Inspection on 28/01/08 for Paternoster House

This inspection was carried out on 28th January 2008.

CSCI found this care home to be providing an Good 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

Paternoster House 07/10/09

Paternoster House 11/01/07

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 28th January 2008 08:45 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.V354382.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.V354382.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 manager.paternoster@osjctglos.co.uk 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.V354382.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th January 2007 Brief Description of the Service: Paternoster House is a purpose built care home providing nursing and personal care for 40 older people. It is situated near to Cirencester town centre, and is managed by The Orders of St John Care Trust. 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 £539 to £742 per week; the home also accepts the Local Authority contract rates. Opticians, dentists, hairdressing and chiropody are charged at individual extra costs. Paternoster House DS0000064617.V354382.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 2 star. This means the people who use this service experience good quality outcomes. 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 inspection on one full day in January 2008. Checks were made against the statutory requirements issued at the last key inspection, in order to assess the home’s compliance. Care records were inspected, with the care of five residents being closely looked at in particular. The management of residents’ medications was also inspected. A number of residents and relatives 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. Some of their 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.V354382.R01.S.doc Version 5.2 Page 6 What the service does well: Paternoster House is a well managed home, provides a safely maintained and clean environment for the residents to live in, and offers a very welcoming atmosphere for visitors. Residents are admitted to the home on the basis of an assessment of their individual needs, although the format for this has varied, with the designated assessment tool not being consistently used by the assessor. Upon admission each resident has their own personal documented plan of care to address their individual needs. Many residents and their families spoke very positively about the care and attention they received from the staff. Appropriate support equipment was in use on the basis of individual risk assessments, there was evidence of appropriate sourcing of medical reviews and healthcare, and there were many examples seen of residents receiving good care and support. Residents’ privacy and levels of independence are respected and maintained as much as possible, and each is afforded good opportunities for exercising choice and for maintaining their social contacts. Some of the residents’ relatives indicated that they too felt well supported and reassured by the home. The standard of food provided for residents here is good. Residents are consulted about the menus, and were happy to confirm their satisfaction with the quality and quantity of food available to them. People are reassured that the home takes any complaints and concerns seriously and does all it can to help them, although there was one isolated exception to this, where the complainant had taken some time to obtain satisfaction. 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. There are some good quality monitoring approaches adopted here, with residents and their families encouraged to have a say in how their home is run. Staff are recruited in accordance with good recruitment procedures, with the necessary pre-employment checks taking place. Paternoster House DS0000064617.V354382.R01.S.doc Version 5.2 Page 7 The competence and skill of the staff group is developed through a structured induction-training programme, and through ongoing training in topics relevant to the needs of the residents. There is also a good focus on the National Vocation Training programme for care staff. What has improved since the last inspection? What they could do better: Although there is generally a good standard of care planning and risk assessment undertaken for residents here, the way in which certain risk assessments are reviewed and updated must be improved so that changes in residents’ condition are reflected more accurately. Residents and visitors generally speak extremely positively regarding the staff and the care they receive here, but there are isolated cases where residents experience some slight delays in receiving a response to their need for assistance from staff. Residents’ health needs in relation to their medications are met, however a number of improvements to the medication systems are required following this inspection. These relate to storage, dating of supplies and aspects of recording, which will ensure greater safety and continuity for the residents. There are currently two days each week when there is no designated laundry worker; care staff undertake laundry duties on these days, and this has the potential to encroach on the caring duties they are responsible for. However, it is the manager’s intention to recruit to this position as soon as possible. Paternoster House DS0000064617.V354382.R01.S.doc Version 5.2 Page 8 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.V354382.R01.S.doc Version 5.2 Page 9 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.V354382.R01.S.doc Version 5.2 Page 10 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. People living in this home receive an assessment prior to their admission, so that they can be assured that the home will be able to meet their needs. EVIDENCE: In the care records belonging to more recently admitted residents there were completed assessments that identified each individual’s health and care needs prior to admission to