Inspection on 12/06/07 for Honeymead Care Home

This inspection was carried out on 12th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Honeymead Care Home 20/04/09

Honeymead Care Home 27/02/08

Honeymead Care Home 23/05/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Honeymead Care Home 183 West Street Bedminster Bristol BS3 3PX Lead Inspector Vanessa Carter Unannounced Inspection 12th and 13th June 2007 09:15 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 DS0000066334.V335969.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. DS0000066334.V335969.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Honeymead Care Home Address 183 West Street Bedminster Bristol BS3 3PX 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) 0117 953 5829 0117 923 1480 honeymead@mimosahealthcare.com None Mimosa Healthcare (No4) Limited Isla Joanna Nicholson Care Home 68 Category(ies) of Old age, not falling within any other category registration, with number (68) of places DS0000066334.V335969.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two named persons under the age of 65 years at time of registration may remain in the home while their needs continue to be met. Registration will revert to the over 65 year age group once these persons leave the Home. The Registered Manager must be a RN1 or RNA on the NMC Register To accommodate one named person aged 43 years or over. The registration will revert back to the over 65-year age group when this person leaves. 23rd May 2006 2. 3. Date of last inspection Brief Description of the Service: Honeymead Care Home is one of four nursing homes in the Bristol area owned by Mimosa Healthcare Ltd. The three other homes in the Bristol area are in Bishopsworth, Southmead and Shirehampton. All four homes were purchased at the beginning of 2006. The home manager has recently left and a new manager is to be appointed. Honeymead Care Home is a purpose built care home with accommodation provided over two floors. The home is run as two units. The first floor, the Ashton Suite, accommodates 37 persons. The ground floor, the Clifton Suite, has 31 beds. Placement is for people aged 65 years and over. Both floors have communal rooms and bathing facilities. The home is located within walking distance from the main Bedminster area where there are local shops, public houses and a post office. There is a regular bus service into the centre of Bristol that passes in front of the home. The front of the property is used for car parking, so visitors can park near to the front entrance and main reception. The gardens to the rear of the home are level, have a pleasant patio area and established shrubbery. The area is secure and fairly secluded. The cost of placement is between £471 - 600, the price dependent upon assessed need. Additional charges are made for a number of services - these are listed in the homes brochure. The home also provides a limited number of day care places. Prospective residents can be provided with information about the home and this will detail the services and facilities available at the home. DS0000066334.V335969.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key inspection was unannounced, took place over two days and was completed by two inspectors – Lead Inspector Vanessa Carter and second inspector Kath Houson. A combined total of 15 hours were spent in the home. Evidence to form the report has been gathered from a number of sources:• Information provided by the previous Home Manager in the Annual Quality Assurance Assessment (AQAA) • Talking with the person in charge of the home • Talking with some of the registered nurses, care staff and ancillary staff • Observations of staff practices and their interaction with the residents • A tour of the home • Case Tracking the care of a number of residents • Talking with a number of the residents • Talking with a number of visitors to the home • Looking at some of the homes records • Information supplied by relatives in CSCI survey forms (no resident survey forms were returned) • Information supplied by healthcare professionals The home continues to provide a good quality service for its residents. Both requirements made from the last inspection have been met, the home showing compliance with the relevant regulations. A number of areas of improvement have been referred to in the report. What the service does well: Information made available about the home and the homes admission procedures ensure that placement is only offered to those residents whose needs can be met. Residents can be assured that their individual care needs will be met because the home has good care planning processes in place. They will receive the healthcare support they need and will be well treated and cared for. Residents have the opportunity to participate in a range of different activities. Residents can be assured that any concerns they have will be listened to and acted upon. Residents will be cared for by staff who are aware of abuse issues and will safeguard them from harm. Residents live in a home that is well maintained and safe, is comfortably furnished, and is fully equipped to meet their needs. DS0000066334.V335969.R01.S.doc Version 5.2 Page 6 Residents are cared by staff who are skilled and competent and able to meet their needs. Residents live in a safe home that is run in their best interests, where their views are valued and acted upon. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000066334.V335969.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000066334.V335969.