Inspection on 02/04/07 for Howbury House

This inspection was carried out on 2nd April 2007.

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

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

Other inspections for this house

Howbury House 02/04/09

Howbury House 13/10/05

Howbury House 18/04/05

Howbury House 05/01/05

Howbury House 13/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Howbury House Pickersleigh Grove Malvern Worcs WR14 2LU Lead Inspector Nic Andrews Key Unannounced Inspection 2 & 3 April 2007 09:25 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 Howbury House DS0000037483.V333140.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. Howbury House DS0000037483.V333140.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Howbury House Address Pickersleigh Grove Malvern Worcs WR14 2LU 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) 01684 571750 01684 571753 www.worcestershire.gov.uk Worcestershire County Council Ms Patricia Averil Bradley Care Home 36 Category(ies) of Dementia - over 65 years of age (36), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (36), Old age, not falling within any other category (36), Physical disability over 65 years of age (36) Howbury House DS0000037483.V333140.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home may accommodate people over the age of 60 for the purposes of intermediate care and respite care The home may provide intermediate care for a maximum of 17 service users. The home may also provide this intermediate care to one person under the age of 60 years. 13th October 2005 Date of last inspection Brief Description of the Service: Howbury House is a large, single storey building located in a residential area a short distance from the main road that runs through Malvern Link. There is easy access to public transport and shops. The premises have attractive gardens including enclosed gardens and sitting areas. There is a large, open field on the one side of the premises that allows pleasant views of the Malvern Hills. The premises are owned and operated by Worcestershire County Council. The premises are designated as a resource centre and are currently registered to provide personal care for a maximum of 36 older people. The service users are accommodated in single bedrooms in units. Currently, there are two units each of which accommodates 10 service users and there is one unit that accommodates 6 service users. A new unit has been developed to provide respite care for people with a dementia illness. This new unit will accommodate 6 service users. The new unit will also include a day care service with places for up to ten people per day. It is anticipated that the new unit will open in June 2007. When this happens the number of service users for which the resource centre is registered will be reduced from 36 to 32 older people. The units have their own communal bathroom and toilet facilities, a combined lounge and dining area and the shared use of a small, domestic kitchen. A service is provided on two units for a total of 16 service users that require intermediate care. The maximum length of stay is normally six weeks. A third unit provides eight places for people that require a respite care service. In addition, one place is designated as a ‘rapid response’ facility. This one place forms part of the intermediate care service. Although the provision of a permanent residential care service has been phased out, one permanent service user continues to reside on the premises. The purpose of the resource centre is to work closely with families and in partnership with healthcare and other professionals in order to provide a Howbury House DS0000037483.V333140.R01.S.doc Version 5.2 Page 5 flexible service that is responsive to the needs of local people whilst maximising the resources available. The fees ranged from £64.65 per week to £343.00 per week. A day care service is provided for up to 11 people a day, five days per week. The day care service is staffed separately and did not form part of the inspection. Howbury House DS0000037483.V333140.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place over the course of two days. The service was inspected against the key National Minimum Standards with the assistance of the registered manager and deputy manager. Various records and a number of policies and procedures that the service is required to maintain were inspected. Parts of the premises were also inspected. Individual discussions were held with three service users and seven members of staff. As part of the inspection Comment Cards were issued to a number of service users and/or their relatives and to visiting professionals. A total of eleven Comment Cards were completed and returned. Seven Comment Cards were from service users/relatives and four were from visiting professionals. The majority of the responses to the questions that were asked in the Comment Cards were positive. Any additional comments that were made are reflected in the body of this report. What the service does well: What has improved since the last inspection? Since the previous inspection the rehabilitation and assessment service had been ‘streamlined’ into an intermediate care service and the single assessment process had been introduced. Training had been provided to enable staff to work more closely with the service users to increase their involvement in care Howbury House DS0000037483.V333140.R01.S.doc Version 5.2 Page 7 planning. Joint training had been developed with staff in the home care service. Unit 8 had been redecorated. There had been a complete refurbishment of units 5 and 6 in order to provide a short-stay, respite care service for people with a diagnosed dementia illness. When opened the new unit would provide 6 respite care places, including one emergency place, for people living in the community for a maximum of two weeks per stay. It was proposed that the new unit would be lead by a person with an RMN qualification and staffed by people who are trained to work specifically with people with dementia. A new, brick-built storage facility and a new, quiet room that was also used as the designated smoking area had been provided. All the corridors had been redecorated and new carpets and curtains had been provided throughout the premises. A new sunroom in unit 4 had been provided and the office space had been extended. New lounge furniture had been purchased for units 3 and 4. Four new nexus beds and a new hoist and cushions had been provided. Paper towel and liquid soap dispensers had been installed in all of the rooms. 