Inspection on 14/11/07 for Neva Manor Residential Care Home

This inspection was carried out on 14th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Neva Manor Residential Care Home 28/02/07

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 Neva Manor Residential Care Home 4 Neva Road Weston Super Mare North Somerset BS23 1YD Lead Inspector Patricia Hellier Unannounced Inspection 09:00 14 November 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 Neva Manor Residential Care Home DS0000068269.V350674.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. Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Neva Manor Residential Care Home Address 4 Neva Road Weston Super Mare North Somerset BS23 1YD 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) 01934 623413 01934 623413 neva.manor@enningsmail.co.uk Dharma Rajoo Bungaroo Mrs Devianee Bungaroo Kimberly Neale Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate one service user aged less than 65 years of age, as named in CSCI letter dated 19.09.06 28th February 2007 Date of last inspection Brief Description of the Service: Neva Manor Residential Care Home is a large Victorian house situated in a quiet residential road in Weston-Super-Mare and close to the seafront. The town centre is nearby with a range of shops and recreational activities. The home is registered to provide residential care for up to 14 older persons in a converted property. The accommodation is situated over two floors with a chair lift and stairs for accessing the upper floor. A lounge and dining area is situated at the rear of the property and there is an additional quiet lounge situated at the front of the home. Mr & Mrs Bungaroo own Neva Manor and registered with the Commission in September 2006. Ms Kimberley Neale is the registered manager. The provider makes information available through a brochure and information pack. The information pack contains the Statement of Purpose and Service User guide and all relevant information about the home. The current fee levels are between £336.65 and £405.39 per week. Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place over 8.5 hours on one day. The Registered Manager, Ms Kim Neale, was present throughout the inspection. Since the last Key inspection in February 2007 a random inspection was undertaken in May 2007 to see if the requirements made at the Key inspection had been met. The health and safety requirements had been met but not the recruitment one which was repeated with a new timescale. An inspection by the Environmental Health Authority (EHO) was undertaken in September 2007 when a number of requirements were made is respect of the kitchen and health and safety issues in the home. A follow-up visit in October 2007 noted that conditions had improved, and the provider had supplied an action plan with timescales for the completion of the works, for the safety of people who use the service. Following this EHO stated that they had no objections to registration continuing. Before the inspection the information about the home was received from the file held in the office, surveys received from 2 people who use the service and 7 relatives. The last two inspection reports were reviewed together with the completed Annual Quality Assurance Assessment (AQAA) form, from the provider. We also reviewed all correspondence and regulatory activity since the last inspection. The accumulated evidence for this report comes from the above and also fieldwork that included the following: discussions with 9 residents, 2 relatives, and 4 staff; observation of practices, tour of the premises, review of documents relating to care, recruitment and health and safety; review of policies; inspection of medication records and storage. Of the 14 resident surveys sent 2 were returned and both were satisfied with the care they received. Common themes were that people who use the service experience it as happy caring home, with cheerful staff. Of the 14 relative surveys sent 7 were returned and all felt that the home meets their relative’s needs in a friendly and safe environment. All relatives spoken with felt welcomed at the home and that they were consulted regarding their relatives care and needs. Comments included “the staff are very friendly and welcoming”. Surveys were sent to 8 Health Care Professionals that visit the home and none were returned. All residents and staff spoken with told the inspector that the home was very good and the staff very kind. Comments received were “it is very homely and comfortable”; “the staff come when I call”. What the service does well: Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 6 Neva Manor provides a very homely ‘family feel’ environment for service users. There is an extremely relaxed atmosphere where service users are supportive of one another. The outcome for the residents is good. For example 5 residents spoken with said, “the home is lovely, the staff are kind and caring, and the food is good.” There is a good rapport between staff and residents. The routines in the home are flexible to suit the needs and wishes of people who use the service. The staff work hard to ensure the well-being and comfort of the residents’ and treat them with great respect and kindness. Staff were described as kind and always ready to listen. Meals are varied, healthy and nicely presented offering choice and variety. Residents feel that if they had something to complain about they would speak to a member of staff. All residents spoken with said they had nothing to complain about. One relative said ‘the home is excellent’. What has improved since the last inspection? What they could do better: The staff team work hard but are overstretched. The provision of more staff would ensure that residents’ needs are met in a timely manner. The employment of a cleaner would enhance the infection control practices and protect people who use the service. Residents would benefit from staff that had received training and had a good knowledge of moving and handling people, how to prevent the spread of infection and the recognition and reporting of abuse. Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 7 The safety of the building would be enhanced for residents’ protection with the assurance of the safety of the electrical wiring and a clear fire risk assessment process that is understood by all staff. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Neva Manor Residential Care Home DS0000068269.V350674.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 Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose and Service User Guide is comprehensive and provides prospective residents with information to make an informed choice. The home’s assessment process is satisfactory and ensures that it is able to meet residents’ needs. Prospective residents and relatives are encouraged to visit the home to assess suitability. EVIDENCE: Residents are provided with a comprehensive Residents’ folder containing the Statement of Purpose, Service User Guide and all the information required to ensure they, or their relatives, have access to the relevant information at all times. The Statement of Purpose does not include information regarding equality and diversity issues and how the home would meet differing cultural and spiritual needs. All residents spoken with had a copy of this in their rooms. Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 10 All residents were aware they had a contract of residency and were happy with the provision that they receive. On inspecting the Terms and Conditions of residency document the weekly fees to be charged are clear, but it does not show who contributes what amount to make up the weekly fees. This should be included for clarity for residents and their relatives and in line with the recommendations of the recent “Fair Price for Care report”. An assessment procedure for new residents is undertaken but there are gaps in the information recorded. Three files were inspected and two did not contain the information about allergies, past history medical and social, or current illness, to enable staff to provide person centred care. One of the assessment forms does not state where the assessment took place and two were not dated, so it is not possible to evidence that assessments were undertaken prior to admission to the home. A relative spoken with confirmed that an assessment prior to admission had been undertaken. The assessment procedure covered aspects of the resident’s day-to-day life, and general needs such as dietary preferences, mobility and dexterity, incontinence and all other aspects of daily living. The assessment was person centred and included all aspects of physical, psychological and emotional care. This is good practice and is to be commended. Attention to detail in completing the forms would ensure staff had all the information to assist them in the provision of care. The residents’ when spoken to said ‘I am well looked after; they know what I need”. “I am getting used to it and the staff are interested in me, and helping me a lot.’’ Social services care plans had been obtained where relevant. Care practices observed showed that staff were fully aware of the residents needs as stated in their assessments. Prospective residents and relatives are encouraged to visit the home to assess suitability. Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans provide information for staff to meet resident’s needs in a person centred manner. Personal and environmental risks are well managed. Medication administration storage and receipt is satisfactory, some practices are poor and must change for the safety of people who use the service. Respect and dignity are well maintained by kind and caring staff. EVIDENCE: Individual records are kept for each of the residents, which include all key personal information. Three care plans were inspected and all reflected clearly current identified health needs. In two of the three records blood pressure and blood sugar monitoring were being undertaken but there were no parameters or information for staff to know what is abnormal and the action needed for the safety of the resident. Residents are weighed on admission, and regularly following this, to ensure they are receiving enough nutrition to maintain their health and well being. Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 12 The three residents who were case tracked, and all other residents spoke of how the staff at the home respond to their needs, physical, social and psychological in a positive and understanding manner. Staff when interviewed were clearly able to describe all the needs of the residents being case tracked and demonstrated a person centred approach to care. This is good practice that is evidenced in care records. Evidence was seen of regular visits by the chiropodist and optician, and residents being taken to other appointments as needed. Resident’s comments supported this. Monthly evaluation of care plans was seen but no evidence of resident involvement with these was seen. Residents spoken with were unaware of their care plans. Staff interviewed said they did discuss residents’ care with them but did not formally record it in the care plan. The three care plans inspected did have space for recording the arrangements in death and funeral arrangements, however these had not been completed. During the inspection two residents, a relative and a newish member of staff told the inspector, about the recent death of a resident and how well the staff had handled it. Care records did not evidence this good practice and arrangements should be made to ensure residents’ wishes in death are recorded, to ensure there wishes are