Inspection on 12/10/06 for Middlecross

This inspection was carried out on 12th October 2006.

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

Middlecross 28/02/06

Middlecross 19/07/05

Middlecross 20/12/04

Middlecross 12/05/04

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

CARE HOMES FOR OLDER PEOPLE Middlecross Simpson Grove Armley Leeds LS12 1QG Lead Inspector Paul Newman Key Unannounced Inspection 09:30 12 October 2006 and 9th November 2006 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 DS0000033202.V300864.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. DS0000033202.V300864.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Middlecross Address Simpson Grove Armley Leeds LS12 1QG 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) 0113 2310357 0113 2319071 Leeds City Council Department of Social Services Mr Paul Martin Hudson Care Home 32 Category(ies) of Dementia (4), Dementia - over 65 years of age registration, with number (28) of places DS0000033202.V300864.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th February 2006 Brief Description of the Service: Middlecross is purpose built and all accommodation is at ground floor level. A security fence encloses the building and grounds and there is CCTV security protection covering the entrance gates and outside of the building. There is a central courtyard area with raised flowerbeds for service users to access during the day and gardens generally are well laid out, interesting and well maintained. The home is located in the Armley area of Leeds. There is easy access of all the local facilities including shops and public houses and convenient for the local bus service, which gives access to Leeds City centre and surrounding areas. The home provides care for thirty-one residents who are suffering from Dementia. Twenty-six of these are permanent or respite residents and for these nursing care is not provided but the home is supported by local healthcare services and more specialist services in relation to dementia in a similar way to living in your own home in the community. There are four wings to the building but one of these is dedicated to respite care and intermediate care. Intermediate care was introduced in October 2006. The aim of intermediate care at Middlecross is to provide a rehabilitation service that gives people with dementia the best chance of finding an appropriate setting for them to live. This may be by returning home or in full time care in another setting. Depending on the care needs that are assessed, residents in intermediate care may be helped by any one of a number of healthcare professionals including, registered nurses, registered mental health nurses, physiotherapists and occupational therapists as well as the staff who normally work at the home. Accommodation is provided in thirty-one single bedrooms and all bedrooms have en-suite WCs. There are good communal areas and small kitchenettes. There is a small Snoozelem room for residents. There are bathing and toilet facilities on each of the four wings and separate toilets are available for both staff and visitors. There is a large kitchen, which provides all the meals for the home and a day centre, which adjoins the care home. Laundry facilities are available for all the residents’ personal laundry. DS0000033202.V300864.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection (CSCI) inspects homes at a frequency determined by the assessed quality rating of the home. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a visit to the home. All regulated services will have at least one key inspection before 1st July 2007. This is a major evaluation of the quality of a service and any risk it might present. It focuses on the outcomes for people living at the home. All core National Minimum Standards are assessed and this provides the evidence for the outcomes experienced by residents. At times it may be necessary to carry out additional visits, which might focus on specific areas like health care or nutrition and are known as random inspections. The last inspection was on 28 February 2006. At that time the home’s quality rating was level 3 (good), and no random visits have been needed since then. This visit was unannounced and carried out by one inspector over one day on 12 October 2006 with a brief unannounced follow up visit made on 9 November 2006. As part of her induction to the CSCI, a pharmacy inspector also joined the inspection on the first day and focused on medication policies, procedures and practices. The lead inspector has also been involved in previous visits during 2005. The first inspection visit started at 9.30am and finished at 5.00pm. Verbal feedback was given to the manager. The second visit lasted an hour to check on some matters arising from the introduction of intermediate care to the home. The purpose of the visit was to make sure the home is being managed for the benefit and well being of the residents and to see what progress had been made meeting requirements from the last inspection. Also to check how the home was managing the introduction of intermediate care. Information to support the findings in this report was obtained by looking at the pre inspection questionnaire (PIQ). Examples of information gained from this document include details of policies and procedures in place and when they were last reviewed, when maintenance and safety checks were carried out and by who, menus used, staff details and training provided. Records in the home were looked at such as care plans, medication records, policies and procedures, and complaints and accidents records. Some residents were spoken to as well as members of staff, the clinical manager of the Primary Care Trust staff team who provide specialist support for intermediate care and the management team of the care home. CSCI comment cards and post-paid envelopes were left at the home to be given to residents and their relatives as well as comment cards for health care professionals who visit the home. At the time of writing this report none have DS0000033202.V300864.R01.S.doc Version 5.2 Page 6 been received but a specialist psychiatric doctor visiting the home at the time of inspection completed a questionnaire that was positive. From the information in the pre inspection information