Inspection on 22/10/08 for Laurieston House

This inspection was carried out on 22nd October 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Laurieston House 09/09/09

Laurieston House 03/10/07

Laurieston House 03/10/06

Laurieston House 15/11/05

Laurieston House 13/07/05

Laurieston House 13/12/04

Laurieston House 06/05/04

Laurieston House 14/10/03

Similar services:

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 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Laurieston House 78 Bristol Road Chippenham Wiltshire SN15 1NS     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sally Walker     Date: 2 2 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Laurieston House 78 Bristol Road Chippenham Wiltshire SN15 1NS 01249444722 F/P01249444722 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Jennifer Jobbins Type of registration: Number of places registered: Jennifer Jobbins care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Not more than 3 service users over the age of 65 years with a mental disorder Date of last inspection Brief description of the care home Laurieston House is a care home for up to ten older people. The home is a two storey, detached property in a residential area of Chippenham. There is a large garden at the rear of the home and a parking area at the front. Laurieston House is owned by Mrs J. Jobbins, who is also the registered manager. There is a staff team which includes a deputy manager, senior carers and carers. Other staff members are deployed to carry out domestic work. People who use the service have accommodation on the ground and first floors. There are four double rooms and two single rooms. There is a staircase, but no lift, to those rooms on the first floor. The communal areas consist of a lounge and a dining room. Information about Laurieston House is available in the Care Homes for Older People Page 4 of 36 Over 65 3 7 0 0 Brief description of the care home homes Statement of Purpose. The fees for the home are between 440.00 and 510.00 pounds a week. Copies of inspection reports can be obtained from the home. These are also available through the Commissions website at: www.csci.org.uk Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place on 22nd October 2008 between 9.45am and 7.40pm. Mrs Jobbins, registered manager, was present until 11.15am and returned at 2.45pm after a short rest, having worked the previous night duty. We spoke with people who use the service and staff. We looked at care plans, risk assessments, medication, staff records that were available, the staffing rota and activity records. We also were given a tour of the building. We asked Mrs Jobbins to complete her AQAA (Annual Quality Service Review). It was completed and returned on time. Care Homes for Older People Page 6 of 36 As part of the inspection process we sent survey forms to the home for people who use the service, staff and healthcare professionals to tell us about the service. Comments can be found in the relevant section of this report. The last Key inspection was on 3rd and 25th October 2007. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the care home does well: What has improved since the last inspection? What they could do better: The homes certificate of registration includes three places for people who may have a mental disorder, excluding dementia. Some of the people who use the service may have a dementia. Mrs Jobbins has been sent an application to vary the registration to dementia and this must be progressed. The homes statement of purpose should include more detail about the range in needs that the home intends to meet. Policies on restricting our access to files, and other information kept about people who use the service, must state our role and powers as regulators. Staff should be made aware that they may be committing an offence if they obstruct us when we carry out our duties under the Care Standards Act 2000. Care plans must identify how any behaviours are managed. Bathing risk assessments must identify how long people are to be left unattended. Care Homes for Older People Page 8 of 36 Medication must never be crushed and administered in food. If people have difficulties in swallowing tablets or a GP says that medication can be crushed, the home must ask for written confirmation of this from the prescriber, or request alternative preparations such as liquid or dispersible medication. A record must be kept if the meal on the menu is changed. The windows to the first floor must be restricted to allow safe opening. Hairbrushes and combs should not be kept in bathrooms, to reduce the risk of communal use. Staff must be made aware of the risks of cross infection when dealing with clean and soiled laundry. Laundry should not be put on electrical equipment. There must be clear written clarification on the role of staff during induction who are awaiting clearance to work with vulnerable people. Staffing records must contain recent photographs of all staff who are employed. All staffing records required by regulation must be available for inspection. The home must not accept open references addressed: to whom it may concern. There must be an annual development plan, following obtaining views and comments from people who use the service and others involved in their care. Although staff have certificates to show that they attended moving and handling training, monitoring must take place to ensure they are putting their learning into practice. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 36 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. 