Inspection on 20/03/08 for Inwood House

This inspection was carried out on 20th March 2008.

CSCI found this care home to be providing an Good 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

Inwood House 15/01/07

Inwood House 27/02/06

Inwood House 13/09/05

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Inwood House Inwood House 10 Bellamy Lane Salisbury Wilts SP1 2SP Lead Inspector Sally Walker Unannounced Inspection 09:35 20 March 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Inwood House DS0000063485.V359756.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. Inwood House DS0000063485.V359756.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Inwood House Address Inwood House 10 Bellamy Lane Salisbury Wilts SP1 2SP 01722 331980 01722 331985 admin.inwood@btinternet.com 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) Mr Alan Butchers Mrs Diana Butchers Miss Donna Marie Malone Care Home 20 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (1), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (10), Old age, not falling within any other category (20) Inwood House DS0000063485.V359756.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. No more than 20 service users with old age over 65 years of age at any one time. No more than 10 service users with a mental disorder, over 65 years of age at any one time Within the category of Mental Disorder (MD), no service user to be admitted under the age of 55 years 15th January 2007 Date of last inspection Brief Description of the Service: The home is an established care home in Salisbury near the city centre. It is registered to provide personal care to up to 20 older people 10 of whom may also have additional mental health needs; one of whom is under the age of 65. Accommodation is to three floors accessed by a passenger lift and stairs. All but one of the single bedrooms has en-suite toilet facilities. There are 2 bathrooms and one shower room with toilets to the ground floor near the sitting room and dining room. The staffing rota provides for a minimum of 5 care staff during the mornings, four during the afternoon and evening, with one waking night staff and one member of staff sleeping in. This is one of 2 homes run by Mr and Mrs Butchers. Miss Donna Malone is the registered manager. Inwood House DS0000063485.V359756.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 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection took place on 20th March 2008 between 9:35am and 6:50pm. Mr Butchers and Miss Malone were present during the inspection. Mrs Butchers also visited on another matter. Since the last inspection of 15th January 2007, our pharmacist inspector carried out a Random inspection on 3rd May 2007 to inspect the arrangements for medication in the home. Findings are to be found under standard 9: health and personal care. As part of the inspection process we sent survey forms to the home for residents, relatives, staff and healthcare professionals to tell us about the service. Comments can be found in the relevant section of this report. We asked Miss Malone to complete the Annual Quality Assurance Assessment. This was completed in full and returned on time. Current fees for the home are between £396 and £465 per week for basic care. The home charges between £44 and £300 extra per week depending on additional needs. 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. What the service does well: Information is given to residents as they come to live at the home. Detailed assessments are carried out with potential residents and their representatives so that a plan of care can be established. Residents’ social and family history is included in the assessment process. All residents’ care, support and preferred routines are detailed in care plans. Care plans are regularly reviewed and revised as needs change. Daily reports show that care plans direct the care. Residents have good access to healthcare professionals. Inwood House DS0000063485.V359756.R01.S.doc Version 5.2 Page 6 Residents are consulted about who provides their intimate personal care. Their decisions are recorded in care plans. Systems for safe administration of medication are in place. Residents enjoy a range of activities both at the home and in the locality. Care plans take into account residents interests and hobbies. One to one time is offered as well as group activities. Residents enjoy a range of healthy meals. The complaints procedure is discussed with residents at their meetings. Issues arising from these meetings are considered by management and changes made if needed. A box is provided for comments on the service. The complaints log showed good evidence of investigations and outcomes being discussed with residents or letters to complainants. The home is warm, well maintained and cleaned to a good standard. Residents can personalise their bedrooms with items of furniture and personal possessions. Staffing levels enable residents to have the support and care they need and leisure activities they enjoy. Staff have good access to relevant training for the work they do. Mr and Mrs Butchers and Miss Malone keep themselves up to date with legislation and current good practice with regular seminars and training. What has improved since the last inspection? Staff are recording only their observations and interventions in the daily reports rather than using subjective terminology. Those residents who like to go out alone have strategies in their care plans showing what happens if they do not return at a given time. Tissue viability training has taken place and further sessions are planned. Guidance is now in place for the administration of medication prescribed to be taken ‘as required’. Staff are signing the medication administration record after having given medication. Regular audits of the medication systems are being carried out. Staff have been trained in the local safeguarding adults procedures and had a copy of the ‘No Secrets’ booklet. The gardens have been landscaped and a patio provided. The dining room carpet has been replaced with a non-slip floor covering. The kitchen has been refitted. Inwood House DS0000063485.V359756.R01.S.doc Version 5.2 Page 7 A programme of training in caring for people with mental health problems is now in place. All the documents and information required by regulation are now obtained before staff start working at the home. Mr Butchers has produced a code of practice setting out the home’s expectations of good practice and conduct. 