Inspection on 04/06/08 for Raleigh Court

This inspection was carried out on 4th June 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Raleigh Court 14/06/07

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Raleigh Court Cambridge Street Hull East Yorkshire HU3 2EP Lead Inspector Beverly Hill Key Unannounced Inspection 4th June 2008 09:30 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.V365680.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.V365680.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 manager.raleighcourt@hica-uk.com 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.V365680.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 14th June 2007 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 people 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. People 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 £348.50 and £470. 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.V365680.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key inspection of the home on 14th June 2007, including information gathered during a site visit to the home, which took approximately nine hours. Throughout the day we spoke to people that lived in the home and one relative to gain a picture of what life was like at Raleigh Court. We also had discussions with the registered manager, the deputy manager, six care staff members and a domestic staff. Information was also obtained from surveys received from eleven people that live at the home, five relatives, eleven staff members, and one health care professional. Comments from the surveys have been used throughout the report. We 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. We checked how staff documented regular pressure relief for those at risk of developing pressure sores and also how they monitored the food and fluid intake of those with nutritional risks. We also checked with people 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. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. The providers had returned their annual quality assurance assessment, (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We would like to thank the service users, staff and management for their hospitality during the visit and also thank the people who completed surveys. Raleigh Court DS0000000869.V365680.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The registered manager has produced a letter to let people know whether they can meet needs following the pre- admission assessment. There has been an improvement in the care support plans and it was clear that staff had worked hard to improve them. There was still some work to be done updating them when needs changed. See below. Raleigh Court DS0000000869.V365680.R01.S.doc Version 5.2 Page 7 The way senior staff members evaluated care support plans had improved as they now looked at other recordings throughout a set period and collated information together. They could make sure changes in needs were acknowledged though. Management completed better behaviour management plans and risk assessments to enable a consistent approach to peoples’ complex needs and behaviours that were challenging to other people. The activity coordinator had undertaken specific training to help them in their role and had assessed which people needed help to personalise their bedrooms. The home also reported to the Commission and the local authority, incidents between people that lived at the home. The deputy manager said this helped the home to focus more on peoples needs and enabled the home to recognise more quickly when they were unable to meet their needs. The management of medication had improved especially in the areas of stock control and recording. Staff retention appears to have settled, which helps in the consistency of care and less agency staff have been used. Training needs of the staff team had been identified and steps taken to meet them. The home has made sure that bedrails comply with manufacturers instructions and risk assessments take into consideration health and safety guidance. There is now a system to monitors the safety of the bedrails. The percentage of staff trained to national vocational level 2 and 3 in care has improved from 21 to 33 . This is a good achievement in a year. The home is aiming for 50 . What they could do better: Management must make sure that staff members follow the care plans to make sure that peoples’ needs are fully met. Care plans must be updated when peoples needs change. This would make sure that staff have up to date information about how to support someone. When managers feel that monitoring charts for food and fluid intake or pressure relief are required, or health professionals request them, they must be filled in accurately and consistently. They can give an accurate picture of the care provided when completed fully and can help to plan treatment. Raleigh Court DS0000000869.V365680.R01.S.doc Version 5.2 Page 8 Staff at all levels must adhere to the policies and procedures for safeguarding adults from abuse. This means that alerts to the local authority and notifications to the Commission must be completed in a timely manner and any investigation carried out by the local authority or under their guidance. The home must make sure that there are sufficient staff members on duty at all times to meet the needs of the people living there. Staff members have told us they are short staffed at times. Now that staff training needs have been identified the home could make sure that they are met. Staff also told us that communication and teamwork could be improved. The home still routinely employs people before the return of the criminal record bureau check, although always after a check of the protection of vulnerable adults register. This system should only be used in exceptional circumstances and not routinely. 