Inspection on 11/01/08 for Kington St Michael Residential Home

This inspection was carried out on 11th January 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

Kington St Michael Residential... 18/08/06

Kington St Michael Residential... 20/12/05

Kington St Michael Residential... 02/08/05

Kington St Michael Residential... 22/03/05

Kington St Michael Residential... 30/03/04

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Fairfields Country Rest Home

Poldhu

Queensmount

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 Kington St Michael Residential Home 81 Kington St Michael Chippenham Wiltshire SN14 6JB Lead Inspector Elaine Barber Unannounced Inspection 10:30 11 January 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 Kington St Michael Residential Home DS0000028153.V344608.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. Kington St Michael Residential Home DS0000028153.V344608.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kington St Michael Residential Home Address 81 Kington St Michael Chippenham Wiltshire SN14 6JB 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) 01249 750737 Mr Jitendra Kumar Singh Tirbhowan Mrs Sashtee Teelucksingh-Tirbhowan Mrs Sashtee Teelucksingh-Tirbhowan Care Home 9 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (9), Old age, not falling within any other of places category (9) Kington St Michael Residential Home DS0000028153.V344608.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Only the two named male service users in the category DE referred to in the application dated 3rd November 2005 may be accommodated in the home. Once these service users reach the age of 65 the service user category DE will no longer apply. 18th August 2006 Date of last inspection Brief Description of the Service: The home is situated in the village of Kington St Michael in a large building, parts of which date back to 1660. The home is registered for older people and older people who have had a diagnosis of dementia. The home is adjacent to the pub and the village provides many amenities. The home is owned and run by independent providers, Mr and Mrs Tirbhowan. During the waking day there is a minimum of two staff who are involved in cooking and cleaning as well as care. There are two members of staff sleeping in at night. There is are steps from the pavement to the front door although there is level access to the rear of the property. All the bedrooms are single accommodation and have en-suite facilities except one, which has its own nearby private toilet. On the ground floor there is a large sitting room, separate dining room, kitchen, toilet, laundry facilities, one of the bedrooms and an office. The first floor is accessed by two sets of stairs, one with a stair lift. To the rear of the home there is a garden with a large level patio. Information about the home is available in their statement of purpose and service user guide. The fees range between £350 and £450 per week. Copies of inspection reports can be obtained from the home. These are also available through the Commission’s website at: www.csci.org.uk Kington St Michael Residential Home DS0000028153.V344608.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 inspection included an unannounced visit to the home on 11th January 2008 and a planned visit the following day. During the visits information was gathered using: • • • • • • Observation Speaking with five people who lived in the home Speaking with the manager. Speaking with a Community Psychiatric Nurse. Speaking with two members of staff. Reading records including care records. Other information has been received and taken into account as part of this inspection: • • An Annual Quality Assurance Assessment (referred to as the AQAA). The AQAA is the owner’s assessment of how well they are performing. It also provides information about what has happened during the last year. Comment cards that were returned by seven people who lived in the home, four relatives and four staff members. The judgements contained in this report have been made from all this evidence gathered during the inspection. What the service does well: People could decide whether the care home could meet their support and accommodation needs. This was because they, or people close to them, had been able to visit the home and had been given full, clear, accurate and up to date information about the home. If they decided to stay in the home they knew about their rights and responsibilities because there was an easy to understand contract or statement of terms and conditions between them and the care home. This included how much they would pay and what the home provided for the money. People’s health, personal and social care needs were met. The home had a plan of care that the person, or someone close to them, had been involved in making. Each person was registered with a local GP and saw other health care professionals such as the dentist, optician and community nurse. Kington St Michael Residential Home DS0000028153.V344608.R01.S.doc Version 5.2 Page 6 People were not able to manage their medicines and the staff supported them with them, in a safe way. Each person had their own room and private toilet. People’s right to privacy was respected and the support they had from staff was given in a way that maintained their dignity. Individual needs were recorded in the care plans so that each person was treated as an individual and the care home was responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They were part of their local community. People who were able went out into the village independently. Others went out with support. Representatives from local groups visited the home. The care home supported people to follow personal interests and activities. People were able to keep in touch with family, friends and