Inspection on 20/07/07 for Keep Hill Rest Home

This inspection was carried out on 20th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Keep Hill Rest Home 09/07/08

Keep Hill Rest Home 30/08/06

Keep Hill Rest Home 07/02/06

Keep Hill Rest Home 14/12/04

Keep Hill Rest Home 16/06/04

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech 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 Keep Hill Rest Home 17 Keep Hill Drive High Wycombe Bucks HP11 1DU Lead Inspector Mike Murphy Unannounced Inspection 20th July 2007 09:30 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 DS0000022983.V346733.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. DS0000022983.V346733.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Keep Hill Rest Home Address 17 Keep Hill Drive High Wycombe Bucks HP11 1DU 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) 01494 528627 N/A keep.hill@tiscali.co.uk N/A Mr Grahame Robinson Mrs Gillian Robinson Grahame James Robinson Care Home 9 Category(ies) of Old age, not falling within any other category registration, with number (9) of places DS0000022983.V346733.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th August 2006 Brief Description of the Service: Keep Hill Rest Home is a care home registered to provide care and accommodation to nine older people. It is privately owned and is located in a residential area on the edge of High Wycombe, close to local amenities, shopping and public transport. Keep Hill Rest Home was originally a semi-detached, double fronted house, which has been extended to accommodate nine residents. All bedrooms are single and two are fitted with en-suite facilities. Other bedrooms are close to bathrooms and toilets. The home has a limited number of car parking spaces at the front of the home and there is a compact, but accessible, garden with a patio area and pergola at the rear of the home. The fees at the time of this inspection were £425 per week. Information about the home can be obtained by contacting the home. DS0000022983.V346733.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector in July 2007 and included a whole day visit over the course of a Friday and a final brief visit to examine personnel files the following Monday. The inspection included discussion with managers, residents and staff, perusal of the home’s website, consideration of information supplied by the registered manager in advance of the inspection, consideration of CSCI survey forms completed by residents, relatives and healthcare professionals, observation of practice and examination of records. Keep Hill is a small care home situated in a pleasant residential area of High Wycombe. The home is an older house which has been converted for its current use. The quality of the environment is variable and there are a number of matters which need to be addressed by managers. The registered manager has recently been successful in bidding for a grant to have some of this work carried out in the autumn. Standards of cleanliness are good. The home’s systems for assessing the needs of prospective residents are good. There is a care plan for each person. Residents expressed satisfaction with the care provided. The home liaises appropriately with local NHS and other healthcare services. The arrangements for dealing with residents medication are satisfactory. The home offers a one hour group activity each weekday morning and a religious service on Sunday. There are occasional outings. A number of respondents to the CSCI survey carried out in connection with this inspection reported a lack of stimulation for residents. The quality of the food is generally satisfactory. The home’s arrangements for dealing with complaints and for the protection of vulnerable adults (POVA) are generally satisfactory but some amendment to the home’s POVA procedure is suggested to ensure that the procedure is in line with the Buckinghamshire joint agency policy. The home looks after some monies for residents and the home is required to ensure that practice conforms to its policy. Staffing levels are adequate throughout the week when there are two staff on duty between 8:00 am and 10:00 pm plus the manager and care manager for the main part of the day. At weekends, however, between 2:00 pm and 7:00 pm, there is only one member of staff on duty plus a manager on call. Since the number of residents does not reduce during these hours it is felt that there may be an increase in risk to residents during these hours. The manager is asked to review staffing levels during this time. What the service does well: DS0000022983.V346733.R01.S.doc Version 5.2 Page 6 Resident’s needs are assessed prior to their moving to the home in order that both they, their families and the home can have confidence that their needs can be met. Their health and personal care needs are met and staff take care to respect residents’ privacy and dignity. Residents’ rooms are personalised and the home is maintained on a regular basis. There are no offensive odours and standards of hygiene are good. There is a stable management and staff team and the home is consistently managed. What has improved since the last inspection? What they could do better: In consultation with residents and relatives explore means of providing a diverse and stimulating range of activities. This will provide residents with a wider choice of activities and potentially increase mental and physical wellbeing. Address outstanding health & safety matters in the environment to provide a safer environment for residents. Ensure that staffing levels are appropriate to the needs of the residents at all times. This will ensure that residents receive appropriate support from staff when they need it. Maintain rigorous food safety procedures in the home. These should reduce to a minimum the chances of a resident suffering ill effects from substandard practice. DS0000022983.V346733.R01.S.doc Version 5.2 Page 7 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. DS0000022983.V346733.