Inspection on 11/01/07 for Paternoster House

This inspection was carried out on 11th January 2007.

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

Paternoster House 07/10/09

Paternoster House 28/01/08

Paternoster House 16/01/06

Paternoster House 01/08/05

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 Paternoster House Watermoor Road Cirencester Glos GL7 1JR Lead Inspector Mrs Ruth Wilcox Key Unannounced Inspection 11th January 2007 10:00 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 Paternoster House DS0000064617.V320170.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. Paternoster House DS0000064617.V320170.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Paternoster House Address Watermoor Road Cirencester Glos GL7 1JR 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) 01285 653699 01285 644630 The Orders of St John Care Trust Mrs Sheila Ling Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Paternoster House DS0000064617.V320170.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th January 2006 Brief Description of the Service: Paternoster House is a purpose built care home providing nursing and personal care for 40 older people, aged over 65 years. It is situated near to Cirencester town centre, and is managed by The Orders of St John Care Trust. The home has one room in which respite care is provided on a contractual basis with Social Services. The home also offers day care for up to four people each day, and is able to offer an assisted bathing facility, a meal and social activity for these day care clients. The accommodation is purpose built, and is provided on two floors. A staircase and a shaft lift provide access to the first floor. Residents private accommodation is provided in single rooms on both floors, two of which have an en-suite facility. All rooms have a wash hand basin. Spacious and easily accessible toilets and bathrooms are conveniently situated around the home. Hoisting equipment and assisted bathing and showering facilities are provided, and throughout the home there is level access, grab rails and a resident call system. The home provides two spacious sitting rooms, a large lounge and dining area, and a small sitting room on the first floor also. Information about the home is available in the Service User Guide, called the Residents’ Handbook, which is issued to prospective residents, and a copy of the most recent CSCI report is available in the home for anyone to read. The charges for Paternoster House range from £368.25 to £693.00 per week. Opticians, dentists, hairdressing and chiropody are charged at individual extra costs. Paternoster House DS0000064617.V320170.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. One inspector carried out this unannounced inspection over two days in January 2007. A check was made against the requirements that were issued following the last inspection, in order to establish whether the home had ensured compliance in the relevant areas. Care records were inspected, with the care of four residents being closely looked at in particular. The management of residents’ medications was inspected. A number of residents and visitors were spoken to directly in order to gauge their views and experiences of the services and care provided at Paternoster House. Some of the staff were interviewed. Survey forms were also issued to a number of residents, visitors and staff to complete and return to CSCI if they wished. 100 of resident and 50 of relative surveys were returned; none of the staff surveys were returned. Some of the survey comments feature in this report. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, training and provision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. Paternoster House DS0000064617.V320170.R01.S.doc Version 5.2 Page 6 What the service does well: Paternoster House provides a safe, well maintained, clean and pleasant environment for the residents to live in. The home has a relaxed and welcoming atmosphere for visitors, and relatives and other visitors generally indicated that they felt this, and that they were consulted and kept appropriately informed by the staff. Visitors were also happy with the standard of care their relative received in the home. Residents are admitted to the home on the basis of a full assessment of their individual needs. Once admitted, a personal plan of care is drawn up for each resident. Care plans are generally well written here, although certain isolated aspects of them could be improved by the addition of more detail. Care was seen being delivered in accordance with care plans, and staff were well informed about individuals’ needs. Each resident is assured of good access to health care services, with appropriate medical treatments when required, to assist in meeting their health needs. Residents themselves were happy with the care they received, and had confidence in the staff to look after them well. Medications were safely managed, with very isolated amendments needed to certain aspects of recording. Residents are free to exercise their personal choices, as far as they are able, and the home offers a good range of social opportunities for residents’ enjoyment. There is a good standard of meals served here, and on the whole residents were very satisfied with the quality and quantity of food they have. The home uses some good monitoring systems in order to assess and improve its services, and this includes seeking the views of the residents. People can be assured that the home takes any complaint seriously, and has a thorough approach to addressing any that are received. There is a regular core group of staff here, including the long serving manager, who are familiar to the residents and visitors, and many of these were seen as polite, caring and hardworking. The home is working towards getting as many carers qualified to National Vocational standard as possible, though has a little way to go meet their target of at least half the carers. There are policies and procedures in place for the protection of the vulnerable residents, which staff are familiar with, and the home offers a safe and transparent system for safeguarding personal monies or valuables for those residents wanting such a service. Paternoster House DS0000064617.V320170.