Inspection on 12/03/07 for Marden Court

This inspection was carried out on 12th 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

Marden Court 19/03/09

Marden Court 27/01/06

Marden Court 15/08/05

Marden Court 01/02/05

Marden Court 25/10/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Marden Court Quarr Barton Calne Wiltshire SN11 0EE Lead Inspector Ms Sally Walker Unannounced Inspection 09:10 12 March 2007 th 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 DS0000028292.V324801.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. DS0000028292.V324801.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Marden Court Address Quarr Barton Calne Wiltshire SN11 0EE 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) 01249 813494 manager.mardencourt@osjctwilts.co.uk The Orders Of St John Care Trust Tracy Ann Carash Care Home 28 Category(ies) of Dementia - over 65 years of age (2), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (4), Old age, not falling within any other category (28) DS0000028292.V324801.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users who may be accommodated at any one time is 28. No more than 4 service users over the age of 65 years with a mental disorder MD(E) may be admitted at any one time. No more than 2 service users with Dementia (DE(E)). Date of last inspection 27th January 2006 Brief Description of the Service: Marden Court was built in the 1960s as a purpose built residential home offering accommodation and personal care to a total of 28 residents over the age of 65 who require care primarily through old age, although the home is also registered to accommodate 4 residents who have mental health needs and 2 with dementia needs. Two of the 28 beds are used for respite care. The home also provides day care facilities for up to 16 residents. The home is set in its own gardens, in a quiet residential area close to the centre and facilities of the market town of Calne. The home was originally opened in the 1960s as a local authority home and was taken over by the Orders of St Johns Care Trust in 2000. The registered manager is Miss Tracy Ann Carash. Residents are provided with their own bedrooms and these are located on the ground and first floor levels and are accessed by the use of a passenger lift. A call bell system is installed in each room, which can be used by residents to call for staff assistance. The home provides suitable communal space together with adequate bath and toilet facilities. The minimum care staffing levels are 3 with a care leader during the mornings, 2 and a care leader during the afternoons and evenings and three waking night staff. DS0000028292.V324801.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place between 9.10am and 5.10pm. Miss Tracy Carash had managed the home since 2nd October 2006. Six residents were spoken with in the privacy of their rooms. A tour of the building was made. The care records, staff records, training records and medication records were inspected. As part of the inspection process the views of relatives and GPs were sought. One of the relatives said they were very pleased with the care provided and their family member was looked after very well. They said the staff let them know straight away if there were any concerns. One of the GPs wrote: “as for my patients who live at Marden Court are concerned, they are cared for well, and the general impression one gets from the home, is that it is run efficiently and there are certainly always a lot of staff in attendance.” Comment cards were sent to the home prior to the inspection to gain the views of residents. All ten residents responded. Four residents said they had received a contract and one said they did not. Six residents said they had received enough information before coming to the home and three said they did not. One said they did not think they had a contract, 2 were not sure and one could not remember. One resident said they “knew the home was a place [they] would feel happy & safe”. Another resident said “I came for 2 weeks respite and was invited to stay permanently I liked it and accepted to stay.” Another said they “used to come to day centre”. Another resident said they were “able to visit – look at rooms – talk to staff”. Another resident said they “can’t remember I think family decided due to illness”. One resident said “I was poorly at the time can remember some information given.” Five residents said they always received the care and support they needed and five said they usually did. One resident stated that they “always receive the support I need”. Another said “my need to go to the toilet many times a day makes it difficult for staff”. All ten residents said that staff listened and acted on what they said. One resident said: “most of the time staff do as asked”. Two residents said staff were always available when needed, seven said staff were usually available and one said staff were sometimes available when they needed them. Nine residents said they always received the medical support they needed and one said they usually received it. Six residents said there were always activities arranged that they could join in with, three said there usually were and one said there sometimes were. One DS0000028292.V324801.R01.S.doc Version 5.2 Page 6 resident said there was “always something going on in the home”. Another said “at Christmas the activities in Marden Court was so good, everyone enjoyed it and family was included”. Four residents said they always liked the meals and six said they usually liked the meals. One resident