Inspection on 20/03/07 for Low Furlong

This inspection was carried out on 20th March 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Low Furlong 23/02/06

Low Furlong 21/06/05

Low Furlong 16/02/05

Low Furlong 17/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Low Furlong Darlingscote Road Shipston on Stour Warwickshire CV36 4DY Lead Inspector Jackie Howe Key Unannounced Inspection 20th March 2007 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 Low Furlong DS0000036324.V330296.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. Low Furlong DS0000036324.V330296.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Low Furlong Address Darlingscote Road Shipston on Stour Warwickshire CV36 4DY 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) 01608 662005 01608 664090 Warwickshire County Council, Social Services Department Ruth Carter Care Home 35 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (11), Old age, not falling within any other of places category (35) Low Furlong DS0000036324.V330296.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The total number of residents accommodated will be 35 to include up to 11 service users assessed as requiring dementia care. The entrance and exit doors to the dementia unit must have a discreet alarm system fitted so that staff are aware when service users leave the unit. (1st January 2006) Service users assessed as requiring dementia care to be admitted only to the dedicated unit identified as `Stanbury` The garden to be used for service users admitted to the dementia unit should be made safely accessible and stimulating for service uses with dementia. (31st July 2006) 23rd February 2006 Date of last inspection Brief Description of the Service: Low Furlong is a home for twenty-four older people, and 11 people requiring specialist dementia care. The home is owned and managed by Warwickshire County Council. It is about half a mile from Shipston town centre, where all community and health facilities offered in the town are sited. There is no bus service up to the home from the town centre. There is parking to the front and side of the building. Low Furlong was refurbished in 1996 and has recently undergone an extension and some further refurbishment including the provision of a new laundry and large conservatory in the dementia care unit. The home provides long stay care, short stay and day care. All thirty-five bedrooms have en-suite facilities, one with a shower. One unit on the ground floor provides care for eleven older people with either a dementia or other cognitive illness. Within this area there are two lounges, one of which has a dining area and a conservatory. The other unit on the ground floor provides two long stay bedrooms, while the rest are used for short stays or respite care. All the first floor accommodation is for long stay residents. There are two units, each with a lounge/diner. The home has a shaft lift. The fees are as per council arrangements; additional charges are made for private chiropody, hairdressing and sundries such as newspapers. A copy of the most recent inspection report is displayed in the reception area of the home and is therefore readily available. Low Furlong DS0000036324.V330296.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first inspection of the inspection year 2006/07 and was unannounced. It was undertaken over a period of one day, and was carried out between the hours of 09:30 am and 5:00pm. The inspection focused on the outcome for residents of life in the home. The manager supplied the commission with a Pre inspection Questionnaire (PIQ) and a number of ‘comments cards’ completed by residents and relatives were received prior to the inspection taking place. Information from these have been used to make judgements about the service, and have been included in this report. The inspection process reviews the home’s ability to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision where improvements may be required. During the inspection, the care of three residents who live in the home was examined. This included reading care plans and documentation, observing care offered to them and that staff have the necessary skills to care for them. This is part of a process known as ‘case tracking’ where evidence is matched to outcomes for residents. Records including staff files, policies and procedures, health and safety / environmental checks and risk assessments were also read. The Registered manager was present through out the day, and the inspector was able to tour the home, and spend time speaking with residents, and staff. The inspector ate lunch with the residents in the dementia care unit, and was able to observe care practices, and how staff interacted with residents in the home. The inspector would like to thank staff and residents for their co-operation and hospitality. What the service does well: The manager has worked in the home for over ten years and is experienced in this care field. Policies and procedures in place are good and efficiently managed. Low Furlong DS0000036324.V330296.R01.S.doc Version 5.2 Page 6 Staffing levels are maintained as per the agreed workforce model and turnover is manageable, although there are currently absences within the management team, which is having an effect on some service provision. Comments received about the staff team are positive. ‘Staff in the home perform acts of kindness that are additional to their duty as carers’. Relatives confirmed that they were happy