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information made available about the home and the homes admission procedures ensure that placement is only offered to those residents whose needs can be met. EVIDENCE: The homes Statement of Purpose contains all the information necessary for a prospective resident and/or their representative to make an informed decision about moving to the home. Of the five relative survey forms returned to CSCI, four stated that they had received enough information about the home, prior to choosing the home, enabling them to make their minds up. Each new resident is provided with a service users guide or Welcome Pack upon admission – this contains a summary of the statement of purpose and gives details of the services and facilities they can expect to receive in the home. Copies of the welcome pack were seen in a number of rooms during a tour of the home. DS0000066334.V335969.R01.S.doc Version 5.2 Page 9 All newly admitted residents have been provided with a residency agreement, and the home has good administrative procedures in place to ensure but signed copies are returned by next-of-kin or other representative. The majority of residents are part funded by a local authority, and a financial contract is set up between both parties. A sample copy of the residency agreement is included in the homes welcome pack. The home has clear admission criteria and will only admit people to the home whose needs can be met. Since the last inspection in May 2006, the home has admitted a number of younger residents who need 24 hour nursing care, and this has been done in agreement with CSCI. For the most part, the home is fully occupied and at the time of inspection, the one vacant room was already earmarked for a new resident. The home has established a waiting list of residents wanting to live in the home – this is evidence that the home has raised its profile within the care sector. A comment received from visitors to the home “ its lovely here, our friend seems very happy here and seems to have settled very quickly.” The pre-admission assessment document of recently admitted residents were examined in order to look at how the home made the decision that it would be able to that the needs of that person. Information was gathered concerning their personal and health care requirements, communication, mental health and social care needs. One resident said “the manager visited me at home and asked me lots of questions”. Where residents are part funded by the local authority, a copy of the community care assessment and care plan, plus a health needs assessment is also obtained. This gathering of information will ensure that the home has as much information as possible to then plan the care that is provided. Most residents are admitted directly following a stay in hospital, and family members will therefore family will have visited the home, had a look around, found out what the home has to offer and will have had a conversation with the staff team. All new admissions are generally reviewed after a four week ‘trial period’ but this can be dependent on individual circumstances. One resident spoken with during the inspection confirmed that a review meeting had been held along with their family and a social worker. In some instances the service can take admissions on an emergency basis but this would largely depend on the individual circumstances. DS0000066334.V335969.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be assured that their individual care needs will be met because the home has good care planning processes in place. They will receive the healthcare support they need and will be well treated and cared for. EVIDENCE: Six care plans were looked at, three from each floor. The plans set out the specific care needs of each resident and stated how these needs were to be met. For one resident there was specific guidance for care staff on how to communicate with the resident, and for another specific details regarding their personal hygiene needs. This is good evidence that each resident receives person-centred care. Those residents who have lived at the home for sometime have had a complete ‘re-assessment of their needs’ and new care planning documentation prepared. This ensures that their plans remain up to date and they each get the care that they need. Wound care-planning documentation however was not clear. Whilst there was clear evidence that the home were attending to the dressings on a regular basis and recording an evaluation of the wound on each occasion, the plan did DS0000066334.V335969.R01.S.doc Version 5.2 Page 11 not state what dressing products were to be used, or how often the wound was to be looked at. This shortfall was discussed with the person in charge. The plans were supported with photographic evidence of the wounds progress. Along side these plans, the home have completed a number of risk assessments in respects of falls, nutrition, continence and pressure sore formation. The ‘core’ assessments in respects of falls do not take into account any specific factors that may affect that individual and cause falls. Falls risk assessments should be individually prepared and be based upon any identified trends or particular significant events. For one resident, there were three falls that had been recorded within a two week period, each happening at approximately the same time of night, but this was not reflected in either their risk assessment or their care plan. Reference is made under the health and safety section in this report, regarding the need for falls and accident auditing to be undertaken so that any possible preventative measures can then be taken. There was noted to be a good standard of recording in the daily notes, and this evidenced the care provided and the involvement of other healthcare professionals. The home maintains a record of all contacts with GP’s and other healthcare professionals, such as foot healthcare practitioners, hospital consultations and home nutrition nurses. One GP wrote in a CSCI comment card “there have been vast improvements in the overall care that patients have received since the