described the meals as “very good”. Another said they “always enjoy the meals. There is a variety of good food”. Another said “more variety would be nice sometimes”. Another resident said “I think the menu could be improved, more selection”. Eight residents said they always knew who to speak to if they weren’t happy and 2 said they usually knew. Five residents said they always knew how to make a complaint, four said they usually knew who to complain to and one said they sometimes knew. One resident said they would go to their “keyworker or another care leader”. Another said “but I have nothing to complain about”. Seven residents said the home was always fresh and clean and three said it usually was. Other comments included: “very good home nice and clean regular staff”, “I have been very happy and contented at Marden Court”, “everything is regular would like more regular baths but happy with everything else”. The fees for the home are from £390.00 to £460.00. What the service does well: The home encourages residents and their families to visit the home before deciding to move in. Personal care details in residents care plans were well documented. Residents had good access to healthcare professionals. Residents said they felt well cared for. Residents were well groomed and all personal care was carried out in private. Residents’ personal space was respected with staff knocking on doors before being invited in. Residents had good relationships with staff. Most of the residents could decide how they spent their day and whether or not they joined in with activities. Residents were used to having a regular activities programme which included trips out and parties that they enjoyed. Care staff recognised this and were providing a programme of activities for March pending the appointment of a part time activities co-ordinator. Mrs Carash had asked the organisation for an extra five hours for the activities post. Most of the residents enjoyed the meals. If residents had any comments to make about the food they could do so at the regular residents meetings. Changes had been made to a range of items following comments from residents. Residents and their families were also able to comment on different aspects of the service via the home’s quality assurance system. Staff ensured that those residents who spent time in their bedrooms had immediate access to drinks and their call alarms. Residents had keys to their bedrooms. Residents’ rooms were comfortable and personalised. Staff had good access to NVQs and training provided by the organisation. A DS0000028292.V324801.R01.S.doc Version 5.2 Page 7 robust recruitment system was in place with no staff commencing duties until a negative Criminal Records Bureau certificate was obtained. Miss Carash was well known to the residents. What has improved since the last inspection? What they could do better: The organisation’s current assessment document does not allow assessors to gain the detail of information needed to compile the care plan. As some of the prospective residents may have complex care needs, staff are compiling their own questions and gaining more relevant detailed information than the format allows. Although care plans were more detailed, consideration needs to be given to recording explicit detail or instruction. Unclear phrases, for example, “sore on leg” must not be used. Although residents risk of developing pressure sores was being documented. There was no evidence of how risks levels were arrived at or what action should be taken when risks were noted. Records must be kept of exact location of any wounds together with details of size, colour and whether the skin was broken. Records must go on to record healing progress. Body maps would support this evidence. Although fluids intake charts were being used, measuring drinking vessels would enable staff to evidence actual amounts being taken. Daily totals should be recorded. The organisation’s medication policy had not been amended to state that all medication must, rather than should, be checked with the resident’s GP on admission. This had been highlighted at a recent organisational audit. The building is in need of refreshment. Please contact the provider for advice of actions taken in response to this DS0000028292.V324801.R01.S.doc Version 5.2 Page 8 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000028292.V324801.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000028292.V324801.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The organisation’s current pre-admission assessment format did not allow staff to assess the often complex care needs of prospective residents. Consequently staff were devising their own assessment questions. Many of the residents said they had either previously known the home through contact or had time to visit and discuss their potential admission. EVIDENCE: Not all of the residents had had a pre-admission assessment undertaken. Miss Carash said this had already been identified at a recent audit by the organisation. The organisation was piloting a new pre-admission assessment document in some of its homes. No new permanent admissions had taken place since Mrs Carash came to the home in October 2006. However staff had completed assessments for those people using the respite service and an example was shown. The current system for assessment was mainly a tick list to determine funding. However staff were completing past histories, daily DS0000028292.V324801.R01.S.doc Version 5.2 Page 11 personal care routines details and compiling their own questions and notes for those areas not covered by the current format. One resident described how they had come to live at the home and said they had settled in very well. Another resident said they knew the home very well before they came as they had visited many times. They also said that their GP had suggested Marden Court to them. DS0000028292.V324801.