Inspection on 24/07/08 for Leafield Residential Care Home

This inspection was carried out on 24th July 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 but made no statutory requirements on the home.

Other inspections for this house

Leafield Residential Care Home 16/01/08

Leafield Residential Care Home 12/10/06

Leafield Residential Care Home 11/08/05

Leafield Residential Care Home 18/04/05

Leafield Residential Care Home 10/01/05

Leafield Residential Care Home 17/08/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Leafield Rest Home 32a Springfield Drive Abingdon Oxfordshire OX14 1JF Lead Inspector Delia Styles Unannounced Inspection 24th July 2008 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Leafield Rest Home DS0000013103.V365422.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. Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Leafield Rest Home Address 32a Springfield Drive Abingdon Oxfordshire OX14 1JF 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) 01235 530423 Leafieldhome@aol.com Mr Prashant Brahmbhatt Post vacant Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24) of places Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of persons that may be accommodated at any one time must not exceed 24 16th January 2008 Date of last inspection Brief Description of the Service: Leafield Care Home is situated to the north of Abingdon town centre, within a residential housing estate. The accommodation is provided on two floors and there is a passenger lift for access. There are 21 single rooms, 5 of which are en-suite, and 1 double room with en-suite facilities. The ground floor communal areas of the home – 2 lounges, a dining room and small lobby area - provide a choice of places to sit, or entertain visitors. There is a small garden area at the rear of the home that is accessible to residents. The home is registered to provide care for older people who are frail and may be mentally infirm. The current range of fees is £436 to £525.00 per week. Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The overall quality rating is made using ‘key lines of regulatory assessment’ KLORA – and a ‘rules base approach’. This takes particular account of how safe and how well managed a care service is. As they are especially important to quality, we have stricter rules for those outcomes relating to Health and Personal care, Complaints and Protection, and Management and Administration. Services can only be as good as their poorest rating in these areas. This inspection of the service was an unannounced ‘Key Inspection’ during which we assessed a number of the standards considered most important (‘key’) by the Commission out of the 38 standards set by the government for care homes for older people. The inspection visit was undertaken by a regulation inspector and a regulatory manager from the Commission and lasted 3 hours; it was a thorough look at how well the service is doing. We took into account information provided by the homes manager in the form of the Annual Quality Assurance Assessment (AQAA) - a self-assessment and summary of services questionnaire that all registered homes and agencies must submit to the Commission each year; and any information that the Commission had received about Leafield Rest Home since the last inspection. A tour of the building, and inspection of a sample of the records and documents about the care of the residents and the recruitment and training of staff, were part of the inspection. Talking with a number of residents and staff gave us information about the home and peoples’ opinions about what it is like to live here. Some of the Commission’s comment cards (surveys) – ‘Have your say about Leafield Rest Home’ - were sent the home for residents, staff, relatives, and visiting health and social care workers to have an opportunity to have their say about the home. We received completed surveys from 2 health care professionals and 3 members of staff and their opinions are included in the report. We would like to thank all the residents, staff, and the manager for their welcome and the time taken to help us with the inspection process. Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 6 Please note that reference is made to ‘the manager’ throughout this report. This refers to the person appointed by the registered person (Mr Brahmbhatt) to manage the home in the absence of a registered manager. All registered residential care homes and other ‘establishments’- for example, nurses’ agencies and domiciliary care agencies - are required by law to be run by a registered manager – that is, someone who has applied to the Commission and has been assessed and approved by the Commission as a ‘fit person’ (suitably qualified and experienced for the role) What the service does well: What has improved since the last inspection? What they could do better: Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 7 The registered provider has failed to meet a requirement made at the last inspection: Regulation 26 of the Care Homes Regulations 2001 states that the proprietor (or one of the directors or other persons responsible for the management of the organisation) must make unannounced monthly visits to the home to inspect the premises, talk to residents, visitors and staff to get their views about the standard of care, and to write a report about how the home is managed. Repeated failure to meet legal requirements within the times scales given may lead to us taking enforcement action against the provider. The home has been without a registered manager since January 2007. The registered person, Mr Brahmbhatt, must appoint a person to manage the home who will be registered (under Part 11 of the Care Standards Act 2000) and legally accountable (together with the registered person) for maintaining the standards of care and facilities for the people living here. We have made good practice recommendations for improving the way that any changes to peoples’ prescribed medicines are written in their records to make sure that there are no mistakes that could harm residents if they receive the wrong medicine or dose. The systems for auditing and record keeping in relation to any valuables and money held on behalf of residents could be improved, to show that residents’ financial interests are protected. The home is in need of redecoration in parts and some of the soft furnishings and corridor carpets are in need of replacement. The manager said that this work is in hand so we have not made any recommendations in the report. There has been no progress yet in starting building work that the provider has told us he intends to do, to extend and improve the facilities for residents – for example, the laundry, kitchen and storage space for equipment and increasing the number of rooms with en-suite facilities. 