Inspection on 25/09/08 for Overslade House

This inspection was carried out on 25th September 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Overslade House 22/09/09

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 20/12/2008.

CARE HOMES FOR OLDER PEOPLE Overslade House 12 Overslade Lane Rugby Warwickshire CV22 6DY Lead Inspector Michelle McCarthy Unannounced Inspection 25th September 2008 09:50 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 Overslade House DS0000072901.V372821.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. Overslade House DS0000072901.V372821.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Overslade House Address 12 Overslade Lane Rugby Warwickshire CV22 6DY 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) 01788 522 577 01788 522 507 www.barchester.com Barchester Healthcare Homes Ltd Mrs Janet Hutchinson Care Home 89 Category(ies) of Dementia (44), Old age, not falling within any registration, with number other category (45) of places Overslade House DS0000072901.V372821.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing To service users of the following gender: Both Whose primary needs on admission to the home are within the following categories: Dementia (DE) 44 Older Persons (OP) 45 The maximum number of service users to be accommodated is 89 2. Date of last inspection This is the first inspection of this service. Brief Description of the Service: Overslade House is a large, detached, purpose built care home set amongst landscaped gardens approximately 1 mile from Rugby town centre. The home is set back off a busy road and close to local bus stops and schools. Overslade House offers personal and nursing care to up to 89 service users with physical frailty and dementia care needs. The home also admits people for end of life care and is working with Macmillan Nurses to achieve the National Service Framework (NHS standards) Gold Standard for Palliative Care The home provides a total of 86 single accommodation rooms with en-suite facilities and includes 22 rooms in the recently built ‘new wing’. Three of the rooms are suitable for double occupancy if, for example, a married couple were to be admitted to the home. The dementia care unit is situated on the ground floor and comprises 43 rooms. The elderly frail unit is situated on the first floor and comprises 43 rooms. There is a large communal lounge incorporating a dining area in each unit as well as another small lounge and dining room in the ‘new wing’ of each unit. Written information about the scale of charges was not available on the day of the inspection visit. Overslade House DS0000072901.V372821.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This serviced was registered with a new provider, Barchester Healthcare, on 23rd September 2008. It was previously registered with Westminster Healthcare, which was a wholly owned subsidiary of Barchester Healthcare (the new registered provider). Consequently, the organisation and management of the home and the staff group remain unchanged. This was a key unannounced inspection visit. This is the most thorough type of inspection when we look at all aspects of the service. We concentrated on how well the service performs against the outcomes for the key national minimum standards and how the users experience the service. Before the inspection, we looked at all the information we have about this service, such as information about: • • • concerns, complaints or allegations incidents previous inspections and reports. We do this to see how well the service has performed in the past and how it has improved. The manager completed an Annual Quality Assurance Audit (AQAA) and returned it to us within the timescale required. We made two visits to the home on 25th September and 2nd October 2008, spending a total of 12 hours there. We used a range of methods to gather evidence about how well the service meets the needs of people who use it. Some time was spent sitting with residents in the dementia care unit lounge, watching to see how residents were treated and looked after. These observations were used alongside other information collected to find out about the care they get from staff. We also looked at the environment and facilities provided and checked records such as care plans and risk assessments. 14 service user survey forms were completed returned to us. Some were completed by residents, some were completed by relatives. Their comments are reflected throughout this report. Three people using the service were identified for case tracking. This is a way of inspecting that helps us to look at services from the point of view some of Overslade House DS0000072901.V372821.R01.S.doc Version 5.2 Page 6 the people who use them. We track peoples care to see whether the service meets their individual needs. Our assessment of the quality of the service is based on all this information, plus our own observations during our visit. At the end of the visit we discussed our preliminary findings with the home manager. What the service does well: What has improved since the last inspection? Overslade House DS0000072901.V372821.R01.S.doc Version 5.2 Page 7 This is the first inspection since the service was registered with Barchester Healthcare Ltd. as the registered provider in September 2008. What they could do better: 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. Overslade House DS0000072901.V372821.