Inspection on 27/02/08 for Honeymead Care Home

This inspection was carried out on 27th February 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

Honeymead Care Home 20/04/09

Honeymead Care Home 12/06/07

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 27th and 28th February 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Honeymead Care Home DS0000066334.V359568.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. Honeymead Care Home DS0000066334.V359568.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 Position Vacant Care Home 68 Category(ies) of Old age, not falling within any other category registration, with number (68) of places Honeymead Care Home DS0000066334.V359568.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. 12th June 2007 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. 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 Ashton Suite, accommodates 37 persons. The ground floor Clifton Suite, has 31 beds. The home has a number of shared rooms that are only used by one person and therefore the number of people that can be accommodated is reduced to 64 in total. Placement is generally for people aged 65 years and over, however providing the home is able to meet the needs of younger people they can live here. 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 £486 - 500, the price dependent upon assessed need. Additional charges are made for a number of services - these are listed in the homes brochure. Prospective residents can be provided with information about the home and this will detail the services and facilities available at the home. Honeymead Care Home DS0000066334.V359568.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 star. This means the people who use this service experience good quality outcomes. This key inspection was unannounced and took place over two days. A total of 13 hours were spent in the home. Evidence to form the report has also been gathered from a number of other sources:• Information provided by the Home Manager in the Annual Quality Assurance Assessment (AQAA) • Talking with the Home Manager • Talking with some of the registered nurses, care staff and ancillary staff • Observations of staff practices and their interaction with the people who live in the home • A tour of the home • Case Tracking the care of a number of people, talking with them and a number of others • Talking with a number of visitors to the home • Looking at some of the homes records • Information supplied in CSCI survey forms by 2 people who live in the home, 1 relative and 3 healthcare professionals • Information that has been received by CSCI since the last inspection. What the service does well: The information made available about the home and the pre-admission assessment processes ensure that placement is only offered to those people whose needs can be met. The people who live here can be assured that their needs will be met because care planning processes are good. They will receive the healthcare support they need and will be well treated and cared for. The people who live in this home are given the opportunity to take part in a variety of activities, but arrangements are ad-hoc. Visitors are welcomed and interests outside of the home are encouraged. They are well fed with good quality home cooked meals. People who live in this home can be assured that any concerns they have will be listened to and acted upon. They will be cared for by staff who are aware of abuse issues and will safeguard them from harm. Honeymead Care Home is well maintained and safe, is comfortably furnished, and is fully equipped to meet their needs of the people who live here. Honeymead Care Home DS0000066334.V359568.R01.S.doc Version 5.2 Page 6 The people who live in this home are cared for by staff who are skilled and competent and able to meet their needs. The people who reside at Honeymead Care Home live in a safe place that is run in their best interests. 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. Honeymead Care Home DS0000066334.V359568.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 Honeymead Care Home DS0000066334.V359568.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. The information made available about the home and the pre-admission assessment processes ensure that placement is only offered to those people whose needs can be met. EVIDENCE: The homes Statement of Purpose contains all the information necessary for a prospective person who wants to live at the home and/or their representative to make an informed decision about moving to the home. This has been updated to include the details of new home manager. The views expressed in survey forms returned to CSCI by both people who live in the home and relatives was that they had received enough information about the home, prior to choosing the home, enabling them to make their minds up. Each new person is provided with a service users guide – the home refer to this as the Welcome Pack. The manager is in the process of updating and reformatting this but it will still contain a summary of the statement of purpose and 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. Honeymead Care Home DS0000066334.V359568.R01.S.doc Version 5.2 Page 9 All newly admitted people are provided with a ‘residency agreement’, and signed copies are kept on file for each person. Some people are part funded by a local authority, and a financial contract is set up between both parties. Where a person is responsible for meeting their own fee’s, a contract is arranged between the