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. Inwood House DS0000063485.V359756.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Inwood House DS0000063485.V359756.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 standard 6 is not applicable Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents can be sure that the home will fully assess all aspects of their support and care needs in order to confirm that those needs can be met. EVIDENCE: We saw that the two residents being admitted that week had an information pack in their bedroom. Pre-admission assessments were carried out with all prospective residents. In the Annual Quality Assurance Assessment Miss Malone told us that the admission policies and assessment form had been changed. Information had been gained from all parties involved in residents care programmes. The assessments covered all aspects of residents’ lives including social, medical and personal history. One of the residents told us that they would make a point of getting to know new residents and make sure they were settling in well. Inwood House DS0000063485.V359756.R01.S.doc Version 5.2 Page 10 Residents’ comments in survey forms included: “Came in on respite – decided to stay.” “Social worker came to see me in hospital.” Relatives comments in survey forms included: “Inwood House has proved to be probably the luckiest find imaginable and has given far more support and care than a residential home could be expected to provide.” Inwood House DS0000063485.V359756.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All aspects of residents’ care and support needs are known. This means that care plans direct the care. Residents’ healthcare needs are being met and monitored. Systems are in place for safe administration of medication. Staff are respectful of residents privacy and positively engaged with residents. EVIDENCE: All residents had a detailed care plan which itemised all of their care and support needs. These included routines on waking, continence management, medication and healthcare needs, emotional wellbeing, nutrition and pressure area care. Preferred routines were recorded for personal care. Night time routines were also identified. One care plan identified how staff should support a resident who had a broken arm. Another care plan detailed how staff should support the resident with anxiety. There was clear guidance to staff on how certain behaviours were presented together with guidance on management. Inwood House DS0000063485.V359756.R01.S.doc Version 5.2 Page 12 One resident who was being cared for in bed had good detail in their care plan about how they were cared for. This included special diet, mouth hygiene and turning to reduce the risk of pressure damage. Risk assessments were carried out with individual residents. Pressure relieving equipment was in place where necessary. These were regularly reviewed and any changes noted in the care plans. Care plans were regularly reviewed each month. Six monthly reviews were carried out with relatives invited. Residents’ life histories were noted in care plans. We advised that body maps should record size and colour of any wounds to further evidence progress in healing of any wounds or marks. Action has been taken to address the good practice recommendation we made about considering recording observations and interventions rather than meaningless words such as ‘no problems’. Daily reports showed that the care plans directed the care with good detail of how staff were meeting assessed needs. We discussed requests by families on not resuscitating a resident. We advised the home to consult the Department of Health website about advanced statements. Staff must continue to take action to save life unless a specific Advanced Statement has been put in place. Mrs Butchers and Miss Malone had recently attended a seminar on the Mental Capacity Act 2005 with regard to delegated decisions on people’s healthcare. One of the residents told us that at first they did not like to be cared for by male staff that they described as ‘young boys’. However they were now happy with the arrangements. We looked at female residents files. There were letters to residents asking them whether they agreed to intimate personal care being delivered by male staff. Details of consent were recorded in care plans. We saw staff engage personally with residents. It was clear that good relationships were established. All personal care was carried out in private. A separate file was kept of all healthcare interventions. Residents told us that their own GP would visit them at the home or they could go to the surgery. They said that staff would always call the GP when needed. Residents had good access to other healthcare professionals. The falls co-ordinator nurse had carried out an audit of the home. Results had been discussed with staff. One of the residents said they were looked after very well. Two residents told us they were very happy at the home. Action has been taken to address the requirement we made that strategies are in place for those residents who like to go out alone if they do not return at a given time. Action has been taken to address the requirement we made that staff are