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 Overslade House DS0000072901.V372821.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): Standard 3 was assessed. Quality in this outcome area is good. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the case files of three people to assess the pre admission assessment process. The manager said that it was usual practice for a senior member of the nursing staff to visit people who are considering moving into the home to undertake an assessment of their needs and abilities. All three files contained a pre admission assessment of each person’s needs and abilities. For example, staff identified that a person admitted to the home Overslade House DS0000072901.V372821.R01.S.doc Version 5.2 Page 10 with a pressure sore required a specialist, pressure relieving mattress. We saw this in use for the person and their file contained a care plan to treat the pressure sore. The assessment of another person with dementia care needs identified, ‘very difficult to understand or have a conversation due to aphasia. Thought process quite disjointed’. A care plan was available in the person’s file to give staff directions on communicating effectively with the resident. This means that sufficient information was available so that the home could confirm they could meet each person’s needs and develop care plans. People’s comments about choosing this home included, • • ‘I was taken around all the homes and picked this one’ ‘We knew of the home from other people who had family in here and they were satisfied with the care’ Overslade House DS0000072901.V372821.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): Standards 7, 8, 9 and 10 were assessed. Quality in this outcome area is good. People living in the home are treated respectfully and are protected from harm by the safe management of medicines. Care plans are available for each of the identified needs of residents and staff recognise and respond to changes in the health and well being of people living in the home. This means that people living in the home can be confident their health and personal care needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We observed that people living in the home looked well cared for and were clean, their hair had been combed and nails were trimmed and clean. They were well presented and wore clothes that were suited to the time of year. It was evident from observation that the personal care needs of people living in the home are met. Overslade House DS0000072901.V372821.R01.S.doc Version 5.2 Page 12 Comments from residents and relatives about the way the service meets health and personal care needs included, • ‘We are always told if anything has happened to my relative whether large or small’ ‘always worn glasses but carers do not put them on, therefore can’t see TV etc. Pointless having eyes tested and lenses upgraded if glasses aren’t put on’ ‘If my relative has any medical problems we are always informed and a doctor is brought in if necessary’ ‘If we ask for anything or my relative needs anything it is always seen to straight away or resolved as soon as they are available to do so’ ‘Generally I feel my relative is being well cared for – the staff are friendly and helpful’ • • • • We looked at the case files of people identified for case tracking. Case files were standardised, well organised and easy to follow. This should mean that staff have good access to information about the needs of people living in the home and the actions they need to take to meet those needs. Each person had a care plan, daily records and monitoring records. Care plans were based on information secured during the pre admission assessment and supplemented by further assessment on the day of admission. Care plans were available for each of the identified needs of each person and supplied staff with the information needed to make sure the person’s needs were met safely and appropriately. For example, the care plans for one person with dementia care needs documented, ‘XXXX may become anxious in mood when confused due to being unable to collect her thoughts. Staff to give 1-1 at times of anxious episodes. XXXX responds to reassurance and is able to listen to simple, short sentences of 2-4 words.’ The care file for one person admitted to the home with a pressure sore included a care plan for treatment of the wound and evidence of referral to the tissue viability nurse specialist. A wound assessment chart and photographs demonstrated improvement in the wound. The care plan for a person with diabetes documented that blood sugar should be monitored weekly. Records were available to confirm this had been done, which means staff are monitoring this person’s medical condition which should promote their health. Overslade House DS0000072901.V372821.R01.S.doc Version 5.2 Page 13 The service uses risk assessments for falls, nutrition and pressure sores, which are reviewed at least monthly. When the outcome of the assessment identifies an increased risk, action is implemented to minimise the