the home. The assessor had gone out to visit the prospective resident at their location at that time. Although the home has a comprehensive assessment tool for this purpose, the manager has opted not to use it and, has instead, used the multi disciplinary assessment already conducted by the placing authority and other involved health care professionals; the manager had added very brief additional comments to these pre-existing assessment forms, where relevant. Paternoster House DS0000064617.V354382.R01.S.doc Version 5.2 Page 11 The recently introduced comprehensive assessment tool had the potential to capture a very good standard of information about the person’s needs, and identified any risks at an early stage; it was the manager’s view that the home would only use this tool in cases where a specialist assessment was not available. Prospective residents had received written confirmation of their placement in the home, as was required. Paternoster House does not provide intermediate care. Paternoster House DS0000064617.V354382.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. 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. People living in this home have their health and care needs met through good care planning and delivery that is mindful of their privacy and dignity, and through a mostly well managed system for administering their medications. EVIDENCE: All residents have their own written personal plan of care, which is subject to regular review. Residents, and their families if they wished, had been involved in this process and had also taken part in a six monthly review of the care and services they had been receiving. Residents’ care plans were individualised, and were reflective of their personal wishes, choices and levels of independence as far as possible. A whole new assessment and care planning system was being phased in here, with this gradually replacing the old one; staff had received training in its use. Paternoster House DS0000064617.V354382.R01.S.doc Version 5.2 Page 13 Four plans were selected for a case tracking exercise, with a fifth for medication purposes, and were scrutinised in closer detail. Each of these care plans was devised on the basis of an assessment of the resident’s needs, incorporating health, personal and social issues, and provided some good guidance for staff. A good range of risk assessments had also been carried out, to include manual handling, pressure sore vulnerability, nutrition, falls and the use of bed rails if relevant. Support equipment was in use on the basis of assessments, where applicable. Recorded evidence of multidisciplinary working was seen between the home and other health care services. Residents were receiving regular medical reviews and consultations, and had access to a range of health care services, either in the community or in the home to promote their health and well being as far as possible. There were a large number of ill residents being nursed in bed and requiring significant health and care input. In one case the nutritional risk assessment did not accurately reflect the resident’s current circumstances, and a more thorough review was needed. In the same case the reviews of the pressure area care plan showed a similar shortfall. Residents appeared comfortable and appropriately cared for, with all speaking positively regarding the way in which they were looked after here. Many spoke of caring staff and good standards of care and attention, as did some visitors to the home. One resident said that ‘you couldn’t fault it here; it was just the best’. One visitor spoke less positively, saying that their relative ‘due to staff shortages, sometimes experienced a problem getting staff to take them to the toilet just when they wanted’, and that ‘sometimes they could be kept waiting to get dressed and to go to bed’. Staff were busy, and residents’ call bells were heard ringing persistently particularly throughout the morning. Staff were managing all residents’ medications, although there is the opportunity for people to manage their own should they be able and wish to. Medications were held securely, although in one case there were two external medicinal creams on a sink unit in a room, which did not appear to have been prescribed, and were undated when opened, making it difficult to know the exact circumstances of their use; these were disposed of at the time. Medication administration charts were printed clearly by the supplying pharmacy, and contained a record of drug administrations; two people had signed any handwritten amendments on charts. Paternoster House DS0000064617.V354382.R01.S.doc Version 5.2 Page 14 There was some discrepancy identified in two cases, where the administration instruction was incorrect, requiring amendment. However, in practice the drugs were being administered appropriately, with staff having omitted to ensure the necessary changes were made to the chart. In another case a plan of care directed staff in the use of a steroid cream, but the item did not appear on the medication administration chart, having not been brought forward onto the new one; this meant that there was no current record of administration in this case. Not all boxed medications were dated on opening, and because of this it was not possible to carry out an audit of analgesic tablets on this occasion. An audit of controlled drug storage and dispensing was in order, although staff had not completed the register at the right time in one case. The Annual Quality Assurance Assessment (AQAA) states that regular audits are carried out on the medication systems, however, in view of the above shortfalls this needs to be more robust. Staff were observed being polite and respectful towards residents, and were delivering care in the privacy of their own rooms. One member of staff commented that the home ‘tries to promote people’s independence and best quality of life’. Care planning directed staff towards this, displaying sensitivity towards residents’ dignity and privacy. Residents themselves confirmed that staff were respectful, and were mindful of their privacy. Paternoster House DS0000064617.V354382.