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? 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. Paternoster House DS0000064617.V320170.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 Paternoster House DS0000064617.V320170.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): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments are carried out on all prospective residents, so that they can be assured prior to admission that the home can meet their needs. EVIDENCE: Copies of assessments carried out on more recently admitted residents were inspected. These had been conducted and recorded in hospital before the resident’s admission to the home was agreed. Appropriate care and health information from other health care professionals was also on file, as were copies of the placing authority assessments and care plans where applicable. Copies of Registered Nurse Care Contributions assessments were on file where relevant. Paternoster House does not provide intermediate care. Paternoster House DS0000064617.V320170.R01.S.doc Version 5.2 Page 10 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good care planning system in place, which in the main adequately provides staff with the information they need to satisfactorily meet residents’ health and personal needs; more detailed recording in isolated areas would further improve this. The systems for managing medications are good, although very isolated adjustments are needed to recording to ensure consistency for some residents. Care and support is offered in such a way as to promote the privacy and dignity of the individual. EVIDENCE: All residents have a recorded plan of care that is clearly drawn up on the basis of an individual assessment of their health and personal needs; plans are regularly reviewed, although there were isolated instances where the frequency of review was inconsistent. Paternoster House DS0000064617.V320170.R01.S.doc Version 5.2 Page 11 Four were chosen for closer scrutiny as part of the case tracking exercise. In the main, plans were satisfactorily written, and provided clear guidance for staff to follow in most cases. There were isolated areas, which could be further improved by the addition of more detail specific to the actions needed to meet certain needs, such as preventative actions in cases where a risk of developing a pressure sore had been identified on risk assessment. Assessments of risk in relation to manual handling, falls, pressure sores and nutrition were recorded, with areas of concern built into the plan of care. The home does not currently use a specific nutritional assessment tool for calculating risks, but anticipates introducing one soon for future assessment. In one of the nutrition care plans, a review entry recorded that ‘feeding was now necessary’; however, the action plan had not been amended to reflect this change, and advice was given in this regard. Residents’ weights were monitored and recorded, and there was evidently access to all health care services, with regular checks and treatments in relation to health issues whenever necessary. Care and assistance was being delivered in accordance with plans of care, with those staff observed or spoken to demonstrating their awareness of the needs of each individual. Appropriate equipment and facilities were in place in accordance with needs identified in care plans during the case tracking exercise. The systems for handling residents’ medications were safe and well managed. Residents are supported to self-medicate if they wish and are able to, with a risk assessment carried out and recorded first; however it was recommended that a proper assessment tool be used in order to expand on the detail necessary when assessing the risks and problems this activity might pose to a resident. There were clearly printed Medication Administration Records from the supplying pharmacist. These records were thoroughly recorded by the staff, and were well maintained. There were very isolated gaps in administration with no recorded reason for omitting the dosage, although it was reported that the particular medication had ‘not been required’; in cases such as this, staff must record why a dose has been omitted, or have the administration instructions reviewed to reflect the ‘as required’ arrangement. Medications were stored safely and securely. The majority of medications were dispensed in a Monitored Dosage System, although some were boxed and bottled; bottled items were dated on opening so that they were not used beyond their expiry date, and it was recommended that all boxed items be dated in this way for accurate auditing purposes. Items requiring cold storage were held securely in a designated