Inspection on 09/01/07 for James Dixon Court

This inspection was carried out on 9th January 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

James Dixon Court 06/01/09

James Dixon Court 12/01/06

James Dixon Court 04/10/05

James Dixon Court 23/02/05

James Dixon Court 06/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE James Dixon Court Harrops Croft Netherton Liverpool Merseyside L30 0QP Lead Inspector Mrs Margaret Van Schaick Key Unannounced Inspection 9th January 2007 09:00 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 James Dixon Court DS0000005406.V327624.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. James Dixon Court DS0000005406.V327624.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service James Dixon Court Address Harrops Croft Netherton Liverpool Merseyside L30 0QP 0151 931 5748 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) Arena Housing Association Limited Mrs Christine Cole Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places James Dixon Court DS0000005406.V327624.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 30 OP The service must employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 4th October 2005 Date of last inspection Brief Description of the Service: James Dixon Court is a registered care home registered to provide personal care for up to 30 older people of both sexes. Arena Housing Association, who provides a range of services as a registered charity, owns the home. Arena also manages a sheltered housing complex, which is adjacent to the care home. The home is situated in a residential area close to local facilities and transport links. The home has been purpose built to accommodate residents of varying abilities with adaptations fitted throughout. A call bell system is fitted to all bedrooms, bathrooms and public areas. Residents are accommodated in single rooms, all with en-suite facilities. Communal facilities consist of a large lounge, separate large smoking room and dining room. There are also smaller seating areas around the home. The garden grounds are attractive, and easily accessed by residents. There are several sitting out areas with some seating areas covered. There is parking to the front of the building. Weekly fees are £360.50-£371. James Dixon Court DS0000005406.V327624.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day and lasted approximately 7 hours. This was the key unannounced inspection to be carried out as part of the regulatory requirements. As part of the inspection process all areas of the home were viewed including most of the residents bedrooms. Residents care records and other care home records were inspected also. Discussion took place with the registered manager. The inspector also had discussions with the senior carer, cook and one to one interviews with three care staff. Several residents were also spoken with. Residents were interviewed in private and their views obtained on how the home was run. Relatives were interviewed also. Have your say about…questionnaires were sent out to residents by the Commission prior to the inspection. These have been completed and returned and their views are included in this report. What the service does well: Residents’ comments include, “it is a home to me, when I’ve been out I say I’m going home, that’s a home to me”. Residents have their needs clearly identified prior to admission therefore this ensures that the home is able to make an informed decision on whether they can manage the individuals needs or not. Care plans are well set up and maintained to include the changing needs of the residents. Residents confirmed that their healthcare needs are met with comments including, “you always get the care here, they, (staff) are very helpful”. Residents and their families were clearly impressed with the care and support provided by care staff. Residents interviewed stated, “I like it here very much” and “I like everyone, I am a diabetic and they look after me, I’m on a special diet for diabetes”. Visiting health professionals’ views of the home were obtained and include “I think this is the best home in the area”. The home provides a well balanced diet that is enjoyed by all residents. Residents interviewed stated, “the food is lovely, we had liver today and we also have home baking” and confirmed that they had a choice at mealtimes. Residents comments with regard to food include, “I eat everything” and “the meals are always very nice” and “no fault with meals I like them very much”. The home promotes the safety of the staff and residents. The home has an effective complaints procedure. James Dixon Court DS0000005406.V327624.R01.S.doc Version 5.2 Page 6 Residents live in a well-maintained, clean and pleasantly decorated environment. The home is clean, hygienic and odour free. Relatives interviewed stated, “it’s a beautiful home, spotless, the bedroom has no smells, the beds are clean and it’s well maintained”. Residents’ comments included, “ It’s A1”, “fresh and clean”. The home ensure residents and staff are protected through the pre employment checks carried out on all new staff. Relatives interviewed stated, “staff are marvellous, nothing is too much trouble, they’ll go that extra mile”. Residents interviewed stated, “staff are wonderful”, “I have to press the buzzer for the toilet at night, the staff are very kind to me”, “staff are always very respectful”, staff are very understanding and patient”. Visiting health professionals views of the home were obtained following a brief discussion and include “It’s great in here, the staff are wonderful, very well trained”. The home is well managed and all health and safety checks, servicing of equipment are in place and