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People living in this home have the opportunity to remain socially active, exercise choice, and have a nutritious diet that offers choice and variety. EVIDENCE: The AQAA states that although the senior care leader is currently devoting eight hours each week towards coordinating social activities for residents, a permanent appointment to this position is going to be made, allowing for more hours. It also states that the provision of activities has increased, with community links within the local community enhanced for the residents, although transport has proven a challenge when trying to organise outings for them. A varied programme of social activities was available, with something held every day, if not twice a day; residents had been consulted about their ideas and suggestions for social activity and events. The programme was designed to meet a variety of abilities, tastes and interests, and included music and art therapy, entertainments and exercises, quizzes and games, and reading poetry and the local news together. Paternoster House DS0000064617.V354382.R01.S.doc Version 5.2 Page 16 Staff endeavoured to spend social time with those residents choosing not or unable to join in socially, on a one-to-one basis, and the music therapy was reported to have been particularly beneficial for those residents with dementia. A light hearted quiz was being held during the afternoon, which was evidently a lot of fun for those who were present; the coordinator was particularly mindful to ensure that all of those present were able to participate and get the maximum benefit from the activity. There is a multi-denominational religious service held in the home each month, and residents are given the opportunity to go out to the local church if they want to. Just one visitor said that they would like to see more funding for social stimulation, whilst others spoke extremely positively in this regard, with one saying that the home ‘celebrated all events, and also encouraged families and friends to join in as well’. All visitors surveyed or spoken to confirmed that they were made to feel very welcome here. People spoke of a friendly atmosphere, with one staying regularly to have meals with her relative. This person said that ‘the staff were very supportive to her, as well as to her relative’. Visitors were witnessed coming in an out of the home, and there were no restrictions placed upon them when spending time with their relative. Residents were seen spending time in various locations around the home, in accordance with their wishes. Some were rather more reliant on the staff to assist them in this regard, but staff were mindful of this, and were heard offering choice to people, and being sensitive to their wishes. A number of residents confirmed that they were freely able to choose what they did, with one saying that ‘there were no laws here’. Visitors to the home confirmed on surveys that residents are supported to live their lives how they choose, with levels of independence respected. Many of the residents’ bedrooms contained personal belongings, and as a consequence appeared individual and homely. The service of breakfast and lunch was seen, and the meals appeared wholesome and nutritious, with lunch containing fresh produce. The mealtime was calm and unhurried, with residents able to enjoy their meals in a relaxed way. Residents spoke well of the food, with several saying it was excellent, and staff were overheard offering choice and additional portions. Paternoster House DS0000064617.V354382.R01.S.doc Version 5.2 Page 17 Staff were also assisting where necessary, and those residents requiring it were provided with protection for their clothes and eating aids. A new heated trolley had been provided, to allow for an improved meal service to residents in their rooms, and staff were observed tending to residents’ needs in their rooms efficiently and sensitively. Meal times had been altered slightly to allow for a more even space of time between meals to suit the needs of the residents better. Residents had been consulted about their views for the menus, and options have been reviewed as a consequence of this; one visitor commented that the cook had given a lot of thought to the menus. Special diets were catered for, and the cook was able to speak knowledgeably about the needs of certain individuals. Good catering records were maintained, and the kitchen was well organised. Paternoster House DS0000064617.V354382.R01.S.doc Version 5.2 Page 18 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. People living in this home have confidence in the staff to help, and resolve their concerns, and are reassured regarding the policies protecting their rights and the prevention of abuse. EVIDENCE: The home had a clearly written and accessible procedure for addressing any concerns and complaints; a copy was issued to all residents and their families. Changes are now needed to some of the detail contained within it, so that interested parties can have access to the correct contact details for the CSCI, as these are now out of date. A full record of any that had been received was maintained, and since the last inspection four had been fully addressed by the home. The majority of residents and their relatives confirmed that they knew how to raise complaints if they had any, and that they had faith in the staff to deal with them. Some said that if they had raised any they had been addressed to their satisfaction. In one case a relative was less satisfied, having had to follow up issues in relation to their relative’s care on more than one occasion. During conversation however, it was established that the concerns had eventually been addressed. Paternoster House DS0000064617.V354382.R01.S.doc Version 5.2 Page 19 The home had documented policies and procedures to address forms