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 that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The statement of purpose is regularly reviewed but does not set out the range of needs the home intends to meet. People have opportunities to visit the home prior to admission. Peoples needs are assessed before they are admitted. Evidence: We looked at the homes registration certificate and statement of purpose. The category of registration includes three places for people with a mental disorder, excluding dementia. From care planning documentation and discussions with people who use the service, we saw that some people had a dementia. Mrs Jobbins told us she thought her registration included dementia. We have sent Mrs Jobbins an application form to vary the category of registration to include dementia rather than mental health. No action has been taken to address the good practice recommendation we made that Care Homes for Older People Page 11 of 36 Evidence: the statement of purpose includes more detail about the range of need the home intends to meet. The statement of purpose was revised in January 2008, but did not mention information about the category of registration, or which needs could be provided for. In the AQAA Mrs Jobbins told us that a number of local older people used the respite service. Mrs Jobbins or the deputy manager visits people who are considering using the service, to assess whether their needs can be met. This takes the format of a resume of care needs. One of the people who use the service told us that their daughter had visited the home before their admission. In a survey form, one of the people who use the service told us about receiving a contract I am not sure, my daughter has signed on my behalf a form when I first came in regarding fee structure, meals, laundry etc. Mrs Jobbins came to see me and explained everything to me, answered all my questions satisfactorily and reassured any anxieties I had about living in residential care. In a survey form one of the relatives told us visited numerous occasions. Third party recommendation. Professional recommendation. Another relative told us we were struck by the welcome and homeliness of the house. Care Homes for Older People Page 12 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are set out in a care plan. Some care plans do not give full detail of how those needs are to be met. People who use the service have good access to healthcare professionals. Systems and training are in place to ensure safe handling of medicines. Staff uphold peoples right to privacy and respect. Evidence: Some action has been taken, to address the good practice recommendation we made that the format of the assessment forms and care plans are reviewed. We said that peoples support needs should be appropriately described, to reflect a more person centred approach to care. Action has been taken to address the good practice recommendation we made that the forms for recording are reviewed. We said that this should include, assessments and personal money accounts. We said that the assessment forms should include a separate section for reviews to identify any changes. Care Homes for Older People Page 13 of 36 Evidence: All people who use the service have their care and support needs set out in an individual care plan. Peoples routines for personal care during the day and at night, were well recorded. Care plans identified peoples communication needs, medical treatments, moving and handling and dietary requirements. We saw evidence that peoples food and fluid intake is regularly monitored, with staff filling out charts of consumption when a risk was identified. Those people in their bedrooms had jugs of juice to help themselves. Their care plans identified risks and action to be taken if refusing food. We said that there must be more detail in how some care needs are to be met. We said that phrases such as good pressure care needed, two carers to transfer, needs assistance when standing and suitable diet, need clarification. Peoples risk of developing pressure damage was being assessed. Mrs Jobbins told us that she had purchased pressure relieving mattresses when needed. Staff had recently been trained in tissue viability. People were being regularly weighed and any concerns referred to the relevant healthcare professionals. People had good access to different healthcare professionals or specialists. One person had a behaviour chart but their care plan did not have reference to management of any behaviours. One persons bathing risk assessment stated do not leave for many minutes alone in bath. We advised that if people do like to spend some time alone in the bath, the care plan must clearly state how long they are to be left with strategies for monitoring. There was good information in one persons care plan about their risk of using the stairs unsupervised. Care plans were reviewed each month and any changes dated. Daily reports generally related to the descriptions of how care must be provided in care plans. All of the people we spoke with told us that staff gave them their medication. One person told us they were given their painkillers when needed. They also said their GP visited them at the home. The deputy manager told us that people had their medication regularly reviewed with their GP. The supplying pharmacist had provided a training session in March 2008. We looked at the medication administration records. The file contained a procedure for safe administration of medication. We saw evidence in some peoples care plans of what prompted administration of a medication prescribed to be taken only when needed. One persons care plan stated that the GP had requested that medication was crushed and placed in honey or food. We advised that written confirmation must be obtained regarding this practice. This is because crushing tablets may render the medication unlicensed. We also said that alternative preparations such as liquid or dispersible medication should be requested. There were records to show that peoples GPs had agreed some homely remedies that could be taken by individuals. One persons care plan did not show