nursing home changed ownership……there have been numerous examples when I would describe the nursing care as excellent”. During the inspection one visitor said that “any instructions I leave for ongoing care are now followed through. This is much better than things used to be”. Medication systems were discussed with a registered nurse on the ground floor. There are well established procedures in place for the ordering, receipt, storage, administration and disposal of medications. Arrangements are underway for an alternative ground floor medication storage room. The current room has no ventilation however the home have installed an air-con unit, and monitor the room temperature twice daily, to ensure that medications are stored at the right temperature. Controlled drugs were checked and tallied with the homes records. During the inspection the registered nurses were conducting a medication audit in the upstairs unit. Registered nurses must always ensure that “medication rounds” are conducted safely – the nurse must not be distracted from the task so as to ensure that errors do not happen. One nurse was seen to walk away from an open drug trolley to direct a visitor to the toilet, and on the other floor a similar event happened. Where oxygen therapy is in use, appropriate warning signage is displayed. Two residents between them had a large stock of filled cylinders, and the person in charge agreed to suspend the next delivery. DS0000066334.V335969.R01.S.doc Version 5.2 Page 12 Six relatives returned a CSCI survey form - “the home cares for my relative as I would wish” and “permanent staff know how to handle my relative who has severe arthritis, but agency staff do not”. A student who was completing a work experience placement commented that “ the home is caring and the staff are really nice and friendly to the residents”. One resident commented “this is my home and its comfortable, the people are nice here, I can go to bed anytime I want to”. A few less favourable comments were received – “ call bells are not answered promptly enough”, “staff ask my relative to do things that she can’t and then they get frustrated – put your hand here etc”. One resident said they had had to insist on not being helped with personal care tasks by a male member of staff, this had taken some time to sort out but was now working well. The home has offered placement to residents who have attracted continuing health care funding, are reaching the end of their life and are expected to die shortly. The home will also continue to look after their long-term residents when their illness deteriorates. The home may need to involve the “Rapid Response or Intermediate Care Teams” in order to prevent hospital admissions, so that the resident can continue to receive the care and support they need “in their own home”. When appropriate, the home will have discussions with residents, their family and the GP regarding end-of-life wishes, and this is good practice. DS0000066334.V335969.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have the opportunity to participate in a range of different activities. Residents are generally provided with good meals, but the quality is not consistent at the weekends. EVIDENCE: The home has two activity organisers and their hours are spread over six days (not Saturday). One has been working at the home for over a year, whilst the other has only been working at the home for several months. Comments were received from both residents and staff, and one relative in a CSCI survey form that one of the organisers only works with a couple of the residents and has little to do with the others. This is not an acceptable situation. The person in charge was aware of this situation, and this is something that needs to be addressed by the new home manager. The home has an activity plan and this is posted in the main reception area and at various points throughout the home. The programme has a range of activities that will appeal to different residents, but comments made on CSCI survey forms included “the activities need to be more varied”, “activities are only bingo, I have asked about exercises”. One of the activity organisers talked about the future plans for trips out from the home – to Horseworld. DS0000066334.V335969.R01.S.doc Version 5.2 Page 14 There have recently been two trips to the Zoo and the photo’s were displayed in the main reception area – the residents looked like they had had a good day and this was confirmed by a number of them. On the first day of inspection a group of residents did some painting, and there was a quiz. The organiser has recognised the need to prepare new quiz questions as a number of the residents were too familiar with the answers. The organiser also talked about 1:1 work with residents and the need for this to be individual and take account of specific preferences. One resident said “it is not quite like I thought it would be. I spend all my time sitting in this chair” whilst another said “I like watching TV and reading but I always take part in whatever is going on. We have a good time”. Residents are asked what time they would like to get up in the mornings and retire at night and this information is recorded within the care plan. They are also able to choose where they want to spend their time and can remain in their own room if this is what they want. Residents spoken with during the inspection said “I prefer to sit quietly in my room and listen to my music”, “I like to come out into the garden whenever I can”. A number of residents were moving independently around the home, whilst others were totally reliant upon the care staff. The home has open visiting arrangements and visitors are encouraged at any reasonable time. Observations were made that there was a very friendly and informal ‘banter’ between many of the visitors to the home. One