with the care provided and were positive about the services and the management of the home. ‘I am very pleased with all the care, everyone is very friendly and approachable’. Food provision is good. Residents spoken with said that they enjoyed their food, and confirmed that there was always plenty of it. ‘The food is very good and varied’. The home has a garden area, which is used in the summer months, and provides a pleasant outlook. The garden is safe for residents to use independently. What has improved since the last inspection? There were three requirements made following the last inspection and two of these have been fully met. Systems for the management, administration, storage and ordering of medication have improved, and staff are well trained in this area of care. The arrangements for attending to resident’s laundry have changed, with the provision of a new laundry and equipment. This has provided the home with a clean and more spacious area to work, although further improvements are needed to ensure that laundry arrangements are better organised and laundry does not go missing. Some improvements have been made to the environment, with the provision of a new large conservatory in the dementia care unit, a new sensory room, and the refurbishment of some bedrooms. As a result of a recent investigation, the home has introduced care-planning documents to record concerns noted around the skin condition of residents. Low Furlong DS0000036324.V330296.R01.S.doc Version 5.2 Page 7 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. Low Furlong DS0000036324.V330296.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 Low Furlong DS0000036324.V330296.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6 Quality in this outcome area is good. An initial care needs assessment takes place prior to admission and information is obtained from other professionals allowing the home to make an informed decision as to its ability to meet the needs of the residents. The Home does not admit people for intermediate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The pre admission assessments undertaken on two residents in the home were read. Information had also been received from the care management assessment. Low Furlong DS0000036324.V330296.R01.S.doc Version 5.2 Page 10 Areas required for assessment in the National Minimum Care Standards are covered in the documentation and those read showed that a thorough assessment had taken place in aspects of personal and health care needs. More could be documented at the assessment regarding the social and psychological effects of moving into a care home, and what actions staff may need to take to minimise this, and offer personal reassurance. The assessment and subsequent care plan was read of one resident only recently admitted to the home and the resident was spoken with to assess how the admission to the home had been experienced. Whilst the care needs had been clearly identified, this resident said that she had not settled yet into the home, and did not feel that she was getting any company, as she preferred to spend time in her room, and found it difficult to make conversation. Residents spoken with confirmed that their relatives had visited the home to look round before they moved into the home, but due to them coming straight from hospital, they had not done this personally. One resident spoken with could not remember receiving any information about the home prior to moving in. Documentation examined, evidenced care plans are developed from the initial care needs assessment. The home does not provide an intermediate care service. The manager said that the ‘Statement of Purpose’ had been reviewed a year ago to reflect the changes by the introduction of the new dementia care unit. This document was not read at this inspection. Low Furlong DS0000036324.V330296.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, and 10 Quality in this outcome area is good. Resident’s needs are documented in a care plan which guides staff in how to meet their health care needs, and assesses risks, but could be further developed to identify individual care needs. Systems for the safe storage and administration of medication are robust. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plans were requested for the purposes of case tracking, one from the dementia care unit, one resident with high care needs, and a recent admission to the home. Two of the three care files examined held an initial care needs assessment, photographs of the resident, nutritional screening, including weight checks and medical history and risk assessments where required. The care plan of the new resident did not as yet contain a completed nutritional assessment, and a weight had not been recorded on admission. Low Furlong DS0000036324.V330296.R01.S.doc Version 5.2 Page 12 An inventory of personal items brought into the home is also held. Personal and health care needs were in most case quite detailed, and the manager said that new documents were now available to accurately record where bruises, marks or pressure areas may be noted, and report changes to these. It was good to note that there was evidence of care plans being regularly reviewed by staff. The manager said that residents and their families were involved in these reviews, which also then formed part of the quality assurance measuring tools. Daily records read should be more detailed to show what actions have been taken in response to certain circumstances or