up to date. Residents, staff and relatives were very complimentary about how the home is managed. Staff interviewed stated, “I enjoy working here, she’s a marvellous boss, a very caring, understanding person”, “I have full confidence in Chris (manager)”, “the residents all like Chris”, “she listens, is supportive, nice to staff and residents and is good with families, very professional”. Through discussion with residents and their relatives it is apparent that both have positive views of the manager. Residents interviewed stated, “Chris is very good, very nice, I would talk to Christine if I had any concerns”. Relatives interviewed stated, “we are kept informed, the home ring us up” and “the atmosphere is so nice”. What has improved since the last inspection? What they could do better: Medication issues continue to be a problem. Two requirements have been made with regard to this. The home need to assess each staff responsible for administration of medication to ensure they are competent in this task and the medication and records need to be audited regularly to ensure safe management of prescribed medications. James Dixon Court DS0000005406.V327624.R01.S.doc Version 5.2 Page 7 Staffing levels need to be reviewed as residents, relatives and staff has raised concerns that there are not enough staff. Relatives canvassed for their views commented, “there are not enough staff available at times”. The home needs to provide sufficient activities to enable residents to socialise on a regular basis. At present staff are unable to provide activities for the residents. Residents have also raised the issue about lack of activities. Residents interviewed stated, “we use to have lots, now we haven’t, we don’t have the staff, I miss the activities”. Therefore management need to review staffing levels to ensure residents’ needs are fully managed including social and activity events. 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. James Dixon Court DS0000005406.V327624.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 James Dixon Court DS0000005406.V327624.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. That residents have their needs clearly identified prior to admission therefore this ensures that the home is able to make an informed decision on whether they can manage the individuals needs or not. EVIDENCE: Three care files were case tracked (when all care documentation relating to the resident is examined). Three of the residents care files were examined with regard to the assessment process. For all three residents a written pre admission assessment is evidenced in all three residents care notes. The assessment documentation identifies all heath care and personal care needs. All activities of daily living have been addressed and include areas such as personal care, psychological needs, mobility, oral care, continence, pressure areas, communication and James Dixon Court DS0000005406.V327624.R01.S.doc Version 5.2 Page 10 dietary needs. Previous medical history, personal details and GP contact details is documented also. Personal preference care plans identify such areas as night checks, outside support, family input re finances, visitors and key holding of the residents’ bedroom. This is good practice. There is signed agreement of the care agreed from residents and relatives. The assessment documentation gives some detail with regard to the individual resident therefore this ensures that when the initial care plan is set up it is specific to their identified needs prior to admission. There is documented evidence that care plans are further developed following admission to include any newly identified areas once the resident settles into the home. Risk assessments are carried out prior to admission to include risks of falls, pressure areas, suitable footwear and bed rails. Prospective residents are invited to spend the day or have lunch. Bedrooms are identified and agreed prior to admission. One resident did not like the bedroom she was offered prior to admission therefore waited until a more suitable bedroom became available. Prior to admission a ‘check list’ of the bedrooms are carried out to ensure all areas are safe and that equipment is in place that is required. This is good practice. This is documented in care files. There is documented evidence of one resident being admitted as an emergency and an emergency care plan was put in place including a statement of needs. Relatives and residents canvassed for their views on the admission process gave positive responses. All received enough information about the home prior to admission and one resident confirmed this and stated, “you want to know all about it and who you’ll be with”. Through discussion with families it was apparent that they were involved in the admission process and were able to support their relative throughout. James Dixon Court DS0000005406.V327624.