Inspection on 21/08/06 for Lilliput House Rest Home

This inspection was carried out on 21st August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Lilliput House Rest Home 17/01/06

Lilliput House Rest Home 06/09/05

Lilliput House Rest Home 21/02/05

Lilliput House Rest Home 07/09/04

Lilliput House Rest Home 02/02/04

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 Lilliput House Rest Home 299 Sandbanks Road Poole Dorset BH14 8LH Lead Inspector Carole Payne Key Unannounced Inspection 21st August 2006 09:30 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 DS0000051239.V308960.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. DS0000051239.V308960.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lilliput House Rest Home Address 299 Sandbanks Road Poole Dorset BH14 8LH 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) 01202 709245 Mr Mark Edney Mrs Louise Edney Mrs Victoria Lynes Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places DS0000051239.V308960.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th January 2006 Brief Description of the Service: Lilliput House was originally two detached residential properties, which have been linked on the ground floor. It is set in a residential area of Poole and close to local shops and facilities as well as transport links. The registered providers, Mr and Mrs Edney, are frequent visitors to the home and the registered, day-to-day manager is Mrs Lynes. Mrs Lynes is currently on leave and the deputy manager is acting as manager. The home is registered to provide care and accommodation to a maximum of 20 residents in the category of OP (older people) and had no vacancies at the time of the inspection. The home’s fees range from £414.75 to £481.86 per week. There are charges for extras including hairdressing, chiropody, newspapers, toiletries and outings. Accommodation is offered on both the ground and first floors of the home. All bedrooms are for single occupancy and have ensuite facilities. There is a passenger lift on each side of the home therefore making all areas of the home fully accessible. The home has a comfortable main lounge and a separate dining room that also has some comfortable seating. Both of these areas are on the ground floor at the rear of the property and have views of the garden, which is attractively landscaped and well maintained. There are also communal bathrooms on both floors in addition to ensuite facilities. There is a parking area at the front of the property. DS0000051239.V308960.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out on the 21st August 2006 and took a total of 10 hours, including time spent in planning the visit. The inspector, Carole Payne, was made to feel welcome in the home during the visit. The manager was not available. However, the deputy manager was present throughout the visit. This was a statutory inspection and was carried out to ensure that the residents who are living at Lilliput House are safe and properly cared for. A requirement and recommendations made as a result of the last inspection visit were reviewed. The premises were inspected, records examined and the daily routine observed. Time was spent in discussion with six people living at the home and three staff members on duty. Thirteen resident survey forms, ten relative visitor comment cards and one care manager / placement officer comment card, were received prior to the inspection. Friends or family members had completed some resident survey forms on behalf of residents. At the time of the visit major building work was taking place to add seventeen new individual rooms to the service and additional communal and bathing facilities, to accommodate the increase in occupancy proposed. This will be subject to successful application for registration to the Commission for Social Care Inspection. What the service does well: Residents spoken to at the time of the visit spoke very highly of the standard of service they receive at Lilliput House. One resident said that the home is just ‘what I would have wanted. The staff make it.’ Another said it ‘was the best of the one’s I looked at.’ One person living in the home said that they felt ‘part of a family.’ One resident responding in a survey form said ‘I am so happy here.’ Throughout the visit the commitment of the deputy manager, who was the person in charge at the time of the service, supported by one of the providers and the staff team was apparent in the commitment to address any issues raised responsively and in the systems of reviewing and continuously improving the service. An assessment is carried out to ensure that the home is able to meet the needs of prospective residents. Opportunities to visit the home and DS0000051239.V308960.R01.S.doc Version 5.2 Page 6 information provided by the service assure people that their needs will be met. One resident said that when they had seen the home they were in no doubt ‘it was the best place I saw.’ Both prospective residents and their families are very welcome to visit and assess the quality of facilities and suitability of the home, enabling them to decide if Lilliput House is the place for them. ‘I already knew someone who lived here and they were happy’ said one resident responding in a survey form. Residents are treated with the utmost care, consideration and respect for their privacy and dignity. ‘We could not be treated with greater care’ said one resident. Residents living at Lilliput enjoy a varied quality of life, which meets with their expectations, preferences and social and religious needs. ‘There is always something to do’ said one resident. Residents are supported to maintain relationships with relatives and friends, enabling people to enjoy continuing links with their families and people in the local community. People living at Lilliput are enabled to live independent lifestyles, making choices and exercising control over their lives. Residents are supported to take responsibility for their own medication if they wish. People living at the home enjoy an appetising and varied menu in pleasant surroundings. One resident said that the meals are ‘excellent.’ The home has a clear complaints procedure in place and an open ethos of listening, which enables people to be unafraid to say what they think, confident that concerns will be responded to. Detailed policies and procedures, supported by staff awareness, act to protect people from abuse. People living at Lilliput House enjoy a safe and well-maintained environment. A good standard of cleanliness provides residents with pleasant and hygienic surroundings. Suitable training supports staff to develop the competencies they need to ensure that residents are in safe hands. The service is well run, in the best interests of people living at the service. Residents’ personal monies are safely kept, ensuring that people’s financial interests are safeguarded. DS0000051239.V308960.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: DS0000051239.V308960.R01.S.doc Version 5.2 Page 8 The registered person must ensure that all needs are assessed, including risks and are used to inform planning of how care is to be delivered to meet residents’ needs. Nutritional and pressure sore risk assessments should be developed to ensure that residents’ healthcare needs are accurately assessed. A member of staff should countersign handwritten entries to the Medication Administration (MAR) charts. The General Practitioner should be consulted to ensure that medicines written up to be given regularly and changed, by handwritten entries, to be given as and when, are reviewed, and an alteration made to the prescription as appropriate. The registered person should survey residents regarding the timing of mealtimes and, according to the results, provide more flexibility according to residents’ choices. The review of fixed handrails around the home and the installation, where appropriate, of additional rails will provide an aid to residents safely mobilising around the home. The registered person must ensure that there are at all times sufficient numbers of waking care staff working in the home, and an appropriate skill mix of staff, to ensure that residents needs are fully met. Recruitment policies and practices must adequately protect residents. 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. DS0000051239.V308960.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 DS0000051239.V308960.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5, Standard 6 is not applicable to this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. A basic assessment is carried out to ensure that the home is able to meet the needs of prospective residents. Opportunities to visit the home and information provided by the service adequately assure people that their needs will be met. Both prospective residents and their families are very welcome to visit and assess the quality, facilities and suitability of the home, enabling them to decide if Lilliput House is the place for them. EVIDENCE: Most people moving into Lilliput House come from within the local community. It was clear that a high proportion of residents move in following personal recommendations. ‘I already knew someone who lived here and they were DS0000051239.V308960.R01.S.doc Version 5.2 Page 11 happy’ said one resident responding in a survey form. All residents returning survey forms said that they had received enough information about the home to enable them to make a decision about moving in. Pre-admission assessments were viewed for two residents who had recently moved into the home. Assessments include aspects of daily living, supporting the home to decide if they are able to meet people’s needs. Assessments and all care documentation provide space for residents, or their representatives, to sign to say that they have been consulted and involved in the admission process. One resident said that when they had seen the home they were in no doubt ‘it was the best place I saw.’ Information viewed included personal details and family links, which would be important to know on admission to support a smooth transition to living at the home. Care is taken to collect information, which is important and relevant to the person, for example, not just whether the person uses glasses but also when the person needs to use them. Medical histories are detailed and informative, enabling current relevant health problem to be identified and monitored. Since the last inspection a new pre-admission assessment form has been devised which is detailed and clear in identifying areas of care and support needed. This will enable a clear assessment to inform the process of assessing and planning care on admission. (See Health and Personal Care.) This record is now ready to be implemented. It was advised that the record include the name of the person providing information. The deputy manager explained that great care is taken by the service to ensure that people are supported to take the step of moving in. Prospective residents are invited for coffee or a meal. A resident who had recently moved in had come for lunch first, to experience what it is like to live at the service. One resident said on a survey form that they ‘tried it for one day each week for a few weeks first.’ One resident had recently moved into the home and staff members were ensuring that they felt welcome and at ease. During the visit a resident already living in the home said that when the new resident had moved in the care staff had spent a lot of time making the person welcome and supporting them to feel at home, sitting with the resident and reassuring them. The resident said that they were looking forward to moving into one of the rooms in the new building, and had been promised ‘first choice.’ (A large extension is currently being made to the home – see Environment.) DS0000051239.V308960.