Inspection on 31/07/06 for Loran

This inspection was carried out on 31st July 2006.

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

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

Other inspections for this house

Loran 16/07/08

Loran 26/07/07

Loran 25/01/06

Loran 13/06/05

Loran 25/11/04

Loran 29/06/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Loran 106a Albert Avenue Anlaby Road Hull East Yorkshire HU3 6QU Lead Inspector Eileen Engelmann Key Unannounced Inspection 31st July 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 Loran DS0000000861.V306046.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. Loran DS0000000861.V306046.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Loran Address 106a Albert Avenue Anlaby Road Hull East Yorkshire HU3 6QU 01482 355996 01482 571230 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) Sandco 1(T/A Hill Care Services) Ms Brenda Johnson Care Home 35 Category(ies) of Dementia - over 65 years of age (35), Old age, registration, with number not falling within any other category (35) of places Loran DS0000000861.V306046.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To admit one male service user under 65 years in DE category. Date of last inspection 25th January 2006 Brief Description of the Service: The large old house and extension is behind the properties on Albert Avenue, Hull. It accommodates 35 older people who may have dementia, in single and double rooms (22 new singles have en-suite shower and toilet). There is a chair lift and a passenger lift, a large conservatory, a secure garden, car park, and local shops, health services and pubs near by. The home is on a bus route to the city centre. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home. A copy of the latest inspection report for the home is on display in the entrance hall of Loran. Information given by the manager on 11/05/06 within the Pre-Inspection Questionnaire indicates the home charges a fee of £327.50 per week and that there are no additional charges other that those for hairdressing, private chiropody treatment, toiletries and newspapers/magazines. The home is in the process of informing residents and relatives that it intends to charge a top-up fee of £15 per person from July 2006. Loran DS0000000861.V306046.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit was carried out with the registered manager, staff and residents of Loran Care Home. The visit took place over 1 day and included a tour of the premises, examination of staff and resident files and records relating to the service. One of the staff on duty and four of the residents were spoken to; their comments have been included in this report. Information was gathered from a number of different sources before the inspector visited the home. Questionnaires were sent out to relatives, residents and staff and their written response to these was good. The inspector received 5 back from relatives (56 ), 3 from staff (27 ) and 12 from residents (80 ). The provider completed a pre-inspection questionnaire and returned this to the Commission within the given timescale. Since the last inspection (January 2006) the Social Service Team for Hull Council have received one expression of concern about the care at the home. The team went out to visit the home and the manager was asked to investigate the concerns raised. At the time of this visit the concern has been looked at and a satisfactory response given to the team by the manager. What the service does well: What has improved since the last inspection? Care plans now show how the oral and foot care needs of the residents are met, and staff recruitment procedures are up to date and the necessary employment checks are done. The above areas of practice were requirements in the last inspection report and now meet the standards. Loran DS0000000861.V306046.R01.S.doc Version 5.2 Page 6 What they could do better: The home must produce the statement of purpose and service user guide in a large print type for residents who have poor eyesight. Residents spoken to said that the staff are very good at giving them verbal information and they felt comfortable talking about the service and their needs. The home must produce a needs assessment for prospective self-funding residents as there is none in place at the moment, however the manager does go out to see all residents and all individuals in the home have a care plan. Care plans need to clearly document the needs of the residents and include input from the residents. Staff training in this area of practice has also been recommended in the report to ensure they have the skills to improve the plans. Staff practices regarding medication record keeping and administration are not safe and could place residents at risk of harm. Requirements and recommendations have been made to improve record keeping and supervise staff. Residents have asked for a wider range of activities both within and outside of the home. Staff comments also say they would like the opportunity to spend more time with the residents. Information gathered during this visit indicates that staffing numbers are insufficient at peak times of activity and may not meet the needs of the residents. The provider must ensure that enough staff are on duty at all times to give residents a good standard of life. Staff training is in place, but uptake of this has been patchy over the past year. This may affect the competency of the staff and impact on the care of the residents. The manager needs to monitor this and improve the supervision of the staff to ensure high standards of care are achieved. The inspector would like to thank everyone who completed a questionnaire and/or took the time to talk to her during this visit. Your comments and input have been a valuable source of information, which has helped create this report. Loran DS0000000861.V306046.R01.S.doc Version 5.2 Page 7 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. Loran DS0000000861.V306046.