Inspection on 01/09/06 for Nora Chase House

This inspection was carried out on 1st September 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

Nora Chase House 01/12/05

Nora Chase House 30/08/05

Nora Chase House 17/03/05

Nora Chase House 03/11/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Nora Chase House 50 Valentines Road Ilford Essex IG1 4SA Lead Inspector Stanley Phipps Key Unannounced Inspection 10:00 1 September to 15 September 2006 st 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 DS0000025919.V309902.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. DS0000025919.V309902.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nora Chase House Address 50 Valentines Road Ilford Essex IG1 4SA 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) 020 8518 0336 F/P 020 8554 9129 Mrs Mary Louise Crosdale Mrs Mary Louise Crosdale Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10) of places DS0000025919.V309902.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th August 2006 Brief Description of the Service: Norah Chase House is registered as a care home for ten (10) older people. It is owned and run by the Proprietor/Manager - Mrs Crosdale since it opened in 1985. Although Mrs Crossdale is a registered nurse, nursing is not provided on the premises, except that which is provided by the district nurses. The aims of the home are to offer high standards of care in a homely atmosphere. There are now nine single rooms on the ground and first floor, as the registered person carried out some restructuring work to the physical environment. Therefore, all service users currently have their own room and do not share. As part of the home’s development a conservatory had been added in 2005 to give additional communal space to service users. There is no lift and most of the service users are mobile and self-caring. There is a main lounge, which is separate from the dining area and the conservatory gives an option for service users to meet relatives. There is a back garden with handrails from the fire exit on the right of the building - along the length and width of the garden to enable service users to maintain their independence while mobilising. The home is near Valentines Park with reasonably close access to public transport and the centre of Ilford. The fees range from £465.00 to £521.00 and exclude dry cleaning, hairdressing, outings, newspapers, toiletries, personal activities and personal phone installations all of which are variably priced. The home’s statement of purpose is made available to service users prior to their admission and is a copy is also kept in the home. A copy of the service user guide is given to each individual admitted to the home. DS0000025919.V309902.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and a key inspection of the service for the inspection year 2006/2007. This meant that all key standards were covered as well as any other standard for which a requirement was made at the last inspection. It was carried out over two days beginning on the 1/9/06 at 10.00 a.m. and finished on the 15/9/06. As part of the inspection interviews were held with two care staff, three service users and a relative. An assessment was carried out on: recruitment records, menus, service users’ files, policies and procedures and financial records held on service users. Detailed discussions were also held with the manager, the deputy manager and a number of service users – not formerly interviewed. A detailed tour of the building was undertaken and written feedback from service users and staff, was also considered in compiling this report. The inspection found that service users generally received a satisfactory service at Norah Chase House. To this end there were some improvements to the service resulting from requirements made in the last inspection report. There were also some an improvement that was made by the manager in the interest of service user safety and independence. However, further improvements are still required to improve the quality of outcomes for service users living in the home. More importantly, at least two of them have been previously identified at previous inspections. The Commission is of the view that a failure to meet requirements may adversely impact upon the welfare of service users. This failure would lead to enforcement action being taken against the registered person to achieve compliance, if the requirements are not met by the revised timescales. This situation i.e. a failure to meet repeated requirements has been discussed with the registered provider previously and has also been raised in a previous inspection reports. What the service does well: Service users continue to pay positive tributes to the care they receive at Norah Chase. To quote one of the service user’s -‘ the staff take very good care of me and I am happy in this home’. There was no doubt that the management and staff had a caring attitude towards all service users regardless of their individual needs. The home continues to provide consistent and stable support to individuals that as a result enable them thrive for long periods. Most of the service users have lived there for over two years and for one individual – over twenty years. DS0000025919.V309902.R01.S.doc Version 5.2 Page 6 All service users are given opportunities to go out and be part of the community, although this varies from with individuals and/or their interests. This is positive as it allows service users to make choices about their lives. Service users may go out as part of a group or individually. The home continues to ensure that as far as possible service users’ independence is promoted and one of the most recent developments i.e. fitting handrails around the garden, is evidence of this. The management and staff are also proactive in ensuring that service users