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements had been made to the care plans to ensure all care needs and guidance was recorded. However some key information was not recorded. Healthcare needs were being met and residents had good access to healthcare professionals. Systems were in place to ensure safe administration and control of medication. Staff respect residents privacy and dignity. EVIDENCE: The requirement that care plans were reviewed and updated when residents’ needs changed was in good progress. The home was also required to identify how those needs were to be met, record the risks together with any behaviour plans. This part of the requirement was in good progress. Care plans were variable in the detail they contained. Miss Carash was working with staff to ensure that all residents’ care and support needs were well documented. Each resident had a monthly review and their care plan was revised as necessary. One of the residents said they had diabetes which they controlled with their diet. They said the district nurse monitored their blood sugar levels and monitored their progress. This residents care plan made no reference to this. DS0000028292.V324801.R01.S.doc Version 5.2 Page 13 However there was very detailed guidance on other aspects of their health, risks and medication to be taken when required. All of the other details of their care they had spoken about were noted in their care plan. Another care plan showed good detail of the residents preferred personal care routines, which foods they liked and how they liked their room set out. Another care plan gave good detail of the residents need for regular oxygen. Although some residents had a short-term care plan entitled “pressure risk assessment”, there was often little detail in showing how residents were at risk or what action should be taken to reduce the risk. One resident’s care plan stated: “prone to pressure marks”, but there was no detail as to where these marks may appear or what to do when they appeared. There was information that they sat on a pressure-relieving cushion. There was also a chart to record when the resident was turned in their bed. Another resident’s pressure risk assessment identified that they had a special mattress on their bed. There was a record that the resident had a sore on their leg but there was no record of where it was, which leg, the size, colour or whether the skin was broken. It could not be established from this record whether the wound was a pressure sore or ulcer. There was no record of its healing progress. The records suggested that there was little understanding of preventative measures, although pressure-relieving equipment was in place for some residents. Miss Carash said that tissue viability training was being organised through the organisation’s training department. She went on to say that she was discussing with the district nurse their input into the home’s training programme. The recommendation that body maps should be considered to augment the recording and monitoring of wounds had not been actioned. Food and fluid intake charts were being filled out where indicated for some residents. The inspector advised that the measuring of drinking vessels would enable more efficient monitoring of what is actually taken. Totals should be recorded each day. Miss Carash said that the organisation was piloting a new care plan format in some of its other homes. One of the community psychiatric nurses comes to the home once a month to discuss mental health issues. Residents had good access to healthcare professionals. Residents said they would ask staff to arrange for their GP to visit when needed. One of the residents said they were very well looked after and this was clear from the attention they received from staff. Another resident said they liked having a shower and staff would assist them with this whenever they wanted. Another resident said they were satisfied with a weekly bath but could one more often if they wanted. As a matter of good practice it was noted that residents who were in their bedrooms were able to use their commodes during the day if they could not get to the nearest toilet. All personal care was DS0000028292.V324801.R01.S.doc Version 5.2 Page 14 carried out in private. Staff had good relationships with residents. Staff respected residents’ private space by knocking on bedroom doors before being invited to enter. Residents were well groomed. The care leader with the delegated responsibility for the administration and control of medication showed the inspector the arrangements. Residents could administer their own medication following a risk assessment. However none of the current residents were administering their own medication, apart from eye drops and a sublingual spray. Staff could not administer medication unless they had been deemed competent by an assessment process and training. Staff’s competence was regularly monitored. Medication was administered from a monitored dosage system put up by the supplying pharmacist. Medication was stored in the designated fridge where indicated, with daily records of temperature parameter monitoring. Records were kept of opening of short life medication, for example, eye drops. One