respected and fulfilled. All care plans contained well-formulated risk assessments for falls and any environmental risks e.g. use of the stair lift. Other personal and environmental risk assessments were present to ensure the safety of the resident while promoting independence as able. Daily records seen were respectful and contained relevant information to care needs and provision. Some people who use the service require assistance to move them to meet their daily needs. Equipment in the form of a handling belt and slide sheets are provided. However one resident told us that she is moved using a under arm lift, which is poor practice and can potentially cause injury. Staff when interviewed described this practice of moving and were unaware of its poor practice and potential to cause harm. Staff told us they have not received training in this area recently. Care practices observed showed caring interactions and good communication skills from staff. Choices and preferences were observed being discussed and offered. Medication storage, receipt and disposal are well managed. The home uses the “Nomad system” of medication administration. A full audit trail of medicines entering and leaving the home that are not supplied in the Nomad packs is possible. Medication received into the home in Nomad packs is not recorded for audit purposes. The manager and her deputy write up, and sign, the medication administration records kept by the home on a monthly basis. Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 13 Medication practices observed were satisfactory. The senior member of staff on duty dispenses medication prescribed after the nomad pack has been dispensed, from the bottle into the nomad pack when they arrive. This means that the nomad packs have been tampered with and potentially puts residents at risk. This poor practice was discussed with the manager who agreed to stop this unsafe practice for the safety of residents. Staff interviewed had received some medication training but had not been competency assessed for the protection of people who use the service. Hand transcribed prescriptions were seen and these had been signed by two members of staff when written. The home does not have a policy for the administration of homely remedies. The manager understood the need for this and is planning to access the North Somerset PCT policy and discuss and agree it with the local GP’s. All residents spoken with felt that kind and caring staff respected their dignity and privacy. The home has an Equality and Diversity policy that recognises the cultural and social needs and differences that are present in society. Staff observed in helping a resident with sight impairment showed patience and understanding of the residents needs when accessing her food. Both management and staff demonstrated clear knowledge and desire to meet cultural and diversity needs as and when they should arise. Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. 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’ benefit from routines, and menus, that are flexible to meet their needs. A variety of activities is offered, and residents right to choice and control over their lives is well respected, and encouraged. Friendly staff always welcome relatives and visitors. EVIDENCE: Many residents commented on the atmosphere of the home. One person described it as nicely informal, and residents’ felt that their visitors are also helped to feel relaxed and at home. All residents described very warm relationships with the staff. Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 15 A range of activities is provided with posters displaying information of forthcoming events in the front hall. Two residents said, “there is something on every day of the week if you want it”. Special activities are arranged at varying points of the year. All residents spoken with enjoy the outings arranged at varying times in the year. In the front hall information regarding general health matters is displayed together with information about the police care watch. Information about care home funding and fees assistance is also displayed, together with information about advocacy services. The atmosphere in the home was lively and all residents appeared to be enjoying themselves. Residents told the inspector they can see their visitors at any time and that routines are flexible. Residents said that they are given help promptly, and that staff always come quickly if they ring their call bells. Relatives were seen popping in during the course of the inspection and being welcomed by staff. One relative said, “I feel quite happy coming here and the staff are very good to me”. Comments made by relatives indicated that they were made welcome; “there is always a warm welcome when I visit”. A friendly banter was evident between staff and residents throughout the inspection. The dining room is homely and tables well presented. All residents said they liked the meals and felt that they provided a good balanced diet. The menus show a varied and interesting balance. The cook talks to each person about their meal preferences and any menu ideas. She regularly sees the residents to get more feedback. All meals are home-made from fresh ingredients. In addition to the usual cups of tea and coffee, a choice of cold drinks was regularly offered throughout the day. At the EHO inspection it was recommended that the kitchen be renewed and food written food safety system is implemented for the safety of residents. Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are confident that they are listened to and their requests acted upon. Staff do not have a clear understanding about how to safeguard residents from abuse. EVIDENCE: The home has a comprehensive complaints procedure and all residents have a copy of it. There have been no complaints since the last inspection. Residents stated that if they were not happy about anything they would speak to the manager. A complaint, comments and compliments leaflet is available in the front hall for any resident or visitor to complete if they so wish. Residents said that the manager and staff are very approachable and they would always raise any niggles with them. Two residents, who said they had done this, were very satisfied with the outcome. Staff and residents spoken to, say the manager is very approachable and understanding. One resident said ‘I’ve nothing to complain about, it’s just like home – we are one family”. A system for keeping clear records of complaints received with actions taken and outcomes are available should any complaints be received. Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 17 The home has a copy of the North Somerset ‘No Secrets’ Guide. The home has an abuse policy and information about responding to allegations of abuse, however it makes no reference to the ‘No Secrets in North Somerset’ guidance and does not contain the information for contacting Care Connect. It does not include information and contact details for CSCI. Staff have not received any formal training regarding Safeguarding Adults and the how to whistle blow should the need arise. Staff when interviewed were unaware of the policy and ho best to respond to any allegations should they occur. All residents said, “The staff are very kind and take time”. “I can’t fault them”. Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22,24,25, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are provided with homely, safe and comfortable surroundings. Health and safety issues are not always well managed. Outdoor space is attractive and accessible for residents to enjoy. The home has suitable equipment to maximise resident independence. People who use the service are at risk of potential cross infection due to poor infection control practices. EVIDENCE: Many parts of the home are welcoming and comfortable with homely communal spaces. Residents’ rooms are personalised and comfortable. The lounge is furnished with a variety of suitable and comfortable chairs to suit residents’ needs. Some areas of the home are in need of redecoration and one resident’s room had a damp patch. The manager and owner told us that they are planned for redecoration in the near future. The owner’s maintenance and ongoing refurbishment plan was seen. Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 19 Residents’ rooms are personalised and comfortable. All rooms are provided with en-suite facilities. The home has grab rails situated at relevant points and a stair lift that is easily used to assist resident mobility, and aid independence within the home. Risk assessments for the use of this have been undertaken and actions recognised to ensure the safety of people using it. Since the last inspection the hall stairs and landing carpet has been replaced and the area decorated. It provides a peaceful and pleasant environment to the home. Two grab rails have been pulled of the walls in the mezzanine area and remedial work is needed to repair the damage and provide grab rails in all areas for the safety of residents. Environmental health have visited since the last inspection and required that the threadbare carpets in two rooms be replaced. Hot water outlets supply water at scalding temperatures. Notices by the communal taps warn people of this but the potential for harm remains. A system of thermostatic valves for hot water outlets, or the control of the temperature of supply at source, is required for the safety of people who us the service. In two bathrooms a thermometer for recording bathwater temperatures were present and records seen indicated that bath water temperature are around the recommended heat of 43°C for the protection of residents. Equipment to assist residents in bathrooms was observed to have cracked and flaking paintwork and to be rusting, providing potential for cross infection and should be replaced. The home was clean and tidy on the day of the inspection. A tour of the premises was undertaken and the inspector viewed all the communal areas and some of the service users’ private bedrooms. All service users’ rooms viewed had been personalised to reflect individuals’ choices and preferences. Service users rooms were well personalised. Wardrobes and other furniture in some rooms, were not secured therefore posing a potential risk. Not all radiators in the home have been covered and risk assessments for these have not been undertaken to safeguard residents from potential harm. . The home was clean and free from offensive odours. During the inspection a dirty toilet seat was seen and the wash hand basin did not have any soap for handwahsing. This is unsatisfactory and a potential for infections to be spread around the home. Hand washing facilities in some communal areas did not have soap for good hand washing practices to be followed for the prevention of spreading infection. Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 20 There are no hand washing facilities in the laundry, as the sink there is used for sluicing soiled laundry. Staff have to come back into the house and through the dining room, to the staff toilet or kitchen sink before being able to wash their hands after handling dirty laundry. This is poor practice and potentially puts residents at risk of cross infection. The laundry facilities were well organised. The laundry has an industrial washing machine and a tumble dryer. The flooring was observed to be of an impermeable nature and clean. The home’s infection control policy is out of date and should be reviewed to provide best practice guidance for staff and the protection of residents. Staff interviewed and observed demonstrated a limited understanding of Infection Control procedures and practices, to maintain a clean and hygienic environment. Neva Manor Residential Care Home DS0000068269.V350674.