refrigerator, and temperatures in here were regularly checked and recorded. Paternoster House DS0000064617.V320170.R01.S.doc Version 5.2 Page 12 Scheduled drugs were stored securely, and the associated register properly recorded. An audit trail was conducted on two specific medications, and the results were accurate in each case. The home had received information regarding the safe use of lancing devices for monitoring blood sugar levels for diabetic residents, and good practice was evidently being followed in this area. Survey responses and those residents spoken to directly all indicated their satisfaction with the care and support they received from the staff. Nearly all of those spoken to said that staff were respectful, kind and caring, with one making particular mention that they were also ‘reliable’. One resident said that ‘some were less helpful than others’. Recording in care plans reflected residents’ individuality and choices, and instructed staff to promote individuals’ independence in accordance with their wishes and abilities. Care was being delivered in the privacy of individuals’ bedrooms or in bathrooms. Most of the staff were observed as sensitive and respectful when dealing with residents. Surveys and comments from relatives and visitors indicated satisfaction with the standards of care that their relative received in the home, and the manner in which staff addressed them. Paternoster House DS0000064617.V320170.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. 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. The home ensures that residents have the opportunity to participate in a social activities programme, and can spend time according to their choice, and that they can keep close contact with their families and friends. Dietary needs are well catered for, with a selection of food available that meets residents’ tastes and choices. EVIDENCE: The home has recently appointed a designated social activities coordinator, and this person is currently in the process of developing this role within the home. Record keeping is gradually improving to show that there is consultation with residents about their particular interests and ideas, and that records of activity participants are kept. There are regular opportunities for residents to participate in social activities; activities are sometimes provided on a group basis, and sometimes on an individual basis, according to individual preference and/or ability. A varied Paternoster House DS0000064617.V320170.R01.S.doc Version 5.2 Page 14 activity programme was displayed on the residents’ notice board, and photographs of recent events and outings were also displayed. There were various competitions advertised. One resident in particular, was very active and independent, and enjoyed ‘helping out’ with certain social events. Good links are maintained within the local community, and during the period of this visit, a number of residents were taken out to a pantomime production. There is a monthly multi-denominational religious service held in the home. A small group of quite dependent residents were seen being helped to get the best out of a light and gentle physical exercise activity to music. Other residents chose to observe, whilst many others were spending time quietly in their rooms, as was their choice, some reading or watching television. Visitors were seen coming in and out of the home during this visit, and are evidently free to do so at any time of theirs or their relative’s choosing. Written survey responses from relatives confirmed that they feel welcome here, and that they are consulted about things appropriately. Two visitors were spoken to directly, and each said that they felt very relaxed and welcome at Paternoster House. They both felt that they were given good information by the staff, and that they were very approachable. They confirmed that they were offered refreshment when they visit. They also said that the staff were fully mindful and respectful towards their relative’s wishes and choices. Some residents were moving freely around the home, and many were spending their time how and where they chose; other less able people were rather more dependent on the staff to remain alert to their wishes however. One resident said that he enjoyed being able to please himself about what he did, and that he regularly went out. Another said that she was able to select what events she participated in, according to her preference. Individual choices were reflected in resident bedrooms with the introduction of personal items and treasures. Residents also confirmed a good choice of food. Their preferred meal choices had been ascertained in advance, with a list of choices supplied to the cook; at least three different options were served on each day of this visit. The service of two meal times was observed, and the dining room was quite calm and unrushed. Meals served were well presented, with fresh vegetables and good quality meat in cases where this was the selected option; some had a vegetarian option. Special diets were observed, and those requiring assistance or supervision with feeding were helped; two carers were observed as particularly gentle, Paternoster House DS0000064617.V320170.R01.S.doc Version 5.2 Page 15 considerate and mindful of individuals’ dignity and ability when providing help with feeding. Soft or pureed diets were well prepared and presented. Residents said that the standard of meals was very good, with one saying that the meals were ‘gorgeous’. Only one person said that the standard could be ‘variable’. Snacks were available between meals, and freshly baked cakes were available for afternoon tea. The kitchen was clean and organised, and records pertaining to food preparation and monitoring were maintained appropriately. Paternoster House DS0000064617.V320170.