maintain links with their relatives and friends. Service users spoken to – expressed a sense of satisfaction about this as they feel valued and in touch with the outside world. What has improved since the last inspection? What they could do better: Detailed assessments need to be carried out for each individual if they are to have assurances that the needs identified could be met by the home. Staff must also be aware as to the benefit/s and effects of medication used by service users. Service users would enjoy a better quality of life if staff act to ensure that all their health care needs are met. This includes making referrals to appropriate health professionals as and when a need is identified. DS0000025919.V309902.R01.S.doc Version 5.2 Page 7 To enhance monitoring of stock control, it is vital that as well as the quantities that the names of drugs coming into the home are recorded. The adult protection policy needs to define the various forms of abuse and make reference to the DOH guidance on ‘NO SECRETS’ to give staff a broader understanding of adult protection. More attention must be given to maintaining the environment, particularly in areas like the kitchen. Environmental safety needs addressing with regards to wheelchair users and more specifically – one service user’s bedroom. Better support could be provided for staff through formal supervision, which once regularly carried out would have a positive impact on the service. Recruitment practices in the home needs to be more robust if they are to ensure the safety of service users living in the home. The registered manager should verify whether her current qualifications satisfy the criteria set by standard 27 and if it does not, then take advice as to what is required. An annual development plan needs to be completed for the home. In the interest of complying with health and safety guidance the registered manager should research the criteria for reporting incidents under RIDDOR. As stated previously in this report, the registered manager needs to do better at complying with repeated requirements set by the Commission. 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. DS0000025919.V309902.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 DS0000025919.V309902.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): (1,3,6) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users and their relatives have updated information about the services provided at Norah Chase House. A detailed assessment of service users’ needs is generally carried out prior to their admission in determining whether they could be met by the home. However, this must be carried out for each service user in assuring them that their needs would be met. The home does not provide intermediate care. EVIDENCE: An updated statement of purpose and service user guide is available to service users, their relatives and stakeholders. The information contained in these documents enables individuals to determine the services and facilities offered by the home. They had been recently reviewed and as a bonus, a document entitled ‘some of your commonly asked questions answered’ has been developed. This is a useful document, which provides concise answers to key questions about the home and what it means to live there. Because of its recent publication, it was not possible to get service user’s views on it. However the idea, it must be stated – is a positive one. DS0000025919.V309902.R01.S.doc Version 5.2 Page 10 From sampling and case tracking the two most recently admitted service users, detailed assessments were carried out and in place. The system used is comprehensive and once fully used would enable one to determine whether the individual’s needs could be met by the home. However in one of the cases assessed – a behavioural assessment was not completed for the individual concerned. This assessment would have been crucial to the home’s ability to meet the special needs of the service user. In this respect it was difficult to see how the service user could be assured that the home could provide for the needs that were not even identified. Another example was where the same service user was on a drug that staff were not aware as to why this was given to him. This again raised the question, could the service user be assured that his needs would be met by the home? This needs to improve. Norah Chase House does not offer intermediate care and if a decision was taken to so do, then changes would have to be made to the environment, staffing and policies and procedures. DS0000025919.V309902.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (7,8,9,10) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users generally benefit from having a service user plan detailing their needs and this includes their personal, social and health care needs. Generally service users are supported to maintain a healthy lifestyle and this includes support with medication. Some improvements are required in both areas to improve the quality of health care that is provided by the home. All service users spoken to were pleased with the level of privacy and respect they receive at Norah Chase House. EVIDENCE: From a sample of four of the service users’ records three had service user plans with the personal, health and social care needs of the individuals set out. The file consisted of a weekly review of the wellbeing of the individual. This was the case as the service user had newly moved into the home. However, a copy of the care management assessment and plan was on the file of the service user. For most individuals, their needs and goals were identified and risk assessments were linked to each plan to ensure the safety of each service user. There was evidence that service users’ plans were reviewed as and when needs change and this would involve the service user and/or relatives