relative brought their dog in and the group of people sat in the reception area, made a great deal of fuss over the dog. The person in charge said that relative meetings had been discontinued as often maybe one or two people turned up. The out going manager had an open-door policy and was always pleased to see relatives to discuss concerns, views and any suggestions. The home has a four-week menu plan and there is a choice of two main meals at lunchtime. On the first day of the inspection, most of the residents had steak and kidney pie, served with vegetables. One resident commented after the meal “I am very well fed, dinner was lovely today”. A comment was received on two of the CSCI survey forms about the quality of the meals served at the weekends, and this was discussed was the cook and the person in charge. The cook is already addressing these concerns and has put together an action plan to improve performance of the weekend cook. One resident commented “there was one roast meal recently that was inedible – the meat was not cooked properly”, whilst another said “the buffet tea on a Sunday is always the same. There needs to be some changes”. DS0000066334.V335969.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be assured that any concerns they have will be listened to and acted upon. Residents will be cared for by staff who are aware of abuse issues and will safeguard them from harm. EVIDENCE: The homes complaints procedure is displayed in the main reception area and is included in the service users guide. It details the processes that will be followed if concerns are raised and says that any complainant will be informed of any actions taken and the outcome. The six CSCI survey forms completed by relatives said they were aware of the homes Complaints Procedure, with all but one saying that any complaint they have had has been dealt with appropriately. An examination of the complaints log evidenced that the home has a system in place to log any complaints made and a procedure for recording the outcome of any investigation. This is good practice and does evidence that the home takes seriously any complaints made about their service. CSCI were copied into one complaint but the service provider dealt directly with the complainant. Looking at a sample of the complaints received and the corresponding paperwork, it is evident that complainants are provided with an outcome. A number of residents said they would have no hesitation in raising concerns if they were unhappy. One resident said “I would ask to speak to the manager”. DS0000066334.V335969.R01.S.doc Version 5.2 Page 16 The home has a policy on the Protection of Vulnerable Adults (POVA) and clear guidance is available for the staff to follow if abuse is suspected, alleged or witnessed. On a number occasions the home manager has sought the advice of CSCI or the safeguarding adults officer, when there has been concerns regarding the care of a resident or the conduct of certain staff members. This evidences that the home takes responsibility to ensure that all the residents are safeguarded from harm. The acting person in charge is fully aware of agreed protection of vulnerable adult (POVA) procedures. Staff spoken with during the course of the inspection, were aware of their responsibilities to report bad practice and to safeguard residents. Some said they had had recent POVA training whilst others said that they were looking forward to attending the training sessions with the new training provider. DS0000066334.V335969.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is well maintained and safe, is comfortably furnished, and is fully equipped to meet their needs. EVIDENCE: The home is a purpose built two- storey care home. The home is entered by one main entrance and this is secured at all times. Visitors are able to wait inside the first set of double doors until they can gain entry. Instructions are posted upon the door, of the procedures to follow if the door is not answered promptly enough ‘out of office hours’. There is a passenger lift between the two floors making the home fully accessible to disabled people, plus a central staircase. The doors at the top of the staircase, and the fire exits at each end of the building, are secured with a keypad system – this ensures that those residents who are at risk of wandering are not at risk of falling on the stairways. DS0000066334.V335969.R01.S.doc Version 5.2 Page 18 The outside of the home, and gardens are well maintained. The rear gardens run the length of the building. There is a small herb garden and fish pond complete with goldfish and a water feature, paved areas, lawn and flower beds. A large gazebo was erected to provide a shaded area and several of the residents were sat outside making the most of the warm weather. The home has two pet rabbits and a number of the residents and a visitor commented that it was great for the home and a “good talking point”. The home has its own maintenance person, who will either undertake maintenance and repair tasks themselves or arrange the appropriate tradesman. The home was well decorated throughout and one relative commented in a CSCI survey form “ my relative has a lovely room and it has recently been decorated”. A number of bedroom carpets and those in the main reception area and all corridors, have been replaced. The acting person in charge explained that there were plans for some of the lino floors to be replaced with better quality washable flooring. The home looked fresh and welcoming throughout. There are communal facilities on each floor. The manager’s office, nurses office and receptionists office all lead off from the main reception area. Previously the home had one small lounge on the ground floor where residents could smoke however smoking is no longer permitted in the home or anywhere within the grounds. On