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 DS0000022983.V346733.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, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures are in place to ensure that the needs of prospective residents are assessed before admission to enable the home to meet the person’s needs. EVIDENCE: Prospective residents may get to hear of the home through word of mouth, via the list of home circulated by BACH (Buckinghamshire Association of Care Homes), through its website (www.keephill.co.uk), or through a healthcare or social services professional. The home accepts referrals from a local authority social services department or through direct contact with the prospective resident or their family. At the time of this inspection the majority of places were wholly or partly funded by a local authority – Buckinghamshire and Hillingdon social services. DS0000022983.V346733.R01.S.doc Version 5.2 Page 10 Enquirers are provided with a copy of the home’s brochure or can download a copy from the website. If the enquiry progresses to an application then the Care Manager (currently one of the proprietors of the home) makes arrangements to visit the person at their current place of residence to carry out an assessment of needs. If it is felt that the home can meet the person’s needs then an offer of a place is made. The person or their family may visit the home to view its facilities as part of the process. In the first instance a ‘trial’ admission of four weeks is offered. This is to allow both parties the opportunity to consider whether the home can meet the person’s needs. A review with the resident, their family and social worker is held at then end of this time. The home does not offer intermediate care therefore standard 6 does not apply to this home. DS0000022983.V346733.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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents care plans are based on assessment of needs and support the provision of appropriate care. Liaison with healthcare agencies appears good. Arrangements for the control, storage and administration of medicines are generally satisfactory and aim to minimise the risk of errors. Together, these aim to ensure that residents’ healthcare needs are met. EVIDENCE: There is a care plan for each resident. Care plans are based on assessment of needs and are reviewed monthly. Those examined on this inspection appeared up to date. Care plans include risk assessments on mobility, medication, use of bed rails, falls and fractures. It was noted that one care plan included reference to a potential sensitivity to an antibiotic but this information was not recorded on the person’s medicines administration record. Residents are weighed monthly and the result recorded on a table and a graph. DS0000022983.V346733.R01.S.doc Version 5.2 Page 12 Additional guidance notes are made on residents’ night and morning routines. The monthly review notes are written up by the care manager and summarise the care position of the resident at that time. A comprehensive multi-agency review is carried out annually and notes in preparation for this were noted in the care plans examined. Notes, summarising the care given, are made by care staff towards the end of each shift, three times every 24 hours. Residents appeared generally well cared for and expressed satisfaction with the care provided. They described it as “a happy home”. The staff were described as “marvellous – very caring”. Relatives who were visiting at the time expressed confidence in the care given to the resident. Concerns about two residents who were not eating were appropriately discussed. However, it was felt that a relative who was assisting a resident with lunch was not provided with sufficient staff support. Residents are registered with a local GP although they may retain registration with their current GP if the home is within the catchment area of the surgery. A chiropodist visits every six weeks, for which an additional charge is made. An optician visits the home by arrangement. Dental services are accessed through a local dentist in High Wycombe. The home can provide transport and an escort if required. GP respondents to the CSCI survey in connection with this inspection expressed satisfaction with the overall care provided to residents. Other NHS services such as district nurses, dietician, occupational therapy, physiotherapy and mental health services are accessed through the GP. All local authority sponsored residents are reviewed annually by the relevant social services authority. The home has a policy governing the administration of medicines. The procedure includes a flow chart. Samples of the signatures of staff approved to administer medicines are retained. Staff training is ‘in-house’ through discussion with the care manager, a video training resource and supervised practice. It would be advisable for at least one member of staff to complete a more advanced course (such as the Certificate in the Safe Handling of Medicines). The care manager has attended a Boots course on ‘Advanced Care of Medicines’ in March 2005. Medicines are prescribed by the resident’s GP and dispensed by a local pharmacy. The pharmacy does not offer typed up medicines administration records (‘MAR’ charts), supply medicines in monitored dosage systems, or carry out a periodic audit of the home’s facilities (not in the last twelve months according to records). Medicines are dispensed in standard containers and are stored in cabinets in the office on the first floor. Medicines are temporarily transferred and stored in a portable box for administration. The box is then taken downstairs for the administration of the medicine to the resident. If an emergency happens while medicines are being administered the box is