Inspection on 03/05/06 for Leonora

This inspection was carried out on 3rd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Leonora 09/07/09

Leonora 12/07/07

Leonora 08/12/05

Leonora 08/07/05

Leonora 15/03/05

Leonora 27/09/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Leonora Wood Lane Chippenham Wiltshire SN15 3DY Lead Inspector Alison Duffy Key Inspection 09:30 3 and 24 May 2006 rd th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Leonora DS0000028393.V291580.R01.S.doc Version 5.1 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. Leonora DS0000028393.V291580.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Leonora Address Wood Lane Chippenham Wiltshire SN15 3DY 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 651613 01249 460037 Chippenham@pilgrimhomes.org.uk www.pilgrimhomes.org.uk Pilgrim Homes Gaie Rachel Marshall Care Home 21 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (21) of places Leonora DS0000028393.V291580.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. When the accommodation identified in the variation application dated 28 June 2004 is no longer required by one or both of the two service users referred to in the same application, occupancy of the home must revert to 20. The Commission must therefore be notified immediately of any changes to occupancy of the identified accommodation. 8th December 2005 Date of last inspection Brief Description of the Service: Leonora is operated by Pilgrim Homes, which is a Protestant Christian organisation. The Registered Manager is Mrs Gaie Marshall. The home is registered to provide care to twenty one older people, five of whom may have dementia. Leonora is situated within a residential area of Chippenham. Residents who are very able may manage the walk into town although a car journey would probably be more appropriate. The home is a spacious detached property, which also contains a sheltered and very sheltered housing scheme. All areas are well maintained, comfortable and furnished to a good standard. Residents’ private accommodation is located on the ground and first floor and a passenger lift gives level access to all but five bedrooms. These rooms are accessed by a short flight of stairs. Residents are encouraged to personalise their room and treat it as their own individual space. There are two pleasant communal lounges and a separate dining room. Staffing levels are maintained at three carers and one senior carer on duty until 2pm and one senior carer and two carers throughout the rest of the afternoon and evening. There are also additional housekeeping and catering staff and an administrator and maintenance officer. At night there is one member of waking staff and a sleep in carer. An on call management system is also available. The home does not provide nursing or intermediate care. Leonora DS0000028393.V291580.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place on 3rd May 2006 between 9.30 am and 4.45pm. The inspector returned on the 24th May to complete the inspection and give full feedback. At the start of the inspection a tour of the building was made and the inspector met with residents within their private accommodation. Some residents’ care was examined in greater detail through discussions with specific residents and staff. The viewing of associated documentation took place and a number of comment cards were sent to a number of relatives and health care professionals in order to gain feedback about the service. Within such written feedback one GP stated ‘I have no hesitation in offering my highest commendation to Matron and Staff of the Leonora House. Over 20 years, this home has offered the highest standard of care to its residents: they have a highly developed community ethos, which I am sure, contributes to the longevity of their residents. They have a population of extreme age, which emphasizes the quality of care offered. When these longstanding elderly residents develop problems, the carers in this home cope extremely well and do not seek to transfer patients, who develop over the course of time, physical or mental problems; this policy is admirable.’ During the visit, feedback was extremely positive. Such comments included the dedication of staff and the amount of in house activity available. The consideration given to spiritual needs was paramount and many spoke of their strength received from this. Meal provision was also a topic of praise and many spoke of the environment and its level of cleanliness. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. Such matters are described in detail within this report. The judgements contained in this report have been made from evidence gathered during the inspection, which included the visit to the service and taking into account the views and experiences of people using the service. The overall judgement of the quality of the service provided is good. What the service does well: The home is very resident focused and established practices promote residents’ rights. Dedicated provision is in place in order to address residents’ spiritual needs. Leonora DS0000028393.V291580.R01.S.doc Version 5.1 Page 6 Care planning is of a very good standard. All documentation is well written, detailed and up to date. The home is relaxed, residents are consulted with and interactions are attentive and respectful. A varied selection of food is offered which is based on healthy eating, home cooking and residents’ preferences. The home is well managed with organised management and administrative systems in place. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Leonora DS0000028393.V291580.R01.S.doc Version 5.1 Page 7 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 Leonora DS0000028393.V291580.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and after the visit to the service. The admission process is detailed, organised and well managed thus minimising the possibility of inappropriate placements. EVIDENCE: Leonora has a detailed well written Statement of Purpose. The organisation has also devised a comprehensive Service User’s Guide, which gives a clear summary of key themes as required. All information is up to date and professional in its presentation. A copy of the home’s last inspection report is placed on the notice board and therefore available to residents and visitors as required. Within discussions with residents it was apparent that all chose Leonora due to the organisation and the shared beliefs of the Protestant Christian Church. Pilgrim Homes was the initial decision and then it was apparent that location was the next consideration. One resident reported the values of the home were everything and she would not be able to consider living anywhere else. Leonora DS0000028393.V291580.R01.S.doc Version 5.1 Page 9 Another resident reported that living in the adjoining flats, gave her total confidence to believe that moving into residential care was the right decision. All prospective residents are required to formally apply to the home. All are then fully assessed before admission in order to ensure Leonora is able to provide appropriate care provision. A medical report is gained from the prospective resident’s GP following individual consent and consultation also takes place with other professionals as required. Documentation demonstrated such liaison thus ensuring continuity of services such as Community Nurses. Following sufficient information, a decision is then made within the organisation to offer the placement. This is undertaken in writing and contracts are then devised. Such contracts are detailed, contain the number of the room to be accommodated and clearly explain the terms and conditions of the home. Signed copies are located within individual resident’s files. These are stored securely and have limited access. In order to ensure that all matters are addressed before and during an admission, staff complete a written checklist of events. Leonora does not provide intermediate care and therefore Standard 6 is not applicable to this service. Leonora DS0000028393.V291580.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is generally good although greater concentration within medication administration would ensure greater safety. This judgement has been made from evidence gathered both during and after the visit to the service. Care planning is of a good standard and residents receive health care intervention as required. Residents are treated with respect and their dignity is maintained through established systems. EVIDENCE: All residents have an organised, well-maintained plan of care, which is detailed and regularly up dated. All plans follow the same structure, which portrays a holistic view of each resident’s individual needs. There are a number of assessments such as nutrition and pressure care management and each give guidelines when an identified health care professional is required. The documentation clearly evidences all medical intervention and a quick reference section identifies matters such as blood tests and a record of weight. Clear objectives are set as part of the plan and each are reviewed on a monthly Leonora DS0000028393.V291580.R01.S.doc Version 5.1 Page 11 basis. Such objectives cover social needs and general interests as well as various health care matters. A life history is in place and various risk areas, such as falling, weight loss and the use of the stairs are identified. Information clearly states when residents have exercised their choice of declining health care appointments and the resident or their representative have appropriately signed plans of care. Within one care plan it was evident that bedrails are in use. Mrs Marshall was advised, therefore to gain a written agreement from a relevant professional regarding such use. While the resident’s family have given their consent, Mrs Marshall reported agreement from a professional is often difficult to gain. However, a comprehensive risk assessment, which gives detailed triggers of assessment in terms of safety and monitoring of such, is in place. Staff ensure that all residents are reported upon each day within the handovers that take place at each shift change. A written entry is also made in the residents’ daily records. Daily records demonstrate a range of visits from health care professionals and also regular updates of conditions and general well being. Mrs Marshall was advised however to ensure that staff clarify the meaning of ‘is aggressive’ by recording facts rather than judgements. Mrs Marshall confirmed that this matter had been noted and discussions were currently taking place with staff. Challenging behaviour forms part of the home’s training programme and Mrs Marshall confirmed that it was planned for this topic to be revisited. There was evidence that health care personnel were kept informed of controversial matters such as non-compliance with dietary requirements. Out patient appointments are evidenced and residents are referred to specialised services such as occupational therapy as