Inspection on 14/06/07 for Raleigh Court

This inspection was carried out on 14th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Raleigh Court 04/06/08

Raleigh Court 01/11/05

Raleigh Court 28/07/05

Raleigh Court 01/03/05

Raleigh Court 17/08/04

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Raleigh Court Cambridge Street Hull East Yorkshire HU3 2EP Lead Inspector Beverley Hill Key Unannounced Inspection 14th June 2007 09:00 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 Raleigh Court DS0000000869.V334561.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. Raleigh Court DS0000000869.V334561.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Raleigh Court Address Cambridge Street Hull East Yorkshire HU3 2EP 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) 01482 224964 01482 219833 Humberside Independent Care Association Limited Karen Fowler Care Home 56 Category(ies) of Dementia (56), Old age, not falling within any registration, with number other category (56) of places Raleigh Court DS0000000869.V334561.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate two service users under 65 years of age. Date of last inspection 1st November 2005 Brief Description of the Service: Raleigh Court is a purpose built care home located in Kingston upon Hull in a residential area, close to the city centre. The home’s location provides service users with easy access to a variety of shops, pubs and public transport etc. It is owned By Humberside Independent Care Association Ltd (HICA), which is a not for profit organisation. The home provides personal care and accommodation for a maximum of fifty-six older people, some of whom may have memory impairment. The home is laid out on two floors with access to the upper floor via a passenger lift. Central to the home are two courtyard areas with patio tables, chairs and a water feature. All service users are able to access these areas safely. There is ample car parking facilities at the front of the building. All bedrooms are single with thirty-two having en-suite facilities. A number of these single rooms have a lockable interconnecting door which means couples are able to share a bedroom whilst using the other as a lounge area. There are six bathrooms and one shower room and sufficient toilets throughout the home. Communal areas consist of four lounges and two dining rooms. The home is clean, tidy and welcoming. According to information received from the home the weekly fees are between £395.00 and £440. There is a top up system of £10 for a basic room and £20 for an en-suite room. Additional charges are made for hairdressing, chiropody, clothing, toiletries, transport, newspapers, personal television licence, nametapes, holidays and outings and alcohol and cigarettes. Information about the home and services can be located in the statement of purpose and service user guide. Raleigh Court DS0000000869.V334561.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit to the home took place over one day. Throughout the day the inspector spoke to several service users to gain a picture of what life was like for people who lived at Raleigh Court. The inspector also had discussions with the registered manager, care staff, domestic staff, the activity coordinator and the administrator. The inspector looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. The inspector also checked with service users to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. The inspector also observed the way staff spoke to service users and supported them and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. Prior to the visit to the home the inspector had sent out a selection of surveys to service users, some family members, a selection of staff members and professional visitors to the home. Those returned were checked and comments used throughout the report. There were positive comments about the home in general and the care provided by the staff team. What the service does well: The home makes sure that people are only admitted to the home after they have had an assessment of their needs. Staff members also obtain assessments done by the local authority. This helps them decide whether or not people’s needs can be met in the home. The home provides a very pleasant environment for people to live and work in. It had a friendly and homely feel, and was clean and fresh. Visitors were welcomed at any time of the day and this was confirmed in discussions with service users the inspector met on the day. There were plenty of activities provided and people commented on the difference the new activity coordinator had made. Staff members enjoyed their jobs and supported people in ways that respected privacy and dignity. They Raleigh Court DS0000000869.V334561.R01.S.doc Version 5.2 Page 6 showed good understanding of how to make sure people remained as independent as possible. Service users were complimentary about the staff, ‘the girls are lovely’ and ‘they look after us well’. People who lived at the home stated they liked the meals and drinks provided. There was choice on the menus and the home had been awarded a healthy heartbeat award for having health alternatives to the main meal. The induction and training provided in the home gave staff the opportunity to develop their skills and knowledge and staff members feel they are supported and well supervised by management. The large staff turnover had affected training records. The home had been awarded part 1 and part 2 of the Local Authority Quality Development Scheme for ensuring care plans and a quality monitoring system was in place, however some sections of their quality assurance programme could be improved. Any complaints were looked at straight away and sorted out. What has improved since the last inspection? What they could do better: The manager needs to write to