trained in tissue viability so that they can assess the early indicators of Inwood House DS0000063485.V359756.R01.S.doc Version 5.2 Page 13 residents risk of developing pressure sores. Further training was planned form the tissue viability specialist nurse. Since the last inspection our Pharmacist Inspector made a Random unannounced inspection. This was to inspect the medication arrangements in the home. They reported that medication was stored securely. Records of medicines received and returned were kept. Medication administration records were clear and evidence was seen of the use of codes for doses not given. There were some gaps in the signatures for administrations and this needs to be tightened up. Instructions for medicines prescribed ‘as required’ were written on the chart but were not in the resident’s care plan as a protocol to follow. This is particularly important when giving drugs for anxiety or aggression. Staff spoken to were able to describe safe medication procedures and training for medicine handling. The administration of medicines was not observed; however pots and lids, some with names on, were seen on the trolley. The use of lids may encourage staff to ‘pot up’ medication and lead to bad practices. Residents are able to manage all or part of their medication if they are able and want to do so. Risk assessments are carried out and regularly reviewed. One service user said that they felt well supported by staff to maintain their independence. Some medicines requiring disposal had been left on the trolley. These were removed during the inspection. Two requirements and one recommendation were made during this inspection of 18th April 2007. Action has been taken to address the requirement made that a protocol for the use of ‘as required’ medication is included in the care plan to ensure it is used safely. One resident’s care plan showed guidance on what behaviour prompted the administration of a medication. This medication was prescribed to be taken ‘as required’. Action has been taken to address the requirement made that staff must sign the medication administration record after having administered medication. The medication administration records were up to date. Action has been taken to address the good practice recommendation made that the administration of medication should be regularly reviewed to ensure safe procedures are used at all times. The home carries out regular written audits of the medication system. At this inspection, most of the residents told us that staff held their medication and would administer it when prescribed. One resident told us that they could administer their own medication if they wanted. Another resident told us that staff would always ask them if they needed pain relief medication. One care plan detailed the risks to the resident taking Warfarin together with management of regular blood tests and any change in dose. Files showed that written confirmation was obtained from the prescriber if the Warfarin prescription was changed. One resident had benefited from a review and Inwood House DS0000063485.V359756.R01.S.doc Version 5.2 Page 14 reduction of their medication for a better quality of life. Two staff were checking the weeks medication delivered by the pharmacist. We saw that the medicines trolley was not secured to the chain on the wall. Miss Malone said that this was because the room had been reorganised and was about to be redecorated. She said this would be addressed immediately. Relatives’ comments in survey forms included: “Mr Butchers & Donna make themselves readily available at all times for comment and/or discussion and always keep us informed. Mr Butchers and his staff have been more than flexible in accommodating my [relative’s] needs and their review process means that [the resident’s] needs are under constant assessment. The team at Inwood always let me know of any significant changes or occurrences and always offer excellent advice on course of action.” “Medical care is well provided for.” “There is a strong ( commendable) emphasis on respecting resident’s freedom of choice autonomy. There are times when I would like staff to feel free to offer sensitive guidance more assertively, when autonomy is being unwisely exercised. (E.g. resident feels personal hygiene needs are met by a weekly bath underwear change – [relatives] would insist on a more frequent regime). I’ve been particularly struck by the sensitivity with which the mentally less able are handled. I visit frequently – I can only comment on what I have observed.” “We have been very pleased with the care that Inwood House has given our [relative]. It is a very difficult situation and we feel that they enable our [relative] to have as much dignity as is possible with [their] deteriorating health. Nothing in this situation is going to be perfect as everything has to be managed on a day-to-day basis.” Healthcare professionals comments in survey forms included: “I do not witness drug administrations. Very helpful & caring especially Donna. I have only been to Inwood a few times as I am new to this team. I have usually seen Donna who is very caring towards residents and helpful.” “My contact with Inwood House has centred on advice and training for staff and provision of an early warning system (health) which includes referral pathways. Therefore my contact has been limited. I would however like to mention that home management and staff have been extremely positive and enthusiastic about receipt and use of the new support systems I have put in place. This in turn should help to improve the health and wellbeing of home residents if used as agreed.” Inwood House DS0000063485.V359756.