Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Merrivale 90 East Road Burnt Oak Middlesex HA8 0BT The quality rating for this care home is:
one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Duncan Paterson
Date: 1 3 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home
Name of care home: Address: Merrivale 90 East Road Burnt Oak Middlesex HA8 0BT 02089527639 02089515310 manager.merrivale@fremantletrust.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) The Fremantle Trust Type of registration: Number of places registered: care home 56 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Merrivale is registered to provide care to fifty-six older people, who may also have a mental health diagnosis or a diagnosis of dementia. The home has transferred from local authority responsibility to being run by The Fremantle Trust. The home is divided into eight units and includes two dedicated respite units one of which is for people with dementia. The units accommodate between five and nine service users and have lounge, dining room and kitchenette. The units are staffed separately. The building has three floors. The ground floor has one respite unit and one mainstream unit. The second floor has one respite unit and two units for people with mental health needs. The third floor has one mainstream unit and two units for people with dementia. There Care Homes for Older People
Page 4 of 30 Over 65 56 56 56 0 0 0 Brief description of the care home are mature gardens to the front and rear of the premises. The overall aim of the home is: To provide a high standard of care and support that is tailored to meet individual needs taking account of each persons right to exercise choice and self-determination in pursuing their own lifestyle. The current fees are £492 per service user a week. Care Homes for Older People Page 5 of 30 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection took place on 10th, 12th and 13th November 2008. The inspection involved spending time on each of the homes eight units talking with a sample of residents and staff as well as looking at care plans and medication arrangements. A number of staff were interviewed and there were discussions with the manager and area manager who was visiting the home on 12th November. A small number of visiting relatives were also spoken with. A tour of the building also took place as well as discussions with the catering, laundry and maintenance staff. Staff records were inspected as well as a sample of the homes policies and procedures. The Annual Quality Assurance Assessment (AQAA) which had been sent to us was taken into consideration as were returned surveys we had Care Homes for Older People
Page 6 of 30 received from residents and staff. The inspector would like to thank the manager and staff who were helpful and cooperative and gave up their time willingly to answer questions. What the care home does well: What has improved since the last inspection? What they could do better: The service is still rated as adequate / one star following this inspection. This is because there is still some way to go to demonstrate that residents receive a good quality of service. Primarily, this relates to getting the staffing arrangements right so that direct care provision to residents is not affected. However, there are also matters relating to the environment, to activity provision and to staff training and supervision that need to be addressed as well. Having said that, the direction of the service is one of improvement. The new manager has already brought about an improvement to the service and she has identified how the service can be further improved. Many, if not all of these areas for improvement will take time to address. The evidence of this inspection is that improvements will be sustained and there will be increased positive outcomes for residents. This inspection has highlighted that the most important issues facing the home are that of staff deployment and day-to-day supervision of care provision. Getting this right is the key to overall improvement in the service. This inspection found that senior staff Care Homes for Older People Page 8 of 30 were not getting enough time on the units they supervised to oversee care provision. In turn, care staff on those units felt that more support was needed. At worst, some staff felt there was a lack of support for them from the management team and the wider Fremantle organisation. Added to this was the situation that changes were sometimes made to the staffing rota at short notice to accommodate staff sickness or cover in other units. Even if this was for a short duration staff reported that they found this unsettling. These staffing issues were seen to have an impact on residents. Residents told us they wanted more to do during the day whilst a number of staff said that they did not always have time for activities. One member of staff felt that the main issue facing the home was, providing meaningful activities. In addition, the sample of care plans inspected identified that, although there were some very clear examples of good care planning, not all records were up-to-date and it was sometimes difficult to tell how staff were working to meet residents needs. This current arrangement does not service residents well. The manager is aware of these issues and has started to address them. A new senior worker started work just before the inspection and a new senior night worker was to start immediately after the inspection. This will allow senior staff to spend more time on the units they supervise. The manager has identified that the staff rota needs to change so that staff can work much more on the units where they provide a keyworking service to residents. This will provide more continuity and assist with daily activity provision. Completing the dependency profiles for each resident will also help so that the manager can be sure there is adequate staff on duty for the needs of residents. A linked staffing issue and one which the manager is addressing is that of improving staff morale. There had been a period of poor staff morale and this was still evident from some of the feedback received from staff. This was discussed with the manager. She has been