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. Howbury House DS0000037483.V333140.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 Howbury House DS0000037483.V333140.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 and 6. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. Prospective service users were provided with comprehensive and relevant information about the service and they were given a contract that contained clear details about the service they would receive. EVIDENCE: A copy of the statement of purpose was made available for inspection. The statement of purpose included all of the required information except for the physical environment standards met by the resource centre referred to in Standard 1.1. The resource centre provided prospective service users with an information pack that also contained a range of relevant information normally found in a service users’ guide except for the physical environment standards, the correct number of service users and details of the new respite care service for people with a dementia illness. The registered manager confirmed that all of the service users were given a statement of their terms and conditions of residence (contract of care) at the time of their admission. The service users were asked to sign a form confirming that they had been issued with a contract of care. A copy of the Howbury House DS0000037483.V333140.R01.S.doc Version 5.2 Page 10 contract of care was kept on the service users’ individual files. It was stated that the resource centre retained the signed form. The contents of the contract of care were satisfactory. However, the contracts did not include details of the fee. The fees were assessed by financial assessors who worked for the Council but who were independent of the resource centre. The staff stated that they were unaware of the fees for each service user and that sometimes there were long delays before the service users were informed about the charges. There was no charge for intermediate care, only for respite care. Two of the three service user files that were inspected had a copy of the contract of care, one of which was signed but not dated. All prospective service users were assessed prior to admission. Two social care assessors that were based in Worcester were responsible for assessing the needs of prospective service users. The care staff were given copies of the assessments of the service users but they did not have their own assessment form. The assessments carried out by the social care assessors did not cover all of the relevant aspects of care referred to in Standard 3.3 in sufficient detail to enable the care staff to prepare a comprehensive care plan. It was stated that the resource centre did not have its own assessment form. Instead, the form that was used as a care plan was used as the assessment form. The care staff should carry out their own care needs assessment using an assessment form that includes all of the aspects of care listed in Standard 3.3. The occupational therapist and physiotherapist also carried out their own individual assessments of the service users. The registered manager confirmed that prospective service users were given the opportunity to visit the resource centre before admission whenever possible. However, in practice, when service users were admitted from hospital they did not normally make pre-admission visits. Sometimes the prospective service users’ relatives visited on their behalf. Similarly, service users that were admitted to the resource centre for respite care were advised to visit beforehand. They did not always do so but sometimes their relatives visited on their behalf. The registered manager stated that she and/or the deputy manager occasionally visited prospective service users in their own homes. The resource centre provided a total of 17 places for intermediate care i.e. 6 places in unit one, 10 places on units three and four and 1 place on unit seven for rapid response emergency use. The facilities included a physiotherapy room with stairs, walking bars, a physiotherapy bed, exercise aids and different types of walking frames. There was also a therapy kitchen that included both gas and electrical appliances and adjustable work surfaces to reflect a ‘domestic’ environment to enable service users to prepare their own drinks and snacks. There was a therapeutic input from healthcare staff to provide expert advice i.e. district nurse, physiotherapist and occupational therapist. In addition, two outreach workers continued to monitor and support the service users’ rehabilitation and progress following their discharge home in Howbury House DS0000037483.V333140.R01.S.doc Version 5.2 Page 11 order to re-establish their community living. All the staff had undertaken the resource centre’s ‘in house’ training including the use of aids and adaptations provided by the therapy staff. However, not all of the care staff had undertaken the formal intermediate care training. Howbury House DS0000037483.V333140.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 and 10. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. The service users’ health and personal care was based on their individual needs and the principles of respect, dignity and privacy were understood and put into practice. However, more attention needed to be given to care planning and medication. EVIDENCE: It was confirmed that all of the service users had a care plan that was based on an assessment of their needs. The care plans that were inspected contained a reference to all of the aspects of care covered in Standard 3.3. Risk assessments had also been carried out in respect of moving and handling, pressure care and nutrition. However, some of the information in the care plans tended to describe the service users’ needs rather than stating the way in which their needs should be met. Consequently, the instructions in the care plans regarding the action to be taken to meet the service users’ needs were not always as clear or specific as they should be. For example, under ‘General Health’ it stated in the ‘Care Interventions’ column for one service user ‘to elevate legs when necessary’. There was no reference to who would ensure that this intervention was carried out, when it should be done or for how long. The same care plan was signed but not dated. In regard to the care plan of Howbury House DS0000037483.V333140.R01.S.doc Version 5.2 Page 13 another service user, there was no evidence to show that it had been reviewed between 24 September 2006 and 15 March 2007. There was evidence to show that the staff worked closely with other healthcare professionals. It was reported that none of the service users had pressure sores. However, the resource centre had pressure-relieving equipment including four nexus beds. Any additional equipment that was needed was accessed via the district nurse. The continence adviser visited when requested and carried out assessments. Service users that received regular respite care were monitored and staff liaised closely with social workers and community psychiatric nurses as appropriate. A district nurse, physiotherapist and two occupational therapists employed by the Health Authority were based at the resource centre to provide a service for people in receipt of intermediate care. Risk assessments on falls and nutritional screening were carried out on all service users on admission. The service users retained their own GP unless they were admitted from outside the area. Otherwise, the service users would be registered with a local GP if they required a prescription or the help of a district nurse. The service users were not routinely provided with services for people living in the community e.g. ophthalmic and dental services, but if specialist care was needed appropriate referrals were made. A recommendation was made as a result of the previous inspection that service users should have a full nutritional, pressure care and moving and handling assessment. The recommendation had been implemented. The Comment Cards received from two of the visiting professionals contained the comments ‘A very good establishment from my perspective’ and ‘My experience is of an excellent level of care’. Most of the medication was kept in three lockable medicine trolleys in a lockable storeroom. Access to the storeroom was restricted. Some service users self-administered and others self-administered under staff supervision. Risk assessments had been carried out for service users that administered their own medication. A lockable facility had been provided in the service users’ bedrooms so that medication for the service users that self-administered could be stored safely. There was a lockable, controlled drugs cabinet that complied with the Misuse of Drugs (Safe Custody) Regulations 1973. The register for recording the administration of controlled drugs was satisfactory. The MAR charts that were inspected contained photographs of the service users in order to enable the staff to identify them correctly. It was confirmed that the list of the names of the staff involved in the administration of medication and their signatures was in the process of being updated. The competency of the staff that administered medication was assessed annually by means of observation and the use of a questionnaire. The dates on which medication such as eye drops and creams were opened were written on to the outside of the containers. All of the Medication Administration Records (MAR charts) were completed by hand. The MAR charts sometimes included the number of tablets that had been administered and on other occasions did not, even though the prescribed number of tablets had not been changed. The way Howbury House DS0000037483.V333140.R01.S.doc Version 5.2 Page 14 in which members of staff complete the MAR charts should be consistent. It was also noted that there were gaps in the record of administration of medication on the MAR charts in respect of two service users. The medication that had been written on to the MAR chart for one service user had not been double signed. There was a dedicated fridge for medication that required cold storage. However, there were gaps in the record that was kept of the daily temperatures. It was confirmed that some staff had undertaken accredited training in the administration of medication and that all of the senior staff were in the process of receiving accredited training. It is good practice for a copy of the prescription to be maintained by the resource centre so that it can be referred to, if necessary, in the future as it is the only document regarding the service users’ medication that is signed by the GP. The staff with whom discussions were held understood the importance of upholding the service users’ privacy and dignity. The responses that were given by the staff to the questions that they were asked reflected good practice. It was confirmed that a mobile telephone was available for use to enable the service users to make and receive calls in private and that mail was given to the service users unopened. It was stated that a supply of clothes for use by service users who were admitted direct from hospital was available ‘until their relatives or social worker could sort things out’. It was also confirmed that the staff induction included instruction on how to treat service users with respect. The privacy of the service users was enhanced by the provision of all single room accommodation. The service users with whom discussions were held confirmed that they were treated with respect by the staff, that they were referred to by their preferred term of address and that their privacy was maintained. Howbury House DS0000037483.V333140.