risk. For example, one person admitted to the home had an increased risk of poor nutrition. Weight monitoring records showed a significant increase in weight since their admission several months ago. Each person’s case file contained a record of contact with or visits by Health Care Professionals. These included the GP, optician, tissue viability nurse specialist and hospital consultants. Evidence was available in case files that the care planned for people living in the home is discussed and reviewed with them or their relatives to agree the care planned. One resident signed the care review summary to indicate their agreement of the care planned. We looked at the systems for management of medicines in the elderly frail unit and dementia care unit. A monitored dosage (‘blister packed’) system is used. Medication was safely stored in locked trolleys, which are kept in locked clinical rooms. Medicine fridges were available with daily recordings of the temperature, which was within recommended limits. Daily room temperature recordings show that medicines are stored within recommended limits to maintain their stability. The facility for storing controlled drugs (CD) was satisfactory and complies with legislation. The contents of the controlled drug cabinets were audited against the controlled drug registers and the quantities were correct. We audited the medicines of two people involved in case tracking by comparing the quantity in stock against the signatures on the medicine administration records (MAR). The audits indicated that the medicines had been administered correctly. We found an unlocked medicine trolley in middle of the lounge during the evening meal service. The nurse had gone to a resident’s room to give their medicine. This practice does not restrict unauthorised access to medicines. We advised the nurse the trolley must be locked when it is left unattended during a medicine ‘round’. People living in the home were observed to be treated with respect and their dignity maintained; for example, personal care was provided in private and residents were spoken to respectfully. We observed several interventions where safe practice was used when staff assisted people to move using a hoist. During observation of working practice it was evident that staff are knowledgeable about the likes and dislikes of people living in the home and were kind, caring and attentive towards them. Overslade House DS0000072901.V372821.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): Standards 12, 13, 14 and 15 were assessed. Quality in this outcome area is adequate. The home has a planned programme of activities led by a team of dedicated staff so that some of the people in the home can maintain their enduring interests. People benefit from a nutritious and varied diet with a good menu choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs a team of four people to provide activities for people living in the home; an activities co-ordinator plans the programme and is supported by three activity assistants. Case files examined documented the life histories of people living in the home and included details of their enduing interests and relationships. This should enable the activity co-ordinator to plan a programme that reflects the interests of the people living in the home. Overslade House DS0000072901.V372821.R01.S.doc Version 5.2 Page 15 Individual records are maintained to document when a person has participated in an activity. For example, the monthly activity review for one person recorded their participation in 1-1 sessions, pampering, games, outings, special occasions and family visits During our visits we observed residents participating in ball games and prize bingo. The hairdresser was in the home’s salon and people enjoyed having their hair ‘done’. Residents in the dementia care unit particularly enjoyed a visit from three golden retriever dogs. The notice board in the home’s reception area displayed forthcoming attractions from visiting entertainers. Several residents were unable to participate in group activities because of their physical frailty; activities staff said they spent one to one sessions with these people, but not on a daily basis. Comments from residents and relatives about the lifestyle experienced by people living in the home include: • • ‘I choose not to take part in the activities provided’ ‘There are activities every day. When my relative was well we took him to them ‘I enjoy the trips to the pub – they’re excellent’ ‘Good effort is made to include wheelchair users in outings’ ‘Activities are arranged but my relative is unable to take any active part. My relative does like the music activities and visits from the dogs’ ‘The home has many activities. It would be nice if my relative was encouraged to join in and not just left out because he cannot always respond verbally quickly enough. Every day in his life is different. Sometimes, on a good day, he can react’ • • • • The home supports the people living there to have visitors at any time. We spoke to visiting relatives who said they were always made welcome. We observed a midday meal service in the dementia care unit and an evening meal service in the elderly frail unit. Meals arrive from the kitchen