successful in raising morale so far and will require more time in order to be fully effective. The others areas identified by this inspection where the home can do better are as follows. More day-to-day activities need to be provided for residents. Residents said that they wanted to do more and that they did not always like the activities that where provided. There have been a range of activities provided such as a trip to Buckingham Palace and visits from musical entertainers. There were also some activities taking place during the inspection such as a bingo session. We were advised that an activities co-ordinator had been appointed but had been unable to start work. The manager is to recruit a new worker to provide activities. In addition, the Fremantle organisation plans to appoint a number of centrally located activities organisers who will provide an activities service in each of the Fremantle run Barnet care homes. It is anticipated that this will be from April 2009. Both these initiatives will improve activity provision at this home for residents. The environment presents a challenge for the smooth running of the home. Unfortunately, it is not clear whether the home will be rebuilt like other Barnet based Fremantle homes have been. This affects planning for the future. Currently, the Care Homes for Older People Page 9 of 30 manager is working on a programme to improve the physical standards and introduce more homely touches. For example, redecoration has taken place in many parts of the home with new carpets laid. New bedding and furniture was expected immediately following the inspection. However, the older style of the building presents some difficulties with layout that redecoration is not able to change. For example, bedroom size and lounge areas. In addition, the upgrade work has not yet been fully completed. A bathroom was closed temporarily during the inspection. There had also been a Health and safety audit in May 2008 which identified some shortfalls in the service. The manager advised that a follow up meeting was to be held following the inspection and the expectation was that the contractors would be rectifying matters. There has been an improvement to the extension of training to staff as well as the recording of staff training. Staff have been provided with training on Parkinsons disease and the manager is to arrange pressure area care training from the district nursing service. However, the recording of training needs to be developed. Currently, to establish what training staff have completed involves a lengthy trawl through paper records. The manager advised that training will be recorded on individual staff personal development diary sheets and Fremantle have advised that new computer training records will be developed. Similarly, there has been an improvement to the frequency of staff supervision. A sample of records were seen that provided evidence that staff were receiving supervision on a regular basis. However, some staff staff that supervision was happening less frequently and the new senior worker will need time to take up her supervisory duties. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 30 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is good information available for people about the service. The service provided is friendly and homely and peoples needs are identified before moving to the home. Further work on identifying peoples individuals needs will help make sure that the staffing levels for each unit matches peoples needs. Evidence: The homes statement of purpose and service users guide were re-written in November 2007 and reviewed in June 2008 when the new manager started. Both provide residents and others with a useful, easy to read guide to the home and the people working there. There are pictures of the staff and some of the residents. The guides complement the homely, friendly approach adopted by staff to visitors. Staff were friendly and helpful with the inspection process and open about their work. The home provides dementia care, mental health, old age and respite services within
Care Homes for Older People Page 12 of 30 Evidence: the eight units. This arrangement allows people to take up respite care when needed and to transfer to a permanent arrangement from respite when needed. This allows continuity for people using the service. All the permanent places are taken up through referrals from Barnet Council and the respite places are taken up by Barnet residents using the voucher system. Again, this allows continuity. It also allows a flexibility from the service in that it can admit people with a wide range of needs and then provide specialist services for them. Time was spent with the manager discussing the service and the managers plans for development. There are plans to develop the dementia care services. There is a senior worker who is the homes dementia care specialist and dementia care mapping has started. Other initiatives are planned. In addition, the manager plans to re-organise the keyworking arrangements. When completed this will benefit residents. This inspection focused on staffing matters and an arising issue was about the need to establish the needs of residents so that staffing numbers and expertise could be matched accordingly. There had been an exercise to assess each residents needs. The manager agreed to complete this process and analyse the results so that staffing numbers would be based on concrete information. More detail on staffing is provided in the Health and Personal Care and Staffing sections. This inspection identified that providing a warm, personal, friendly service was a strength of the home. Staff were observed to interact very sensitively with residents and it was clear that many staff enjoyed their work. Residents, in turn, liked the interactions with staff and praised a number of staff. Such a friendly, welcoming atmosphere is a useful starting point for provision of good individual care for people. Care Homes for Older People Page 13 of 30 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements have an impact on provision of care for residents. Improving staffing arrangements should also improve care provision. The current care plans, although detailed, have not all been updated so that it is not always clear how peoples care and health needs are being addressed. Planned new care planning documentation will help address this issue. Evidence: The evidence of this inspection is that the crucial aspects of staff deployment and dayto-day supervision of staff has a fundamental impact on the standard of care experienced by residents. For example, staff, who were very open about their experiences as well as often highly motivated and dedicated, identified problems with staff deployment and support from the management team of senior staff. In turn, a number of senior staff spoken with felt that they did not have sufficient time in their units to supervise day-to-day care provision. At the extreme end of this some staff felt that they were not supported by the organisation and assisted to give of their best when at work. These matters were discussed with the manager who had already
