did not highlight the person in charge and designation and contracted hours of staff members. Since the last inspection, three senior staff have training underway in order to attain the Registered Managers Award. Records examined show that five out of a total of eight care staff have an NVQ qualification. Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 21 We were told at the inspection that, upon commencing these qualifications senior staff were finding it helpful with understanding processes better with things like recruitment and supervision practices and enhancing their body of knowledge on meeting the national minimum standards. The home has a very low turnover of staff and there have been no new staff employed since the last inspection. The recruitment procedure remains appropriate. Three staff files were sampled and, as at the last inspection visit, there is evidence of appropriate documentation around recruitment such as staff photographs, proof of identity, declaration of fitness to work in a care home and Criminal Records Bureau (CRB) checks. Staff spoken with show an enthusiasm around training and records examined confirm that staff generally keep up to date with training. Staff commented, “They enjoyed the training they have and welcome learning new skills”. All staff have attended Protection of Vulnerable Adults (POVA) training and fire safety last year and any updates due are being addressed. There are plans for further medication training and they are waiting funding for this. The benefits of having a training matrix were discussed so that updates are apparent. The AQAA also confirms that in order to do better the home must “Ensure that all staff training needs are updated” Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 22 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, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management team of Homeacre generally ensure the home it is run in the best interests of the residents. Some improvements with regard to health and safety need to be made so residents can be confident they are protected by the home’s practice and procedures. EVIDENCE: Two senior members of staff have completed a Qualification (NVQ) level 4 Registered Manager’s Award. National Vocational Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 23 At the last inspection it was highlighted that although the management team work closely together, the registered manager who is in day-to-day control of the home has a responsibility to obtain appropriate qualifications so that she meets all standards that apply to the registered manager. We have been informed that the manager is to register for an appropriate management course on the 16th July 2008. Discussions with members of staff, the management team and relatives show a strong person centred ethos in the home. Discussions with staff highlighted they are able to demonstrate a common purpose, which is to recognise the individuality of all those living in Homeacre and to provide care in a way that promotes the home’s family atmosphere. Since the last inspection, the home continues to make some progress with their quality assurance system. The AQAA states that the home “Listens to their service users and also their families. We offer up questionnaires to be filled in but our service users families prefer the more personal approach which is face to face.” The management team need to continue to build on the work they are doing around quality assurance and develop an action plan for the home that takes into account feedback from staff, relatives and people living in the home and to demonstrate how they take action. Staff spoken with were confident that their views are taken into account. Feedback from one relative confirmed that relatives are very much involved in decision-making processes. Completed surveys received from relatives contain positive comments about the home. One person said, “Takes care of them well and looks after them very well with all the services, and another commented that their relative is cared for to a very high standard and all needs are catered for even though they could be demanding and moody at times.” As at the last inspection, no one in the home has the capacity to manage their own finances and this is carried out by relatives. The home only looks after the finances of one person, who is also a relative of the manager. Records examined show that any money spent is appropriately documented and receipts are in place. The staff at Homecare do not at present have any formalised supervision and appraisal structure. This was discussed with a view to it being implemented following this inspection. This will benefit the home’s staff personal development. The servicing of equipment is carried out including electrical equipment, the stair lift, fire equipment, gas appliances and emergency call equipment. A sample of records examined confirms that servicing and testing has been carried out. Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 24 The home has COSHH (Control of Substances Hazardous to Health) assessments on hazardous substances such as cleaning products. These are kept in a locked cupboard in the upstairs bathroom. Overall the kitchen was observed to be clean and staff are aware of good practices around hand washing. However, the home’s culture of being a ‘home-from-home’ means that some professional practices around the storage of food are not in place, such as leftover food stored in the fridge was not labelled and there was nothing to confirm how long it had been there. This was highlighted at the homes last inspection and has now been addressed. The home’s AQAA confirms “We are introducing a new system of assuring foods used are not out of date and kept hygienically in proper containers and labelled, dated and checked daily.” Although, as stated in the AQAA, there is a high ratio of staff to people living in the home, people are not constantly supervised and are free to come and go throughout the home as they please. This reinforces the feeling that people are living in their ‘own home’. A tour of the premises highlighted some areas of risk at the last inspection; these had overall been addressed at this inspection. This referred to most window restrictors, apart from one in a service users bedroom. Double doors leading from one bedroom, on to a balcony at the front of the premises are secured by a small bolt at the bottom; this now locks properly with a lock and key. The home needs to carry out a thorough audit of the premises to identify all ongoing areas where there may be health and safety risks for the people living there and make improvements where potential dangers are identified. Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 2 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 2 X 3 X 3 2 X 2 Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 26 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 OP25 Regulation 13(4)(c) Requirement People living in the home must be kept safe by ensuring window restrictors are in place or appropriate locks based on an assessment of their vulnerability and the potential risk. This applies to windows in communal areas such as the upstairs bathroom and individual’s rooms such as the bedroom with balcony doors. Hot water temperatures in sinks in service users bedrooms must be thermostatically controlled so people are kept safe from accidentally scalding themselves. This is a partially repeated requirement from the homes last inspection which took place on 24/07/07 Timescale for action 30/09/08 Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 27 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 OP7 Good Practice Recommendations The management team should continue to develop care plans and risk assessments so that they contain more details about all aspects of people’s health, personal and social care needs in a similar way to the plans in place around people’s morning routines. The storage facilities for medication should be reviewed to ensure that the home has appropriate facilities to store medications that may be prescribed for people living in the home, specifically controlled drugs. This includes medications that need to be stored at a controlled temperature. A drug cupboard should comply with the Misuse of Drugs (Safe Custody) Regulations 1973. The registered manager should obtain a qualification of NVQ level 4 in management and care (or the equivalent). This would ensure people living in the home benefit from a robust management structure in which the manager has obtained the qualifications needed to meet the National Minimum Standard. The home should implement an appropriate supervision and appraisal structure for all staff and ensure appropriate records are kept. The management team should continue to audit the maintenance of the home and ensure any health and safety matters that would put service users at risk are addressed and appropriately risk assessed. 2. OP9 3. OP31 4. 5. OP36 OP38 Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Homeacre DS0000017853.V366155.R01.S.doc Version 5.2 Page 29 - 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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