home and the person. A sample copy of the residency agreement is included in the homes welcome pack. Only one completed CSCI survey form was returned from someone who lives in the home and they said they had been provided with a contract. The home has clear admission criteria and will only admit people to the home whose needs can be met. Pre-admission assessments will be carried out prior to an agreement being made for admission – these assessments are comprehensive and detailed and cover the full range of needs. The home will only take people in as an “emergency admission” in special circumstances, but will ensure that they gather as much information as possible to make a judgement that can meet needs. One person who had been admitted in such circumstances said “the support I had set up at home broke down and I had to come in very suddenly. I am being well looked after but I am still settling in and don’t know what will happen in the future”. Most people will be admitted following a stay in hospital, but will still be encouraged to visit the home prior to making a decision to move in. Generally this is done by family members who will look around, find out what the home has to offer and will discuss arrangements with the staff team. All new admissions are generally reviewed after a four-week ‘trial period’ but this can be dependent on individual circumstances. Evidence was seen where review meetings have been held along with family and the social worker. Honeymead Care Home DS0000066334.V359568.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. The people who live here can be assured that their needs will be met because care planning processes are good. They will receive the healthcare support they need and will be well treated and cared for. Written instructions regarding safe moving and handling procedures will improve information recorded about each person. EVIDENCE: Care plans are prepared for each person who lives in the home and they set out the care needs of the individual and say how they are going to be met. Six plans were selected to look at, three from each of the units. The plans in general were satisfactory, setting out the specific care needs of each person, but would be improved if there was a more person centred approach to service delivery arrangements. This has already been identified as an area of improvement by the organisation and there was a discussion about how the staff team will be achieving this. Having said this though there is evidence that each person receives the individual care that they need. The staff team spoke about the different needs of the people they look after and how they try to accommodate everyone’s preferences into the daily routines. Honeymead Care Home DS0000066334.V359568.R01.S.doc Version 5.2 Page 11 Included with the care plans are a number of risk assessments in respects of falls, nutrition, manual handling and pressure sore formation. The manual handling risk assessments only record the level of risk and whilst all six assessments stated there was a moderate or a high level of risk, a full manual handling risk assessment resulting in a safe system of work had not been devised. Staff said that they would rely upon senior staff knowledge in respects of moving and handling tasks or would look at the mobility care plan. However, these mobility care plans did not in all cases, stipulate the full equipment needs, for example sling sizes, and the different methods to be used with different transfer moves. A requirement has been issued in respects of this so that staff team always has easily accessible information about each persons moving and handling needs. The new home manager plans to display this information in each person’s bedroom. Some people had a generic falls risk assessment in their care file, but they provided little information and did not take into account any specific factors that may affect that individual and cause falls. The use of these forms should be reconsidered to ensure that the staff put the appropriate measures in place to prevent falls, with any person who has been assessed at risk. It would be good practice for those people who have lived at the home for sometime to have a complete ‘re-assessment of their needs’ and new care planning documentation prepared. This would ensures that their plans remain up to date and they each get the care that they need. Two of the plans looked at had been prepared at the end of 2006, and whilst staff confirmed that they were generally correct, there were some examples of minor differences. Wound care-planning documentation was clear and evidenced that the progress of the wound is monitored on a regular basis. Plans stated what dressing products were to be used and how often the wound was to be attended to and an evaluation of the wound was made each time it was redressed. One healthcare professional who completed a CSCI survey form thought that more staff should receive training in a specific wound care management treatment. There was generally a good standard of detailed recordings in the daily progress notes, evidencing the care provided, any significant events and the involvement of other healthcare professionals. Staff must ensure that when entries are made in these notes, that any required actions are followed through. A record is kept of all contacts with GP’s and other healthcare professionals, such as foot-care practitioners, community nurses, physiotherapists and specialist tissue viability nurses. Three healthcare professionals completed CSCI comment card