Inspection on 28/04/08 for Inver House

This inspection was carried out on 28th April 2008.

CSCI found this care home to be providing an Adequate service.

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

Other inspections for this house

Inver House 15/04/09

Inver House 15/09/06

Inver House 26/01/06

Inver House 12/07/05

Inver House 03/03/05

Inver House 17/08/04

Inver House 11/03/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Inver House Foreland Road Bembridge Isle Of Wight PO35 5UB Lead Inspector Annie Kentfield Unannounced Inspection 28th April 2008 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 Inver House DS0000012502.V361439.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. Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Inver House Address Foreland Road Bembridge Isle Of Wight PO35 5UB 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) 01983 872312 01983 875814 joanne.bennett@islecare.org Islecare `97 Ltd Mrs Joanne Debora Bennett Care Home 25 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0), Physical disability (0) of places Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Physical disability (PD) 2. Dementia (DE). The maximum number of service users to be accommodated is 25. Date of last inspection 15th September 2006 Brief Description of the Service: Inver House is currently registered to provide care for up to 25 older people. The home is in a period of development and change with new accommodation being built (and almost completed) in the grounds of Inver House. When the new accommodation is registered there are interim plans for the new building to be used temporarily whilst the original building is upgraded and refurbished. There are also plans to develop a specialist dementia unit for 15 older people in the new building. At the moment, Inver House is a large three-story period building situated next to a GP Surgery. There is some parking available in front of the house, or street parking nearby. The building is accessible and has a passenger lift to access the upper floors. Fees currently range from £376.67 per week to £530.00 per week. There are additional costs for toiletries, chiropody, hairdressing, phone calls, newspapers, transport to and from appointments, clothing, and some specialist equipment. Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This report is a summary of information we have received, or asked for about Inver House since the last inspection of 15th September 2006. Included in the report is the outcome of an unannounced visit to the home on 28th April 2008, this was with one inspector (Annie Kentfield). During the visit, that lasted from 10.30 am to 6.30 pm, we spoke to the manager, three of the residents, and three members of staff and looked at some of the home’s records including care plans, medication records, staff training and staff recruitment records. Before the unannounced visit we sent surveys to 20 of the residents and 27 to staff and also surveys to 2 Social Services care managers, the GP surgery and the District Nursing Team. We received completed surveys from 7 residents, 7 members of staff and 1 care manager. Feedback from the survey forms is included in the body of the report – generally all of the feedback that we received about the service is positive. We also received written information from the manager of Inver House in the form of the Annual Quality Assurance Assessment (AQAA). This document gives us information about the service and is a self-assessment by the registered manager of how well the home is providing good outcomes for people using the service and where further improvements are planned. What the service does well: The service is in a period of change and development and is undergoing major building work and refurbishment. This has affected the home environment for the residents and there have been temporary changes to bedrooms and some of the communal areas. Comments from residents in the home demonstrate that the home has managed the disruption caused by the building work, well. One resident told us ““the staff I look upon as being wonderful friends” and another resident told us “ I have been very happy here for 8 years – it has been my salvation”. We also received positive comments from some relatives and visitors who felt that the staff in the home have worked well to overcome the restrictions of the accommodation whilst the building work has been carried out and one person said “The present staff are very good but with the building work they are restricted in the space they have to use, this does not mean that the clients are neglected but hopefully by the end of the year the home will be able to broaden their way of life”. Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service is aware of the need to make sure that prospective users of the service have the information they need to make an informed choice about moving in to the home and is in the process of reviewing and updating information about Inver House. Service users who move into the home can be confident that all of their health and social care needs will have been assessed to ensure that the home is able to offer an appropriate service to meet their care needs. However, the service needs to demonstrate how their assessment process will be developed for people with specific dementia related care needs. EVIDENCE: We looked at the information currently available about the home and the way that the home assesses the care needs of prospective residents. We saw a glossy brochure about Inver House that provides some brief and general information about the home. Detailed information about the services Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 9 that the home can provide is in the process of being updated to reflect the imminent changes and development to the service when the new accommodation is ready. Following the inspection visit the manager sent us a draft copy of the new Statement of Purpose: this includes what is and isn’t covered by the care fees, details of staffing and qualifications, and some information about the special support and facilities that will be offered in the new dementia unit. The draft guide also makes mention of what specialist training will be available to care staff in order to secure positive outcomes for people with dementia. This means that the service is planning to provide a statement of purpose that is specific to the home and the resident group they care for