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents, who are mainly independent, are satisfactorily supported by the plans of care in place. However assessments and care plans are not sufficiently detailed to explain how aspects of care are to be carried out to meet residents’ needs. Residents’ healthcare needs are generally satisfactorily met by the home. Specific healthcare risk assessments will support the meeting of people’s needs. People living at Lilliput House are enabled to take responsibility for their own medication, if they wish. Generally residents are adequately protected by the safe procedures of the home in the management of medicines. Residents are treated with the utmost care, consideration and respect for their privacy and dignity. DS0000051239.V308960.R01.S.doc Version 5.2 Page 13 EVIDENCE: Care plans were seen for four residents living in the home. Most residents are independent and as such the planning needed in terms of care is very minimal. From information provided in the home’s pre-inspection questionnaire there are currently two people requiring ‘assistance only’ with washing and dressing. Some residents use equipment to help them to mobilise around the home, three residents have ‘memory loss.’ Basic assessments of activities of daily living are carried out and inform the development of care planning, which supports staff members to carry out the unobtrusive and enabling care, which is provided. Support required in terms of personal, social and healthcare needs are clearly set out. Specific risk assessments are in place in relation to some hazards, however, issues highlighted in the initial assessment, are not always risk assessed, for example in relation to the risk of falling, or anxiety and panic attacks and restlessness at night. Each need identified, therefore, is not assessed to support the writing of a care plan to minimise the identified risk. Basic details are written down in relation to nutritional needs and where there is a concern regular weights are recorded. The carrying out of specific nutritional risk assessments was discussed with the deputy manager. This will also need to be considered in terms of skin integrity. Descriptions of support required included reference to ‘encourage to wash and dress’, ‘assist’, ’support’, but do not describe how the support is to be delivered. From talking with the deputy manager she was very clear about the sensitive, supportive and individual ways in which each person receives any help and expressed her intention to review and ensure that the process of assessment and care planning clearly describes when, how and where support is to be provided. The removal of out of date care plans will also support the clarity of current records in use. Daily records are thoroughly completed. It was noted that different members of staff now contribute to these records, which are now more accessible. All care plans seen had been reviewed regularly and a new consolidated summary provides a clear account of what has happened since the last review took place, any changing needs are identified. Care plans seen included reference to the participation of residents in planning their care. A record of links with external healthcare professionals is set out within individual care records, providing a clear summary of contact details. One resident spoken with said that the staff members help them when they may need to see a General Practitioner. From service user survey forms nine people said that usually receive the care they need, four said that this was DS0000051239.V308960.R01.S.doc Version 5.2 Page 14 always the case. In terms of medical support four said that they always receive support, eight usually, one said that this was because they did not need medical help at present. Residents are supported to undertake exercise. Recent building work has meant that residents have been unable to access the garden. The providers have purchased a minibus and regular trips out are organised. Some residents have sticks or rollators to help them in moving about the home independently. Some residents have needs in terms of continence. One care plan seen spoke of the discreet support given to enable people to manage their own needs. According to the pre-inspection questionnaire submitted by the service, the home does not have a policy in respect of the promotion of continence. The deputy manager has confirmed that this will be rectified. Psychological well-being is referred to on two of the care plans seen and specialist advice was referred to in case of deterioration. However the care plan did not identify what the signs of deterioration might be to prompt such a referral. From discussion with residents in the home they feel very well cared for and in good spirits. Throughout the home there was the hum of companionable conversation between staff members and residents, and residents visiting their friends in other rooms in the service. More able residents may give a less able friend a hand, which is appreciated and shared by both and contributes to the sense of personal well-being, expressed by residents. Three residents’ medicines were checked and amounts held corresponded to amounts recorded as given on the Medication Administration Record (MAR) chart. The home now has a cupboard for storing controlled drugs and as good practice, records amounts of Temazepam held. Medicines requiring refrigeration are appropriately stored in the fridge and the temperature is monitored daily. A risk assessment had been carried out for a resident who chooses to administer his or her own medication. Medicines are logged in and the person is provided with a lockable storage space. A person checking the entry had, mostly countersigned handwritten entries on the new MAR charts. However, medicines which had been changed to be given as required, and alterations to the instructions in relation to one medicine in current use, had not been countersigned. The deputy manager confirmed that she now ensures that any alterations are now changed on the prescription to show the correct details as soon as possible. DS0000051239.V308960.R01.S.doc Version 5.2 Page 15 In each resident’s file there is a record of their current medication, with details of the reason for prescribing and possible side effects, enabling the home to monitor the needs of residents taking regular medications. Throughout the visit