CARE HOMES FOR OLDER PEOPLE
Laurieston House 78 Bristol Road Chippenham Wiltshire SN15 1NS Lead Inspector
Malcolm Kippax Key Unannounced Inspection 3rd & 25th October 2007 09:55 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 DS0000028410.V346540.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. DS0000028410.V346540.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Laurieston House Address 78 Bristol Road Chippenham Wiltshire SN15 1NS 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 444722 F/P 01249 444722 Jennifer Jobbins Jennifer Jobbins Care Home 10 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (3), Old age, of places not falling within any other category (7) DS0000028410.V346540.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Not more than 3 service users over the age of 65 years with a mental disorder 3rd October 2006 Date of last inspection Brief Description of the Service: 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. The service users’ accommodation is 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 home’s ‘Statement of Purpose’. The fees for the home are between £395.00 and £440.00 a 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 DS0000028410.V346540.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection included an unannounced visit to the home. This took place on 3rd October 2007 between 9.55 am and 3.55 pm. The service users and three members of staff were met with throughout the day. The inspection process was discussed with the registered person, Mrs Jobbins, who was present during the morning. Arrangements were made to see the relatives of two service users and they were spoken with in the afternoon. The relatives of a third person were also met with during their visit to the home. A second visit was arranged with Mrs Jobbins in order to complete the inspection and discuss the outcome. This took place on 25th October 2007 between 9.00 am and 2.00 pm. Evidence was obtained during the visits through: • • • • Time spent with the service users and with three staff members. Discussion with Mrs Jobbins, when she reported on the action that has been taken in response to the previous inspection’s requirements and recommendations. Observation and a tour of the home. An examination of records, including three of the service users’ care files. Other information has been taken into account as part of this inspection: • • An Annual Quality Assurance Assessment (referred to as the AQAA) that was completed by Mrs Jobbins. The AQAA is the provider’s own assessment of how well they are performing. Surveys about the home that were completed by eight service users, eleven relatives, eleven staff members, three GPs and one other health professional. Some of the service users received assistance from relatives with completing their surveys. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visits. What the service does well:
Mrs Jobbins visits prospective service users in their own homes, which helps to ensure that people have the information that they need before a move takes place. The daughter of one service user said that their mother’s move had gone very smoothly, which she thought was mainly due to the home’s actions. Further information is recorded after a person moves into the home. This includes an individual plan, so that the staff members know what care each person needs and how this should be provided.
DS0000028410.V346540.R01.S.doc Version 5.2 Page 6 Staff members write reports about people’s care and welfare on a daily basis. This helps to ensure that concerns about people’s health and well being are identified and followed up. Three GPs and a district nurse who visit Laurieston House commented positively about the home and the care that people receive. People experience an informal lifestyle in the home and feel that they are treated with respect. People’s contact with their relatives and friends is well supported, which helps them to have fulfilling lives. Close relatives feel that their contribution is valued and that they can talk about things with Mrs Jobbins or with one of the staff team. They feel confident that people in the home are being well cared for. There is a varied menu and people said that they liked the meals. Their comments included: ‘the food is largely home made’; ‘good portions and healthy well balanced diet’ and ‘always nutritious’. Staff members receive guidance and training, which helps to keep people safe. There are procedures so that people know what to do if they have concerns. The accommodation looked clean and tidy at the time of the visits, with no unpleasant odours. Comments were made that Laurieston House was small enough to feel homely and that it was like a ‘home from home’. Many of the staff have several years’ experience of working in the home, which means that people are supported by staff who they know well and are familiar with. The management and staffing arrangements ensure that there is good continuity in the day to day running of the home. What has improved since the last inspection?