details of specific prescribing instructions of a medication that is taken only once a week. As a matter of good practice the British National Formulary and Mimms, (information about prescribed medication), were available for staff consultation. Care Homes for Older People Page 14 of 36 Evidence: We saw that staff were upholding peoples dignity when asking them, in front of others, if they needed to use the toilet. We also saw and heard a member of staff tell one of the people who they were supporting to use a wheelchair. They told the person that they were about to lift their feet onto the foot plates of the wheelchair. We saw that people who use the service and staff had developed good relationships. One of the relatives who was visiting told us that Mrs Jobbins would ring them to discuss any change in need. They said they were pleased that their relative had put on weight since coming to live at Laurieston House. Another relative told us that their relative was very happy living at the home. They made very positive comments about the staff and the care provided. They described the home as home from home. In a survey form one of the people who use the service told us I cannot walk unaided now so sometimes I have to wait for someone to come in the lounge before I can go to the toilet. I have been fortunate so far to not need too much support apart from given my tablets at the appropriate times. Another person described the care as excellent. In a survey form one of the relatives told us this is a first class home, giving first class care, not adequate care. Mum is reviewed regularly by doctors and mental health. The staff adapt to changes and disease progression. They respect and treat my Mum with the care that anyone would choose for their Mum. That is why I choose Laurieston House. Laurieston is gold, no premier care, that my Mum deserves and gets. Another relative told us they are very friendly, cheerful. Apart from giving my relative their medication, we have no need of medical support, as far as I know the staff take my relative to buy a paper or a drive. My relative seems satisfied. Care Homes for Older People Page 15 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most people decide how they spend their day. People enjoy the activities provided. People are encouraged to retain contact with families and visitors are welcomed. People enjoyed the meals. Evidence: Those people who could decide, spent their day as they wished. Other people relied on staff for direction. An activities diary was kept with details of what people are involved in. This recorded various games, people having their nails manicured, Holy Communion and assisting in the kitchen. Those people who used the kitchen had a risk assessment in their care plan. We saw a board with photographs of people who use the service receiving Easter eggs. We also saw a board that had been decorated for Halloween. Some of the people who use the service had made a collage. A social evening had been held to raise money for a cancer charity. Peoples friends Care Homes for Older People Page 16 of 36 Evidence: and relatives had been invited. People had made and decorated cakes for the event. Some older people in the community come to the home for a few days each week for day care. Some of these people also use the respite service. The deputy manager told us that at least one trip out occurs every week. Four people had recently been out to lunch at a local pub. People go into Chippenham to do shopping, go out for coffee or to the local garden centre. Staff provide activities. The deputy manager told us that people enjoy the cooking sessions, making cakes and pies. She said that some people enjoy folding laundry or helping with washing up. The deputy manager told us about the life books that are completed with with people, during the first six months of their stay. Staff were spending time with people to discuss their social history. When we visited some people were having a game of skittles in the sitting room with staff. One of the people who use the service told us they did not like going out, although they had a wheelchair so they did not have to walk. They told us they were happy to sit and watch the birds from their window. People told us their family and friends could visit them at any time and were made welcome. In the AQAA Mrs Jobbins told us we ensure the resident has regular contact with their family friends advocate. One of the people who use the service told us that they liked to have their breakfast in the dining room. Another person told us that they liked the meals provided. They told us they liked cheese on toast but did not have it very often. They also said that they had recently been for a coffee in Chippenham with a member of staff. One of the staff who was preparing lunch told us about the meals provided. They said that staff tell people what the meal is. There were alternative dishes of a pie or sausages if people did not like any meal. We looked at the menus. There were two choices for lunch but only one meal being cooked. The meal on the menu was not what was being cooked. The staff told us that they knew what people liked and had prepared accordingly. They said the baked potatoes in the oven were for staff. The staff said that any changes to the menu were recorded in the daily diary. We looked at the diary later in the day and found the change recorded. There were no other changes recorded for some months, so we could not determine whether records were being regularly made or not. The staff told us that people were asked on admission about their meal preferences. They told us that people who use the service contributed their Care Homes for Older People Page 17 of 36 Evidence: ideas when the menus were compiled. Most people had their lunch in the dining room. Those people who had their meal in their bedroom were given