provided by the home, the standard weekly fees range from £10.31 per night for respite care and weekly charges for permanent residents up to £433. Personal toiletries, hairdressing and private chiropody are not included in the fees. From the evidence gathered at this inspection, the quality rating remains good. What the service does well: What has improved since the last inspection? The home continues being committed to making sure that staff are well trained and twenty of the staff team have now completed the Dementia Care Certificate and others to follow the course. The home exceeds targets set for the number of staff who should hold a National Vocational Qualification. Some areas have been redecorated in the rolling programme of refurbishment. It is planned to upgrade the bathroom facilities this financial year and this will include the provision of shower facilities not currently provided and this has been an ongoing recommendation to improve the home. DS0000033202.V300864.R01.S.doc Version 5.2 Page 7 What they could do better: There is just one requirement outstanding for the manager to complete the Registered Manager’s Award. There has been much going on with the introduction of intermediate care so his progress has been slower than expected. Intermediate care is now provided and although there were some initial issues about the quality of the information about residents being referred, these were resolved following a settling down period but in this respect recommendations are made that: • • The manager should continue to work with professionals who make referrals for intermediate care to make sure that the quality of information before admission is consistently detailed. The manager, with the support of the Social Service Department, should make sure that service level agreements are maintained by the Primary Care Trust Intermediate Care team involved so that healthcare professional assessments and ongoing advice and support is also consistently provided. More urgency should be given to adapt the dedicated part of the building for intermediate care that will help assessments and their rehabilitation. • Other recommendations are as a result of speaking with staff and include making sure that equipment for the housekeeping team is available for them to maintain good standards and for there to be more regular staff meetings. The emergency call system should be checked to make sure that there are call points available in all communal areas. 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. DS0000033202.V300864.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 DS0000033202.V300864.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents and/or their relatives have the information that is needed before they choose a home. Assessments are made before people move in to the home, that give staff a clear idea of the person and their care needs. In respect of intermediate care, at the beginning of the service being set up the quality of information about residents before their admission was inconsistent in detail, but has improved. The Primary Care Trust Intermediate Care team that is involved and carries out healthcare assessments and ongoing advice and support now maintains Service level agreements. EVIDENCE: The home’s statement of purpose and the service user guide have both been amended to reflect that intermediate care services that are now provided at the home. Copies of these were provided to the CSCI in advance of DS0000033202.V300864.R01.S.doc Version 5.2 Page 10 intermediate care being introduced and give accurate information about the care, facilities and services provided at the home. Five care plans were checked to see that pre admission assessments were being made that would accurately provide information for a plan of care to be drawn up. For the three permanent residents seen the home continues to be effective in getting up to date information in line with National Minimum Standards. These each had detailed pre admission documentation and the manager said that he insists that prospective residents ‘always’ make an introductory visit that also forms part of the pre admission assessment. At the first inspection visit, the information collected for intermediate care residents was not adequate and while it is accepted that the nature of intermediate care is that placements may need to be done at short notice, it seemed that the team responsible for intermediate care in the Primary Care Trust, were failing to give the home sufficient information for staff to make the situation safe. Details about general health conditions and medication were provided, but, in reality, the home should receive the same quality of information as residents being considered for a permanent placement so that important information about risk factors like moving and handling, falls and dietary needs are clearly known. At the time of the first visit, the intermediate care service was very much in its infancy and had only been operating for a number of days. It would be fair to say that the manager of the home was himself ‘uneasy’ about the quality of the information provided. This was discussed and whilst confident that the manager would be proactive in making sure that pre admission information was more thorough and detailed, a second inspection visit was made on 9 November to check things had improved. At this point the manager had devised a pre admission information sheet for intermediate care residents that had been introduced and was far more effective in getting up to date, accurate ‘across the board’ information. Also at the time of the first visit, the service level agreement for healthcare professional input was not fully implemented and as a consequence the ‘in house’ assessments of residents for intermediate care were being delayed and were not within the previously agreed timescales. This once again placed the care staff team in a position where they were not aware of the support and assistance that was needed to get residents on to an effective rehabilitative plan. On the second visit the manager reported that things were much better and that the healthcare professional care plans were being done. Intermediate care is provided in one wing of the home dedicated to the service. Before the service started it was known that funds were available to adapt the environment to maximise the opportunities for residents to be assessed and supported with a view to going back home if that was possible. No work had been done to the environment, although discussions about what may or not be needed were continuing between the home, Social Service DS0000033202.V300864.R01.S.doc Version 5.2 Page 11 department and healthcare professionals in the Primary care Trust. This was disappointing and more urgency should be given to adapt the building to assist residents in their recovery. DS0000033202.V300864.