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 poor. This judgement has been made using available evidence including a visit to this service. The home’s staffing levels are not always sufficient to manage the care needs of residents. The procedures for the recruitment of staff are poor and do not provide the necessary safeguards to protect residents. Staff have not received the necessary training to ensure they are competent to do their job. EVIDENCE: The staffing rotas for November were reviewed. The home has one waking and one sleeping night staff, which appear to be sufficient to meet residents’ needs. Residents spoke of how kind the night staff is and how they are always available to make tea or have a chat with. Staffing levels during the day appear to be three care staff in the morning with one cook. There is no cleaner. Staff informed us that having provided care one of them does the cleaning. While most parts of the home were clean on the day of inspection, as mention in previous section of this report there was a dirty toilet and staff told us that there was not enough staff to provide good person centred care, and ensure the cleaning was completed in the time allowed. The owner told us that he is advertising for a cleaner. Staffing levels in the afternoon are satisfactory. Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 22 An accurate record of staff who were on duty at any one time should be kept in the home. On Monday 12th November there appears to be only one member of staff on duty in the afternoon shift. In discussion with the manager she told us she had covered the shift but that it had not been recorded. Staffing levels appear to be minimal and should be reviewed to ensure there are sufficient staff to meet the needs of people who use the service in a safe way at all times. Both staff and residents spoken with felt that there are not always sufficient staff to meet residents needs at times. The manager should keep the staffing levels under review against the changing needs of the people who use the service. Staff observed; approached residents with directness, openness and consideration. Each of the resident’s with whom we spoke said, “how nice the staff are”. Staff interviewed said, “the home is a happy place to work, we are like one big family”. Recruitment practices for the new staff employed are poor. Three recruitment files were inspected and one file showed the person to have commenced work in the home prior to a POVA 1st check being received. This record did not show evidence of supervised practice for the three weeks prior to receipt of a POVA 1st. Another record shows the person to have commenced work following a satisfactory POVA 1st check but 10 days prior to receipt of a Criminal Record Bureau (CRB) check, and no evidence of supervised practice was available. This individual had also stated they had a criminal conviction and one pending according to the declaration on the application form. There is no record that this information as explored with the applicant prior to commencement of employment. Gaps in employment in two records had not been explored and one record had references that had not been dated and signed rendering them unsubstantial for employment. One relatively new member of staff told the inspector that she had received an induction, which covered Fire and Health and Safety issues. It is recommended that staff undertake the Common Induction Standards programme to ensure they have the skills and knowledge to meet residents’ needs. Personnel files inspected did contain evidence of induction but this had not been signed by the employee to acknowledge understanding of induction topics covered. The home currently has 30 of staff with an NVQ qualification. At present no further staff are undertaking the qualification. Training in the last year has been limited. Records show that staff have received mandatory training in 2007 in Fire procedures, food hygiene and infection control. There was no certificated evidence of staff having attended these sessions and no signed attendance records with which to check this. Staff interviewed said they had received fire training but were not sure about the others. Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 23 Staff have not received annual mandatory training in Manual Handling or Safeguarding Adults. There are no records of specialist training received in the last year. Staff interviewed said they had not received training in the moving and handling for more than a year. Staff said they had not received training in specialist areas to meet resident needs. Training must be provided to ensure a competent staff team to meet residents’ needs. Evidence was seen of planned training to provide staff with mandatory training updates in the coming year. Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 24 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): 31,32,33,35,36,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager provides clear leadership and guidance to staff to ensure residents receive consistent care in a safe environment. Quality assurance processes in the home are formal demonstrating that the home consults with residents, families and visiting professionals. The management of resident’s monies in the home are well managed. Health and safety issues are monitored in the home to ensure that issues are identified and addressed where they arise. EVIDENCE: The manager gives clear leadership, guidance and direction to staff. Residents feel she is approachable, available and seeks to ensure all their needs are met. Staff interviewed stated that they felt well supported by an approachable manager. Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 25 A formal quality assurance tool was available for inspection in order to demonstrate that the home consults with residents and relatives. There was no report or evidence to show how these views are acted upon, and used in the development and ongoing provision of the service, as the first survey is currently taking place. Residents felt that their comment were listened to and acted upon. Policies and practice guidance are provided in the home. They are currently being reviewed. Residents’ pocket monies held by the home were inspected in the presence of the manager, and one was found to be accurate but did not always contain signatures for money spent. Receipts were present. Monies for a second resident did not tally. The manager told us that she had been shopping for the resident at the beginning of the week. Receipts for the shopping were present, but these purchases had not been entered on the log sheet and the money was not present. The manager then produced it from her handbag saying that she had forgotten to return it to the box. On checking the money produced all monies tallied. It is recommended that two signatures for any transactions be made for the safeguarding of all concerned. Supervision for staff is provided both formally, and informally at hand over times and other times, when the staff discuss resident’s care needs and how best to meet them. Records seen were sporadic and did not evidence the practices spoken of by staff and the manager. Records seen showed evidence that care practices for residents and training needs were discussed. Supervision records need to show that supervision is provided at least six times a year for all staff. Information received indicated regular safety and fire checks are carried out. Information regarding certificates of safety checks, servicing of equipment and other required safety inspections were supplied. The home does not have a certificate of safety for the electrical wiring in the home for the protection of residents Staff spoken to confirmed that regular fire instruction and drills had taken place and records inspected verified this. Some fire doors were seen to be ill fitting and others wedged open thus not providing the safeguards required. The manager told the inspector that advice has been sought from the Fire Safety Officer in relation to the safety of the home, and the updating of the Fire Risk Assessment for the home and for any wedged open fire doors for the protection of residents. Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 3 11 2 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 1 2 3 X 3 X 3 3 1 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 1 2 X 1 Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 27 YES Are there any outstanding requirements from the last inspection? 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 OP8 Regulation 13.5 Requirement To ensure staff receive training and use a safe method for moving and handling residents. Medicines must be dispensed straight from the container in which it is supplied to the residents. All staff to receive Safeguarding Adults training. Arrangements must be made and adhered to, to prevent infection, toxic conditions and the spread of infection in the home. The registered person is required to ensure that all the stated checks in schedule 2 have been completed prior to the commencement of employment at the home. Previous timescales of 30/03/07 & 30/06/07 not met Staff must be provided with the appropriate training for the work DS0000068269.V350674.R01.S.doc Timescale for action 31/01/08 2 OP9 13.2 20/12/07 3 4 OP18 OP26 13.6 13.3 31/01/08 14/01/08 5 OP29 19 (1b) 19 (5d) Schedule 2 31/12/07 6 OP30 18.1 (c) 31/01/08 Neva Manor Residential Care Home Version 5.2 Page 28 they are to perform. 7 OP35 13.6 Two people must be present when handling monies held and administered for residents, for their protection. You shall ensure that a current fire risk assessment and procedures for safeguarding residents in the event of a fire are in place, for the protection of residents You must obtain a certificate of safety for the electrical wring of the home for the protection of residents 31/12/07 8 OP38 23.4 31/01/08 9 OP38 23.2 (b) 31/01/08 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 OP2 Good Practice Recommendations To amend the Terms and Conditions of residency document to show the way in which the fees are made up and who is contributing what amount. To ensure attention to detail when completing assessment documentation to ensure all key information is recorded to provide person centred care. That clear guidance is obtained from the health professionals, when monitoring blood pressure and blood sugars, as to what the normal limits are and what top do if readings are outside of these. All residents who are wishing to self-administer medication are competency assessed to ensure suitability for this. The recording of residents wishes in and following their death. The installation of a system of controlling the temperature DS0000068269.V350674.R01.S.doc Version 5.2 Page 29 2 OP3 3 OP7 4 5 6 OP9 OP11 OP19 Neva Manor Residential Care Home of water supplied from the hot water taps. 7 8 OP27 OP28 To keep the staffing levels under review to ensure there are sufficient numbers to meet residents’ needs. That staff are provided with the opportunity to undertake NVQ training to enable them to better understand and meet residents’ needs. Supervision records to be kept up to date to evidence the regular supervision that takes place. 9 OP36 Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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. Extracts may not be used or reproduced without the express permission of CSCI Neva Manor Residential Care Home DS0000068269.V350674.R01.S.doc Version 5.2 Page 31 - 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!