service users when they have been assessed to let them know that the home is able to meet their needs. At the moment people are told verbally but it is important that the home puts this in writing. When people have assessments, their needs and how care staff will meet them, are written down in support plans. The home needs to make sure that they include all the needs identified or staff may not have the full information they need to support someone fully and care may be missed. The staff members look at the support plans monthly to check they are meeting peoples’ needs. When changes occur in peoples’ behaviour or needs this is documented in parts of the care file but staff don’t always refer to what’s written when they check the support plans. This means that they may think the support plan is meeting someone’s needs but actually it needs changing. Raleigh Court DS0000000869.V334561.R01.S.doc Version 5.2 Page 7 It was noticed that some service users who were confused had behaviour that caused harm to others. The staff did not have any proper plans to follow so they could support the people consistently. The manager had not reported the incidents to the local authority so they could check them out and give advice as to how to protect people. They had also not reported the incidents to the Commission, which they must do to comply with regulations. Generally service users medication was managed quite well but there were some areas of recording that needed improvements. Also one person ran out of important medication for over a day. It is important that staff have clear instructions about medication and that they do not run out of stock of medication. The way the home completes checks on new staff coming to work at the home is usually very good. In some instances staff started work after an initial check but before the police check came back. When this happens, which should only be in exceptional circumstances, the staff must be closely supervised. The home must have some system in place to monitor the safety of bed rails. Some of those checked did not comply with manufacturers instructions and could place service users at risk. The home had had quite a large turnover of staff in the last year. This had affected their training records. Some staff had not completed mandatory training and the percentage of staff trained to national vocational qualification level 2 and 3 was 21 . The home is aiming for 50 . The manager and staff carry out audits and checks on the quality of the service it provides. Some of the checks could be improved, especially around documentation, as the inspector found some shortfalls in this area. If checks were made thoroughly then things may be picked up and service users needs would be more thoroughly met. 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. Raleigh Court DS0000000869.V334561.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 Raleigh Court DS0000000869.V334561.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 and 5 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users had assessments of need completed prior to admission and the home obtained copies of assessments completed by care management. This enabled the home to have full information about the service user in order to decide whether they can meet needs. The home offered visits and trial stays so people could assess the service prior to making a decision. EVIDENCE: The inspector examined five care files during the visit; four were of service users funded by the local authority and one person who paid privately. There was evidence the home obtained assessments and care plans completed by the local authority and the manager confirmed they visited service users at home or in hospital to complete the homes in-house assessments. The information Raleigh Court DS0000000869.V334561.R01.S.doc Version 5.2 Page 10 gathered enabled the home to decide whether they were able to meet the persons’ needs within the home. Examination of the documents indicated all needs were identified and the date of completion was prior to admission. The manager needs to formally write to service users or their representatives, following the assessment stating their capacity to meet identified needs. Currently, as with other homes in the company, this information is provided verbally. The company had routine documentation used throughout all the homes. After admission the staff completed strengths and needs assessments, which related to service users activities of daily living and these informed care plans. They also completed personal profiles and fact files which identified diverse needs, routines and preferences. Staff members described the admission process and how they showed the service user around and supported them to settle in, introduced them to staff and other people and generally made them feel welcomed. The manager and staff confirmed that the home offered short respite stays to enable people to see what the home was like. The first few weeks of admission were seen as a trial period, after which a review was held and the service user and their relatives discussed the option of permanent residency. The home does not provide intermediate care services. Raleigh Court DS0000000869.V334561.