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 good. This judgement has been made using available evidence including a visit to this service. The home has a good system for addressing complaints, with evidence of residents feeling that any concerns they may have are listened to and acted upon. The home’s Adult Protection policies help to provide a safe environment for the residents. EVIDENCE: Nearly all written survey responses from residents and visitors confirmed their awareness of the home’s complaints procedure should there be any concerns. Despite just one visitor response indicating a lack of awareness there is a clearly accessible written procedure for dealing with complaints displayed in the entrance hall of the home. Records of all complaints received in recent months were inspected, and these clearly showed that the home takes all concerns very seriously, and does all it can to investigate and resolve issues for complainants appropriately. Two visitors spoken to directly said that they had had cause to complain on one previous occasion, but that the home had resolved the issues well, and to their satisfaction. Paternoster House DS0000064617.V320170.R01.S.doc Version 5.2 Page 17 One written survey response said that, although staff were exceptionally kind and caring and go out of their way to make residents happy, some situations were ‘not acted upon as soon as they might be, due to the stresses placed upon their numbers’. Most residents said that the staff did all they could to help them with any concerns or problems they might have. The home has written policies and procedures for the protection of vulnerable residents; the content of such policies has a reasonable profile within the home, with staff aware of what might constitute abusive practices, and of the steps to take if there were any concerns. Instruction in this subject is given during induction and National Vocational training (NVQ), however there has been no recent training to encompass all staff in this area for some time, and this is about to be rectified with a training course now planned in the near future. Power of attorney arrangements were in place for more vulnerable residents where appropriate. Paternoster House DS0000064617.V320170.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 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within this home is satisfactory, and provides residents with a comfortable and safe place to live. It is generally clean and hygienic for the residents, with observation given towards the control of infection. EVIDENCE: A designated maintenance person is employed at Paternoster House, and since the last inspection, maintenance work and redecoration has been ongoing. A first floor bathroom had been refurbished, with the provision of a new and improved assisted bath. A number of carpets had been replaced; some rooms currently have an alternative floor surface, as this suits the needs of the current occupant more appropriately. The home now provides a non-smoking environment, and the small smoking lounge had been turned into an additional storage area for the laundry; the Paternoster House DS0000064617.V320170.R01.S.doc Version 5.2 Page 19 manager was advised that all prospective residents must be made aware that the home is a non-smoking one in the Service User Guide. The maintenance person was present in the home throughout this visit, discreetly carrying out some redecoration, and his meticulous records showed that there was regular attention to cyclical and small maintenance issues; external contractors address larger maintenance issues appropriately. A record was kept of all maintenance issues needing attention, and generally the environment was well maintained and decorated, with attention to safety. The passenger lift has broken down on a number of occasions, and repairs to date have been initiated in very good time; a more permanent solution to the lift problem is currently awaited. The home was fresh, clean and free of odours during this visit. A number of carpets had required more regular cleaning, with some having been replaced, in order to ensure good standards of cleanliness and odour control. Residents surveyed were generally happy with the standards of cleanliness that are maintained here. One resident commented that she thought the home was particularly ‘homely’. The laundry room was orderly, with items appropriately segregated; however during interview, it was clear that the laundry assistant had not been washing bed sheets in accordance with infection control measures consistently. This appeared to have been due to a misunderstanding among the staff team, and advice in this area was given, with the most appropriate wash temperatures for control of infection made clear for future reference. There was a good supply of gloves, aprons, liquid soap and paper towels for staff use. All grades of clinical waste were managed appropriately, with a contract in place to ensure it is collected and disposed of safely. Paternoster House DS0000064617.V320170.