and made the following comments “the staff help the residents in they way they need” and “the staff are receptive to listening to any instructions I give”. Honeymead Care Home DS0000066334.V359568.R01.S.doc Version 5.2 Page 12 Medication systems were discussed with one registered nurse and the manager. There have no changes to the systems followed and the procedures in place for the ordering, receipt, storage, administration and disposal of medications. A new ground floor medication storage room has been completed and provides improved storage facilities. Controlled drugs were not checked on this visit. Where oxygen therapy is in use, appropriate warning signage is displayed and is suggested that a note be kept of the location of such equipment with the fire log. A number of staff have recently attended end of life training with St Peters Hospice enabling them to provide better care for those people who are at the end stages of their illnesses. A number of people have been admitted to the home with palliative care needs and the staff work closely with the hospice nurses to ensure all needs are met. Those people who have lived in the home long-term will continue to be looked after when their health deteriorates. The “Rapid Response or Intermediate Care Teams” are contacted to prevent unnecessary hospital admissions, so that people can continue to receive the care and support they need “in their own home”. When appropriate, discussions with the person, their family and the GP will be instigated regarding end-of-life wishes. Honeymead Care Home DS0000066334.V359568.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. The people who live in this home are given the opportunity to take part in a variety of activities, but arrangements are ad-hoc. Visitors are welcomed and interests outside of the home are encouraged. They are well fed with good quality home cooked meals. EVIDENCE: The home currently has one activity organiser but they were not working during the inspection visit and therefore could not participate in the inspection process. Because of their absence, there was a general feel of inactivity in the home. Care staff were doing their best in between their caring duties, and were spending time with some of the people and chatting. There was a great deal of banter and respectful familiarity between some of the people who live in the home and the staff. A small group of people like to sit in the main reception area “It is nice to watch all the comings and goings, and speak to people as they come in”. One other person said “there is nothing to do” whilst others said “I like joining in with the music sessions in the lounge” and “there was a very interesting slide show recently about wildlife”. During the inspection, care staff took one person out for a wheelchair walk for some fresh air, and another was taken across the road to meet up with friends. There is a Honeymead Care Home DS0000066334.V359568.R01.S.doc Version 5.2 Page 14 suggested activity plan that has been put together by the activities organiser and this is displayed in the main reception area – “I am not always sure what is going on as there is no actual plan now” was what one person said. Examples of activities that might be arranged are quizzes, reminiscence sessions, bingo, gentle exercise classes and sing-a-longs. Three healthcare professionals completed CSCI survey forms and two commented that some people would benefit from “day trips out from the home”. Parties are arranged for all festivals and the photographs from Christmas were displayed in the main reception area. The new home manager is planning to review the provision of activities and ensure that things are arranged that people want to participate in. Personal preferences are recorded regarding the time they would like to get up in the mornings and retire at night and this information is recorded within the care plan. A number of people said they were happy with the time they were assisted to get up or retire to bed, whilst others who were disorientated in time were unable to respond. Prior to the last inspection the timing of staff shifts was altered to take account of work load at 7am and in the early evening– this is good in that it evidences that the people who live in this home do not have to fit in with “home routines”. People can choose where they want to spend their time and can remain in their own room if this is what they want. “I always sit in this chair. This is my chair”. A number of people spend their time between the communal rooms and their own rooms. Visitors are welcomed at any reasonable time. Two visitors said “the staff are always very welcoming”. The home has a four-week menu plan and there is a choice of two main meals at lunchtime. One visitor commented that the menu’s were displayed too high on the wall for wheelchair users and that their relative is often not aware of the choices on offer. People should be asked about their preferences the day before by the care staff but on occasions, this is overlooked and therefore the kitchen staff have to “guess” quantities of each choice to prepare. One meal was sampled during the inspection it was delicious, well looked and nicely presented. Two people who were sat at the same table said that this was the usual standard of meal. The week’s menu included two roast meals, salads, fish and chips, vegetarian options and casseroles. Two residents said “the meals are always good”. One relative commented in a CSCI survey form “my mother is always very complimentary about the meals”. Care staff said that the meals were always very good and that the cakes served with afternoon tea are always home baked. A visiting relative was concerned that evening tea was served at 4.30pm but was unaware that sandwiches and hot drinks are served before settling for the night – the person they were visiting pointed this out to them. Honeymead Care Home DS0000066334.V359568.