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The healthcare needs of residents’ are met and care plans provide clear and detailed instruction for staff to follow. Staff are aware of residents’ needs and there is good communication amongst the staff group and with healthcare professionals. Medication policies, procedures and practices are good. Residents are treated with respect and in a dignified way. EVIDENCE: Three care plans (lifestyle plans) were checked. The plans continue to be detailed and provide staff with clear information about the care needs of individual residents and guidance about the way to deliver the care. Any liaison with healthcare professionals was well recorded, showing that there is regular contact with specialist services in relation to mental health and dementia. A psychiatrist visiting at the time of inspection was not spoken to but completed a questionnaire that indicated that • The home works in partnership with psychiatric services DS0000033202.V300864.R01.S.doc Version 5.2 Page 13 • • • • • Staff demonstrate a clear understanding of the care needs of residents That specialist advice is incorporated in the care plan Medication is appropriately managed The home seeks advice and makes the right decisions when they can no longer meet care needs The doctor was satisfied with the overall care Contact with relatives was recorded clearly showing that staff communicate significant events including the outcome of Doctors’ visits. Care plans are evaluated each month and changes are recorded. Risk assessments are also included and these are also subject to review and are up to date. This inspection also involved a pharmacy inspector who conducted a detailed inspection of medication policies, procedures and practices. This was done over a five-hour period and was the type of very detailed inspection only normally carried out at homes where there are concerns. There were no such concerns at Middlecross and the inspector was carrying out this work as part of her induction to the CSCI. Nevertheless, the home manager welcomed this focused checking. Verbal feedback was given about the outcome of her work and a detailed report sent separately to the home. Whilst some recommendations were made and the manager undertook to act upon these, overall, things were found to be safe with positive procedures and practices were noted. These are some of the things said: POLICIES: • • • • • • • • A very good policy, lots of detail. Contained within medicine file. Names and signatures kept of senior staff who have read the policy. Only senior care staff involved with medicines. Uses “Six rights of medication administration” e.g. right resident, right medication. Contains RPSGB document “Administration and Control of Medicines in Care Homes and Children’s Services.” Old records of fridge temperatures kept in file. Controlled drug receipts kept in file RECORD KEEPING • • • • Good. MAR charts are good and well kept. A copy of the 11-step procedure (taken from the medicine policy) for the administration of medicines is kept at the front of each MAR chart folder. A record of staff signatures is also kept at the front of the MAR chart folder. Residents MAR charts are separated and their photos attached, except new and IC residents. DS0000033202.V300864.R01.S.doc Version 5.2 Page 14 • • • • • Correct codes are used for recording omission of medicines e.g. Rrefused. Times are highlighted especially for single daily doses e.g. a morning dose only. GTN spray (for angina) is offered to residents at each round. Entries for eye drops indicate which eye. The ordering of medicines is thorough and provides an effective audit trail. The ordering of prescriptions is the responsibility of senior care staff, usually night staff who have more time and less distractions. Prescriptions are always seen before being sent to the pharmacy, therefore allowing plenty of time to liaise with the GP if problems such as wrong medicines are issued. The medicines are usually received from the pharmacy on the Wednesday before the Monday start date. There were positive comments made on drugs administration including controlled drugs, storage and disposal. Observations made by both inspectors throughout the day showed staff to be professional but personable with residents and relatives. The relationships were warm and friendly. Residents looked well cared for. Staff were observed to manage the residents sensitively and survey questionnaire results indicated that staff are held in high regard. Residents said that staff gave them good support, gave assistance when they needed it and respected their privacy like knocking bedroom doors before entering. DS0000033202.V300864.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are positive about their lifestyles. Their social needs are assessed and documented and activities are arranged that are geared to stimulate and interest them. Residents are encouraged to make choices about what they do and enjoy contact with family, friends and visitors from the community. There is a balanced menu that residents like and any special dietary needs are catered for. EVIDENCE: Previous inspection reports have commented positively on the range of activities that are provided. These are outlined in the newsletter that is published for relatives and visitors. In recognising the importance of keeping families involved in the life of their relatives family events are arranged and there was a successful summer fair. The service user guide makes it clear that visiting is encouraged and welcomed. A number of visitors came throughout the day. The daily activities taking place include gardening, ‘lifetime matters’, reminiscence therapies, regular entertainers, use of the snoozelem, trips