locked in the utility room which is on the ground floor. DS0000022983.V346733.R01.S.doc Version 5.2 Page 13 Arrangements for storage on the first floor are satisfactory. Medicines are store in metal cabinets secured to the wall and the keys are kept in a metal cabinet with a secure coded lock. Medicines requiring cool storage are kept in a plastic container in the fridge. Ideally, these should be stored in a lockable container while in the fridge. On the day of this inspection the base of the portable box was noted to have a sticky residue of liquid medicines which had apparently spilt over earlier days. The pharmacy does not supply pre-printed ‘MAR’ sheets. The care manager transcribes details of medicines to be administered from the GP prescription. The home records the receipt and disposal of medicines and the care manager does a stock check weekly. The home’s procedure for the self-administration of medicines include risk assessment and the signature of the resident, the manager and the GP. Staff are made aware of the need to respect residents’ privacy and dignity. Medical examinations and confidential meetings are carried out in residents bedrooms. Residents autonomy is respected and the manager said that they are not pressured to participate in a social activity. DS0000022983.V346733.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): 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. Residents benefit from social activities but the range of these need to be reviewed and increased to ensure that residents quality of life includes appropriate stimulation and variety. EVIDENCE: The home aims to accommodate individual choice wherever possible. Equality and diversity needs are met in terms of age, gender, disability and religion. The manager said that the home would make adjustments to meet other needs. Residents are not obliged to participate in activities. Resident’s confirmed this to be the case. One resident said that she was quite happy in the home and was able to spend time with others in the lounge or be on her own reading as she wished. Residents may have visitors at any time. All but one were in regular contact with their families. Visitors who were in the home around lunch time said that they had a good relationship with managers and staff and were happy with the visiting arrangements. One respondent to a CSCI survey said ‘The home is well kept – clean and pleasant. Very welcoming to relatives visiting. Care continues DS0000022983.V346733.R01.S.doc Version 5.2 Page 15 when mother in hospital e.g. visits from staff, laundry done and taken to outpatients’. However, another reported communication problems on occasions. These concerned either being notified of significant issues on all occasions or of managers not appearing to take account of matters raised with them. The home maintains good relations with its neighbours and is a member of the local residents association. A notice for a forthcoming strawberry tea event was observed on the notice board. The religious needs of residents are respected. The home will make contact with local religious organisations as needed. It is in contact with a local Baptist day centre. In the recent past it has made arrangements for a local Catholic priest to visit a resident. A religious service is held on Sunday mornings. The manager said that the range of activities had increased since the last inspection. It is involved in a schools project in which pupils from a local school visit and participate in quizzes or arts and crafts with residents. It has established a group activity led by staff for one hour each morning. The programme includes word games, quizzes, exercises to music, arts & crafts, and on Sundays a half hour religious service. The home used to arrange tea visits with another home but these have now been discontinued at the request of residents. A number of respondents to the CSCI survey commented on the activities offered in the home. Comments included ‘I feel that there is little to no stimulation. There is a radio and nothing else in the lounge, a TV would give residents a little more entertainment’; ‘…the home felt uninviting and without stimulation. It was very quiet, no music playing, no television….also the décor was very dated and requires redecorating’; ‘They have a Sunday religious service but (relationship) may want to go out to church more often’; ‘More social outlets for residents (required)’; and, ‘A bit more mental stimulation would help’. The lack of a television in the lounge was raised with the manager who said that residents like to have a quiet area and that they can have televisions in their rooms if they wish. The manager said that the home maintains regular contact with residents and relatives and that these provide an opportunity for such matters to be discussed. Breakfast is served in residents’ rooms from 6.45 am onwards. Morning coffee is served at 10.00 am. Lunch is served at 12.30 and is the main meal of the day. Lunch is a three course meal consisting of soup, a main course with vegetables, and a dessert. Afternoon tea is served at 2.00 pm. Tea is served at 5.00 pm. This is a lighter meal consisting of sandwiches, a savoury dish such as quiche or fish cakes , and a cake such as fruit loaf or cream cakes. A hot drink is served at 7.30 pm. Water is available in residents rooms as required. The manager reports that residents are consulted on the menu. Lunch choices from the menu submitted with the papers for this inspection included, DS0000022983.V346733.R01.S.doc Version 5.2 Page 16 Vegetable Soup followed by Chicken with Mashed Potatoes, Carrots, Cauliflower and Peas, with a dessert of Rice Padding and Jam; Chicken Soup followed by Poached Eggs, Bacon, Mashed Potatoes, Tomatoes, Green Beans and Carrots, with a dessert of Banana and Cream; and, Leek and Potato Soup followed by Fish, Mashed Potato and Peas with a dessert of Mince Pies and