Care Homes for Older People Page 14 of 30 Evidence: identified staff deployment as something that needed to be developed. In addition, an additional senior had just started work at the home which will assist in day-to-day supervision. There was evidence from the sample of care plans inspected of the impact of the staffing issues. Although many care plans were clear and up-to-date, some were not and it was not always possible to tell how staff were addressing the needs of residents. For example, staff said that food and fluid was being monitored for one resident but there was no paperwork to support this. Other records, such as Waterlow assessments, were not signed or dated. The Fremantle organisation plans to introduce a new care planning system. This should improve matters for residents as the current system involves a great deal of paperwork. In the meantime the current care planning documentation must be kept up-to-date and a requirement is given about this. A requirement is also given about recording night time care. There were night time care plans which is a good initiative. However, there were no records of actions that night time staff may have taken. Records are needed to assist in handover information and continuity between night and day staff. The care plans provided details about residents health care needs and occasions when they may have seen the GP, dentist and optician as well as health care professionals such as district nurses. Medication storage arrangements and recordings were inspected in three of the units. There were separate rooms available for storage and the records were clear. One of the senior staff takes the lead for medication. She advised that it was now much better at the home to complete this work. A flexi-day was provided for her to check medication into the home. The Boots medication system is used and the senior advised that GPs review regularly. One area that had not been completed from the November 2007 key inspection that that of making sure that residents had individual medication profiles. The recommendation about this is repeated. Care Homes for Older People Page 15 of 30 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Initiatives to improve activity provision for residents have not yet been fully successful. Plans to recruit activities co-ordinators and more focus on day-to-day activity provision for residents should lead to better outcomes for residents. Evidence: Activity provision was discussed with residents, staff and the manager and observations were made about activity provision throughout the inspection. There had been recent events, such as trips out of the home to places such as Buckingham Palace as well as visits from musical entertainers and a charity that brings animals. During the inspection activities, such as a bingo session, were observed. There is also a day centre within the home which residents can attend if they wish. However, the general consensus of the feedback received was that activity provision needed development. Residents, via returned surveys, made a number of comments about activity provision. For example, one resident said that, the only time we get to do activities is when we go to the day centre. Other residents ticked the never box when asked if there were activities they could take part in. Some staff members said they did not always have time for activities and a visiting relative felt that residents
Care Homes for Older People Page 16 of 30 Evidence: needed people to sit with them and chat more often. On the positive side, staff were helping residents go out of the home to church or to the shops and relatives were made welcome when they visited. There was a definite feeling of the home being in the community, perhaps assisted by the fact that a number of local people were at the home for respite stays. Activity provision was discussed with the manager and area manager when she visited the home during the inspection. There has been work to develop activities. For example, there is a forthcoming initiative where Age Concern are to come to the home to train staff in providing activities. An activities organiser was appointed but was unable to start work. The manager has agreed that a new activities organiser will be recruited. And the Fremantle organisation plans to recruit a number of activities organisers to work in each of its Barnet care homes from April 2009. All these initiatives should improve the activities provided for residents. In the meantime a requirement is given that attention be given to providing residents with a range of relevant day-to-day activities based on their needs and wishes. The meal time arrangements were observed in a number of the homes units throughout the inspection. The food appeared tasty and looked attractive and staff were knowledgeable about residents needs including that of special diets. There had been some adverse comments about food waste in the surveys returned but none of the people spoken with during the inspection confirmed this. Comment was received about the food trolleys used. Meals are transported to the units from the kitchen in heated trolleys. Staff felt the trolleys were too large and the manager was able to advise that alternative trolleys were to be provided soon after the inspection. Care Homes for Older