to DS0000033202.V300864.R01.S.doc Version 5.2 Page 16 local facilities like museums, shopping trips and churches. On the day of inspection there was a pub lunch arranged. Above all, it is the personable way that staff treat residents that is a feature of the home and there always appeared to be a calm reassuring word for residents. Staff were good at picking up non-verbal cues from residents and quick to give support. Residents have their own personal routines and preferred way of doing things like getting up and going to bed times or when they bath or shower that are identified in their daily living plans. But staff were asked how they dealt with residents who had poor communication for example in choosing what clothes they wear each day. It was clear that they knew their residents well and their training in recognising the importance of non verbal communication had been beneficial in being aware when someone was pleased, liked or didn’t like what they were being shown or were doing. During a tour of the building early on in the inspection, staff were observed serving breakfast. The residents looked well cared for and their care was sensitive, warm and personable. The breakfast menu had several choices including a ‘cooked’ meal. The visiting policy makes it clear that relatives and friends can choose to eat as well. The rolling programme of menus that was provided in the pre inspection information looked to provide choice with good wholesome food. Choices are made at the time of the meal and do not have to ‘booked’ in advance. Residents’ who were able, said that they enjoyed the food. Certainly the lunchtime meal was well presented and the special dietary needs were clearly dealt with. The residents were assisted with great care, sensitivity and encouragement. DS0000033202.V300864.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Relatives are aware of how to complain if they are unhappy with the standard of service, and this helps safeguard residents. Where they are able, residents are encouraged to express their views and with all residents, special note is taken of their non-verbal communication to determine if they are happy or unhappy with things. EVIDENCE: The pre inspection questionnaire confirmed that the home has a complaint’s and an adult protection procedure. The manager was fully aware of the adult protection procedure and how to report any allegations of abuse. Adult protection training has been provided for staff working at the home. The pre inspection information said the home had not received any complaints within the last twelve months and the manager confirmed this was still the case. The home has a complaint’s book to record any complaints and a copy of the procedure is on a notice board in the home and in the service user guide. DS0000033202.V300864.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is safe and well maintained and offers a variety of comfortable communal lounge areas. Bedrooms suit personal needs, are en-suite and can be personalised with your own possessions and made private. The home has aids that make things like bathing and toileting easier. The gardens are safe, interesting and well maintained. EVIDENCE: Middlecross is a purpose built care home providing a selection of small and larger seating areas within each colour coded section for sitting, eating, and interacting with other residents, staff and visitors. Although most residents have a preferred area it was observed that they were free to move around if they wished. Communal spaces include small lounges and a dining area in each section and a large room near the bar area. Each bedroom has an ensuite toilet and washing hand basin but residents have the choice of four DS0000033202.V300864.R01.S.doc Version 5.2 Page 19 bathrooms and access to five toilets positioned on the corridors near communal areas if they do not want to return to their own rooms. The range of bathing facilities should be expanded to include walk in showers that would give residents a choice and the manager said that this is planned for this financial year. There are aids, adaptations and specialist hoists to make things safe for staff and residents moving about the building, toileting and bathing. The tour around the building found good standards of cleanliness and no unpleasant odours. There are high levels of incontinence and the housekeeping team do well to keep the home clean and odour free. In discussion with the housekeeping team they said that to continue to maintain good standards their equipment could be boosted with a new rotor washer that helped clean up spillages and a buffing machine that had been ordered but was the wrong machine should be sorted out without any further delay. This was discussed with the manager. Residents are able and encouraged to bring their own items of small furnishings, pictures, photos, ornaments and electrical gadgets, so that their bedrooms are personalised, homely and familiar. There is an ongoing programme of redecoration. The gardens are well maintained, interesting and provide some stimulation and are a safe outdoor space for residents to enjoy. With regard to intermediate care, more urgency should be given to adapt the dedicated part of the building that will help assessments and their rehabilitation. This is specifically addressed in the National Minimum Standard that addresses intermediate care, Standard 6. DS0000033202.V300864.