staff members provided gentle and respectful support to residents, be it knocking on a resident’s door or taking their arm when they go to the dining room for lunch. Care records seen also spoke of respect for the dignity and privacy of people living in the home. Residents spoken with expressed their satisfaction with the sensitive support given. DS0000051239.V308960.R01.S.doc Version 5.2 Page 16 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, 15, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents living at Lilliput enjoy a varied quality of life, which meets with their expectations and preferences and meets their social and religious needs. Residents are supported to maintain relationships with relatives and friends, enabling people to enjoy continuing links with their families and people in the local community. People living at Lilliput are enabled to live independent lifestyles, making choices and exercising control over their lives. Residents enjoy an appetising and varied menu in pleasant surroundings, meeting both social and nutritional needs. Review of the flexibility of mealtimes will support the home’s commitment to meet with people’s dietary preferences. DS0000051239.V308960.R01.S.doc Version 5.2 Page 17 EVIDENCE: An activities coordinator comes into the home each afternoon. On the day of the visit nine residents were enjoying a quiz in the lounge. There was much good humour and laughter. Since the last visit the home has acquired a minibus. This has enabled some residents to go out, whilst the building work is underway, as the garden is not currently accessible. However, there are plans in place for the garden, which includes a level path for residents to take a stroll, a pond and water feature is also planned. Outings include picnics, cream teas and lunch out. During the morning some residents were spending time in the lounge chatting, others were visiting friends in their rooms. Afternoon activities include skittles and bingo and there are regular visits from outside entertainers. Some residents prefer to stay in their own rooms and wishes are respected. One resident said that they very much did what they wanted to do. Seven people responding in resident survey forms said that there were always suitable activities, five that this was usually the case. One resident said ‘I am deaf so it does not apply.’ The activities coordinator was using a microphone on the afternoon of the visit, so that his voice was more audible. The deputy manager also confirmed that, as part of the planned changes to the home, a loop system is going to be installed to support people who may have a hearing difficulty to join in with the life of the home. Ten relatives / visitors returning comment cards said that they are always made welcome at the home. The deputy manager said that one relative was taking lunch on the day of the visit. Ten relatives / visitors to the home returning comment cards said that they could visit their family member or friend in private. As part of the home’s annual development plan the home has focused upon making people welcome, including offering visitors refreshments when they visit the service. Residents enjoy friendships both outside and within the home. During the visit residents sat in groups in the lounge chatting, or were seen going and visiting their friends in the home and perhaps having a cup of tea together. At lunchtime one resident waited for their friend so that they could go down to the meal together. On the day of the visit residents sat in a group in the lounge chatting about how they make choices about how they like to live, be it from when they get up and go to bed, to going out and their daily routine. According to the preinspection questionnaire three residents have advocates or representatives who act on their behalf. Information is made available both to residents and staff members, regarding external agencies that speak out for older people, for example Action on Elder Abuse. DS0000051239.V308960.R01.S.doc Version 5.2 Page 18 Six residents spoken with during the visit praised the standard of meals provided. They said that fresh fruit and vegetables are prepared and if they do not like the set meal, an alternative is provided. One resident said the meals were ‘excellent.’ The dining room was busy at lunchtime and meals are evidently a social event with much conversation enjoyed. Tables are attractively laid and meals served looked well presented and appetising. One resident said ‘look it’s great.’ Three residents spoken with said that they were happy with the timing of meals. Two residents raised concerns in survey forms that the evening meal is too early and the two main meals too close together. One person completing a survey form said that they could not eat the meat ‘It is too tough.’ The home has focused upon mealtimes as part of its annual development plan. Sherry is served at 11:30 and wine is available with all meals. Ice creams are available in the afternoons in the warmer weather. DS0000051239.V308960.R01.S.doc Version 5.2 Page 19 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, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a clear complaints procedure in place and an open ethos of listening, which enables people to be unafraid to say what they think, confident that concerns will be responded to. Detailed policies and procedures, supported by staff awareness, act to protect people from abuse. EVIDENCE: The home has a suitable complaints policy in place. The procedure is clearly set out in the form of a flow chart, clearly setting out the home’s open approach to the receipt of complaints and identifying what the home will do in order to ensure that issues are satisfactorily responded to. Complaints forms are made available in one of the communal areas, should anyone wish to raise an issue in writing. As part of the home’s annual development plan, the service has introduced procedures to ensure that people are made aware of the home’s procedures. According to the pre-inspection questionnaire the home has received no complaints in the last twelve months. Ten people returning resident survey forms said that they know who to speak to if they are not happy, two said that this was sometimes the case, one said ‘I find it difficult to get the right result.’ Seven relatives / visitors to the home said that they were aware of the DS0000051239.V308960.R01.S.doc Version 5.2 Page 20 complaints’ procedure; three said that they were not. People spoken to at the time of the visit were not afraid to say if they had any concern. One resident said ‘I would have no problem in raising any complaints.’ The deputy manager said that the complaints procedure was going to be made available in different formats, on request, such as Braille. The deputy manager has recently updated the home’s abuse and whistle blowing policies, which are very clear and informative, including details of local relevant agencies. Most staff members have received training in adult protection, according to the home’s summary of training undertaking. Six staff members are going to complete the new pack, which the deputy manager has devised, which is supported by a questionnaire and includes referral to the local policy adult protection policy. The deputy was advised to resource training from one of the local social services departments, to support good practice. DS0000051239.V308960.R01.S.doc Version 5.2 Page 21 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, 22, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. People living at Lilliput House enjoy a safe and well-maintained environment. A good standard of cleanliness provides residents with pleasant and hygienic surroundings. EVIDENCE: Although major building work is currently taking place, adding seventeen new rooms to the home and an increase in communal and bathing facilities, this is being carried out with the minimum of disruption. The deputy manager described how residents had been consulted about the project and were aware of progress. One person living in the home said that they had been asked what they would like in the garden. They said that, although it is a nuisance, the owner regularly comes and lets them know what is happening and the DS0000051239.V308960.R01.S.doc Version 5.2 Page 22 builders ‘are very polite.’ The site manager confirmed that early morning noise is minimised and will not be undertaken if residents are still sleeping. Information provided on the home’s pre-inspection questionnaire confirms that there were no requirements or recommendations from the last visit from the fire and environmental health officer. One room has been redecorated and an en suite fitted since the last inspection and another personal room has been redecorated. A new kitchen has also been fitted since the last visit to the service. The home accommodates some residents who have some degree of visual impairment and problems with mobility. One resident was edging their way along a wall in a corridor making their way to the dining room. Another resident was having difficulty negotiating their way to the ground floor toilet, with their walking aid. The deputy manager said that rails are going to be installed as part of the current work being undertaken, providing an aid for residents to safely mobilise around the home. This is included as a recommendation within this report. All areas of the home seen were clean, well maintained and pleasantly furnished. Residents’ rooms were personalised. One resident praised the housekeeper who comes in to clean the room. Staff members observed good standards of hygiene in carrying out tasks, washing their hands appropriately and using protective tabards. A resident commented that the laundering of clothes is carried out to a good standard. DS0000051239.V308960.R01.S.doc Version 5.2 Page 23 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, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The number of hours currently allocated to waking care staff is not currently sufficient to adequately ensure that residents’ needs are met. Suitable training supports staff to develop the competencies they need to ensure that residents are in safe hands. Recruitment policies and practices do not adequately protect residents. EVIDENCE: From rosters seen staffing levels are not currently adequate to meet the needs of residents. Currently there are two sleep-in staff members at night. On the day of the visit the manager was one of two care staff on duty. One resident returning a survey form said that it was difficult to get help between 10.30pm and 6am. A number of survey forms highlighted that staff were always busy, but normally were there when needed. One resident returning a survey form said ‘Sometimes I have to wait.’ Six relatives / visitors returning survey forms said yes there was always sufficient staff on duty, three said that this was not the case. During the visit residents were very complimentary regarding the caring natures of staff members. Due to the low dependency levels of most residents the home employs a number of housekeeping staff. On the day of the visit there were three housekeepers on duty. Since the inspection the DS0000051239.V308960.R01.S.doc Version 5.2 Page 24 deputy manager has confirmed that the home has already started to review staffing levels and improve care support levels provided. Residents commented during the visit that ‘staff members make it like a family.’ Very impressed with staff. They are very caring.’ Three members of staff currently have a National Vocational Qualification in Care (NVQ) at level 2. Three members of staff are currently studying for the qualification and three members of staff are due to start the course in September. Twelve members of care staff are currently employed to work at the service. The files for two members of staff working at the service were viewed. One member of staff was new. The other had left the service and then returned to work there. For one member of staff a POVAFirst (check of the Protection of Vulnerable Adults list) had been undertaken prior to starting work. The deputy manager confirmed that this member of staff was undertaking basic housekeeping duties at present under supervision. However, during the visit the staff member was working unsupervised, giving care support to a resident and supporting the person to make their way around the home. The deputy manager confirmed that the member of staff would work under supervision until the Criminal Records Bureau (CRB) check was received. She confirmed that this was received the day after the inspection. One written reference was on file from the last employer and a written statement regarding a verbal reference, which had been received. The person had started work at the beginning of June. The second written reference had been sought, but had not been received at the time of the visit. Evidence of proof of identity, interview, and equal opportunities monitoring forms were on file. Information for the second member of staff working at the home did not contain a full work history; there was insufficient information regarding places where the person had worked with vulnerable people and there was only one reference on file. Since the last inspection visit the deputy manager has produced documentation to be used in the future to support the carrying out of adequate checks to ensure the suitability of applicants to work with vulnerable people. Both the application form and reference requests have been improved. For example, they now provide space for gaps in work histories to be identified and reasons given, and for references to be signed and dated indicating the position of the person acting as a referee. The home’s recruitment procedure has also been updated to reflect current guidelines. The deputy manager has started to use the Skills for Care induction programme and said that she is waiting for supporting documentation to be DS0000051239.V308960.R01.S.doc Version 5.2 Page 25 published so that she can utilise the full pack to ensure that staff members are fully supported by the induction process. According to the update of the home’s annual development plan all new staff now have mentors during their induction period. Useful websites were discussed at the time of the visit and are detailed below: http:/www.picbdp.co.uk/ This is the Partners in Care website and provides information for funding streams for training, including NVQ, Life skills and Leadership & Management. http:/www.skillsforcare.org.uk/ This is the Skills for Care web site and includes information regarding induction standards and there are downloadable knowledge sets and learning logs for areas of practice including: Dementia Infection Control Medication Workers not involved in direct care These knowledge sets are the first 4 of approximately 30 that are currently planned. They are designed to improve consistency in underpinning knowledge for the adult social care work force in England. They identify learning outcomes and are designed for use alongside the Common Induction Standards, which are also available from this web site. They also count as underpinning knowledge towards NVQs and link to the Health & Social Care National Occupational Standards. http:/www.traintogain.gov.uk/ This is a programme and funding stream supported by the Learning and Skills Council and Business Link, who provide a skills brokerage role. This project takes off from 1st August in Dorset and the brokers are currently engaging with care providers to establish what their needs are and how best to access funding and which training provider can best assist to meet the identified needs. http:/www.lsc.gov.uk/bdp/employer/eggt_intro.htm This is the Employer Guide to Training website, which is aimed at assisting employers to choose the most suitable training provider to meet their workforce needs by the use of a search facility. A pilot is being run in the South West to enable employers to give their feedback on the training they have experienced. DS0000051239.V308960.R01.S.doc Version 5.2 Page 26 A summary sheet has been compiled for training undertaken by all staff, to ensure that staff are regularly updated in good practice. The deputy manager said that she was going to go through the list to highlight care and non-care staff, so that the different training needs of staff are identified and met. The list of training undertaken includes mandatory areas of practice. Copies of individual certificates were seen on a personal file. DS0000051239.V308960.R01.S.doc Version 5.2 Page 27 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, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Although the registered manager is currently not working, the service is well run. An annual development plan supports the running of the home in the best interests of people living at the service. Residents’ personal monies are safely kept, ensuring that people’s financial interests are safeguarded. The health, safety and welfare of residents is generally adequately promoted and protected, issues identified which compromised safety, were swiftly responded to, protecting people living in the home. DS0000051239.V308960.R01.S.doc Version 5.2 Page 28 EVIDENCE: At the time of the visit the registered manager was on maternity leave. The deputy manager was present throughout the visit and the provider confirmed that it is intended that the deputy submit an application to be registered as manager of the service. When the current registered manager returns from maternity leave, it is proposed that she jointly manages the home. The current deputy will work full time and take senior management responsibility. The current registered manager holds an NVQ at level 4 in management and the deputy is currently undertaking the Registered Manager’s Award. During the visit staff members consulted the deputy regarding day-to-day issues. The deputy has also contributed to the development of some of the home’s paperwork, which has improved some aspects of organisation and management of the home through good record keeping. One of the providers, Mrs Edney, visited the home during the inspection. Residents spoken with said that they see her often and she takes them out on trips regularly. A