and will give prospective residents details of what they can expect and give a clear account of what specialist services will be provided. Further good practice would be for the home to be able to provide a copy of the statement of purpose in a format that will meet the varying capacity of the resident group. Inver House has an assessment process in place. This means that the home will only admit new residents into the home when their care needs have been assessed and the home is confident that those care needs can be met by the staff team and the home is suitable and appropriately equipped to meet assessed care needs. The manager explained that the home requests a care summary or care assessment from the Social Services care manager or relevant health and social care professional where this is appropriate. We received feedback from a care manager who was confident that the service communicates well with care managers with regard to any concerns or queries about a care assessment. As the service is planning to develop a specialist dementia unit, the manager needs to review and develop the home’s assessment procedures to reflect how they will assess people who have significant dementia related care needs. This will demonstrate that the service has considered how they can provide best practice in all aspects of the specialist service they plan to offer for people with dementia. Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health care needs of the residents are monitored and appropriate action and intervention taken but more attention must be given to the changing needs of the residents. Medication records are generally up to date for each resident and medicines received, administered and disposed of are recorded. The home needs to update the storage of controlled drugs to meet changes in the regulations. EVIDENCE: We looked at the care plans and medication records for three people and spoke to two of the residents. We also looked at what people had told us in the surveys that we received from residents, staff and a Social Services care manager. The care plans demonstrate that residents have access to health care services when needed and a record is kept of all contacts with GP’s, District Nurses and other health care services. The care plan sets out the care tasks as guidance Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 11 for care staff on the care to be provided. Although the care plans are dated and signed as being reviewed each month, we found that in one care plan, it did not fully reflect changing care needs and the care plan and risk assessment needed reviewing and updating to provide clear guidance for care staff on what action they should take to manage any risks or events. In another care plan, one of the tasks on the care plan had changed and although recorded in a separate medication record, the care plan had not been updated. One of the residents was using a mobility aid that was broken and needed cleaning. Although the aid had been looked at, there should have been a follow up referral to the appropriate service for a new piece of equipment. Care plans and risk assessments need to be reviewed regularly and must provide clear guidance for care staff, particularly new care staff, otherwise there is a risk that care needs may be overlooked or care practice is not consistent for the people using the service. Staff must have written guidance on the action they have to take to manage any risks or events and this should be part of care practice. Some of the care plans identified a need for people to have regular weight checks where this was part of their care needs. The ‘sit on’ scales that the home has purchased are not currently in use; this means that some people cannot be weighed. The manager needs to address this and ensure that residents can be weighed when needed. The care plans include a comprehensive ‘life history’ or social history for each resident and residents would benefit from the life history being incorporated into each care plan so that the care plan provides a holistic or person centred individual plan for each resident and informs care staff on how care is to be provided. This would also help staff to communicate well with people with dementia. Medication is stored in two trolleys that are securely attached to the wall when not in use. We looked at some of the medication records and these were up to date. The manager is now aware that the regulations for the storage of controlled drugs have changed and care homes must provide storage that meets the amended regulations. In the feedback that we received from 7 residents, in the written surveys, everyone expressed their satisfaction with the care provided in the home, however, decisions on how personal care is delivered might not be consistently recorded if care plans are not reviewed in an organised way. One resident did complain about the laundry service and said that they get the wrong clothes returned and some of the clothes are damaged or have shrunk. We discussed this complaint with the manager who said she would look into it. The home has a stated commitment to providing a service that respects dignity and privacy. If some residents are experiencing difficulties with clothing and Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 12 laundry this needs to be addressed to ensure that residents are treated with dignity and respect at all times. The home does not use a separate care planning system for residents who have care needs related to dementia, although the home currently has a separate unit within the home for seven people with dementia related care needs. The manager told us that she has done some training in dementia care mapping. This is an evaluation tool designed to evaluate the quality of care from the perspective of the person with dementia. The information is then used to draw up an action plan to bring about change or improvements. As yet, this assessment tool has not been put into practice in the home and is part of the service’s overall plans to develop a dementia unit that supports residents with specific and good practice in dementia care. It would be good practice for the home to develop this assessment tool for the benefit of residents who have dementia related care needs. Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service are given the opportunity to take part in a variety of activities both within the home and trips out of the home. The food in the home is of a satisfactory quality and meets the dietary needs of people who use the service. A more co-ordinated approach to meeting the specific and individual social and recreational preferences of the residents, particularly those residents with dementia related care needs, is needed to demonstrate that the home is committed to best practice in this area. EVIDENCE: We looked at the menus and activities and spoke to some of the residents and staff. We also received comments from some of the residents in the written survey forms. The evidence in the Annual Quality Assurance Assessment (AQAA) recognises that activities and social life in the home have been temporarily restricted at times due to the building works and change of use of some of the communal areas of the home. The communal space in the current dementia unit is very limited for residents but the manager is confident that this will improve greatly with the planned move to the new building where residents will have access to Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 14 more spacious, light, and pleasant surroundings and easy access to attractive outside space. At the moment the dining area in the dementia unit is split between the lounge and a small windowless room, this means that residents are not able to eat their meals in an attractive and spacious dining room and staff have to move between two areas to support residents at mealtimes. In the other part of the home there is a larger dining room with sufficient tables and chairs for residents to eat their meals. We received feedback from residents that the meals offered in the home are of good quality with choices available. However, in the main dining room we noticed that the menu board had not been changed for three days and did not inform residents what was on the menu that day. One of the comments we received from a resident was a request for crusts to be cut off sandwiches. This was discussed with the manager who said that she would ensure that care staff do ask residents for their preferences about this. We observed that a bowl of fresh fruit was taken round to residents in the dining room following the teatime meal, however, some of the residents missed out on this as they had already left the dining room. The home employs an activities co-ordinator on four days per week and we were told that a Pet Therapy (PAT) dog visits the home on a regular basis. Family and friends of residents are encouraged to visit the home and we saw visitors coming and going during the day. On Mondays and Tuesdays residents are offered the opportunity of mini-bus trips to places of interest. Residents also have the opportunity to take part in religious worship in the home. We spoke to one of the residents who did not go on the mini-bus trip but as there was not an alternative activity for residents who did not go on the bus trip, the resident told us they were “bored”. They told us that they like listening to music but this was not arranged on the day we visited. In the area of the home that is currently the dementia unit, two of the seven residents had gone on the mini-bus trip. The other residents were offered some hand and nail therapy by a member of staff and this appeared to be an enjoyable activity for the residents. However, when we talked to some of the care staff we found that social activities are not organised in the dementia unit to meet the specific needs of the residents who have dementia. Sometimes residents in the unit take part in activities in the other part of the home otherwise residents are dependent on whoever is on duty to arrange meaningful or enjoyable activities during the day. At the moment, residents are not able to easily access the garden area of the home because of the building work. It was evident from the information provided in the Annual Quality Assurance Assessment and in discussion with the registered manager that the service wants to provide social and recreational opportunities for residents that will satisfy their differing cultural and social preferences. There have been some barriers to doing this while the home is undergoing building work and a temporary re-organisation of bedrooms and communal space. The manager Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 15 hopes that when the residents are in more spacious and purpose built accommodation the service will be able to develop a person-centred approach to meeting residents’ social, cultural and recreational needs in an organised and planned way. Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has systems in place to ensure that any complaints or concerns are listened to, taken seriously and acted upon. Residents are safeguarded by robust procedures for responding to any concerns about practice in the home that may put residents at risk of harm or abuse. EVIDENCE: We looked at how the home has dealt with any complaints or concerns about the safety of residents in the home. We also talked to the manager and to Social Services about the outcome of a recent investigation into concerns about some aspects of practice in the home. The home has a written complaints procedure and tells us that this is also available in Braille or in audio form where appropriate. In practice, residents told us in the 7 surveys that were returned that they are generally happy to raise any issues of concern with the manager, in the first instance. All of the comments told us that the manager is approachable and available. We saw the manager taking time to talk to some visitors who had some queries, during our inspection visit. Since the last inspection there have been some issues of concern about practice in the home. These have been investigated by Social Services under their ‘Safeguarding Adults’ procedures. The home has co-operated fully with Social Services to look at these concerns and although the allegations were not Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 17 substantiated, some recommendations were made to improve practice in the home, to ensure the safety of people using the service. The manager confirmed that these recommendations have been put into practice in the home to ensure that residents are protected. Social Services told us that they will be visiting the home again to monitor how well the home are maintaining the improvements to practice in the home. We have judged that the outcomes for residents in the home are good in this area. This is because the manager has worked with Social Services in an open and positive way to look at concerns and make improvements to practice that will benefit the residents in the home. The service now needs to demonstrate that improvements will be embedded into care practice and maintained. Residents are protected by the home’s recruitment procedures, and new staff are employed subject to satisfactory checks and references. This ensures that residents are protected from the risk of harm and demonstrates that staff are suitable to work in the home. Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 18 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, 23 and 26 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a safe and comfortable environment that is pleasant and homely, however, some of the bedrooms and communal areas are not suitable for long-term use and are only being used temporarily. The home is clean and hygienic. EVIDENCE: We looked at all of the communal areas of the home and some of the residents’ bedrooms (with their permission). Although residents have had to use some rooms on a temporary basis and further changes are planned when the new building work is completed: comments from residents and relatives demonstrate that the service has managed the inconvenience of building work and change well. One resident told us in a survey that the home is always fresh and clean “especially under great difficulties with the building work going on”. The manager had planned a Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 19 meeting with residents and relatives the day following our visit to discuss the new building and how residents will be affected. Some of the bedrooms that are being used temporarily are suitable for residents’ needs but one bedroom is very dark and looks directly onto the building site. One bedroom did not have a cupboard for toiletries and these were being stored on the floor. In another bedroom, the alarm call system had come away from the wall and was hanging loose. The manager said that this would be repaired that day. It is appreciated that the home is in a period of change and the home environment will change when all phases of the building work are completed and the new rooms are registered. The home environment for residents in the dementia unit is not suitable for long term use, the lounge and dining areas are not spacious and residents cannot easily access the garden. However, it is planned for the dementia unit to move to a purpose built new building. The manager told us that the service has taken professional advice on planning the best environment for people with dementia related needs such as space to walk around easily, bathroom doors painted in an easily recognisable colour etc. At the last inspection there were serious concerns about the poor state of some of the beds – some were then found to be wet and poorly made up. We looked at a number of beds and found these to be clean and dry, however, one bed did not have a bottom sheet or valence under the special mattress and the mattress was at risk of sliding off the plastic mattress cover. Some of the bedding, although clean, is worn and tired looking. The manager told us that all of the bedrooms in the new building would have new bedding and new beds. In addition, all bedrooms in the new building will have en-suite facilities. The home employs domestic staff in sufficient numbers to maintain a clean and hygienic environment and we saw that the laundry, bathrooms and toilets have liquid soap and paper towels as part of the home’s good practice for maintaining good hygiene. Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are protected by the homes’ recruitment procedures. Generally, staff receive suitable training to enable them to meet residents’ care needs but further training is needed in the area of dementia care to demonstrate that the staff team have the skills and knowledge to provide specialist care in the dementia unit. EVIDENCE: We looked at the recruitment and training records for three members of staff. We also spoke to three members of staff individually and other members of staff during the course of our visit. We also looked at the written comments that we received from 7 other members of staff. During the visit we also saw how the manager and staff work with the people using the service and we saw some examples of good communication between staff and residents. The service is currently recruiting new staff to work in the home when the building work is completed. At the moment there are two staff working in the dementia unit during the day and two staff working in the other part of the home with an additional senior carer and the manager. A care support worker is employed on five days a week from 2pm to 8pm. The home also employs Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 21 other staff for cooking, administration, cleaning, maintenance, and a part-time activities co-ordinator. This is currently for 22 residents. Comments from care staff said that sometimes there are staff shortages, usually due to staff absence for a number of reasons, but that this did not happen all of the time. Some of the staff were confident that they had received all of the training they needed to do their work and some staff felt that their induction and initial training could have been more detailed and less “rushed”. Islecare has a number of staff available to do ‘bank’ work so that they know that staff can be available to cover staff shortages, that are already trained and suitable to work in the home. The manager tries to arrange staff rotas so that new and less experienced staff are working with experienced staff but there are occasions when this cannot be arranged. The staff training programme includes all of the necessary training in safe working practice including safe moving and lifting. The staff members that we spoke to confirmed that they had done this and receive regular updates. Care staff also enrol to achieve the National Vocational Qualification (NVQ) in care level 2 and 3. The information provided by the manager in the AQAA confirmed that at least half of the care staff have achieved NVQ 2 in care and some of the staff already have NVQ 3. All of the care staff receive additional training in specialist areas of care such as dementia care, and some of the staff have recently received training in continence care. The dementia training is provided ‘in-house’ and consists of 3 x two-hour sessions using resources provided by