required. Documentation gave evidence that other organisations such as the Stroke Association are involved as appropriate. The medication within the home is dispensed within a monitored dosage system and is only administered by a senior member of staff. The medication is stored in a locked trolley that is attached to the wall within a locked room. The keys are held on the person of the senior member of staff. The system is clear, ordered and organised. Procedures are placed at the beginning of the medication administration file and other reminders are strategically placed. There is a photograph of each resident before the record of his or her medication. Such records demonstrate the satisfactory receipt of medication and generally all medication is appropriately signed. Two entries however stated ‘F’, which in the key was determined as ‘forgotten.’ A requirement has therefore been made to investigate this. This is particularly essential in respect of two other drug errors this year. Within the medication administration records all handwritten instructions were countersigned. A homely remedies policy is in place and all such medication was clearly identified. The policy was however signed by a GP in February 2004 and therefore this would benefit from review. Mrs Marshall was also advised to ensure staff state the date of opening items such as eye drops. Leonora DS0000028393.V291580.R01.S.doc Version 5.1 Page 12 Residents confirmed that their privacy is fully respected. All are able to spend undisturbed time in their room and receive visitors in private as they wish. Staff were observed to enter rooms appropriately and spoke with residents with attentiveness and respect. Matters such as preferred forms of address are clearly stated on care planning information and this was evidenced within discussion. Leonora DS0000028393.V291580.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and after the visit to the service. A range of social activity is available although due to the enthusiasm of some residents regarding recent external events, further opportunities would be beneficial. Dedicated input is given to residents’ spiritual needs, which is greatly appreciated. Leonora is welcoming and resident focused. Systems are in place to enable decision-making and involvement within the home. A varied menu based on home cooking and residents’ choice is in place. EVIDENCE: Residents described an active programme within the home and this is clearly displayed on the notice board. Such activities include ‘sit and be fit’, handicrafts, story reading, video afternoon, games and Bible Study. Residents reported that they are able to join in if they wish although there is absolutely no pressure to do so if the session doesn’t appeal. One resident reported that the staff are excellent and find additional jobs for her to do such as laying the Leonora DS0000028393.V291580.R01.S.doc Version 5.1 Page 14 tables, as she does not enjoy group activities. There were various positive comments about looking forward to the better weather when more time could be spent in the garden. One resident stated that she missed going into town and the spontaneity of just deciding to go for a wander. This was further discussed and it was reported that using a wheelchair would be difficult which dismissed the appeal of the events. Some residents spoke with enthusiasm regarding a recent trip to the Westbury White Horse and tea at a local church. One resident felt that more trips out would be beneficial although the organisation of such was understood. It was then confirmed that more trips would be arranged within the better weather although ‘not going out wasn’t a problem.’ It was evident that events such as coffee mornings and plant sales are organised and residents have access to information such as advocacy services. The home with its emphasis on the shared religious beliefs of residents, gives priority to a worship service on Sunday mornings and Monday evenings with devotions on other days. All residents expressed great strength and contentment from this focus. One resident also confirmed that they have excellent speakers. Another gained satisfaction from her large print Bible. Radios and televisions are not permitted in communal areas although residents are able to have such within their private accommodation. The home does however reserve the right to request the removal of a personal television if it is disturbing other residents. Leonora is very relaxed and all staff are extremely friendly and welcoming. Visitors are welcome at any time and a number of residents spoke of the importance of this and being able to go out whenever required. Leonora has a number of ‘Home Visitors’ who were reported to provide an excellent service and be very much relied upon for matters such as personal shopping. Staff also reported that ‘Home Visitors’ undertook the majority of the residents’ daily activity programme which was invaluable. There were many positive comments about the food, which included the content, choice, variety and presentation. There is always a choice of the main meal and on the day of the inspection, lunch consisted of beef stew or homemade cheese and onion pasties. Vegetables were served in serving dishes so that individuals could help themselves to required amounts. Residents are able to choose what they would like the day before. Additional likes and dislikes are also taken into account. Emphasis is given to fresh produce and home cooking and the cook reported that a number of items