medication with specific prescribing instructions was not recorded in the resident’s care plan. The requirement that the home must ensure that the organisation’s new medication policy was fully implemented and that the organisation made changes to its admissions procedure to reflect this, had been actioned. The requirement that the revised medication procedure was further amended to avoid any possible ambiguity by staff had not been actioned. The procedure still read: “1. Medication being received via the resident or a carer should [as opposed to must] be checked with the residents GP.” Miss Carash said that this had been noted during a recent quality audit and had been referred to the organisation’s policy makers. The home was, as a matter of course, checking the medication of new residents with their GP, with written confirmation via a fax. One of the GPs regularly reviewed their patients medication. One of the community psychiatric nurses was currently reviewing their patients’ medication. The requirement that records were made when a GP visited their patients together with any advice given had been actioned. The recommendation that medication prescribed to be taken when required, should be stated in residents care plans was in progress. Care plans were variable in recording this information. The recommendation that the supplying pharmacist should be asked to remove details of medication that was not currently prescribed from the medication administration record had been actioned. DS0000028292.V324801.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents who could choose generally followed their own routines; others relied on staff for direction. Residents enjoyed the activities, which were established events in the home. Care staff continued to provide some activities until the vacant post was filled. Visitors and community contact was encouraged. Most residents enjoyed the meals. EVIDENCE: Those residents who could make choices followed their own routines; others relied on staff for direction. One resident said they did not join in with the activities and preferred to listen to their radio, watch television and read their daily newspaper. They said their friends and family visited them regularly and were made welcome. They said there had been discussions at the residents meeting about a coach trip which they would be interested to go on. They also talked about a trip to a local pub for a meal which they had enjoyed. Another resident said they liked the coach trips. Another resident said there were lots of things to do during the day. They also said the local library would regularly bring them books. Many of the residents described how they would either have a walk round the garden or sit outside when the weather was warmer. One resident said there was always something going on in the home, DS0000028292.V324801.R01.S.doc Version 5.2 Page 16 particularly in the summer. They said they had enjoyed the fetes. They also said that there were lots of parties and people came to entertain them. They mentioned a comedy act. A 16-hour activities post was being recruited for. Miss Carash said that the new budget allowed for 20 hours for activities. She went on to say that pending the appointment, care staff were covering the activities as extra shifts to ensure that activities still took place. This was evidenced from the very positive comments from residents. The planned activities for March were displayed on the notice boards. These included: exercises, games, quizzes, beauty sessions, reminiscence, Melksham Pearlies and events for Red Nose Day. A monthly newsletter advertised events in the home. One of the residents said they enjoyed the regular Holy Communion services held at the home by their church. Residents had transport tokens for taxis for trips out. The daily menu was displayed on a notice board near the sitting room. The home operates a 5-week menu. Miss Carash showed the inspector the draft menus, which would be available to residents at the dining room tables each day. There was a choice hot meal at lunchtime with a salad available every day. There was also a choice evening meal. Residents said they enjoyed having their breakfast in their bedrooms so they could get up at their own pace. Miss Carash said that a cooked breakfast was being introduced for one day a week. Boiled or poached eggs were already being offered for breakfast. One of the residents who was following a special diet said that the meals were very good with plenty of choice. Another resident said they could always have something else if they did not like either of the meal choices. All of those residents who were visited in their rooms had drinks within easy reach and were brought drinks by staff. One of the residents said they could have drinks during the night if they wanted. Many of the residents said they had keys to their bedrooms. DS0000028292.V324801.