it at the same time as others had their meal. That evening people were having a buffet meal served to them in the sitting room. In a survey form one of the people who use the service told us due to macular degeneration in both eyes, it is not always appropriate for me to join in. I do not take part in the cookery sessions. Some tastes I am not keen on but on the whole I enjoy my food and am told I have a good appetite for a woman of my age. Another person told us time spent at home very beneficial by engaging in various activities this is stimulating and helps in keeping the mind active, so slowing the progress of Alzheimers. Another person told us I do not always want to join in but I do sometimes. One person described the meals as delicious. In a survey form one of the relatives told us playing ball, small games, baking cakes, helping in kitchen, chores, garden, shows, singing, outside activities. More activities than if in own home. Fresh cooked home baked food. Care Homes for Older People Page 18 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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 and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place for people who use the service and their representatives to make complaints about the care and support provided. Staff are trained in reporting any allegations of abuse to the local safeguarding vulnerable people process. Evidence: In the AQAA Mrs Jobbins told us encourage the residents and their representative to use the home complaints procedure and discuss openly all issues of concern with the manager or senior deputy manager if unavailable. One of the people who use the service told us that they would tell their daughter if they had a complaint, or talk to Mrs Jobbins or the deputy manager. One of the relatives who was visiting told us that Mrs Jobbins makes herself available to discuss any concerns. They said they had no reason to make any complaints. They said that the home keeps a small amount of cash on behalf of their relative. They said the home kept records of all transactions and receipts of any purchases on file. There were no records of complaints received by the home. Mrs Jobbins told us that none had been received. She went on to say that complaints would be logged in either peoples individual files or in staff files, as appropriate. In the AQAA Mrs Jobbins told us policies and procedures cover all kinds of abuse and Care Homes for Older People Page 19 of 36 Evidence: staff know they have a duty and are accountable to report any kind of abuse they have witnessed or are suspicious of abuse taking place. They have all signed the policies and procedures on abuse or attended a seminar or completed courses. An in house seminar was held on what constitutes abuse. Accessed the services of a psychiatric nurse to talk to staff about abuse. Action has been taken to address the good practice recommendation we made that additional safeguarding adults training is undertaken involving the local safeguarding unit. A policeman from the local safeguarding unit had provided training in May 2008. Staff told us they had received training in the local safeguarding adults reporting process. They told us how they would report any suspected abuse of people who use the service to the manager. In a survey form one of the people who use the service told us if I have a problem or raise an issue it is recorded in my care plan, so that all of the staff are aware. I like to speak to the boss but she is not always available but everyone else is helpful. I have not had to complain, but I would tell the boss or my daughter. In a survey form one of the relatives told us staff notice when Mum is not happy. No need to complain Laurieston is the best home ever. Care Homes for Older People Page 20 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a homely and clean environment. The home is gradually being upgraded. People remain at risk where windows to the first floor are not restricted. Locking these windows is not a solution. Evidence: In the AQAA Mrs Jobbins told us we have a regular programme of maintenance and decoration and renewal of items of furnishings when required. The residents are involved in the fabric and decor colours. The garden is enclosed to permit easy safe access to all residents to relax and enjoy this area. The residents assist in choice of flower shrubs. Mrs Jobbins told us that the dining room would be redecorated and have a new carpet and curtains during the following few weeks. The home has no passenger lift. People who live upstairs have to be able to manage the stairs. There is a large garden to the rear of the property. This had been fenced off to allow people to use the garden in safety, without going out on to the main road. The deputy manager told us that people enjoy sitting out in the garden in the better weather. Care Homes for Older People Page 21 of 36 Evidence: Little action had been taken to meet the two requirements we made that unnecessary risks to peoples health and safety are identified and as far as possible eliminated. This is in relation, firstly, to written assessment being carried out of the window openings on the first floor. Secondly the requirement relates to the window openings being restricted. This is to ensure that people who use the service cannot fall from an upstairs window. Mrs Jobbins told us that she had had a contractor out who had told her that restrictors could not be fitted to the windows. There was no written evidence of this statement or the reasons why. Mrs Jobbins had locked all of the first floor windows. We said that this restricted individual peoples enjoyment of fresh air. By the end of the inspection Mrs Jobbins had made arrangements with a contractor to visit the follwoing day. Mrs Jobbins told us she would let us know when the work was completed. A written risk assessment