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Loran DS0000000861.V306046.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3. Quality in this outcome area is adequate. The homes needs assessment process is inadequate and does not give privately funded individuals full written assurance that their needs can be met, prior to their coming into the home. EVIDENCE: Copies of the statement of purpose and service user guide are on display in the entrance hall and available to anyone wanting to read them. Information in the pre-inspection questionnaire indicates that the statement of purpose and service user guide is not in a user-friendly format, and the manager said that she would look at producing a large print version that is more suitable for the residents with poor eyesight. Four residents were able to show a clear understanding of what services and care were on offer at the home and were satisfied that they had been given enough verbal information from the staff/manager before deciding to come into the home. These individuals said they ‘were able to visit the home before coming in and been made welcome,’ and felt comfortable talking to the staff about the service. Loran DS0000000861.V306046.R01.S.doc Version 5.2 Page 10 Checks of the residents’ personal files showed that the home has produced a statement of terms and conditions (contract for private paying residents), which meets the required standard, but this document has not been given to all residents. The manager said that this would be resolved as soon as possible and she would ensure everyone had the necessary information and signed the document. Each resident has their own individual file and four of those looked at have a full needs assessment from Social Services completed within them. The information from the assessment process is used to formulate the individuals care plan. Discussion with the manager indicated that the home does not have its own assessment format for those individuals who are self-funding, although care plans are in place for these residents. The manager must make sure that a needs assessment for the home is developed and implemented as soon as possible, which meets the criteria of standard 3.3 in Care Homes for Older People. Four residents spoken to were able to give detailed information about their care needs and the input they required from the staff, service and outside professionals, and this was found to be accurately documented within their care plans. Loran DS0000000861.V306046.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected 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. The systems for care planning and medication must be improved as they contain practices that could potentially place the residents’ health and safety at risk. EVIDENCE: Individual care plans are in place for all residents and set out the health and personal care needs identified for each person. The manager has evaluated four of the plans looked at on a 1 to 2 monthly basis, and any changes to the care being given is documented and implemented by the staff. Only one of the four plans looked at had regular entries from the individual’s key worker and had been reviewed by this person on a monthly basis. Risk assessments around moving and handling, pressure sores and nutrition have been carried out and are recorded within the individual resident’s plan. These need to be updated as some are over a year old. Additional risk assessments must be carried out, where residents have a kettle or microwave in their bedrooms, to ensure all hazards to health and safety have been recognised. One resident is using bed rails, but there is no risk assessment completed in their file. This must be done as soon as possible. Loran DS0000000861.V306046.R01.S.doc Version 5.2 Page 12 The care plans are basic and need to include detailed information about the needs and expectations of the residents; social aspects of care and the specific care being given on a daily basis. There is no evidence that the residents are able to contribute to their own care plan, other than at the yearly reviews held with the Funding Authority. Areas where the plans could be improved include having a photograph of each resident in their own file, taking out all old or unnecessary paperwork and filing this, ensuring that staff sign in full instead of initialling their entry, stop the use of abbreviations in the records and use black or blue ink when writing. Resident views and choices must be clearly documented in the plan and signatures from the resident/relative obtained to show it has been read and agreed by the individuals concerned. Discussion with the manager indicated that she is working towards developing the plans further. It is recommended that the manager access training on Care Planning so that staff have the necessary skills and knowledge to produce care plans of a high quality. Four residents said that they have good access to their GP’s, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. One resident said ‘ the district nurse comes to see me twice a week, and staff always get the GP out if I am feeling unwell’. Responses to the surveys indicated that the residents and relatives are satisfied with the level of medical support given to the people living at the home. Comments from four residents and information from the surveys indicated that there is some issues around bathing, with individuals wishing these were done more frequently. Checks of the care plans showed that individuals are only getting a general bath once a week on average. This was