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. People who live in this home can be assured that any concerns they have will be listened to and acted upon. They will be cared for by staff who are aware of abuse issues and will safeguard them from harm. EVIDENCE: A copy of the complaints procedure is displayed in a wall cabinet in the main reception area but this may not be accessible for everybody as it is now sited behind a settee and a coffee table. It may be appropriate for this cabinet, or the information to be relocated elsewhere. The complaints procedure is also 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. CSCI have received a number of complaints since the last inspection, and these have been forwarded to the home for investigation. The home manager has responded to each complaint appropriately and where relevant, has shared information with the staff team regarding what is said about the home. As a result of this each staff member was re-issued with the companies whistleblowing policy so that concerns can be raised in a proper and more meaningful manner. An examination of the complaints log evidenced that the home has a system in place to log complaints and record the outcome of any investigations. This evidences that the home responds appropriately to any complaints made about their service. A number of people said they would have no hesitation in raising concerns if they were unhappy. Honeymead Care Home DS0000066334.V359568.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. There is also information displayed so that staff know what to do if they have any concerns about bad practice (whistle-blowing procedures). 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. Staff who were spoken with during the course of the inspection all stated that they would have no hesitation in reporting bad practice and were aware of their responsibilities in safeguarding the people who live in the home. The home manager is fully aware of agreed protection of vulnerable adult (POVA) procedures and has recently attended the training put on by Bristol City Council. The registered nurses and senior carers also knew what to do. POVA training is arranged on a regular basis and all staff are expected to attend – further sessions are planned for the next couple of months. Honeymead Care Home DS0000066334.V359568.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. Honeymead Care Home is well maintained and safe, is comfortably furnished, and is fully equipped to meet their needs of the people who live here. EVIDENCE: Honeymead Care Home is a purpose built two- storey building. 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’. One relative wrote in a CSCI survey form “the home is bright and cheerful”. There is a lift between the two floors plus a central staircase meaning the home is accessible for disabled people. The doors at the top of the staircase, and all fire exits are secured with a keypad system – this ensures that those people who may wander are not at risk of falling on the stairways. The outside of the home, and gardens are well maintained. The rear gardens run the Honeymead Care Home DS0000066334.V359568.R01.S.doc Version 5.2 Page 18 length of the building and are a pleasant place in which sit outside in the warmer weather. The home has its own maintenance person, who will either undertake maintenance and repair tasks themselves or arrange the appropriate tradesman. There is an ongoing programme for the renewal of carpets or other floor coverings, in bedrooms and communal areas. The carpet in one bedroom upstairs was noted to be in a very poor condition and could present a trip hazard – arrangements for its replacement were already in place and the ‘job order’ was seen. There are communal facilities on each floor. The manager’s office, nurse’s office and receptionist’s office all lead off from the main reception area. On the ground floor there is one lounge, and 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. Both of the dining rooms are due to be re-floored with washable coverings, making it easier to keep clean. The home has sufficient equipment to assist the care staff with moving and transferring residents with impaired mobility – four electrical hoists and two manned hoists. Additional transfer belts will be obtained as necessary. 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 a number of specialist profiling beds, and a plentiful supply of alternating air mattresses, however plans to increase the amount on a gradual basis, taking account of the increasing frailty of people who are admitted to the home. 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 en-suite facilities of a toilet and wash hand basin. There are seven shared rooms, but these are not always used for two people – this means that the home can only look after up to 64 people. All bedroom doors have thumb-locks installed, to ensure privacy can be maintained whilst personal care is being delivered. 