Custard. It is noted that this menu (‘Meal Plan 2’) includes in the same week, Chicken Soup on Tuesday, on Thursday and on Saturday, and Chicken on Monday and on Sunday, and that the lunch on Wednesday is listed as Tomato Soup followed by Mashed Potatoes, Cauliflower Cheese, Cabbage and Carrots with a dessert of Apple Crumble and Custard. Lunch on the day of this inspection consisted of soup, followed by a choice of fish dishes (breaded, poached or fish cakes) with vegetables and a dessert of pie and custard. Lunch was taken with the residents who appeared satisfied with their meal. DS0000022983.V346733.R01.S.doc Version 5.2 Page 17 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, 17 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s complaints procedure aims to ensure that complaints by residents about the service are properly investigated. Weaknesses in the home’s protection of adults policy and in its arrangements for dealing with monies held on behalf of residents need to be addressed to ensure the welfare of residents is fully protected. EVIDENCE: The home has a complaints procedure, a copy of which is on display on the wall and is also in the policy manual. The policy is straightforward and aims for resolution of dissatisfaction as early as possible. The home would suggest looking to Age Concern for advocacy if required. The home has received no complaints since the last inspection. CSCI has received no complaints about this service since the last inspection. Two letters of compliment were also noted. All residents are registered to vote. The registered manager said that residents usually have a postal or proxy vote. The home has Protection of Vulnerable Adults (POVA) and Whistle Blowing policies. Staff receive training using a video or CD-rom package on induction and through periodic updates. A copy of the current Buckinghamshire multiagency policy could not be located at the time of the inspection visit. The DS0000022983.V346733.R01.S.doc Version 5.2 Page 18 home’s own policy appears to suggest that there should first be an internal investigation to determine if there is a case to answer. It would be advisable to review this, seeking the advice of the Adult Protection Officer at Buckinghamshire County Council as necessary, since this may lead to a delay in conducting an investigation in the context of the statutory multi-agency framework. The home’s arrangements for conducting CRB and POVA First checks as part of its staff appointment procedures were found to be satisfactory. The home looks after some money on behalf of residents. This is covered under standard 35 below. It was felt that potential weaknesses in the home’s arrangements need to be addressed. DS0000022983.V346733.R01.S.doc Version 5.2 Page 19 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, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home generally provides a comfortable environment for residents. However, a number of health and safety related matters need to be addressed by managers before it can be said to provide an entirely safe home for vulnerable residents. EVIDENCE: The home is situated in a quiet residential area of High Wycombe. There is very limited off street parking to the front of the home and no apparent pressure on daytime parking in nearby streets. There is a bus stop on the main road about one third of a mile away. The nearest rail station is High Wycombe. The ground floor accommodation is comprised of the entrance hall, kitchen, dining room, lounge, utility room, five bedrooms, two WC’s and two showers. The first floor includes the office, four bedrooms (of which two have some ensuite facilities), a store room, one WC, and one shower. The garden to the rear DS0000022983.V346733.R01.S.doc Version 5.2 Page 20 of the house is comprised of a lawn, shrubs, flower beds and a water feature. There is also a storage cabin and workshop. All areas of the home were clean and tidy on the day of this inspection and no untoward odours were noted. The quality of the décor is variable. The manager said that it is due to be upgraded in the near future (this inspection took place in July 2007). A number of respondents to the CSCI survey commented on the ‘tired’ standard of décor but also on the good standards of cleanliness. The temperature of the hot water in areas to which residents have access is not regulated. One radiator did not have a cover which could pose a risk to a resident. The manager has been successful in his bid for a capital grant to improve the environment. This is to be used to upgrade three bathrooms and nine sinks, improve access to and around the garden, install hand rails in corridors, and acquire some new dining chairs. This will include fitting thermostatically controlled vales to hot water outlets in areas to which residents have access. As stated above all areas were clean and tidy. The cleaning schedule includes the laundry. Linen is not allowed to be taken through the kitchen The home does not have a sluice room. It was noted that the clinical waste bin is not lockable. The manager said that the contract is with Wycombe District Council and they have not provided a lockable bin. DS0000022983.V346733.R01.S.doc Version 5.2 Page 21 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. While staffing is generally satisfactory a reduction in day time staffing levels at weekends may lead to increased risk for residents during those times. Staff recruitment procedures have improved and new arrangements are in place for staff training. These aim to ensure that residents are protected from the appointment of staff who may be unsuited to care work and that care is provided by appropriately trained staff. EVIDENCE: The present staff establishment supports the following staffing: Monday to Friday 08:00 Monday to Friday 22:00 Monday to Friday 09:00 also in the home. Saturday and Sunday 08:00 Saturday and Sunday 14:00 