where possible. Feedback received from one relative informed that although she can’t DS0000025919.V309902.R01.S.doc Version 5.2 Page 12 always attend a review – she is made aware of any changes to the care provided to her relation. There was good evidence to confirm that the health of most service users was adequately provided for. All service users were registered with a GP and were in receipt of dental, optical, and chiropody services. Staff worked closely with service users and external professionals to ensure that the individuals were in receipt of prompt and appropriate health care. In one case a service user became unsettled and the staff alerted the doctor who reviewed her medication. This action enabled the service user concerned to enjoy a better quality of life in the home. The individual was engaging more with staff and others and was able to maintain a greater feeling of control in their daily life. However, there was one case in which a service user was in need of a hearing aid and there was no evidence of this being followed up. This inaction compromised the individual’s ability to communicate effectively. The home has a record of all contacts made with the health services, so it was easy to track the health care support that service users received. As far as health promotion is concerned, most of the service users rely on medication to help maintain a healthy lifestyle. In this regard staff trained in the handling of medication, provides this support. A satisfactory medication policy was in place to guide them, as well as a drug formulary should they be unsure of the actions of drugs. This formulary could be used more effectively i.e. when drugs are unknown to staff. Medication storage was satisfactory and at the time of the inspection, none of the service users were able to independently handle their medication. The recording of medication administered was satisfactory. However, there were different recording systems used at the time of the visit, which could lead to confusion. This should be reviewed to ensure that a consistent system is used. More importantly medication entering the home must be recorded by name to enable one to carry out an accurate audit trail of the drugs used in the home. In speaking with individual service users, they were happy with the support given to them. On both visits, the staffing engagement with service users indicated that service users were respected and their privacy upheld. This was evident as personal support was provided in a sensitive manner. Interviews held with service users and one relative confirmed this. Staff on duty demonstrated a caring attitude towards service users and worked in line with the General Social Care Council’s Code of Conduct. Staffing interventions focussed on individuals and the feedback received from relatives strongly supported this. One service user stated ‘ the staff take my abilities and needs into consideration when providing support to me. I am a private person and I am grateful to them for the way in which they support me’. This is positive. DS0000025919.V309902.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. 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 the service. Service users enjoy increased levels of activity at Norah Chase House that is in line with their social, recreational and religious interests. They also enjoy maintaining strong links with family, friends and the local community. Their lifestyle is enhanced by the provision of meals that are suited to their needs. EVIDENCE: From discussions with service users, relatives and staff, it was clear that individuals living in the home were happy to pursue individual interests. Equality and diversity was evident here as all service users are given the opportunity to pursue their religious, social and cultural pursuits. One individual goes to church every Sunday and staff ensures that she is supported to so do. Others were not keen to follow a religious pathway and that was respected. Some service users are happy with walks in the park, lunch out or a trip to the theatre and it was recorded that a group of service users went to see the Sunshine Boys in May 2006. Evidence was provided where one service user with mobility difficulties went for a week’s holiday and this was arranged with her brother and an organisation providing specialist services. This is quite positive. Internally activities are predominantly low-key with service users choosing whether they prefer a group or an individual activity. Some of the group DS0000025919.V309902.R01.S.doc Version 5.2 Page 14 activities included bingo, questions and answers relating to reminiscence, puzzles, exercises, discussion groups, story telling and occasionally bringing a performer in. It was reported that the last entertainer visited the home two months prior to the visit. Many service users were observed reading, another enjoys her crosswords, one individual spends a lot of time drawing and has this as his personal activity, while another spends considerable time listening to radio programmes. Service users were generally happy with their activities. There was evidence service users are encouraged to maintain contact with their families and friends. In this respect relatives visit the home at various points in time and from all reports were made to feel welcome. On the first day of the visit a friend was visiting and gave positive feedback about her experience and of the care that the service user received at the home. Written feedback received from two relatives was also complimentary about the service. In many cases relatives were involved in service users’ personal and financial affairs. One service user commented ‘my brother has always looked after my affairs and this suits me fine’. This is a strong area of the homes operations. Good examples were seen in