People Page 17 of 30 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be confident that their complaints will be taken seriously and investigated. There are suitable arrangements in place to make sure that safeguarding is properly addressed. Evidence: The complaint records were inspected. These are contained within a large file called the Fremantle Feedback file. This file contains a record of all complaints and compliments received at the home. There were a large number of compliments received. There were a number of complaints as well as standard forms on which to record complaints. There was evidence that complaints had been properly investigated. The safeguarding arrangements are suitable with an overall policy that sets out the action that will be taken following incidents or allegations of abuse. Staff have received training in this area. The sample of staff spoken to during the inspection confirmed that they had received this training. As will be mentioned below, in the Staffing section, there is a need for the staffing records to be more accessible. It will greatly improve the service to be able to demonstrate that staff have received relevant training such as safeguarding training. The records will also be useful in identifying which staff may have missed the training first time around. This is especially important in a home of this size where there are many staff. New staff will need to have
Care Homes for Older People Page 18 of 30 Evidence: safeguarding training as well. Care Homes for Older People Page 19 of 30 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is now much better and provides an improved quality of life for residents. The development work planned will further improve the facilities provided. Attention is needed to make sure that health and safety shortfalls are put right. Evidence: Inspections over the last few years at this service have highlighted the need to improve and upgrade the facilities so as to provide better outcomes for residents. This inspection has identified that much work has taken place and that residents are now enjoying a much improved quality of life. The manager was able to advise where further improvement work was planned and how she is keen to add more homely touches to the building. New beds, furniture and more decorative work is planned. The manager advised that the future direction of the home was not certain yet in terms of whether the home would be re-provided in a new build care home, as other Fremantle Barnet care homes have been. This affects planning for the future. Finance would be needed to further improve the home in its current form. And the existing home, although pleasant and homely, does not have the larger bedrooms, en suite facilities and larger communal space that new build care homes have. A Health and Safety audit of the home, carried out in May 2008, was seen. This audit
Care Homes for Older People Page 20 of 30 Evidence: covered the environment including fire safety, infection control and legionella. A number of shortfalls were identified. The manager advised that the expectation was that the contractor, who had been carrying out recent work at the home, was to have put these matters right. A follow up meeting with the contractor was scheduled for the day after the inspection. To make sure that the shortfalls are addressed a requirement is given in this report. Care Homes for Older People Page 21 of 30 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. More work is needed to ensure that residents needs are not adversely affected by the current arrangements for staff deployment. The manager is aware of the issues and has plans to address and overcome the problems. Success in this area should greatly enhance the service provided to residents. Evidence: As has already been mentioned throughout this report one of the most important findings of the inspection was that the staff deployment arrangements needed to be addressed. This was because senior staff were not spending enough time on the units they supervised, care staff were feeling they needed more support and there were some care plans and care arrangements for residents which were unclear. In addition, there was some low morale identified in some areas of the staff team and a need to complete and analyse the individual needs assessment for residents. All these matters were discussed with the manager and area manager. The manager was clear that she had identified areas that she wanted to improve upon such as the staff rota arrangements, the keyworking arrangements and staff supervision arrangements. There had been a lift in staff morale since the manager started work at the home and many positive comments were received about the manager and the positive impact that she had made. The recruitment of a new senior worker brings to
Care Homes for Older People Page 22 of 30 Evidence: full the complement of senior staff. This will assist in allowing senior staff to spend more time in the units within the home. The manager and area manager also suggested an improvement to staff deployment where care staff in adjoining units can support each other. Agreement was also given for the floating staff member to work more flexibly to provide staff cover where needed. Up to now the floating worker had just provided cover for staff breaks. In summary, the identified problems with staff deployment should be eased by the appointment of the senior worker and the changes planned by the manager. Should the residents individual needs assessment indicate a shortfall of staff cover then additional staff cover must be provided. The manager advised that 44 of staff have NVQ qualifications. However, there are NVQ assessors amongst the staff team so this number should increase over the coming months. A sample of newly appointed staff files were inspected to check that recruitment was being carried out properly. The files provided evidence that the relevant checks were being carried out. There are relevant records of staff training as well as good opportunities for staff to take up training opportunities. There is a central Fremantle training unit which is accessible to staff. However, there is a need to store the records of staff training in such a way