Inspection on 13/12/07 for Littlefair

This inspection was carried out on 13th December 2007.

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

Littlefair 10/12/08

Littlefair 12/10/06

Littlefair 17/01/06

Littlefair 05/09/05

Littlefair 10/02/05

Littlefair 12/07/04

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Littlefair Warburton Close East Grinstead West Sussex RH19 3TX Lead Inspector Judy Gossedge Key Unannounced Inspection 13th December 2007 10:15 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 Littlefair DS0000014612.V354718.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. Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Littlefair Address Warburton Close East Grinstead West Sussex RH19 3TX 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) 01342 318008 01342 300017 sue.dorman@littlefair.net www.littlefair.net Mr Robin Christopher Sherard Kennedy Mrs Orosia Lilianne Kennedy Mrs Susan Dorman Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41), Physical disability (3), Physical disability of places over 65 years of age (3) Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Up to 3 persons in the category physical disability (PD), age 60 years and over requiring personal care may be accommodated. Up to 3 persons in the category pysical disability elderly (PD(E)) requiring personal care may be accommodated. No more than a total of 41 service users may be accommodated. Date of last inspection 12th October 2006 Brief Description of the Service: Littlefair is a privately owned care home providing personal care and accommodation for 41 older people for long term care or respite care. Littlefair is purpose built, and situated in a residential area close to East Grinstead town centre, shops, train station and other amenities. There are gardens to the front and side of the building and a central secluded garden area. There is a large car park at the rear. Service users accommodation consists of forty-one single rooms arranged on three floors of the property accessible by lifts. Communal space is provided in two lounges and a dining room on the ground floor. The service provides prospective service users with a copy of the homes brochure and a welcome pack, which includes the homes’ statement of purpose and service users guide. The range of fees charged at the time of the Inspection is from £351.00 to £551.00 per week. Additional charges are made for hairdressing, chiropody and newspapers. Intermediate care is not provided. Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced Inspection took place over six and a half hours on 13 December 2007. The Manager had been asked to complete an Annual Quality Assurance Assessment (AQAA) and this was received just after the Inspection and information from the AQAA has been quoted in this report. A tour of the premises took place to look at communal areas and a selection of service user’s bedrooms and care records were inspected. Thirty-nine service users were resident and seven service users were spoken with individually in their bedroom or communal areas and a number were spoken to as part of the Inspection process. The care that four of the service users received was reviewed. The opportunity was also taken to observe the interaction between staff and service users in the communal area. Fifteen service user surveys were sent out and fourteen came back completed. Five care workers, the catering manager/ cook, the housekeeping manager and two members of the housekeeping team; the maintenance person, the activities co-ordinator, two team leaders and the deputy manager were all spoken with. The Manager was not present during the Inspection, but was spoken with after the Inspection. Seven relative’s surveys were sent out and all came back completed. Two relatives were spoken with during the Inspection. What the service does well: The home provides service users with a homely, relaxed and caring environment. Service users are enabled where possible to exercise choice and control over their lives whilst resident in the home. Staff was observed to deliver care with dignity and respect. Four service users spoken with felt the care provided respected their privacy and dignity. Ten of the service users surveys stated they always received the care and support they needed, three usually and one sometimes. Relative’s surveys stated service users always or usually received the agreed care and support and met service users different needs. Comments received from service users and their relatives were, ‘this is the best home I looked at and I am very happy and comfortable here,’ staff are very good through the night,’ ‘plenty to do in the home,’ ‘happy here,’ I am very happy here.’ ‘very caring and understanding,’ usually very kind and helpful,’ ‘I have had a wonderful time, good care and attention and all the staff are so friendly,’ and ‘they are very caring.’ Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 6 Regular activities are being organised for service users during the week with opportunities for service users to socialise with their relatives/representatives at events arranged in the home. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, and 6. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is detailed information available for service users and/or their representatives to view. Potential new service users are individually assessed prior to an admission to ensure that their care needs can be met in the home. EVIDENCE: The Statement of Purpose, Service User’s Guide and a copy of the last Inspection report are available to read in the home. Some service users were receiving respite care at the time of the Inspection and the care to be provided should be detailed in these documents. The Manager subsequently stated that these documents had both been recently reviewed, but that this information had now also been included. Twelve of the service users surveys stated they had received enough information about the home and one had not. Comments received were, ‘I came to visit with my social worker, I stayed to lunch, met the staff and other service users, and also met the activities lady,’ ‘I was also Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 9 introduced to the activities lady,’ ‘I came to visit my room for myself and I met some service users and the staff,’ ‘I came with my family,’ ‘looked around home but learnt more when I moved in,’ ’a relative looked around on my behalf and chose this one, ‘ ‘I came with my niece to look around,’ ‘ I feel lucky to be here,’ and ‘my daughter visited.’ Four relatives surveys stated that they felt they always received enough information about the home and one usually. The AQAA details that the service users contract/terms and conditions were updated this year. All of the service users surveys stated they had a contract and the documentation viewed for three new service users resident in the home had a completed contract in place. The deputy manager stated that the Manager, or the deputy manager visits service users prior to any admission. This is to ensure individual service user’s care needs can be met in the home and to provide staff with information on the care to be provided. A pre-admissions assessment format is in place, and for three new service user admitted to the home since the last Inspection there was detailed pre-admission information viewed, which had been completed. For service users referred through a local authority a copy of the care assessment and care plans are also obtained. New care workers receive an induction and attend mandatory training. There are policies and procedures in place for staff to reference. There is a programme for National Vocational Training (NVQ). Intermediate care is not provided in the home. Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users are protected by a detailed individual plan of care being in place, where all their personal, social and health care needs are identified and which informs staff of the care, which needs to be provided and with supporting risk assessments completed. But it must be ensured that staff has received adequate detail at the start of a service users residency in the home. Medication policies and procedures are in place and staff that administer medication have received training. EVIDENCE: Eight of the service users individual care plans were viewed. Six of these were very detailed and gave clear guidance to staff of the care to be provided, service users health care requirements, dietary needs, social and leisure interests. Supporting risk assessments were also viewed and where there are any identified risks the recording detailed how these will be managed. For two Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 11 new service users the care plans and risk assessments had not been fully completed and both had been resident in the home for a number of weeks. This was discussed with the Manager who stated this should be completed on admission and that this would be rectified with immediate effect. So a Requirement has not been made on this occasion. All these documents had been reviewed, but for a number the monthly updates had not been maintained. The Manager stated she was aware that these updates were behind and felt this would be addressed with the further recruitment of staff to work in the home. All service users are registered with a local General Practitioner (GP) and have access to other health care professionals, including district nurses, via the surgeries. It was noted, in care plans that were examined, that appointments with or visits by health care professionals are recorded. Thirteen of the service users surveys stated they always received the medical support they need and one usually. Comments received were, ‘ I was taken to hospital for appointment by staff, who were kind and good,’ ‘the staff were very good when I am ill,’ ‘I had a horrible cough and the carers called the doctor for me in the night,’ ‘staff will always arrange a GP if needed,’ ‘does not need a GP very often, but staff would call GP if needed as staff are kind and caring,’ and ‘only have to ask for a GP and team leader will arrange this.’ Service users spoken were asked about access to a GP, chiropodist optician or a dentist. Not all had required these services, some they stated they had accessed these services. The AQAA details that medication policies and procedures are in place and are regularly reviewed. Medication is stored in locked facilities and sample of the recording of medication administered was viewed. The Manager agreed to review and risk assess the storage of medication which is required to be kept in a refrigerator to ensure the safety of service users. Staff confirmed a pharmacist regularly visits, but the records to support these visits were not viewed on this occasion. Staff spoken with who administered medication all confirmed they had received medication training and the Manager subsequently stated she had recently attended an advanced medication course. The AQAA details that staff is due to receive a further training update. All the service users feedback was that they felt that their medical care needs were met in the home. Staff was observed to deliver care with dignity and respect. Four service users spoken with felt the care provided respected their privacy and dignity. Ten of the service users surveys stated they always received the care and support they needed, three usually and one sometimes. Relative’s surveys stated service users always or usually received the agreed care and support and met service users different needs. Comments received from service users and their representatives were, ‘this is the best home I looked at and I am very happy and comfortable here,’ staff are very good through the night,’ ‘plenty to do in the home,’ ‘happy here,’ I am very happy here.’ ‘very caring and Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 12 understanding,’ usually very kind and helpful,’ ‘I have had a wonderful time, good care and attention and all the staff are so friendly,’ and ‘they are very caring.’ Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Where possible service users are enabled to exercise choice in their lives whist resident in the home, there are opportunities to participate in social and recreational activities provided, service users are encouraged to maintain contact with family and friends as they wish and a varied diet is provided. EVIDENCE: Service users social interests are recorded on their individual care plans and a regular programme of activities is arranged in the home, copies of which was seen to be around the home for service users to reference. On the day of the Inspection two service users had attended the neighbouring schools Christmas festivities, and following which a group of service users participated in light exercises to music and an activity with a ball. There was a pleasant atmosphere and good interaction between staff and service users was observed. Six of the service users surveys stated activities were always arranged, seven usually and one sometimes. Comments received were, ‘ I enjoy taking part in many activities, but not all of them,’ ‘I occasionally join in Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 14 the activities with the ones I like,’ ‘I quite often join in,’ ‘I choose to take part in activities,’ yes if I want to. I spend a lot of time in my room,’ ‘I join in the games and the quizzes that I enjoy,’ ‘not really interested,’ yes, lots I want to join in,’ ‘In go on the outings,’ ‘I enjoy my own company, but I do take part when there are parties and entertainment arranged,’ and ‘activities held on a regular basis if so wish to join in.’ The AQAA detailed that this is an area which is planned to be developed over the next twelve months to provide activities at the weekend with the recruitment of volunteers to facilitate this. The service users and relatives spoken with on the day confirmed there was flexible visiting, that staff are very welcoming and they could see their relative/visitor in private if they wished. Two relatives surveys stated the home always helps the service users to keep in touch, three usually and two stated the question was not applicable. The care and support provided was observed to enable service users where possible to exercise choice whilst at Littlefaire. Six service user files viewed, staff and the service users spoken with and relatives feedback confirmed this. The catering manager who is one of the two cooks who works in the home was spoken with. He stated he works four days a week and holds an advanced food hygiene certificate. A rotating four-week menu is place, which the catering manager stated has been seasonally varied, takes into account service users likes and dislikes and was seen to identify that choices available at all meals. Lunch on the day was homemade soup, pork chops in cider and applesauce with creamed potatoes and mixed vegetables, or chicken and spinach curry and rice, followed by mincemeat tart and cream or tapioca pudding. Special diets are catered for. Service users were observed being assisted with their lunch in the dining room and it was a relaxed environment taking into account the different length of time that individual service users would need to finish their meal. Fresh fruit and flowers were arranged on the dining room tables. Records are kept of food consumed individually by each service user to ensure they are receiving an adequate diet. Nine service users surveys stated they always liked the meals and five usually. Comments received were ‘the chef is very good, nice food and pleasant and smart dining room like a three star hotel,’ ‘ I think they are excellent,’ ‘excellent, very goods choice,’ ‘ enjoys all the meals. Good choice of menu,’ ‘meals are well presented and enjoys what you eat,’ ‘good varied menu and two choices per meal,’ ‘I think the meals are great,’ ‘I enjoy as much as I can eat, when it is something I like. I only enjoy certain vegetables,’ and ‘meals are very good, I always have a large choice.’ Further comments received were that the food could be difficult to eat for those who find chewing a problem particularly tough meat and undercooked vegetables. This was discussed with the deputy manager who confirmed an awareness of these concerns, which had been raised through the homes own quality assurance process and stated that work had already been undertaken and was ongoing to try to address this, particularly with individual service users. A further comment was received that Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 15 it was felt that better seating arrangements at lunchtime to enable conversation between service users would make meal times more enjoyable. This comment was passed to the deputy manager. Staff confirmed that the home had recently been visited by an Environmental Health Officer and stated they were in the process of addressing issues raised. Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place to enable service users or their representatives to raise any concerns about the care being provided and to ensure that service users are protected from abuse, but it must be ensured these are followed. EVIDENCE: There is a detailed complaints policy and procedure in place. The deputy manager stated that one complaint had been received at the home during the last year and was in the process of being investigated. The CSCI have not received any concerns in relation to the care provided at Littlefair. Twelve service users surveys stated they always know who to speak to if they are not happy and two usually and fourteen stated they know how to make a complaint. Comments received were, ‘I would go to the manager to sort it out,’ ‘I would refer to my handbook and seek advice,’ ‘follow home’s policy and procedure,’ and ‘refer to my handbook.’ Five relatives surveys stated they knew how to make a complaint and two could not remember. Three felt the home always responded appropriately to concerns, three usually and for one the question was not applicable. Comments received were, ‘usually very Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 17 good,’ and another commented when asked what the home does well, ‘listen to any complaints.’ The AQAA detailed are policies and procedures are in place in relation to the protection of vulnerable adults. All staff spoken with confirmed they had attended this training and demonstrated an awareness of the policies and procedures. Staff recruitment procedures must ensure that no staff member is engaged to work in the home until a POVA First/CRB clearance check has been returned. Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 and 26. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is decorated and furnished in a homely style. The maintenance plan and ongoing work to refurbish and improve the facilities in the home ensures that the standard of the environment continues to be maintained and improved. EVIDENCE: Littlefaire is a detached property situated in a residential area of East Grinstead. A tour of the building was made. The home is decorated and furnished in a homely style. There was some evidence of wear and tear. The Manager subsequently confirmed an awareness of this and stated there is an ongoing maintenance programme in place in the home and improvements planned to ensure the continual improvement of the environment. The AQAA Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 19 details plans for the next twelve months includes the re-design of the quadrangle garden to make it more attractive, and interesting and accessible to wheelchair users, to install a covered smoking shelter for the use of service users and staff and the re-decoration of the main corridors and communal areas. There are forty-one single bedrooms on all floors in the home. A number of bedrooms were viewed and displayed service users individual styles and interests. All bedrooms have an emergency call bell system. Twenty-three of the bedrooms have en-suite facilities of a toilet and wash-hand-basin and two also have a shower and one a bath. Bathroom facilities are provided throughout the home. The homes recording of the testing of the hot water temperatures was viewed and detailed that water at the bath outlets accessed by service users is being maintained at close to the recommended safe temperature of 43 º C. Hot water outlets at the sinks accessed by service users are currently only checked yearly and the Manager subsequently agreed to seek advice from the Environmental Health department as to the frequency of checks required. So a Requirement has not been made on this occasion. Four service users spoken with confirmed there is adequate heating and hot water in the home. The home has two passenger lifts, one which services all three floors and the other is available from the lower floor to the second floor. There is are two lounges, and a dining room on the ground floor and new lounge chairs have been purchased since the last Inspection. Several comments were received raising concerns about the security of the front door to the home. This was discussed with the Manager who stated there had been a problem with the front door lock and the wrong part had been received to mend this. But that this was due to be resolved imminently and that further security measures had been put in place during this period. There is an attractive garden for service users to access and a separate wildlife garden. The AQAA details that there is a policy in place for managing infection control and that Department of Health Guidance has been used to assess current infection control management. The home was clean and free from offensive odours at the time of the Inspection. Comments were received that there is a strong odour in the downstairs corridor. This was not evident during the Inspection, but was discussed with the deputy manager who confirmed an awareness of this and that work had been undertaken to resolve this issue. Feedback from the service users, relatives and visitors to the home was that the home was always or usually fresh and clean. Comments received were, ‘my room is thoroughly cleaned every day,’ ‘my room is kept clean,’ ‘perfect my room is always lovely,’ ‘very clean and well kept,’ ‘very clean and Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 20 comfortable,’ ‘very happy and loves room,’ ‘my room is cleaned and tied every day,’ my room is cleaned daily,’ and ‘pretty good.’ One relative stated when asked what the home does well, ‘Littlefair always looks nice. It is clean and welcoming, with fresh flowers in the dining room on all the tables.’ Two domestic assistants and their manager were spoken with and who all stated they had received training/guidance in infection control or the control of substances hazardous to health (COSHH) and that there was good access to protective clothing. Recording was viewed of routine fire checks that had been carried out in the home. Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Further staff recruitment is in process to improve the continuity of staffing in the home. A robust recruitment procedure needs to be in place to ensure service users are in safe hands at all times. Care workers are being provided with training to ensure they can meet the care needs of the service users. EVIDENCE: Staff spoken with and rotas viewed confirmed that six members of care staff are deployed to work in the home during the morning and five during the afternoon. The Manager and deputy manager were not working in the home at the time of the Inspection, although the deputy manager came in to assist with the Inspection process. At night the home deploys three ‘waking night,’ members of staff. Ancillary staff are employed to cover domestic, housekeeping, maintenance and administrative tasks in the home. Fourteen service users surveys stated the staff listen and act on what you say and nine service users surveys stated staff always available when you need them and five usually. Comments received were, ‘the staff always answer the call bell as quick as they can. My requests are always dealt with,’ ‘the staff are well Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 22 organised and listen when I need them,’ ‘staff are very good and always listen,’ ‘staff are very understanding and very good,’ ‘very happy with the staff as they always listen to what I have to say,’ ‘definitely,’ ‘I am always listened to,’ ‘they are very good,’ ‘yes they are very helpful,’ only ring the bell if I need as staff are always on hand,’ ‘If I ring the call bell a carer always comes to see what I want and I am not left there waiting,’ and ‘they come as soon as they can day/night.’ A number of comments were also received raising concerns that due to staff being so busy not all service users care needs were always met. One comment related to night staffing that it was felt a positive response was not always received when asking for assistance. This was discussed with the Manager who stated that it had been a difficult period for staffing in the home, which had lead to a high use of agency staff, but that where possible the same agency staff were requested to try to maintain some continuity. A further three care workers were in the process of being recruited to work in the home, which should help address this issue. That staffing ratios are based on the Residential Forum’s staffing model, with staffing ratios automatically generated by computer on a daily basis from actual hours worked, which is reviewed weekly. The Manager also agreed to review the staffing levels maintained in the home when staff are taking their breaks to ensure adequate numbers of staff remain on duty to meet individual service users needs. The deputy manager confirmed that of the twenty-one staff twelve care workers holds an NVQ Level 2 in care or above and this equates to 57 of the care staff. Two care staff are currently enrolled to work towards this qualification. A thorough recruitment process was not demonstrated to be in place and as detailed in the AQAA. The documentation was viewed for three new members of staff, all of whom had been recruited since the last Inspection. The recruitment practice evidenced to be in place, included the completion of an application form, two written references and a completed a CRB/and a Pova First check. For two staff it was not evidenced that a Pova First check had been received prior to staff commencing work in the home. The Manager subsequently stated that for one she had received a verbal acknowledgement that a satisfactory check had been completed and agreed a record of this should have been recorded. But for the second the check had not been received. The AQAA details that induction training is in place and that this meets the requirements of the General Skills for Care induction standards. Documentation for two of the new members of staff evidenced the completion of an induction for the third it was stated this was in the process of being completed and two new members of staff spoken with confirmed the completion of an induction. Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 23 Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home benefits from a Manager who ensures an open, supportive, homely and caring environment. Quality assurance systems have been developed to enable ongoing feedback about the care provided in the home. EVIDENCE: The Manager has been in post for over nine years and previous Inspections have identified that the Registered Manager has the required qualifications and experience to run the home. The Manager subsequently confirmed that she has undertakes regular training to update her knowledge skills and competence and that she is a qualified NVQ and Manual Handling Assessor. Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 25 A quality assurance system is in place. It was evidenced that feedback about the service provided has been sought from service users/representatives through service users meetings and surveys. The AQAA detailed that following service user feedback it was planned to increase the frequency that service users meetings are held, and that a regular newsletter is also due to be reinstated and circulated to inform service users/representatives about issues relating to the home. Records of the last service users meeting and the outcome of the quality assurance process were viewed. The AQAA detailed that policies and procedures are in place and had been reviewed. Visits to meet the requirements of Regulation 26 are made and records of the last two visits were viewed. Where a small ‘float’ of money is held for some service users and the financial records to support this activity were adequate. None of the service users spoken with had used this facility. All staff spoken with and the sample records viewed confirmed that individual staff supervision occurs on a regular and ongoing basis and there were regular staff meetings. Staff spoken and the sample records viewed detailed they had attended or were due to attend an training/update in moving and handling, first aid, and basic food hygiene training and spoke of good access to training opportunities. The Manager subsequently stated that she had attended a ‘train the trainers’ course and facilitated most of the training for staff in the home, but that external trainers were also accessed for first aid training and some medication training. It was not possible to view all the record and evidence if all staff had received the required training and the Manager stated that it would be ensured that this information is available for the next Inspection. The AQAA detailed that the maintenance of equipment and services has been carried out. A fire risk assessment is in place and had been reviewed and records were viewed to evidence that regular health and safety/fire check of the building had been undertaken and recorded. Detailed records evidenced that day and night staff attended fire training and there are also fire drills facilitated in the home. All of the staff spoken with confirmed attendance at this training, but one care worker had not attended a fire drill. This was discussed with the Manager who stated that a further fire drill was already booked and she would ensure all staff had attended. Samples of accident records were viewed and were detailed. Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 19 (1) (b) (i) Requirement That staff do not commence working in the home until a CRB/Pova First check have been received. This is to protect service users. Timescale for action 14/12/07 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 Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Littlefair DS0000014612.V354718.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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