Inspection on 26/11/07 for Millbrook Lodge

This inspection was carried out on 26th November 2007.

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

The inspector 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 18/01/07

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 Key Unannounced Inspection 09:00 26 & 27th November 2007 th 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.V351254.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.V351254.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.V351254.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. 18th January 2007 user under 65 yrs old. named service user reaches user under 65 yrs old. named service user reaches Date of last inspection 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; the home now features as part of a planned redevelopment programme. 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 £539 to £742 per week and the home also can admit residents at the contract rates from the Local Authority. Hairdressing, chiropody and toiletries are charged at individual extra costs. Horsbere House DS0000064618.V351254.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 unannounced inspection over two days in November 2007. Care records were inspected, with the care of four residents being closely looked at in particular. The way in which staff addressed and worked with many of the residents was observed. The management of residents’ medications was inspected. A number of residents 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 large number of residents and visitors to complete and return to CSCI if they wished; a large number of responses were received, and some of their comments feature in this report. A small number of the home’s staff responded to the survey forms that were issued to them. 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, supervision 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.V351254.R01.S.doc Version 5.2 Page 6 What the service does well: Horsbere House provides a safely maintained and generally comfortable environment for the residents to live in. The home provides a welcoming atmosphere for visitors, and ensures that there is a good amount of information about the home, its services and facilities, to assist residents and their families. Residents are admitted to the home on the basis of an assessment of their individual needs, and upon admission each has their own personal documented plan of care to address their individual needs. Residents’ choices and levels of independence are respected in a variety of ways here, and many positive comments were received regarding the care and attention they received in the home, with some citing improved health, and dedicated, caring staff. Appropriate support equipment was in use on the basis of individual risk assessments, there was evidence of appropriate sourcing of medical reviews and healthcare, and there were many examples seen of residents receiving good care and support. The designated social activities coordinator works hard to provide some very good opportunities for residents to remain socially active, however there are some who feel that they are afforded little opportunity to do much with their time, and would prefer more. The meals seen appeared nutritious and appetising. Residents were generally appreciative of the quality and quantity of the food provided for them, and despite a good degree of choice evident from records, an isolated few thought that choice could be better. People can be assured that the home takes any complaint seriously, and has a thorough approach to addressing any that are received. There are some good quality monitoring approaches adopted here, with residents encouraged to have a say in how their home is run. There are policies and procedures in place for the protection of the vulnerable residents, which staff are familiar with, and the home offers a safe and transparent system for safeguarding personal monies or valuables for those residents wanting such a service. Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 7 Staff are recruited in accordance with good recruitment procedures, with the necessary pre-employment checks taking place, and staff receiving regular supervision. They have the opportunity to attend training appropriate to their work, which includes a good focus on the national vocational training. What has improved since the last inspection? What they could do better: The home has failed to meet the requirement to revise care plans appropriately on the basis of the monthly reviews that are carried out. The home has also failed to consistently meet the requirement to ensure clear directions for the usage of external medicines are printed on medication administration charts, and although there was some improvement with devising care plans in relation to certain external preparations, gaps remained with this also. Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 8 Some slight discrepancies were also identified during the medication audit, which require some investigation by the manager and nursing team. Some comments were received from residents and visitors about having to wait for a staff response to a call bell, with times being too long on occasions. The cleaning team was depleted at the time of this visit, and some unpleasant odours were detected in several locations around the home for part of this inspection. The laundry room was very busy and cluttered, with an agency worker in there. A lapse in the otherwise good infection control procedures was witnessed in relation to washing cycles. The residents have not particularly welcomed the increased use of agency staff in recent months, but the use has been for valid reasons, and is not the longterm and accepted strategy for providing staffing here. Horsbere House has had to deal with a number of tensions within the staff team, with communication issues appearing to contribute to this; the manager and many of the staff are working hard to overcome this problem. 