that they are easily viewed and analysed. It was only possible to see if staff had done relevant training by looking through the complete manually held staff training records. The Fremantle organisation plan to hold staff training records electronically and this will improve matters. In addition, the manager has asked supervisory staff to record staff training on individual staff record sheets. These are held on staff files. These records were viewed and will greatly assist. However, the majority of staff record sheets are currently blank and work is required to complete them. Care Homes for Older People Page 23 of 30 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The new manager has had a positive impact on the service. The overall movement is one of improvement with benefits provided to residents from a well lead and organised staff team. Extending the quality assurance initiatives should assist in confirming how well the service is performing and in identifying future areas for improvement. Similarly, regular staff supervision will extend support to staff. Evidence: The new manager has had a positive impact on the service, is ambitious about transforming the service even further and keen to provide a quality care home for residents. Many staff said positive things about the manager. The following were typical. The new manager is excellent. It makes working as a team the best ever. The service has improved under the new manager. Care Homes for Older People Page 24 of 30 Evidence: The direction of the service is very much geared to improvement with the manager having plans in place and the organisational skills to make improvement a reality. The manager described the quality assurance initiatives followed. In line with other Fremantle care homes there is a regular quality audit which involves use of surveys and an audit of the home. The manager said that the feedback from the 2008 audit was not yet available. In addition, there are consultation meetings with relatives, meetings with residents, monitoring visits and use of the feedback file. The consultation meetings with relatives will need to be reviewed as there had been only one person present at the last meeting. The arrangements for looking after residents money were inspected. The system is relatively straightforward with the service looking after residents money in the homes residents account. A sample of records of this account was seen including paper and electronic records. The records seen were well ordered. A sample of staff supervision records were inspected. These provided evidence that staff supervision was provided regularly. However, some staff said that they did not receive supervision on a regular basis. Also, the manager advised that she knew that there were some shortfalls in supervision frequency. A requirement is given about this. It is important that staff are supervised on a regular basis. The introduction of the new senior worker will assist in making sure that supervision is more frequent. A range of paperwork and certificates were seen that provided evidence of the maintenance of the home and servicing of equipment. For example, records were seen of the servicing of the hoists, the lift and fire safety. This was all in order with the exception of some of the fire safety arrangements. There was no certificate, for example, for the recent servicing of the emergency lighting system. In addition, during the inspection there was a fire drill. It was observed that when the fire alarm sounded not all the doorguards activated. Doorguards are a safety feature which should close at the sound of the fire alarm. In addition, it was not clear that visitors to the home were accounted for when the alarm went off. These matters were raised with the manager. An overall requirement is given about fire safety arrangements. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 4 14 Complete the work to assess 02/02/2009 each residents needs dependency profile, analyse the information and amend staffing numbers as indicated. Having accurate information about residents needs will assist with staff matching and numbers. 2 7 15 Care plans must be kept up- 01/01/2009 to-date, providing clear records of residents needs and how staff are working with residents to meet those needs. To provide evidence that residents needs are being met. 3 12 16 Residents must be provided with a range of day-to-day activities that reflect their needs and wishes. 02/02/2009 Care Homes for Older People Page 27 of 30 Providing more activities for residents will improve the quality of life offered. 4 19 23 Make sure that all outstanding work identified in the May 2008 Health and safety audit of the home is completed. Completing outstanding work will improve the facilities provided for residents. 5 27 18 Revise the staff deployment and supervision arrangements so that senior staff have more time to supervise the day-to-day care arrangements. Allowing more supervision time on the homes units will provide better outcomes for residents. 6 36 18 Ensure that staff supervision 01/01/2009 is provided on a regular basis. Regular staff supervision should ensure that staff are supported and carrying out their tasks properly. 7 38 23 Make sure that fire safety devises are fully operative including doorguards and emergency lighting. Fully operative fire safety arrangements provide additional safeguards for residents. 01/01/2009 12/01/2009 02/02/2009 Care Homes for Older People Page 28 of 30 Recommendations
These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 4 5 7 8 9 30 33 Records of night time care provision should be maintained. Make sure that the forthcoming pressure sore training from the district nursing service is available for all staff. Medication profiles for residents should be drawn up. Make sure that staff training records are organised to simplify the retrieval of data. Consideration should be given to extending the quality assurance initiatives so that residents, relatives and other stakeholders at the home have increased opportunities to comment about the service. Care Homes for Older People Page 29 of 30 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - 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!