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users health and social care needs were met in a way that promoted privacy and dignity. Some gaps in care plan formation means that staff may not have all the required written information about service users needs. The home generally managed and administered service users medication well but recording deficiencies could lead to staff confusion. EVIDENCE: The inspector examined five care files and they contained a wealth of information and assessments, including those completed by care management, to enable staff to formulate care plans. The files were well kept with individual sections making it easy to access information. Identified strengths and needs were formulated into care support plans. Some of the care support plans were more comprehensive than others, gave clear Raleigh Court DS0000000869.V334561.R01.S.doc Version 5.2 Page 12 tasks for staff and incorporated advice from professionals. For example, one service user often declined personal care but the plan for this support detailed advice provided by the community psychiatric nurse. One care support plan examined made it clear that the service user was to be encouraged to complete some tasks themselves. Another service user with dementia and anxiety had a care plan with clear tasks for staff to support them in these areas. Other care plans did not include all assessed needs, for example, treatment for relieving reddened pressure areas and preventing them from breaking down had been missed off one care plan. Information to guide staff with approaches to use to manage behaviour that was challenging to service users and staff was not in place for other service users. There was evidence that care support plans were evaluated monthly and some were updated when needs changed. However this was not consistent in all the care plans examined. When cross referenced with daily records, health monitoring forms and accident reports it was clear that evaluations did not include information that had been documented in other areas of the file. If taken into account this would have impacted on the support provided and even alerted carers to seek further professional advice. For example one service user with dementia was very confused and had behaviour that was challenging to both other service users and staff. The care plan evaluations for safety issues for one month when most of the incidents had occurred stated, ‘safety none recorded’. All service users had a review at six monthly intervals, whether this was conducted by the home or care management. There was evidence that service users or their representative signed agreement to the care plans. There was evidence that service users health needs were monitored and they had access to health professionals and services, such as GP’s, community nurses, dieticians, opticians and chiropodists. The home had completed charts for particular needs, for example bowel care, weight, and food and fluid monitoring. Some of the charts were not consistently maintained and it was difficult to monitor food and fluid intake on some of them due to a lack of detail about accurate amounts consumed. The manager stated that accidents were audited and referrals made to the GP where appropriate. The inspector recently received a concern from a district nurse about the amount of skin tears a service user had received in a short space of time. This was discussed with the manager and new measures had been put in place to address moving and handling issues and seating for the service user. This had improved the care for the service user and no further incidents had occurred. Raleigh Court DS0000000869.V334561.R01.S.doc Version 5.2 Page 13 The home completed risk assessments for activities deemed to pose a risk for people, for example their nutritional intake, falls, moving and handling needs and frail skin. A consultant and community nurse had assessed one service user as requiring their medication to be administered covertly in their food. Whilst it is not standard practice to hide medication in this way the home had followed procedures and family members were in agreement with the health professionals that this was essential for their health and welfare. In a discussion with staff members it was clear they were aware of service users needs and had the opportunity to read care plans. They had a good understanding of how to provide care that maintained privacy, dignity, choice and independence. This was confirmed in discussions with service users and they were observed to be smartly dressed in clean clothes, attention had been paid to nail and hair care and male service users had been assisted to shave. The inspector observed staff members speaking with service users in a respectful way. One relative stated, ‘they treat my mother as a person’. The home had a separate medication room, and medication was stored appropriately and generally well managed, although there were some areas that required attention: The full manufacturers instructions must be written on the medication administration record when transcribing medication. When using codes to indicate why medication had not been administered these need to be used consistently. When inputting information into the controlled drugs book the name and strength of the medication must be written on each page not just the name of the service user. The inspector was unable to audit this properly. There had been one occasion when a service user had run out of important medication required for Parkinson’s disease. It is important that stock control is well managed. Raleigh Court DS0000000869.V334561.