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to ensure that residents and their families can complain about the service. Staff have familiarised themselves with the procedure for promptly reporting any allegations of abuse. EVIDENCE: The home followed the organisation’s complaints policy and procedure. This was displayed around the home. Miss Carash kept a log of complaints together with good detail of her investigations, action plans and outcome letters to complainants. One of the residents said they did not know whether there was a complaints procedure but they were clear that they would go to Miss Carash if they had any concerns. Another resident confirmed that they would go to Miss Carash if they had any problems. A Random inspection was made on 2nd October 2006 with the investigating manager for the then, vulnerable adults process. The purpose of the visit was to inspect records following allegations of assault between two residents. A requirement was made that all staff were aware of the local procedure for the prompt reporting of allegation or incidents of abuse to the Safeguarding Adults process. This involved updated training for some staff. This had been actioned. Miss Carash said that one of the staff had attended Safeguarding Adults training and had cascaded the training to all staff. Mrs Carash said that she intended that all the care leaders would undertake the organisation’s training. Two staff were asked about the process of reporting allegations or DS0000028292.V324801.R01.S.doc Version 5.2 Page 18 observations of abuse. They were aware of the steps they needed to take to alert the relevant authorities, protect victims and evidence, and record details. The local procedure was kept in the care office for easy reference. DS0000028292.V324801.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The building is in need of refreshment. Mrs Carash had identified areas needing upgrading and had requested the budget from the organisation. Residents’ bedrooms were comfortable and personalised. Although the home was generally cleaned to a good standard, undersides of toilet surrounds and bath hoists were in need of attention. EVIDENCE: All of the bedrooms were single accommodation. Residents had personalised their bedrooms and could bring small items of furniture. Miss Carash had budgeted for new bed linen. Miss Carash said she had requested budget for the home to be redecorated and refurbished to make it more homely and utilise some of the areas not currently used. The bar area which was rarely used by residents was to be converted to another sitting area. Residents would still be able to purchase DS0000028292.V324801.R01.S.doc Version 5.2 Page 20 small items from the shop which would be taken around to them on a trolley. The organisation’s property manager had visited and an action plan was in place. The handyman had already started redecorating the corridors. Residents had been consulted about the colour scheme. The conservatory was currently being used as a smoking room and only used by one of the current residents. Miss Carash planned to redesignate another area for residents who smoked and refurbish the conservatory so that all residents could use it. The home has a hairdressing salon. Residents make appointments with the hairdresser each week. It was noted that some of the undersides of bath hoist seats and toilet surrounds had dried yellow drip marks and other matter, suggesting that only areas that were immediately visible had been cleaned. All other areas of the home were cleaned to a good standard and there was no unpleasant odours detected apart from the sluice area. Miss Carash had changed the cleaning schedule to ensure that cleaning was done in the afternoons as well as the mornings. There was a daily checks list of areas to be cleaned. Miss Carash had identified poor ventilation in the sluice to the property manager. The sterilizing unit took some time to complete its cycle, resulting in commode pots stacking up awaiting sterilisation. Miss Carash was considering other systems to clean the pots to avoid infection control issues. Miss Carash planned to improve the laundry area which was in need of redecoration. A member of staff worked 2 mornings each week on laundry duties and housekeepers and care staff did the laundry at other times. All of the stored wheelchairs had their footrests fitted to ensure that residents feet did not drag on the ground when being moved. Miss Carash said that she had set up a contract for servicing the wheelchairs. All of those residents who were visited in their bedrooms had their calls bells with in easy reach. DS0000028292.V324801.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels enable residents to receive a good degree of care and support. Staff have good access to NVQs and training. A robust recruitment process is in place for residents’ protection. EVIDENCE: The staffing rota provided for a minimum of 3 care staff and a care leader during the mornings, 2 care staff and a care leader during the afternoons and evenings and 3 waking night staff. The home also employs an administrator, cooks and kitchen staff, housekeepers and a handyman. Fifteen of the care staff held NVQ Level 2, five of the support staff held NVQ Level 2 and three of the care leaders held NVQ Level 3. Staff had good access to NVQ training. A robust recruitment process was in operation with all the documents and information required by regulation held on file. Records were kept of interviews. No staff commenced duty without receipt of a negative Criminal Records Bureau certificate. Miss Carash had surveyed the staff’s training needs and produced a matrix to show what was needed. Most of the training is provided by the organisation. All staff had an individual record showing the certificates for courses DS0000028292.V324801.R01.S.doc Version 5.2 Page 22 undertaken. Staff were required to undertake core subjects related to their role and have regular updates. All staff were expected to undertake dementia training. Other core subjects included: health and safety and risk assessment, first aid, food hygiene, supervision skills and moving and handling. The organisation had installed a computer so that staff could also access its training