Inspection on 28/07/06 for Hunters Care Centre

This inspection was carried out on 28th July 2006.

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

Hunters Care Centre 18/01/08

Hunters Care Centre 01/02/06

Hunters Care Centre 28/09/05

Hunters Care Centre 21/03/05

Hunters Care Centre 10/11/04

Hunters Care Centre 17/03/04

Hunters Care Centre 03/09/03

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Manor Lodge

The Garden House

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

CARE HOMES FOR OLDER PEOPLE Hunters Care Centre Cherry Tree Lane Cirencester Glos GL7 1AF Lead Inspector Mrs Kate Silvey Key Unannounced Inspection 28th July & 11th August 2006 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hunters Care Centre DS0000016479.V300913.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. Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hunters Care Centre Address Cherry Tree Lane Cirencester Glos GL7 1AF 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) 01285 653707 01285 655529 hunters@barchester.com www.barchester.com/oulton Barchester Healthcare Homes Limited Mrs Anne Millan Care Home 89 Category(ies) of Dementia - over 65 years of age (33), Old age, registration, with number not falling within any other category (56) of places Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one named service user under 60 years of age in the older persons nursing unit. 1st February 2006 Date of last inspection Brief Description of the Service: Hunters Care is a purpose built care home with nursing for older people, which accommodate older people with both general nursing and dementia care needs. The general nursing accommodation is situated on two floors and comprises of both single and double room accommodation with en-suite facilities. There is a large lounge area and dining room on the ground floor with several smaller lounges on both the ground and first floor. The recent additional nineteenbedded general nursing care unit on the first floor has two spacious lounges and a dining room. Many of the lounges give a view across the surrounding landscape and some smaller ones provide privacy to service users and their relatives if they wish to use them. The dementia care Unit provides nursing care and is situated on two floors. It is divided into three separate units with the more able service users accommodated in the ground floor units with access to a large circular ‘wandering corridor’ with seats and a lounge area. An enclosed garden area can be accessed from this corridor, which service users can freely use. The accommodation on the first floor has an open lounge area and separate dining room/lounge. A new enclosed garden area has been developed at the side of the unit for service users to use with staff support. There are assisted bathrooms and toilets situated in all of the areas used by service users. The kitchen and laundry area is situated on the ground floor. Hunters Care Centre DS0000016479.V300913.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. The inspection took place over two days with two inspectors. There was a two week break between the two days as the home had several service users in the dementia care unit with a possible infection, and it was advisable to await the result of tests to ensure that it was contained. Eighty service users were accommodated and many were spoken too during the inspection. Eleven service users’ surveys, twenty-one relatives/visitors comments cards, and nine care staff surveys were completed and returned to the Commission. The pre-inspection questionnaire completed by the manager was received on 29 August 2006. There was direct contact with the home’s proposed registered manager, the nursing staff in charge of two of the units, the training co-ordinator, an activity organiser and several members of the care staff. A number of records were viewed including service users care plans, and medication records. The care and records of eight service users were looked at in detail. The environment was fully inspected and staff were observed interacting with the service users. Since the last inspection there has been a change in where some service users are accommodated. All service users with dementia as their predominant care need are now accommodated on the nursing dementia care unit. Here service users who wander have an open and spacious environment with free and secure access to the enclosed garden on the ground floor. Service users who have dementia but their predominant care need is physical nursing care, can be accommodated in a separate nineteen-bedded general nursing Unit upstairs. This means that there are qualified nursing staff in all units now as all service users are accommodated in nursing care units. The weekly fees range from Social Services current level of funding for nursing care to £900.00, and additional charges include hairdressing, chiropody, newspapers and visitor’s meals. Tea and coffee are available for visitors at no extra cost. Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 6 What the service does well: The staff complete a comprehensive pre-admission assessment to ensure the home can meet service users needs. There were several positive comments about pre-admission visits to the home e.g. ‘we were received by one of the managers and given a full and leisurely briefing about Hunters Care’ The care plans had very good monthly reviews recorded to track the progress or otherwise of the care plan. All the daily records seen were excellent and had a detailed clear account of what care had been provided. A comment from a relative’s survey stated ‘I am very happy with the kind and thoughtful care my mother receives. I consider standards to be very high. The home is clean and well maintained and careful thought is given to my mother’s care and nursing needs. The home is to be congratulated for the fact that it seems to have low staff turnover, which makes it easy to form relationships with my mother’s carers and to monitor her care.’ Service users enjoy a range of activities and the activity organisers are also sensitive to any changes required. It was clear that considerable thought is being given to what activities are appropriate in the dementia unit and there is a frequent review to ensure changing needs are met. The home makes great efforts to provide a balanced and appetising menu and the food is presented in a professional and pleasant manner. The home operates in an open and transparent environment, which encourages relative, friends and service users to comment. All areas are accessible, safe and well maintained. The communal areas are in good decorative order and appropriately furnished. The bedrooms are personalised and were clean and in good decorative order. Bathrooms and toilets were appropriately equipped, accessible and clean. Recruitment records indicate that there are appropriate procedures. The homes quality monitoring systems include a ‘fast response’ feedback questionnaire, which is completed by service users, relatives and friends. The questionnaire refers to how staff are seen, whether they are friendly and courteous and if the level of care is seen as appropriate and sufficient. It also refers to their knowledge of the complaints procedure and its availability and operation. The survey asks if the home is maintained to a good standard and kept clean and tidy. The general manager deals with the comments soon after they are received. The general manager informed the inspector of the many plans to improve the home and the facilities, demonstrating good identification of any shortfalls. Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The care plans were generally good and identified the service users care needs. Some person centred care plans were more detailed than had previously been seen at other inspections, however there was still some room for improvement to enable care staff to have individual actions to help them manage some behaviour. The use of pet names by the care staff for service users should be discouraged, as it is disrespectful. Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 8 The home has been maintained to a good standard although additional signage/more appropriate colour schemes would be helpful in the dementia Unit. Two of the bedrooms doors were wedged open. If service users want the doors open Dorguards should be fitted to ensure their safety is not compromised by the present practice. A number of the bedrooms had stained carpets and they must be cleaned or replaced ( bedrooms 11 and 9 ). Some equipment is being left in the corridors and could be hazardous for service users. Care staff should not complete hostess duties when they are required at peak times of activity in the dementia Unit. The proposed registered manager is suitably qualified and competent, however, the registered person must ensure that the proposed manager submits an application to become registered with the Commission. To record hairdressing completed by the four hairdressers with regard to finances, it is recommended that a simple spreadsheet be used, and this would protect everyone concerned. 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. Hunters Care Centre DS0000016479.V300913.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 Hunters Care Centre DS0000016479.V300913.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. All service users are admitted to the home after a full assessment by competent nursing staff and service users and relatives have sufficient information to satisfy them that the home can meet their needs. EVIDENCE: Records were inspected in the dementia unit and the new older persons unit. Pre-admission assessments completed by the care staff were seen and assessments by other stakeholders prior to admission had also been obtained. The surveys completed by the service users and their relatives all confirmed that there was sufficient information given to them before admission to the home. There were several positive comments about pre-admission visits to the home e.g. ‘we were received by one of the managers and given a full and leisurely briefing about Hunters Care’ Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 11 The home has a comprehensive Service User Guide, and welcome pack, which has recently been revised. Hunters Care Centre DS0000016479.V300913.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans are generally good and staff are able to meet the service users needs with clear actions recorded and adequate monthly reviews. There were some omissions, which when included would improve the records and provide a more consistent approach. Medication was well recorded but not all procedures and protocols were in place to ensure safe practices. Care is given in a way that meets residents’ needs in respect of their privacy and dignity. EVIDENCE: Seven care records were looked at in detail in the dementia Unit, and one in the additional new Unit for accommodating service users with predominantly general nursing care needs, who had previously been accommodated in the dementia unit. Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 13 Dementia unit. The care plans were generally good and identified the service users care needs. Some person centred care plans were more detailed than had previously been seen at other inspections, however there was still some room for improvement to enable care staff to have individual actions to help them manage some behaviour. A service user who had absconded from the home had a good dementia care plan with clear actions and regular reviews. The service users whereabouts had been recorded every ten minutes to minimise the risk, and the outside fence had been altered to provide additional security. The nurse in charge was reminded about Regulation 37 notices to the Commission, which means the Commission must be informed of any event which affects the well being of service users. It was discussed with the nurse in charge whether the use of pressure pads to alert care staff to service users movements may be helpful. There were good care plans for managing sexuality, evidence was seen in respect of a recent issue between two service users. A service user who had lost 10 kilogrammes in a year had a nutritional risk assessment, but there was no evidence of a professional dieticians advice. The nurse in charge stated that finger food was available in the home to encourage some service users to eat. Attire charts are sometimes used to ensure that service users are appropriately dressed at all times. Generally social histories are recorded to help care staff know what life values and interests each service user has and enable more meaningful activities and care. The care plans had very good monthly reviews recorded to track the progress or otherwise of the care plan. All the daily records seen were excellent and had a detailed clear account of what care had been provided. It was evident that some health care needs were identified and met. An example of this was that the doctor had organised a Doppler test for a service user, special support stockings had been ordered, and pressure relieving equipment had been provided. There were good wound records describing the progress and care of two pressure ulcers, which a service user had on admission. A new service user, however, had no record of the assessment of vision, hearing or dental health which would help plan what professional health care needs were required. Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 14 One service users needs were tracked through the plan of care. The specific activity referred to the management of challenging behaviours. The problem had been identified and the action for staff was clear and being carried out. There had been a regular review of the plan and a commentary of events. Staff were asked about the plan and were conversant with the actions. Nursing care, new 19 bedded unit, first floor. One care plan was looked at in detail for a service user who was sometimes nursed in bed due to two pressure ulcers. There was a good ‘activity of daily living’ assessment completed in 2002 and it was recommended that this should be completed annually for all service users. This service user was nutritionally a very high risk and had lost 11 kilogrammes in the last year. However, there was no record of dietary intake, which may be affecting the rate at which the wounds were healing The care plan for mouth care was good and had monthly reviews. The manual handling record was last reviewed in 2005 and it was recommended to the staff on duty that this should be completed again. Appropriate pressure relieving equipment was being used both in bed and out of bed, and was reviewed monthly. The wound care plan described the wound quite well, but the record would have been clearer using a mapping tool or photo. The wounds were recorded as healing. There were good health care records of when the doctor had visited. Medication was looked at in this unit only. The room where medication was stored was very hot and temperatures should be recorded to ensure that the maximum temperature for storage is not exceeded. There was a different procedure in this unit dated 1995, which looked very well used and unhygienic. There was no procedure for homely remedies seen and the returns book was unavailable as it was kept on another unit. The medication is audited, but a random check should be completed by counting medication to ensure good practice. The inspector did an audit of a new service users medication and all was satisfactory. The stock levels were appropriate and the medication was secure. Liquid medication was dated when opened. Some transcribed medication records had not been signed. A new British National Formulary was on order for this unit. A service user that may have seizures did not have a protocol for staff to follow, which would ensure that the correct intervention was given. A care plan seen for non-compliance of medication was good. The service users surveys said the care staff treated them with dignity and that their privacy was respected. Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 15 A relative commented in the survey that the staff in the dementia unit give ‘superb care and support, were fabulous and incredibly caring’ Care staff were seen being kind and polite with the service users, showing them respect and providing privacy when required. . Hunters Care Centre DS0000016479.V300913.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14,15, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The daily life for service users is organised having regard for their individual needs. Families/friends are welcome in the home at any time and they feel comfortable about visiting. Where service users are able to provide an informed choice their wishes are met. The home makes great efforts to provide a balanced and appetising menu and the food is presented in a professional and pleasant manner. EVIDENCE: The General Unit Service users enjoy a range of activities and the activity organisers are also sensitive to any changes required. Whist there is a programme of events they will change them if it is seen as beneficial for the service users. The inspector joined a group activity and felt it was conducted in a friendly but organised Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 17 manner, with the organiser being sensitive regarding individual abilities of the individuals in the group. The skill of the organiser resulted in excellent participation by the service users. The home undertook an audit of activities in June 2006 and discussions are now in progress between the organisers and the manager The Dementia Unit It was clear that considerable thought is being given to what activities are appropriate and there is a frequent review to ensure changing needs are met. Whilst activities occur a number of staff were not aware of the programme. It is appreciated that the question of activities is being reviewed and it is anticipated that there will be a dedicated area for activities for both Units. A relative commented in the questionnaire that there was little encouragement to exercise, e.g. ‘chair-based’ exercises or assisted walks in the garden by staff for ambulant or wheelchair bound service users. A number of visitors/relatives were seen and spoken to. They confirmed that they were always made welcome in the home and could visit whenever they were able. They saw staff as helpful and caring and felt that senior staff were approachable. Subject to an informed consent service users are able to exercise choice over what they do and how they spend their time. This also applies in the dementia Unit where if service users are able they can determine day-to-day matters e.g. getting up and going to bed. All of the staff observed were seen as perceptive and quick to see any