Concerns were raised at the last inspection about aspects of the care plans and the records produced about people’s needs. Improvements have been made in the way that information is recorded. The terminology used is now more objective. The environment has improved, as areas of the home have been refurbished. Work has taken place in the kitchen, with the installation of new units, flooring and appliances. This helps to ensure that the meals are prepared in hygienic and well maintained surroundings. A device has been fitted to the dining room door, so that it can now be kept open safely without the use of a wedge. Mrs Jobbins reported that the grounds have been made safer for people to use and that other work has been planned for the garden. This will produce an improved environment for the service users. DS0000028410.V346540.R01.S.doc Version 5.2 Page 7 The recruitment documentation is being reviewed and changes made in the way that the records are kept. This will provide better protection for service users, by ensuring that prospective staff members provide good information about their backgrounds and any issues can be followed up. Mrs Jobbins said that both she and the home’s deputy manager had completed the necessary units for the registered managers award, although they had not yet received accreditation. Completion of this award demonstrates that the people with management responsibilities in the home have gained the relevant management qualification. There was discussion during the inspection about what was required in respect of a quality assurance system for the home. Since the visits, a policy has been produced which describes how quality assurance will be undertaken. What they could do better:
The home’s Statement of Purpose should include more details about the range of needs that the home intends to meet. This is so that prospective service users have better information about the specialist care that the home aims to provide and the level of need that can be met. Changes could be made to the assessment forms and care plans so that these reflect a more person centred approach to the care that people receive. Improvements are being made to the environment, although work on two bedroom en-suite areas has not significantly progressed during the last year. This gives them an unfinished appearance. It is recommended that this work is completed as a matter of priority, so that service users benefit from the improved facilities as soon as possible. Mrs Jobbins was advised at the last inspection about the need to include some areas within the risk assessment process. Risk assessments need to be completed in respect of window openings and the safety of service users. As a permanent safety measure, the windows on the first floor need to be fitted with restrictors, which limit their opening to a safe amount. Mrs Jobbins said that staffing levels are being reviewed on an on-going basis. It would be good practice to refer to a recognised staffing model or reviewing system when a review of staffing levels is undertaken. Mrs Jobbins said that before having contact with service users and the outcome of their POVA check was known, a new staff member may attend the home for the policies and procedures element of their induction. This arrangement should be documented within the home’s 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. Written confirmation of these arrangements would add to the evidence that a robust recruitment procedure is in place.
DS0000028410.V346540.R01.S.doc Version 5.2 Page 8 It is recommended that a training needs assessment and a training plan for the staff team are produced. This is so that there is a clear strategy in place for staff training and will help ensure that the training that staff receive reflects the service users’ needs. As mentioned in the ‘What has improved since the last inspection?’ section, a start has been made with developing a system of quality assurance. A requirement about this has been met in part since the last inspection. The outcomes and effectiveness of the system described could not yet be assessed. Full compliance with the requirement will be judged when the system has been fully implemented and an action plan produced. Implementation of a quality assurance system will ensure that people’s views are taken into account when deciding on what improvements need to be made in the home. It is recommended that the policy on quality assurance includes details about the type of improvement or annual development plan that will be produced after people’s views have been obtained and analysed. This is to ensure that there is a plan which clearly describes the action that will taken and the timescales involved. 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. DS0000028410.V346540.R01.S.doc Version 5.2 Page 9 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 DS0000028410.V346540.R01.S.doc Version 5.2 Page 10 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 and 3 Quality in this outcome area is adequate overall This judgement has been made using available evidence including the visits to the home. Prospective service users would benefit from further information being included in the home’s Statement of Purpose about the range of needs that can be met. People have their needs assessed before moving into the home. EVIDENCE: In their surveys, the service users all confirmed that they had received enough information before moving in, so they could decide if Laurieston House was the right place for them. One of the service user’s relatives reported that Mrs Jobbins had visited them at home to discuss the move. The relative also commented that it was ‘due entirely to the home that the move went so smoothly’. Mrs Jobbins confirmed during the inspection visit that she visited prospective service users in their own home, or in hospital if this was more appropriate.