on the internet. Miss Carash was due to undertake mental health training provided by the organisation the following day. She would then cascade this to the staff group. Miss Carash also said that she had been given some information about the Mental Capacity Act 2005 due to come into force in April 2007. Residents spoke very positively about the staff, particularly their good relationships with their keyworkers. One of the residents described the staff as wonderful. They said that staff came immediately when they pressed their call bell and this was demonstrated to the inspector. Another residents said that staff always knocked on their bedroom door before being invited to enter. They said that staff were always very polite. One of the staff said they had worked at the home for a number of years. They said it was a good staff team who all worked together well. They talked about their training, including health and safety, moving and handling, infection control and fire prevention. They said that staff meetings were held every two months but they had not had supervision since the previous manager left. DS0000028292.V324801.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): 31, 33, 35 & 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Miss Carash is clear about how she intends the home to develop. The home is run in the best interests of the residents. Safe systems are in place for holding money that residents may wish to keep at the home. Care staff are supervised and other staff will be supervised following training. EVIDENCE: Miss Carash has been in post since 2nd October 2006. She was nearing completion of NVQ Level4 and working towards the Registered Managers Award. She had completed a course in dementia care. Miss Carash had had ten years experience of working in care homes and a nursing home, more than 2 years in a senior role. Mrs Carash had identified areas that needed DS0000028292.V324801.R01.S.doc Version 5.2 Page 24 improvement including care planning and upgrading the environment. She was clear about further developing the service. One of the residents said they regularly went to the residents meetings and said they had put forward a list of suggestions but nothing appeared to be done. The minutes of these meetings itemised the items discussed at the previous meetings together with an action plan. Miss Carash also mentioned implementation of many of the items mentioned by this resident. Miss Carash said that the organisation had sent residents and their families a questionnaire to comment on the service as part of the quality assurance system. The responses had been collated and Miss Carash had developed an action plan. She said that changes had been made as a result of the survey, mainly regarding the food; for example, residents now helped themselves to fresh fruit that was readily available. Residents were able to keep small amounts of money in one of the home’s safes. Records were kept of all transactions. Only senior staff had access to the safe. The administrator regularly audited the records. Although one member of staff said they had not had supervision since the previous manager left, it was clear that regular supervision was being offered to some staff, particularly carers. Miss Carash said that the administrator was to supervise the housekeepers and the chef, the kitchen assistants. However both needed to undertake the training first. Regular care staff meetings were also being planned. DS0000028292.V324801.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 2 X 3 X 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X X DS0000028292.V324801.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 OP9 Regulation 12(1)(b) Requirement Timescale for action 12/03/07 2. OP7 15 3 OP8 13(4)(c) The responsible individuals must ensure that the revised medication procedure itemised under ‘Receipt of medicine from resident/carer/hospital’ is further amended to read 1) Medication being received via the resident or a carer must (as opposed to should) be checked with the resident’s GP. This change is to avoid any possible ambiguity by staff. This standard was not assessed at this inspection. [The home’s recent audit had identified that this had not been amended] The person registered must 12/03/07 ensure that where residents’ needs change, that their care plan is reviewed and revised to show how that need is to be met and whether there are any associated risks for consideration. Any behaviour plans must be included in the care plan. [In Progress] The person registered must 12/03/07 ensure that all residents are assessed as to their risk of developing pressure damage. DS0000028292.V324801.R01.S.doc Version 5.2 Page 27 4 OP26 16(2)(j)& 23(2)(d) Care plans must show how those identified risks are to be minimised or managed. The person registered must make arrangements to ensure regular cleaning of the undersides of toilet surrounds and bath hoist seats. 12/03/07 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. Refer to Standard OP9 Good Practice Recommendations The registered person should ensure that the rationale for medication prescribed to be taken when required should be stated in the care plan The registered person should consider the use of body maps to augment the recording and monitoring of wounds The person registered should consider measuring drinking vessels so that daily totals can be made of fluid intake to assist monitoring. 2. 3 OP37 OP37 DS0000028292.V324801.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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