manager (Deputy Manager) Saturday and Sunday 19:00 to 22:00 to 08:00 to 19:00 to 14:00 to 19:00 to 21:00 Two Care Workers One Care Worker Manager and Care Manager Two Care Workers One Care Worker on call Two Care Workers The registered manager said that staffing had been increased by 25 since the last inspection. The difference in care staff hours between 14:00 and 19:00 DS0000022983.V346733.R01.S.doc Version 5.2 Page 22 hours Monday to Friday and during the same time at weekends was discussed with the registered manager and care manager. The registered manager said that this is because the level of activity drops significantly in the afternoon, particularly at weekends. The manager felt that the difference was justified for that reason. However, the number of residents doesn’t change, nor therefore, it would seem the potential demand or potential risk. He said there was always a manager on call during this time and that she would invariably drop in to see how things were. The manager referred to correspondence with CSCI on this subject in November 2006. It was suggested that there was a need for an additional staff member at night. Given that most, if not all residents will be in bed there is a significant reduction in activity between 22:00 and 08:00 hours. There is always a manager on call. According to the AQAA (Annual Quality Assurance Assessment) completed by the manager, 33 of care staff have acquired NVQ2 or above and 33 are currently working towards the qualification. Three new staff have been recruited since the last inspection. Examination of staff files show that the home is conforming to the Regulations and that files contain the information required under Schedule 2. The home does not currently provide new staff with a copy of the GSCC codes of practice but the manager resolved to acquire copies and distribute them soon after this inspection. New staff undergo an-house induction which the manager reports is based on the Skills for Care programme. It was not clear however, whether it fully conformed to that programme. The home’s induction includes discussion, video and CD-rom based training and supervised practice. Staff not already holding an NVQ would be referred to the home’s NVQ training provider. Training in the protection of vulnerable adults (POVA) is initially provided in-house and later by attending a Buckinghamshire County Council training event. The home has recently joined with other care homes in Buckinghamshire to form a ‘cluster group’ with the aim of undertaking joint training events for staff working in homes. This is a relatively new initiative which is supported by Buckinghamshire County Council but it was a little early to say whether it effectively meets the training needs of care staff. The manager who has a responsibility for co-ordinating the group was optimistic. DS0000022983.V346733.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, 36 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 run by experienced managers who are in daily contact with the residents. However, there are a number of matters which require management attention in order to ensure that the health and safety and welfare of residents is maintained. EVIDENCE: The registered manager, who is also one of the proprietors, has managed the home for six years and has been the registered manager for three years. The registered manager has acquired the registered manager’s award (RMA) and is currently undertaking a business degree. He is also responsible for coordinating the care home’s cluster group which is addressing some aspects of care staff training. The care manager, who is the other proprietor, has a DS0000022983.V346733.R01.S.doc Version 5.2 Page 24 background as a medical scientific laboratory officer (MLSO) and has acquired the NVQ3 in care. The registered manager outlined the quality assurance framework being developed, but which, at the time of this inspection visit was not operational. This includes clarification of the home’s statement of purpose, review of operational policies, protocols and procedures, standardisation of forms, staff training and development, identification of performance indicators, review of suppliers and services, and continual monitoring and action where required. It was unclear when this process would be established. The registered manager reports that the home has a five year business plan which commenced in 2004. The home does not conduct service user surveys because the care manager meets every resident for a 10-15 minute individual meeting once a month. It is felt that these meetings provide an opportunity for the resident to raise any issues of concern. Notes are taken and filed. Meetings with relatives are informal although the home does arrange an annual gathering around Christmas time. Relatives are invited to annual care reviews with social workers. It is felt that these contacts, together with meeting by appointment when required, provide sufficient opportunities for relatives to raise any matters of concern and comment on the quality of the service. Suggestions for improvement by respondents to the CSCI survey included: ‘Home is rather dated in décor. More social outlets for residents’; ‘A bit more stimulation would help’; ‘I would like to know the names of new staff’; and two comments already quoted under standards 12 to 15 above regarding a perceived lack of stimulation for residents. A number of respondents commented favourably on the good standards of cleanliness maintained in the home. The home looks after some monies to cover the day to day expenses of residents. There is a written procedure and the home charges a 2.5 administration fee which the manager said covers bank charges and associated expenses. There is a safe for the secure storage of cash and valuables. In some cases the home will purchase the service on behalf of the resident (chiropody or hairdressing for