DS0000028410.V346540.R01.S.doc Version 5.2 Page 11 The majority of service users had needs relating to their age and were admitted under the home’s ‘old age’ category of registration. People could also move into Laurieston House under the home’s ‘mental disorder’ category of registration. The home’s Statement of Purpose did not give detailed information about the range of needs of people who might be admitted under this category, or about the type of service that they could expect to receive. Mrs Jobbins said that one person had moved on to a more specialist type of care home since the last inspection. The current categories of registration were discussed with Mrs Jobbins. There has been some flexibility in the past about who has been admitted under the ‘mental disorder’ category of registration, although a review of the arrangements would be beneficial at this time. Mrs Jobbins said that she liaised with prospective service users’ relatives and GPs when assessing their needs. The admission process included undertaking an initial assessment, which was added to following the move into the home. A six-week assessment was then carried out, which gave the opportunity to confirm the suitability of the move. Assessment records were looked at for two people who had moved into the home since the last inspection. There were assessment forms, which provided a range of sections for recording relevant information. This included, for example, the reason for the admission, medical history and information about religion, diet and significant life events. The records also included a ‘Resume of Care’ form, which highlighted aspects of people’s personal care needs. Separate forms were being used for the recording of moving and handling and ‘pressure sore’ assessments. There had been discussion at the last inspection about the level of detail that is being recorded. There was further discussion with Mrs Jobbins about this during the visit on 25th October 2007. The same assessment forms have been used over a number of years and not been amended to reflect National Minimum Standards and the range of needs as specified under Standard 3.3. However, there was a ‘Special Needs’ section that could be used to record some needs that were not identified elsewhere on the assessment form. The format meant that there was limited space for recording some information. DS0000028410.V346540.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good overall. This judgement has been made using available evidence including the visits to the home. People’s needs are set out in individual plans, although some areas could be better described. People’s health needs are met and they are protected by the way that medication is being managed. People feel that they are treated with respect and that their right to privacy is upheld. EVIDENCE: Three of the service users’ individual care records were looked at in detail. The date of a new service user’s care plan showed that it had been written at the time of admission. The care and assessment records were linked, as the production of a care plan was seen as a continuation of the assessment process. DS0000028410.V346540.R01.S.doc Version 5.2 Page 13 There had been discussion at the last inspection about some aspects of care planning and how particular matters were being responded to. Mrs Jobbins reported on the action that had been taken. She confirmed that some matters concerning the service users that were raised at that inspection were no longer applicable. The service users’ records seen during this inspection contained a range of documentation. The care plan format had a section for the recording of ‘problems’, and another section showed the ‘nursing intervention’ that would be needed. There was another section for describing the aim or goal that the intervention was intended to meet. Some other guidelines had been written about particular needs and how these were to be met. In the surveys, the service users confirmed that they always received the care and the medical support that they needed. Ten relatives stated that the home always gave the care or support that they expected or had agreed. One person responded that this was usually the case. The staff members who completed surveys confirmed that they were aware of people’s needs. The records in general set out people’s personal care needs. The care plan format focussed on ‘problems’ although it was evident from discussion with Mrs Jobbins that it was the wish to provide a service that was person centred. The use of the term ‘nursing intervention’ was not appropriate for a residential care setting. As with the assessment forms, there was limited space for recording the information. There was evidence that the service users’ care was being kept under review. ‘Progress Record’ forms were being completed, which gave a record of the service users’ on-going health and welfare. Some matters of particular significance had been highlighted in red. Staff kept the records up to date throughout the day, so that they reflected what had happened at the time and what the staff had done. It was good practice to maintain the on-going care records in this way. Mrs Jobbins said that the use of appropriate terminology and particular phrases had been discussed with staff since the last inspection. Staff members also confirmed this. It was seen from the minutes that this subject had been discussed at a staff meeting. There had also been a discussion about the importance of how to speak to people, for example before undertaking a task. In their surveys, two relatives commented that staff were aware of changes in the service users’ conditions and took action to follow these up. This included contacting the GP. Health matters, including appointments were being recorded on the ‘Progress Record’ and other forms. Three GPs and another health care professional completed surveys about the home. They commented positively about their