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.V365680.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 Raleigh Court DS0000000869.V365680.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 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. People 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 potential residents in order to decide whether they can meet needs. EVIDENCE: We examined four care files during the visit. All contained assessments of need and care plans produced by the local authority for people funded by them. The manager or deputy manager also completed the homes own assessment prior to admission to check there had been no change in need and to assess whether they were able to meet the persons needs. They confirmed the assessments took place in a range of settings and helped them to get to know the person. The confirmed they would take into account the dynamics of the home and the needs of other people that resided there. Raleigh Court DS0000000869.V365680.R01.S.doc Version 5.2 Page 11 The homes assessment covered areas of physical, social and psychological needs and those examined had been completed appropriately. Surveys indicated that generally families were instrumental in choosing the residential home for their relative and assessments indicated family involvement in providing relevant information. The company had routine documentation used throughout all the homes. After admission the staff completed strengths and needs assessments, which related to people’s activities of daily living and these informed care plans. They also completed personal profiles and fact files which identified diverse needs, routines and preferences. Since the last inspection the home had formulated a letter to write to people following assessment stating formally the homes ability or not to meet the identified needs. Raleigh Court DS0000000869.V365680.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 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. Although there have been improvements in the formulation of care plans and the setting up of new monitoring systems, staff were not always following them. This means that peoples health needs will not be fully met. EVIDENCE: We examined four care files during the visit. The care files were well organised and easy to access information. There had been a definite improvement in the formulation of care support plans, risk assessments, behaviour management plans and evaluations since the last inspection. Family members generally signed agreement to their relatives plan if the person was unable to. There were some issues about updating care support plans with relevant information. For example, one person had hurt their arm and hand about five weeks before the site visit, which had severely restricted movement, and although this was referred to in daily records the care plan had not been updated to reflect this and the extra support and observation this required. Raleigh Court DS0000000869.V365680.R01.S.doc Version 5.2 Page 13 Similarly another person had a catheter insitu but the care plan had not been updated to include this. The night support plan did prompt staff to empty the catheter bag but there was no plan for its overall management, for example, correct positioning of the catheter tubing and securing of the bag when the person was up and about, monitoring flow, colour and quantity of urine, personal hygiene, encouragement of fluid intake, the changing of night and day bags, district nurse involvement etc. The daily records on the 1st of June stated that the bag was emptied and there was a very strong smell to the urine and the following day it states the person was incontinent of urine and faeces. There did not appear to be any follow through of this information and whether the catheter was bypassing and what action the staff took. There was also concern that staff members were not following the care plans in practice to fully meet peoples’ health care needs. For example staff confirmed that one person required assistance when using a nebuliser machine but he was found unattended, the machine still going and his mask on the floor. It was unclear whether he had actually received all the medication. Also one persons’ file examined stated they required two hourly positional changes, as they were a very high risk when assessed for their nutritional needs and skin integrity. They were to wear heel protectors, ‘at all times’ and have a pillow, ‘to relieve pressure to heels when sitting’ and to have feet elevated. They were also to have assistance with eating and drinking and, ‘fluids encouraged’. The monitoring chart stated the person was assisted to get up at 7.30am. We entered the lounge at approximately 9.30am and the person was sitting in a chair. They were observed until 13.30pm and had no positional change during that time. They did not have heel protectors on or a pillow for support. The monitoring chart states they were assisted to rest on their bed at 13.30pm, which means the person had missed two positional changes. A beaker with tea was placed near to them but they were not assisted