Inspection on 19/08/08 for Littlebourne House

This inspection was carried out on 19th August 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Littlebourne House 21/11/06

Littlebourne House 01/10/05

Littlebourne House 13/06/05

Littlebourne House 18/01/05

Littlebourne House 19/07/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Littlebourne House 2 High Street Littlebourne Canterbury Kent CT3 1UN Lead Inspector Mark Hemmings Unannounced Inspection 19 August 2008 09:00 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 Littlebourne House DS0000023469.V369215.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. Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Littlebourne House Address 2 High Street Littlebourne Canterbury Kent CT3 1UN 01227 721527 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) cares@littlebournecarehome.co.uk Mrs Maralyn Hussein Mr Michael Moreland Mrs Luciana Jarmaine Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the service may accommodate up to 3 service users in the DE (E) category. 21st November 2006 Date of last inspection Brief Description of the Service: Littlebourne House (the Service) is registered to provide care for up to 41 older people. Of this number, three older people may be accommodated who have problems with their understanding. The premises are an older property that has been modernised and extended. The accommodation is arranged on the ground floor and the first floor. A stair-lift connects these two levels. In the main building, there are 33 bedrooms. Three of these can be shared by two people each. All of them have a private toilet and wash hand basin. Most of them also have a private bath or shower. Also in the main property, there is a self contained flat which can be used by visitors who have travelled a long distance. It can also be used as another shared bedroom. Recently, the Registered Providers have developed a suite of self contained flats. These are in a building which is separate from but which is near to, the main house. These flats have a bedroom, lounge, bathroom and kitchenette. They are designed to be used by service users who want the security of being able to call upon assistance, while at the same time wanting to keep most of their independence. The Service is set back from the main high street of Littlebourne. This is a small village that is about five miles from Canterbury. It has a small selection of shops. The Service has a large, attractive garden at the back. There are various garden seats so that people can relax and enjoy their surroundings. A large all-weather conservatory looks out onto the garden. To the side of the main house, there is room for relatives to park their cars. People who might want to move in can get information in several ways. There is a Service Users’ Guide. This is a brochure that outlines the main things available in the Service. There is also a document called a Statement of Purpose. This gives a more detailed account than the Guide. The Manager is happy to talk with people to answer any remaining questions. A copy of our most recent Inspection Report is available in the Service for people to read. The range of fees charged currently for each person to live in Littlebourne House runs from £300.00 to £550.00 per week. The amount actually charged depends upon the amount of personal care needed and the bedroom occupied. The fees include all accommodation, meals, personal care, laundry and inLittlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 5 house entertainment. They do not cover things such as personal toiletries and hairdressing. Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this Service is 2 Star. This means that the people who use this Service experience good quality outcomes. Since 1 April 2006, we have developed the way we do our inspection of care services. This inspection of the Service was an unannounced “Key Inspection”. We arrived at the Service at nine o’clock in the morning and were there for about eight hours. It was a thorough look at how well the Service is doing. It took into account detailed information provided by the Registered Providers in their self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). Further, it considered any information that we have received about the Service since our last inspection. During the inspection, we spoke with various members of the management team. These included both of the Registered Providers, the Office Administrator and the Manager. We also spoke with other members of staff. These included the Development Officer, the activities coordinator, three care workers, the chef and one of the housekeepers. We spoke with six of the people who live in the Service and with three of their relatives. We saw the lounges, some of the bathrooms and toilets and some of the bedrooms. We walked around the grounds and we looked at a selection of key records and documents. Before the inspection, we invited people to fill out questionnaires to tell us what they think about the Service. We got twelve of these back. Seven were from people who live in the Service and the remainder were from members of staff. What the service does well: There is a relaxed and homely atmosphere. People say that the care workers are kind and attentive. Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 7 They also say that they receive the support and assistance they need and that this is in line with their expectations. People are served with good quality meals. What has improved since the last inspection? What they could do better: More detailed records need to be kept of some of the meals that are served. This is so that we can be sure that people do indeed have a choice of things to have. Some security checks for one of the care workers are missing. This is not safe because we need to be doubly sure that all care workers are trustworthy people. More needs to be done to find out what people think about the Service and to tell them what improvements are going to be made. Please contact the provider for advice of actions taken in response to this Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 8 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Littlebourne House DS0000023469.V369215.