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 and 15. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. The resource centre promoted the service users’ quality of life by seeking their views, offering choice and encouraging them to remain as independent as possible. EVIDENCE: A ‘welcome pack’ was given to service users on admission and this required them to record their interests. Various social and recreational activities were provided including music, library books, television, Bingo, quizzes, manicures, knitting and singsongs. A hairdresser visited weekly and exercises to music were also held every week. An organist visited every three to six months. A local Anglican minister visited every month to hold a Communion service and members of an Evangelical church also visited once a month. The registered manager was particularly aware of the social needs of one permanent service user and endeavoured to ensure that these were met. Birthdays and special occasions were celebrated and coffee mornings were held. Service users were encouraged to eat communally but were given the choice of eating their meals in their own rooms if they so wished. The service users that received intermediate or respite care and attended the day centre were encouraged to continue with their attendance. Service users were informed verbally about social and leisure activities and relevant information was displayed on the notice boards. Howbury House DS0000037483.V333140.R01.S.doc Version 5.2 Page 16 There were no unreasonable restrictions regarding the visiting arrangements. Visitors were asked to avoid coming at meal times. However, visitors could be provided with a meal, if requested, at a small cost. The service users with whom discussions were held confirmed that they were able to receive their visitors in private and that their visitors were always made welcome and offered a drink. The registered manager supported the service users’ right to exercise personal autonomy and choice. The service users were provided with information about the local advocacy service and Age Concern. There was evidence to show that the service users were able to bring personal possessions with them when they were admitted. However, because of the nature of the service, personal possessions were usually limited to small items such as photographs and radios. The service users had access to the records held about them by the resource centre. It was also stated that the service users took the Single Assessment file home with them when they were discharged. The registered manager was advised to add the Single Assessment file to the discharge sheet and to obtain the signature of the service users as a receipt for the file as well as other items when they were discharged. The service users with whom discussions were held confirmed that they were enabled to make choices in regard to their daily routines and matters affecting their care including the food provided, where they ate their meals, their clothes and the time they got up and went to bed. The resource centre operated a five-week menu. The record of the food provided showed that the service users received a wholesome and balanced diet. The meals that were observed being served were appealing and attractively presented. The service users were provided with a choice of food and the catering supervisor said that there was always a choice of three meals at lunch times. Vegetables were served in dishes to enable the service users to help themselves. Meals were served from the main kitchen at appropriate times and drinks and snacks were available throughout the day. The kitchens in each of the units allowed the service users and their visitors to make their own drinks at any time. The service users’ dietary needs and personal preferences were catered for appropriately. New service users were asked to complete a Diet Consultation Sheet. This enabled the staff to be aware of any allergies or special dietary needs as well as individual preferences and requirements. Liquidised meals were provided in separate portions when necessary. The service users were consulted about the food and menus were adjusted according to individual needs. The dining areas were clean and comfortable and provided a congenial setting in which to eat. The catering supervisor confirmed that the main kitchen contained all of the necessary equipment. A food probe, cleaning schedule, fire blanket, fire extinguishers and a first aid box were provided. The food was labelled and a record of food temperatures was maintained. The fridge and freezer temperatures were recorded twice a day. Food samples were kept for three days. The catering service operated in accordance with ‘Safer Food Better Business’ standards. Howbury House DS0000037483.V333140.R01.S.doc Version 5.2 Page 17 The registered manager stated that the resource centre had received the Heartbeat Award annually for the past three years. The service users with whom discussions were held spoke positively about the food and described it as ‘very good’. One service user said, ‘The food is excellent. I can’t fault it. If I ask for anything the staff provide it for me’. Howbury House DS0000037483.V333140.