to drink and the full beaker was taken away. They were observed to have lunch and a glass of juice at 12.30pm assisted by staff. The person was not observed to have a cup or beaker of tea at lunchtime but the monitoring form states she did. As a result we examined other monitoring charts at 6pm. They were completed in an inconsistent way giving us an incomplete picture of the health care provided. Because of this we were unsure whether people had received the appropriate amount of pressure relief and fluid intake. The chart of one person on complete bed rest suggested they had not had any positional changes since 5am and no fluid between 10.45am and 5pm. They had a glass of juice nearby but it was unclear if this was the one charted as consumed at 5pm or a new one provided. Similarly another person’s chart had gaps in positional changes during the night and nothing recorded since 5.38am. Their food and fluid chart had nothing recorded since 5.38am. Raleigh Court DS0000000869.V365680.R01.S.doc Version 5.2 Page 14 The home had a complaint documented by a district nurse in November 2007 about insufficient turn charts and the person not receiving the correct level of care. The outcome states that a new recording form was set up. This area must be improved and management must be proactive in ensuring monitoring charts, obviously put in place for a reason, are completed fully with accurate information and care plans are followed to ensure peoples needs are met. The home ensured that people had access to a range of professionals for advice and treatment such as GP’s, district nurses, speech and language therapists, physiotherapists, chiropodists and opticians. There had been two instances recently when staff members had not contacted the emergency care practitioners when people received skin tears but had treated the wounds themselves, however the correct procedure has now been communicated to all staff and they now followed it. Staff completed risk assessments, good personal profiles and fact files that detailed preferences. Daily recording had improved, although some staff members were more detailed than others about recording the care they provided. Peoples’ one to one time with their key workers had not been recorded for over a month in the files examined. People spoken with were happy about the care they received, ‘they look after us well’ and ‘the staff are very good if I need them’. Nine of the surveys received from people stated they received the care and support they needed either, ‘always or usually’, two people stated this was, ‘sometimes’. Comments from relatives were, ‘they treat people in their care with dignity and respect’ and ‘treats them as proper people not patients – they are brilliant and look after my mother very well’. One relative felt that needs were not met all the time, ‘they don’t encourage him to mix; he is untidy sometimes, with clothes inside out – not supervised properly’. This was echoed by a professional visitor who stated there were some personal care issues for some people with very severe dementia and indicated there was perhaps a training issue for staff when people continually declined personal care especially when they were incontinent. The management team could seek advice in this area from specialist workers. The management of medication has improved since the last inspection and staff stated senior managers had been advising on a number of medication issues such as the administration of prescribed creams and assessing competence for this. Medication was stored and recorded well and a personal care manager was observed administering medication appropriately. One person received a specific medication twice daily at 8.30am and 9pm. However some days she liked to sleep late so the first dose was not actually given until after 12.30pm. Staff members were advised to check that this shorter gap between doses was in line with instructions by the persons GP. We accepted the assurances made by the personal care manager that the issue of Raleigh Court DS0000000869.V365680.R01.S.doc Version 5.2 Page 15 one person receiving nebuliser medication unsupervised was a one-off occurrence. The home had an out of date British National Formulary. Raleigh Court DS0000000869.V365680.R01.S.doc Version 5.2 Page 16 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: The home provided a range of in-house activities such as bingo, crafts, games, discussions, quizzes, clothes parties, slide shows, hand and nail care, birthday and other seasonal parties and visiting entertainers. Outings were organised to places of interest such as garden centres, the Humber Bridge viewing area and Hornsea. The activity coordinator advised that sometimes just a bus ride for an ice cream or fish and chips treat was arranged. The home had access to a minibus as often as they required but usually this was three times a month with extra in the warmer weather. The week of the site visit had two outings booked with about five people for each trip. Raleigh Court DS0000000869.V365680.R01.S.doc Version 5.2 Page 17 Church services were organised and community links had been maintained with specialist groups such as the Alzheimer’s Society and Golden Leaf Charity. The home organised the Alzheimer’s Society to visit and talk to relatives and Golden Leaf brought their ‘road show’ with singers and dancers, and have invited people to their planned events in the community. The activity coordinator continues to be very enthusiastic about