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home had flexible routines and promoted choice and individual decisionmaking. The home provided well-balanced meals, which met service users nutritional needs. EVIDENCE: Via discussion with staff members and service users it was evident that the home provided activities for people and for the last three months had employed an activity coordinator for three days a week. They were very enthusiastic about their role and had improved the range of activities on offer for people. Those arranged included, painting and craft work in the activities room, bingo sessions, one to one chats with people, visiting entertainers, trips out, walks around the home and outside, hand massages and various games. The activity coordinator explained how important it was just to sit and talk to people especially if they didn’t always want to join in arranged activities. This Raleigh Court DS0000000869.V334561.R01.S.doc Version 5.2 Page 15 had been mentioned as an area for improvement in one of the relative’s surveys. Seasonal activities take place, for example, bonnet making at Easter, summer fairs, Christmas parties, wine and nibbles evenings and a day with an American theme is planned for July. The activity coordinator described a recent ‘Ascot Day’ when service users who wished to participate dressed up in hats and had a, ‘day at the races’. This was in-house and involved watching a special event DVD with refreshments. The home also has the use of a minibus. One service user stated, ‘She (Activity Coordinator) does things like hairdressing and manicures, cards and dominoes and bingo at night sometimes. Singers come in. I’ve asked her for some exercises and she is going to arrange them for us’. Another person explained that they chose not to take part in activities but had been out on trips and enjoyed Hull Fair last year. The activity coordinator explained that activities were tailored, for example, one service user was supported to visit the local betting office, four more able service users were supported to get together each week for a dominoes match and a further person enjoyed working in the greenhouse. Staff spoken to had an understanding of how to promote privacy, dignity, independence and choice, ‘we get to know people and remember what they like’, ‘we always make sure doors and curtains are closed’, ‘lots of service users like to just walk around and touch things, people can do what they want to do’, ‘ we offer two choices at lunch and alternatives’, ‘we don’t have any set routines’. There was also evidence that service users could bring in items of furniture to personalise their bedrooms. The inspector observed one service user with dementia walking around the home pushing a pushchair. This gave the service user some comfort and purpose and staff observed from a discreet distance. The quality of life and choice for some service users had been affected by some incidents that had occurred between service users. However the inspector has mentioned this in the complaints and protection, and management parts of the report, as staff members have made very good efforts to provide service users with a good quality of life, choices and decision-making. Service users spoken with stated their visitors could come at anytime and could be seen in private. This was confirmed in discussion with staff and in surveys received from relatives. The inspector observed visitors coming and going freely and they were offered refreshments. Service users also confirmed staff knocked on doors prior to entering and supported them in a nice way. Relatives commented in surveys that staff kept them informed, ‘ they ring me if there is a problem and they let him know when I am visiting’, ‘they treat people with respect and try to maintain dignity and explain what they are doing when they assist them, they do a good job’, ‘they always inform relatives about illnesses’, ‘there is always a welcome’. Service users spoken with enjoyed the meals provided by the home, ‘we get plenty to eat and drink, lots of biscuits and cakes’, ‘ we always have two Raleigh Court DS0000000869.V334561.R01.S.doc Version 5.2 Page 16 choices and its well cooked and they will give you something else if you want’. Menus were on display and they indicated choice and alternatives. Special diets were catered for and the staff checked with service users if they had enjoyed their lunch or if they required any more. Staff members were observed supporting service users to eat their meals in a patient and sensitive way. The home had gained the Healthy Heartbeat Award and scored highly in a recent visit by environmental health officers. Raleigh Court DS0000000869.V334561.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): 16 and 18 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides an environment where service users and relatives feel able to complain. Although staff members have received training in safeguarding adults, and policies and procedures are in place, some service users have been harmed. A failure to follow the policies and procedures in practice has meant that the measures put in place have not completely resolved the issues. EVIDENCE: The homes complaints policy was on display and via surveys most staff were aware of how to record and action complaints. No formal complaints had been received at the home, although the Commission had received a concern from a district nurse about a service user receiving skin tears. This was passed onto the home to look into and there was evidence it was dealt with quickly and measures put in place to ensure more effective moving and handling. Complaints recorded were minor in nature and had been resolved quickly. Service users spoken with stated they would complain to someone if they were unhappy and some knew the names of staff members and the manager. Three surveys received from them indicated they were not sure how to complain but did not have any complaints. One service user stated that staff asked them if Raleigh Court DS0000000869.V334561.R01.S.doc Version 5.2 Page 18 they had any complaints when they had their residents meetings, ‘we had one last night, about six of us go, they ask about complaints and meals’. Staff members received training in the protection of vulnerable adults during their induction and staff and the manager were aware of the multi-agency policies and procedures regarding alerting and referral. However during the visit the inspector noted in the accident book and daily records that there had been some incidents where service users had hit out at other people. The home had attempted to deal with the incidents and