example) and invoice the relatives for reimbursement of costs. The home’s procedures do not entail providing a relative with a receipt for cash received. Records are maintained on an Excel spreadsheet. Receipts are maintained for monies spent. However, a sample of balances could not be checked at the time of the inspection because there was no cash in the boxes provided. The manager said that this would not affect the residents. The system should be reviewed and controls over cash and non-cash transactions improved. DS0000022983.V346733.R01.S.doc Version 5.2 Page 25 A system of personal supervision is in place for care staff. Notes are maintained. The manager said that he aims to ensure that this happens at approximately six weekly intervals. Discussion with staff and records confirm that supervision takes place but the frequency appeared less that the six weekly interval which the manager aims for and for the home to achieve the six times a year minimum standard. All staff have an annual appraisal. Arrangements for ensuring the health and safety of residents were uneven at the time of this inspection visit but should improve when planned work is completed in the autumn of 2007. The manager carried out a fire risk analysis in October 2006. Staff receive fire safety training based on a video/CD-rom package on induction and every six months. Contracts are in place for the maintenance of fire safety equipment and emergency lighting. The home received a visit from a local health and safety inspector in the autumn of 2006. The inspector made five requirements which the manager said have been acted on. There was also an exchange of correspondence with CSCI on staffing levels around that time. A sample of water had been tested for the Legionella bacterium in January 2007 and the results were negative i.e. the organism was not found. Accidents are recorded on an Access database. Care planning includes a falls risk assessment and the care manager said that the falls team at Wycombe General Hospital had talked to staff about the subject. Two radiators were uncovered. The manager said that one will be covered soon but that the resident in the room where the other was located had expressed a wish that it remain uncovered. Where this is the case a risk assessment should be carried out and filed in the resident’s care plan. This should be reviewed periodically. Hot water outlets in areas to which residents have access remain unregulated but the home has now received a grant to cover the cost of installing temperature regulating valves in the autumn. The kitchen was generally in good order. The manager said that he was now following the guidance contained in ‘Safer Food – Better Business’ package published by the Food Standards Agency. Records are maintained of food and refrigerator temperatures. The freezer appeared in need of defrosting but the temperature did not appear to be affected. Brief inspection of the fridge revealed bottles of sauce and a pot of jam which had not been labelled when opened and it was not therefore possible to determine if they were within the four to six week ‘use by’ (from open) date listed on the container. The registered manager reported that procedures are in place for the testing of portable electrical equipment. The fixed wiring in the house is due for checking DS0000022983.V346733.R01.S.doc Version 5.2 Page 26 in 2007. The lift is checked by contractors six monthly. Soiled waste is disposed of by Wycombe Council. It is noted that the waste bin is not lockable. DS0000022983.V346733.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 2 X 2 DS0000022983.V346733.R01.S.doc Version 5.2 Page 28 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 OP18 Regulation 13(6) Requirement The registered manager is required to ensure that the home’s policy and procedures for the protection of vulnerable adults conforms to the Buckinghamshire joint agency policy for the protection of vulnerable adults. Thermostatically controlled valves should be fitted to all showers and baths. Risk assessments should be undertaken for all other hot water outlets. (Previous timescale of 31/03/07 not met) Timescale for action 31/08/07 2. OP25 13(4) 31/10/07 3. OP25 13 (4) 4. OP27 18(1)a Appropriate safeguards must be 31/10/07 in place to protect residents where radiators are not guarded and do not have low temperature surfaces. There must be sufficient care 30/09/07 staff on duty at all times to meet residents care needs in a timely way. The registered manager must assess the dependency levels of all residents, and provide staff in sufficient numbers to meet the needs of all DS0000022983.V346733.R01.S.doc Version 5.2 Page 29 5. OP38 16(2) residents, also taking into account the layout of the building. The registered manager must ensure that high standards are maintained at all times with regard to the storage and handling of food. 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations It is recommended that references to suspected or known adverse reactions to medicines be recorded both in the care plan and on the resident’s medicines administration chart It is recommended that at least one member of staff complete an advanced course in the administration of medicines. It is recommended that medicines requiring cool storage be stored in a lockable container in the refrigerator It is recommended that the registered manager consult with residents and relatives on the development of the home’s programme of activities. It is recommended that the registered manager review the home’s policy and procedures with regard to the handling of money on behalf of residents. 2. 3. 4. 5. OP9 OP9 OP12 OP35 DS0000022983.V346733.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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 DS0000022983.V346733.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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