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 Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6. People who use the Service experience good outcomes. This judgement has been made using available evidence including a visit to the Service. People who are about to move in are asked about what support they need and how they want this to be done. People who want to stay for shorter periods are helped to go back home. EVIDENCE: People who are considering moving in are asked about what support they need and want. This is done so that everyone can be confident that moving into Littlebourne House is the right thing for them. The Annual Quality Assurance Assessment recognises the importance of this process. We looked at the sorts of things that are usually considered. These are practical and relevant. For Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 11 example, they include the help that is needed for the person to use the bathroom in safety and comfort. Also included is an account of their general health and the medication they take. The Manager then tells care workers about this information so that they know what to do from the start. We asked three care workers about how this all works out in practice. They say that the system works well and that they know about the support they will need to provide as soon as someone comes in. Some people stay for shorter periods of time. This can be on a planned basis or as a one-off. These shorter stays might be because they have been in hospital and are not yet ready to go home. Or, it might be so that a carer can have time to themselves. The Registered Providers say that careful attention is given to helping people to go back home so that their stays do not last longer than is necessary. Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. People who use the Service experience good outcomes. This judgement has been made using available evidence including a visit to the Service. People are provided with the personal and health care they need. Medicines are dispensed in the correct manner. People are treated with respect. EVIDENCE: The people who live in the Service say that the care workers offer them all the assistance they need. There is a written individual plan of care for each person. These are important because they are one of the ways that people can say what assistance they want to have and how they want it to be done. Also, the plans give information to staff so that they know what to do. We looked at five of these plans. They give a clear account of who needs to do what and why. For example, there is useful information about things such as helping people in Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 13 the bathroom, about health care and about keeping people safe. We asked three care workers about some of these requirements to check out their understanding of what the plans say needs to be done. They have a good knowledge. For example, they know about one person who is not able to get out of bed and who has some sore areas on their skin. They know about another person who needs to be encouraged to drink regularly and about someone else who can become anxious and who needs re-assurance. The plans are kept up to date so that they are accurate. This includes a monthly review. At the moment, these monthly reviews do not actively involve each of the people who live in the Service. The Registered Providers are going to look into this so that people are more clearly invited to take part. Sensible steps are taken to ensure that people do not have any avoidable accidents. For example, bed rails can be fitted so that someone doesn’t roll out of bed. The Manager considers this carefully before fitting the rails. This is because bed rails can sometimes make a problem worse if they are used at the wrong time. People are helped to stay healthy. Care workers keep a tactful eye open so that medical assistance can be sought if someone is becoming unwell. Since our last inspection, a number of people have seen their doctors, some on more than one occasion. There have also been consultations with professionals such as district nurses and dieticians. One person needs to use a special mattress that helps people who are prone to having sore skin. The mattress was ordered from the local health service. When it was delivered after several weeks, there was a misunderstanding between staff in the Service. This resulted in the mattress not being used for a short time after it had arrived. The Registered Providers have looked into how this delay occurred. As a result of this, they have made several improvements. These should ensure better communication between the staff team about when things arrive and who they are for. They already own one of these special mattresses, but this was being used at the time by another person. The Registered Providers are now going to buy another one. This means that in future they won’t have to wait for one to be delivered from the local health service. This should make the whole thing easier to manage. None of the people manage their own medication. The Manager says that people will be assisted to do this if this is their wish. There is a system to check that the correct medicines are received from the chemist. Once in the Service, they are stored securely. There is a procedure for administering medicines that is designed to double check that the right medicines are given to the right people at the right time. There is a record that is completed on each occasion that a medicine is dispensed. We examined three sets of these records. They are correctly completed. We looked at three medicines in more detail to see if Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 14 the remaining stock matched what should have been there. Again, we found things to be in order. We asked five people what they think of the care workers. They praise them saying that they are courteous and attentive. One person summarises the general mood when they say that they are “perfectly happy” with their home and with the assistance they receive. One of the visitors we spoke with said, “the home is wonderful, my dad gets all the care he needs, The staff do everything for him. They make sure that he has drinks and that he is tried to be moved in bed. I’ve no complaints at all with his care and I come here three times a week”. Care workers are relaxed and informal in how they are. They chat with people about everyday things. There are little kindnesses to note. For example one person had their shoe laces undone and might have tripped on them. A care worker noticed this and offered to do them back up. We also noted how people are assisted to use the bathroom in a private manner. They are quietly helped to leave their armchairs. Once in the bathroom the door is closed to give them privacy. People are helped to wear neat and clean clothes so that they can present themselves as they wish. People are given their post promptly and they have the use of a telephone. Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. People who use the Service experience good outcomes. This judgement has been made using available evidence including a visit to the Service. There are social activities for people to do. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. EVIDENCE: There is an activities coordinator. She organises a range of activities that people can choose to join in if they want. These include things like artwork, needlework and various games. Some of the activities are in small groups. Others involve one to one activities with people who prefer to be on their own. These things include doing hand massages and just having a cup of tea and a chat. One relative told us, “I think that it’s really good the way that (the activities coordinator) sees my dad. She doesn’t just write him off because he’s so frail and can’t really respond. No, she comes in now and then and does a hand massage with him and talks to him even though there is no reply”. Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 16 We asked three people what they think about the activities and they say that there is enough going on. When we were in the Service some people were in their bedrooms where they were watching television, reading and so on. Others were in the conservatory. Some were watching the Olympics on the big screen television, some were chatting with each other and others were speaking with visitors. There was a lively atmosphere. Later in the day there was a visiting accordion playing old time tunes. The activities coordinator says that she is about to consult with each person to see what new activities they might like to do. She has some good ideas. She hopes to have the use of a new people carrier quite soon. The Registered Providers plan to buy the vehicle in the near future so that it is easier to arrange trips out. People are helped to keep in touch with members of their families, if this is necessary and if it is their wish. Family members and friends are welcome to call to the Service at any reasonable time. The Service keeps in touch with family members so that they know how things are going. One relative said to us that, “Maralyn (one of the Registered Providers) is absolutely wonderful. Nothing is too much trouble and she keeps in touch with me all the time to tell me how dad is doing. The girls too are so kind and they really care, not like it’s just put on because they have to”. The Annual Quality Assurance Assessment says that people are encouraged to make their bedrooms their own. For example, they can bring personal things in with them like small items of furniture, ornaments and photographs. We saw plenty of examples of all these in the bedrooms we looked at. People say that they receive good quality meals and that they have enough to eat. They consider meal times to be a relaxed and pleasant affair. People can have a cooked breakfast if they want or they can have things like cereals and toast. The main meal of the day is lunch. This is a set meal, but people can have something else if they prefer. There is a cooked tea and people can have sandwiches if they want. The records of the meals actually served at lunchtime are not detailed enough for us to know how often people are actually choosing an alternative to the main dish. The Registered Providers are going to make sure that the record is now more detailed so that we can tell who is having what. The overall menu does provide people with a normal healthy diet. People can dine in their bedroom if they want to. Special diets can be met. Also, some people are helped by having their food cut up into smaller pieces to make it easier for them to manage. Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 17 Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. People who use the Service experience good outcomes. This judgement has been made using available evidence including a visit to the Service. There is a system for sorting out complaints. People are helped to stay safe. EVIDENCE: There is a written complaints procedure. This explains how the people who live in the Service and other people can go about raising a concern. We asked two people about how free they feel to raise a concern with the Registered Providers or with other members of staff. They say that they are confident to approach them. They also say that there was no need to do so at the moment, because they do not have any concerns. These views were repeated in the questionnaires that we received. Since our last inspection, we received a complaint from a relative of someone who stayed in the Service for several weeks. The complaint concerned a number of things to do with the personal support provided. We asked the Registered Providers to look into the matter and to tell us their conclusions. Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 19 They did so in a prompt and thorough manner. We don’t think that there is any need for us to make any further enquiries. There is a written statement of the Registered Providers’ commitment to making sure that the people who live in the Service are safeguarded from being abused in any way. For example, this might involve being bullied or taken advantage of in some way. We asked three care workers about this matter. They have a good knowledge of things to look out for that might be a cause for concern. None of them have any concerns about how things are going. At the moment, Kent County Council is looking into some concerns that have been raised by the local district nursing service. They have been passed to the Council because it takes the lead when there are concerns about the wellbeing of people who live in residential care settings. We understand that the Registered Providers are cooperating fully with the Council’s investigation. They have told us that they will implement any improvements that may be suggested as a result of the investigation. The people who live in Littlebourne House say that they feel safe there. Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 22, 25 and 26. People who use the Service experience good outcomes. This judgement has been made using available evidence including a visit to the Service. The accommodation in general is homely and comfortable. However, bathrooms and toilets are rather bare. There are aids to help people who have problems getting about. EVIDENCE: On the outside, the building is well maintained. On the inside, the accommodation including the bedrooms is homely. The decoration and the furnishings are of a good standard. However, the bathrooms and the toilets are Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 21 clean but rather bare. More could be done to make them into welcoming spaces. The premises are fitted with an automatic fire detection system. This provides a high level of fire safety protection. It is understood that the Kent Fire and Rescue Service says that the system meets the national standard. The Registered Providers have prepared a fire risk assessment. This has been done to make sure that there is nothing that might reduce the level of protection in place. The assessment is due to be updated in October 2008. After this is done, the Registered Providers are going to send it to the Kent Fire and Rescue Service. This is so that it can check that overall system is still okay. The local Department of Environmental Health inspected the kitchen at the end of 2007. It gave the Service three stars out of a possible five. It said that two minor things needed to be put right. One of them was the need to put up fly screens at doors and windows. This has since been done. The other thing was the need to replace a fridge that has rusted a bit around where the seal is. The cook says that the fridge in question is still serviceable but that it is going to be replaced soon. We looked at the records in question and we found them to show the cold storage to be working alright. The kitchen is well equipped, clean and well organised. The cook does sensible things to ensure good food hygiene. For example, once food is opened it is covered. Then a date is written on it to make sure that things are not allowed to hang around for too long. People who need it are helped to get about. There are banister rails in corridors. At key places there are assistance poles. These are fitted to the wall and they are there for people to hold onto for extra support. Help is also given in the bathroom. Some of the baths are fitted with hoists that swivel so that it easy to get on and off. Others of them have fixed rise and fall seats. There is a mobile hoist that can be used in the bedrooms. There are various other things such as slide sheets. These are helpful when people are being assisted to move in bed. There are also handling belts that can be used to help people steady themselves when getting up and sitting down. We asked people how warm the accommodation is kept. They say that they are always comfortable even during the coldest weather. The radiators in the bedrooms are not fitted with guards. The Registered Providers intend to fit these in the neat future. This will be done so that there are no heated surfaces that might burn someone. The hot water taps are fitted with thermostatic valves. These are designed to reduce the temperature to a level that is not likely to scald someone. The laundry has a commercial grade washing machine. This has an extra cycle for items that need an especially hot wash. There is also a large dryer. The laundry is organised and clean. The Registered Providers say that the Service complies with new regulations designed to prevent used water from leaking back into the main pipe-work. Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 22 Littlebourne House DS0000023469.V369215.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. People who use the Service experience good outcomes. This judgement has been made using available evidence including a visit to the Service. There are enough staff around. There are some shortfalls in the recruitment system. Care workers know what they are doing. EVIDENCE: During the day and evening there are at least four care workers on duty. There is always someone in charge. At night there are three care workers on waking duty. Each day there is a cook on duty and various housekeepers. Care workers generally say that there are enough staff on duty. However, two of the questionnaires we got back say that some shifts can be short and that care workers then have to rush a bit. The Registered Providers will need to keep this under review. People who live in the Service think that they get all the care they need. We asked about things such as how long it takes to respond to the call bells. People say that these are answered without too much delay and we saw them being answered promptly when we were there. Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 24 The Registered Providers complete a number of security checks on new care workers. These include things such as confirming their identity and doing a police check. This is done to ensure that they are trustworthy people who are suitable to have unsupervised access to the people who live in the Service. We looked at the records for two recently appointed care workers. Most of the checks have been completed. However, for both of them the employment histories do not give a full account of what work they have done. This means that we cannot be sure that all of the necessary references have been requested. We do know that two references for Care Worker A are missing. The Registered Provider says that these shortfalls will be put right by 1 October 2008. New care workers receive introductory training before they work on their own. We asked two care workers about their introductory training. They say that it was very useful. They say that they were introduced to the people who live in the Service and that they were told about each person’s needs for support. After their introduction, care workers are provided with ongoing training. This is designed to develop further their ability to provide a high quality residential care experience. We looked at some of the records of this extended training provided