need and then without further delay meet that need. One service user’s survey stated that there was an objection to the use of pet names by the staff e.g. “darling”, “sweetheart” and even “sugar plum” on one occasion. This was discussed with the manager who will remind staff of this disrespectful practice. The service users who were able said they enjoyed the food and that there was enough food, plenty of choice and that it was presented in a professional manner. Daily menus are prepared and there is always a fish and meat dish for the main meal. In the unlikely event that none of the options are acceptable the service users told the inspector that they are able to determine a further option, which would be decided by them. The inspector saw meal times, and it was evident that this was a highlight of the day and one that they enjoyed. One service users commented in the survey that ’fish and meat are very good quality, but a good cheese board would be appreciated’. Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 18 The majority of service users were happy with the food provided, however one service user would appreciate more seasonal fresh fruit and vegetables. Hunters Care Centre DS0000016479.V300913.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home operates in an open and transparent environment, which encourages relatives, friends and service users to comment. The procedure, practices and values of the home promote a safe environment. EVIDENCE: The home has a good complaints procedure, which was reviewed in May 2006. The service users and relatives surveys indicate that most people know who to complain to, and people have confidence that their concerns are listened to, some concerns identified in the surveys were shared with manager. There has been only one complaint in the last year. The home has a procedure for adult protection and the prevention of abuse, which was last reviewed in September 2005. All new staff read the homes procedure during their induction as part of the Skills for Care induction process, which includes adult protection and whistle blowing. The homes training co-ordinator is currently completing the Gloucestershire County Council’s Protection of Vulnerable Adults training and will cascade the knowledge to all the staff. The manager had a copy of the Gloucestershire County Councils Alerter’s Guide, which should be distributed to all staff for reference. Training for staff in managing challenging behaviour was planned. Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 20 The police are investigating two service users and one member of staff’s missing monies. There has been a police presence at the home and a warning to all staff. The outcome is currently unknown. The manager is competently handling this difficult situation and service users are discouraged from leaving money unattended. Many service users have lockable storage in their rooms but not all choose to use it. Hunters Care Centre DS0000016479.V300913.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has been maintained to a good standard although additional signage/more appropriate colour schemes would be helpful in a dementia unit. EVIDENCE: The evidence is based on two visits to the home. The general Unit was inspected on 29 July 2006 and the dementia Unit inspected on 11 August 2006. The inspector was advised that the home hopes to have a dedicated painter, this will ensure that all painting will be undertaken in a shorter time scale. It was noted that some exterior doors require painting The General Unit All of the communal areas and a random sample of bedroom toilets and bathrooms were seen. The areas are accessible, safe and well maintained. The communal areas are in good decorative order and appropriately furnished. The Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 22 bedrooms are personalised and were clean and in good decorative order. Bathrooms and toilets were appropriately equipped, accessible and clean. The Unit has many options for the service users in respect of communal areas and this ensures there is choice about where to sit during the day. A number of the corridors had new carpets and were pleasantly decorated with flowers and pictures. The outside areas are level, accessible and well maintained and a number of the service users were sitting in the gardens. The Dementia Unit The “inner garden” and walkway continue to be maintained to a good standard and this has encouraged service users to use the areas. At the time of the inspection a number of service users were in the garden enjoying their surroundings during a period of fine weather. All the communal areas and bedrooms were inspected. The communal areas are to be refurbished and this will include the replacement of the corridor carpets, which are stained and have not responded to attempts to clean them. The cleaner advised the inspector that she would soon have a more effective machine to hoover and clean the carpets. A number of the bedrooms had stained carpets and they must be cleaned or replaced ( bedrooms 11 and 9 ). Two of the bedrooms doors were wedged open. If service users want the doors open Dorguards should be fitted to ensure their safety is not compromised by the present practice. Bedroom doors have been painted in different colours, however there is no further distinction in colour to assist the service users to determine different facilities. The inspectors were advised that the refurbishment programme will further address issues of signage and colours/decoration to assist confused service users. One bedroom had a damaged light switch (bakelite cover was missing), which had not been reported for repair. The home has a system where all staff report faults, which are checked by maintenance staff each morning and any urgent matters are usually dealt with. The home must ensure that staff report all faults, particularly if there is a health and safety risk. The home also has an emergency response contractor for all events. Some equipment is being left in the corridors and could be hazardous for residents. Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 23 Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. 