behaviours, so that outcomes and follow up actions can be assessed. One example of this was: ‘……. was very aggressive towards everyone today, very unsettled and wandering non-stop’. There was nothing to indicate what may have contributed to this behaviour, what actions the staff had tried to alleviate behaviour to show a continuity of approach, or how this resident was in the afternoon, or the following day. Care plans read also lack sufficient detail to demonstrate a real ‘person centred’ approach to care. For example some care plans stated ‘encourage independence’ without detailing how this was achieved, or identifying in some instances what ‘distractional techniques’ where appropriate, were best for each individual. These findings were discussed with the manager during the inspection, who demonstrated a good understanding of where care plans could be further improved. Evidence was seen in care files that professional health workers are involved in monitoring the health outcomes and residents have access to their GP, optician, and chiropody. Systems to ensure the safe administration, storage and receipt of medications are robust, and improvements required at the last inspection have been met. The manager closely monitors staff in administration procedures to ensure accuracy. This could further be improved by a record being maintained of these audits. The storage and administration of controlled drugs was checked and found to be accurate. Comments received indicate that relatives feel that the care provided is good. ‘My mother receives excellent loving care and attention’. Low Furlong DS0000036324.V330296.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): All of the above standards were assessed at this inspection. Quality in this outcome area is adequate. Availability of resources, potentially means that not all residents are receiving a life style, which fulfils their needs or interests. Residents receive a well balanced diet, with a menu, which is regularly reviewed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was found that there were mixed outcomes for residents in this group. A programme of activities and social events for March was displayed on the walls in the home. These were three exercise classes, two church services, and two musical / singing sessions. The manager said that activities and other social events are limited at present due to long term sickness/absence within the management team. The home does not employ a worker whose primary role is to manage activity/ social events. The manager said that they did have access at times to a mini bus to take residents on outings in the summer, but that this was difficult at present. Low Furlong DS0000036324.V330296.R01.S.doc Version 5.2 Page 14 Generally during the inspection, those living on the ground floor of the home appeared fairly active, residents in the mainly short stay unit were busy around the lounges or in their rooms, and the comings and goings of the day care unit, brings new faces into the home. A number of people who attend day care also make use of the short stay facility, resulting in some mixing of service users. In the dementia care unit, it was noted that residents are occupied, by the care staff, more on a short term 1-1 basis, although some group bingo had taken place. Some of the residents enjoyed the church service, and spoke enthusiastically about the singing. Staff on this unit have also provided games, dolls, colouring and activity items as appropriate. There was evidence of resident’s artwork on the walls. It was commendable to note that residents were also supported to undertake some ‘daily life’ activities, and one resident was happily sweeping the floors, and helping to collect plates for washing up. There is a lack of ‘life history’ information available, which would enable staff in the home to understand better the social and recreational interests of residents. The residents spoken with living on the top floor were not so happy with the availability of things to do. The inspector went to the floor and walked around on a number of occasions during the day, and there was little evidence of any meaningful activity taking place. On the day of the inspection, three residents occupied one lounge. There was a TV, which was playing very loudly. One of the residents said that there was nothing to do ‘as usual’ and did not want to attend activities down stairs. One gentleman was reading the newspaper another resident slept in a chair. A number of residents were noted to be lying on their beds, or sitting in their rooms silently and the staff appeared quite rushed with little time to interact. One resident stood in the doorway of her room, but would not step over the threshold. Staff spoken with said that the top floor was usually a very busy place to work. Another resident said that she stayed in her room because there was nobody to talk to. The manager said that residents meetings where residents may be offered an opportunity to get together and pass on comments, or make suggestions were not something that happened in the home. Low Furlong DS0000036324.V330296.R01.S.doc Version 5.2 Page 15 Residents in this home are free to receive visitors and maintain contact with family and friends, and the local church offers spiritual support, The inspector ate lunch in the dementia care unit. Staff served the lunch, which was pre plated, courteously to residents and gave discreet help where required. There was no visual choice offered with