discussed with the manager and she assured the inspector that residents would be given the opportunity for more regular bathing. Since the last inspection (January 2006) there has been one expression of concern around the care and service provided at the home, passed onto the Social Service Team. Investigations by team and the home manager have been carried out, and all issues were resolved to the satisfaction of the resident and their family. The home uses the Nomad medication system and information from the staff surveys and discussion with the staff and manager indicate all those responsible for giving out medication have undergone basic medication training. Four of the senior staff are taking part in more in-depth training provided by Social Services, and the rest of the staff responsible for medication giving are booked to attend future sessions. Loran DS0000000861.V306046.R01.S.doc Version 5.2 Page 13 Checks of the medication records and the system used showed that documentation in these could be improved. ∗There is a need to introduce positive identification of residents (photographs of the individuals) as a safe practice measure. ∗Where staff are hand writing medication onto the sheets (transcribing), they are not following best practice. Staff must include the amounts of medication received or brought forward, and have two staff sign the entry to indicate they have both witnessed that the information on the sheet is correct. ∗Staff must ensure that all medication received from the pharmacy is documented onto the MAR charts. ∗Stocks of medication held in the home, which are given on an as and when needed basis (PRN), must be brought forward onto each new MAR chart so an accurate audit can be carried out. The manager should audit the medication charts weekly to ensure staff are completing these correctly. Checks of the controlled drugs in the home showed these are held correctly in a locked cupboard and are recorded accurately in a Controlled Drug Register. Resident and relative comments show that they are very satisfied with the care and support offered by the staff. Discussion with four residents revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. One person said ‘ the staff are very good to us, they are kind and we get the care we need.’ Three individuals said ‘we can talk to the staff about any problems we have and they or the manager will make sure our needs are met.’ ‘We can go to bed when we want and staff don’t get us up too early.’ ‘We have a laugh with the staff and there is plenty of good humour around the home.’ Observation of the premises showed that privacy curtains are not provided in the three double rooms. The manager said that screens have been used in the past, but there was no evidence to suggest these were in place at the time of this visit. The provider must ensure these facilities are provided in the double rooms as soon as possible. Loran DS0000000861.V306046.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected 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 adequate. Residents are provided with a limited choice of social events, giving them little opportunity for stimulation or recreational activities. Meals at the home are good and meet the nutritional needs of the residents. EVIDENCE: Information gathered from the surveys and talking to the residents, staff and manager indicate that activities within the home could be better. There is a daily programme of events that care staff endeavour to carry out when time permits. The residents say that they do not want to take part as they do not like what is offered or their poor physical condition prevents them from joining in. Three individuals said that they like the monthly visits from an occupational therapist as they do quizzes, bingo and talk about Hull in times gone by. The home has three monthly visits from the local Mobile Library service and the residents said they enjoy reading the books provided. Comments from the staff show that they would like to have the time to sit and talk to the residents and participate in more social interactions with them. Little information is documented in the care plans about individual wishes and needs regarding social and emotional care. The manager must take action to improve this area of practice and provide the residents with a more consistent range and variety of stimulating activities and recreational events. Loran DS0000000861.V306046.R01.S.doc Version 5.2 Page 15 Discussion with the residents indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family or staff would take them into town. Residents’ files indicate that there are a number of individuals who follow different spiritual faiths, including Church of England and Church of Scotland. Discussion with the residents showed that they do not want to go to church on a regular basis, but those expressing a wish to do so are assisted by the staff to attend local services. There is a Church of England service held at the home once a month for those who wish to participate. The manager is in the process of updating the visitors’ policy for the home, and this will be on display in the entrance hall when completed. Discussion with four residents showed that they are offered choice in their daily lives and have a satisfactory awareness of their rights. There is no information about advocacy services within the home and the manager said she would find out about local contacts and put their names and addresses into the Service User Guide. There is no evidence that residents are encouraged to access the advocacy services and it was recommended that the manager discuss these options with the residents. Information from the Pre-inspection Questionnaire indicates that none of the residents handle their own financial affairs, but