of abuse and whistle blowing procedures, which were readily available for staff to read. The home also had useful guidance on Residents’ Rights, Risks and Restraint, as published by CSCI, the Department of Health guidance ‘No Secrets’, and the local council’s Safeguarding Adults Multi-Agency policies and procedures. An easy-read version of the recently introduced Mental Capacity Act had been made available to staff, and training was given about this, and about safeguarding vulnerable adults and prevention of abuse during induction. Other staff had received a group training session in safeguarding vulnerable adults last year, and from records seen and from isolated comments from staff it was clear that staff had an understanding of abuse issues, and what to do if they had any concerns. A number of residents said that they had ‘trust and confidence in the home’. Paternoster House DS0000064617.V354382.R01.S.doc Version 5.2 Page 20 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. People living in this home are provided with comfortable and generally pleasant accommodation, which is suitable and safe to meet their needs. EVIDENCE: The AQAA states that the home now provides a non-smoking environment; this was made clear in the home’s information brochure. The passenger lift had been refurbished, and extensive repair and redecoration works were being carried out to the exterior of the building, with scaffolding erected all around the outside; the home had experienced some water leak problems that had affected the fabric of the building. Paternoster House DS0000064617.V354382.R01.S.doc Version 5.2 Page 21 New items of furniture, bedroom flooring, linen and equipment have been purchased; some more new carpets are planned for two of the communal areas. The home has a committed and efficient maintenance person, who keeps meticulous records in this area. Areas of the home looked bright, clean and well maintained. Some odours were detected earlier in the day, but these were managed and had disappeared by later in the morning. All residents who responded to surveys were satisfied with the standards of cleanliness in the home. Clinical waste was correctly managed, and sluice rooms were reasonably clean and orderly. There were good supplies of liquid soaps, paper towels, gloves and aprons for staff to use as part of the prevention of cross infection. The laundry room was organised, with items appropriately segregated and washed in accordance with infection control measures. The home does not have a specifically written policy on infection control, although there are plans to introduce one, and uses the Department of Health Infection Control guidelines for Care Homes in the interim. Paternoster House DS0000064617.V354382.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): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home receive care from a currently stable and competent workforce, and can be assured by the home’s recruitment procedures, which observe robust pre-employment checks. EVIDENCE: The AQAA states that there had been a change to the rota and working practices to enable greater continuity for the residents, and that the use of agency staff has been significantly reduced more recently, with an increase in the actual number of staff hours used each week. During this visit it was reported that the use of agency more recently was largely due to sickness within the staff group. The rotas demonstrate that there will generally be two qualified nurses on duty each day, with one at night; there were six carers on duty during the day and three carers overnight. An ancillary team of cleaning, catering, maintenance, administration and laundry staff supports the care and nursing team, and the manager works in a supernumerary capacity; the deputy manager also has a regular supernumerary day. Paternoster House DS0000064617.V354382.R01.S.doc Version 5.2 Page 23 Recruitment is ongoing however, with a cleaning vacancy, and two days in the laundry that are not covered. On these two days care staff have to undertake laundry duties, and clearly this takes at least one person away from the care of residents for a time. Residents spoke well of the staff, saying they were kind and caring. One said that he ‘really liked them and got on well with them’. Another said that they were ‘always smiley and nice’. One person indicated much the same, but with one exception, and had had cause to speak with one of the staff, whom they felt had been disrespectful. One resident and three visitors said that the home could do with more staff, with one expressing some concern about how long it took residents to adjust to new faces when they started work here. The residents’ call bells were heard ringing a lot during the morning, with staff very busy with residents in all areas of the home. Although marginally short of the standard for 50 of the care staff to be qualified to at least National Vocational Qualification (NVQ) level 2 at the time of this visit, the home is making good progress towards achieving this. There were fifteen care staff qualified to at least level 2 at this time, with another two still working towards it. Personnel files relating to three members of staff who had been recruited in recent months were inspected. In each instance, the prospective employee had completed an application form providing details of their employment history. Interview notes were recorded. At least two written references had been provided in each case, including one from the last employer. Proof of identity and medical statements had been obtained. Correct POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) screening had been completed for each person, although the return of a full CRB disclosure was still awaited for one; this person was still under supervision during this time. The home has a designated training coordinator, who maintains records of training and development needed or completed for all staff. These records demonstrated the range of training