which service users maintain control of their lives at Norah Chase. One individual goes to church every Sunday while another maintains her finances. Service users choose which newspaper they read and would go out and purchase it. There was evidence that they choose their clothing, times for going to bed and preferred methods of going to bed. All service users spoken to informed that they can make choices in the home – and for one service user, he no longer visits the pub as regular as he did previously. However he now goes twice weekly by a cab. He visited a friend in Bournemouth earlier this year and also does his own banking. He is quite clear that he wishes to continue to so do. From the home’s perspective the fitting of handrails in the garden is an example of ensuring that service users maintain control in their lives. There was a four-week rolling menu in place in the home and all service users confirmed that they were given a choice of meals. All service users also expressed satisfaction with the quality and quantities of food provided at Norah Chase House. Lunch was observed and was fairly relaxed with service users having pleasant conversations and exchanges at the table. Two options were available on the day i.e. fish and chips or sausage and chips with vegetables. There was a chorus at the table after the meal – ‘that was a nice meal B’. Food storage was satisfactory and there were also satisfactory supplies of dry foods, drinks and snacks available to service users. Service users requiring support with meals expressed satisfaction with the way they received the support. The registered person could ensure a greater balance in the use of fresh vegetables in the home, for enhancing the nutritional status of service users. DS0000025919.V309902.R01.S.doc Version 5.2 Page 15 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): (16,18) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Satisfactory protocols and are place for safeguarding service users from abuse, although there is room for improvement. This is complimented by a satisfactory complaints procedure that is made available to service users and their relatives. EVIDENCE: A satisfactory complaints procedure is in place and available to service users and their relatives. Staff interviewed demonstrated an understanding of their role in enabling and supporting service users to complain. Service user and relatives’ feedback indicated that they were aware of how to complain. There were no complaints on record and all service users expressed satisfaction with their care in the home. Feedback from relatives were positive and in one case a complimentary letter was written about the care provided in the last three months of a service user’s life – the comments extremely very positive in relation to the individual’s experience at Norah Chase House. There were no adult protection issues in the home and staff interviewed, were clear about their role in protecting vulnerable adults. This included having an awareness of whistle blowing. Three of the current staff members received adult protection training and plans were in place for three more to go in October 2006. The adult protection policy needs to be reviewed to ensure that it makes reference to the D.O.H guidance on ‘NO SECRETS’ and should define the various types of abuse. This would ensure that all staff including those awaiting training to have a clearer understanding of adult protection issues. DS0000025919.V309902.R01.S.doc Version 5.2 Page 16 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): (19,23,26) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users continue to live in an environment that is homely, accessible and generally safe. Some improvements are required to ensure that the overall standard and safety of the home is enhanced. EVIDENCE: Service users and their relatives were pleased about the standard of the accommodation with respect to both the private and communal spaces in the home. Importance is placed on ensuring that service users retain their independence and do so in a safe manner. A good example includes the recent installation of handrails in the rear garden for the benefit of service users. Service users had taken a liking to the use of the conservatory and as such this is a useful development. There is a handyman employed at the home to deal with minor refurbishment works. There is a system where a walking route is done to identify areas of maintenance of which safety is prioritised. The registered person did not have a redecoration and maintenance plan for the home, although she stated what needed doing. DS0000025919.V309902.R01.S.doc Version 5.2 Page 17 Several areas were identified at this inspection for improvement. They included: making ramps available in areas such as the front (internal aspect), the ground floor fire exit and conservatory doors, replacing the floor covering in the kitchen, renewing counter tops where they are broken, chipped with deteriorated grouting and fitting an appropriate floor covering in the staff toilet. The ramps are a priority as the home has a service user that mobilises in a wheelchair. All service users were pleased with their bedrooms and they were all individually decorated, warm and homely. Their rooms were adorned with their personal effects from pictures to furniture and there was a strong sense of ‘this is my home for life’- which is positive. Some re-decorative work was carried out to the shared bedrooms upstairs and the standard was good. Four spaces have now been made into three i.e. there are no more shared spaces in the home. Service users rooms generally met their needs, however there was one case in which the door access (opening width) was approximately twenty inches. This is because of the service user’s personal furniture that is cited behind the door. While this was