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. Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 3. Standard 6 is not applicable; the home does not provide intermediate care. Quality in this outcome area is good. The home undertakes detailed personalised needs assessment so that people’s care and welfare needs are identified and planned for before they move into the home and prospective residents and their representatives can be assured that their needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager said that they are in the process of updating the Statement of Purpose and Service Users Guide and this information, together with residents’ individual contracts, provide residents and their families with enough information on which to form an opinion about whether the home is likely to meet their needs. The manager assesses prospective residents needs before they come in to the home. This process includes family’s and other professional carers’ information and provides the basis for the resident’s individual care plans. Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 10 A health care professional’s survey response to the question ‘Do the care service’s assessment arrangements ensure that accurate information is gathered and that the right service is planned and given to individuals? was that this is always the case: ‘I have always found Leafield to provide accurate care plans and assessments in relation to clients with dementia’ We looked at a sample of three residents’ care records and these had detailed information gathered as part of their pre-admission assessment about their care and support needs and included a ‘person-centred’ care assessment of peoples’ previous and current hobbies and interests, family, friends and social contacts. All new residents have a ‘trial’ four week settling in period during which further assessment and discussions can take place so that the individual, their family and/or representatives and the home staff can be sure that the person’s assessed needs can be met. The copies of the contracts – Terms and Conditions of Residence – for the 3 residents whose records were checked were incomplete or not up to date on the day of our visit. The manager explained that the fee payments and contracts are all dealt with through the provider’s head office. We requested that the current information about contracts was made available to us; the manager obtained these and they were checked by us at the home and found to be satisfactory, a few days after the inspection. Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. Residents’ health care needs are well met with evidence of good communication between the home and health and social care professionals about ways to improve peoples’ health and wellbeing. Personal support is offered in such a way that promotes and protects residents’ privacy and individuality. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at a sample of 3 residents’ care plans. These were detailed about peoples’ likes and dislikes and how they wish to be cared for. The senior care staff review the care records at least monthly. Additional reviews take place if a resident has involvement with social services or the NHS mental health service. We discussed with the manager ways in which the care plans could be further improved – for example, writing more detailed instructions for care staff in the care plans about the action they should take when, because of their mental health problem, a resident’s behaviour is ‘challenging’ and aggressive. Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 12 Also, the records could be further improved to include some ‘evaluation’ comments to show to what extent residents and/or their representatives are satisfied with the care and support they receive and that it still matches what is written in the care plans. The homes AQAA tells us that the manager has plans to encourage staff to be involved in writing and contributing to the care plans and attend courses about this. A survey received from a GP showed that they are satisfied that the care received by residents in the home is of a good standard: ‘Leafield is well regarded locally and I am not aware of any negative issues in regard to the care of my patients/its residents’. Another survey response showed that staff are skilful in responding to residents with confusion and short-term memory problems – ‘This home always appears to have a relaxed atmosphere, allows for eccentric behaviour and manages this in a calm way’. The home staff communicate well with the district nurses and community psychiatric nurses about the care of any resident who needs temporary nursing care in the home. There was evidence that if residents need special equipment, such as pressure relieving mattresses or seat cushions, that these are promptly obtained through the community nursing service. We checked a sample of the Medication Administration Records (MAR); these were up to date and signed, showing that residents had received their prescribed medicines correctly. Some MAR charts had hand-written changes made by the care staff when the doctor had ordered a new medicine or different dosage for a resident. It is ‘best practice’ for staff to avoid making changes on the MAR sheet – ideally the GP should write these – but if necessary, the care staff who has taken the verbal instruction from the GP should write the new instructions and have a second carer check and countersign their entry, to avoid the risk of the wrong medication or dose being given to the resident. None of the current residents are able to manage their own medication independently – ‘self-administer’. There is a medication policy available, but it is a generic document that includes, for example, references to ‘registered nurses’ and their role in ordering, administration and recording medicines. We recommend that that the home reviews and expands the document to include topics such as non-prescription (over the counter/’homely remedy’) medicines and how to deal with medicines that are regularly refused by residents. The home should also have a copy of the most recent guidance from the Royal Pharmaceutical Society of Great Britain – ‘The Handling of Medicines in Social Care’ (further information is available on the Commissions website). This would provide more useful help and guidance to staff. Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 13 Respect for people as individuals is evident from discussion with staff and observation of their interaction with residents. Our survey question about how well the home promotes and protects residents’ privacy and dignity was answered positively by the health and social care professionals who responded. The staff are of a more varied ethnic background than the residents. The home provides training for staff in equality and diversity issues and there is a booklet on this topic given to staff. Staff whose first language is not English are given access to English language courses. From the evidence seen by the inspector and comments received, the inspector considers that this home would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. The home offers a range of activities that suit the individual residents abilities and needs so that residents have opportunities to participate in stimulating and motivating pursuits. The meals are good offering both choice and variety and catering for special dietary needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a member of staff whose specific responsibility is to encourage residents with individual and group activities – board games, floor games, and cookery on one day a week. This makes sure that there is the opportunity for residents to take part, or watch others, as they want and caters for those whose concentration is poor but who benefit from feeling included in the home’s social life. At other times, care staff said they try involving residents in ‘ad hoc’ activities and chats during the day. A trip to the seaside during the summer is planned for a day in August. The homes AQAA tell us that they try to encourage residents to choose the types of activities they would like and that the home has improved the range of activities in the last 12 months. They recognise that improvements could Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 15 still be made and that staff should include more information about which activities residents have enjoyed in their care records. On the morning of our inspection several residents attended the monthly Holy Communion service held in the home. One resident has space in her room to practice her Buddhist faith. Staff said that residents are assisted to have as much choice and control over their lives as possible. A social care professional wrote in their survey response to the question – ‘Does the care service provided support individuals to live the life they choose wherever possible? –‘I have always found the home to do this whilst managing risk in an appropriate manner’. Visitors are welcomed in the home. A visitor we spoke to during the morning told us that their relative ‘ is very happy here’. From conversation with staff and their interactions with relatives and other visitors, we found that the home is welcoming and friendly. Staff clearly have a good knowledge about residents’ usual family and social support networks and encourage residents to keep in contact with their family and friends as far as possible. Most residents come to the dining room for main meals, but can remain in their rooms at mealtimes if they prefer. Several residents ate in the conservatory, smaller TV lounge or at a table in the lobby area next to the staff office. The menus and meal choices seen show a good variety of traditional food. The meal choices for the day were written up on a white board in the dining room. The cook said that they use as much fresh produce as possible and that residents are offered an alternative if they don’t like the choices served. The lunchtime main course was shepherd’s pie, with fresh cabbage and carrots and gravy. The food looked and smelled appetising. Most residents said they had enjoyed their meal. One person did not want his main course but was offered sandwiches instead. The kitchen was clean and well organised. There were lists of individual residents’ food likes and dislikes in the kitchen. Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. Residents, relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. There are procedures in place to protect residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no formal complaints made directly to the home and no complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. A copy of the homes complaints procedure is displayed in the entrance hall. The health and social care workers surveys indicate that if they ever have cause to raise a concern with the home this is dealt with promptly and effectively. From observation of staff and residents’ interactions during the inspection, it was evident that residents felt at ease and able to talk to staff. Safeguarding of residents is included in induction training for all new staff and update sessions are held for all staff so that they are alert to the potential for abuse of vulnerable residents. However, two staff questioned about safeguarding issues were less confident about the role of the local social services safeguarding team and how to contact them. We recommend that the homes training includes specific practical examples for staff about the local Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 17 guidance and codes of practice that should be followed if staff have any concerns that a resident is being abused. Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 18 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. There have been some improvements to the décor and furnishing since the last inspection but progress is slow in undertaking planned work to improve the facilities. The home is comfortable and clean for people living here. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We inspected the communal areas of the home during this visit. All areas of the home were fresh and clean. The housekeeper was busy shampooing the carpets in the lounge areas during the morning. A visitor was overheard complimenting her on how clean the home is whenever s/he visits. The carpeting on the ground floor corridor is looking worn in places with a frayed torn area by the entrance to one lounge. Some of the small tables in the conservatory have chipped frames that should be repainted or replaced because they are old and difficult to clean. Similarly, protective chair seat covers had frayed edges and should be replaced. The manager said that she is Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 19 in the process of having the budget approved to buy new curtains and to replace some of the items that are old and worn out. One of the lounges is used as a designated smoking area. However, this room opens onto the ground floor corridor and does not appear to meet the criteria for designated smoking rooms introduced in the smoke free legislation from 1st July 2007. The provider should check with the Local Authority (who is responsible for enforcing the legislation and advising people about the changes to comply with the law) that the arrangements made for residents who wish to smoke meet the relevant requirements. He should also take account of whether the arrangements for smoking has adverse effects on other nonsmoking residents, who may be unable to express a view about the shared use of a communal room with smokers. Two of our survey respondents felt that improvements should be made to the homes environment, commenting that ‘the house needs decorating throughout’ and ‘the premises are congested’. The home has insufficient storage space for equipment and disability aids for residents; for example, incontinence pads are stored in the en-suite facilities of bedrooms. The lack of storage space can only be improved by extending the premises to create additional rooms and the provider’s plans for building an extension should be progressed as soon as possible. The improvements that were to be made in 2007 to the ground floor bathroom (to make it accessible for more dependent residents with staff assistance) are still not completed (the work was ‘in progress’ when we inspected in January 2008) but the manager said that they were just waiting for the bath to be fitted. There is a very small laundry area that is cramped and also used as a storage area. The home uses an external commercial laundry service in the town for bed linen and towels; the homes own laundry is used for resident’s personal clothing only. The laundry was clean and tidy. Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. Since the last inspection, there have been improvements to the standard of vetting and recruitment of new employees so that residents are protected. The staffing numbers and skill mix of staff is satisfactory and meets the care needs of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes staff rotas and the staff on duty confirmed that overall, the numbers and skill mix of staff meets residents’ needs. On the morning of the inspection there was a senior carer and 3 care staff (one was supernumerary) available to care for 19 residents; the housekeeper and cook were also on duty. The manager was out assessing a prospective new resident and returned to the home just before lunch. The 3 staff members’ surveys we received showed a range of views about whether there are enough staff to meet the individual needs of residents. One felt this was ‘always’ the case and two ‘usually’. One person added the comment that ‘the services are always stretched, short of staff – always makes standards of care more difficult to maintain’. Another wrote that they felt that sometimes certain residents could benefit from more ‘one to one’ time with staff but there was ‘not enough time’ for them to do this. Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 21 Staff said that they feel well supported by the manager and her deputy. Staff spoken to also said they felt that the homeowner, Mr Brahmbhatt, was approachable and they could discuss any issues about the home with him. Since the last inspection the home has met the immediate requirement made at our last inspection by improving its recruitment procedures so that no new workers start work in the home without having had the required police checks and confirmation of a satisfactory clearance. One person was working under supervision of another carer because their full Criminal Record Bureau (CRB) clearance had not been received. The initial check (PoVAFirst) had been made to ensure that this individual’s name is not on the list of people excluded as unsuitable to work with vulnerable adults. However, there was no record of this in the home but the manager requested that the information was sent from the head office and this was made available to us during the inspection. We checked a sample of staff records: all had references and evidence of qualifications or experience (where relevant) to show their suitability for working in the home and that the home safeguards residents through its recruitment and employment procedures. Four out of the 15 permanent staff have National Vocational Qualification in Care at Level 2 and a further 5 are working towards NVQ Level 2 or 3. The staff survey responses and staff spoken with during the inspection confirmed that their induction and training is good, relevant to their work and gives them the right skills and confidence to meet the various needs of the residents. Our checks of a sample of staff training files showed that they have refresher updates in mandatory topics such as safe moving and handling, fire safety and first aid. Recently staff have attended a course about caring for people with dementia that they found very useful. Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 22 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, 37 and 38 Quality in this outcome area is adequate. The management arrangements are meeting the needs of the service but must be formalised because a person registered with the Commission must manage the home. Since the last inspection the home has introduced a formal quality assurance and monitoring system to measure success in meeting the aims and objectives of the home in regard to the care of the people living here. However, the registered provider has again failed to comply with the requirement to visit and report under the terms of Regulation 26 of the Care Standards Act. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As we reported at the last inspection, the home has been without a registered manager for over a year. In the interim, the former deputy manager has taken on the responsibility for running the home with the support of the proprietor. Prior to being appointed as manager she had been deputy Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 23 manager and has a good understanding of the home, the staff team and the people living here. The registered person must formalise the management arrangements of the home by ensuring that they propose a person who applies and successfully completes the ‘fit person’ process with the Commission in order to become the ‘registered manager’ for the home. It is a legal requirement that registered care homes and a registered manager runs establishments. As found at the last inspection the manager was not able to provide evidence that Regulation 26 ‘provider’ visits have been carried out. The registered person (Mr Brahmbatt) is required to visit the home ‘unannounced’, at least every month to inspect the premises, its record of events and records of any events, and to talk to residents and any visitors, and staff in order to get view about the standard of care provided in the home. He must then ‘prepare a written report on the conduct of the home’ a copy of which must be made available to the manager and the Commission. These ‘provider visits’ are an important part of the way in which the registered person can evidence that the standard of care and facilities provided in the home is meeting residents’ needs and expectations and that any concerns are followed up and resolved. However, the manager and staff confirmed that Mr Brahmbhatt visits the home weekly and is readily available to talk to them and to residents when he comes. Since our last inspection the home has acted on the requirement made to establish a system for formally reviewing the quality of care provided in the home, in that it has made available in-house surveys/questionnaires to residents and their relatives from April 2008. The manager said that any issues that arise from the survey responses are dealt with at the time. However, no report is produced and there is no indication that peoples’ views have been taken into account to inform a development plan for the home. The government has set National Minimum Standards (NMS) for Care Homes for Older People which state that ‘the results of service user surveys are [should be] published and made available to current and prospective users, their representatives and other interested parties, including the NCSC’ (now CSCI). The NMS also recommend that the home should use ‘an objective, consistently obtained and reviewed and verifiable method (preferably a professionally recognised quality assurance system) and involving service users. A copy of any report of the outcomes of the quality review should be made available to residents, their representatives and the Commission and included in an annual development plan for the home. Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 24 The home is not responsible for any of the residents’ finances and staff are not allowed to accept gifts from residents. The home does keep small amounts of personal allowances on behalf of residents if requested. Residents’ money is kept in individual named folders in a secure facility with the receipts and records of any transactions made on their behalf – for example, paying the hairdresser or podiatrist. The manager said that there is no external system of auditing the accounts for the residents’ money or the residents’ amenity fund – donations received by relatives and friends make up this fund that is used to pay for additional treats and refreshments when residents go on organised outings and days out. It is strongly recommended that the home introduces a system of regular external audit of money and valuables held on behalf of residents to demonstrate that residents are financial interests are safeguarded. The system for recording residents personal property should also be reviewed and improved: the property ‘record’ seen in one of the sampled resident’s files was an undated, unsigned list of items written on a loose non-duplicated sheet of paper, so that it is unlikely that should the resident or their representative claim lost or missing property the home would find it difficult to identify or trace the items. The manager completed the AQAA. It gives a limited picture of the current situation within the service and more evidence and detail should have been provided about how the home still needs to improve and how this will be achieved. We looked at a sample of the records of routine maintenance of equipment, fire safety records, hot water temperatures and checks for water-borne bacteria (Legionellae). These, and the maintenance log, were up to date and showed us that there are good systems in place for the protection of residents, staff and visitors from injury. The manager confirmed that there were no delays in attending to routine in-house maintenance and minor repairs. Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 25 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 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 X 2 3 Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP31 Regulation Care Standards Act 2000 Section 11(1) Requirement Timescale for action 31/10/08 2. OP33 26 and Schedule 4 (5) 3. OP33 24 It is a requirement to register: ‘1) Any person who carries on or manages an establishment or agency of any description without being registered under this Part in respect of it (as an establishment, or as the case may be, agency of that description) shall be guilty of an offence’. The registered person must carry 31/08/08 out unannounced visits to the home at least monthly, to monitor the standard of care provided; and ensure that evidence of these visits in the form of a report, is available in the home and available for inspection. 31/10/08 The registered person must establish and maintain a system for reviewing the quality of care provided in the home including the views of residents, relatives and outside professionals. The registered person shall supply to the Commission a report in respect of any review of the quality of care conducted by him and make a copy of the report DS0000013103.V365422.R01.S.doc Version 5.2 Leafield Rest Home Page 27 available to service users. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP7 OP9 OP19 Good Practice Recommendations Include written evaluation of the care and support provided by staff in residents’ care plans. Review the homes medication policy. More information can be found on our website www.csci.org.uk/professional The home should take measures to comply with the smoke free legislation introduced on 01/07/2007. More advice and information can be found on the CSCI website (as above), the Smoke Free England website: www.smokefreeengland.co.uk and the Local Authorities Co-ordinators of Regulatory Services website: www.lacors.gov.uk Improve the systems for recording and auditing in relation to residents’ personal allowances and property. Improve the information given in the AQAA so that it gives sufficient detail about the current situation in the service and evidence to support the claims made in it. 4. 5. OP35 OP37 Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Leafield Rest Home DS0000013103.V365422.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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