have recently been withdrawn from the menu in order to provide healthier options. Daily homemade cake is also available. Specialist diets are provided for although at present, only diabetic diets are required. The cook reported that she aims to make similar items, so that the resident is not made to feel different. Residents are able to eat in the dining room or within their private accommodation. The store cupboards were viewed and were noted to contain a high level of stock. The cook reported that she is totally responsible for all Leonora DS0000028393.V291580.R01.S.doc Version 5.1 Page 15 cooking and housekeeping tasks such as stock rotation and cleaning. Despite having a gas cooker, an aga is used for the majority of all cooking. It was reported that once able to use the aga, such cooking is better and residents are able to identify with the aga’s use through their own personal experiences. Through discussion it was evident that the cook clearly realises the importance of food, enjoys feedback and aims to please as much as she can. A record of food is maintained. Leonora DS0000028393.V291580.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and after the visit to the service. An open culture gives opportunities to discuss concerns informally as required. The risk of abuse to residents is minimised through the home’s organised systems of adult protection. EVIDENCE: The home has a formal complaints procedure that encourages residents or their representatives to raise their concern initially with the home’s manager. The concern can be referred to the Director of Care Services, the Chief Executive or Chairman. The CSCI can also be contacted at any time. The procedure is readily available to residents within a handbook given on admission. On an informal basis, regular residents meetings are held and daily interaction and discussion takes place. An open culture has been developed and therefore residents are encouraged to raise any anxieties before they escalate. Within discussion with residents, it was evident that there were no complaints and all residents were clear that they would speak to a member of staff as required. Mrs Marshall confirmed that the home has not received any formal complaints and any issues are discussed thoroughly at an early stage. Leonora has the Wiltshire and Swindon Vulnerable Adults procedure within the home and the ‘No Secrets’ documentation is readily accessible. Adult protection forms part of the home’s training programme and some staff have recently undertaken such. Leonora DS0000028393.V291580.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and after the visit to the service. Leonora is homely and furnished to a good standard. Private accommodation is individual in style and personalised according to individual wishes. All areas are cleaned to a good standard and well maintained. EVIDENCE: Private accommodation is located on the ground and first floor and a passenger lift provides level access to all but five bedrooms. These rooms are accessed by a short flight of stairs. All rooms vary in size and due to the age of the building, many are below the recommended space requirements. Such details are however, documented within the home’s Statement of Purpose and drawn to the attention of prospective residents. One resident with a very small room reported complete satisfaction. She reported that the restricted space was of Leonora DS0000028393.V291580.R01.S.doc Version 5.1 Page 18 benefit to her as she could use the furniture to successfully get around. All private accommodation is individual in style and furnished in accordance to individual need and preference. This generally included a high level of personal possessions although one room was relatively sparse, due to health and safety issues associated with repeated falls. Residents have access to a call bell system and are available to have their own telephone line if they wish. A communal telephone booth is available to ensure privacy if this is not required. Radiators have been fitted with covers and matters associated with infection control principles, such as soap dispensers, are in use in communal areas. At present the main hallway is being decorated and hot water regulators are being fitted within residents’ private accommodation. There are two communal lounges and a separate dining room. All rooms are comfortable and well furnished. There are also ten WCs, three bathrooms and a shower room. The bathrooms provide an assisted bath and all facilities are within close proximity to private accommodation and communal areas. On the day of the inspection all areas were very clean and there were no unpleasant odours. Through discussion with housekeepers, it was evident that both were committed to their designated areas and were flexible in order to fit in additional tasks such as carpet cleaning. Positive rapports were also observed with residents. The kitchen is centrally located and is due for refurbishment. At present the room gets very hot, is difficult to keep clean and is showing its age. The cook reported that plans have been designed although a fitment date has not been confirmed. The cook was consulted with, within the design process and it was evident that the kitchen would be significantly improved following completion. The home has an additional carers’ kitchen whereby the washing up of all residents’ crockery is undertaken. Visitors are also able to make their own refreshments within. There is a sluice facility that was noted to be very clean and ordered. The laundry was also noted to be very organised and cleaned to a high standard. Leonora DS0000028393.V291580.