her role and has completed an, ‘Active in Age’ three-day training course to enable her to provide exercises to people safely. Fact files were produced about people’s preferences, interests and previous hobbies. One relative stated, ‘they do try to stimulate her – well organised activities’ and another said, ‘they provide a good range of activities/entertainment’. Staff also felt the home provided good activities for people and that this had improved over the last year. People spoken with stated their visitors could come at anytime and could be seen in private. This was confirmed in discussions with staff and a relative, and surveys received from them. We observed visitors coming and going freely. Relatives commented in surveys that staff kept them informed, ‘ they ring me about every issue, minor or major’, ‘staff have done everything and more to make her quality of life better’ and ‘they treat people in their care with dignity and respect’. One person did state that they wished they had regular updates about their relative rather than just when incidents occurred. People confirmed staff knocked on doors prior to entering and supporting them with personal care and staff showed a good understanding of how to promote privacy, dignity, and choice. Some comments from staff were, ‘we knock on doors and ask if it’s ok to come in’, ‘we close doors and curtains’, ‘keep people covered’ and ‘we would hold up clothes for people to choose’. People spoken with generally enjoyed the meals provided by the home. Out of eleven surveys received seven people stated they liked the meals, ‘always’, three people said, ‘usually’ and one person said, ‘sometimes’. Comments were, ‘the choice of food is always very good’, ‘I don’t like dark meat so they give me light meat’, ‘if I want something they usually get me it’, ‘the meals always look ok’ and ‘its all good, there’s a choice for puddings’. Menus were on display and they indicated choice and alternatives. Special diets were catered for and the staff was observed checking with people if they had enjoyed their lunch or if they required any more. Staff members were observed supporting people to eat their meals in a patient and sensitive way. The home had gained the Healthy Heartbeat Award and gained an, ‘A’ in Hull City Council’s ‘scores on the doors’ assessment system of food management. Raleigh Court DS0000000869.V365680.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 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 continues to provide an environment where service users and relatives feel able to complain. The home has not followed the multi-agency policies and procedures in all instances, which resulted in delays in reporting and in one instance a delay in investigating. EVIDENCE: The homes complaints policy was on display and via surveys staff indicated they were aware of how to record and action complaints. A complaint form was available that had space to detail the complaint, how it was investigated and what the outcome was. The AQAA document completed by management indicated that five complaints had been received by the home since the last inspection, four of which were upheld as correct. The home dealt with the complaints quickly and appropriately. The Commission had received one complaint and liaised with the home on behalf of the complainant. Management investigated the complaint and it was resolved. The Commission had received three concerns each of which was dealt with by the manager. One related to the home running out of catheter equipment and the district nurse dealt with the issue directly with managers. The other two concerns related to staff treating skin tears themselves and not calling the Raleigh Court DS0000000869.V365680.R01.S.doc Version 5.2 Page 19 emergency care practitioner straight away. Staff have now been made fully aware of the correct procedures. In surveys seven out of eleven people stated they knew how to complain and eight stated they knew who to speak to if they were unhappy about something Some people knew the names of specific staff members they would talk to. Four surveys indicated they were not sure how to complain but one person did state they had, ‘not wanted to make one up to now’. Staff members received training in the protection of vulnerable adults from abuse during their induction but in discussions they were not fully clear on the need for third party investigation stating, ‘the area manager would investigate’, although senior care staff were aware the Commission and local authority would be notified. However the registered manager was aware of the multi-agency policies and procedures regarding alerting and referral to the local authority as the lead agency for investigation. Since the last inspection there had been an improvement in staff completing safeguarding alert forms to the local authority when there were significant incidents between people that lived in the home. This enabled the local authority to be aware of the incidents so they could monitor them more effectively. The deputy manager advised that this focus on safeguarding had improved their understanding and recognition of when they were unable to meet a person’s needs. This self-evaluation was good practice and an important part of quality monitoring. There had been several reports of incidents involving one particular person. Two of the reports we looked at had significant delays in the reporting to the Commission and the local authority. One was reported eleven days