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to continue with established interests. Residents benefit from a good range of activities both at the home and in the community. Contact with families is maintained. Those residents who can decide, follow their own daily routines. Residents enjoy a range of healthy meals. EVIDENCE: Those residents who could decide spent their day following their own routines. Other residents relied on staff for direction. In the Annual Quality Assurance Assessment Miss Malone told us that she had consulted residents about activities and the menus. In response changes had been made. Care plans identified how residents spent their leisure time with guidance on which residents to support in meaningful activities. Residents are encouraged to continue to follow established hobbies. A record was kept of individual residents participation in the events, both during the morning and afternoons. Care staff provide the activity programme. Records also detail any benefits residents had gained from each activity. Activities included: talking about the Inwood House DS0000063485.V359756.R01.S.doc Version 5.2 Page 16 news and current events, crosswords, ball games, keep fit, music and walking to the local shop or going into Salisbury. There was also evidence that some residents who perhaps did not want to join in with group activities, had some one to one time with staff. One of the residents told us that they regularly went out shopping in Salisbury in a taxi. They said they liked to do small mending jobs for other residents. Another resident said they read a lot and wrote letters. They told us they regularly went to stay with family for weekends. They said there were occasional trips out to a supermarket for coffee, to the theatre and to a garden centre. Another resident said there was always an activity of some kind every day. They said they liked reading and could always ask for a book. They said they joined in with the quizzes. Some of the residents attended the Communion service held at the home that day. Residents also said some of them attended local churches. Residents told us that their families and friends could visit when they wanted and were always made welcome. On the day of the inspection Mr Butchers was doing the cooking as the chef was on leave. Miss Malone told us she was considering offering different menus. One of the residents said that the food was “up and down”. Another resident told us that the meals were getting better. They said they had spoken to Mr Butchers about the meals at the residents meeting. They said their favourite meals were fish and bacon and eggs. Another resident told us that there was a good selection of meals on the menu. They said staff would tell them what was on the menu that day. Another resident said: “I’ve never been given anything I don’t like”. One resident said “at Easter and Christmas we have quite good meals”. Residents had a glass of sherry at 11.30 before lunch. We sat with residents and sampled the meal. The meal was chilli con carne with rice, however alternatives were available. Two residents had jacket potato instead of rice. Two residents had steak pie, vegetables and mashed potatoes. One resident had a salad and cold meat. The pudding was peaches and ice cream. Yoghurt, ice cream or fresh fruit were also available. The meal was well presented and tasty. The meal was served according to residents appetites. The meal was not hurried and places were cleared in a quiet manner. The evening meal was pate and toast, soup or sandwiches with apple strudel. After lunch staff asked residents their preferences for the evening meal. The menus showed a range of dishes taking into consideration healthy eating. Residents comments in survey forms included: [Activities that you can take part in?] “Not really.” “I don’t usually take part in activities – my choice. Lots of fruit veg which I like. Always an alternative if I don’t like something.” Relatives comments in survey forms included: “The staff are well motivated to provide stimulating activities and entertainment for their residents and also Inwood House DS0000063485.V359756.R01.S.doc Version 5.2 Page 17 provide great ‘social occasions’ to involve residents family members.” “More one-to-one social interaction would be helpful to my [relative’s] needs. Food is adequate and well presented.” “Provision of activities encouraging the more able to join in even lead (e.g. quizzes crosswords). Outings provided monthly variety. Food is good – quality quantity choice. Inwood House provides a homely friendly atmosphere for residents. Visitors are welcomed as friends.” “The staff are very prompt in informing me of any issue that affects my [relative]. This care home has always put [my relative’s] needs first. The atmosphere is always pleasant. The staff are friendly and helpful. [My relative] is settled and this makes [them] happy and safe. [My relative] has friends to talk to and this means [they] can be [themselves] and so is more relaxed. Altogether [my relative] loves being at Inwood House and this means I do not have to worry about [my relative] so much – this makes me happy too! At present the overall package offered by Inwood House (staff/facilities) is wonderful. I would be hard pushed to think of any way to improve the home.” “My [relative] is very happy at Inwood House. The management staff are all very kind considerate towards [my relative].” Inwood House DS0000063485.V359756.