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff are experienced, well trained and know what they are doing. They have good relationships with the residents and care for them well. EVIDENCE: The pre inspection information provided copies of duty rotas that showed sufficient staff on duty. The housekeeping team have been carrying a vacancy but an appointment has been made and a start date agreed. Additional care hours have been given to take account of intermediate care services and these have been filled and the home is essentially fully staffed with officers and care assistants. Four care staff were spoken with and they felt that they had been kept informed about the introduction of intermediate but there was a degree of frustration about delays but were now pleased that the service was up and running. There was a general consensus that they would like more staff meetings to express views so that issues that were important to them could be addressed at an early stage. This was raised with the manager. The staff spoken with talked about the training that they have been involved in and twenty have completed the Dementia Care Certificate and others to follow the course. There are some bits of training that are overdue like fire lecture and food hygiene updates but the manager is aware of this and addressing this through the Departments training programmes. The home has DS0000033202.V300864.R01.S.doc Version 5.2 Page 21 exceeded targets for the numbers who should have achieved a National Vocational Qualification and currently stands at 71 . National Minimum Standards should achieve at least 50 . Staff turnover is minimal and there is a good core of staff who have worked at the home for many years and are experienced, well trained and qualified. There are well-established systems of communication and the shift handover sheets seen in the central office showed how detailed information was passed on and how staff were organised and deployed. The afternoon shift handover was seen. Once again the staff spoken with demonstrated their professionalism, good knowledge of the residents they care for and their commitment to personal development and training. The home had conducted its own satisfaction survey in September and this probably accounted for the poor response to the CSCI survey. The home’s results showed the confidence and satisfaction that relatives and residents have in the manager and staff. The next survey the home conducts should include healthcare professionals involved with the home. DS0000033202.V300864.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an open and friendly atmosphere created by good leadership and management. There is a clear approach to resident care that is person centred and puts the best interests of individual residents central to staff practice. Residents’ financial interests are safeguarded. Record keeping, safety checks and systems of communication make sure that the home is a safe place to live. EVIDENCE: The manager continues to be ‘hands on’ to make sure there is personal ‘on the job supervision’ and checking, as well as the established formal supervision system of the staff team. The conversations with staff and residents and the home’s satisfaction survey show a high regard and appreciation for his management style. He has yet to complete the Registered Manager’s Award. DS0000033202.V300864.R01.S.doc Version 5.2 Page 23 The atmosphere in the home was warm with a lot of good humour. Staff were busy and their relationships with the residents were good. There was a lot going on with activities and personal care and one resident took a fall during the morning that was handled well with the resident taken to hospital for checks and treatment to a cut. It was good to see that relatives have been kept informed about the intermediate care service starting and any implications that there might be. An open meeting was held for them to ask any questions. As noted above the home has conducted a satisfaction survey as part of its quality assurance approach. There is regular auditing of records and systems by the manager and through the regular monthly visits by the line manager for the home. Monthly reports of these visits are sent to the CSCI. The home has an annual development plan. Some residents’ personal monies are held for safekeeping. The records of two residents were checked and these showed transactions in and out that were supported by receipts. In both cases, a reconciliation was made with the cash held and found to be correct. The City Council has thorough financial procedures and the home has recently been through a major audit by the Council’s central Audit Department. The pre inspection information showed that safety checks on the building and equipment are held as they should be to make sure that everything is working properly and in a serviceable condition. There are monthly health and safety checks. Based on the inspectors experience of a home of similar design, it was recommended that the manager does a complete check of the emergency call system to make sure that call points are available in all communal lounges. DS0000033202.V300864.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 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 3 X X X X X X 3 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 2 3 3 X 3 X X 3 DS0000033202.V300864.R01.S.doc Version 5.2 Page 25 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 OP31 Regulation 9 Requirement The manager must complete the Registered Managers Award or other recognised qualification. (Outstanding from inspection report of 19/07/05. New timescale set.) Timescale for action 01/06/07 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 OP3 Good Practice Recommendations The manager should continue to work with professionals who make referrals for intermediate care to make sure that the quality of information before admission is consistently detailed. The manager, with the support of the Social Service Department, should make sure that service level agreements are maintained by the Primary Care Trust Intermediate Care team involved so that healthcare professional assessments and ongoing advice and support is also consistently provided. More urgency should be given to adapt the dedicated part DS0000033202.V300864.R01.S.doc Version 5.2 Page 26 2. OP6 3. OP6 4. 5. 6. 7. OP19 OP26 OP32 OP38 of the building for intermediate care that will help assessments and their rehabilitation. The provision of walk in shower facilities would be beneficial and give residents an alternative to bathing. The house keeping team should be provided with efficient and effective equipment to maintain good standards of cleanliness and hygiene in the home. To maintain good professional relationships, the manager should consider holding staff meetings more regularly in line with staff wishes. The manager should carry out a complete check of the emergency call system to make sure that call points are available in all communal lounges. DS0000033202.V300864.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000033202.V300864.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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