in a heated trolley so that meals are still hot when they are served to residents. The main meal of the day is served about 1pm and a choice is available, residents chose from stewed steak or quiche on the day of our visit. We observed an evening meal service of sandwiches, Overslade House DS0000072901.V372821.R01.S.doc Version 5.2 Page 16 cheese and potato pie, tomato soup, and thick vegetable soup with a selection cakes for dessert. Staff were available to offer timely and sensitive assistance to residents. We observed seven staff sitting beside residents, helping them to eat. Comments from relatives about the quality of the food served to people living in the home include: • ‘My relative is unable to choose food and has to be fed. She looks as if she is fed properly’ ‘Meals are very good, with generous helpings’ ‘Meals are varied, plentiful and there’s seconds if you want them’ • • Overslade House DS0000072901.V372821.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed. Quality in this outcome area is adequate. People living in the home can be confident that their concerns will be listened to and acted upon. The manager is not consistent in the way she responds to suspicion or allegations of abuse so people cannot be confident they are effectively safeguarded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a formal complaints policy. People are encouraged to raise their concerns with the staff on duty. Residents were observed to be familiar with the senior staff on duty and felt confident to make requests. This suggests residents would be confident in raising concerns with staff. Comments from residents and relatives about the way the home manages concerns or complaints include: • ‘If we weren’t happy we’d talk to the care staff first, then if still not happy we’d talk to the nursing staff and the manager if needed’ ‘I’m quite happy in the home. Little things niggle sometimes’ ‘We feel we can ask anything, at any time, of anybody’ DS0000072901.V372821.R01.S.doc Version 5.2 Page 18 • • Overslade House A record of complaints is maintained in the home. Two concerns have been recorded since the last key inspection. One relative was concerned about the length of time a resident spent in bed, which was resolved with an explanation of the reasons for this, relating to the person’s medical condition. The other concern recorded an incident reported by a visiting health professional concerned that a staff member acted inappropriately towards a resident while they were assisting them to move using a hoist. The staff member had been suspended while the incident was investigated. This is currently ongoing. The home has an adult protection policy to give staff direction in how to respond to suspicion, allegations or incidences of abuse. Staff training records were seen to demonstrate that most of the staff had received training in recognising and responding to signs of abuse. Discussion with the manager established that she was familiar with local Adult Safeguarding Procedures and how to refer allegations of abuse but evidence available since the last inspection demonstrates that the manager does not have a consistent approach to safeguarding. In June 2008 the manager was made aware of an allegation of a staff member verbally abusing and neglecting a resident. The manager made an appropriate referral to social services under safeguarding procedures for investigation of the allegation, which was not substantiated. The manager failed to take appropriate action to supervise the staff member during the investigation. In September 2008 the manager suspended a staff member when it was alleged they acted inappropriately towards a resident. The manager did not refer this to social services for consideration under safeguarding procedures. Arrangements must be made to make sure the manager is aware of her role and responsibilities in responding to allegations or suspicion of abuse and makes a consistent response in line with local police and social services guidelines. This is to make sure people using the service can be confident they are effectively safeguarded. Overslade House DS0000072901.V372821.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 were assessed. Quality in this outcome area is good. People are provided with clean, attractive, well-furnished and comfortable surroundings to live in and enjoy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The reception area of Overslade House has a ‘hotel reception’ feel to it. It is very well decorated, beautifully furnished and accessorised with coordinating soft furnishings, ornaments and framed pictures. The home has an ongoing refurbishment programme in place to maintain the environment. Overslade House DS0000072901.V372821.R01.S.doc Version 5.2 Page 20 The manager told us they had recently developed an accessible ‘Woodland Walk’ in the wooded area of the home’s gardens fro residents to enjoy. The home is divided into three areas. The dementia care unit is on the ground floor and is secured by a coded keypad lock. The elderly frail unit is upstairs and is not locked. The ‘new wing’ accommodates frail elderly people upstairs and people with dementia care needs downstairs. The large communal lounges in the elderly frail