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 and 18. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. The resource centre had a clear complaints procedure and other relevant policies and procedures to ensure that service users were protected from abuse. The service users felt confident about making a complaint and were also confident that any concerns would be responded to quickly and appropriately. However, relevant staff training in regard to the protection of service users needed to be provided. EVIDENCE: The resource centre had a clear complaints procedure. The complaints procedure formed part of the information that was given to the service users when they were admitted. A book was maintained in which complaints that were made against the resource centre were recorded. Since the previous inspection the resource centre had received four complaints. The complaints had been responded to appropriately. A folder was also kept which contained numerous cards and letters from former service users and their relatives. These were expressions of gratitude for the help and kindness that had been shown to them by the staff. The service users with whom discussions were held felt confident about making a complaint. They felt that, if it were necessary to make a complaint, the matter would be dealt with quickly and appropriately. They confirmed that the registered manager and staff were approachable. The resource centre had various policies/documents to help ensure the protection of the service users including ‘Managing Actual or Potential Aggression’, ‘Dealing with Allegations Made Against Staff’, ‘No Secrets’, ‘Protection of Vulnerable Adults from Abuse’ and ‘Confidential Reporting Howbury House DS0000037483.V333140.R01.S.doc Version 5.2 Page 19 (Whistle Blowing)’. The registered manager confirmed that no incidents of alleged or suspected abuse had occurred within the resource centre or been reported to her or otherwise come to her attention since the previous inspection. The registered manager also confirmed that she had had no reason to refer any member or former member of staff for consideration for inclusion on the POVA register. However, it was noted that the senior staff had not undertaken training in the protection of vulnerable adults from abuse and that not all of the care staff had received basic awareness training in abuse. The registered manager stated that all of the issues referred to in Standard 18.6 regarding the service users’ money and financial affairs were included in the resource centre’s policies. However, the policies and procedures needed to be reviewed and updated in line with the resource centre’s present function and purpose. The registered manager said that the members of the Quality Standards Working Group intended to undertake this work. Howbury House DS0000037483.V333140.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 and 26. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. The service users lived in safe, well-maintained surroundings. However, some aspects of the environment needed attention in order to ensure the comfort and safety of the service users. EVIDENCE: The resource centre was located in a suitable position for its stated purpose. The premises were purpose built in 1988 and were situated in a residential area near to local amenities. All the accommodation was provided on the ground floor. The premises had been adapted, extended and refurbished in order to meet the needs of the service users. The premises had undergone a successful change of purpose from a long-stay residential care home to a resource centre providing short-term intermediate and respite care. The premises were accessible, safe and well maintained. Handrails were installed in the corridors and the toilets and bathrooms had suitable aids and adaptations. There was a small, designated smoking area that was also used as a quiet room. The gardens were attractive but the grassed areas had not been cut because the gardener was absent through sickness. There were two Howbury House DS0000037483.V333140.R01.S.doc Version 5.2 Page 21 enclosed garden areas. It was intended that the garden area adjacent to the new dementia care unit would be developed as a sensory garden. The registered manager stated that she met annually with a member of the department for Human Resources and Accommodation. The purpose of the meetings was to prepare a capital programme bid in order to ensure that the premises were properly maintained. The registered manager kept an ongoing programme of routine maintenance and renewal of the fabric and decoration of the premises. The handyman was responsible for carrying out any decoration that was required and a record was kept of the work that was undertaken. The registered manager was allocated a budget for spending on contracted services. This enabled the registered manager to exercise greater autonomy and to plan the work that needed to be done. It was noted, however, that the showers were out of use following tests that had been carried out on the water supply. The delayed reintroduction of the use of the showers adversely affected the provision of personal care for some service users with physical disabilities and also limited the service users’ choice. The showers must be brought back into use as soon as possible. The Comment Card from one service user stated, ‘I think it is time the showers could be repaired (o. o. o since 12/10/06)’. The Environmental Health Officer had visited the premises on 30 March 2007. The registered manager gave an assurance that the issues that had been highlighted as a result of the visit would be addressed in the near future. The