the main course, as the staff said that there was not sufficient supply to do so, but there was a visual choice with the pudding. The menu on the day of the inspection was a choice of gammon with mashed or jacket potatoes, with pickles, or cauliflower cheese and vegetables. Pudding was a hot and cold choice. Residents said that they really enjoyed their lunch, and there was a friendly and chatty atmosphere in the dining room. Tables were laid without tablecloths, but with serviettes and placemats and residents drank from glasses, not plastic beakers that can tarnish the taste of drinks. More could be done to evidence that residents’ are consulted with and their comments and thoughts about the food are taken into consideration in menu planning. Comments received both during and prior to the inspection about the food were good and included: ‘The food is very good and varied’. ‘I do not believe there could be better kitchen staff anywhere in the country, the home cooking is so good’. Low Furlong DS0000036324.V330296.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): Standards 16 and 18 Quality in this outcome area is good. The home had a complaints policy and procedure displayed and people are encouraged to report complaints and make their comments known. Care practices and staff training indicate that residents are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has recently undertaken an investigation into an allegation in which the home followed the procedures for Protection of Vulnerable Adults (POVA). Some of the concerns raised during this investigation were upheld, and the home has introduced some new procedures as a result. The manager took the opportunity following the investigation to speak with the staff group about Adult Protection issues. The manager demonstrated a good understanding of the procedures to follow, and took the opportunity to bring to the attention of staff key areas to be aware of. Low Furlong DS0000036324.V330296.R01.S.doc Version 5.2 Page 17 Staff have recently started working to the new workbooks in Adult protection, and those who find this method of learning difficult, will additionally be able to attend further training later in the year. Staff in the home spoken with, were aware of the ‘whistle blowing’ policy. The home has a copy of the Department of Health ‘No Secrets’ document, and also a copy of the Warwickshire County Council Multi Agency policy, on how to deal with allegations of abuse. The home has a box on the wall in the entrance hall where anyone either living in or visiting the home, is encouraged to write their comments, compliments, or concerns. A record if also displayed showing how many of these have been received on a monthly basis. Records show that the home has received no comments for a few months. The box is located very near to a table holding other information about the home, and may not be visible to all. On the day of the inspection, there was nothing available to write on or with, which could put people off making comment. The manager keeps a record of complaints made and investigations undertaken, but this could be further improved, by recording informal complaints or comments, and actions undertaken to resolve them. Residents spoken with confirmed that they understood the complaints procedure and knew who to go to with any concerns. Recruitment procedures show that the home is vigilant in seeking full working histories of new employees and that Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks have been undertaken. Low Furlong DS0000036324.V330296.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): Standards 19, 20, and 26 Quality in this outcome area is adequate. The environment has been improved, and further developments planned, will enhance the home to make it more suitable and appropriate to the needs of the residents. Storage is limited in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector was given a tour of the home and was able to see both communal and personal rooms. Some significant changes have been made including the new large conservatory and sensory room in the dementia care unit, and the change in laundry facilities. Low Furlong DS0000036324.V330296.R01.S.doc Version 5.2 Page 19 The new laundry has been equipped with two new driers and washing machines. The washing machines are able to meet the required disinfection standards. The manager said that she was awaiting some new trolleys and storage units. On the day of the inspection the new laundry was found to be neat and tidy and there are hand-washing facilities for staff. Dirty laundry was in individual bags waiting to be washed. The kitchen was found to be clean and well maintained. Environmental Health checks found that no action was required, and the home has cleaning schedules. Staff employed in the kitchen, are well trained and aware of basic food hygiene and infection control requirements. This has a positive outcome for residents in the home. Due to the adaptations and refurbishment being made to the home, this has included changing the use of some rooms. This work has not yet been completed, and has resulted in some equipment etc being stored through out the home. Some rooms have been left unfurnished and parts of the home are looking rather dated, and as mentioned above the problems with storage, make some areas of the home look untidy and not welcoming. Corridors on the day of the inspection were dark, with a lack of natural light, lights were not turned on, and the