Inspection on 17/07/08 for Homemead

This inspection was carried out on 17th July 2008.

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

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

Homemead 09/10/07

Homemead 12/09/06

Homemead 24/01/06

Homemead 17/06/05

Homemead 28/09/04

Homemead 14/05/04

Homemead 26/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Homemead 28 Park Road Teddington Middlesex TW11 0AQ Lead Inspector Sandy Patrick Key Unannounced Inspection 09:00 17th July 2008 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 Homemead DS0000017373.V365863.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. Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Homemead Address 28 Park Road Teddington Middlesex TW11 0AQ 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) 020 8977 5002 0208 977 8888 carmel.regan@ccht.org.uk Central & Cecil Housing Trust Ms Carmel Regan Care Home 30 Category(ies) of Dementia (30) registration, with number of places Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 30 9th October 2007 Date of last inspection Brief Description of the Service: The service is operated by the Central and Cecil Housing Trust, a not-for-profit provider. The home provides accommodation for a maximum of twenty-nine older people who may have dementia. Staff support is available to residents twenty-four hours a day. The home is situated in a residential area of Teddington. The nearby high street provides a range of community facilities, such as shops, banks, pubs and restaurants. Bushy Park is a short walk away and the River Thames is close by. The Central and Cecil Housing Trusts mission statement reads as follows: We aim to maintain and improve the quality of life, independence and dignity of all within our care by providing comfortable, secure homes in an environment of support. Fees are between £580 - £600 per week. Homemead DS0000017373.V365863.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 2 stars. This means the people who use this service experience good quality outcomes. The inspection included an unannounced visit to the home on 17th July 2008 by two regulation inspectors. We met people who live at the home, visitors, staff on duty and the Manager. We looked at the environment and at records. We spent time observing what was happening in the home and used a special tool to help us record how people with dementia were being supported. We wrote to people who live at the home, their visitors and staff and asked them to complete surveys about the service. 17 visitors completed surveys and returned them to us. We asked the Manager to complete a quality self assessment. We looked at all the information we had received since the last inspection, including information on any complaints, allegations and incidents. We also visited the home on 11th June 2008 to conduct an inspection following an allegation. People told us that they were happy with the care and support they received at Homemead. Some of the things people said were: ‘The staff are unwaveringly supportive and endlessly patient.’ ‘Homemead does not regiment residents and there is a feeling of freedom.’ ‘My relative is happy at Homemead and settled.’ ‘Caring, loving, considerate, respectful to residents, respectful to relatives and great food too.’ ‘The home has helped me to care for my relative and I thank the staff.’ ‘The staff do so much for my relative I can’t name all the things.’ ‘Homemead always has a welcoming and informed atmosphere. The staff do care for the people who live there.’ ‘A small community of friendship.’ ‘The staff care for him as if he was their own relative.’ Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: There needs to be some improvements to care plan recording. The staff need to find out about, record and help people to meet their individual social needs. The Manager needs to make sure everyone feels their needs are being met. There needs to be some more improvements to the environment. The staff need to have regular formal 1:1 meetings with their manager. Homemead DS0000017373.V365863.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. Homemead DS0000017373.V365863.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 Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are given enough information to help them make a decision about moving to the home. The Manager assesses people’s needs to make sure the home is suitable for them. EVIDENCE: There is a Welcome Pack, which includes a brochure, Statement of Purpose, Philosophy of Care, Charter of Rights, residents’ handbook, complaints procedure and application forms. The Manager told us that this is given to anyone who expresses an interest in moving to the home. Everyone who is thinking of moving to the home has their needs assessed by the Manager. She told us that she visits them in their own home or hospital and talks to them and their family to gain information about them. She also gets information from other professionals. Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 10 People are invited to visit the home for a day and share a meal and activities with others this helps staff to understand about their needs and helps the person to make a decision about whether they would like to move there. Relatives told us that they had been given enough information to help them choose the home. One person told us, ‘we looked at a number of homes, and we liked this one. There are a small number of residents and the staff can give more attention’. Six weeks after moving to the home each person has their needs reviewed and they and the staff can decide whether the home is the right place for them. When we spoke to one of the local authorities who fund people’s places at the home, they said that sometimes staff had not asked for a new review and extra assistance when someone’s needs had changed. The Manager must make sure there is a multidisciplinary review of people’s needs if these change so that they can receive the right support and services to meet these needs. Everyone at the home is given a copy of their licence agreement. Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s individual needs are recorded within care plans, but some areas of these should be improved. The way in which risks are assessed should be improved so that staff have clear information on how to minimise risks. People are supported to stay healthy and to take their medication. EVIDENCE: Most relatives told us that the people at the home were well cared for and had their needs met. There is a plan of care for everyone at the home. These contain information on meeting care needs. These plans did not have much information on people’s social needs. Information in care plans was clear and focused on positives and abilities. Daily care notes recorded basic care given but did not give much information about what the person actually did during the day. Some care plans contained old information which contradicted with more Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 12 recent information. This older information needed to be archived to make things clearer. Most care plans contained a summary of needs and care given which is designed to assist new and agency staff. Not all plans had these and should have. Not all records were clearly dated. Some people at the home share a bedroom. Their care plans did not contain any information on this. People should only share a bedroom if this is their choice or if there is agreed to be beneficial to their wellbeing. This should be recorded. Some people had inventories stating the things they had brought into the care home. Other people did not and some people’s inventories were not detailed. There should be up to date information on everyone’s belongings. The Manager told us about some people’s changes in need. We found that not all their care plans clearly recorded these changes in need. We looked at a sample of risk assessments. We found that many of these indicated what the risk was but did not include an in-depth plan on how the risk would be minimised. Everyone is registered with a local GP and sees other health care professionals as needed. We saw records of consultations with health professionals. One person told us that the staff escorted people to hospital if relatives could not do this. Another person said, ‘the staff were very supportive when my relative was in hospital’. The staff have all had regular training in manual handling techniques. There is equipment to help people move if needed and everyone at the home has had their mobility assessed. In general we saw people being supported appropriately. However, we saw one person being pushed along in a dining room chair. This puts the person and the staff assisting them at risk. We told the Deputy Manager about this and she said that this was not normal or approved practice. We talked to senior staff about the medication procedure and observed people being supported to take their medication. Senior staff are responsible for administering all medication and are trained to do so. They are reassessed by the Manager periodically. Medication is securely stored. We saw that medication records were accurate and information clearly recorded. The thermometer on the medication fridge indicated that the temperature was too high, although the fridge felt cool. The Manager should make sure the thermometer is working correctly and that the fridge temperature is not too high. The procedure for administering medication was generally appropriate and we saw that the staff checked medication and recorded this. However, medication was taken to each person in a container without a lid. We felt that Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 13 it would be better if the container had a lid to minimise the risks of tablets falling or being misplaced. People’s personal care needs are recorded within their care plans. In general people said that they felt needs were being met. However some people told us about some of their concerns. One person said, ‘sometimes there are not enough staff to support my relative when going to the toilet – sometimes she has dirty fingernails and sometimes she is not given a change of clean clothes’. Another person told us, ‘the staff do not make sure my relative drinks enough’. A recent review by the local authority indicated that although people’s fluid intake was monitored there was no recorded action if people were not drinking enough. We saw that some people were offered drinks throughout the day of our visit, but others only had drinks during the tea round and mealtimes. One person told us, ‘my relatives dentures are not always cleaned’. One person told us that their relative had requested female only carers but had had care from male staff. We saw that some care plans clearly stated where people had requested same gender carers. The Manager told us that this was respected. Homemead DS0000017373.V365863.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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported to participate in organised group activities. There needs to be more support for people to meet individual social needs. EVIDENCE: There are two dedicated Activity Coordinators. There is a planned programme of activities which include aromatherapy, knitting, bingo, baking, choir, dancing, singing and arts and crafts. The Deputy Manager told us that they were looking at ways to match staff skills and interests to activities. She also told us that she wanted to involve more relatives and visitors to help with outings and some activities. On the afternoon of our visit we saw staff supporting people to dance and sing to a selection of music. Some people clearly enjoyed this and the staff were enthusiastic in their support. Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 15 The Manager told us that over the last year a film club has started where people can chose and watch a variety of films on a large screen television. She told us that cake baking was a popular activity and that there were links with local school children who visit and entertain people. There have been recent improvements to the garden creating a sensory environment. The Manager told us that they plan to use the garden more for parties, activities and for people to take part in gardening. However on the day we visited the doors from the lounge to the garden could not be used because chairs were placed in front of them. Different cultures and countries are celebrated through themed days and events where food from that country is served for people to try. The Manager said that these events were popular. The home shares a minibus with another local home and sometimes outings are arranged. The Manager said that she would like to use the minibus more for day to day activities as well as longer outings. There are monthly church services at the home and visits by other religious leaders. The Manager told us that people’s birthdays were celebrated and the staff were planning the celebration of a 50th wedding anniversary at the time of our visit. We felt that, although there were planned group activities, there was not enough support for people to meet their individual social needs. Some people did not want to join in the activity on the day of our visit and staff told us that this was true of other activities. The staff need to think about how everyone’s social and leisure needs can be met. Care plans did not contain much information on people’s social needs, hobbies and interests. There was limited information on their lives before they moved to Homemead. The staff need to make sure they record more detailed information to help them understand about individual needs. During the morning people spent a lot of time sitting in communal areas without staff support. Some of the staff spent time in these rooms but did not initiate conversation except to respond to needs or during a task. Some people who contacted us told us that they would like the staff to spend more time chatting to people, others told us that they thought some staff were very good at this. Some of the comments people made about activities were, ‘more music would be good’, ‘the home has good special occasions such as Christmas, birthdays, Easter and a summer garden party’, ‘I would like the staff to have more conversation time with people’, ‘there could be more entertainment’ and Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 16 ‘Homemead celebrated Christmas and Easter by involving residents in painting, cake making, decorating, singing and partying’. The Manager told us that there are 6 meetings each year for the people who live at the home. Relatives join 3 of these meetings and 3 are with the catering company to discuss the menu and food. Visitors and relatives told us that they were made welcome at the home and that staff kept them well informed. They said that they were able to continue to be involved in caring for their relative if they wished. One visitor told us, ‘This is a wonderful home the best I’ve ever seen’. Other visitors comments included, ‘I would like there to be more social gatherings at the home, where I can meet other friends and families’, ‘I wish there were more activities and people were supported to use the garden more’, ‘a happy atmosphere with time given to people – sometimes just a chat or hand holding reassurance’, ‘I always felt fully informed and know that my relative has everything explained to her and is quite happy about any decisions’ and ‘they always contact us about any issues and are very considerate’. One person suggested that subtitles should be used on the television to make it easier for people to understand. In general, we felt that the atmosphere at the home was calm and relaxed. Most of the staff were very kind and caring and treated people with respect. We saw some good examples of staff supporting people and talking to them. For example we saw staff getting people snacks and drinks whenever they wanted them. We also saw staff complimenting people on their appearance and hairstyles. We felt that some staff lacked interpersonal skills with people and did not always communicate with them well. For example, at lunchtime the staff serving food did not explain to people what their meal was, did not ask about their enjoyment of the meal or check if people needed anything else. One person was taken to the hairdresser immediately after finishing their main course and they did not have any dessert. Another person asked for a condiment but this was not brought to them. There were a few incidents where people seemed distressed and were calling out for staff but did not get staff attention. For example one person told a member of staff, ‘I want to go home’ but they did not get any reassurance. Another person seemed distressed and asked where they were, the staff responded simply by saying ‘Homemead in Teddington’. The staff need to have a good understanding of the needs of people with dementia who may be confused and distressed at times. Their responses should reassure and comfort people. Most people we spoke to told us that they liked the food. We saw that it was freshly prepared and that people had a choice. However, people are given the choice about meals the day before and the staff told us that sometimes they Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 17 forget what they have requested. There should be some flexibility so that people who have forgotten what they ordered and want something else are able to have an alternative. We spoke with the chef and they had a good understanding of individual needs and special diets within the home. Food was stored appropriately and there are recorded checks to make sure food is safe to eat. The Manager said that she would like there to be more flexibility around mealtimes and to introduce photographic menus to help people to make decisions about their food. We saw the meal choices of that day were written on a notice board in the dining room. New mealtime comment sheets have been introduced and the Manager told us that staff have started to use these to ask people whether they enjoyed their meals immediately after they have eaten. We saw that meals were served on white plates. Plates with coloured rims or coloured plates would make it easier for people to see their meals. Some of the things people told us about food were, ‘the food could be a lot better it is nearly always the same’, ‘good food’ and ‘I think there should be more drinks available’. Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 18 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are appropriate procedures designed to help keep people safe and to enable them to make complaints. EVIDENCE: The complaints procedure is displayed in the main foyer and is accessible to visitors. Copies of the complaints procedure are given to people as part of the welcome pack. The Manager told us that when someone raised a concern they were given a copy of the procedure. Most relatives told us that any complaints or concerns that they had were responded to appropriately and quickly. They told us they were confident that the staff would act on their concerns. One person told us that they were frightened to complain in case there was adverse reaction. ‘I have no worries about raising any concerns regarding my relative’s care as I feel that any concerns are received in a positive manner and dealt with appropriately’. We saw a record of complaints and how these had been investigated and information fed back to the complainant. We saw a selection of thank you letters and cards from relatives. Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 19 The organisation has its own procedures on abuse and whistle blowing and there is also a copy of the local authority procedure on safeguarding vulnerable people. All staff have had training in this area and staff we spoke to demonstrated a good understanding of the procedures. There are appropriate pre employment checks on all staff including criminal record checks. Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 20 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, 23, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a well maintained and clean environment. There needs to be some improvements to make sure the environment is safe. EVIDENCE: Parts of the home were redecorated in the last few years. The Manager told us that people living at the home and their relatives helped to choose the colour schemes. New furniture has been purchased for the dining room and lounge. Areas of the home have been equipped with new flooring. At the time of the inspection corridors were being redecorated. People who live at the home and their relatives said that they would like a safe and accessible garden. Over the past year a sensory garden has been created using different plants and a water feature in response to this request. The Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 21 Manager told us that people were able to use the garden on their own and that parties and special events also took place there. At the time of our visit one of the bathrooms was being refurbished and a new bath which better suited the needs and wishes of people living at the home has been installed. The Manager told us that following risk assessments furniture in people’s rooms was being secured. All hot water pipe work has recently been boxed in. The Manager needs to make sure these boxes are painted so that they look attractive. There was a hole in the wall of the main hallway where the old alarm call system had been situated. There is a hole in the laundry room wall. These need to be repaired. The stairwell has an attractive stained glass window. Some of the panels are cracked or damaged. These must be repaired. There needs to be some protection, such as clear Perspex coverings, to make sure people are not at risk if this window or other windows are cracked or damaged. Some parts of the building are showing wear and tear. For example damaged paintwork, chipped woodwork, damaged furniture and marks where old emergency call bells have been removed. There is a stair gate at the bottom of the stairs restricting peoples’ access. The use of this must be fully assessed. The gate could present a risk if people attempted to climb over it. Alternatives should be sought to make sure people are kept safe without restricting their rights to move about the home. Most people told us that they liked the environment particularly the garden. One person told us ‘sometimes bedrooms are too hot’. All of the bedrooms have en suite toilets. Some also have en suite bathrooms. However, the Manager said that people could not use these because they need specialist baths. She said that the people living at the home have requested showers and that people would benefit from having their own showers instead of baths which they cannot access. A new nurse call system was installed earlier in the year. We saw that some of the cords for call bells had been removed or were not accessible. The Manager told us that some people were at greater risk from entanglement in the cords than they were a benefit. The Manager said that not everyone knew how to use the call bells. She has updated procedures in the home to make sure there are more visual checks on these people. She also told us that they were considering different types of equipment which would help keep these people safe. These included sensor pads which alerted staff if someone got out of bed and portable alarms which could be used if people fell or needed assistance when away from the wall mounted alarm. Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 22 We saw that the home was clean and odour free throughout when we visited. People told us that the home was always fresh and clean. The Manager told us that the way in which clothes are laundered has changed to minimise the risks of items being lost or misplaced. Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 23 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are cared for by well trained and supported staff. EVIDENCE: Some of the things people told us about the staff were, ‘the staff are always helpful and very friendly and approachable’, ‘the care staff seem not only to have the right skills and experience, but seem to love the residents and enjoy working with them’, ‘the staff are always caring and loving’, ‘the staff are kind’, ‘I think that the staff are good and obviously have good training in handling difficult circumstances’, ‘some staff are excellent, very dedicated and caring but some are poorly trained’, ‘very friendly and caring staff who do a difficult job well’, ‘the compassion, care and understanding of the staff is amazing’, ‘the staff are great – they do a tough job and still manage to maintain a homely atmosphere’ and ‘there have been a lot of changes of care staff recently, but they are all kind and cheerful, they do not always have time to talk’. The staff we spoke to said they worked well as a team and supported each other. They said that there was good communication. We saw that the staff used communication books and diaries every day. They said that the managers supported them informally. However we saw that formal Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 24 supervision did not happen regularly. One person had not had any recorded supervision since 2006. One person comment that the staff did not always wear name badges and that their names were not always clearly displayed. They suggested that staff have larger print name labels. There are thorough checks including criminal record checks and references made on all staff before they are employed. All the staff have signed written contracts of employment. We looked at a sample of staff records and saw evidence of these checks. The Manager said that she was reviewing staff recruitment records to make sure they all contained the correct information. The organisation is offering ‘Leadership’ training to senior staff to help them understand about management roles and the policies and procedures of the organisation. Senior staff have attended a 5 day dementia care course and other staff have completed a shorter version of this course. All staff should have the opportunity for in depth dementia training because this will help them understand and meet the needs of the people living at the home better. New staff complete induction workbooks and training. They work alongside other staff for a week and are closely mentored and monitored by senior staff throughout their induction. The staff we spoke to said that they had good training from the organisation and the local authority. Volunteers also have training in some areas such as fire safety. We looked at a selection of staff training records and saw that there was varied and up to date training. Over half the care staff and all domestic and catering staff have NVQ level2 or above. All staff are supported to undertake this qualification once they complete their induction. There is a handover of information between the staff when there is a change of staff on duty. These have been improved to include visual checks of all the people living at the home. We saw records of these. There are regular recorded staff meetings. We looked at records of these. We saw that there was good discussion and that staff were informed of changes and procedures. All staff have annual appraisals of their work and these were taking place at the time of the inspection. The senior staff have had training to make sure they can support other staff with the appraisal process. Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a well managed home. EVIDENCE: The Manager has worked at the home for a number of years. She is appropriately experienced and qualified. She demonstrated that she knew the people who lived at the home well and was committed to meeting their needs. She showed a kind and caring attitude and had a good rapport with everyone at the home. One person told us, ‘there is a fantastic Manager at the home who keeps and eye on all the staff and residents’. Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 26 Senior staff take part in leadership training and organisation work groups. The Deputy Manager told us she had attended a risk assessment and a human resources working group. She told us that she and the Manager had attended a budget planning group a short while ago. She told us that these groups were useful and staff at Homemead felt they had a voice in the organisation. The Manager told us that people were asked to complete surveys about the quality of the food. In 2006 the relatives were asked to complete surveys on their opinions of the home. The Manager should consider introducing other ways of monitoring customer satisfaction and giving people surveys again to ask for their views. There are annual reviews for all the people living at the home. Senior Managers within the organisation visit the home each month to conduct a quality review. These are recorded and the Manager is given an action plan to address any issues. Records at the home are generally well organised, clearly labelled and dated and information is accessible. Everyone at the home has some one who supports them to manage their finances away from the home. People are able to leave a small amount of cash for safekeeping with the Manager. There are records of all money held and transactions. The Manager keeps receipts for all purchases including invoices from the hairdresser. The organisations maintenance worker visits the home once a week to inspect the environment and health and safety. We saw records of checks on fire safety, water temperatures, electrical appliances, gas safety and general health and safety. These were up to date and showed where action had been taken to address identified problems. There were records of fire drills. The Manager has recently reviewed the building risk assessments and has made individual risk assessments for all bedrooms taking into account the environment, furniture and equipment and the person’s needs. We saw copies of these and saw that there was an action plan to address identified risks. There have been 3 recent fire risk assessments on the building and the Manager told us that action had been taken to address actions idenitified in these. Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 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 X X X 3 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 3 3 3 X 3 2 3 3 Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 28 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 OP4 Regulation Requirement 14 Timescale for action The Registered Person must 31/08/08 make sure there is a multidisciplinary review of people’s needs if these change so that they can receive the right support and services to meet these needs. The Registered Person must 31/08/08 make sure changes in need are clearly recorded within care plans. The Registered Person must 30/09/08 make sure risk assessments give clear guidance on how risks can be minimised. The Registered Person must 31/08/08 make sure staff use approved manual handling techniques at all time and do not put people or themselves at risk when supporting someone to move. 2 OP7 15 3 OP7 13 4 OP8 13 Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 29 5 OP10 12 The Registered Person must 31/08/08 make sure people are having enough to drink, that their fluid intake is monitored and that action is taken when people are not drinking enough. The Registered Person needs to 31/10/08 make sure people’s individual interests and social needs are recorded and they are supported to meet these needs. The Registered Person must 30/09/08 attend to the decorative needs identified in the report. The Registered Person must 30/09/08 assess the risk and benefits of having a stair gate in the home. The assessment must look at ways to minimise risks without restricting people’s freedom to move around the home. The Registered Person must 30/09/08 make sure there is a full recorded risk assessment on the use of call bells for each person and that action is taken to make sure people who cannot use their call bells are safe. The Registered Person must 30/09/08 make sure all staff have regular formal supervision meetings. 6 OP12 12 16 7 OP19 23 8 OP25 12 13 9 OP25 13 10 OP36 18 Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 30 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 Good Practice Recommendations Standard OP7 The Manager needs to make sure old and out of date information from care plans is archived. The Manager needs to make sure all care plans have a summary for agency and new staff. The Manager needs to make sure all care plan information is dated. People should only share a bedroom if this is their choice or if there is agreed to be beneficial to their wellbeing. This should be recorded. There should be up to date inventories of everyone’s belongings. The Manager should make sure the thermometer on the medication fridge is working correctly and that the fridge temperature is not too high. The Manager should make sure the containers used to take medication to people have a lid to minimise the risks of tablets falling or being misplaced. People should always be supported to go to the toilet when they need to. People should always be supported to have clean clothes and be clean themselves. DS0000017373.V365863.R01.S.doc Version 5.2 Page 31 2 OP7 3 OP7 4 OP7 5 OP7 6 OP9 7 OP9 8 OP10 9 OP10 Homemead 10 OP10 The staff must make sure people’s dentures are kept clean at all times. The Manager must make sure people are offered same gender care whenever they request this. The Manager needs to make sure people furniture does not obstruct doors to the garden. The staff need to have a good understanding of the needs of people with dementia who may be confused and distressed at times. Their responses should reassure and comfort people. The Registered Person must make sure all the staff have the skills and training to understand and meet the needs of people who have dementia. 11 OP10 12 OP14 13 OP14 14 OP14 People must not be taken to the hairdresser in the middle of their meals. The Manager should think about ways to give people alternative meals if they do not want the choice they made the day before. The Manager should consider serving meals on coloured plates or plates with coloured rims. The Manager should think about ways to support people to feel able to make a complaint without fear of negative consequences. The staff should make sure information they have about people’s interests and personal needs are recorded in care plans so that all the staff can give them support to meet these needs. The Registered Person should consider replacing en suite DS0000017373.V365863.R01.S.doc Version 5.2 Page 32 15 OP15 16 OP15 17 OP16 18 OP12 19 OP23 Homemead baths with showers, which are accessible to the people living at the home. 20 OP27 Consideration should be given to issuing staff with large print name badges so that it is easier for people living at the home to identify them. The Manager should consider introducing other ways of monitoring customer satisfaction and giving people surveys again to ask for their views. 21 OP33 Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Homemead DS0000017373.V365863.R01.S.doc Version 5.2 Page 34 - 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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