DS0000028410.V346540.R01.S.doc Version 5.2 Page 14 experience of the care that service users received in the home. There were no concerns raised about any medical matters. The home’s medication arrangements were looked at. There were appropriate arrangements for the safekeeping, administration and recording of medication. The relatives spoken to during the visits confirmed their satisfaction with the care that the home provided. They felt that they were being consulted and could be actively involved in people’s care. The service users seen during the inspection looked well supported with their personal care. One person commented that their relative in the home ‘was looked after wonderfully’, with good attention being given to their personal care and appearance. DS0000028410.V346540.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good overall. This judgement has been made using available evidence including the visits to the home. People experience an informal lifestyle in the home. Their contact with relatives is well supported and this helps people to have fulfilling lives. The meal arrangements are meeting people’s individual needs and preferences. EVIDENCE: In their surveys, six service users stated that there were always activities arranged by the home that they could take part in. Two people stated that there usually were. Comments in the surveys included: ‘the home puts on regular parties, activities and day trips’, ‘Activities are being arranged’ and ‘Regular cake stalls and little tea parties’. In response to the survey question ‘Does the care service support people to live the life they choose?’, ten of the service users’ relatives stated that it always did and one person that it usually did. DS0000028410.V346540.R01.S.doc Version 5.2 Page 16 Relatives were regular visitors to the home and the relatives of three service users were spoken with during the inspection visits. One service user was playing a board game with their visitors. There was a requirement at the last inspection that consideration is given to developing a more regular and varied social activity programme. Mrs Jobbins responded to this and said that she felt that the current arrangements were meting people’s needs. Since the last inspection a list had been produced of the different activities that are arranged and how these are fitted in around some regular events, such a monthly church meetings, daily exercises and visits from family and friends. There were planned activities on four days a week, which included cooking, hand massages and trips into town. The list of activities included scrabble, as one service user had requested this. Staff members commented that service users were taken out regularly and did a lot of different things in the home. One person commented that more games could be played with the service users. One relative said that staff ‘want to understand their residents and like to have details of their lives, plus photos, which they put together in a scrap book’. Another person commented ‘every effort is made to be as much a home as possible with many extras such as therapy, entertainment, shopping trips, etc’. It was evident from the comments made in surveys that relatives felt that they were closely involved in the care of their family members. Relatives saw their visits as a time to discuss matters with Mrs Jobbins or with one of the staff. They felt that they were involved in decision making and that their contribution was valued. One relative commented ‘ when visiting, someone always found time to update me on progress and events’. Another person commented ‘the home puts on regular parties, activities and day trips. Families are invited to all the activities and parties in the home or at local clubs’. A daily diary was being kept of the events and activities that had taken place. Recent entries showed that service users had been out to a concert, gone shopping, and had their nails manicured. There were also entries showing where people had chosen to be involved in the daily routines, such as by helping to fold the laundry. At a recent staff meeting, staff were reminded of the need to encourage service users to maintain their self-management skills. Lunch was observed on 3rd October 2007. Service users received assistance from staff and it was an unhurried meal. The meals were prepared following a four week cycle of menus. People said that they enjoyed the meal. In their surveys, six service users stated that they always liked the meals; two people stated that they usually did. Comments made about the food in the surveys and during the visits were all positive. These included: ‘the food is largely home made’; ‘good portions and healthy well balanced diet’ and ‘always nutritious’.
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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 and 18 Quality in this outcome area is good overall. This judgement has been made using available evidence including the visits to the home. Procedures and guidance for staff are helping to safeguard people and give people confidence that any concerns will be followed up. EVIDENCE: All the service users and relatives who completed comment cards said that they knew how to make a complaint. Service users also confirmed that they always knew who to speak to if they were not happy. One relative commented ‘the procedure for complaints is outlined in the papers given to the client from the beginning’. Another person reported that it had never been necessary to make a complaint. One relative mentioned that a concern had been discussed with Mrs Jobbins, who dealt with it ‘tactfully and promptly’. In the AQAA, Mrs Jobbins reported that there had been no formal complaints received, or safeguarding adults investigations undertaken during the last 12 months. The home had a copy of the Wiltshire and Swindon Safeguarding Vulnerable Adults guidance. Copies of the ‘No Secrets’ guidance booklets were also available, although Mrs Jobbins was advised to update these with the latest version. All the staff members who completed surveys confirmed that they were aware of the adult protection procedures.