last fire risk assessment/compliance audit was dated 22 December 2004. The fire risk assessment/compliance audit must be reviewed by a suitably competent/qualified person. The service users with whom discussions were held were pleased with the standard of accommodation. One service user said, ‘The windows are a nice size and the rooms are fairly bright. The pictures are old fashioned but quite nice’. The premises were clean, tidy and free from unpleasant odours. The laundry was appropriately sited and equipped. The laundry contained a wash hand basin and paper towel and liquid soap dispensers. The facilities included two washing machines and two tumble dryers. The washing machines met disinfection standards. It was confirmed that the washing machines had a sluicing facility. The laundry floor finishes were impermeable and these and the wall finishes were readily cleanable. Commode pots were cleaned mechanically on each unit. It was confirmed that a new infection control policy and procedure were in the process of being developed. An infection control audit was carried out each year. The service users with whom discussions were held felt that the standard of cleanliness within the home was good. They also expressed their satisfaction with the standard of laundering of their own clothes. Howbury House DS0000037483.V333140.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 and 30. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. The staff were experienced, trained and employed in sufficient numbers to fulfil the aims of the resource centre and to meet the changing needs of the service users. EVIDENCE: Details of the staffing establishment and copies of the staff duty rota were made available for inspection. The staffing establishment included senior staff, care staff, clerical and domestic support and other ancillary staff. The information provided showed that the number and deployment of staff during the working day were appropriate for the needs of the service users and to fulfil the purpose of the home. Three members of staff were on waking duty and one member of staff was on sleeping-in duty at night. The catering supervisor received the support of two members of staff, one fulltime and one part time. There was a vacancy for one part time kitchen assistant (20 hours per week). Agency members of staff were used to cover occasional shifts. It was stated that the same staff were used wherever possible in order to ensure continuity and consistency of care. There were several vacant posts for staff that were to be recruited to the new unit providing care for people with a dementia illness. It was intended to appoint an RMN as the head of the unit who would be responsible to the registered manager except for clinical supervision. A co-ordinator and five rehabilitation support assistants were responsible for the care of the service users in the intermediate care unit (16 places). In addition, the staffing in the intermediate care unit was supplemented by the provision of a district nurse (30 hours per week), a physiotherapist (27 hours per week) and an occupational therapist (37 hours Howbury House DS0000037483.V333140.R01.S.doc Version 5.2 Page 23 per week). The service users with whom discussions were held spoke positively about the staff. One service user described them as ‘very good’. Another service user described them as ‘very cheerful and good natured’. Another service user said, ‘The staff are absolutely excellent. You couldn’t wish for better care. I get on with all of them. The staff are lovely to me’. However, one of the service users said, ‘Sometimes they’re a bit short staffed and that makes quite a difference’. Another service user said, ‘They get a little bit short-staffed especially on a Saturday. They could do with a few more staff’. The Comment Cards received from the relatives/visitors of the service users were positive. One respondent stated, ‘The staff do everything well. They are all very friendly and helpful’. Another respondent felt that the standards were ‘very high’. Another respondent was pleased with the care that her relative had received and stated that the staff treated the service users with ‘compassion’. One respondent stated that their relative was ‘looked after and well respected at all times’. The resource centre employed a total of 47 care staff. Evidence was provided by means of an NVQ Monitoring Form to show that 22 members of care staff had completed NVQ level 2 training i.e. 47 . This was slightly less than the 50 trained members of care staff required by the National Minimum Standards. However, it was pleasing to note that a further 14 members of care staff were undertaking NVQ level 2 training. These arrangements should ensure that the National Minimum Standard is met during 2007. It was also pleasing to note that four members of staff had also completed the NVQ level 3 training. The files of three members of staff were inspected. The contents of the files included an application form, two written references, evidence of an enhanced CRB disclosure check, proof of identity and a copy of a staff contract. It was also confirmed that all members of staff had been issued with a copy of the code of conduct and practice set by the General Social Care Council. However, it was noted that none of the files contained a photograph. The registered manager stated that that this aspect of the staff information needed to be updated. A recommendation was made as a result of the previous inspection that newly appointed staff should receive a contract of employment in a timely manner. The registered manager confirmed that the recommendation had been implemented. The resource centre had its own staff induction programme that was based on the Skills for Care standards. The induction training covered issues that were included in NVQ level 2 training and incorporated fire safety, personal care giving, privacy and dignity and abuse. All the staff received a minimum of three paid days training per year and had individual training and development assessments and profiles. The registered manager confirmed that the effectiveness of the training was discussed and monitored through the individual staff supervision meetings. Howbury House DS0000037483.V333140.R01.S.doc Version 5.2 Page 24 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 and 38. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. The management of the resource centre was based on openness and respect for the service users’ best interests, rights and safety. However, the systems for developing and monitoring the quality of the service needed to be enhanced. EVIDENCE: The registered manager had considerable relevant experience and was competent to run the resource centre. The registered manager had obtained the Certificate in Social Services in 1986 and had completed the NVQ level 4 and Registered Managers’ Award training in 2006. She had been the manager of the centre since the premises opened in 1988. The registered manager had undertaken various training during 2006. The training included Managing Conflict, Outcome Based Assessment, Moving and Handling, First Aid at Work, Long Term Conditions (Intermediate Care), Heart Disease and Data Protection. The registered manager had a satisfactory job description. She displayed a strong ethos of being open and transparent in her management of the resource Howbury House DS0000037483.V333140.R01.S.doc Version 5.2 Page 25 centre. She was service user focussed and supported a strong staff team who had been trained to a high standard. Senior staff had also undertaken appropriate training. Two senior staff members were undertaking NVQ level 4 training and one other senior staff member had already completed the NVQ level 4 and had embarked on the Registered Managers’ Award training. There were clear lines of accountability within the resource centre and with external management. There was an Independent Business Unit Service Plan for the resource centre and a Team Plan. The Team Plan included such issues as equality and diversity, NVQ training, National Minimum Standards, retention of the Charter Mark Award and the development of the specialist unit for people with dementia. The registered manager stated that she was a member of a Quality Standards Group that were in the process of developing a quality assurance system. The members of the group had completed their work on a quality standard on food entitled ‘Meals and Provision of Food in Resource Centres’. The Quality Standards Group intended to produce a similar piece of work on infection control. The registered manager acknowledged that a quality assurance system needed to incorporate a simple but verifiable method of determining whether each of the quality standards was being met. Feedback about the service was obtained from the service users through the use of questionnaires. Questionnaires were issued to each of the service users every time they were discharged from the resource centre. It was also stated that a questionnaire was issued to all service users at least once every six months. The results of the surveys were analysed and published independently in an annual report. The views of family and friends and of stakeholders in the community on how the resource centre was achieving goals for service users had not been sought. The registered manager stated that one of the outreach workers, who was also the ‘Have your say’ representative, met with the service users individually and/or in small groups every month. The service users’ views were obtained and a report on the findings was produced. The service users were encouraged to retain responsibility for their own money. The registered manager confirmed that no one employed by or connected with the running of the centre acted as an agent or appointee on behalf of any of the service users. However, money was held in safekeeping on behalf of service users. The money was kept in separate envelopes in a safe. The corresponding accounts were also maintained separately. Receipts were issued and copies were retained for all financial transactions. The money and records in respect of two service users was checked at random and these were correct. Access to the money held on behalf of service users was restricted. The registered manager stated that the service users were not encouraged to bring valuable items into the resource centre. Items that may be held for safekeeping included a chequebook and a door key. The registered manager supervised the senior members of staff. The senior staff were responsible for supervising the care staff. A new form for recording Howbury House DS0000037483.V333140.R01.S.doc Version 5.2 Page 26 supervision meetings had recently been introduced. The form did not refer specifically to aspects of care practice or to the resource centre’s philosophy of care. However, the registered manager confirmed that these topics were covered in the supervision meetings and recorded. The registered manager also gave an assurance that all of the care staff received formal supervision at least six times a year. Arrangements had been made for staff to receive ongoing training in all of the core areas including moving and handling, COSHH, medication, equality and diversity and health and safety. It was also stated that the majority of staff had received training in dementia care. It was confirmed that relevant training would be provided for the staff intending to work in the new dementia care unit. The resource centre had a health and safety policy, an accident book, COSHH sheets and RIDDOR forms, copies of previous inspection reports, copies of the notifications made to the CSCI