have family who deals with this. Residents were satisfied that they can access their personal allowances when needed. The residents said that they could speak to the manager on a daily basis and prefer this to meetings. They were happy that the manager acted on any issues that needed resolving and they received feedback as to what action had been taken. All the residents said that the home encouraged them to bring in small items of furniture and personal possessions to decorate their bedrooms. Discussion with the residents showed that they were not all aware of their care plans, but were confident that they could talk to staff about their care and make their wishes known and the staff would respect these. All residents spoken to were full of praise for the quality and quantity of the meals provided at the home. One resident said ‘the staff always ask us what we want to eat and we have a good choice of food at every mealtime’. Jugs of fruit juice are kept in the lounges at all times and the residents said ‘we can help ourselves or the staff will get us one and those who need assistance have regular drinks offered’. Seasonal menus offer residents a choice of summer and winter meals, but some individuals would like to have more input to what is on offer. Comments received indicate that a cooked breakfast would be appreciated every now and then and individuals are getting fed up of sandwiches (a cooked option is available at lunch and tea-time). The manager should consider how she could incorporate residents’ views into the development of the menus. Loran DS0000000861.V306046.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. Improvements to the recording aspect of the complaint system must be made, although residents are confident that their views are listened to and acted on. EVIDENCE: The home has a clear complaints procedure in place. Residents spoken to said that they had no complaints about the home and felt confident to raise issues of concern if they arose. Individuals said they could express their opinions in the satisfaction surveys they complete each year and that the manager is always available for them to talk to if needed. The Social Service Team for Hull City Council has dealt with one concern since the last inspection (January 2006), the home manager was asked to carry out an investigation and the concern was resolved successfully. Discussion with the manager showed that she is not recording the complaints that she investigates; this is not acceptable practice. The manager must ensure that a clear record is produced of all complaints made, with details of any investigation carried out and any actions taken. The record must also contain any letters or documentation produced as part of the complaint investigation. A grumbles book has been reintroduced since the last inspection, but the manager said that she is not consistently recording in it. This aspect of practice must be improved. Information from the Pre-Inspection Questionnaire and discussion with the manager indicates that the home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical Loran DS0000000861.V306046.R01.S.doc Version 5.2 Page 17 intervention and restraint and management of resident’s money and financial affairs. The staff on duty displayed a good understanding of the vulnerable adults procedure. They are confident about reporting any concerns and certain that any allegations would be followed up promptly and the correct action taken. Discussion with the manager indicated that she has received training around Protection of Vulnerable adults and four senior staff have applied for training. Loran DS0000000861.V306046.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24, 26. Quality in this outcome area is adequate. Residents are provided with a safe, comfortable and clean environment. They are able to personalise their own rooms, and the provision of door locks means that their personal belongings can be kept secure. EVIDENCE: A recommendation from the last inspection report (January 2006) was that the registered person should develop a programme of routine maintenance including actions and timescales for completion of work planned. This has been started, as a plan for bedroom refurbishment is in place, but this does not say what refurbishment/redecoration is to be undertaken or has indeed been carried out since the last inspection. It is recommended that the manager document everything that is renewed and/or refurbished within the home making it easy for her to audit in the future. Residents have easy access to the outside of the home, through the provision of ramps/sloped walkways. There is a garden area to the side of the home, provided with benches and a table and a large patio area near to the new Loran DS0000000861.V306046.R01.S.doc Version 5.2 Page 19 extension that has tables with parasols and adequate seating for residents to sit out and enjoy the sunshine. All areas outside are well maintained and tidy. Observation of the interior of the home showed that there are a few small areas needing attention from the provider and manager. ∗The corridor carpets near the new extension to the front of the house are uneven in places and present a trip hazard to the residents. This was identified and documented by the provider in his regulation 26 visit to the home in July. Action must be taken by the provider to remove this hazard. ∗The front extension staircase carpet is wearing on the treads and the provider should consider replacing this, as it could be a potential hazard if the wearing continues. ∗One tumble dryer in the laundry is out of action and the manager said that an engineer would be looking at this. ∗The dishwasher in the kitchen was not working and the manager asked the maintenance man to look at this