representatives. They were as independent as they could be, led their chosen lifestyles and had the opportunity to make the most of their abilities. People had nutritious and attractive meals and snacks and enjoyed their food. If people had concerns about their care, they or people close to them knew how to complain. There was a complaints procedure and records were kept so that any concern was looked into and action taken to put things right. There was a procedure about protection form abuse and staff had received training about prevention of abuse. The care home safeguarded people from abuse and neglect. People lived in a safe and well-maintained home that was homely, clean, pleasant and hygienic. There was a lounge and a dining room with a seating area. People moved freely between the two and chose where to sit. People had enough space and facilities for them to lead the life they chose and to meet their needs. All the bedrooms were decorated and furnished in a different way. Some people had brought some of their own furniture. People’s rooms were individual, comfortable and they felt safe when they used them. People’s needs were met and they had safe and appropriate support as there were enough competent and trained staff on duty at all times. There were at least two staff on duty at all times. Four out of the eight staff had a National Vocational Qualification (NVQ) at level 2 or above. Staff received basic training in first aid, food hygiene, manual handling and health and safety. They also received more specialised training in administration of medication and dementia. People had confidence in the care home because it was led and managed appropriately. The manager had the right qualifications and experience to run the home and kept her training up to date. The manager conducted a survey of people’s views and wrote a development plan. This meant that improvements to the service were made as a result of people’s ideas. Kington St Michael Residential Home DS0000028153.V344608.R01.S.doc Version 5.2 Page 7 People could not manage their money and it was managed by someone close to them or a legal representative. Where there was no representative, money was managed by the care home in their best interests. There was a health and safety policy and the environment was safe for people and staff because appropriate health and safety practices were carried out. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Kington St Michael Residential Home DS0000028153.V344608.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 Kington St Michael Residential Home DS0000028153.V344608.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): 1, 2, 3 People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home. This includes how much they will pay and what the home provides for the money. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a statement of purpose and a service user guide, which contained all the necessary information about the home. The manager stated in the Annual Quality Assurance Assessment (AQAA) that all new or prospective service users receive a service user guide and a statement of purpose. One Kington St Michael Residential Home DS0000028153.V344608.R01.S.doc Version 5.2 Page 10 person said that their daughter was given information about the home before they moved in. Four out of the seven people who completed comment cards said that they had enough information about the home to decide if it was the right place for them. One said that their daughter had all the information, one said they could not comment and one did not answer that question. A copy of a blank statement of terms and conditions was seen. The manager stated that signed copies were sent to the social worker, appointee or solicitor. The records of three people who lived in the home were seen. Each had a contract with social services and the home. Four out of seven people who completed comment cards said that they had had a copy of their contract, one said that they could not say and two did not answer that question. In the AQAA the manager said that a pre-assessment is always carried out prior to a visit to the home. They also said that a choice of menu is readily available. Full assessments are completed and choices are recorded. The records of three people who lived in the home were seen. Two people had had an assessment of their needs when they were admitted to the home. They both also had a community care assessment completed by a social worker. A third person had recently moved into the home from hospital. They had assessment information from the hospital and the home was also completing their own assessment. The manager said that they talked with the person about their assessment and care plan. The manager said in the AQAA that a prospective service can visit the home and the visit is always facilitated by a member of staff and a meal is always offered. All new service users are given a three months trial stay. The manager and the community psychiatric nurse stated that this did not happen when a person had moved in a few days ago. They had planned a visit for the person but on the day the ward was short staffed and no one could bring them. They had therefore come straight from hospital. The community psychaitric nurse said that they knew the home and were confident the home could meet the person’s needs. At previous inspections it was noted that people had visited the home before they moved in. Kington St Michael Residential Home DS0000028153.V344608.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 People’s health, personal and social care needs were met. The home had a plan of care that the person, or someone close to them, had been involved in making. People were not able to manage their medicine and the staff supported them with it, in a safe way. People’s right to privacy was respected and the support they had from staff was given in a way that maintained their dignity. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager said in the AQAA that each person had a detailed care plan which identified their needs. This was followed and implemented by the care staff. Their care plan was reviewed on a monthly basis and changes were fully recorded. The records of three people were read. Two people had care plans including action to meet all the needs identified in standard 3.3 of the National Kington St Michael Residential Home DS0000028153.V344608.R01.S.doc Version 5.2 Page 12 Minimum Standards for Older People. There was a separate sheet recording the aims and outcomes these two people wished to achieve from their plans. The people had signed these sheets to confirm their agreement. The plans included a box to tick to confirm that the person agreed with their plan and they had also signed their plans. Their plans were reviewed once a month. The third person had recently moved into the home. The manager said that they talked with the new person about their assessment and care plan. The person had signed their plan, and a declaration that it had been read to them, to confirm that they understood it and agreed with it. The sheet to record the outcomes had not yet been completed for this person. Five people who completed comment cards said that they always received the care and support they needed and two said that they usually did. Three out of four relatives who completed comment cards said that the home always met the needs of their relative and one did not answer that question. Each person also had a preferred daily routine and a manual handling care plan. There were risk assessments, including risks of falling, with action taken to minimise risks. A recommendation was made at the last inspection that risk assessments should be reviewed at regular intervals to ensure that they continue to reflect people’s needs and risks continue to be managed. The manager said that these had all been reviewed. Two people had new risk assessments. A risk assessment had not yet been completed for the person who moved in recently. However, their care plan showed that they were not at risk of falling. The care plans included the support that people needed with health care. They also identified that staff were supporting people to manage their own personal and oral care when able including washing, dressing and cleaning teeth. Advice was sought from the district nurse when people were at risk of developing pressure sores. Treatment, specialist equipment and continence aids were also provided by the district nurse. The community psychiatric nurse monitored people’s psychological and mental health. People had opportunities for physical activity and could go for walks. Two people said that they were able to go for walks on their own. People’s nutritional needs were identified in the personal notes and their weight was recorded. People were registered with the local GP. There were records of appointments with the GP, dentist, optician, chiropodist, district nurse and community psychiatric nurse in the personal notes. Six people said in their comment cards that they received the medical support that they needed and one was not able to answer the question. There was a medication policy. The home used a monitored dosage system, and medication was kept securely in a locked cupboard. This does not meet the current requirements for storage of controlled drugs. No controlled medication was prescribed at the time of the inspection. No one administered their own medication. There were records of all medication received into the Kington St Michael Residential Home DS0000028153.V344608.R01.S.doc Version 5.2 Page 13 home, administered and returned to the pharmacist. These were properly recorded. The GP monitored people’s medication. The staff had received training about medication. The manager sought advice about medication from the pharmacist. The pharmacist had visited recently and was satisfied with the arrangements for storage, recording and disposal of medication. The pharmacist had also conducted an in depth review of each person’s medication. If they thought someone’s medication needed changing they would refer this to the GP. Each person was individually dressed in their own clothes. Care was given in the privacy of people’s bedrooms and the bathrooms. Each person had a single room and each had their own toilet most of which were ensuite. The name each person preferred to be called was recorded in their admission form. Staff knocked on people’s doors and waited for permission before entering people’s rooms. Consultation with professionals took place in the privacy of people’s rooms. Kington St Michael Residential Home DS0000028153.V344608.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, 15 Each person was treated as an individual and the care home was responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They were part of their local community. The care home supported people to follow personal interests and activities. People were able to keep in touch with family, friends and representatives. They were as independent as they could be, lead their chosen lifestyles and had the opportunity to make the most of their abilities. People had nutritious and attractive meals and snacks and enjoyed their food. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a programme of activities. One person said that there used to be activities like scrabble but these had stopped recently. The manager confirmed that the regular activities had stopped over the Christmas period. People were playing scrabble again on the afternoon of the inspection. In the AQAA the manager said that activities were flexible and varied. There was a pleasant garden and people sat out if they chose. Some people had been involved in Kington St Michael Residential Home DS0000028153.V344608.R01.S.doc Version 5.2 Page 15 planting hanging baskets and one person took responsibility for watering them. People were seen in the lounge watching the television at different times during the inspection. People also moved around the home freely and spent time in their rooms, the lounge or the dining room as they chose. Some people had televisions in their rooms. Two people said that they were able to go for walks in the village independently. Information about people’s hobbies and interests was recorded in their care plans. Five people who completed comment cards said that there were activities in the home that they could take part in, one said that there sometimes were and one did not answer that question. Three out of four relatives who completed comment cards said that the home met people’s different needs in terms of race, age, disability, gender, faith and sexual orientation. One relative did not answer that question. People said that they kept in contact with their family and friends. One person said that they had visits from their cousin. Another said that they had weekly visits from their daughter. There were visits from representatives of groups from the village. One person said that a Baptist minister used to visit them. Another person said that they had recently been to the pub next door for lunch. Contacts with family and friends were recorded in the care plans and daily records. People could go out unaccompanied if they chose and were able. People had independent arrangements to manage their finances. Some people’s money was managed by their family and some by solicitors. People managed small amounts of cash independently. Some people had brought items of furniture into their rooms and everyone had brought personal possessions. The owner reported that people were aware that they could access their own records and one person had requested access to their records in order to find a phone number. People chose where to spend their time and during the inspection were observed freely moving around between their rooms and the communal areas. People were offered three full meals a day; breakfast, lunch and supper. Breakfast was flexible and people had this in their rooms. Lunch was around 12 noon and supper was at 5-30pm and drinks were served throughout the day. There was a further drink and snack at 8-30 pm. Two people also took sandwiches to their rooms in the evening. Nutritional needs were assessed and recorded. Special diets could be catered for, including diabetic and food served took account of any cultural needs. The menu showed that a varied and balanced diet was being served. The dining room table was attractively laid and people had individual napkins. Lunchtime during the inspection was a pleasant social occasion. The food was well prepared and hot. An alternative was offered if someone did not like the planned meal. At tea time a choice of meal was seen, as each person had something different according to their Kington St Michael Residential Home DS0000028153.V344608.R01.S.doc Version 5.2 Page 16 tastes. All the people who were spoken to said that they enjoyed the food. All the people who completed comment cards said that they liked the meals. Kington St Michael Residential Home DS0000028153.V344608.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, 18 If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a complaints procedure. The manager stated that she had reminded people how to make a complaint. She had put a copy of the complaints policy in the lounge together with a form to complete if anyone had a complaint. There had been no complaints. People who were spoken to were very satisfied with the service and said they had no complaints. One person said that they knew how to make a complaint. Another said that they did not but their daughter had all the information and would complain on their behalf. Six out of seven people who completed comment cards said that they knew how to make a complaint. The seventh did not answer that question. Two out of four relatives who completed comment cards said that they knew how to complain and two did not answer that question. There was a policy about abuse, a copy of the Swindon and Wiltshire Protection of Vulnerable Adults Procedure and a copy of the ‘No Secrets’ booklet. There had been no allegations of abuse to record and no staff had been found to be Kington St Michael Residential Home DS0000028153.V344608.R01.S.doc Version 5.2 Page 18 unsuitable to work with vulnerable adults. All staff had received training about prevention of abuse. Four staff who completed comment cards said that they were aware of the adult protection procedures. Checks of the Protection of Vulnerable Adults (POVA) list were made before staff started to work with people. Kington St Michael Residential Home DS0000028153.V344608.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, 20, 21, 24, 26 People lived in a safe and well-maintained home that was homely, clean, pleasant and hygienic. People stayed in a home that had enough space and facilities for them to lead the life they chose and to meet their needs. People’s rooms were individual, comfortable and they felt safe when they used them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was decorated and maintained to a high standard. Last year all the shared areas had been repainted and the lounge had been wallpapered. New curtains were hung and new carpet had been laid throughout. People had been consulted about the colours. At the front of the home there was a flight of steps from the pavement. There was a stairlift to the first floor. The owners made it clear to people, who were thinking about moving into the home, that the building was not always Kington St Michael Residential Home