undertaken, with different courses and learning available according to the person’s role in the home. There were plans to introduce designated ‘trained trainers’ amongst the existing staff group in order to provide ongoing training in a number of specific areas, and DVD training materials have been obtained to assist with this project. These included Infection Control, Food Hygiene, Abuse, Health and Safety, Nutrition and Risk Assessment. Paternoster House DS0000064617.V354382.R01.S.doc Version 5.2 Page 24 Training records demonstrated that new staff receive a structured induction training that is in line with the national common induction standards for care workers, and that they worked under supervision for this period; supervision records were seen in new staff files. One member of staff said that staff received relevant training, had a good induction, and were kept up to date with new ways of working. Visitors confirmed on surveys that they considered staff to be appropriately skilled and experienced for their roles. Paternoster House DS0000064617.V354382.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): 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. The people living in this home benefit from respectful management, which strives to monitor quality and standards. EVIDENCE: The manager of Paternoster House is long serving here, is a registered nurse, and is very experienced in providing care to older people in this setting. She is registered with CSCI for her role, and has achieved the Registered Manager’s Award. The home’s AQAA was completed to a good standard. There are regular auditing arrangements as part of the quality control systems, and the home had recently been accredited for the ISO Quality Award. Paternoster House DS0000064617.V354382.R01.S.doc Version 5.2 Page 26 The Orders of St John Care Trust carry out regular monitoring visits, producing written reports as required, and the outcomes of CSCI reports are shared with the staff team. Residents had been invited to participate in an annual survey, during which they could give their views and opinions of the service they had received. Action plans were drawn up on the basis of such an exercise, with actions taken to address any particular areas. Residents and their families had also been able to attend meetings, and recorded minutes of one of these demonstrated that residents and their families were consulted about their views, and could have a say in how their home is run. The home offered a safe system for looking after residents’ money and valuables if they wish, and a number had chosen to use this. All items were held securely, and well-kept and transparent records were held in each case, providing a clear audit trail throughout. The home had written policies and procedures in relation to the promotion of the health and safety of the residents, visitors and staff, and associated training was provided for staff. Records showed that regular safety checks and planned maintenance visits had been carried out on the fire safety systems. Fire drills for staff had not been carried out regularly, with only one carried out during last year, the one prior to that being in August 2006. However, fire safety training for staff had been made more in depth and comprehensive of late, with practical instruction delivered, and instruction in evacuation procedures. Individual fire safety risk assessments were carried out and recorded in each resident’s plan of care. Hot water temperatures were regularly checked for safe levels, and regular Legionella checks on the water supply had also been carried out, with the appropriate control measures in place, including for the cold water storage. Corrective action had been taken where anomalies had been found. All the necessary safety checks and maintenance of utilities and equipment had been undertaken in a timely fashion, and the associated records were kept in these areas. There was first aid equipment provided, and first aid training had been provided to the nursing staff and the manager in order to provide adequate first aid cover for the home. Paternoster House DS0000064617.V354382.R01.S.doc Version 5.2 Page 27 Accident records were maintained, with incidents monitored and audited, and examples of these were seen during the case tracking exercise with residents’ records. Paternoster House DS0000064617.V354382.R01.S.doc Version 5.2 Page 28 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 3 29 3 30 3 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.V354382.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 13(4c) 14(2b) Requirement Residents’ risk assessments must be reviewed and appropriately revised in order that they take account of any change of circumstances. This is so that variations in risk factors are clear, and that the necessary measures can be taken to promote residents’ health. Residents’ medication administration charts must contain clear instructions for the use of all medications. This is so that residents will receive their medications in the prescribed manner to meet their health needs. A record of all medication administered must be kept, including those for external creams. This is to provide a clear audit trail of medications given or applied, and to avoid any risk of errors. Timescale for action 29/02/08 2 OP9 13(2) 29/02/08 3 OP9 17(1a), Schedule 3 (3i) 29/02/08 Paternoster House DS0000064617.V354382.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations • • All boxed medications should be dated when opened, in order to provide a clear audit trail of the use of the medication You should ensure that where creams and ointments are stored in bedrooms the arrangements are safe for everyone in the home. Paternoster House DS0000064617.V354382.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Regional 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Paternoster House DS0000064617.V354382.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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