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are provided in sufficient numbers to meet the needs of the residents. Recruitment procedures will ensure that suitable staff are employed for the protection of residents, when consistently and robustly applied. The arrangements for their induction and training are satisfactory, although gaps in this provision may pose risks to some staff being able to learn the skills necessary for their role. EVIDENCE: A staff rota is maintained, which allows for one registered nurse to be on duty at all times, with one care leader and six care staff in the morning, one care leader and five care staff in the afternoon and evening, and three care staff overnight. The home has endeavoured to provide two qualified nurses in the mornings, but has not been able to achieve this recently. There has been a degree of instability among the staff team, due to a number leaving, and new starters coming in; there has also been a significant amount of agency staff usage, although this is gradually reducing now. Despite this, there remains a regular core team of experienced and familiar workers for the residents. The deputy manager now has one day each fortnight when she can work in a supernumerary capacity, and the manager works totally supernumerary. Paternoster House DS0000064617.V320170.R01.S.doc Version 5.2 Page 21 An ancillary team of cleaning, catering, maintenance, administration and laundry staff ably supports the care and nursing team. However there are some occasions when care staff are involved in laundry duties, as there is no designated assistant in this area on at least three occasions each fortnight. Also, although the home now provides an evening supper cook on most days, there continue to be occasions when care staff numbers are depleted when one is allocated to work in the kitchen. The staff team appeared to be a hard working and committed team of people, and from those interviewed, were aware and sensitive to the needs of the residents. There were occasions during this visit when the resident call bell was heard to ring for quite long spells before being answered, as staff were busy in other areas. Residents themselves spoke very positively about the staff, confirming they were kind and caring, with some saying that ‘the staff would do anything they could to help’. Visitors also were very complimentary about the staff team. One new staff member said that it was a friendly and supportive group, and that all endeavoured to provide individual and holistic care to the residents. The home is making progress with the National Vocational Qualification (NVQ) training programme for care staff, but has not yet reached the target of 50 of care staff being qualified to NVQ level 2 standard. There were ten care staff qualified to at least this level at this time, with one other considered to be equivalent, and two others currently on a course; there were plans for another three to start it as soon as possible. It was reported that accessing the NVQ courses could be problematic, with delays being experienced. Six staff files were chosen for inspection, on the basis of their recruitment to the home since the last inspection. Each record contained application forms, including a full employment history. Records of interviews were seen. Evidence of the required pre-employment checks was seen in the files, which included medical checks, proof of identity, two written references, POVA (Protection of Vulnerable Adults) checks and CRB (Criminal Records Bureau) clearances. However, in two cases photographic evidence of the person’s identity had not been obtained, as is required. There is a designated training coordinator in the home, and records of all training undertaken by staff were kept. The training manager at the county office of The Orders of St John Care Trust had devised a training programme for staff, which comprised some mandatory and optional training; however, at least two staff commented on experiencing slow access to the programme, with some unable to confirm that they had had any particular training recently, apart from food hygiene. Training actually undertaken had not encompassed many of the staff, with some optional subjects only delivered to isolated members. Paternoster House DS0000064617.V320170.R01.S.doc Version 5.2 Page 22 Newer staff had received induction training, and there were comments from them about the good level of support and supervision they had received during that time. However the induction records seen were incomplete, and the inhouse topics were not consistently covered and achieved within the appropriate timeframe for structured induction, with many topics outstanding for several months. The home had recently introduced a new electronic induction-learning package for new staff, which provides training in six modules, each of which incorporates the Common Induction Standards for care staff, including Principles of Care, Roles and Organisation, Health and Safety, Communication, Abuse and Neglect, and Developing as a Worker. This system of learning was reported to have been problematic in setting up in the initial stages, but one member of staff was now using it. Staff are issued with certificates of their learning for their own personal training record, and although not directly evidenced, the deputy manager confirmed that staff are issued with the General Social Care Council (GSCC) Code of Conduct. Paternoster House DS0000064617.V320170.R01.S.doc Version 5.2 Page 23 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, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are some