a national organisation in dementia care. However, not all of the care staff working in the dementia unit have completed this basic training. This means that care staff working in the specialist unit may only have a limited understanding of how dementia care and support is to be delivered and this may mean that care practice is not consistent. When there are two staff working in the dementia unit, there are some periods when the two staff are required to assist one person with personal care, leaving the other residents on their own. The manager is aware of this and explained that assistance can be requested from other staff in the home. In discussion, it was evident that the manager has done some additional professional training in good practice in dementia care such as dementia care mapping with other training planned. The service needs to demonstrate that all of the staff have the right skills and training to provide good quality care for people with dementia. Staff told us they felt well supported by the senior staff and manager and they have opportunities for regular personal supervision to discuss any work issues they may have. We looked at the recruitment records for three members of staff and this confirmed that the home follows thorough recruitment procedures that protect Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 22 people using the service and ensures that staff are suitable to work in the home. Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 23 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 and 38 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally well managed in the best interests of the people using the service. The health and safety of the residents and staff is promoted and maintained, but the service must ensure that risk assessments are up-to-date and regularly reviewed. The service needs to develop systems for monitoring and assessing the service provided to people with dementia to ensure that people using this specialist service are receiving good quality care that meets their needs. EVIDENCE: We looked at the information provided by the manager in the Annual Quality Assurance Assessment (AQAA). The AQAA was returned when we asked for it and was fully completed. The manager told us the service promotes equality and diversity by making sure that care plans are person centred and that Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 24 residents have some choice in who provides their care. However, we found that the home still needs to develop a person centred care approach in their specialist unit for people with dementia. This will demonstrate good dementia care that is about the whole person. The home has an experienced manager who has achieved qualifications in care and management. Comments from residents and staff confirm that the management approach of the home is open, warm and friendly. The service is in the process of making major changes to the home environment and although well managed and organised, this has had some impact on the organisation and running of the home. The manager feels that the current facilities in the home are not always conducive to residents’ well being but is optimistic that this will change when the new and better facilities are ready for use. The home has systems in place for monitoring the quality of the care provided by asking residents to comment on their experience of living in the home, and also by monitoring how well the service is meeting it’s regulatory requirements, with the overall aim of providing good care for people using the service. The service was in the process of having an internal quality audit when we visited the home. However, the service need to develop ways of making sure that residents with dementia related care needs are also included in the home’s quality assurance systems. This will demonstrate in practice the home’s commitment to recognizing that people with dementia have the same rights as any other person to make decisions about their lives. The manager is aware of the complex issues around ‘capacity to give consent’ and it is planned that further training in this area will be available to care staff. The health and safety of the residents and staff is promoted through regular checks on practice in the home and compliance with relevant legislation. A recent inspection of the home for food safety gave a four star rating for food safety and hygiene. However, the service must ensure that care plans and risk assessments are reviewed and changes in care needs recorded. Where a risk to a resident is identified, there must be clear, and up to date written guidance for care staff on the action they must take to reduce or manage any risk or event. This will ensure that practice in the home is consistent and safe for people living in the home. The service also needs to develop care assessments and care plans that are suitable for people who have dementia related care needs. The service needs to do this because they are planning to provide a specialist service for people with dementia and need to demonstrate that they can meet complex needs in a co-ordinated way to improve the quality of life for older people with dementia. Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 25 Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 26 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X 2 X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15 Requirement Timescale for action 30/05/08 2. OP9 13 To ensure the safety and welfare of the service users, the care plans and risk assessments must be reviewed to reflect changing care needs and provide clear written guidance for care staff on what action they must take to minimise any risks or manage events. The storage of controlled drugs 30/08/08 must meet the requirements of the Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The registered manager needs to develop systems for monitoring and assessing the service provided to people with dementia to ensure that people using this specialist service are receiving good quality care that meets their DS0000012502.V361439.R01.S.doc Version 5.2 Page 28 Inver House individual needs. This should include developing an assessment and person centred care-planning process that recognizes and values the wide variations in the experiences of people with dementia. Inver House DS0000012502.V361439.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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