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. That care plans are well set up and maintained to include the changing needs of the residents. That medication issues continue to be a problem. EVIDENCE: All three residents case tracked have full and detailed care plans in place. The home also has ‘personal preference’ care plans in place, which look at the individual resident and lists their preferred way of living in the home. This is good practice. Care plans are detailed and evidence regular reviews with the next review date identified. The senior carer is responsible for keeping care plans up to date and when reviews with the resident and their relatives (where agreed) take place they and the key workers take part in this review process. This is good practice. Personal care is detailed with agreed support from staff identified and includes oral care, hearing/hearing aids, spectacles, mobility, diet, psychological needs and religious needs. Care needs are detailed and clear for James Dixon Court DS0000005406.V327624.R01.S.doc Version 5.2 Page 12 the individual resident so that staff knows exactly how to assist and support them. Care is then reviewed and care plans are updated to include any new changes. There is documented evidence of residents agreeing and signing their care plan. One resident interviewed stated, “we have discussed my care plan”. Risk assessments are in place to cover areas including pressure areas, risk of falls, slipping, walking aids, wheelchairs and walking for exercise. Mobility needs are identified in detail and include how much staff support or equipment is required for individual tasks. For residents who are at risk of falls the GP has requested additional support through the falls screening programme, which is good practice. One resident who was at risk of sliding out of bed had 15minute checks throughout the night. This resident was also assessed for the use of bed rails but it was decided that the use of these would further put the resident at risk of injury. These documents are signed and dated. Practice nurses are invited to the home to further assess and advise on how to manage residents who become increasingly at risk of falls or pressure area problems. This is good practice. Residents confirmed that their healthcare needs are met with comments including, “they (staff) would get the Doctor for me” and “you always get the care here, they are very helpful”. Healthcare professionals visit the home regularly including chiropodists, dentists, opticians, speech therapist, physiotherapists and District/Practice Nurses with some residents accessing healthcare needs at clinics or surgeries where arranged. Residents and their families were clearly impressed with the care and support provided by care staff. Residents interviewed stated, “I like it here very much” and “I like everyone, I am a diabetic and they look after me, I’m on a special diet for diabetes”. Care staff records a daily evaluation of care (24hours) and these are kept separately then filed in the individual care files when completed. Medical letters and appointment details are in place in care files with GP input also. Specialist dietary needs are catered for and residents are weighed on admission and on a regular basis. District nurse records are in place where they provide care to individual residents. Visiting health professional’s views of the home were obtained and include “I think this is the best home in the area”. There is a list of staff signatures and initials for those trained to administer medication. Storage of medication is good and well organised. The home has a small fridge to store medications as recommended. A returns book is in place with the pharmacist’s signature and dates in evidence. One resident is prescribed cream and following discussion with staff this cream is applied but there is no staff signature to confirm this. One resident self medicates and documentation is in place to confirm they are able to safely. Senior care staff carries out a ‘stock check’ then order monthly prescriptions. This is good practice. The prescriptions are then collected from the GP surgery by the pharmacy. The inspector would recommend that the prescriptions are James Dixon Court DS0000005406.V327624.R01.S.doc Version 5.2 Page 13 passed back to the home to ensure that all are correct but care staff advised the inspector that the pharmacy are able to confirm that the prescriptions ordered are correct and so far there have been no problems. This is acceptable as long as there are no discrepancies. Eye drops are delivered one bottle at a time on a monthly basis. The home need to seek advice from the pharmacist to ensure that this is alright as recommendations are that one bottle of prescribed eye treatment be used for two weeks only therefore it may be that two bottles need to be ordered each month. Three of the residents have missed an important prescribed medication at night (Atrovastin) with some of these residents missing 3, 5 and 7 doses. Following discussion with the manager it is agreed that all of these residents have their medication in the evening as recommended but a little earlier to ensure it is administered. Atrovastin is prescribed as an evening dose after all meals/snacks are eaten. One resident missed an evening dose of antibiotics, as they were asleep. Staff needs to be alert to the residents sleep pattern so that prescribed antibiotics are administered throughout the 24-hour period at regular intervals. The start date of Diazepam for one resident is a little confusing. It took some time to audit this medication to ensure that all the medication was administered as prescribed. The medication was audited and the numbers are correct but a simpler method as discussed needs to be followed so that it is easy for senior staff to carry out audits. The home needs to ensure that the monthly medication records are audited regularly to ensure all medications are administered as prescribed and records are clearly understood. The home needs to assess staff to ensure they are competent to administer medication. This needs to be recorded on staff files. Residents have the use of en-suite facilities and are able to choose from a selection of spacious bathing facilities although most of the residents prefer to use the newest one with a ‘bubble’ facility. Through discussion with residents it is apparent that their dignity is maintained by staff when providing personal care. Residents interviewed stated, “staff are always very respectful”. Residents interviewed also confirmed that they received assistance and support from care staff that they preferred. All of the residents were well groomed during this visit. Staff were observed to knock on residents doors prior to agreed entry by residents. Relatives commented, “the staff are very supportive and caring towards my mother I have every respect for the home and staff”. James Dixon Court DS0000005406.V327624.