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. The home was clean, tidy and free from any bad smells throughout. There have been occasions in the recent past when visitors have been dissatisfied with the cleanliness of the home and have raised concerns with the home manager and CSCI. One relative wrote in a CSCI survey form “the home is always very clean”. It was noted during a tour of the home that the standard Honeymead Care Home DS0000066334.V359568.R01.S.doc Version 5.2 Page 19 of bed making was very poor, with linen hanging onto the floor, mattresses hanging over the bed bases and bed rail equipment not always positioned correctly under the mattresses. Care staff must ensure that they take greater care when making beds and must, on a daily basis ensure that bed rails are correct. One relative who was visiting the home said that they always tidy up their relatives bed when the go along to the room. The appearance of the beds is not helped by the fact that most of the bedding is very ‘wishy-washy’ – new bed linen and curtains are to be ordered to improve the appearance of bedrooms. The home now has a new senior housekeeper who has recruited additional domestic and laundry staff and will be ensuring that the standards of housekeeping and the laundry service, particularly at the weekends, are raised. Honeymead Care Home DS0000066334.V359568.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. The people who live in this home are cared for by staff who are skilled and competent and able to meet their needs. Improvements have been made with the homes recruitment procedures. This means that unsuitable workers will not work in this home. EVIDENCE: There is a full compliment of staff although the manager will still interview for staff to cover staff turnover. There has been a number of new registered nurses and care staff employed to work at the home since the last inspection. The staff team now appears to be stable and agency staff are only used when there is last minute staff shortages and when the homes own staff team can not cover. This all means that the people who live here will be looked after by staff who are familiar with their needs. A number of concerns have been raised with CSCI regarding staffing numbers on some shifts. There have been occasions when the home has been run short-staffed and agency cover has not been possible. Staff spoken to during the course of the inspection confirmed that this does sometimes happen and “we have to work extra hard to get everything done, but we all do our best”. None of the staff spoken with, or the manager, stated that this was a regular situation. One relative who was visiting the home said that the home was short staffed a while back, but “things are okay at the moment”. The duty rotas showed that, for the day shift, each unit is staffed with at least one Honeymead Care Home DS0000066334.V359568.R01.S.doc Version 5.2 Page 21 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. Those staff members spoken to during the course of the inspection visit, demonstrated a good knowledge of the people who were in their care. The home is committed to an NVQ training programme at both Level 2 and level 3. A number of staff have already achieved level 2 and are now in the process of doing NVQ Level 3. Some staff spoken to were doing their ‘skills for life’ training prior to starting level 2. Whilst the home has not yet achieved a 50 ratio of trained members of staff, it is well on the way to meeting this target. It is a condition of employment that all new recruits to the care team will undertake the NVQ course. A sample of six staff recruitment records, (five new staff) were examined in order to check that the home has improved their recruitment procedures. The procedures include written application, attendance for interview, written references and POVAfirst and CRB checks. In all cases previous employers have supplied the written references. Records evidenced that new recruits do not start work at the home until at least a POVAfirst clearance has been obtained, this is then followed by the CRB checks. New staff will always be allocated to work with a senior member of staff when they start work. One new care assistant said “I always work with a senior carer. They monitor what I am doing”. All new staff should complete an induction-training programme at the start of their employment, however three new staff spoken to were unaware of what they were expected to achieve during this time and records in respects of any programme had not been given to them. Each person said they were allocated to work with a senior staff member and that they were shown how to do things, told about the homes policies and procedures, and were trained to do their job. An “Induction to the Caring Profession” document was found in one persons training file, but this contained only personal work and had not been ‘signed off’ to confirm competence in the caring role. The formal induction process that the home has followed must be re-introduced so that all staff receive training that meets current training and development targets. The training matrix showing what training each staff member has received was in the process of being updated now that the new training programme for 2008 has been finalised. This means that the home manager will be able to identify which staff members are to attend which training. Staff confirmed that they have attended regular training including principles and practices of safe moving and handling, fire awareness and adult abuse, first aid and food hygiene. Mimosa Healthcare have commissioned a training provider to do all the mandatory training and other specific tailored made training, such as risk assessment and dementia awareness training. Honeymead Care Home DS0000066334.V359568.