unit and the dementia care unit also accommodate the dining area. These areas were clean, bright and were furnished and decorated to an acceptable level but are large and spacious making it difficult to achieve a cosy or homely feel. The ‘new wing’ has a separate lounge and dining room on each floor. The smaller lounges in the new wing were cosy and had a more homely feel to them. Residents were able to interact with each other and with staff more easily because the space was smaller. Comments from residents and relatives about the home’s environment include: • ‘Cleaning is carried out on a regular basis. Any problems are dealt with very quickly’ ‘My room is always clean and tidy’ ‘Chairs and upholstered furniture get soiled and dried food stains are frequently visible’. • • The bedrooms of the people case tracked were visited. Each room was single accommodation, all have en-suite toilet and hand basin and some of the ensuites have accessible showers fitted. The rooms were each decorated in a similar way with pale coloured paint and coordinating borders, bedding and curtains. The beds were electric or hydraulic variable height nursing beds appropriate for the people accommodating the room. Various types of pressure relieving mattresses were observed in use. Most people had taken the opportunity to personalise their rooms with photographs or small items of soft furnishings. Corridors in the dementia care unit are decorated with prints of images from the past, such as old films, to stimulate memories. Systems are in place to manage the control of infection. Staff wore protective clothing when attending to people’s personal hygiene and dealing with soiled laundry. Different coloured aprons were used during food service. There are sufficient hand washing facilities for staff. Overslade House DS0000072901.V372821.R01.S.doc Version 5.2 Page 21 The home was clean and fresh throughout. The Environmental Health Officer awarded a Gold rating for Food Hygiene in March 2008, indicating a good standard has been achieved. The home has a modern, well-organised laundry room with dedicated laundry staff. Residents clothing looked well laundered and ironed. Overslade House DS0000072901.V372821.R01.S.doc Version 5.2 Page 22 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): Standards 27, 28, 29 and 30 were assessed. Quality in this outcome area is good. There are sufficient competent staff on duty to meet the needs of people living in the home. Residents are safeguarded by robust recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was evident from the appearance of people living in the home and information recorded in their case files that there are sufficient staff on duty to meet the health and personal care needs of people living in the home. One resident said, ‘I’m very happy here; the staff are very helpful. They look after us very well. I can’t think of anything they need to improve.’ Other comments included: • ‘Staff listen but do not always act. When requesting that my relative needs to use the toilet, even when desperate, he seems to be kept waiting an unnecessarily long time’ Overslade House DS0000072901.V372821.R01.S.doc Version 5.2 Page 23 • ‘Occasionally staff shortage can sometimes result in poorer service. Bank holidays and weekends are times when this can happen’ The manager is supernumerary and there are sufficient laundry, catering, cleaning, maintenance and administrative staff to ensure that care staff do not spend undue lengths of time undertaking non-caring tasks. The manager informed the inspector that the usual staffing complement for the home is: Ground Floor Dementia Care Unit 7.30am till 2pm 2pm till 9.30pm 9.30pm till 7.30am One Registered Nurse and six Care Staff One Registered Nurse and five Care Staff Ground & First Floor New Unit One Registered Nurse and five Care Staff One Registered Nurse and five Care Staff First Floor Elderly Frail Unit One Registered Nurse and six Care Staff One Registered Nurse and five Care Staff Two Registered Nurses and seven Care Staff OR Three Registered Nurses and six Care Staff We looked at the duty rota between 14th September and 4th October 2008, which confirmed the staff complement in the table above is achieved. Eight out of 43 care staff employed in the home have a National Vocational Qualification in Care (NVQ) at level 2 or above which, at 19 , is below the National Minimum Standard for 50 of staff to be qualified. 20 of the remaining care staff employed in the home have an overseas nursing qualification, which is not valid with the UK’s Nursing and Midwifery Council (NMC). The service is unable to demonstrate that the overseas nursing qualifications are equivalent to NVQ at level 2 or above and therefore cannot include them in the numbers of care staff with an NVQ qualification. The provider should make arrangements to compare staff’s overseas’ nursing qualifications with a UK equivalent so people living in the home can be certain they are cared for by competent staff. We looked at the personnel files of three recently recruited staff. Each file contained evidence that satisfactory pre-employment checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA), and references were obtained before staff started working