after the event and the other seven days. Also one of the reports to the Commission and the local authority had missed out specific information that we saw when examining the persons care file. It is important that the Commission and the local authority receive the alerts in full and in a timely fashion so they can act accordingly. The policy and procedure when it is alleged that a person is abused in any way is to refer to the local authority for advice, guidance and possible investigation. An incident that occurred in September 2007 was not reported but investigated by senior managers and a staff disciplinary was organised. Senior managers informed us five months after the event that the staff member left before the disciplinary hearing. We advised them to alert the local authority so they can still complete an investigation. This investigation is still open. It is important that staff at all levels use the multi-agency policies and procedures regarding the safeguarding of adults from abuse. Raleigh Court DS0000000869.V365680.R01.S.doc Version 5.2 Page 20 Raleigh Court DS0000000869.V365680.R01.S.doc Version 5.2 Page 21 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, 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 continues to provide a well-maintained, clean and comfortable environment for people. People have 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. Raleigh Court DS0000000869.V365680.R01.S.doc Version 5.2 Page 22 There are six bathrooms and one shower room and sufficient toilets throughout. The home also has two open-system sluice rooms on each floor. Communal areas consist of one lounge and two dining rooms downstairs and three lounges and one dining room upstairs. There are also two courtyard areas with seating and easy access, and a coffee area in the foyer with occasional tables and chairs. The home had a hairdressing room and an activity room. Corridors were wide, had handrails and were decorated with old pictures of the surrounding area. The home was nicely decorated and furnished. Some items of furniture continue to look 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. Some of the bedrooms lacked a personal touch, however this had been noticed and the activity coordinator was assisting people to decorate them. All bedrooms had privacy locks and lockable facilities were available if required. People spoken with and surveys received from them were happy with the home in general and the bedrooms, ‘it’s lovely’, ‘the home is alright’, ‘cleanliness has improved’, ‘cleanliness is generally good, you get the odd odour’ and ‘home is nice and clean’. One relative did state that, ‘communal areas are fine but I feel my mums room is sometimes a little dusty and also it needs decorating’. The home had sufficient laundry and cleaning equipment. Raleigh Court DS0000000869.V365680.R01.S.doc Version 5.2 Page 23 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. Although rotas suggest the home is appropriately staffed in terms of numbers each shift, there is a perception of being understaffed at times. This has been expressed by staff and could lead to peoples needs not being met. The company has good induction and training opportunities for staff to ensure they are equipped to complete their role. However gaps in mandatory training and some service specific areas could affect staff skills and knowledge in caring for people. EVIDENCE: Discussions with care staff members indicated that there were four care staff and a personal care manager downstairs to support twenty-eight people and three care staff and a personal care manager upstairs to support eighteen people. In surveys staff stated that despite the use of agency staff they still struggled when absences occurred, ‘we are nearly always understaffed’, ‘they need to ensure that work loads are appropriate for each staff member’, ‘more staff would make a better service’ and ‘to give an excellent standard of care you need to be fully staffed at all times. We received eleven staff surveys and one person stated there was enough staff, ‘always’, five stated this was, ‘usually’ and five said, ‘sometimes’. Raleigh Court DS0000000869.V365680.R01.S.doc Version 5.2 Page 24 The manager and deputy manager were supernumerary. We received eleven surveys from people that lived in the home and five from relatives. Four relatives commented that needs were met always or usually, ‘they are brilliant and look after my mother very well’, whilst one thought this was sometimes, ‘he’s untidy sometimes, with clothes inside out, he’s not supervised properly’. Nine of the surveys from people that lived in the home stated they received the care and support they needed, staff were available, and, staff listened to them, ‘always or usually’. Some comments were, ‘staff are very good if I need them’, ‘it’s lovely’, ‘quite content’ and ‘they’re very good’. The remaining two felt this was, ‘sometimes’. Two people stated that staff did not always listen to them, ‘the staff seem to grumble at me telling me which room to go in’ and ‘some are nice, some are not’. One professional visitor commented on the difficulties of high staff turnover, the effect this had on continuity of care and that the home was short staffed at times. The home supports some people with quite complex needs that require close monitoring and there have been several incidents between particular people. This close monitoring of a few people will impact on general care for others, which may account for