the ground floor there is one lounge, a separate dining room and a hair salon. Access out to the gardens is via the dining room. Upstairs there are two lounges, and a dining room. These rooms are each furnished with comfortable and domestic style furniture, however the home has just been awarded DoH funding to refurbish and enhance the lounges. The home has equipment to assist the care staff with moving and transferring residents with impaired mobility – four electrical hoists and two manned hoists. The corridors on both floors are wide and have grab rails fitted on both sides. Bathrooms and toilets are fitted with handrails. The home has increased the numbers of specialist profiling beds, and has a plentiful supply of alternating air mattresses. There are toilets located throughout the home and eight assisted bathrooms. Some of the baths can be used with a hoist and sling. There is one parker bath and one shower room. The majority of bedrooms have ensuite facilities of a toilet and wash hand basin. There are seven double bedrooms, but these are not always used for two residents – this means that the maximum number of residents can only be 64. All bedroom doors have thumb-locks installed, to ensure privacy can be maintained whilst personal care is being delivered. Each of the bedrooms are DS0000066334.V335969.R01.S.doc Version 5.2 Page 19 comfortably furnished with a large proportion of the bedrooms having divan beds. A number of specialist nursing beds have already been purchased and there is a rolling programme of replacement. The home is centrally heated and well lit with domestic style light fittings. Each bedroom has an opening window, fitted with width restrictors for safety. Emergency lighting is installed throughout the home and this is checked on a regular basis. Particularly so of the upstairs floor, the room temperatures were high despite there being no heating, plenty of ventilation and fans in a number of rooms. There are air-con units in the communal rooms and the home is doing its best to provide as comfortable an environment as possible. The home was clean, tidy and free from offensive smells throughout. There have been several occasions when visitors have been dissatisfied with the cleanliness of the home and have raised concerns with both the home manager and CSCI. Since the last inspection a new senior housekeeper has been appointed. The housekeeping staff were seen going about their duties effectively and interacting well with the residents. DS0000066334.V335969.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. Residents are cared by staff who are skilled and competent and able to meet their needs, but some improvements are needed with the homes recruitment procedures. EVIDENCE: The home and residents benefit from having a full compliment of staff although a small number of care assistants are about to leave. The recruitment process for the replacements has already started. There is now a well-established team of registered nurses and bank registered nurse and this has brought about a raised standard of care service. The staff team is now stable and the use of agency staff only occurs when there is last minute, staff shortages. Records showed that only 7 shifts have been covered in a recent 12 week period. This all means that residents will be looked after by staff who are familiar with their needs, and are skilled to meet them. Staffing numbers on each shift are sufficient to meet the resident’s needs. The duty rotas showed that, for the day shift, each unit is staffed with at least one registered nurse plus senior carer assistants and care staff. The nursing and care staff are supported in meeting the residents’ daily living needs by catering, laundry and housekeeping staff. One GP who commented on a CSCI survey form said “some of the nurses do not understand my instructions and I am asked to write them down or repeat DS0000066334.V335969.R01.S.doc Version 5.2 Page 21 them. This is re-assuring as it indicates that the nurses in question want to be clear on my instructions”. Relatives comments in CSCI survey forms included “some foreign staff cannot understand or speak English”, “the carers are wonderful and really do care”, “some carers are extremely good”. Registered nurses and care staff spoken with during the course of the inspection visit, demonstrated good communication skills and a knowledge of the residents who were in their care. The home has a number of staff who have already achieved an NVQ Level 2 in care (29 ). Other staff are working towards the award and others again are doing NVQ Level 3. The homes policy is that it is a condition of employment that all new recruits to the care team will undertake the NVQ course. A sample of staff recruitment records was examined. Whilst most files evidenced that the home follows a robust recruitment procedure, for one there was an example of extremely poor practice. The written references that had been supplied for one person who is employed at the home, were provided by their spouse, and the other was provided by another member of the staff team. Safe vetting procedures have not been followed and this shortfall may have the potential to mean that unsuitable workers are employed and residents may be placed at risk. All other vetting procedures had been followed – new recruits do not start work at the home until POVAfirst clearance has been obtained, followed by a CRB checks. The recruitment files of all other new staff members were in order. All new staff will complete an induction training programme at the start of employment, to ensure they are aware of the policies and procedures of the home and are competent in all areas of their work. The completed programmes of new care staff were not seen during the inspection but one staff member confirmed that they had had specific training, a work book to complete and had been allocated a mentor to see them through the process. The previous manager has maintained a detailed spreadsheet that shows what training each staff member has received. Mimosa has just commissioned a new training provider and a programme of training sessions for the staff has been arranged. Some staff went to manual handling training during the inspection, and others had recently attended Adult abuse and protection. The person in charge will be doing risk assessment training in July and will cascade what is learnt to the registered nurses. DS0000066334.V335969.