the service user’s choice, it presents a hazard particularly in an emergency. This needs to be reviewed and a risk assessment carried out to ensure the service user’s safety. The home was clean and hygienic throughout the inspection and feedback received from relatives strongly supported this. Plants adorned the living room, conservatory and in some cases, service users bedrooms. The laundry facilities were adequate and the equipment - suitable for cleaning soiled linen. There were facilities in place for infection control and they were cited in toilets, bathrooms and the laundry. Staff awareness of infection control was also good and their practices promoted safety in the home. They worked well with service users to ensure that the home is kept clean and to a standard that makes them proud to be living there. DS0000025919.V309902.R01.S.doc Version 5.2 Page 18 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, 29,30) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Generally service users receive a good standard of care from a team that is motivated and in adequate numbers to provide for their needs. The quality of care would be enhanced with more regular supervision of staff. Service users would also be safer once the registered person’s recruitment practice in the home - is more robust. EVIDENCE: From the examining the rota the staffing numbers were adequate in meeting the needs of the seven service users in the home. There is always two staff on shift and given the dependency levels of service users, this was satisfactory. Feedback from service users informed that staff were always available to them. Relatives and one friend commented that the care in the home was good and they were satisfied with it. There is usually an experienced staff member on duty and this includes the manager or deputy manager. There are sleeping in arrangements in the home with an on-call system for emergencies. All staff interviewed were satisfied with the numbers on shift and felt able to support service users in achieving their daily goals. This is positive. The training records were assessed and although just about thirty-nine percent had achieved at least an NVQ level two in Care, arrangements were in place for at least two more of the care staff to go onto this programme. Staff in general, have a good basic understanding of care and service users enjoyed the benefits of having a key-worker supporting them in achieving their goals. The level of accidents in the home is usually minimal, with one person having a fall and sustaining an injury in the last year. Staff interviewed demonstrated an DS0000025919.V309902.R01.S.doc Version 5.2 Page 19 understanding of the service users needs and this is positive. They receive guidance and support from both the manager and her deputy. However, there was little improvement in the frequency of formal supervision for staff. This failure could mean that staffing development and the quality monitoring of the service, is at risk of being compromised. Therefore increased efforts are required to provide formal supervision to staff. This would be a repeated requirement in this report. The files of the two most recently recruited staff were assessed to ensure that the process was robust. This is to ensure that service users are protected from working with staff that may be unsuitable or unfit for that purpose. In one of the cases, only one reference was obtained for the individual and the registered person was accepting CRB checks from other agencies. CRB references are not portable and a minimum of two satisfactory references must be obtained prior to employing an individual. The recruitment process needs to improve and as such the previous requirement would be repeated. As part of improving staffing competence, the registered person did develop a staff training profile and has provided staff with training. Examples of the training provided included: ‘Person Centred Approach to Dementia Care’, ‘Medication Awareness’ and ‘Oral hygiene’. The training thus far is useful and specific to the needs of the service user group i.e. older persons. Plans were in place for three staff to have ‘first aid’ and ‘Prevention of Vulnerable Adults’ training. Two staff members are to pursue their NVQ level 2 and one plans to pursue NVQ level 3. The deputy manager was also in the process of completing her NVQ level 4 in Care. The registered manager showed a good awareness of the need for training, which once implemented would have a positive impact on the service as a whole. One of the new starters described her induction stating that she found it useful. DS0000025919.V309902.R01.S.doc Version 5.2 Page 20 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): (31,33,35,38) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users benefit from a home that has satisfactory management practices, which positively impacts on the quality of care they receive. Their health and safety, financial and best interests are also well provided for. This could be enhanced further, by completing the annual development plan for the home. The registered manager also needs to verify that her current qualifications are the equivalent to the NVQ 4 in Management and Care and the Registered Managers Award. EVIDENCE: Feedback from service users and their relatives indicated that the home was managed well. As stated in previous reports the registered person has developed and managed the service for over twenty years. There was evidence to confirm that she participates in training to update her skills and knowledge in line with the needs of elderly service users. She reportedly has a first degree in Social Administration and Social Policy and a Post Graduate Diploma in Social Policy. It was not clear that her qualifications satisfy the requirements of DS0000025919.V309902.R01.S.doc Version 5.2 