the perception of not enough staff. In general it appears staff retention has settled down since the last inspection and one person was to move to another home more suitable for their needs, which will increase staff availability for other people. The block induction for new staff covered a range of mandatory training such as moving and handling, first aid, health and safety and infection control. Since the last inspection new staff also completed skills for care induction booklets over a period of time to help consolidate their knowledge. These were overseen by senior staff and signed off on completion. Since the last inspection management had collated staff training needs and forwarded these to head office. The training plan evidenced that mandatory and service specific training was covered. Each staff member had a personal training plan that recorded the training completed and booked. Although the training plan was underway there were significant gaps in mandatory training such as fire, first aid and basic food hygiene and service specific such as dementia care for some staff. These should be addressed throughout the year. According to information received from the manager on the day of the visit the home had 33 of care staff trained to national vocational qualification (NVQ) level 2 and 3. Further staff members were progressing through the course. This is progress since the last inspection and the home is aiming for 50 of care staff trained to this level. 60 of domestic staff had also completed NVQ training. The company provided a one-day introduction to dementia during the block induction week and a further two-day consolidation course. A professional Raleigh Court DS0000000869.V365680.R01.S.doc Version 5.2 Page 25 visitor did comment that staff experienced some difficulties when providing personal care to people with very complex dementia care needs. This was mentioned to the deputy manager to enable them to liaise with the professional visitor for advice. Those staff spoken with and surveys received from them commented that the company continued to provide good training opportunities. Records showed that staff had annual appraisals to look at training needs and set goals. Generally the home continued to operate 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. The AQAA document states that criminal record bureau checks are obtained ‘before employment commences to safeguard our clients’, however records showed that members of staff are still employed routinely after a check against the protection of vulnerable adults register but before the criminal records bureau check has been returned. The manager stated staff members were not allowed to work unsupervised until their CRB has returned and staff confirmed this in discussions. This process should only be used in exceptional circumstances and not routinely. Staff files required recent photographs of the employee. Raleigh Court DS0000000869.V365680.R01.S.doc Version 5.2 Page 26 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, 32, 33, 35, 36, 37 and 38 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. Generally the home was well managed. The system in place to monitor that specific personal care tasks have been completed needs to be fully implemented to ensure peoples needs are met as their care plan indicates. 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 courses throughout the year reflecting her commitment to improving her knowledge and skills and is an assessor for national vocational qualifications. The registered manager felt the company provided them with a good structure of support, which included an area manager and a health and safety officer. Raleigh Court DS0000000869.V365680.R01.S.doc Version 5.2 Page 27 The registered manager is well supported by a deputy manager who provides cover to the home during any management absences. Regular meetings with the area manager takes place and staff confirmed the area manager visited the home more than once a month to complete checks in line with regulation 26 of the care homes regulations. Since the last inspection there had been improvements in management alerting any incidents between people that live in the home. The timing and accuracy of two recent alerts were examined and improvements were required. It is acknowledged that the company has its own disciplinary policies but any investigation by senior managers into allegations of abuse must only take place after agreement with the local authority, the lead agency for investigation. Staff spoken with felt supported by the registered manager and deputy manager and the majority of surveys commented on their supportive and approachable manner, ‘the manager is nice and approachable’, ‘the deputy followed one of my enquiries and got me the book I required’, ‘the deputy handles my supervision and gives me great support’, ‘you can go to them with any problems, they are understandable and flexible’ and ‘she takes issues seriously and listens’. However some staff did feel that workload allocation, communication, morale and teamwork could be improved further. There was evidence that staff members were supported by the provision of regular supervision. Supervision records were well organised, up to date and covered all the required areas. Staff also had annual appraisals, which identified training needs. The home has a good quality assurance system in place, which consists of audits and questionnaires to seek the views of all stakeholders. The annual quality assurance assessment (AQAA) requested by the Commission was provided within the timescale. Meetings continue to be held for people that live in the home and staff, and suggestions were listened to. 