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.V351254.R01.S.doc Version 5.2 Page 9 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.V351254.R01.S.doc Version 5.2 Page 10 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 & 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home have access to a good amount of information about it, and are assessed fully prior to their admission so that they can be assured that the home will be able to meet their needs. EVIDENCE: The home has recently introduced a new and revised Statement of Purpose and Service User Guide, known as the Residents’ Handbook. The former is readily available in the entrance hall for anyone wanting to read it, and a copy of the latter, which contains all the information that is required, is issued to each prospective resident. This document now requires a slight amendment, as it indicates that the home provides a designated smoking area, which it now no longer does. Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 11 The Statement of Purpose also requires a slight amendment in order to demonstrate the fact that the home can provide care and accommodation to some residents who are between the ages of 55 to 65 years of age and who have conditions associated with old age, as well as to those over 65 years. Care records belonging to a recently admitted resident, plus two others, contained completed assessment forms that identified their health, care and social needs prior to admission to the home. The assessment was recorded in full, with each process evidently carried out thoroughly. The assessment had been carried out at the location convenient to the prospective resident, and was well supported by information provided by other health and social care professionals previously involved in the care of the individual. Horsbere House does not provide intermediate care. Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 12 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. People living in this home have their health and care needs met, although isolated omissions in documented care planning and medication records could pose a small degree of risk in this regard. Dignity and privacy is largely observed, but with isolated practices potentially compromising this for some. EVIDENCE: All residents have their own personal plan of care, which is subject to regular review. Four were selected for a case tracking exercise, and were scrutinised in closer detail, plus a further three were also checked more closely as part of the medication inspection. Staff have evidently worked very hard with planning residents’ care to meet their particular needs, and the standard of care plan documentation has improved since the last inspection. Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 13 Care plans had been drafted on the basis of the assessed needs of the individual, and evidently reflected the person’s choices and levels of independence. Plans had been regularly reviewed, but many of the review documentation entries were meaningless, as in the vast majority of cases the only entry was ‘no change’. In some instances this was in fact the case, however in other cases the medical information and care notes demonstrated that there had clearly been a change to treatment and actions, which had not been reflected in the review, with no appropriate revision to the associated plan of care. There was a well documented plan of care to address wound management in one particular case, and some good monitoring arrangements in place for someone with mental health needs and challenging behaviour. The tissue viability nurse and the psychiatric team had been involved in each of these respective cases. Risk assessments were in place in relation to nutritional and pressure sore vulnerabilities, with care planning to direct care on the basis of the outcome. In two cases however, although care was obviously being delivered in practice in relation to nutritional needs, a documented nutritional risk assessment had not been done. Falls risk assessments were in place, with care plans to address these where necessary. Some good risk assessment work had also been carried out in one particular case whilst the home, the family and the supporting medical team were carrying out a complete review of the care home placement. There was very good evidence of multidisciplinary working between the home and other health care services, with residents afforded regular medical reviews and consultations, and access to a range of health care services, either in the community or in the home. A general practitioner and the chiropodist were present carrying out consultations during this inspection. All necessary support equipment was in use on the basis of assessed needs and risks, with pressure relieving, mobility, and safety equipment in use in many cases. The home was clearly very busy, and on the first day of this visit, the call bell was heard ringing for prolonged spells. Some residents said that there were occasions when they were kept waiting when they asked to use the toilet, and sometimes to get a response to their bell. Conversely, one relative said that ‘the staff are fantastic and come as soon as the bell is rung’. Other residents generally said they were well cared for, and that the staff were kind and caring. Some residents’ relatives also said that care was good, and that staff were kind. One person said that their relative’s health had ‘greatly improved’ since coming into the home’. Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 14 One relative said they would like their relative to have a more frequent bath, and that there had been occasions when the call bell had been left out of their reach. Although there is no one currently doing so, residents are able to manage their own medications if they wish and are able, on the basis of a documented risk assessment. Storage for medications was secure and clean. Items requiring cold storage were stored in a designated refrigerator; temperatures were monitored and recorded regularly, the records for which showed that the suitable temperature range was only just being maintained. This had already been recognised by the manager, with close monitoring taking place with a view to a replacement as soon as necessary. Controlled Drug (CD) storage was provided, and a tidily recorded bound register was maintained, with regular stock checks also recorded. The supplying pharmacist prints the medication administration charts, which includes highlighting any relevant allergies. The author had signed any hand written entries made in the home, with a second signatory as witness in most cases, although there were