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home needs to provide sufficient activities to enable residents to socialise on a regular basis. The home provides a well balanced diet that is enjoyed by all residents. EVIDENCE: Residents and their relatives were interviewed during the inspection visit and all gave positive feedback with regard to the home providing kindness and support to residents to enable them to live their lives. Residents comments included, “quite happy with everything, they do a good job”, “support A1” and “they (staff) are very good to me”. Relatives interviewed stated, “it’s home from home”. Documentation shows that residents are asked about their daily routines and how they prefer to live their lives. Where possible residents are encouraged to live how they wish with staff support where needed. Residents who live in the home have very positive views of it. Residents comments include, “it is a home to me, when I’ve been out I say I’m going home, that’s a home to me” and “I like the home the people are very friendly”. Activities provided by the home have been many and varied to include film shows, parties, sing-a-longs, beauty evenings, hand massage and visiting James Dixon Court DS0000005406.V327624.R01.S.doc Version 5.2 Page 15 opera groups. The home have been unable to provide regular activities for the residents recently as staff have not had the time. Residents’ comments with regard to the activities included, “I look forward to the parties and singing”. Residents interviewed stated, “we use to have lots, now we haven’t, we don’t have the staff, I miss the activities”. There are no restrictions on visiting hours and relatives interviewed stated, “we can come anytime”. Residents interviewed stated, “I love it here, my daughters visit and they are made welcome, they tell everyone about it” and “up to now I can’t fault it”. There are small seating areas in the home including residents’ bedrooms so that residents can receive their visitors in private. Refreshments are available for visitors to the home and staff were noted to be providing this during the inspection visit. Relatives interviewed confirmed that Communion is provided for the residents in the home who wish to participate. Residents, who need to, have support from their families with regard to finances. The home does not handle residents’ monies. The food standards agency visited the home before Christmas to offer advice and support with regard to managing foods in the home. Both cooks have attended the one-day seminar set up to provide staff with information. The inspector viewed the kitchen and documentation with regard to hot food temperatures, fridge/freezer temperatures, menus and cleaning rotas. The kitchen is well maintained, organised and clean. Storage of cold foods is covered and dated in the fridges. Floors and walls of the kitchen are tiled and easy to keep clean. Fresh fruit and vegetables are stored in specific fridges and a cool ‘dry’ storeroom is in place. The cook meets all new residents to discover their likes and dislikes. On Thursdays both cooks are on duty, which enables one cook to carry out the cleaning programme. Four weekly menus are in place with a minimum of two choices available for residents. The daily menu is also posted on the residents’ notice board. Residents interviewed stated, “the food is lovely, we had liver today and we also have home baking” and confirmed that they had a choice at mealtimes. Residents comments with regard to food include, “I eat everything” and “the meals are always very nice” and “no fault with meals I like them very much”. Mealtimes are set apart from supper and can be flexible dependent on the individual residents activities that day. Separate dining is available for residents. Staff interviewed stated, “the food is very good, well balanced, plenty of fresh fruit and ‘veg’ and with plenty of options including home baking. They do a lot of that”. Other residents stated, “the food is very good and the choice today was liver and onions or chicken curry and chips. James Dixon Court DS0000005406.V327624.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home promotes the safety of the staff and residents. The home has an effective complaints procedure. EVIDENCE: The complaints procedure is provided to each resident on admission to the home and a laminated copy is in each resident’s wardrobe. Minor concerns are dealt with locally and records show that full details are documented. All concerns/complaints are reported to head office and where needed an investigation is carried out. There is documented evidence of incidents that have occurred with full details and outcomes recorded. When canvassed about their views with regard to complaints residents comments included, “I’ve no complaints”, “I would ask about it (complaints procedure) but I don’t have any complaints”, “I would go to the office and tell them”, and “I’m happy here, I feel safe here”. The home does not hold or manage residents’ finances. Resident’s relatives assist where needed. Locks are available on all residents’ bedroom doors. A lockable facility is available in resident’s bedrooms with individual keys and records are kept. James Dixon Court DS0000005406.V327624.