Inspection on 18/01/07 for Millbrook Lodge

This inspection was carried out on 18th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Millbrook Lodge 06/10/08

Millbrook Lodge 26/11/07

Millbrook Lodge 20/02/06

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 Horsbere House Moorfield Road Brockworth Gloucester Glos GL3 4ET Lead Inspector Mrs Ruth Wilcox Unannounced Inspection 18th January 2007 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Horsbere House DS0000064618.V320162.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. Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Horsbere House Address Moorfield Road Brockworth Gloucester Glos GL3 4ET 01452 863783 01452 862643 manager.horsbere@osjctglos.co.uk 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) The Orders of St John Care Trust Mrs Sitabeli Mlotshwa Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To accommodate 1 (one) named service This condition will be removed when the 65 years or leaves the home. To accommodate 1 (one) named service This condition will be removed when the 65 years or leaves the home. user under 65 yrs old. named service user reaches user under 65 yrs old. named service user reaches Date of last inspection 20th February 2006 Brief Description of the Service: Horsbere House is a care home for forty-five older people that provides personal and nursing care, and respite care if required. It is situated in Brockworth on the outskirts of Gloucester, is located close to local amenities, and is managed as part of The Orders of St John Care Trust. A Registered General Nurse is on duty twenty-four hours a day. All health care services are accessible from community resources, and residents can register with a GP of their choice, within the area. The accommodation was purpose built some years ago, and is provided on two floors. A staircase and shaft lift provides access to the first floor. Residents private accommodation is provided in single rooms on both floors. Hoisting equipment and assisted bathing and showering facilities are provided, and throughout the home there are grab rails and a resident call system. There are spacious and easily accessible toilet facilities conveniently situated. There are three lounges and a large, spacious dining room situated on the ground floor, and there is a small visitors lounge on the first floor. Information about the home is available in the Service User Guide, called the Residents’ Handbook, which is issued to prospective residents, and a copy of the most recent CSCI report is available in the home for anyone to read. The charges for Horsbere House range from £352.70 to £693.00 per week. Hairdressing and chiropody are charged at individual extra costs. Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. One inspector carried out this inspection over two days in January 2007. A check was made against the requirements that were issued following the last inspection, in order to establish whether the home had ensured compliance in the relevant areas. Care records were inspected, with the care of four residents being closely looked at in particular. The management of residents’ medications was inspected. A number of residents and visitors were spoken to directly in order to gauge their views and experiences of the services and care provided at Horsbere House. Some of the staff were interviewed. Survey forms were also issued to a number of residents, visitors and staff to complete and return to CSCI if they wished. 60 of resident and 30 of relative surveys were returned, and 40 of the staff surveys were returned. Some of the survey comments feature in this report. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, training and provision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? A designated social activities coordinator has been appointed to consult with residents and plan and organise social opportunities for them; A new and improved assisted bath has been installed; A new manual lifting hoist has been provided; A new resident call bell system has been installed throughout, and: Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 7 A new passenger lift has been installed. The use of agency staff has reduced more recently as there has been some successful recruitment to the team of staff. A new computerised induction-learning package has been introduced, which is providing improved opportunities in relation to core learning for new staff. 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. Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments are carried out on all prospective residents, so that they can be assured prior to admission that the home can meet their needs. EVIDENCE: Copies of assessments carried out on more recently admitted residents were inspected. These had been conducted and recorded in hospital before the resident’s admission to the home was agreed. In at least one case the home had confirmed the offer of a placement in writing as is required. The manager was observed dealing with a request for an assessment, and was seen to be most helpful and professional whilst providing and obtaining as much relevant information as possible. Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 10 Appropriate care and health information from other health care professionals was also on file, as were copies of the placing authority assessments and care plans where applicable. Copies of Registered Nurse Care Contributions assessments were on file where relevant. Horsbere House does not provide intermediate care. Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some inconsistencies in care planning have meant that staff are not always fully informed about the needs of the residents, which has posed a degree of risk in terms of meeting isolated aspects of health needs for some. Most elements of medication management are safely carried out, however discrepancies and omissions in two particular aspects could pose a risk to some residents. Although personal support is mostly offered in such a way as to promote and protect residents’ privacy and dignity, there have been occasions where this has been compromised for some. EVIDENCE: All residents have a recorded plan of care that is drawn up on the basis of an individual assessment of their health and personal needs. Four were chosen for closer scrutiny as part of the case tracking exercise. Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 12 Many aspects of care plans were well written, and provided clear guidance for staff to follow when delivering care to residents; recorded planning directed staff in relation to the individual’s privacy, independence and choice. However, there were some gaps in recording, some of the more important of which appeared to have affected staff understanding of particular needs in practice. In one case where the resident had diabetes, the condition was not adequately reflected in the plan of care, in particular in the dietary plan; their diabetes was also not reflected in their dietary profile, with recording indicating a ‘normal’ diet. During the case tracking exercise it was discovered that this diet-controlled diabetic, who, it was reported, should have diet strictly monitored, had been served a non-diabetic pudding by staff, despite a suitable alternative being readily available. Residents whose care plan had identified they needed thickened fluids for safety and health reasons, or a lidded beaker, had not had this during their lunch time meal. It was reported that these particular aspects of care were not generally observed or needed at that time, despite one of these residents being at risk of choking; the associated care plans had not been adequately reviewed to clearly reflect these changed circumstances. In some cases there were good care plans to address dietary needs and associated risks, and where relevant staff had recorded nutritional risk assessments; in one case where this had been a consideration, the assessment tool had not been completed. Where risk of falling had been identified the risks had been incorporated into the mobility care plan, but there was no specific risk assessment tool used in some cases. In one case the resident was being regularly seen by the district nurse for the management of a pressure sore; this aspect of their care did not feature at all in the care plan. In another case the daily recording identified that the resident was beginning to suffer from some pressure associated soreness; despite the risk assessment showing that this person was likely to be at this risk, there was no plan of care to direct staff to reduce these risks or manage the soreness. Despite some of these shortfalls there was evidently access to all health care services, with regular checks and treatments in relation to health issues whenever necessary. The systems for handling residents’ medications were safe and well managed in most regards. Residents are supported to self-medicate if they wish and are able to on the basis of a risk assessment, although there was currently no-one opting or able to do this. Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 13 There were clearly printed Medication Administration Records from the supplying pharmacist. These records were thoroughly recorded by the staff, and were well maintained. However, there were examples whereby the precise instructions for the usage of prescribed external creams were not printed or handwritten in the interests of clarity on the charts, and nor was there a documented care plan to give staff clear instruction for its usage and application either. Medications were stored safely and securely. The majority of medications were dispensed in a Monitored Dosage System, although some were boxed and bottled; such items were dated on opening so that they were not used beyond their expiry date. Items requiring cold storage were held securely in a designated refrigerator, and temperatures in here were regularly checked and recorded. Scheduled drugs were stored securely, and the associated register properly recorded. An audit trail was conducted on three specific medications, and the results were accurate in two cases. In the third case, there was an excess of dosages in relation to the number administered since the date of opening that had been transcribed on the box. The manager resolved to address this concern with the nurses responsible for medications, as it was unclear at the time whether the date of opening was accurate or not. The home had received information regarding the safe use of lancing devices for monitoring blood sugar levels for diabetic residents, and good practice was evidently being followed in this area. Residents themselves were generally very satisfied with the care they received, saying that staff were mostly very caring, and that they received good medical support. One resident said that some staff could be forgetful about certain aspects of her care on occasions, and needed reminding to do things. Visitors spoke very positively about the care their relative received, with one saying they were ‘thrilled that their relative was so well looked after’. Another said that their relative had been ‘very underweight on admission, but that they were now gaining weight really well’. Another said that the staff were ‘on the ball’ and had employed some ‘good risk management and medical support’ for her vulnerable relative. Isolated residents indicated that despite being reasonably happy, some staff were not quite so helpful, and could be abrupt in their attitude towards them on occasions. Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 14 One person spoke of a very disrespectful attitude from one carer, who had completely undermined her dignity; it was reported that this particular incident had been properly dealt with at the time. However, this resident confirmed that she had experienced similar incidents since then on rare occasions. The majority of staff were observed being attentive and discreet with residents during this visit, with care being delivered in privacy. Some residents were able to confirm that staff always knocked on their door before entering. Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has made much improved efforts to ensure that residents have the opportunity to participate in a social activities programme. They are also supported to spend time according to their choice, and can keep close contact with their families and friends. The meals in this home offer choice and variety, however do not consistently meet with the needs of the residents. This outcome group has been given an adequate rating because of the failings under standard 15, but many of the other outcomes in this group are good. EVIDENCE: The home has recently appointed a designated social activities coordinator, who is now developing the role with great enthusiasm. Residents have been consulted about their interests and ideas for activity, and records of this are maintained, along with records of participants in each event. A weekly programme of planned activities is displayed around the home. Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 16 Most residents spoke positively about the availability of social opportunities, saying that they could choose to join in or not, as was their wish. Some were participating in an organised group activity at one point during this visit, whilst others were pursuing their own preference to sit quietly reading or watching television. Those residents with particular hobbies have been supported to pursue them, and some have been able to take up craftwork again, whilst one person has been able to renew a past interest in bowling. There is a regular multi-denominational religious service held each month. All residents, regardless of ability, are offered the support to join in activity, with additional support where necessary; one resident who is partially sighted receives the Talking Book service. The home is developing good links within the community, with residents being enabled to access the local library, church, an older persons club, shops and public houses. There are no restrictions imposed upon visitors to the home, with people able to come in and spend time with their relative according to theirs and their relative’s choice. Visitors surveyed confirmed that they felt very welcome at Horsbere House, and that they are kept well informed. One visitor spoken to directly said that she felt very welcome and relaxed, and could spend as long as she wanted with her husband. She said that she enjoyed very good relationships with staff, and that she was always offered plenty of refreshment. Another visitor echoed this, saying that her and her family were always made welcome in the home, and were able to be involved in their relative’s care, and were always properly informed and consulted. Families and friends of residents are encouraged to join in the life of the home, and have recently been invited to attend a residents’ meeting to be held in the near future. Residents were seen in various parts of the home, some being more able to move freely around than others who were more reliant on the staff in this regard, and in relation to exercising their autonomy. Residents were spending their time how and where they wished, with one person saying he had wanted to go back on his bed after lunch as he felt tired, and another saying he wanted to go back to the privacy of his room to watch snooker. One lady said that by and large her choices were respected, except in the mornings, when ‘she had to take her turn to be helped up, when she would prefer to be up earlier’. Residents’ rooms appeared individual to a degree, with the introduction of their treasured and personal items, according to their choice. Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 17 Individual choices were also evident during the mealtime. The service of lunch was observed, and residents had been able to select their preferred options from the menu; at least three different choices were served. A sweet trolley, with a variety of puddings on it, was taken around to each table so that residents could make their selection. Of some concern was that a diet-controlled diabetic had been able to have a non-diabetic pudding without staff showing any awareness of this when questioned. The dining room had been pleasantly laid out, and the meal was taken in a calm and unhurried manner. Staff were discreetly helping those residents who needed it, and eating aids were provided where necessary. Many residents spoke very positively about the standard of food provided for them, ‘particularly when the full time, regular cook was on duty’. However, on this day many plates were returned to the kitchen with significant quantities of food left, with residents unhappy with the quality of the ‘tough meat’. One person said that the food was often ‘very good and tasty’, but that ‘today I’ve had the toughest meat I’ve ever had in my life’. Another said that meat and vegetables were often ‘very hard’, and that ‘people don’t always get what they asked for, particularly at teatime’. Staff in the home, and the printed menus, confirmed that choices are available at teatime, but it appeared that there could be a communication issue for the home to resolve in this area. The above concerns did not exist at lunch on the second day of this visit however, with the quality of the meal of a higher standard, and with residents confirming the meat was tender, and that the meal was very good. The cook on duty on this day was very much in evidence, consulting and being generally very attentive to the residents. A diabetic pudding was served to the diabetic resident on this occasion. Snacks were made available between meals, and home-baked cakes were available for afternoon tea. The kitchen was clean and organised, and records pertaining to food preparation and monitoring were maintained appropriately. Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good system for addressing complaints, with evidence of residents feeling that any concerns they may have are listened to and acted upon. The home’s Adult Protection policies help to provide a safe environment for the residents. EVIDENCE: Nearly all written survey responses from residents and visitors confirmed their awareness of the home’s complaints procedure should there be any concerns. Despite just one visitor response indicating a lack of awareness there is a clearly accessible written procedure for dealing with complaints displayed in the entrance hall of the home. Records of all complaints received in recent months were inspected, and these clearly showed that the home takes all concerns very seriously, and does all it can to investigate and resolve issues for complainants appropriately. The vast majority of residents and visitors confirmed that staff were very receptive and helpful if they raised any concerns, and that where relevant, issues had been sorted out to their satisfaction. One visitor said that she had ‘no qualms at all raising concerns’, and that she had ‘complete confidence in Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 19 the home to help and address them when necessary’. This person also commented that all staff, day or night, were approachable and helpful. The home has written policies and procedures for the protection of vulnerable residents, which includes whistle blowing procedures if and when a concern arises. Training in recognition and types of abuse, and the steps to take when concerns or suspicions are identified, was delivered to many of the staff over one year ago. Training in this area has also been delivered to National Vocational (NVQ) trainees, and to new starters in the home. It was recommended that any worker who did not fit into any of these circumstances, for whatever reason, be identified (if any), and a repeat of the training course be implemented for them. Protection of Vulnerable Adults legislation is observed in this home, and the home’s Disciplinary procedures have been instigated when necessary, in the interests of protecting vulnerable residents. Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within this home is satisfactory, and provides residents with a comfortable and safe place to live. It is generally clean and hygienic for the residents. EVIDENCE: Horsbere House has a designated maintenance person. Records showed the range of regular cyclical safety checks that are carried out by this person in the environment, and also any maintenance work and safety checks that are carried out by an external contractor. The home is generally safe and well maintained, and is currently being redecorated in areas where necessary. Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 21 A communal bathroom had been refurbished, with the provision of a new and improved assisted bath, and a new manual lifting hoist had been provided. A new resident call bell system had been installed throughout. The passenger lift had been completely refurbished, with a new one installed. A carpet in one of the resident’s rooms was identified as being very worn and unsightly, and this was already recognised, with steps being taken to replace it. The bedside table in another resident’s room was also badly damaged and unfit for use, and by the second day of this visit had been replaced as requested. There are plans to replace the carpet on the first floor corridor. The home was satisfactorily cleaned and was free of unpleasant odours. There was a good supply of gloves, aprons, liquid soap and paper towels for staff use. The laundry room was orderly, with items for laundering appropriately segregated. The laundry assistant was handling foul laundry in accordance with good infection control protocols. All grades of clinical waste were managed appropriately, with a contract in place to ensure it is collected and disposed of safely. The ceiling in the first floor sluice room was badly damaged and stained; this was reported to be under consideration for attention by the property department. The metal cabinet, used for storage in this room, was stained and dirty, and urinal metal holders were rusted and no longer fit for their purpose. The metal cabinet in the ground floor sluice was damaged by excessive rusting. Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although staff are provided in sufficient numbers to meet the needs of the residents, current deployment can result in some residents remaining unattended at certain times. Recruitment procedures will ensure that suitable staff are employed for the protection of residents, when consistently and robustly applied. The arrangements for their induction and training are satisfactory, with staff able to learn the skills necessary for their role. EVIDENCE: There has been quite a high staff turnover at Horsbere House recently, although a regular core team has remained. The use of agency staff has fluctuated, but the trend is an overall reducing one, as new staff are recruited. A staff rota is maintained, which allows for at least one registered nurse to be on duty at all times, with two in the mornings with eight care staff, seven care staff in the afternoon and evening, and three care staff overnight. An ancillary team of cleaning, catering, maintenance, administration and laundry staff ably supports the care and nursing team. A variety of inconsistent comments about the staff were received from the residents. Many said that the staff were very good, caring and kind. One person even said they were ‘angels from heaven’. However, a small number Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 23 felt that some of the staff were less kind and helpful. One said that although staff were ‘available’, they had to wait for attention when they were busy elsewhere. Visitors generally spoke very positively about the staff team as a whole. Staff were certainly very busy throughout the visit, and most were seen being gentle, caring and attentive; there were isolated ones who appeared slightly less sensitive however. One of the staff surveyed said that they felt the staff team could be unwelcoming and intimidating to incoming new staff. It was also said that not all were good at teamwork. Although the rota allows for a good number of staff, call bells were heard ringing for a prolonged spell on occasions on each day of the visit before they were answered, and the ground floor lounges were unattended largely, with residents sitting alone for long spells. Call bells were not readily accessible to every resident in the lounges, and the home must give consideration to how these rooms could be better attended by staff. Despite some qualified care staff leaving in recent months, the home is making excellent progress with the National Vocational Qualification (NVQ) training programme for care staff. Due to the leavers the home has not yet managed to reach the target of 50 of care staff being qualified to NVQ level 2 standard, but continues to strive towards this. There were twelve care staff qualified to at least this level at this time, with two others near to completing the level 2 course; there were plans for another nine to start it as soon as possible. Five staff files were chosen for inspection, on the basis of their recruitment to the home since the last inspection. Each record contained application forms, including a full employment history. Records of interviews were seen. Evidence of the required pre-employment checks was seen in nearly all aspects, including medical checks, proof of identity, written references, POVA (Protection of Vulnerable Adults) checks and CRB (Criminal Records Bureau) clearances. However, in one case photographic evidence of the person’s identity had not been obtained, as is required, and in another, only one written reference had been obtained, despite the home requesting the required two. In one case there had been some employment gaps in the history, and although these gaps had been explored and explained, the manager accepted she should have recorded the reasons in writing during the recruitment process. A new worker, who had just started in the home, confirmed that she had been allocated to a supervisor for the duration of her induction. Other staff, when surveyed, said that they had received induction and ongoing training. Induction training records were seen, which included an in-house programme of basic topics to learn. Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 24 The home has just introduced a new electronic induction-learning package for new staff; three staff had just completed this. This induction provides training in six modules, each of which incorporates the Common Induction Standards for care staff, including Principles of Care, Roles and Organisation, Health and Safety, Communication, Abuse and Neglect, and Developing as a Worker. In addition to this, new staff attend one day’s instruction away from the home, with The Orders of St John Care Trust. There is a designated training coordinator, who maintains meticulous training records. Records showed a range of topics that had been delivered for staff, which included mandatory and optional subjects, each of which was relevant to the worker’s role and responsibilities. Staff are issued with certificates of their learning for their own personal training record, and are encouraged to maintain and develop their own personal and professional portfolio. Staff are also issued with the General Social Care Council (GSCC) Code of Conduct. Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are some good management systems in place here to ensure that the interests, and health and safety of the residents are safeguarded. The home reviews its performance through a good programme of self-review and consultations, which includes seeking the views of residents and their relatives. EVIDENCE: The manager of Horsbere House is an experienced registered nurse, and is registered with CSCI for her role. She has recently completed the Registered Manager’s Qualification, and is currently awaiting verification of the award. She has continued to attend training courses relevant to her continued professional development and to the needs of the home. Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 26 The manager is committed to the home and the best interests of the residents, and continually strives to effect improvements. One staff survey commented that the manager always ‘strives to get the best from the staff’. Staff are given feedback on the level of achievement in the home, and receive regular instruction in areas for improvement where applicable; this would appear to be an ongoing process with some isolated members of the staff. As part of this process, a range of quality monitoring audits are carried out in areas such as required documentation, accidents and falls, complaints and concerns, health and safety and the environment. Residents’ and relatives’ opinions had also been sought as part of this quality monitoring process, and recently an annual quality assurance survey was distributed to them, so that they could provide feedback on their experience of the accommodation, facilities, catering, care, social activities and visiting arrangements. The manager had drafted a report on the basis of collated results, to address any issues. The manager was very accessible to everyone in the home, and residents and visitors had the opportunity to give comments and suggestions in writing if they wished. A residents’ meeting was planned and advertised. The home has a system for residents to have a six monthly review of their stay, so that they can offer their views about care, services, facilities and any concerns they might have. Many residents have placed personal money and valuables in the home’s main safe for safekeeping. Clear and transparent records for each person, which included transaction details, running totals, and receipts, were seen. Residents or their representative can sign to acknowledge transactions, but where this had not been possible in the majority of cases, two staff members had signed the record to witness on behalf of the resident. A case tracking audit against two residents’ money proved to be correct, with no discrepancies seen. Health and safety issues were addressed satisfactorily, with written policies, procedures and risk assessments and provision of necessary equipment. There is a small health and safety committee, which meets regularly, and comprises members of the senior staff and a resident representative. A full fire safety risk assessment throughout the home has been undertaken by an external assessor, with due regard to fire safety regulations; a significant number of concerns were identified during this assessment, which were being addressed. Staff had received training in fire safety and manual handling, with some qualified in first aid. The home has its own manual handling trainer, who Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 27 provides theoretical and practical training, and fire safety training involves theoretical and practical instruction as well. All necessary safety checks and maintenance of equipment is undertaken in a timely fashion. Servicing records in relation to the portable electrical appliance testing and the fire extinguishers were not available for direct inspection. Hot water temperatures were regularly checked for safe levels, and regular Legionella checks on the water supply were also carried out. Accident records were maintained where appropriate. The environment was generally secure, and there were coded door entries in a number of areas. Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 (1) & 17(1.a) Schedule 3 (3.m.n) Requirement The registered manager must ensure that staff prepare written care plans that incorporate and plan for all aspects of care which are needed in each case; (this is with particular reference to dietary requirements and pressure sore management on this occasion). The registered manager must ensure that care plans are regularly reviewed, and are accurately revised and updated on the basis of the outcome. The registered manager must ensure that staff provide proper supervision to residents in relation to their particular health and dietary needs. The registered manager must ensure that risk assessments are fully carried out and recorded in cases where there are concerns in relation to nutrition and falling. The registered manager must ensure that clear instructions for the use of external medications are recorded on the medication administration charts. DS0000064618.V320162.R01.S.doc Timescale for action 28/02/07 2 OP7 15(2.b.c) 28/02/07 3 OP8 12 (1.b) 28/02/07 4 OP8 13 (4.c) 28/02/07 5 OP9 13(2) 28/02/07 Horsbere House Version 5.2 Page 30 6 OP10 12 (4.a) & 12 (5.b) 7 OP15 16(2.i) 8 9 OP26 OP27 13(3) 18(1.a) 10 OP29 19(1) Sch 2 The registered manager must ensure that all staff members conduct themselves in a way that is respectful and professional towards residents. The registered manager must ensure that all staff provide all residents with a choice of food that is suitable for their needs and is properly prepared. The registered manager must ensure that the metal holders for plastic urinals are replaced. The registered manager must carry out a review of the deployment of staff with a view to ensuring that residents in the ground floor lounges are regularly attended. When recruiting new workers, the registered manager must ensure that: • A photograph of the worker is obtained. (This requirement has been repeated from the last inspection) • Two written references are obtained. 28/02/07 28/02/07 31/03/07 31/03/07 28/02/07 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 3 Refer to Standard OP7 OP26 OP28 Good Practice Recommendations The use of external creams should be linked to an associated plan of care. The rusted metal storage cabinet in the sluice room should be replaced. A minimum ratio of 50 of care staff qualified to NVQ level 2 should be achieved in the home. DS0000064618.V320162.R01.S.doc Version 5.2 Page 31 Horsbere House Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Horsbere House DS0000064618.V320162.R01.S.doc Version 5.2 Page 32 - 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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