good management systems in place here to ensure that the interests, and health and safety of the residents are safeguarded. The home reviews its performance through a good programme of self-review and consultations, which includes seeking the views of residents and their relatives. EVIDENCE: The manager of Paternoster House is long serving here, and is an experienced registered nurse, registered with CSCI for her role. She has achieved the Registered Manager’s Award, and has continued to attend training courses relevant to her continued professional development and to the needs of the home. Paternoster House DS0000064617.V320170.R01.S.doc Version 5.2 Page 24 The home has carried out a number of internal audits as part of its commitment to monitor and improve its services for the residents. The Orders of St John Care Trust has a designated Quality Assurance Manager, and this person undertook a major quality audit in the home four months ago. Residents’ and relatives’ opinions had also been sought as part of this quality monitoring process, and recently an annual quality assurance survey was distributed to them, so that they could provide feedback on their experience of the accommodation, facilities, catering, care, social activities and visiting arrangements. The manager had drafted a report on the basis of collated results, to address any issues. A residents’ meeting had been held, and recorded minutes of this showed that residents were consulted, and were able to have a say in how their home is run. The home has a system for residents to have a six monthly review of their stay, so that they can offer their views about care, services, facilities and any concerns they might have. Recorded staff meeting minutes demonstrated that staff are given good feedback on the level of achievement in the home, and have instruction in areas for improvement where applicable. Many residents have placed personal money and valuables in the home’s main safe for safekeeping. Clear and transparent records for each person, which included transaction details, running totals, and receipts, were seen. Residents or their representative can sign to acknowledge transactions, but where this had not been possible in the majority of cases, two staff members had signed the record to witness on behalf of the resident. A case tracking audit against one resident’s money proved to be correct, with no discrepancies seen. Health and safety issues were addressed satisfactorily, with written policies, procedures and risk assessments and provision of necessary equipment. A full fire safety risk assessment throughout the whole building has been undertaken by an external assessor, with due regard to fire safety regulations. Staff had received training in fire safety and manual handling, with some qualified in first aid. It was recommended that staff training needs in relation to fire safety, be incorporated into the fire risk assessment, so that this training can be delivered in the most appropriate way. All necessary safety checks and maintenance of equipment is undertaken in a timely fashion. Hot water temperatures were regularly checked for safe levels, and regular Legionella checks on the water supply were also carried out. Accident records were maintained where appropriate. The environment was generally secure, and there were coded door entries in a number of areas. Paternoster House DS0000064617.V320170.R01.S.doc Version 5.2 Page 25 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 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Paternoster House DS0000064617.V320170.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15(1) Requirement The Registered Manager must ensure that the care plans that are devised in relation to pressure sore risks clearly instruct staff in all necessary preventative measures to be adopted in practice. The Registered Manager must ensure that care plans are amended, where necessary, in accordance with the outcome of any reviews. The Registered Manager must ensure that staff sign consistently for administering medications, or record the reason for the omission. When recruiting new workers, the Registered Manager must ensure that: A photograph of the worker is obtained. This requirement has been repeated from the last inspection. The Registered Manager must ensure that all staff are afforded access to regular training appropriate to the work they are DS0000064617.V320170.R01.S.doc Timescale for action 28/02/07 2 OP7 15(2.b) 28/02/07 3 OP9 13(2) 28/02/07 4 OP29 19(b.i) 28/02/07 5 OP30 18 (1) (c.i & ii) 31/03/07 Paternoster House Version 5.2 Page 27 to perform. 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 OP7 OP9 Good Practice Recommendations Staff should carry out care plan reviews on at least a monthly basis consistently. For the management of medications, staff should: • Use a risk assessment tool for self-medicating residents • Date boxed items of tablet medication for auditing purposes. A minimum ratio of 50 of care staff qualified to NVQ level 2 should be achieved in the home. All staff should receive induction training within six weeks of appointment to their post. Staff fire safety training needs should be incorporated into the Fire Safety Risk assessment. 3 4 5 OP28 OP30 OP38 Paternoster House DS0000064617.V320170.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Paternoster House DS0000064617.V320170.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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