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a well-maintained, clean and pleasantly decorated environment. EVIDENCE: All 30 bedrooms are at ground floor level and have en-suite facilities. The home is well maintained and all areas are pleasantly decorated to a high standard including residents’ bedrooms with many residents personal items included. Residents interviewed stated, “my bedroom is lovely and I have just got a statue of Our Lady and it’s on display on my table”. Hallways are spacious to enable residents’ easy access throughout the home and to the garden grounds. A separate large lounge is in use for residents who smoke. The home is equipped with adaptations to suit the needs of the residents including spacious bathing facilities. Bathing facilities are varied and include a newly fitted ‘bubble’ bath, which is the resident’s favourite choice at present. Garden grounds are well maintained and contain suitable seating areas for the James Dixon Court DS0000005406.V327624.R01.S.doc Version 5.2 Page 18 residents and their visitors. Some of the seating areas are covered to protect residents from the hot sun. The home is in the process of fitting CCTV’s to monitor the outside of the premises to ensure resident and staff safety. Fire exits were noted to be clear during a tour of the home. The home is clean, hygienic and odour free. Relatives interviewed stated, “it’s a beautiful home, spotless, the bedroom has no smells, the beds are clean and it’s well maintained”. Residents comments included, “ It’s A1”, “fresh and clean” and relative’s comments include, “I always find it lovely” and “the home is very clean”. The laundry floor and walls are tiled and easy to clean. The laundry has two washing machines, a spinner, sluice facility, tumble drier, hand washing facility and rotary iron. The drying cupboard and linen store was well organised and a washing line is available to dry washing weather permitting. James Dixon Court DS0000005406.V327624.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensure residents and staff are protected through the pre employment checks carried out on all new staff. The home needs to ensure staffing levels are sufficient to meet the assessed needs of the residents. EVIDENCE: The duty rota evidences staff on duty and shifts covered. The manager is employed full time and three seniors cover the times when the manager is not on duty. Including the manager/seniors, three staff are on duty throughout the 24-hour period with one senior on call throughout the night. Relatives and residents interviewed were very positive in their praise of the staff employed at the home. Relatives interviewed stated, “staff are marvellous, nothing is too much trouble, they’ll go that extra mile”. Residents interviewed stated, “staff are wonderful”, “I have to press the buzzer for the toilet at night, the staff are very kind to me”, “staff are always very respectful” and staff are kind, very understanding and patient”. The home has a low staff turnover ensuring that staff are familiar to the residents and care is provided by staff they know well. Residents comments also include, “staff are very helpful in every way”, “they do everything for me”, “they are always there”, “staff listen all the time, they are very good” and “staff are always there when we need them”. Visiting health professional’s views of the home were obtained following a brief James Dixon Court DS0000005406.V327624.R01.S.doc Version 5.2 Page 20 discussion and include “It’s great in here, the staff are wonderful, very well trained”. At present staff are unable to provide activities for the residents, as they are busy caring for residents other needs. Relatives canvassed for their views commented, “there are not enough staff available at times”. Residents have also raised the issue about lack of activities therefore the management need to review staffing levels to ensure residents’ needs are fully managed including social and activity events. Staff interviewed stated, “the residents needs are met and they are well looked after with the staffing levels that we have got, but there are lots of things that we would like to do but can’t such as activities as the residents are more dependent”. The home employs 23 care staff and 18 of them are qualified to Level 2 NVQ. Some of the care staff has attained the NVQ Level 3 qualification and senior staff has commenced/gained Level 4 or 5 NVQ. Three staff files were examined. All three have worked at the home for some years and evidence CRB (Criminal Record Bureau) checks are in place at enhanced level. All pre employment checks are in place including completed application forms; two written references and staff induction is evidenced. All three staff have attended up to date mandatory training with certificates and training records in place to evidence attendance. Other training attended includes medication, ‘peg feeds’ (percutaneous endoscopic gastrostomy) abuse, equality and diversity, risk assessment, palliative care, and dementia. Supervision records are in place also. Following discussion with staff it is apparent that they understand the varying care needs of the residents. Staff interviewed stated, “I get enough training to do the job and would like to do an NVQ in care, this is being arranged by Chris (manager)”. It is apparent through examination of staff training files and discussion with staff that the home provides a very good standard of training that includes induction for new staff. James Dixon Court DS0000005406.V327624.