dated October 2007 stated that all the upstairs windows are to be kept locked at all times except at meal times when people are having thier meal in the dining room. These windows would then be locked again before people left the dining room. The risk assessment did not state any identified unneccessary risks to peoples health and safety. All the radiators were guarded to ensure that people were protected from the hot surface should they fall against a radiator. The kitchen and laundry doors had coded locks. We were told this was for peoples safety. The door opening codes had been placed so that access could still be had to the rooms. Some of the people who use the service helped with preparing meals or cooking cakes. Action has been taken to address the good practice recommendation we made that work is completed on the ensuite areas in two bedrooms as a matter of priority. Action has been taken to address the good practice recommendation we made that peoples choice in sharing a bedroom is documented and kept under review. We said that this is pertinent when there is a change in occupancy. Mrs Jobbins told us that people currently sharing rooms did so by agreement at the time of their admission. The people using the respite service do not use a bedroom already occupied. Mrs Jobbins told us that a husband and wife had shared when they used the respite service. Mrs Jobbins told us that she would speak with people who were occupying a double room when the other bed became empty as to their views on sharing with someone else. This would be recorded in the resume of care document. We saw rubber backed mats placed by some peoples beds. We were told this was so that the mats could be washed in any continence accidents. Care Homes for Older People Page 22 of 36 Evidence: We saw that some of the call alarm points in peoples bedrooms did not have leads attached so that people could use the alarms from where they were in the room. Mrs Jobbins told us that most people knew how to use the alarms by pressing the button on the wall plate. In the AQAA Mrs Jobbins told us that staff had attended a course in MRSA. Staff had access to disposable gloves and aprons when needed. In the upstairs bathroom, we saw two hairbrushes and a comb with a quantity of grey hairs in them. To avoid communal use, these items must be removed. People had their own baskets of personal toiletries in their bedrooms. The home was cleaned to a good standard, including those areas not always visible, for example, under the bath hoist seat. We were told that the laundry room floor was due to be replaced. In the laundry room we saw a plastic basket with freshly laundered clothing in it. It was placed over a bowl of soiled laundry. We said that staff must revisit the infection control guidance with regard to laundry procedures. We also saw nightgowns stored on the pump from the hot water storage tank. We said that this may be a potential fire risk. More suitable storage must be found. In a survey form one of the people who use the service told us my bedroom is always clean and tidy and smells fresh never any bad odours anywhere. Another person said clean with fresh smell. In a survey form one of the relatives told us I have never in eight years smelled urine or found the home untidy in any way. This home sets the standard that all care homes should aspire to. Care Homes for Older People Page 23 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by people who are well known to them. Staffing levels should be continually reviewed as more people are admitted to the home. Staff access to relevant training is improving. People are not fully protected by the homes recruitment and induction policies. Evidence: No action has been taken to address the good practice recommendation we made that reference is made to a recognised staffing model or reviewing system regarding staffing levels. This related to some times then there were four staff on duty and other times when there were only two. We looked at the staffing rota. Staff are involved in cooking and cleaning as well as care. There are two volunteers who come to help with washing up and bed making. Mrs Jobbins showed us where extra staffing was available. Both Mrs Jobbins and the deputy manager work some of the waking night shifts. There is a minimum of two staff in the building during the day. At night there is one waking night staff and one staff sleeping in. When we visited there were seven people living at the home. Current staffing levels may mean that peoples needs were being met at the time. However there may be times in the future when more people are admitted where higher staffing levels are needed to ensure needs are met. Staffing levels must be kept under review. Care Homes for Older People Page 24 of 36 Evidence: Senior staff operate an on call system. No action has been taken to address the good practice recommendation we made about new staff who have not yet been cleared to work by a check against the Protection of Vulnerable Adults list. We said that if they receive part of their induction before being cleared, there must be no misunderstanding about what they are able to do before clearance. We said that the homes policies on recruitment and induction should fully document these restrictions. There was no formal record of the role of staff during induction when they are awaiting clearance to work. We looked at the staff personnel files. Mrs Jobbins told us that one staffs Criminal Records Bureau certificate had been requested three months ago and still had not been returned. We saw that recent photographs of those staff who had worked at the home for some time were not on file. Mrs Jobbins told us that she would address this immediately. We were not given all the staff files relating to those named staff on the rota. Mrs Jobbins told us that the other records were kept elsewhere. We