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, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe home that is run in their best interests, where their views are valued and acted upon. EVIDENCE: The registered home manager has recently left and a new manager has already been appointed who will start next month. In the meantime, one of the registered nurses is temporarily ‘person in charge’. The new manager will be expected to make application to CSCI for registration. The person in charge participated in the inspection process and demonstrated her competency. Despite the absence of a manager, residents are being well cared for and are safe. DS0000066334.V335969.R01.S.doc Version 5.2 Page 23 Staff meetings are held on a monthly and staff confirmed that they are encouraged to have a say in how the home is run. Resident meetings are held on a regular basis, with a “Lead Service User” being identified on each floor to represent the views of the quieter residents. One of these people said that they liked being the voice of others and it made them feel useful. Recent discussions have been about weekend catering, ideas for improvements in the gardens, problems with the call bell system (now been sorted), and staffing matters. In the last minutes it was recorded that one resident had said “I like the homely atmosphere in the home”. The home undertakes a number of audits on a quarterly basis. These include catering, health and safety, care plans, laundry and housekeeping, maintenance and infection control. However, all records could not be located during the inspection, but were confirmed as being done by several of the staff team. There are currently no procedures in place to capture views about the day-to-day service provided to the residents. Mimosa should consider undertaking a full quality assurance exercise, encapsulating all stakeholder views and opinions. Opinions from the residents, relatives and other visitors to the home, healthcare and social care professionals must be sought and an annual development plan devised. This will ensure that the home continues to provide the best possible care and changes in line with changing needs. The home has procedures in place to manage any monies they hold on behalf of the residents. A number of the accounts were checked against the records held and they tallied. Records of staff supervision sessions showed that arrangements have fallen by the way side recently. Staff spoken with during the inspection also confirmed that they have not had a formal 1:1 meeting recently but that the home manager had always been available to discuss any concerns. The person in charge explained that a cascade system of staff supervision is to be set up, but training needs to be organised to ensure that registered nurse and heads of departments know what is expected of them. The maintenance team complete regular audits of the fire alarms and equipment, emergency lighting and the water temperatures. From the homes records all necessary service contracts were up to date. The homes records are well organised and are kept secure. The home needs to monitor any falls and accidents more closely to ensure that any trends are identified. One resident had fallen three times at about the same time of the day, but the trend had not been identified as each fall was dealt with separately. For those residents who have falls, a log of each event should be maintained. This will then mean that staff can put strategies in place to eliminate or at least reduce the risk of further recurrences. Care planning documentation can then be amended accordingly. DS0000066334.V335969.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 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 3 3 3 3 3 3 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 DS0000066334.V335969.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The home must ensure that care plans includes all information of how the residents needs in respects of health and welfare are to be met • Wound care plans must contain information about what products are to be used and how often dressings are to be attended to Robust recruitment procedures must be followed to ensure that all workers are ‘fit’ to be employed • Written references should be from a previous employer Timescale for action 13/07/07 2. OP29 19(1) 13/07/07 3. OP38 13(4)c 13/07/07 The home must identify any unnecessary risks to the health & safety of residents and take the appropriate actions to eliminate them. • A record of all falls should be maintained where necessary, so that trends can be identified. DS0000066334.V335969.R01.S.doc Version 5.2 Page 26 • Falls risk assessments must be completed to ensure that unnecessary risks are identified and so far as is possible eliminated. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP36 Good Practice Recommendations All medication rounds must be undertaken safely so that the risk of errors occurring is so far as possible eliminated. Staff must receive formal supervision at least six times per year. DS0000066334.V335969.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 DS0000066334.V335969.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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