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by systems put in place to enable them to complain about the service. Residents are confident in making complaints. Staff are trained in the local procedure for reporting allegations of abuse and know how to use it. EVIDENCE: The home has a complaints procedure which is discussed with residents at their meetings. In the Annual Quality Assurance Assessment Miss Malone told us that a comments box had been provided following discussions with residents. Senior staff had spoken to individual residents about making complaints and showed them the policy and a comment form. It was clear from the records that any comments are taken seriously with evidence of investigations, interviews and outcome reported back to the complainant. There was evidence that management spoke directly to residents about the outcome of any complaints they had made. The records showed when things were changed as a result of a complaint. All of those residents spoken with told us that they would speak to staff, Miss Malone or Mr Butchers is there was anything that they were unhappy with. Inwood House DS0000063485.V359756.R01.S.doc Version 5.2 Page 19 Action has been taken to address the requirement we made that all staff are trained in the local vulnerable adults policy and procedure. All staff had a copy of the local safeguarding adults booklet “No Secrets”. Staff were asked about how they would respond to any allegations of abuse. They said they would report to Miss Malone or Mr and Mrs Butchers. Residents comments about making complaints in survey forms included: “I have never been at a loss for where to get help, but I am sure it would be readily available. This can be done verbally and is always treated sympathetically.” “See Donna or go to office.” Relatives comments in survey forms about making complaints included: “Never been necessary under the current management and staff.” “So far we have had no major problems and minor queries are always dealt with very quickly.” Healthcare professionals comments in survey forms included: “This has not happened. No one has expressed any concerns.” Inwood House DS0000063485.V359756.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a warm, comfortable, clean, well maintained and safe environment. EVIDENCE: All the bedrooms are single accommodation. All but one bedroom has its own ensuite facility. Residents had personalised their bedrooms with items of furniture, photographs and ornaments. The rooms were comfortable, warm and clean. There is a passenger lift between floors. The grounds had been landscaped and a large sitting area created. The weather was too cold for residents to sit outside. Inwood House DS0000063485.V359756.R01.S.doc Version 5.2 Page 21 Miss Malone had made one of the bedrooms into a sitting room for a couple who were coming to live at the home. Action has been taken to address the good practice recommendation we made that if the dining room carpet does not respond to deep cleaning, consideration should be given to replacing it. New non-slip flooring had been fitted to the dining room. Miss Malone told us that the room would now be redecorated. Sine the last inspection the kitchen has been refitted. We found the home cleaned to a good standard. No unpleasant odours were detected in all but one of the bedrooms, early in the inspection. Staff explained how continence was managed for this resident. The room was more pleasant later in the day. A cleaning schedule had been put in the toilet that residents used the most. This was to show that it was regularly cleaned. A programme of maintenance was in place. A person was employed to do maintenance works to the two homes owned by Mr and Mrs Butchers. One of the residents told us that the shower did not work. Mr Butchers told us that the hot water was intermittent so new boilers were to be installed. There was a small laundry room. Care staff carry out laundry. Systems were in place to ensure laundry was processed at the correct temperatures. Soiled or contaminated laundry was laundered appropriately. Staff had access to protective clothing and disposable gloves. Relatives comments in survey forms included: “The home is kept fresh, well maintained and is being constantly improved. The provision of a room to undertake hairdressing (to incorporate proper backwash & chair) and chiropody etc would be excellent.” “Hygiene is very good.” “Recent enhancement of outdoor environment will be enjoyed by residents in the summer especially.” One staff survey form included the comments about what the home could do better: “To take better care of clothes washing, ironing, labelling and putting clothes back to right owner. Clients get very upset clothes are taken away to be washed and not returned due to not being marked.” Inwood House DS0000063485.V359756.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels during the mornings enable residents to receive the care and support they need. At other times some staff feel this is insufficient. Staff are well trained. Residents are now protected by a robust recruitment process. EVIDENCE: On the day of this inspection there were 4 care staff and Miss Malone in the morning and 2 staff in the afternoon and evening. At night there is one waking staff and one staff sleeping in. One of the residents told us that there were usually 5 staff in the mornings. Action has been taken to address the requirement we made that a programme of mental health training was in place. Mrs Butchers and Miss Malone had been to a seminar on the Mental Capacity Act 2005. We talked to staff about recent training. They said the training offered was excellent. They said they had recently attended training in moving and handling, first aid (Mrs Butchers is the home’s trained trainer for both subjects), falls, continence, mouth care, catheter care from the community nurse, infection control, safeguarding adults and a fire safety course planned Inwood House DS0000063485.V359756.R01.S.doc Version 5.2 Page 23 for that week. Other regularly updated training included: food hygiene, medication, schizophrenia, depression, paranoia, dementia and risk assessment. Mrs Butchers told us that the tissue viability specialist nurse was providing training the following month. Miss Malone told us that the training co-ordinator to the two homes resigned recently so this had had some impact on what was provided. Three staff have NVQ Level 3 and four are