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and all health and safety checks, servicing of equipment are in place and up to date. EVIDENCE: The registered manager has many years experience in caring for the older person and it is apparent through discussion that she is knowledgeable about the varying conditions that can affect the older person. The manager has the RMA (Registered Managers Award) and is now studying for the Level 5 NVQ qualification in management. The manager has kept up to date with mandatory/other training including dementia and anti social behaviour disorder. Residents, staff and relatives were very complimentary about how the home is managed. Staff interviewed stated, “I enjoy working here, she’s a James Dixon Court DS0000005406.V327624.R01.S.doc Version 5.2 Page 22 marvellous boss, a very caring, understanding person”, “I have full confidence in her and can talk things through with Chris (manager) all the time”, “the manager is lovely, very nice approachable very easy to talk to, listens and gives good advice”, “the residents all like Chris and I have confidence in her”, “her managerial skills are very good”, “Chris is a very good manager” and “very approachable manager, helpful with any problems, she listens, is supportive, nice to staff and residents and is good with families, very professional”. Through discussion with residents and their relatives it is apparent that both have positive views of the manager. Residents interviewed stated, “Chris is very good, very nice, I would talk to Christine if I had any concerns”. Relatives interviewed stated, “we are kept informed the home ring us up” and “the atmosphere is so nice”. Anonymous questionnaires are sent out by the home to residents, relatives and staff to obtain their views on how the home is run. Returned views were positive. Comments are included in some of the residents returned questionnaires and include, “the home is lovely, and so are the ‘carers’ one resident commented that they were “aware of the complaints procedure and wouldn’t be worried if they had to make one”. The home has also received a five star quality rating from an external quality assurance service. The care service manager carries out monthly audits. The inspector viewed the most recent audits for many areas including staff training, residents meetings, incidents/complaints, fire procedures, accident records, health and safety, menu, building, equipment. Policies and procedures are reviewed and updated regularly by head office with the most recent in November 2006. Head office carry out an annual audit with records available to inspect from 2005 and 2006. The home does not become involved with residents’ monies. Family support is in place for residents who need it. Residents do have an individual lockable facility for safekeeping. Mandatory training is in place for all staff with an infection control training session booked early this year. Safe working practices are in place. First aid boxes are in place and the kitchen one was organised and stocked with sufficient items. All new staff attends an induction, which is evidenced in staff files. Systems, services and equipment on the premises are tested regularly throughout the year and up to date certificates of electrics, gas, hoist/appliances are in place. Hot water temperatures are checked weekly and records are kept of the maintenance of showerheads, water tanks and the most recent Legionella test, (November 2006). Hot water outlets are fixed with preset valves. The fire alarm system is checked regularly testing various points and smoke detectors also. A risk assessment has been carried out by head office with regard to fire routes, escapes with the most recent carried out in August 2006. An approved contractor disposes of the clinical waste and the district nurse takes away any sharps used. James Dixon Court DS0000005406.V327624.R01.S.doc Version 5.2 Page 23 Window restrictors are fitted to all windows. Due to a break in last year the home have fitted secure metal fittings to the resident’s bedroom windows to prevent illegal entry to the home as all the residents’ bedrooms are on the ground floor. The local fire brigade were fully consulted with regard to this and have approved the fittings. Accidents are recorded and reports kept on file. There are no issues at present. The manager is aware of RIDDOR (Reporting of Disease and Dangerous Occurrences Regulations). Risk assessments are in place to ensure residents safety. James Dixon Court DS0000005406.V327624.R01.S.doc Version 5.2 Page 24 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 4 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 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 James Dixon Court DS0000005406.V327624.R01.S.doc Version 5.2 Page 25 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 Timescale for action 14/02/07 2. OP9 13 (2) 3. OP12 16 (2) (n) 4. OP27 18 (1) (a) The registered person must ensure that medication audits are carried out on a regular basis with records kept. The registered person must 14/02/07 ensure that all staff trained to administer medication are assessed for competency and records kept. The registered person must 28/02/07 ensure that residents are provided with recreational activities. The registered person must 28/02/07 ensure that sufficient staff are employed to ensure that residents are able to enjoy recreational activity. James Dixon Court DS0000005406.V327624.R01.S.doc Version 5.2 Page 26 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 OP12 Good Practice Recommendations The inspector strongly recommends that residents should be canvassed for their views on what activities would be suitable for them. James Dixon Court DS0000005406.V327624.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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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