care plan reviews had been called with health and social care professionals present. Some service users had been reassessed and were awaiting a move to another home. The policy and procedure when a service user is abused in any way is to refer to the local authority for advice, guidance and possible investigation. The manager was advised to report the series of incidents to the local authority safeguarding adults’ team, which they did on the day of the inspection visit and to take guidance about any further action required. The home must ensure that service users are protected and feel safe in their environment. The lack of thorough behaviour management plans for service users has resulted in insufficient guidance for staff. One relative survey stated, ‘I would like to see more supervision in the lounges and recreational rooms i.e. people falling and people arguing when no carers are in attendance’. Raleigh Court DS0000000869.V334561.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): 19, 20, 21, 24 and 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provided a well-maintained, clean and comfortable environment for service users. Service users had the opportunity to personalise their bedrooms, which made it homely for them. EVIDENCE: The home is laid out on two floors with access to the upper floor via a passenger lift. All fifty-six bedrooms are single with thirty-two having en-suite facilities. A number of these single rooms have a lockable interconnecting door which means couples are able to share a bedroom whilst using the other as a lounge area. There are six bathrooms and one shower room and sufficient toilets throughout the home. Raleigh Court DS0000000869.V334561.R01.S.doc Version 5.2 Page 20 Communal areas consist of four lounges and two dining rooms. There are also two courtyard areas with seating and easy access. The home was nicely decorated and furnished. The manager confirmed if they needed items they could put in requests to headquarters. Some items of furniture were looking a little jaded and staff acknowledged that some items could do with replacing but in general the home was furnished well. Bedrooms had been personalised to varying degrees and service users confirmed they were able to bring in small items to decorate their room. All bedrooms had privacy locks and lockable facilities were available. Service users spoken with were very happy with the home in general and the bedrooms, ‘it’s a beautiful home’, ‘the home is always clean and tidy’, ‘it’s always like this, the dining tables nicely set’. The home had sufficient laundry and cleaning equipment although the carpet cleaner was currently out of action. Despite this the home was generally fresh and clean on the day of the visit. One of the bedrooms had an odour but the manager was aware and was dealing with it. Staff confirmed they were constantly cleaning carpets and this was confirmed in a discussion with a service user who stated, ‘when the lounges or corridors smell they start shampooing – they deal with it quickly’. One relative survey stated, ‘sometimes there is an overpowering smell of urine when walking down the corridors’, and another stated, ‘there seems to be a drop in standards of cleaning at the weekend, during the week it is very high’. Another also commented on the odour in corridors at times. Others commented, ‘they keep the residents and the home clean’, ‘some towels need replacing’, ‘and I would like to see a more homely feel to the lounges, more comfy chairs, pictures and flowers’. These comments were passed on to the manager to review. Raleigh Court DS0000000869.V334561.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has good staff supervision arrangements and staff training opportunities. Generally, service users are supported by trained and competent staff, but gaps in training have occurred due to a high staff turnover. Generally the company had sound recruitment processes, however a gap in the process identified during the visit meant that people were employed before the return of full criminal record bureau checks. EVIDENCE: The company ensured that new staff members completed a five-day block of induction, which included training in fire procedures, safeguarding vulnerable adults from abuse, moving and handling, health and safety, basic first aid and social care values and communication. The manager confirmed that skills for care induction booklets were to be available for new care staff to work through which covered required standards in separate modules and which will ensure that competency is assessed throughout the process. This will be an improvement on previous induction, as with other homes in the company, induction tasks were signed off but did not evidence any competency in care practices. This was in evidence in one of the induction records examined. Raleigh Court DS0000000869.V334561.R01.S.doc Version 5.2 Page 22 A further staff member had started employment at the home in November 2006 and induction was started but not completed. Nothing had been documented since 18.3.07. Induction needs to be completed fully to ensure staff are equipped with the required skills. The home had a training plan and there was evidence that mandatory and service specific training was covered. Each staff member had a personal training plan that recorded the training participated in. According to information received from the manager on the day of the visit the home had 21 of care staff trained to national vocational qualification (NVQ) level 2 and 3. Four further staff members were progressing through the course. The home needs to aim for 50 of staff trained to this level. There had been a large turnover of staff over the last twelve months and this had affected training records. A large number of care staff, eight in total, were still working through their