DS0000028410.V346540.R01.S.doc Version 5.2 Page 18 Staff members had undertaken adult protection training, which included watching a video on the subject of abuse. A Community Psychiatric Nurse had provided the training. It was recommended to Mrs Jobbins at the last inspection that additional adult protection training is undertaken, involving the local Vulnerable Adults Unit. Mrs Jobbins said that this had not yet been arranged. DS0000028410.V346540.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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including the visits to the home. People live in an environment that is generally homely and clean. The facilities are limited in some respects, although improvements are being made over time. EVIDENCE: Laurieston House is a period, detached property in a well established residential area. The communal rooms consisted of a lounge and a dining room. Both these rooms looked homely and well furnished. They had patio doors, which opened onto a large garden at the rear of the property. The service users’ bedrooms were on the ground and first floors. There was no lift installed. Any service users occupying rooms on the first floor needed to be able to manage the stairs.
DS0000028410.V346540.R01.S.doc Version 5.2 Page 20 There were two single rooms and four double rooms. Privacy screens were available in the double rooms. There had been discussion with Mrs Jobbins at the last inspection about the occupation of the double rooms. Under ‘National Minimum Standards’, service users should only share bedrooms when they have made a ‘positive choice’ to do this. It had been recommended to Mrs Jobbins that their choice in this matter is documented and kept under review. During this inspection, Mrs Jobbins confirmed that the use of a particular room was discussed with a service user and their representative before admission. It was also something that was discussed at other times when there was a significant event. The use of a double room was stipulated within the home’s contract. Recording in this area would provide additional evidence of how this matter is being addressed with the service users, particularly when there is a change in occupancy. It was reported at the last inspection that work had been undertaken to create two en-suite facilities. The wash hand basins and the toilets had been fitted, although not the showers. This work has not progressed, which gave the ensuite areas an unfinished appearance. In the AQAA, Mrs Jobbins reported that the completion of this work was in the home’s plans for the next 12 months. In view of the hazards that can arise from maintenance and refurbishment work, it will be important to assess the on-going safety of the en-suite areas as the work progresses. Mrs Jobbins said that risks in people’s rooms continued to be assessed, for example to ensure that a rug was not a tripping hazard for a particular service user. Work has taken place in the kitchen since the last inspection. It has been improved with the installation of new units, appliances and flooring. It was reported in the AQAA that the grounds had been made safer during the last year and there were plans for further improvements in the garden. Laundry was carried out in a small room that also housed the home’s boiler. It had been recommended at the last inspection that specialist advice is obtained regarding the positioning of the washing machine and the boiler. Mrs Jobbins said that she had followed this up and taken advice from a competent person, who had reported that the arrangement was satisfactory. In their surveys, the service users stated that the home was always kept fresh and clean. One person commented that the home was hygienic and, in their words, ‘passes the smell test’. Another person commented ‘All very nice, also very clean’. Wiltshire Health Authority Guidelines regarding infection control were available in the home.