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good yet a review of the deployment of staff would be beneficial in order to give residents greater opportunities. This judgement has been made from evidence gathered both during and after the visit to the service. Training is given high priority and residents are protected through an organised, well-managed recruitment procedure. EVIDENCE: The staffing roster demonstrated that during the times of 7am and 2pm there are a minimum of three care staff and a senior carer on duty. This reduces to a senior carer and two carers during the late shift, between the hours of 2pm and 9pm. At night one member of staff undertakes a waking night and another staff member provides sleeping in provision. Catering, housekeeping, administrative and maintenance staff also support the team. Mrs Marshall reported that the home has managed to successfully recruit and there is a large bank team available to cover shifts as required. Difficulty in maintaining the staffing roster, which occurred in the past, has therefore now been resolved. Mrs Marshall does not generally work as part of the working roster although is available for assistance as required. The home gives training priority and at present eight members of staff have NVQ level 2. Another member is working towards level 2 and three are working towards NVQ level 3. A member of the bank staff has the Certificate in Social Service and another is studying for her Nursing Diploma. One cook is also Leonora DS0000028393.V291580.R01.S.doc Version 5.1 Page 20 waiting for the final verification of her NVQ level 2 in Food Preparation and Cooking. In addition to NVQ a wide range of additional topics are also undertaken. Since April of 2005 care staff have undertaken training in manual handling, health and safety, risk and restraint, fire safety, food hygiene for care providers, care for diabetic residents and person centre care. In addition senior staff have completed drug administration and supervision training. Housekeeping staff have undertaken all mandatory topics and sessions on COSHH have been attended. The Maintenance Officer has also completed mandatory subjects associated with his role and additional topics such as Maintenance and Risk Assessment of a Buildings Water System. Staff reported that formal supervision is an established system although documentation of such was not viewed on this occasion. Regular staff meetings are also held. These are undertaken with the whole staff team and within specific areas of work such as senior and care staff. An agenda is raised and minutes are taken. Within feedback from residents many positive comments were received about the staff. Many said they were lovely, very kind, attentive, always happy and friendly and couldn’t do enough for you. One resident said ‘they will do anything to please you.’ This was evident within the inspection, from the initial welcome to the home through to observing staff with residents. Within general discussions, it was also apparent however that the staff were very busy. A number of residents said ‘they work very hard’ and another said ‘ you don’t see them much as they’ve got so much to do.’ Feedback from staff confirmed this as it was felt especially in the morning there was little time to socialise with residents. Achieving key worker tasks was also difficult. Within care records it was evident that the home has two residents who need full assistance and this often involves the involvement of two members of staff. This high level of input and the effect of such, in terms of two or three carers on duty, were discussed. It was agreed that some residents were kept waiting or were disrupted if they were in the process of receiving assistance. This matter was discussed with Mrs Marshall who reported to be aware of the situation. Discussions had been held with residents requesting patience, while staff attend to those frailer with greater immediate need. Staffing levels had also been discussed with a recent staff meeting. While these matters are recognised, it is evident that staffing levels are currently restricting aspects of care provision with the potential that matters will be missed. A recommendation has therefore been made for Mrs Marshall to review the deployment of staff at key times of the day. Leonora DS0000028393.V291580.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37, 38 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and after the visit to the service. Leonora is effectively managed and management systems are clear and organised. Health and safety is given priority therefore minimising risks to residents and staff. Residents are regularly consulted with and the home has an established, wellorganised quality auditing system. EVIDENCE: Mrs Marshall gained her position of Registered Manager on the 7th November 2005. Mrs Marshall is a registered nurse and has many years experience of both hospital and residential settings. Mrs Marshall appears committed to her role and has high standards of care provision. General feedback from residents and staff gave evidence that Mrs Marshall works hard, is very kind and good at Leonora DS0000028393.V291580.R01.S.doc Version 5.1 Page 22 listening. She was also reported to be approachable and very helpful. Mrs Marshall is currently commencing the Registered Manager’s Award and the organisation has given its full