during the inspection. ∗The passenger lift was out of order during this inspection. An engineer was in attendance and a new part was ordered. Plans are in place to ensure residents living on the first floor accommodation are able to return to their rooms this evening, but it may take 24 hours to effect the repairs needed. Residents are provided with a number of small lounges and seating areas throughout the home, one lounge is spacious and leads onto a large conservatory, which was unfortunately closed off at the time of this visit as the sunny weather had made it too hot for residents to sit in this area. A ceiling fan in the lounge was in use to try to cool the residents. Elsewhere the home was cool and shady, with comfortable temperatures and a pleasant living environment. Loran Care Home was originally a Vicarage and has had extensions built on to the old house to create more modern facilities for the residents. The new rooms have shower and toilet en-suites, whilst the older rooms have space and high ceilings. There are numerous staircases to the first floor and accessibility to this area is aided by use of the stair lift or passenger lift. The corridors are wide enough for a wheelchair or person using a Zimmer frame to pass along comfortably and thought has gone into providing flat walkways for those with difficulty mobilising. Discussion with the staff indicates that there is a wide range of equipment provided to help with the moving and handling of the residents and to encourage their independence within the home, this includes mobile hoists, slide sheets, turntables, moving belts and handrails. Four residents spoken to were very pleased with their individual rooms and said that they had ‘brought in a number of personal possessions to make them feel more homely’. All bedrooms are supplied with door locks and residents are given their own key if wished. Discussion with the manager and Loran DS0000000861.V306046.R01.S.doc Version 5.2 Page 20 observation of the home showed that very few residents used the locks or had asked for their own key. The new bedrooms have been provided with lockable drawers, but this facility has not been extended to the older rooms. The provider must make sure that all residents have access to a lockable storage space for medication, money or valuables and that a key is provided for this, which he or she can retain (unless the reason for not doing so is explained in the care plan). As highlighted in standard 10 the provider must ensure the double rooms have privacy screening or curtains in place. Overall the environment is clean, warm and comfortable with few malodours present. Comments from the surveys indicates that the residents find the home to be spotlessly clean and are satisfied with the laundry service provided by the home. Staff training files show that individuals have attended infection control training, and observation of the staff during the visit showed they put their knowledge and skills into practice. Loran DS0000000861.V306046.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 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 adequate. Improvements must be made around the deployment and numbers of staff at peak times of activity during the day, to ensure the needs of the residents are met. Since the last inspection the standard of vetting and recruitment practices has improved reducing the risk of harm to the residents. EVIDENCE: Comments from the staff, relatives and residents indicate that the home is extremely busy at times and individuals may wait for attention at peak times, but the friendly attitude of the staff and their wiliness to help make up for this. Two individuals said that ‘those people who are independent can take themselves to the toilet, but people reliant on the staff are sometimes waiting a long time, and this make life difficult’. One resident said ‘the staff take great care of me, they are marvellous people’, and another commented that ‘ the staff are very good, they are helpful and ready to listen if I have any concerns’. Information from the pre-inspection questionnaire and staff rotas about the number of staffing hours provided, and information gathered during the inspection about the dependency levels of the residents, was used with the Residential Staffing Forum Guidance and showed that the home is 100 hours a week short of the recommended guidelines. These figures do not include the manager’s hours or those of domestic staff. The manager must ensure additional staff are provided at peak times of the day, to meet the needs of the residents. Loran DS0000000861.V306046.R01.S.doc Version 5.2 Page 22 Checks of the staffing rotas and discussion with the manager showed that the home employs a ratio of 2 male to 20 female care staff and two of the staff are from different countries and cultures. Information from the manager indicates that there are 7 male residents and 26 female residents living at the home. Discussion with the residents indicates that they have no difficulties communicating with the staff and that they can express their preferences of staff gender for individuals giving their personal care. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. There is an induction and foundation course that meets National Training Organisation specification for new members of staff, and 9 of the care staff have achieved an NVQ 2 or 3, with seven more staff members going through the training. The home provides a mandatory staff-training programme that links to training provided by Hull City Council, and there is a need for more specialised training to be offered that reflects the different care needs of the client group. Information in the staff training files indicates uptake of training has been patchy over the past 12 months and the manager must make sure that everyone attends. A monitoring system should be put in place to assess the skills and knowledge of the staff, and determine how successful the training has been. The manager has met the requirement made in the last inspection report (January 2006) to improve the recruitment process. The home has a recruitment policy and procedure in place and when four staff files were checked it was evident that the manager follows the procedure, and ensures all relevant employment checks are completed before new staff start work. Loran DS0000000861.V306046.R01.S.doc Version 5.2 Page 23 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, 36, 37, 38. Quality outcomes in this area are adequate. The management of the home is satisfactory overall, but the lack of an electrical wiring certificate could potentially place residents at risk. EVIDENCE: The home’s manager is experienced in managing a care home and staff feel well supported and informed to carry out their duties. The manager of Loran has worked for the company for 17 years; she has been in post at Loran for 7 years. The manager has just finished her NVQ 4 in Care and is waiting for verification of her file. She plans to complete an NVQ 4 in Management within the next year and this will give her the required qualifications as a registered manager. Information from the staff minutes and discussion with the staff indicate they have attended meetings and are encouraged to express their views and opinions, however this has not taken place recently and the manager said she Loran DS0000000861.V306046.R01.S.doc Version 5.2 Page 24 will ensure the meetings are restarted on a more regular basis. The manager said resident meetings have been poorly attended and she plans to introduce small group settings where individuals feel more at ease to talk to her and the staff about the home and their needs. The home has achieved the Hull City Council’s Quality Assurance Award (QDS 1 and 2), and audits of the service are carried out on a regular basis. No annual development plan has been created from the results of these audits, and time was spent discussing this with the manager. She assured the inspector that this would be produced over the next year. The residents have completed satisfaction questionnaires, but individuals spoken to said that they were not sure their views could change the service provided. The questionnaires need to be sent out to a wider range of stakeholders so a more detailed view of the service is obtained. Information in the pre-inspection questionnaire indicates that policies and procedures are up dated and reviewed as an ongoing practice. Checks of the financial records showed that residents are able to have personal allowance accounts in the home. These records are computerised and detail the transactions undertaken and the money held for each resident, the manager updates these each week. Information from the manager indicates that the majority of the residents have a family member or representative who looks after their monies and these individuals make sure the personal allowances are sent/brought into the home. Where personal allowances build up above £100, arrangements are made for the families to collect this for safekeeping. For those individuals without family, there is a need to provide them with a bank account for the surplus monies. The manager said she would talk to the residents and the provider about the best way to accomplish this and the finance policy and procedure would be amended to reflect the decisions made. Staff supervision files show that individuals are receiving supervision but it is not as regular as required by the standards, nor is it structured. Discussion with the manager indicated that she is aware of this problem and she assured the inspector that the supervision process would be up dated and carried out on a more frequent basis. This will be looked at the next visit. Checks show that records are generally up to date although some gaps were found in recording such as assessment, care planning, medication, complaints and supervision as discussed in standards 3, 7, 9, 16 and 36. The majority of the Maintenance certificates are in place and up to date for the utilities and equipment within the building. There is no current electrical wiring certificate for the home; this should be renewed. The manager is looking into having a legionella test done, as this is not in place. The manager has completed generic risk assessments for the premises and a fire risk assessment has been completed and reviewed. Loran DS0000000861.V306046.R01.S.doc Version 5.2 Page 25 Accident books are filled in appropriately, and the inspector recommended that the manager complete a monthly audit on these to help spot any problems or recurring themes. Staff are able to access safe working practice training although uptake has not always been as good as it should be over the past year. The manager should monitor this and ensure all staff attend. Loran DS0000000861.V306046.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 2 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X 2 X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 2 2 Loran DS0000000861.V306046.