said that all records set out in regulations must be made available for inspection. We saw that open references addressed: to whom it may concern were being accepted. One person had a statement from someone, which was not signed and appeared to be anonymous. We advised that the home must obtain its own references for potential staff. Not all of the staff files contained all the information and documents required by regulation to evidence a robust recruitment process. One staff file did not contain an application form or a recent photograph or any record of induction. In the AQAA Mrs Jobbins told us she had purchased the services of an outsourced recruitment agency. Action has been taken to address the good practice recommendation we made that a training needs assessment and training plan for the staff team are produced. Whilst there was no formal plan in place, Mrs Jobbins had registered with, and already met with, Skills for Care, the organisation that develops the adult social care workforce in England, to provide an improved and relevant training programme for staff. Mrs Jobbins told us that staff had completed the following training stress management, dementia, medication, health and safety, nutrition, Mental Capacity Act 2005, MRSA and fire safety. Four staff had completed a training course in end of life care at a local hospice. One staff told us about courses they had undertaken. These included food hygiene, risk assessment, first aid and moving and handling. They said they had just started NVQ Level 3. Another staff told us they had recently completed NVQ Level 2 and were hoping to do Level 3. In the AQAA Mrs Jobbins told us that she intends that staff will attend courses on equality and diversity. She went on to say that over fifty per cent of staff have NVQ Care Homes for Older People Page 25 of 36 Evidence: Level 2 or 3 or above. Staff are involved in cooking, cleaning as well as care. Many of the staff have worked at the home for some time and are well known to people who use the service. In a survey form one of the people who use the service told us great care. Great support. Staff listen always. Available all the time. In a survey form one of the relatives told us constant care and attention. Personal attention for every need. Staff listen, absolutely, always take the time to encourage Mum to do things for herself. What she wants. Staff treat Mum as if she were their mother. 2 3 staff on continuously always means someone is near to give attention attend to needs, never left or ignored. Care Homes for Older People Page 26 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. 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. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements ensure good continuity in the day-to-day running of the home. Mrs Jobbins must complete the qualification for registered managers. Quality assurance is being developed. People have their financial interests safeguarded. Staff are not formally supervised but Mrs Jobbins works alongside them. Improvements are gradually being made to promote peoples health and safety but some areas need attention. Evidence: Mrs Jobbins has been running the home for over twenty years. An experienced deputy manager and senior carers take responsibility when Mrs Jobbins is not present. Mrs Jobbins had worked the waking night when we arrived at the home. The deputy manager who normally covers for Mrs Jobbins in her absence was called in to assist us with access to information. Mrs Jobbins returned to meet with us after she had rested. Mrs Jobbins told us that she worked most shifts to familiarise herself with different Care Homes for Older People Page 27 of 36 Evidence: aspects of the care and management of the home. In the AQAA Mrs Jobbins told us that she had attended a seminar on equality and diversity. Mrs Jobbins told us she and the deputy manger had completed NVQ Level 4. We advised Mrs Jobbins to discuss with her training provider, either completing the remaining elements of the Registered Managers Award or its replacement, the Leadership and Management for Care Services National Occupational Standards. Mrs Jobbins and the deputy manager had recently completed a course on supporting people with end of life care with a local hospice. She told us she planned to provide in house training on this subject. Little action had been taken to fully meet the requirement we made that the formal quality monitoring system must be implemented, with production of an action plan. We also made a good practice recommendation that the policy on quality assurance includes the type of improvement or annual development plan that will be produced after peoples views have been obtained and analysed. This is to ensure that there is a plan which clearly describes the action that will be taken and the timescales involved. Mrs Jobbins had obtained comments from people who use the service, families and healthcare professionals. There was no action plan taking into consideration these comments. We observed poor moving and handling practice. One of the people who use the service was lifted to a standing position by their underarms. Yet we noted that staff were regularly updated in moving and handling training. Clearly staff are not putting what they have learned into practice. Staff do not have formal supervision sessions. Mrs Jobbins told us that she would take time to discuss individual issues with staff. She went on to say that staff would bring her coursework to discuss. Mrs Jobbins said she also spoke regularly with senior staff. Staff told us that staff meetings were held twice a year. They said they would bring up any issues as they arose in writing either to Mrs Jobbins or to the deputy manager. We saw that the homes insurance was in place. The certificate was displayed. Staff are trained in health and safety matters including first aid