DS0000028153.V344608.R01.S.doc Version 5.2 Page 20 accessible to people who may have mobility problems. One person with mobility problems had a downstairs room with their own bathroom. There are no outstanding requirements of the environmental health officer’s or the fire officer’s last inspections. The fire log book showed that the appropriate checks and tests were being carried out. There was a record of maintenance. The garden was accessible to people who lived in the home. The manager planned to improve the lay out of the garden and replant it. There was no CCTV. Since the last inspection most of the radiators had been covered following a risk assessment. There were window restrictors on the windows. Since the last inspection the kitchen had been refitted and new cupboards and a cooker had been installed. A water softener had been fitted. The downstairs toilet and wash hand basin had been replaced and new flooring had been laid. Several of the bedrooms had been redecorated and people had chosen the colours. The bedrooms were individually decorated and furnished and some people had brought items of their own furniture into their rooms. All of the bedrooms had ensuite toilets and wash hand basins except for one, which had its own separate private toilet and wash hand basin. Two people had ensuite baths. There was also a toilet downstairs near to the lounge and dining room. There was an assisted bath upstairs. This was in a rather cramped room and the manager planned to refit the bathroom, in consultation with people who lived in the home, and possibly make it bigger. The accommodation was clean and free from odours. All the people who completed comment cards said that the home was fresh and clean. The washing machine was kept in a small room in the rear corridor. Laundry was not carried through areas where food was stored, cooked or eaten. There were no hand washing facilities in this room but there was a hand wash basin in the toilet next to it. The walls of the laundry area were painted and there was vinyl flooring which were easy to clean. A tumble drier was in the airing cupboard upstairs. There were infection control guidelines. The washing machine had a pre-wash facility and a high temperature programme to meet disinfection standards. People’s clothes were labelled to ensure that their clothes were returned to them. The staff knew which clothes belonged to each person apart from rare occasions when relatives brought in a new item of clothing and did not inform them. Kington St Michael Residential Home DS0000028153.V344608.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, 30 People’s needs are met and they have safe and appropriate support as there are enough competent and trained staff on duty at all times. However, they cannot have complete confidence in the staff at the home because not all the checks have been done before they start work to make sure that they are suitable to care for them. Quality in this outcome area is generally good although some improvements need to be made to recruitment practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The rota showed that there were two staff on duty at all times and two staff sleeping in. The staff had a multi-purpose role and were involved in meal preparation, cleaning and laundry as well as care. Three members of staff had worked in the home for several years and were familiar with people’s needs. There were eight staff. Four of these had a National Vocational Qualification (NVQ) at level 2 or above. Two were working towards NVQ Level 2. There was a recruitment procedure and examination of the recruitment records showed that this was being followed. A requirement was made at the last inspection that a Criminal Records Bureau (CRB) check must be obtained for Kington St Michael Residential Home DS0000028153.V344608.R01.S.doc Version 5.2 Page 22 one member of staff. This had been addressed and the CRB check had been obtained. The recruitment records of three staff were seen. Each had completed an application and had had an interview. Notes were kept of their interview. Each had proof of identification and a copy of their birth certificate and/or passport had been obtained. CRB checks, including checks of the Protection of Vulnerable Adults list, and two written references were obtained for two members of staff before they started to work with people. The two written references for one had a date when they were requested but no date when they were returned so it was not clear when they were received. The third member of staff’s CRB was returned after they started work. A POVA first check and one written reference had been obtained before they started work. However the second written reference was obtained after they started work. The manager stated that she had obtained a verbal reference before the person started to work. Two written references are required before a person starts work following a POVA first check. The POVA first check had been obtained by an umbrella body and they had sent an invoice which gave the date when the POVA first check arrived. However, there was no printout to prove when the POVA first check was made. None of the three members of staff had made declarations that they had no convictions or provided proof or a declaration that they were physically and mentally fit. The new staff had had induction training. Staff had received training in first aid, food hygiene, manual handling and abuse. Copies of certificates were displayed in the dining room and corridor. Most of the staff had received training about medication. Training about dementia care and refresher training in first aid had taken place for most staff since the last inspection. Kington St Michael Residential Home DS0000028153.V344608.