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, 32, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who reside at Honeymead Care Home live in a safe place that is run in their best interests. EVIDENCE: A new home manager was appointed in July 2007 but as yet has not made application to CSCI for registration. This process has begun and it is expected that this will be completed shortly. The home manager has previously been a registered manager in another care home, and has demonstrated her competency in this field of care. She is a registered nurse and has already achieved the registered managers award. Staff confirmed that there is a good style of management and that their views and opinions were valued. The manager has an ‘open door’ policy and welcomes staff, relatives and the people who live in the home to make Honeymead Care Home DS0000066334.V359568.R01.S.doc Version 5.2 Page 23 suggestions about anything to do with the home. Unit managers however need to feel a part of the running of the home and should be leading their shifts. Staff meetings are held on a regular basis and staff confirmed that they are encouraged to have a say in how the home is run. “Resident meetings” have been put on hold as for last couple of meetings only two people have attended and it was felt their views might not represent the feelings held by the other. The activities organiser will capture people’s views on an individual basis. Relative meetings have also been discontinued as again only one two families turn up. The manager will arrange to see relatives to discuss concerns, views and suggestions at any time. A number of audits are carried out on a quarterly basis, to ensure that standards are maintained. These audits include catering, health and safety, care plans, laundry and housekeeping, maintenance and infection control. The audits are completed by several members of the staff team, and result in a remedial action plan being devised. Mimosa Healthcare have recently completed one of their regular “Customer Service Questionnaires” – the results are analysed by head office staff and therefore the outcome was not yet known. This questionnaire captures the views about the day-to-day service provided to the people who live there and their relatives. 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. The manager has set up a cascade system of staff supervision but this has yet to get up and running. Records kept in respects of staff supervision sessions, and discussions with staff evidenced that arrangements for formal supervision have fallen by the way side. Staff spoken with during the inspection stated that the home manager is always available to discuss any concerns, and that the day-to-day supervision is provided by the senior staff. Staff must have regular formal supervision and this should be undertaken at least six times per year. The maintenance person complete regular checks of the fire alarm system and fire fighting equipment, emergency lighting and the water temperatures. The records were all in order. All the necessary service contracts were up to date. Hoists and other mechanical moving and handling equipment is services every six months and is due again in March 2008. Safe manual handling procedures were observed during the inspection, but one relative has raised concerns with CSCI and the manager regarding unsafe moving and handling practices that they have observed. Staff are expected to always follow safe working practices and will be disciplined if they do not do so. For this reason it is very important that a safe system of work (standard 8) is devised for each person, so that they are fully aware of what they are supposed to do. Honeymead Care Home DS0000066334.V359568.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 3 8 2 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 2 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 3 Honeymead Care Home DS0000066334.V359568.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 OP8 Regulation 13(4) Requirement Manual handling risk assessments must be completed for all residents. From this a safe system of work must be devised and followed. These must detail how many staff, and what equipment, is needed. All new members of staff complete the organisations induction-training programme and evidence of how their competence has been achieved is recorded. All care staff working in the home must be formally supervised. At least one session for each member of care staff be recorded within this timescale. Timescale for action 01/04/08 2. OP30 18(1)c 26/03/08 3. OP36 18(2) 26/04/08 Honeymead Care Home DS0000066334.V359568.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations For those long-term residents, a complete re-assessment of their needs should be undertaken on at least a yearly basis and new care planning documentation prepared. Consideration should be given to re-locating where the complaints procedure is displayed in the home. Care staff need to take more care when making beds and ensure beds and rooms are left looking nice and tidy. The position of bed rails must be checked on at least a daily basis. Staff must receive formal supervision at least six times per year. 2. 3. OP16 OP24 4. OP36 Honeymead Care Home DS0000066334.V359568.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Honeymead Care Home DS0000066334.V359568.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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