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. The home demonstrates that there is good commitment to meeting the training needs of the staff to ensure that service users needs are met. Recruitment records indicate that there are appropriate procedures. EVIDENCE: There are thirtythree service users who require dementia nursing care, who are now under the direct management of the head of dementia care. The head of dementia care is a Registered Nurse Mental Health and works at least four days each week to include some weekends. This is an improvement as the residential dementia Unit staffed by carers only has closed, and all service users in the dementia care Unit, who may wander and may exhibit challenging behaviour, have qualified nurses on duty at all times. The general manager plans to provide a deputy for the head of the dementia Unit to ensure continuity of care. The nurse in charge of the dementia Unit said the new arrangements were working well and the quality of life for some service users had improved. A member of the care staff had to complete hostess duties for more than an hour in the morning at the peak time of care activity, which depletes the care Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 25 team and is seen as inappropriate, the general manager agreed to look into the arrangement. The need for the qualified nurses in charge of a dementia unit to have appropriate training is being addressed through the Barchester Academy. The homes training co-ordinator has been very busy delivering the Yesterday, Today and Tomorrow accredited Dementia Awareness course from the Alzheimers Society, which includes Barchester’s Memory Lane specifics. Twenty-one care staff have passed since February 2006 and 7 have commenced training in August 2006. Six staff are to commence the NVQ level 3 in Dementia Care facilitated by Barchester NVQ Academy and accredited by City and Guilds and a further twelve will start in January 2007 and April 2007. This indicates a commitment to ensure that the home has suitably qualified staff to meet the service users needs in the dementia Unit. The home has 69 care assistants and 34 have completed NVQ level 2 or 3 and 4 more are in the process of completing NVQ level 3. This exceeds the minimum standard of 50 of care staff completing NVQ level 2 or above and ensures that the many care staff are suitably qualified and that Barchester is committed with generous budgeting to ensure this number is further exceeded. The general manager will ensure that the six qualified nurses working on the dementia unit have appropriate dementia care training and updates to meet the needs of the service users, and manage the care staff appropriately. Information regarding all training undertaken, including induction training, at the home was sent to the Commission and indicates that the home is committed to providing good training, which will help with the retention of care staff. Qualified nurses complete medication and syringe driver updates and the overseas staff have training in literacy and numeracy skills. The training co-ordinator has identified a need to improve record keeping in some areas and is hoping to provide appropriate training. The records of the last three recruitments were seen. The appointments had been made after the required information in respect of employment and health were collected, and checks made to include written references. In two of the appointments POVAFirst was applied for followed by CRB disclosures. The practice of employing staff after obtaining POVAFirst should only be used where it is essential that staff are appointed before a full CRB disclosure, the Commission must be consulted on such appointments. The General Unit Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 26 The four care staff on duty were seen individually. They all confirmed that they had received appropriate training and felt comfortable and competent in delivering care to the service users. They had a good understanding of the philosophy of Barchester and were able to practice the values of privacy, dignity and individuality. It was evident from talking to staff and watching them interact with service users that they were providing a sensitive, prompt and flexible service that met individual needs The Dementia Unit Six members of the care staff were seen and spoken to individually. All of the staff had either completed or were attending the in-house “dementia awareness” course and had a good understanding of the illness and the management of the symptoms. The inspector was informed that there have been a number of changes in the routines and this has resulted in care staff having more time, and that all service users needs are ideally met by mid morning ensuring lunch is able to be taken in a more leisurely manner. The inspector spent some time talking to staff and an equal amount of time observing staff and service users. At one point this covered the lunch period and the following observations were noted. The lunch was served in the dining room and there were five service users sat at the table, one sat on a chair by the table being fed and one sat away from the table eating unaided. There were two members of care staff on duty and when difficulties arose with one service user with “challenging behaviour” it was necessary for one member of staff to deal with the service user, and this meant other needs were unmet or managed ineffectively by one member of staff for a short period. It must be said, however that staff responded to the difficulties in a calm and appropriate manner. The issue is one of having enough resources to manage a small but highly dependant group. In the circumstances the staffing review should be carefully looked at during meal times, and the resources provided to ensure all needs are met. The general manager was completing a review of the staffing levels during the inspection. A meeting between Barchester’s Director of Regulation and the Commission had also recently taken place, to address the need for more suitably qualified staff in the dementia unit. Subsequently the lead inspector has received information regarding the staffing levels review and has spoken to the general manager and is satisfied that there are now sufficient staff on duty to meet the service users needs. The general manager said this is an ongoing process as dependency levels change, however another formal review will be completed in six months time. Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 27 Comments by the staff in the completed surveys include; ‘we have a happy united team of trained staff and in turn a happy united team of carers’, ‘we have few problems’ and ‘’matron is a rock and always wiling to help with any problems at work or even at home’. One comment said that an improvement would be for ‘night and day staff to get on and work better together, with joint meetings. Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 28 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The proposed registered manager is suitably qualified and competent. The home has effective quality assurance systems to ensure it meets the stated aims and objectives. The financial record keeping ensures service users interests are safeguarded. The health and safety of service users, staff and visitors is seen as paramount and practices and procedures support this. EVIDENCE: The new general manager at the home is completing the application form to become the registered manager at Hunters Care Centre. She has transferred Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 29 from another Barchester home as the previous general manager retired, and has many years experience as a manager in other care homes. A deputy who is head of the general nursing Unit and is a Registered Nurse Adults, and the head of the dementia Unit who is a Registered Nurse Mental Health supports the general manager. In addition there is a head of department for catering, activities, maintenance, training, housekeeping and administration who are all responsible for their area of work and report directly to the general manager. The quality monitoring systems include a ‘fast response’ feedback questionnaire, which is completed by service users, relatives and friends. The questionnaire refers to how staff are seen, whether they are friendly and courteous and if the level of care is seen as appropriate and sufficient. It also refers to their knowledge of the complaints procedure and its availability and operation. The survey asks if the home is maintained to a good standard and kept clean and tidy. The registered manager deals with the comments soon after they are received. It was evident that service users are able to raise issues directly and informally with the staff and this included the ability to comment when service users meet as a group. The administration staff were responsible for ensuring that the service users monies were handled correctly. The safe was accessed and two service users monies were checked and both had clear correct records with two signatures for each entry. Invoices are sent to relatives to pay the service users’ hairdressing account. There are four hairdressers who visit the home and there was insufficient information to verify the invoice. It was recommended that a simple spreadsheet be used, each hairdresser could get a signature by the person in charge of a unit when hairdressing has been completed at each visit for a service user. This would protect everyone concerned. The pre-inspection questionnaire provided by the general manger had comprehensive information regarding maintenance checks for health and safety requirements. All appeared to be satisfactory including full risk assessments for compliance with Legionella. The fire safety officer last visited the home in July 2005. The home has a new computerised system to help the training co-ordinator, where all training and updates can be identified to ensure that safe working practices are maintained through regular training in fire safety, first aid, manual handling, food hygiene and infection control. The training co-ordinator is starting health and safety training in September so that she can help with the risk assessments and assist the general manager with this important area of legislation. Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 30 The general manager informed the inspector of the plans for the home which included; • • • • • • • • • • New carpets for the corridors around the home New dining room furniture. New soft furnishings for most communal areas. Extensive redecoration and upgrades in progress. A raised sensory flowerbed and deck area in the garden. Replacement of hoist, wheelchairs and bath. Purchase of new food service trolleys and desert trolleys to improve presentation. Laundry being re-planned with a new washer. The staff room (general) to become the service users activity room. The staff room to be moved to another area, after consultation with the Commission. Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 32 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 OP9 Regulation 13 (2) Requirement The registered person must ensure that; • all units have the correct medication procedures and protocols • medication audits include completing a random count • transcribed medication records are signed • medication is stored at the correct temperature. The registered person must ensure that the proposed manager submits an application to become registered with the Commission. Timescale for action 30/09/06 2 OP31 8 (1) (i) 31/10/06 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 DS0000016479.V300913.R01.S.doc Version 5.2 Page 33 Hunters Care Centre 1 2. 3 4 5 6 Standard OP7 OP7 OP13 OP19 OP19 OP35 The registered person should provide pressure pads to alert staff to service users’ movements, which may help to prevent falls and indicate their whereabouts. The registered person should ensure that all service users have health care assessments and support as required. The registered person should ensure that staff do not use pet names for the service users. The registered person should ensure Dorguards are fitted if service users wish their bedroom doors to remain open. The registered person should ensure that there is easier identification in the dementia Unit. The registered person should ensure that hairdressing monies are managed appropriately. Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 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 Hunters Care Centre DS0000016479.V300913.R01.S.doc Version 5.2 Page 35 - 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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