decoration of the walls is dark. The manager said that she expecting the delivery of more furniture, and that some other refurbishment work was planned for the next year. Comments received prior to the inspection indicates that not all people who use and visit the home are satisfied with the quality of decor, and feel that the home is in need of further redecoration. The bedroom of a resident recently admitted to the home, had some wallpaper coming off the walls, and there were hooks still showing from the previous occupant’s pictures. The room did not feel homely and welcoming. Low Furlong DS0000036324.V330296.R01.S.doc Version 5.2 Page 20 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): All the above standards were assessed at this inspection. Quality in this outcome area is adequate. Training available to staff to meet the needs of residents is generally satisfactory although there some gaps in training records of new staff. A lack of regular dementia care training means that not all staff are sufficiently skilled to meet these needs. Recruitment procedures are robust. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has unfortunately gone through a significant amount of time where members of the management and senior care team, have taken long periods of leave and sickness. This has had a rather unsettling effect on the home, and therefore some of the services have not been as normal. As previously mentioned, activities has been an area that has been affected, as well as staff supervision and attendance on and recording of training courses. Two of the care officers are currently off work, and the assistant manager who recently retired, has not been replaced. Rotas seen show that staffing numbers are being maintained as per the workforce model as described by the manager. Staff work a total of three Low Furlong DS0000036324.V330296.R01.S.doc Version 5.2 Page 21 shifts, the early shift being from 8am – 3pm, the evening shift from 3 – 10pm and the night shift from 10pm – 8am. There is no built in handover, but the inspector was informed that staff arrived 15 minutes early for their shift in order to take the handover. The manager said that there are currently 6 hours per day of domestic cover. and this is also available at the weekend. Care staff are expected to undertake laundry duties. Staff spoken with said that at times this was a problem, and due to the siteing of the new laundry, usually got left to the staff on the ground floor, which at times caused problems. The home is a large two-storey home, and the manager should review the domestic provision in line with a quality audit of the environment and levels of cleanliness. Three staff files were checked at the inspection. Two contained evidence that the results of Criminal Records Bureau (CRB) checks were only made available after start dates, but there was evidence that POVA first checks had been undertaken. This is seen as an acceptable practice so long as staff are suitably supported and supervised. The manager undertakes interviews on all staff employed, and a full work record was seen on files. Two written references had been received and staff had been provided with contracts of employment and job descriptions. The recruitment process recognises the importance of effective recruitment procedures in the delivery of good quality services and for the protection of residents. Staff spoken with confirmed that they enjoyed working at the home and had received an induction on starting at the home, as well as some subsequent training, and supervision from senior staff in their role. The home has a training programme as organised within the Warwickshire County Council workforce development. The home therefore has to wait until some courses are available, which at times can mean that staff are working in the home, who have not had an opportunity to attend all the required mandatory training courses. Records checked showed a number of gaps in staff newly recruited to the home. The manager said that there had not been much training available lately, but was confident that this would be available in the new financial year. Although the home does have a thorough induction process for new staff this may not be sufficient, and the manager must ensure that staff have the required skills to undertake their roles. As the home does not have a dedicated team of staff specifically working within the dementia care unit, and as the manager said that there have not been opportunities for staff to attend dementia care training in the past year, Low Furlong DS0000036324.V330296.R01.S.doc Version 5.2 Page 22 this could mean that staff are not fit to undertake this role. The manager said this was overcome by new staff always working under the supervision of experienced and well trained care staff. On the day of the inspection, the staff on duty were found to demonstrate good skills in caring for people with dementia. Staff spoken with said that they had attended some dementia care training, but ‘ not as much as I would like’. One member of staff said that she would like to have training on meeting the needs of people with challenging behaviours. Training opportunities including the availability of literature, provided for staff to develop specialist skills in caring for people with dementia, are not sufficient to enable staff to meet the challenges of caring for people with special needs. Examples of staff providing ‘Person centred’ principles of care are required in care plans, risk assessment, provision of meaningful activities, the environment and where residents could be given more choice and control over their lives. Low Furlong DS0000036324.V330296.