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 registered manager keeps a monthly record of the action taken to address shortfalls and keeps senior managers informed of progress. The audits should incorporate documentation relating to personal care tasks as monitoring charts failed to provide an accurate picture of the care provided. The AQAA stated, ‘the use of monitoring charts need to be highlighted in the daily recording’. This would be an improvement if implemented. Care plan audits took place and one showed that recommendations had been implemented but the recommendations on another had not been actioned by care staff. Those auditing need a system of checking their recommendations have been addressed. Raleigh Court DS0000000869.V365680.R01.S.doc Version 5.2 Page 28 The company produces an annual development plan, which looks at the organisation as a whole as well as each individual home. At the last site visit 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. Administration staff audited finances regularly and the company audited them on an annual basis. Finances were not assessed at this visit The AQAA detailed that moving and handling equipment was serviced and since the last inspection safety checks on bed rails have been completed. Staff complete training in health and safety and infection control. The home has a designated health and safety representative and the company has a health and safety officer available for guidance and advice. A monitoring chart of one person stated that the person had ‘attempted’ to climb over the rail on two occasions. Staff had been available and increased checks had been implemented. The personal care manager explained the person was at a high risk of falling out of bed if the rails are not in place. The registered manager needs to look again at the risk assessment, seek professional guidance to spread the risk management and consider any alternative equipment that may be required. Raleigh Court DS0000000869.V365680.R01.S.doc Version 5.2 Page 29 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X 2 X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X 3 3 2 3 Raleigh Court DS0000000869.V365680.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The registered person must ensure that changes in need are reflected in care plans so they are up to date. This will ensure that staff have full guidance on the tasks they need to complete to meet peoples assessed needs. The registered person must ensure that care plans are followed and peoples’ needs identified in them met by care staff. The registered person must ensure that staff at all levels are aware of and follow the multiagency policy and procedures for safeguarding adults (previous timescale of 31/07/07 not met) The registered person must ensure that there are sufficient staff on duty at all times to meet the needs of people that live there. The registered person must ensure that staff are routinely employed only after a satisfactory criminal record bureau check and not as a DS0000000869.V365680.R01.S.doc Timescale for action 31/07/08 2 OP8 12 and 13 30/06/08 3 OP18 13(6) 30/06/08 4 OP27 18 30/06/08 5 OP29 19 30/06/08 Raleigh Court Version 5.2 Page 31 6 OP30 18 7 OP37 37 matter of course after a povafirst check and prior to the return of the CRB. This will assist in the safeguarding of vulnerable adults that live in the home. The registered person must 31/12/08 ensure that all staff members complete mandatory training in line with the homes training plan This will ensure staff are skilled and competent for their roles. The registered person must 30/06/08 ensure that notifications of incidents affecting the wellbeing of people living in the home are sent to the Commission in a timely manner. 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 OP8 OP9 Good Practice Recommendations Accurate information on the amounts of food and fluid consumed should be recorded when using monitoring charts for this purpose. Monitoring charts should be completed consistently to give an accurate picture of the care provided. It is recommended the home obtain a recent copy of the British National Formulary to replace the 2004 edition. This will enable staff to have up to date information on medication. The manager should ensure some bedrooms are more personalised to provide stimulation for people with dementia care needs. The home should continue to work towards 50 of care staff trained to NVQ Levels 2 and 3. In light of staff comments in surveys and discussions about the need for improvements in staff communication, workload allocation and some staff divisions leading to morale being affected, management should reflect on how these issues can be improved. DS0000000869.V365680.R01.S.doc Version 5.2 Page 32 4 5 6 OP24 OP28 OP32 Raleigh Court 7 8 OP33 OP38 The manager should review the way specific personal care tasks are monitored and audited to ensure they are carried out in line with care plans. The manager should seek professional advice around risk management for one person who uses bedrails. Raleigh Court DS0000000869.V365680.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Raleigh Court DS0000000869.V365680.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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