Page 21 the standard and a recommendation would be made for her to have this verified with an appropriate body. She has demonstrated the ability to discharge her responsibilities with authority and has increasingly strived towards meeting requirements set by the Commission. One relative wrote ‘the care provided is excellent at Norah Chase’. There was evidence of improvements in the home to indicate that the service was in fact developing. Examples could be drawn from the handrails in the garden and the refurbishment of bedrooms on the first floor. However, the registered manager again failed to complete an annual development plan for the home. It was accepted that seeks the views of service users in the home, although service users meetings have been sporadic. To meet this standard the registered manager needs to provide evidence of the plan. During the inspection she spoke of a number of ideas she had for the service and advice was given to integrate them into her plan. This requirement would be repeated. The financial records of two of the most recent service users were assessed and found to be satisfactory. One individual was not in receipt of benefits and was hence subsidised by the registered manager. Detailed records were held of each transaction, although some ratification was required. This was done at the time of the visit and all funds were adequately accounted for. Evidence was provided that the registered manager was following up this matter with the social worker to enable the service user to receive his funding. Financial management varied from individual to individual, with some requiring less input from the management of the home. One service user spoken to, reported that they were happy with the financial support provided by Norah Chase House. Health and safety records were examined and found to be in order. Risk assessments, fire drills and fire equipment maintenance were satisfactory. Satisfactory arrangements were also in place for gas and electrical safety in the home. Staff interviewed showed a good understanding of their role in maintaining a safe environment. There is an accident and incident record, which indicated that they were kept to a minimum. The registered manager should however research the criteria for reporting incidents to the HSE under RIDDOR. This is recommended, as she was unsure whether she should, given an incident involving a service user fracturing her hip in the home. The internal recording of the incident was satisfactory. Service users staff and relatives could feel safe at Norah Chase House. DS0000025919.V309902.R01.S.doc Version 5.2 Page 22 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X 2 X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 DS0000025919.V309902.R01.S.doc Version 5.2 Page 23 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 OP3 Regulation 14(1) Requirement The registered person is required to ensure that full assessments are carried out for all service users and this includes their behavioural needs and needs related to their medication. The registered person is required to ensure that prompt referrals are made to appropriate professionals, once a health care need is identified. The registered person is required to keep a record including the name of drugs entering the home. The registered person is required to review the Adult Protection policy to ensure that it defines the various types of abuse and that it makes reference to the DOH – guidance on ‘NO SECRETS’. The registered person is required to carry out the works identified in standard 19 of this report. The registered person is required to review with the service user (DR) the furniture arrangement in her room and carry out a risk DS0000025919.V309902.R01.S.doc Timescale for action 16/11/06 2. OP8 12,13 16/11/06 3. OP9 12,13 16/11/06 4. OP18 13 23/11/06 5. 6. OP19 OP23 23 13 31/12/06 16/11/06 Version 5.2 Page 24 7. OP28 18(2) 8. OP29 19 9. OP33 24 assessment with appropriate action to ensure her safety. The registered manager is required to ensure that care staff receive formal supervision at least every two months. (This is a previously made requirement. Previous timescale 31/3/06). The registered manager/proprietor must be able to demonstrate that she operates a thorough recruitment procedure based on equal opportunities to ensure the protection of service users. All necessary information must be obtained in order to assess the fitness of staff and appropriate records kept. (This is a previously made requirement Previous timescale 15/2/06). The proprietor/manager must establish an annual development plan for the home and effective quality monitoring systems to ensure that the home meets all aspects of Standard 33 and the Regulations (Care Homes2001). Any system must regularly review and improve the quality of care and include consultation with service users, representatives and staff. The result of any review must be made available to service users and the Commission. (This is a previously made requirement. Previous timescale of 31/3/06). 30/11/06 16/11/06 16/11/06 DS0000025919.V309902.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP31 Good Practice Recommendations The registered person should maintain a common record for the purposes of drug administration in the home. The registered person should have her qualifications verified to ascertain, whether it is equivalent to the requirements of standard 31 of the National Minimum Standards for Older People. Should they not meet the requirements action should be taken to so do. The registered person should research the criteria for reporting incidents to the HSE under RIDDOR. 3. OP38 DS0000025919.V309902.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 DS0000025919.V309902.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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