probationary period and had still to complete mandatory training. In addition, from information received from the manager, there were a number of staff members who had been employed over six months who still had to complete important training. However most of this was identified and booked. The manager and staff expressed that they were now hoping for a more settled period. Staff members spoken with stated that communication and staff morale had improved recently. The company provided a two-day course in dementia care for staff and there were about twelve people still required to complete this. As the home provided support for up to fifty-six people with dementia this was especially important. Those staff spoken with and surveys received from them commented that the company provided, ‘very good training opportunities’. One professional visitor stated that some staff needed more training especially in the moving and handling of one service user. This was quickly addressed when the manager became aware of the comment. Staff rotas were examined and showed there was usually nine care staff members on duty during the day from 7am to 7pm and four staff worked through the night from 7pm to 7am. There was two additional care staff members employed from 2pm to 10pm and 4pm to 10pm making six staff in all from 7pm until 10pm. This new system of twelve-hour shifts enabled the manager to plan cover and staff the home more efficiently and a staff survey commented that, ‘it seems to meet the service users needs more’. The manager described how staffing levels could fluctuate when service users needs increase to enable more intensive support, for example during periods of illness and leading up to death. Service users spoken with and surveys received from people were complimentary about the care staff team. Comments were, ‘excellent care for Raleigh Court DS0000000869.V334561.R01.S.doc Version 5.2 Page 23 a very sick lady, they have helped with much care and attention to get her semi-mobile and give her some independence, which makes her feel better’, ‘the staff are friendly, caring and very patient’, ‘they talk to the service users well’, ‘I know everyone and am settled here and would like to stay’, ‘ the girls are lovely’, ‘they look after us well’. One professional visitor stated, ‘the service users seem well cared for’. However two of the ten surveys received from service users stated that they did not feel all the staff listened to them all the time. This was mentioned to the manager to pick up in staff meetings. The inspector observed staff talking to people in a friendly and courteous way, they were supportive at mealtimes and had time to sit and chat to people. The atmosphere was relaxed. Generally the home operated a robust recruitment process. References and criminal record bureau checks were obtained and checks made against the protection of vulnerable adults register. Care staff members were selected via an interview process. Usually staff only started work in the home after the return of the criminal records bureau check, however on some occasions staff members started employment after the return of the povafirst check but before the criminal record bureau check had returned. In exceptional circumstances this is acceptable but the home must put in place stringent supervision arrangements and the inspector could not see evidence of this. Raleigh Court DS0000000869.V334561.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Overall the home is managed quite well, however some service users wellbeing and safety continued to be compromised by the home not following safeguarding adults policies and procedures. Improvements in the monitoring systems for bed rails and monthly quality audits will ensure service users safety and wellbeing are promoted and protected. EVIDENCE: The registered manager has worked in the care sector for many years and has completed the Registered Managers Award. She has also completed training Raleigh Court DS0000000869.V334561.R01.S.doc Version 5.2 Page 25 courses throughout the year reflecting her commitment to improving her knowledge and skills and is an assessor for national vocational qualifications. The manager felt the company provided them with a good structure of support, which included an area manager and a health and safety officer. Although regular meetings with the area manager had taken place the manager stated they had not alerted them to the safeguarding issues mentioned in the complaints and protection section. The manager had also not informed the Commission about the incidents. The manager needs to be more proactive in alerting the safeguarding adults team in these situations to enable review and allocation of resources by the commissioning bodies. Staff spoken with felt supported by the manager and surveys commented on her supportive and approachable manner, ‘the manager is extremely helpful’, ‘she is understanding and sympathetic’, the atmosphere is better and communication has improved’, ‘things have got better over the last year, she sorts things out and things are actioned’. There was evidence that generally, staff members were supported by the provision of regular supervision. Supervision records were well organised, up to date and covered all the required areas. One person had missed some supervision sessions but this appeared to be a one-off. Staff also had annual appraisals, which identified training needs. Meetings were held for service users and staff. There was evidence that the views of service users, staff and relatives were listened to and acted on. Staff members stated they enjoyed coming to work and one person said, ‘it’s a very good company with lots of training and good support’. The home has a good quality assurance system in place, which consists of audits and questionnaires to seek the views of all