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. OP1 2. OP2 5 Standard Regulation 5, 6, 16 Requirement The Service user guide must be written in plain English and made available in a format suitable for the residents. Each resident must be provided with a statement of terms and conditions at the point of moving into the home (or contract if purchasing their care privately). The registered provider must ensure that the home develops a needs assessment and carries this out for individuals who are self-funding and without a Care Management Assessment/Care plan. The registered provider must ensure that the resident care plans set out in detail the action staff must take to meet all aspects of health, personal and social care needs of the residents, and evidence that individuals are able to input to these and are agreed and signed by the resident or representative. The resident’s care plan must include risk assessments (where DS0000000861.V306046.R01.S.doc Timescale for action 01/10/06 01/10/06 3. OP3 14 01/10/06 4. OP7 15 01/10/06 5. OP7 15 01/10/06 Loran Version 5.2 Page 28 6. OP8 7. OP9 8. OP10 OP24 9. OP12 10. OP14 11. OP16 12. OP19 13. OP24 appropriate) for bed rails, kettles and microwaves used within their bedroom. 12 Care staff must maintain the personal hygiene of each resident by offering regular baths. 12, 13 Accurate records must be kept of all medication received, administered and leaving the home or disposed of to ensure there is no mishandling. 12, 16 Where residents have chosen to share a room, screening must be provided to ensure their privacy is not compromised when personal care is being given or at any other time. 12,14,15, The registered provider must 16,23 ensure that residents have the opportunity to exercise their choice in relation to leisure and social activities; that these choices are recorded and they are offered a range of stimulating activities both inside and out of the home. 14 Residents and their relatives and friends must be informed of how to contact external agents (e.g. Advocates), who will act in their interests. 17 A record must be kept of all complaints made and includes details of investigation and any action taken. 13,23 The registered provider should ensure that repairs, redecoration and refurbishment as highlighted in the environment section of this report are carried out within the given timescale. 12, 13, 23 Each resident must be supplied with lockable storage space for medication, money and valuables and is provided with the key, which he or she can retain (unless the reason for not DS0000000861.V306046.R01.S.doc 01/11/06 01/10/06 01/10/06 01/11/06 01/12/06 01/10/06 01/05/07 01/05/07 Loran Version 5.2 Page 29 14. OP27 18, 19 15. OP30 12, 18 16. OP33 24 17. OP33 24 18. OP33 12, 24 19. 20. OP36 OP37 18 17 doing so is explained in the care plan). The registered provider must ensure there are sufficient staffing numbers and skill mix of staff to meet the assessed needs of the residents, the size, layout and purpose of the home at all times, and additional staff are on duty at peak times of activity during the day. The registered provider must ensure that there is a training programme in place that ensures staff fulfil the aims of the home and meet the changing needs of the residents. Specialist training on the elderly and diseases relating to old age must be included in the training programme. Residents meetings must be restarted to obtain feedback from individuals relating to the services provided by the home. There must be an annual development plan for the home, based on a systematic cycle of planning-action-review, reflecting the aims and outcomes for residents. The views of family and friends and of stakeholders in the community (e.g. GP’s, chiropodist, district nurses) must be sought on how the home is achieving goals for residents. Care staff must receive formal, structured supervision at least six times a year. The registered person must ensure that records required for the protection of residents and the effective and efficient running of the business are maintained, up to date and accurate. This includes statement of terms and DS0000000861.V306046.R01.S.doc 01/10/06 01/11/06 01/11/06 01/01/07 01/01/07 01/11/06 01/03/07 Loran Version 5.2 Page 30 21. OP38 22. OP38 conditions, assessment of need, care plans, medication records, staff training, quality assurance and supervisions. 12, 16, 23 The registered person must 01/11/06 ensure that the health and safety of the residents and staff is protected by complying with the relevant guidance and legislation around the maintenance of the electrical systems and equipment and regulation of the design solutions to control risk of legionella. 18 The registered provider must 01/11/06 ensure all staff attend safe working practice training. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. Refer to Standard OP7 OP9 OP14 OP15 OP19 OP28 OP30 OP31 Good Practice Recommendations The manager should access training on Care Planning so that staff have the necessary skills and knowledge to produce care plans of a high quality. The manager should audit the medication charts weekly to ensure staff are completing these correctly. The manager should discuss the role and accessibility of advocates from the community with the residents. The manager should consider how she could incorporate residents’ views into the development of the menus. The manager should ensure the maintenance programme records all items renewed and/or refurbished within the home. The registered provider should ensure 50 of care staff achieves NVQ level 2 by the end of 2007. A monitoring system should be put in place to assess the skills and knowledge of the staff, and determine how successful the training has been. The registered manager should achiever a NVQ Level 4 in Management by the end of 2007. DS0000000861.V306046.R01.S.doc Version 5.2 Page 31 Loran 9. 10. OP35 OP38 The manager should assist residents to open their own bank accounts where needed. The manager should complete a monthly audit of the accident records to help spot any problems or recurring themes. Loran DS0000000861.V306046.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Loran DS0000000861.V306046.R01.S.doc Version 5.2 Page 33 - 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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