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The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate and improving. This judgement has been made using available evidence including the visits to the home. People generally benefit from the home’s staffing arrangements although there are areas to develop further. EVIDENCE: It was evident from the rotas and the deployment of staff at the time of visits that staffing levels varied from a minimum of two people, to times when there were 3 or 4 people working. The staffing arrangements at night included one person on waking duty and one person ‘sleeping-in’ on the premises. It was reported at the last inspection that activity and individual time with service users was restricted when there were two people working. There was a requirement that that the staffing levels are reviewed to ensure that there are sufficient staff on duty at all times in order to meet residents’ individual needs. Mrs Jobbins said that staffing levels were being reviewed on an on-going basis. Staff were involved in these discussions, although there was no formal reviewing system, or staffing model in place. It was acknowledged that although staffing levels were being maintained in line with the previous registration authority’s requirements, there were times when additional staff might be needed to meet the needs of particular service users. Mrs Jobbins gave examples of when additional staff cover was being provided. This included having more staff providing domestic support and helping out in the
DS0000028410.V346540.R01.S.doc Version 5.2 Page 22 kitchen at teatime. Mrs Jobbins also reported that one service user had moved out of the home during the last year into a more specialist care setting. In their surveys, seven service users confirmed that there were always staff available when they needed them. One person responded that there usually were. One relative commented ‘Staff are very kind, caring and gentle at all times. Their patience and care are always admirable’. Other relatives reported ‘staff are well trained and confident in discharging their duties’ and ‘staff all have a good understanding and empathy for the conditions they are managing’. Mrs Jobbins confirmed the action that had been taken in response to issues that had been raised at the last inspection about staff practice. This had involved meeting with the staff concerned. Mrs Jobbins reported that she now considered that these matters had been satisfactorily addressed. There was discussion at the last inspection about the provision of training. Training was being undertaken in relevant areas although the discussion had focussed on how the training was being provided. There was a requirement that any specialised training, such as the prevention of a pressure sore is undertaken by a trained, health care professional. Further training in pressure sore prevention had not yet taken place, although Mrs Jobbins confirmed the areas of training that did involve an outside person. These included first aid, moving and handling, dementia and infection control. Staff members had just finished courses in dementia and infection control. Mrs Jobbins said that further first aid training had been planned for December 2007. A training assessment and plan, showing how training would be provided and the timescales involved, had not been produced. Staff members did have their own records of the training they had undertaken. Following induction and after becoming established in the team, staff members could undertake a National Vocational Qualification (NVQ). Over 50 of the staff team had achieved a NVQ at level 2 or above. Two staff members were currently undertaking their NVQ. A requirement was made at the last inspection about the need to ensure that a robust recruitment procedure is evidenced and that the content of the application form is reviewed. It was seen from the files of two new staff members that this was met, subject to the need for some further clarification. Interview notes were now being kept. The application form had been amended and more changes were planned. Mrs Jobbins said that arrangements had been made for an employment consultancy firm to advise on certain matters. This would include checking the application form and making any changes that they felt were necessary. DS0000028410.V346540.R01.S.doc Version 5.2 Page 23 In their surveys, the staff members confirmed that they had completed Criminal Record Bureau (CRB) disclosures. The staff members’ files included evidence that CRB disclosures and checks of the Protection of Vulnerable Adults (POVA) list had been undertaken. There was discussion with Mrs Jobbins about the timing of these. Mrs Jobbins said that before having contact with service users and the outcome of their POVA check was known, a new staff member may attend the home for the policies and procedures element of their induction. Written confirmation of these arrangements would add to the evidence that a robust recruitment procedure is in place. The use of volunteers and the different types of CRB disclosure that may apply were discussed with Mrs Jobbins. Guidance about this was sent to Mrs Jobbins after the visits. DS0000028410.V346540.R01.S.doc Version 5.2 Page 24 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate and improving. This judgement has been made using available evidence including the visits to the home. The management and staffing arrangements ensure that there is good continuity in the day to day running of the home. Further developments will ensure that people benefit from on-going improvements which enhance the service and build on current standards. EVIDENCE: Mrs Jobbins has been running the home for over 20 years and her involvement has continued over this time as the registered manager. The home has an experienced deputy manager and senior carers who take responsibility when Mrs Jobbins is not present in the home. DS0000028410.V346540.R01.S.doc Version 5.2 Page 25 A family member commented that there was always a senior person in the home who could give a report of their relative’s condition. It was reported at the last inspection that Mrs Jobbins was undertaking the Registered Managers Award but progress had been slow, due