stakeholders. The quality audit tool focuses on all areas of service provision with different tasks each month. Results of audits and questionnaires are analysed and plans produced to rectify any shortfalls. The auditing processes should be refined in some areas to address shortfalls in care plans, risk assessments, behaviour management plans and recording of incidents. The manager keeps a monthly record of the action taken to address shortfalls and keeps senior managers informed of progress. The manager stated that senior managers had not been informed of the incidents between service users. The company produces an annual development plan, which looks at the organisation as a whole as well as each individual home. Service users finances were well managed with individual records maintained on a computerised system. Receipts were obtained for money deposited into the personal allowance system and when staff members assisted service users to purchase items form local shops and on outings. The company had introduced third party top ups last year and these were paid by someone other Raleigh Court DS0000000869.V334561.R01.S.doc Version 5.2 Page 26 than the service user. The administrator audited finances fortnightly and the manager, monthly. The company also audited the home on an annual basis. Documentation indicated that moving and handling equipment was serviced regularly and fire drills and alarms completed. Staff completed health and safety training in induction and safety posters were on display in the home. Bed rails were checked throughout the home during the visit and some were found not conform to manufacturers instructions. An immediate requirement notice was issued for the home to address the problem. Raleigh Court DS0000000869.V334561.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 2 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 4 3 4 X X 3 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 2 X 3 3 2 2 Raleigh Court DS0000000869.V334561.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 OP3 Regulation 14(1)(d) Requirement Timescale for action 31/07/07 2 OP7 15 3 OP7 13, 14 & 15 4 OP8 13, 14 & 15 The registered person must ensure that the home formally writes to service users or their representatives following assessment stating their capacity to meet identified needs. The registered person must 31/08/07 ensure that all assessed needs have plans of care in place to provide staff with written guidance on the tasks they must perform to meet them. This will ensure that service users assessed needs are met. The registered person must 31/07/07 ensure that care plans and risk assessments are evaluated thoroughly and accurately taking into consideration information documented in daily recordings. This will ensure care plans are updated with current information and keep staff aware of changes. The registered person must 31/07/07 ensure that a behaviour management plans are formulated with professional input for service users with behaviours that are challenging DS0000000869.V334561.R01.S.doc Version 5.2 Raleigh Court Page 29 5 OP9 13(2) and harmful to service users and staff. This will enable staff to approach difficult situations consistently. The registered person must ensure that: Staff members transcribe medication instructions onto the MAR thoroughly with two signatures. When medication is omitted, codes used are clear and consistent. Stock control is managed efficiently so service users do not run out of medication. The full name and strength of the medication is inputted onto the relevant page in the controlled drugs register. This will ensure that service users receive the medication prescribed for them and staff have clear instructions. The registered person must ensure that staff at all levels are aware of and follow the multiagency policy and procedures for safeguarding adults. The registered person must ensure that stringent supervision arrangements are in place in the exceptional circumstances when staff members start work after the povafirst check but prior to the return of the criminal record bureau check. The registered person must ensure that all staff members complete mandatory training in line with the homes training plan and induction is completed fully in line with skills for care DS0000000869.V334561.R01.S.doc 31/07/07 6 OP18 13(6) 31/07/07 7 OP29 19 31/07/07 8 OP30 18 30/09/07 Raleigh Court Version 5.2 Page 30 9 OP37 37 10 OP38 13(4) standards. This will ensure staff are skilled and competent for their roles. It is recognised that a large staff turnover has affected staff training figures. The registered person must ensure that the Commission is notified of all serious incidents affecting the safety and wellbeing of service users as per guidance. The registered person must ensure that bedrails used conform to manufacturers instructions. Immediate Requirement notice issued – within 48 hours. The registered person must improve the monitoring of bedrail provision to include a system of documenting checks made on the ongoing need for them and maintenance of them. 31/07/07 16/06/07 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 3 Refer to Standard OP8 OP28 OP33 Good Practice Recommendations Accurate information on the amounts of food and fluid consumed should be recorded when using monitoring charts for this purpose. The home should continue to work towards 50 of care staff trained to NVQ Levels 2 and 3. The manager should review the way documentation and recording is audited and evaluated in light of shortfalls identified in areas of care plans, accidents, medication, monitoring charts, behaviour management plans and notifications. Raleigh Court DS0000000869.V334561.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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. 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