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, 38 People have confidence in the care home because it is led and managed appropriately. Improvements to the service are made as a result of people’s ideas. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Kington St Michael Residential Home DS0000028153.V344608.R01.S.doc Version 5.2 Page 24 The registered manager had a Registered Mental Nursing qualification and was updating her knowledge and skills by undertaking a management course. She said that she had two modules to complete and hoped to finish the course by April 2008. She also participated in the training provided for staff. Through her qualification and experience she was familiar with conditions and diseases associated with old age. There were clear lines of accountability between the manager and the staff. The manager had undertaken a service user survey within the last year. The survey showed a high level of satisfaction with the care provided. The manager had written a development plan for the home following the survey. The manager said that she was due to send the surveys out again. She also said that she held monthly meetings with the people who lived in the home and she asked them for their ideas for improvements. The manager reported that most people’s finances were managed by their families or their solicitor. The manager handled money on behalf of one person. They had a detailed financial care plan, which they had agreed and signed. There were records of all transactions signed by both the person and the manager. The manager managed the collecting of the person’s benefits and paying of fees. However, she gave the person their personal allowance to look after themselves. The person asked staff to take them to the post office when they wished to make deposits into their savings account. This was an area of good practice as it provided financial safeguards for the person whilst maintaining their personal autonomy. There was a health and safety policy identifying how the home would comply with relevant legislation. There was a general risk assessment in relation to safe working practices. There were arrangements for the training of staff in moving and handling, fire safety, first aid, food hygiene and health and safety There were Control of Substances Hazardous to Health (COSHH) assessments, equipment was regularly serviced, the electrical consumer unit had been replaced, the electrical wiring had been checked and portable appliances were tested annually. The plumbing, electrics, boiler and central heating were under a service contract. There was a fire risk assessment and records of fire safety checks. The fire officer visited in 2006 and was satisfied with the fire safety measures. The environmental health officer had visited in March 2007 and was satisfied with the arrangements in relation to food hygiene. The environmental health officer had also visited and advised about the health and safety measures. The owners had followed this advice and addressed these requirements. A bath thermometer had been obtained and staff were taking and recording water temperatures before bathing. A new risk assessment had been done about the safety of uncovered radiators. These were being covered according Kington St Michael Residential Home DS0000028153.V344608.R01.S.doc Version 5.2 Page 25 to the level of risk. All but one of the radiators had been covered. Window restrictors had been put on all the windows to ensure no-one fell out of a window. A risk assessment had been done about the hot water from taps. Thermostatic valves had been put on taps according to the level of risk. The manager had arranged for these to be serviced regularly. This would help to ensure that people were not scalded. The worn carpet on the stairs in one person’s living accommodation had been replaced to ensure their safety. Kington St Michael Residential Home DS0000028153.V344608.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 XCHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Kington St Michael Residential Home DS0000028153.V344608.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 OP29 Regulation 19 (9) (10)(a)(b) (11)(a)(b) Requirement When a new member of staff starts work after their Protection of Vulnerable Adults (POVA) first check and before their Criminal Records Bureau (CRB) check is received several conditions must be complied with. A CRB check must have been applied for. All other checks including two written references must have been received. New members of staff must provide evidence, or sign a declaration, that they are physically and mentally fit to do the job. Timescale for action 11/01/08 2. OP29 19 (9) Schedule 2. (6) 11/01/08 Kington St Michael Residential Home DS0000028153.V344608.R01.S.doc Version 5.2 Page 28 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 OP9 OP29 Good Practice Recommendations A controlled drugs cupboard should be provided, which complies with the Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007. When staff references are received the date should be recorded to provide evidence that they were received before the staff member started work. The person who completes the reference should be asked to date it. When recruiting new staff it would be good practice to include a declaration that they are physically and mentally fit and have no convictions on the application form. When Protection of Vulnerable Adults (POVA) first checks are done by an umbrella body a written printout should be obtained as proof of when the check was made. 3. 4. OP29 OP29 Kington St Michael Residential Home DS0000028153.V344608.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Regional Office 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 Kington St Michael Residential Home DS0000028153.V344608.R01.S.doc Version 5.2 Page 30 - 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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