and infection control. Regular checks are made on the safety of the environment. As reported in the environment section of this report, the first floor windows still need to have their openings restricted to reduce the risk of people falling from the windows. During the inspection we were told that we could not examine some peoples files. We Care Homes for Older People Page 28 of 36 Evidence: were told that the home has a policy on people or families withholding our access to files. Staff also refused us when we wanted to sit in on their handover. We said that whilst it was good practice to keep information confidentially, it also must be made clear to people our role and powers as regulators. We said that the policy must also include this information. Staff must be made aware that they could be obstructing us in carrying out our role when refusing us information. Care Homes for Older People Page 29 of 36 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 33 24 The registered person must develop a formal system for monitoring and improving the quality of care provided in the home. This requirement is met in part since the last inspection. Compliance with the requirement will be judged when the system has been fully implemented and an action plan produced. 30/09/2008 2 38 13(4)(c) The registered person must 08/11/2007 ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. This includes ensuring that risk assessments are undertaken in respect of window openings and the safety of service users. 3 38 13(4)(c) The registered person must 31/01/2008 ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. This includes ensuring that windows on the first floor are Care Homes for Older People Page 30 of 36 fitted with restrictors, which limit their opening to a safe amount. Care Homes for Older People Page 31 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 12 The application to vary the homes category of registration to include dementia must be progressed So that the category of registration is appropriate to the care that is provided. 24/02/2009 2 7 15 Care plans must identify how any behaviours are to be managed. For continuity of care and safety of people who use the service. 24/12/2008 3 7 13 Bathing risk assessments must identify how long people should be left unattended. So that peoples risk of drowning is minimised. 24/02/2009 4 9 13 Written confirmation must be obtained from a GP if peoples medication is to be crushed and administered in food. 24/02/2009 Care Homes for Older People Page 32 of 36 To protect people from receiving unlicensed medication 5 14 17 Records must be kept of any 24/02/2009 changes to the published menu. To evidence that people continue to have nutritious and varied meals. 6 19 23 Laundry must not be placed on electrical equipment. To reduce the risk of fire. 7 25 13 People must be able to safely open the windows to the first floor. So they have safe access to ventilation. 8 26 13 Staff must be made aware 24/12/2008 of infection guidance when dealing with clean and soiled laundry. To prevent the risk of cross infection. 9 26 13 Hairbrushes and combs must not be used communally. For peoples dignity and to reduce the risk of cross infection. 10 29 19 Open references entitled To 24/02/2009 whom it may concern must not be accepted as part of the recruitment process. to ensure a robust recruitment process. 24/02/2009 24/02/2009 24/12/2008 Care Homes for Older People Page 33 of 36 11 29 17 Staffing records must contain recent photographs of all staff who are employed. To evidence that recruitment meets the regulation on records to be kept in the home. 28/02/2009 12 29 17 All records required by regulation must be made available for inspection. So that we can be shown evidence that the home is meeting the standards and regulations. 28/02/2009 13 31 10 The registered manager must progress recent training and obtain the relevant qualification in management. So that a qualified manager is running the home 01/05/2009 14 32 17 Staff and others must be made aware of our role and powers as regulators. Any policies on restricting our access to information and documents must state this. So that people who use the service, their relatives and staff know that we can examine all documents and information required by regulation. 24/12/2008 15 33 24 An annual improvement plan 24/12/2008 must be produced after taking into consideration the views gained from different parties. Care Homes for Older People Page 34 of 36 So that the registered person can show the methods and timescales for intended improvements to the service. 16 38 12 Staffs moving and handling of people who use the service must be regularly monitored. To ensure that staff are putting their learning into practice for the protection of people who use the service. 17 38 13 The windows to the first floor must have their openings restricted. So that people are not at risk of falling out. 24/02/2009 24/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 1 7 The statement of purpose should be reviewed and revised to state the range of needs that can be met. Phrases such as good pressure care, two carers to transfer, needs assistance when standing and suitable diet should be expanded upon so that all staff are supporting people in the same way. If a GP or anyone suggests crushing medication, alternative preparations such as a liquid or dispersible medication should be requested. The arrangements being made for staff to receive part of their induction before a POVA check is made are documented within the homes policies on recruitment and induction. This is to ensure that there can be no misunderstandings about what a new staff member is able to do before the POVA check is made. 3 9 4 29 Care Homes for Older People Page 35 of 36 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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