some occasional gaps with this. There was a clear audit trail of administration signatures, with only one gap identified, with no coded reason for an omission recorded. There remained some external preparation prescriptions, such as eye drops and creams, which did not have clear directions for usage identified, despite a requirement for this to improve following the last inspection, neither were there associated care plans to address their use. In two cases these were newly prescribed items, which the nurse had not had the opportunity to address, but in other cases this mitigating circumstance did not apply. In one of the cases looked at more closely, the care plan directed the use of an emollient and barrier cream for skin protection; none of these items had been prescribed or appeared on the medication administration chart, so it was not clear how this was happening. Boxed and bottled items were dated on opening as a precaution against using the item beyond its expiry date, and also provided a good means of conducting audits. Random audits were carried out on four specific boxed medications, and a discrepancy was identified in two cases. There were a small number of dosages in excess of what there should have been at that particular point in time. A definite explanation could not be identified at the time of this inspection, but nurses on duty thought that the date of opening on the box was incorrect, having been added after the event. It was agreed that the manager would further consider and explore this with the nursing team. Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 15 The manner in which care staff were addressing and interacting with residents was viewed as being much better during this visit. The staff group on duty on this occasion were attentive and respectful towards the residents, with support provided in a more sensitive and appropriate way. Some of the residents themselves confirmed that staff were respectful towards them. Care was generally delivered in the privacy of the resident’s own room, although in one instance an examination conducted by the general practitioner in the presence of two staff was carried out with the door open, which did not respect the privacy and dignity of the individual properly. One relative said that in their view ‘the staff always showed tolerance and kindness in even difficult circumstances’. Another said that ‘staff work hard to provide a friendly and caring environment, and make a real effort to become familiar with residents personalities and needs’. A small number of staff raised concerns about ‘certain staff members who enter into discussions with residents about other staff’, which they quite rightly consider inappropriate and which, upon discussion with the manager, is being addressed. Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 16 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. Most of the people living in this home have a degree of opportunity to remain as socially active as they are able and choose, and all have a nutritious diet that offers choice and variety. EVIDENCE: The home has a designated social activities coordinator, whose contracted hours the manager would like to increase ideally. A social programme has been developed, and the coordinator was working very hard to help residents pursue their particular interests. A number were being taken out to visit the local library on the first day, and on the second day the coordinator was witnessed trying to arrange ballroom dancing lessons for one resident who had expressed a particular interest in this area. It was her declared intention to forge links within the local community for the benefit of residents, and she had a forthcoming meeting with a member of the local community association, where a number of event and clubs were held, which residents could access if they were interested. Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 17 Pupils from a local school visit regularly to join in social events and activities with residents, and some residents go out to an older person’s social club run by a church. Ministers visit to provide pastoral support, and there are monthly Holy Communion services held within the home. One person is regularly supported by representatives from within her own personal denominational faith, quite separate from the others, as is her wish. Activity programmes on display showed forthcoming events, including outings, Christmas events, entertainments and parties. In the absence of the activity coordinator, members of the care staff are allocated to carry on this work, and this is where some challenges are faced in terms of quality time to devote to it. During the afternoon, one carer was seen playing dominoes with one person, but apart from that many residents were watching television, or just sitting with no interaction going on, which for some was entirely acceptable, although one said that they ‘spent a lot of time just watching television’. However, despite many residents seeming happy with the social opportunities, there were those among them, plus some of the visitors who felt that there should be more for them to do. One visitor said that there was ‘not as much activity going on as they had been led to believe’, and another said ‘I wish there was more individual stimulation’. One member of staff also felt that social activity for residents was an area that the home could improve upon. Conversely, one particular visitor said that there was ‘very good entertainment’, and her relative ‘enjoyed going out to church regularly’. The home imposes no restrictions on visitors to the home, and residents are free to receive their visitors in accordance with their choice and wish. One resident said that she ‘found it very comforting’ that her relative could stay as she liked, and was made so welcome by staff; she said that ‘the staff treat my daughter just as they treat me’. Most of the visitors who responded to surveys confirmed that they felt welcome in the home, and appeared to enjoy very positive relationships with staff. One person said that staff were always ‘most courteous, and that they were made to feel welcome to sit with their relative whenever they liked’. Another family said that ‘the staff had been very supportive towards them as a family’, whilst another said they were always ‘greeted cheerfully by staff’. Personal choice was reflected in many of the residents’ bedrooms, with most introducing their own personal treasures and belongings, despite some of the rooms being small and limited in terms of space. Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 18 One resident commented that in her experience her choice as to how and where she spent her time was fully respected by staff. Staff were witnessed offering choices to people, and paying heed to their views and requests. Some residents in particular had very particular things they wished to do or not do, and staff were mindful of this. Care plans also reflected personal choice, and directed staff towards respect for this. Although the vast majority of the residents were reliant on the staff for most things, wherever possible levels of independence in relation to retaining autonomy over their lives was upheld. Residents were also exercising choice in relation to mealtimes. Menus for the day were recorded on a notice board, and menus for the week were displayed on each table. A list of residents’ choices from the menu was supplied to the cook for her reference when preparing meals. Some residents were seen having a cooked breakfast if they wanted it, and at least three choices of meal were seen served at lunch. The tables were laid attractively, and the meals were well presented. The level of supervision for residents was much better on this occasion, with sufficient staff available and helping residents wherever necessary; the mealtimes were seen to be quite calm and unrushed. Generally residents were very satisfied with the quality and quantity of food provided for them, although there were very isolated comments about a lack of choice. One person said ‘the meals were first class’. Special diets were catered for, and the cook was able to speak knowledgeably about the needs of certain individuals. She was evident at mealtimes, and took the time to greet and consult with residents. Her records demonstrated that residents often vary from the menu, and that a lot of variety is available to residents if the actual menu choices are not wanted. Good catering records were maintained, and the kitchen was orderly. Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 19 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. People living in this home are able to express their concerns, and can be reassured by the home’s complaints procedure and the policies regarding protecting their rights and the prevention of abuse. EVIDENCE: A copy of the home’s procedure for addressing complaints and concerns is well displayed in the home; it is also issued within the Residents’ Handbook to each person. Residents and visitors generally knew how to raise a complaint if they had to, and said that staff respond appropriately; just one resident said that ‘not all staff did’. A record of any complaints and concerns received is kept; these records show a very robust approach to addressing those that arise. There was also evidence that anything learned from complaints and concerns received is viewed positively, with actions taken and measures put in place to endeavour to rectify and improve for the future. The home has documented policies and procedures to address forms of abuse and whistle blowing procedures, which are readily available for staff to read. Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 20 The manager and senior care leader also said that the profile of protecting vulnerable adults in their care was kept high through discussion at handovers and at meetings. Staff have received adult protection training, and any new staff joining the team receive this training during their induction. Recognition and prevention of abuse training is also delivered during the National Vocational Training programme. Staff who responded to the survey, confirmed that they were aware of these issues, including the whistle blowing procedure. Staff have used these procedures, and there is currently one case under consideration through the staff disciplinary procedures where concerns about practice and attitude have been raised. Staff have been informed about the recent implementation of the Mental Capacity Act, and have access to an easy-read version; the manager has sourced a Department of Health training set for use with staff. Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. Despite some very isolated concerns in this area, people living in this home are generally provided with comfortable accommodation, which is suitable and safe to meet their needs. EVIDENCE: This home features as part of the redevelopment programme being carried out by The Orders of St John Care Trust. In the interim all efforts are being made to maintain the premises in a suitable and safe condition, with ongoing attention to redecoration and necessary repairs. New equipment and items of furniture have been provided in a number of areas. The maintenance person carries out a range of cyclical maintenance checks, records of which were seen. Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 22 The home now provides a totally non-smoking home environment, and has displayed a written notice to this effect. Some of the divan-style beds in some of the bedrooms, although serviceable for the current occupants, have been well used, and in the absence of a valance sheet the exposed worn base does not create a pleasing impression. The manager confirmed that she had provided valance sheets to prevent this, but staff were not being consistent in using them. Despite a depleted cleaning team the home was reasonably clean, although some unpleasant odours were detected in a number of locations, particularly during the first day of this visit; they were less evident on the second day. Residents themselves said that in their view the home was kept clean; a relative commented similarly, and also said that the laundry service was good. The laundry room was very cluttered and busy when visited, with an agency worker on duty. Laundry was appropriately segregated, with foul items contained within red dissolvable bags. Washing machines were capable of washing items at the proper temperatures for disinfection, but it was noted that a load of towels and whites in a red bag, (denoting foul items) were being laundered on a woollen cycle at too low a temperature for disinfection. The laundry worker said she had not done this herself, but would ensure that the items went through the proper disinfection cycle afterwards as a precaution. Clinical waste is correctly managed, and sluice rooms were reasonably clean and orderly. There were copious supplies of the necessary protective equipment for staff use as part of infection control procedures, and this included liquid soaps, paper towels, gloves and aprons. Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Despite isolated concerns regarding staffing, people living in this home receive care from a trained and competent workforce, and can be reassured by the rigorous pre-employment checks carried out on new staff. EVIDENCE: The rotas demonstrate that there are two qualified nurses on duty each morning, with at least one on at all times. There are eight, seven and up to four carers on duty during the morning, afternoon/evening and overnight respectively. An ancillary team of cleaning, catering, maintenance, administration and laundry staff supports the care and nursing team, and the manager works in a supernumerary capacity. At the time of this inspection there were some shortfalls on the domestic side of the staff, with agency cover in the laundry, and a depleted cleaning team, primarily due to sickness. Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 24 Concerns featured in a number of resident and visitor survey responses regarding the apparently high use of agency staff here. Upon investigation there had been significant usage recently, but this had been due to prolonged and necessary absence of one of the nursing team, and was not the accepted way to provide staff here for any longer than necessary. The manager has increased the amount of staff hours utilised in the home, and has been revising the rotas in order to provide a better skill mix as part of improving care delivery for the residents. Isolated members of the care team have proved to be challenging in their resistance to these innovations, and it is fully recognised that this challenge has to be overcome, with greater cohesiveness amongst the team achieved; team building training has been provided as part of the strategy to achieve this, although there are reported to be a very few remaining who continue to undermine the team effort and philosophies of the home overall. Two visitors said that they were often kept waiting at the front door, as they could not get a response to the doorbell; one said that they thought this was due to staff all taking a break together simultaneously. Upon investigation, responses to the doorbell may be slow at times, and this is possibly due to it being connected to the resident call system. The doorbell emits the same sound in the home, and calls register on the system in turn, which means that if residents are ringing simultaneously, then staff would not necessarily be aware that the doorbell was ringing. The manager confirmed that staff are not permitted to take breaks simultaneously, and staff allocation sheets show that breaks are taken in a staggered fashion. Some residents said that staff are usually available when they need them, but some did say that staff are very busy and can be kept waiting. Some also commented that agency staff did not appreciate the needs of the residents very well, and that this affected the way in which care was sometimes given. One family said that the home had a very dedicated staff team; another said the staff team was very pleasant. Some of the staff themselves said that communication problems existed amongst the team, and that this was an area that needed to improve. The home is making good progress with the NVQ training programme for care staff. There are twelve care staff qualified to at least level 2, with two of these at level 3, with a further twelve working towards the award at the present time. Another two are progressing to the level 3 award. Personnel files relating to three members of staff who had been recruited in recent months were inspected. Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 25 In each instance, the prospective employee had completed an application form providing details of their employment history. Interview notes were recorded. At least two written references had been provided in each case, including one from the last employer. Proof of identity and medical statements had been obtained. Correct POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) screening had been completed for each person. An electronic induction-learning package (E Learning) is in use for new care workers, and this incorporates the National Common Induction Standards for Care Workers. New members of staff receive structured induction training, and work in a supervised capacity for that period; this is routinely with one of the senior care leaders. One person commented that the induction training had been very good. Another confirmed that they were feeling very well supported during their current induction period, and were not working alone, although it was noted that she was in fact alone at the time spoken to whilst she made a resident’s bed. This person had only been at the home for two weeks, and had yet to attend the structured induction day with County Office, and had not yet commenced her E Learning package. There is a designated training coordinator for the home, and full records of all training planned or delivered are maintained. There is a range of mandatory and optional training available to staff, all of which is entirely relevant to the role they perform and the needs of the residents. The home has three of its own trained manual-handling trainers. A fire safety trainer was present during this visit delivering fire safety training for all staff. Care planning training was due to be delivered, to assist staff with the introduction and implementation of new assessment and care planning documentation. Cross-cultural training had been delivered for staff recruited from overseas. Staff receive certificated evidence of the training they have undergone, and each is encouraged to develop and maintain their own professional portfolio. Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in this home benefit from open and respectful management, in which a qualified and competent manager strives to monitor quality and standards. EVIDENCE: The manager of Horsbere House is a first level registered nurse, who has long experience of providing care in this setting. She has been registered by CSCI for her role, and has achieved the Registered Manager’s Award. Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 27 She is a committed individual, who endeavours to place the interests and welfare of the residents at the top of her agenda, which has necessitated a strong focus on her part in relation to monitoring certain staff practices and standards generally in the home. One family in particular commented on ‘how good the manager is’. There is a clear intention demonstrated by the manager and some of the senior staff here towards monitoring and promoting standards for the benefit of residents; the manager was observed to be visible around the home as part of this, and was seen meeting with residents and their families where necessary. There are regular auditing arrangements as part of the quality control systems, and the home has recently undergone an in-depth internal audit, and has also been accredited for the ISO Quality Award. The home’s business plan is shared with residents and their families. Residents are invited to participate in an annual survey, during which they can give their views and opinions of the service they have received. Action plans are drawn up on the basis of such an exercise, with actions taken to address any particular areas. Residents and their families are also able to attend meetings, and records of minutes seen clearly demonstrated that their views and input are very much sought and welcomed. The Orders of St John Care Trust carry out regular monitoring visits, producing written reports as required, and the outcomes of CSCI reports are shared with the staff team. As indicated above, there are isolated staff who have not viewed this process particularly positively, and a blame culture has evolved in small sectors, whilst others use it to learn and develop in a positive way. A large number of residents have opted to keep personal money in the home’s main safe. There are well-kept and transparent records for each individual, which clearly demonstrate any receipts, expenditure and running balances. In cases where residents are unable to sign their own records, two staff have signed to witness any entries. Receipts are kept of transactions, and there is generally a clear audit trail of events. Random checks conducted on arrangements showed complete accuracy and transparency. The manager has reviewed staffing and skill mixes, and has made arrangements for care leaders to be more evenly spaced out around the home, as part of the supervision arrangements for the team in practice. Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 28 Despite two care staff saying on survey that they did not receive any supervision, records clearly showed that there are regular staff supervision sessions carried out, with a matrix in place to monitor and plan the programme. Annual appraisals also feature within this programme. Staff meetings are also conducted, and recorded minutes of one such meeting showed that staff receive clear instruction regarding good care delivery, practice issues and other arrangements to benefit those in their care. Probationary supervision records were also seen within new staff files. The home has written policies and procedures in relation to the promotion of the health and safety of the residents, visitors and staff, and associated training is provided for staff. Records showed that regular safety checks and planned maintenance visits are carried out on the fire safety systems, and the policy regarding fire safety training and evacuation procedures is currently under complete review. Staff have received regular fire safety training, with random fire drills carried out, however this is also currently being updated, with a more robust approach to compulsory staff training being adopted, which now incorporates evacuation procedures in the event of fire. The home will have a nominated Fire Marshall with trained assistants. There is first aid equipment in the home, and first aid training has been provided to the nurses and two of the care staff; one of these carers has undergone the more rigorous four-day first aid training course. First aid notices in the home provide reassurance and direction for visitors and residents should they need it. Hot water temperatures are regularly checked for safe levels, and regular Legionella checks on the water supply have also been carried out, with the appropriate control measures in place. All the necessary safety checks and maintenance of utilities and equipment are undertaken in a timely fashion, and the associated records are kept in these areas. The building was secure, with coded door entries in a number of locations. Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 29 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 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 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 30 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(2.b.c) Requirement The registered manager must ensure that care plans are regularly reviewed, and are accurately revised and updated on the basis of the outcome. This requirement is repeated from the last inspection. 2 OP9 13(2) The registered manager must ensure that clear instructions for the use of external medications are recorded on the medication administration charts. This requirement is repeated from the last inspection. 3 OP26 13(3) The registered manager must ensure that when handling foul/infected laundry, appropriate washing cycles are used to disinfect the items. This is in relation to sufficiently hot water temperatures being used during washing cycles. 31/12/07 31/12/07 Timescale for action 31/12/07 Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP12 Good Practice Recommendations The use of external creams should be linked to an associated plan of care. Staff in the home should review the way in which social activities are made available to residents to ensure all have equal opportunities. Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Regional Office 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 Horsbere House DS0000064618.V351254.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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