support to enable Mrs Marshall to complete this as required. Within discussion it was evident that Mrs Marshall aims to fully comply with regulation and CSCI has been kept informed of all matters as required under Regulation 37. Leonora has a strong resident focus and this is reflected by systems such as resident meetings and daily prayer meetings. Within resident meetings, new residents are welcomed and there is an exchange of information. This may include forthcoming events, activities and day-to-day matters within the home. Gentle reminders such as not interrupting staff when administering medication are also discussed within this forum. Residents are asked about the progress of any previous points raised and each resident is given a copy of the minutes after the meeting. The home has a formal quality assurance system that is linked to the National Minimum Standards. The system also has various questionnaires in order to gain feedback from residents and staff. Mrs Marshall reported that the system, consists of a rotating cycle and therefore the process is ongoing. The system has received less attention than is usual due to Mrs Marshall’s other priorities of establishing herself within the home. However, the programme remains on target and will be given further consideration through recent delegation to a senior staff member. The home has policies and procedures regarding the management of residents’ financial affairs. On admission, information such as the location of the resident’s will, the names of executors and who holds power of attorney, is requested. Weekly fees are payable by direct debit and the home holds a small amount of money for safe keeping for some residents. All such money is stored securely within the home’s safe. A number of these records were viewed and all reflected the amount of cash in place. Numbered receipts were available and each transaction generally demonstrated the signatures of two members. Regular checks of the balance were evident in order to ensure accurate practice. The environment is well-maintained and regular health and safety audits take place. Over the last few months there have been workmen in the building supplying a new heating system, painting and decorating and installing hot water temperature regulators. The ongoing work has been difficult for both residents and staff although disruption has been kept to a minimum. Risk assessments have been undertaken in relation to the areas of work and safe working practices have been monitored. Health and safety forms a mandatory part of the training plan and such matters are regularly addressed within staff meetings. The organisation provides detailed booklets such as health and safety and manual handling, for staff reference. Staff are responsible for specific areas and within the inspection the cook was observed to take the Leonora DS0000028393.V291580.R01.S.doc Version 5.1 Page 23 temperature of the casserole. It was reported that food deliveries are also probed and the transportation of such is regularly monitored. A record of temperatures including the refrigerators and freezers are also maintained. The fire log book demonstrated satisfactory testing of the fire alarm systems although the emergency lighting had been missed in April 2006. All visual checks had been undertaken and a fire drill had taken place within each period as required. Such documentation also included the time and participants of the drill. Staff had received fire instruction and a fire risk assessment had been undertaken on a room-by-room basis. A fire procedure was placed on the back of each door within residents’ private accommodation. Leonora DS0000028393.V291580.R01.S.doc Version 5.1 Page 24 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 3 3 3 3 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 3 3 3 X 3 3 3 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Leonora DS0000028393.V291580.R01.S.doc Version 5.1 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement The Registered Person must investigate the reasons why the identified medication was not given and take appropriate action in order to minimise drug administration errors. Timescale for action 30/06/06 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. 4. 5. Refer to Standard OP7 OP7 OP9 OP9 OP12 Good Practice Recommendations The Registered Person should ensure that staff document factual information rather than subjective terms. The Registered Person should ensure that written agreement regarding the use of bed rails is gained from a relevant health care professional. The Registered Person should ensure that staff record the date of opening medications such as eye drops. The Registered Person should ensure the homely remedies list is reviewed by a GP. The Registered Person should ensure that consideration is given to the increase in external social activity offered to DS0000028393.V291580.R01.S.doc Version 5.1 Page 26 Leonora 6. 7. OP27 OP35 residents. The Registered Person should undertake a review of the deployment of staff at key times of the day in relation to the increased needs of some residents. The Registered Person should ensure that there are consistently two signatures, to demonstrate all transactions of residents’ money held for safekeeping. Leonora DS0000028393.V291580.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 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 Leonora DS0000028393.V291580.R01.S.doc Version 5.1 Page 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!