in part to difficulties with training providers. During this inspection, Mrs Jobbins said that both she and the home’s deputy manager had now completed the necessary units for the award although they had not yet received accreditation. During the visits, Mrs Jobbins acknowledged that the ‘paperwork’ was not her strong point. It was seen from the records looked at during visits that redesigning some of the forms could help with this. Better formats could be produced for recording the information that needs to be available as written evidence. This would also build on the work that has been undertaken to develop good recording practice by staff. The arrangements for the recording of service users’ personal money were discussed with Mrs Jobbins and examples looked at. Relatives took the main responsibility for the service users’ financial affairs. Following agreement, the home supported people with looking after usually small amounts of money or had arrangements with relatives for the billing of certain items. In the AQAA, Mrs Jobbins reported that their plans for improvement included trying to ‘keep abreast of the ever changing systems, legislation and law’. Previous inspections have confirmed the need for a system of quality assurance to be in place. Following further discussion about what was required, Mrs Jobbins produced a policy setting out how quality assurance would be implemented and the action that would be taken. A number of methods were identified for gaining feedback, including the sending out of an annual survey and regular meetings with residents and their representatives. Questionnaire forms have been produced for this purpose. This was a positive start, although the outcomes and effectiveness of the system described could not yet be assessed. It was reported at the last inspection that although the hot water outlets had been fitted with temperature controls, the water temperatures must continue to be monitored. Records were seen during the visits, which showed that the temperature of the hot water was being checked from different outlets. Other health and safety checks were being undertaken on a weekly or monthly schedule. These included checks of the home’s fire precautions. Minutes of the staff meeting in September 2007 showed that fire training had taken place. Since the last inspection a device has been fitted to the dining room door, so that it can be safely kept open without the need for a wedge. DS0000028410.V346540.R01.S.doc Version 5.2 Page 26 Mrs Jobbins was advised at the last inspection about the need to address certain areas, such as the stairs and the first floor windows, within the risk assessment process. Mrs Jobbins confirmed that action was being taken. This included a risk assessment in respect of one service user who had a room on the first floor. It was agreed with Mrs Jobbins that individual risk assessments would be undertaken, and that windows on the first floor would be fitted with restrictors, which limit their opening to a safe amount. DS0000028410.V346540.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 DS0000028410.V346540.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes, in part 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 OP33 Regulation 24 Requirement The registered person must develop a formal system for monitoring and improving the quality of care provided in the home. Timescale for action 30/09/08 2. OP38 13(4)(c) 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. The registered person must 08/11/07 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. The registered person must 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 fitted with restrictors, which limit their opening to a safe amount.
DS0000028410.V346540.R01.S.doc Version 5.2 Page 29 3. OP38 13(4)(c) 31/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations That the home’s Statement of Purpose includes more details about the range of needs that the home intends to meet. This is so that prospective service users can have better information about any specialist care that the home aims to provide and the level of need that can be met. That the format of the assessment forms and care plans is reviewed and changes made to ensure that people’s needs and the support provided are appropriately described. This is so that the care plans reflect a more person centred approach to care. That additional adult protection training is undertaken, involving the local vulnerable adults unit. (Recommendation brought forward from the previous inspection). That work on the en-suite areas in two bedrooms is completed as a matter of priority. This is to ensure that service users benefit from improved facilities as soon as possible. That the service users’ choice of sharing a room is documented and kept under review. (Recommendation brought forward from the previous inspection). Records kept will provide additional evidence of how this matter is being addressed with the service users, particularly when there is a change in occupancy. That reference is made to a recognised staffing model or reviewing system when a review of staffing levels is undertaken. That the arrangements being made for staff to receive part of their induction before a POVA check is made are documented within the home’s 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. That a training needs assessment and a training plan for the staff team are produced. That the forms being used for recording in the home are
DS0000028410.V346540.R01.S.doc Version 5.2 Page 30 2. OP7 3. OP18 4. OP19 5. OP23 6. 7. OP27 OP29 8. 9. OP30 OP33 10. OP33 reviewed. This is so that there are good formats in place for recording, in areas such as assessments and personal money accounts. For example on assessment forms, a separate section for reviews helps to identify any changes that have been made. That the policy on quality assurance includes details about the type of improvement or annual development plan that will be produced after people’s 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. DS0000028410.V346540.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection 4th Floor 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
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