for care workers. These show that care workers have done training in relevant things such as first aid, food hygiene, helping people to move about safely and on keeping people safe. The training is being done using a resource pack. This involves care workers watching dvds, discussing issues and receiving advice. Then they complete tests to see what they have learnt and what more they might need to learn. We think that this sort of hands-on training is a very good idea indeed. This is because it is directly related to the needs of the people who live in the Service now. There is a total of 19 care workers. Of this number, 16 have completed a National Vocational Qualification at Level 2 in health and personal care. This qualification is important because it helps care workers deliver high quality residential care services. We spoke with three care workers in some detail to find out about their knowledge and skills. They know a lot about how each of the people who use the Service like to be supported. They also know about important points of detail. For example, they know about helping older people to take care of their skin, about how some people communicate by what they do as well as by what they say and about the important contribution good hygiene makes to health and safety. Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38. People who use the Service experience good outcomes. This judgement has been made using available evidence including a visit to the Service. Things are well managed. People are asked what they think, but this needs to be a little more organised. People are helped to buy what they want. A part of the fire safety regime needs to be strengthened. EVIDENCE: The Registered Providers and the Office Manager divide up their responsibilities. One of the Registered Providers is a qualified nurse. She works Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 26 with the Manager to oversee the personal care provided in the Service. The other Registered Provider deals with money things and sorts out the buildings. The Office Manager makes sure that various records are up to date and in general coordinates things. When we need to ask something, it’s normally the Office Manager who we deal with. This is because she’s best placed to get all the information together. One or both of the Registered Providers is in the Service on most days. When we ask them points of detail about all sorts of things to do with the Service, they know the answer without having to fish around. This is a sign that they know what’s going on. The care workers say that there is good team work between them. There are handover meetings at the beginning and end of each shift. These are held so that care workers can be kept up to date with developments. There are team meetings every now and then. We looked at the records of the last one. They show that useful things are being considered such as how to handover information between shifts in an effective manner. The care workers meet every now and then with the Manager. This is so that they can talk about their work and about how things are going in general. In their questionnaires, members of staff say that they are well supported by the Manager who is east to talk to. Several things are done to ask people what they think about their home. These include informal discussions as part of daily life. The people who live in the Service and their relatives are invited to complete questionnaires about once a year. We looked at the most recent questionnaires. There were 14 of these. They show that people are quite happy with how things are going in the Service. There are no criticisms as such. The questionnaires that we got back largely say the same thing. There are some shortfalls in the consultation arrangements. Members of staff are not included. Also, there is no organised system to tell contributors what is going to be done to respond to any improvements that they may have suggested. The Registered Providers say that the system will now be strengthened. This will be done in time for us to be told about it when they send us their next Assessment in 2009. The Registered Providers help most of the people to manage their personal spending monies. They have been asked to do this by the people concerned. It involves them keeping a float that is then used to pay for things such as newspapers and seeing the hairdresser. There is a record kept of each transaction. We looked at one set of these. They added up correctly and the total matched the cash balance remaining in the float. There were receipts that showed that the purchases said to have been made had been made. Regular checks are completed to ensure that the Service’s fire safety equipment remains in good working order. This includes a weekly test of the fire alarm bells. More detailed periodic checks are completed by a contractor. There are fire drills and members of staff have regular fire training. This is Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 27 done so that everyone knows what to do if there is a real fire safety emergency. There are up to date reports from engineers about the gas appliances and the electrical wiring. These say that they are safe to use. The bath hoists and seats we mentioned earlier are being checked and serviced regularly. We looked at the record of accidents that have occurred in the Service since the last inspection. Most of them are minor slips and bumps that are to be expected. There is nothing in the frequency or in the nature of the accidents that causes us concern. The Registered Providers check the premises and the accommodation to ensure that there are no hazards that might cause someone to have an accident. We looked at the records of the most recent check. These show that sensible things are being looked at. For example, things like trailing leads and slippery floors are examined to help prevent falls. The Registered Providers say that there are no obvious hazards. We didn’t notice any. Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 28 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 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 29 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Littlebourne House DS0000023469.V369215.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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