undertaking NVQ Level 2. Miss Malone told us that a staff meeting was overdue, the last one being held in September 2007. Training sessions were held as part of the staff meetings with different subjects each month. Action has been taken to address the requirement we made that all the information and documents required in staff recruitment are in place. Staff recruitment files now showed that a robust procedure was in place. No staff commenced duty until all the checks had been made as to their suitability to work with vulnerable people. All new staff are required to undertake the home’s induction programme. Mr Butchers had produced the home’s own code of practice for staff, setting out expectations of good practice and conduct. Residents comments in survey forms included: “Most of them very helpful.” Relatives comments in survey forms included: “The staff are exemplary in their standards of care and their attitude to all the residents. [They] always show great respect for their residents and put a huge value on maintaining the dignity of the residents as well as their privacy.” “I have little experience of large scale care of the elderly, so I cannot comment on the suitability of staff. Also I do not know their previous experience/qualifications don’t think that this is for me to comment on. We chose Inwood House because we liked the staff, their approach and the friendly way the home was run. We have been perfectly satisfied think that their patience humanity exercised during an extremely difficult job is to be highly praised.” Staff comments in survey forms included: “We always have handover when coming on duty. Any changes are written on daily handover and in clients care plans. We are given lots of opportunities to learn new skills. District nurses have passed knowledge which is helpful. Example, how and when to put a pad on. When to change it. How and when to apply creams. Mrs Butchers has trained on manual handling, first aid in very enjoyable way. People come in and discuss mental health and give greater understanding. Afternoon shift runs well but if we have residents who become ill, two staff in the afternoon is not enough to be able to give enough time to the resident who is ill. [Does well?] The home meets the need of the individual by allowing them to express their feelings and opinions. To listen understand them. Encourage independence choice and try living harmoniously with one another.” “[What the home does well] Training and paperwork. Not enough staff on shift to cope with the needs of residents.” Inwood House DS0000063485.V359756.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Miss Malone is clear about how she intends to develop the home with support from Mr and Mrs Butchers. The home is run in the best interests of the residents. Residents financial interests are managed by their relatives or representatives. Systems are in place to monitor and maintain residents and staff’s health, safety and welfare. EVIDENCE: Miss Malone was approved as the registered manager in September 2007. She is completing the Registered Managers Award. Mr Butchers and Miss Malone have clearly defined responsibilities in terms of management of the home. Mr Inwood House DS0000063485.V359756.R01.S.doc Version 5.2 Page 25 Butchers remains involved in the home on a daily basis and continues to be involved in the managing the business and financial side of the home. Mrs Butchers provides training and staff appraisals every 6 months. Staff also have group supervision. Miss Malone attends regular management meetings with Mr and Mrs Butchers. Miss Malone told us that the head of care post was advertised. The appointment would enable her to delegate some of the care duties to concentrate on further development projects. Although there was no formal development plan for quality assurance, residents were regularly consulted at their meetings. Actions had been taken to address issues arising from these meetings, for example, changes to the menus and the activity programme. Miss Malone also set out her plans for the next 12 months in the Annual Quality Assurance Assessment that she sent to us. Regular residents meetings are held with minutes kept. Risk assessments were regularly carried out on the environment and any tasks that staff were involved in. The home does not deal with resident’s finances. Relatives are encouraged to take responsibility for residents’ money and pension. Any items purchased on residents’ behalf are invoiced to the relevant family. Relatives comments in survey forms included: “I would only like to commend Mr Butchers, Donna Malone and all the staff at Inwood for providing a really high grade residential home for the elderly and for their really ‘caring’ approach. The amount of investment Mr Butchers makes at Inwood – both financial and time wise is only to be admired and applauded.” Inwood House DS0000063485.V359756.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 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 Inwood House DS0000063485.V359756.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 OP8 Regulation 12(2)&(3) & 13(b) Requirement The person registered must ensure that staff continue to carry out first aid to save life. An Advanced Statement must be in place if a resident requests other instruction. Timescale for action 20/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP8 OP37 OP27 Good Practice Recommendations Body maps should record size and colour of any wounds. Consideration should be given to whether staffing levels in the afternoons and evenings are sufficient to meet residents’ needs. Inwood House DS0000063485.V359756.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Inwood House DS0000063485.V359756.R01.S.doc Version 5.2 Page 29 - 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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