good working relationship exists with the deputy manager and they conferred during the visit, about aspects of the smooth running of the home. On the pre-inspection questionnaire submitted by the service prior to the inspection it is confirmed that either the deputy manager or one of the providers is present at the home seven days per week. Consultation with people involved with the home informs the quality assurance development plan, which is regularly reviewed and updated. The deputy manager outlined plans to extend the process to include individual tools to audit specific aspects of the running of the service. The pre-inspection questionnaire submitted by the service details a recent review in January 2006 of policies and procedures. At the time of the visit it was noted that policies are produced according to the changing needs of the service, for example in relation to the safe operation of the home during the building works being carried out. Applicable policies are made available to residents in the reception area and are produced in large print. A set of policies is available to staff. A list of staff names was seen for staff to indicate that they have read and understood a new policy. The home keeps some personal monies for residents living in the home. Amounts held on behalf of two residents were checked and balances recorded corresponded with amount held. Receipts are kept to account for monies spent. The home maintains records of fire checks, which are carried out at the required regular intervals, according to information provided in the pre- DS0000051239.V308960.R01.S.doc Version 5.2 Page 29 inspection questionnaire submitted by the home. Fire training and drills are also recorded. According to the home’s annual development plan external contractors are now asked to sign to indicate that they have been made aware of the home’s fire evacuation procedures. A summary record is maintained of training in aspects of health and safety. The deputy manager confirmed that the list would be updated to include job roles so that appropriate training is maintained and renewed. The home has a Health and Safety risk assessment in place. Only three members of staff have currently undertaken training in health and safety according to the summary record. The deputy was aware of this and was planning any further training needed. However, the home’s induction and NVQ training does include aspects of health and safety. The home has a roster of trained first aiders on duty 24 hours a day, ensuring that there is always someone qualified on hand to deal with emergencies arising. According to the review of the annual development plan staff have received food hygiene and infection control updates. Manual handling is also routinely updated according to the summary record. During the visit hazardous substances, such as cleaning liquids, were removed from the kitchen to a locked outside area. According to the pre-inspection questionnaire maintenance of facilities and equipment takes place on a routine basis, promoting safety. DS0000051239.V308960.R01.S.doc Version 5.2 Page 30 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 x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 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 1 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 3 3 x x 2 DS0000051239.V308960.R01.S.doc Version 5.2 Page 31 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 OP7 Regulation 15 Requirement Timescale for action 26/09/06 2. OP27 18 3. OP29 19 The registered person must ensure that all needs are assessed, including risks and are used to inform planning of how care is to be delivered to meet residents needs. The registered person must 15/09/06 ensure that there are at all times sufficient numbers of waking care staff working in the home, and an appropriate skill mix of staff, to ensure that residents needs are fully met. The registered persons must 15/09/06 ensure that all persons employed are fit to work in the home. The registered persons must obtain in respect of each person the documents listed in schedule 2 of the Care Homes Regulations 2001 and must be satisfied as to the authenticity of the references and information received. New staff must only be confirmed in post following completion of a satisfactory CRB and POVA check. Previous timescale 31/01/06 not fully met. DS0000051239.V308960.R01.S.doc Version 5.2 Page 32 4. OP38 13 The health and welfare of residents must be supported at all times. Staff members must be made aware that hazardous substances must be securely stored at all times. 15/09/06 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. Refer to Standard OP8 OP9 Good Practice Recommendations Nutritional and pressure sore risk assessments should be developed to ensure that residents’ healthcare needs are accurately assessed. Residents should be protected by the home’s policies and procedures for the management of medications. A member of staff should countersign handwritten entries to the MAR charts. The General Practitioner should be consulted to ensure that medicines written up to be given regularly and changed, by handwritten entries, to be given as and when, are reviewed, and an alteration made to the prescription as appropriate. The registered person should survey residents regarding the timing of mealtimes and, according to the results, provide more flexibility according to residents’ choices. The registered person should undertake a review of fixed handrails around the home and install, where appropriate, additional rails providing an aid to residents to safely mobilise around the home. A minimum of 50 of staff must be trained to NVQ level 2 or equivalent in care top ensure that staff are suitably qualified and competent. Progress has been made in meeting this recommendation since the last inspection. 3. 4. OP15 OP19 5. OP28 DS0000051239.V308960.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 DS0000051239.V308960.R01.S.doc Version 5.2 Page 34 - 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. 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