in accordance with Regulation 37 and a copy of the maintenance programme for 2007/08. The Public Liability Insurance Certificate was valid until 29 September 2007. A gas safety inspection was carried out on 3 October 2006. The boilers and central heating system was serviced on 8 September 2006. The service contract for the sluices disinfector was valid until 1 November 2008. The electrical survey certificate was dated 31 August 2006. PAT tests were carried out on 12 May 2006. Copies of the reports following the visits carried out in accordance with Regulation 26 were available for inspection. However, it was noted that there were two reports dated January 2007 and no reports available for December 2006 or February 2007. The registered manager confirmed that the maintenance man checked the temperature of the water every week. It was also confirmed that thermostatically controlled mixer valves had been fitted to all hot water outlets used by service users. It was also confirmed that opening restrictors had been fitted to all of the windows. Risk assessments had been carried out and recorded in regard to the use of the kitchen, irons, washing machines and tumble dryers. However, risk assessments had not been carried out for all the safe working practice topics covered in Standards 38.2 and 38.3. The registered manager was advised to amend the procedure to be followed in the event of a service user going missing i.e. the reference to Regulation 14 needed to be changed to Regulation 37 and the procedure should include a clear instruction to staff to maintain an accurate record of the action taken. There was no record of the monthly visual check of the automatic detection system for March 2007. Howbury House DS0000037483.V333140.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 2 X 3 3 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 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 2 X 3 3 X 2 Howbury House DS0000037483.V333140.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP2 Regulation 5A Requirement The fee for respite care must be included in the contract of care for all service users at the point of admission. A written assessment that includes a reference to all of the aspects of care listed in Standard 3.3 must be completed in respect of all service users in accordance with the requirements of Regulation 14. The care plans must set out in detail the action which needs to be taken by the staff to ensure that all aspects of the service users’ needs are met. Medication must be administered to the service users at the correct time and the MAR charts signed at the same time that the medication is administered. All the staff that are involved in the administration of medication must undertake accredited training that includes basic knowledge of how medicines are used and how to recognise and deal with problems in use and the principles behind all aspects DS0000037483.V333140.R01.S.doc Timescale for action 30/05/07 2 OP3 14 30/05/07 3 OP7 15 30/05/07 4 OP9 13 02/05/07 5 OP9 13 31/07/07 Howbury House Version 5.2 Page 29 6 OP18 13,18 7 OP19 23 8 OP28 18 9 10 OP29 OP33 19 24 11 OP38 13 12 OP38 13,23 of the home’s policy on medicines handling and records. The senior staff must undertake training in the protection of vulnerable adults from abuse and all the care staff must receive training in basic awareness of abuse. The showers must be brought back into use for the benefit of service users subject to any necessary safety checks being undertaken. Arrangements must be made for staff to receive training that will enable a minimum of 50 of the care staff to attain a qualification at NVQ level 2 or equivalent. A recent photograph must be provided in respect of each member of staff. The quality assurance system must be developed in accordance with the requirements of regulation 24 and Standard 33. Risk assessments must be carried out and recorded for all the safe working practice topics covered in Standards 38.2 and 38.3. All of the checks on the fire safety equipment/precautions must be carried out and recorded in accordance with the recommendations of the Fire Safety Officer. 31/07/07 30/05/07 31/12/07 30/05/07 31/07/07 30/05/07 02/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000037483.V333140.R01.S.doc Version 5.2 Page 30 Howbury House 1 2 3 4 5 6 7 Standard OP1 OP6 OP9 OP9 OP9 OP9 OP18 8 9 10 OP19 OP19 OP33 The statement of purpose and service users’ guide should be amended in order to include all the information referred to in this report. All the staff involved in the provision of intermediate care should undertake the formal intermediate care training. A consistent way of completing the MAR charts should be adopted by all the staff. All the medication that is written on to the MAR charts by hand should be recorded and witnessed by two members of staff. The daily record of the temperatures of the fridge that is used for medication that requires cold storage should be accurately maintained. The resource centre should maintain a copy of the service users’ prescriptions. The policies and procedures regarding the service users’ money and financial affairs should be reviewed and updated including all of the issues referred to in Standard 18.6 in accordance with the resource centre’s present function and purpose. The external grounds should be appropriately maintained. The fire risk assessment/compliance audit should be reviewed by a suitably competent/qualified person. The views of family and friends and of stakeholders in the community should be sought on how the resource centre is achieving goals for service users. Howbury House DS0000037483.V333140.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Howbury House DS0000037483.V333140.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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