in the home. There was evidence that staff, who start work after a satisfactory PoVA check is received but before the CRB is received, are supervised and mentored by an experienced member Overslade House DS0000072901.V372821.R01.S.doc Version 5.2 Page 24 of staff. These robust recruitment procedures should safeguard people living in the home. Staff training records demonstrate that staff complete an induction programme and receive mandatory training in food hygiene, fire safety, Abuse awareness, infection control, nutrition and moving and handling. The home employs several overseas staff. Several relatives commented about communicating with staff that do not speak English as a first language: • ‘The foreign staff sometimes have difficulty understanding what you are saying’ ‘Staff are always there from nursing to cleaning and are always courteous and helpful. They make us feel welcome and ask us about our families and we chat to them all about their lives in their home countries’ ‘Quite a number of the carers are from another country and cannot understand what the patient has requested’ • • Overslade House DS0000072901.V372821.R01.S.doc Version 5.2 Page 25 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): Standards 31, 33 and 38 were assessed. Quality in this outcome area is good. The manager has organisational support to ensure the service is run in the best interests of people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for over 10 years and is registered with us. She is registered general and mental health nurse and has the Registered Manager’s Award (NVQ Level 4). There are clear lines of accountability in the home; each of the three units has an identified ‘head of unit’ who reports to the home manager. Overslade House DS0000072901.V372821.R01.S.doc Version 5.2 Page 26 Residents and relatives told us, • ‘We are very happy with every aspect of the home. As far as we are concerned our relative could not be anywhere better’ ‘The home is very good’ ‘The managerial and nursing staff have been most helpful and kind – particularly during stressful occasions which occur quite frequently’ • • The service has daily communication meetings where the ‘heads of departments’ from each area in the home get together to ensure everyone knows what’s going on in the home that day and who to delegate responsibilities. This should ensure effective communication in the home. Systems are in place to keep working practices under review and consider the opinion of people using the service. We looked at the most recent clinical quality audit undertaken in August 2008 and the results of a resident and relative satisfaction survey carried out in December 2007. Action plans were available to make improvements where they were identified as needed. The service does not hold residents’ personal monies or valuables for safe keeping so standard 35 is not applicable and was not assessed. People are invoiced for additional costs such as hairdressing or chiropody. Information in the AQAA completed by the manager tells us there are effective systems for maintaining equipment and services to the home to promote the safety of people in the home. A sample of service and maintenance records were examined and found to be up to date; labelling on hoists indicated they were serviced in December 2007, and labels on electrical appliances indicated that Electrical Portable Appliance Testing was completed in November 2007. A record of accidents is maintained and reviewed by the manager. Overslade House DS0000072901.V372821.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X N/A X X 3 Overslade House DS0000072901.V372821.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement The medicines trolley must be locked when it is left unattended during a medicine ‘round’. This is to restrict unauthorised access to medicines. 2. OP18 13 Arrangements must be made to make sure the manager is aware of her role and responsibilities in responding to allegations or suspicion of abuse and makes a consistent response in line with local police and social services guidelines. This is to make sure people using the service can be confident they are effectively safeguarded. 30/11/08 Timescale for action 30/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Overslade House DS0000072901.V372821.R01.S.doc Version 5.2 Page 29 No. 1. Refer to Standard OP12 Good Practice Recommendations Arrangements should be made for all the people living in the home to engage in meaningful and stimulating occupation, with regard to their physical and cognitive abilities. This should ensure that people living in the home are stimulated and improve their quality of life. The service should be able to demonstrate that 50 of care staff have a National Vocational Qualification in Care at level 2 or equivalent. The provider should make arrangements to compare staff’s overseas’ nursing qualifications with a UK equivalent so people living in the home can be certain they are cared for by competent staff. 2. OP28 Overslade House DS0000072901.V372821.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Overslade House DS0000072901.V372821.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. 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