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38. Quality in this outcome area is good. The manager is able to fulfil her responsibilities as manager of the home within an organised management system of policies and procedures. Residents and their families are given opportunities to make their opinions of the service known. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has worked in the home for over ten years. She is experienced in this field of work, and has recently completed the Registered Managers Award. Low Furlong DS0000036324.V330296.R01.S.doc Version 5.2 Page 24 Management systems in the home are good, and the manager is able to demonstrate a good knowledge base. As previously mentioned, there is currently a shortage of staff within the management team, which has brought amount a certain amount of stress for the manager, and has resulted in some recording and systems not being up to their normal standard. The manager is aware of this and is working towards bringing everything up to date. Warwickshire County Council undertake a formal Quality review, and the results are shared with the home. Evidence was received prior to the inspection to show that those using the service are happy with what is provided, and on the day of the inspection, this was re emphasised to the inspector. There is currently no informal process in place for the manager and other staff for example the cook, to record comments received and demonstrate what actions they have taken if required, as a response to those comments. This was discussed with the manager at the inspection, who felt that this was something she would like to include in the quality assurance practices for the home. The manager stated that individuals personal experiences were discussed at care reviews, but there was not currently a residents / relatives meeting where people may take the opportunity to share ideas. Monies currently held in the home for safekeeping, are handled in line with the current policy. Pooling of residents monies is practiced, but the manager and the administration staff said that they were aware that this needed to change and were hoping to have all monies in individual accounts by the end of May. Receipts are kept of all expenditure. The Health and Safety of the building, testing of emergency and equipment, water and fridge temperatures and other maintenance, is undertaken by the staff, local authority or specific agencies. Fire safety checks are undertaken, and a fire drill is undertaken every 6 months, the last one being in November 2006. On the day of the inspection the keypad lock on the door to the dementia care unit was noted to be broken. This was reported and repaired in a very short time. Apart from the issues around storage, no other health and safety hazards were noted at this inspection. Low Furlong DS0000036324.V330296.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 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 3 17 x 18 3 2 3 x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 2 x x 2 Low Furlong DS0000036324.V330296.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The registered manager must ensure that care plans adequately guide staff on how each individual, based on a skills assessment, requires their care to be delivered, and how each resident is supported to retain strengths and abilities. Daily records must contain sufficient detail to accurately report changes and incidents. The registered manager must consult with residents in the home and offer them sufficient choice to maintain and support leisure, social and cultural interests. The registered provider must ensure that the home is kept in good decorative repair. (Original timescales of 30/09/05 and 31/05/06 part met.) 4. OP27 12 The manager must ensure that all staff receive training in dementia care. This training should be regularly updated to DS0000036324.V330296.R01.S.doc Timescale for action 31/07/07 2. OP12 16 31/07/07 3. OP19 23 31/07/07 30/06/07 Low Furlong Version 5.2 Page 27 5. OP30 18 6. OP38 12 ensure that there are sufficient staff with the skills required to meet the needs of the residents in the home. The registered manager must ensure that all staff receive training in line with the training programme for the home, and meets the changing needs of the residents. The registered manager must review the storage facilities in the home to avoid the storage of equipment in corridors, bathrooms and communal rooms. 31/07/07 31/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP27 OP30 Good Practice Recommendations The manager should review the domestic hours available in line with a quality audit of the environment and levels of cleanliness. The inspector recommends that the manager accesses specialist dementia care literature and training materials, such as web sites, to assist her in keeping herself and her staff up to date in modern dementia care methods. The home should develop a system of recording comments made about the service, to improve the quality assurance systems in the home, for example in food provision. 3. OP33 Low Furlong DS0000036324.V330296.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Text phone: 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 Low Furlong DS0000036324.V330296.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!