Inspection on 29/08/07 for Read House

This inspection was carried out on 29th August 2007.

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

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

Other inspections for this house

Read House 26/09/06

Read House 09/02/06

Read House 03/08/05

Read House 04/03/05

Read House 15/12/04

Read House 12/03/04

Similar services:

Claremont House

Oak Ridge

Coopers Mill Ltd

Sun Court Nursing Home

Ashville House

Pocklington House

Bramley Avenue (73)

Bilney Hall

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

CARE HOMES FOR OLDER PEOPLE Read House 23 The Esplanade Frinton On Sea Essex CO13 9AU Lead Inspector Key Unannounced Inspection 29th August 2007 11:05 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 Read House DS0000017916.V349644.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. Read House DS0000017916.V349644.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Read House Address 23 The Esplanade Frinton On Sea Essex CO13 9AU 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) 01255 673654 01255 673177 info@essexblind.co.uk www.essexblind.co.uk Essex Blind Charity Mrs Rosemary Danby Care Home 40 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (40), of places Physical disability over 65 years of age (40), Sensory Impairment over 65 years of age (40) Read House DS0000017916.V349644.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Persons of either sex, aged 65 years and over, who require care by reason of Old Age (not to exceed 40 persons) Persons of either sex, aged 65 years and over, who require care by reason of a physical disability (not to exceed 40 persons) Persons of either sex, aged 65 years and over, who require care by reason of a sensory impairment (not to exceed 40 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia, whose names were provided to the Commission in May 2005 The total number of service users accommodated in the home must not exceed 40 persons 26th September 2006 Date of last inspection Brief Description of the Service: Read House is a purpose built establishment for older people with sight impediments and is owned by Essex Blind Charity. It is situated on the promenade of Frinton-on-Sea, within easy reach of the town. The home offers accommodation on three levels, with all rooms being serviced by a passenger lift. The dining room is on the ground floor but there are two small lounges on each level. There is space for parking at the front of the home and a large sensory garden to the rear. All bedrooms are for single occupancy, with en-suites, and two are designated for respite care. Attached to Read House is a day centre. Service users are encouraged to participate in the weekly programme of activities and attend special events, such as concerts. The weekly charge for a room is between £367.15 and £475.00. Additional charges are made for chiropody, hairdressing, newspapers, toiletries and other personal items. Read House DS0000017916.V349644.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection, covering the key National Minimum Standards, took into consideration all recent records and contacts relating to the service, including surveys completed by residents, their representatives and staff. It also included a site visit to the home on 29/08/07, lasting 9 hours. This visit involved speaking with people living at the home, relatives, the responsible individual and staff, as well as a partial tour of premises, observation of care practice and the sampling of records. Of the 22 Standards inspected, 18 were met. The remaining 5 Standards were nearly met. What the service does well: People living at Read House could expect • • • • • clean, comfortable and safe surroundings, suitable for their needs; a choice of menu, and meals and activities they enjoyed; support to meet their personal and health care needs; suitably trained staff, available to listen and support them; a well-managed home. People spoke positively about their experiences of living at the home. One person said, ‘They are very kind here, I really am content and couldn’t be in a nicer place’. ‘Their relative commented, ‘they excel at catering for and understanding the particular needs of the individual’. Another person described the home as having ‘a good balance of care without intrusion’. Other positive views are quoted in the main body of this report. What has improved since the last inspection? Read House DS0000017916.V349644.R01.S.doc Version 5.2 Page 6 • Wherever possible, the responsible individual was writing to people before they moved in to let them know whether the home could meet their assessed needs. Arrangements had been made for people to receive their eye/ear drops in the privacy of their own rooms in stead of the dining area. Staff had undertaken more training for their work of supporting people, such as courses on dementia and infection control. • • What they could do better: • An individual profile completed with the initial assessment helps to ensure that, as far as possible, the care people receive, is consistent with their background and aspirations. For the best outcomes, assessments and care plans need to be easily legible. To reduce the risk of error, people administering medication must follow correct procedures. When people express dissatisfaction with an aspect of the service, this should be recorded in the complaint log as well as in their personal file, for quality monitoring purposes. • • • 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. Read House DS0000017916.V349644.R01.S.doc Version 5.2 Page 7 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 Read House DS0000017916.V349644.R01.S.doc Version 5.2 Page 8 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 6. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People moving into Read House could expect to do so on the basis of an assessment of their needs although this pre-admission assessment might not be fully comprehensive in every case. EVIDENCE: All 3 people living at Read House, who answered the Commission’s survey question about the admission process, said they had received enough information to decide if the home would be the right place for them. All four of the relatives who completed questionnaires said that the home had provided what they had expected or agreed. Two newcomers to the home, who spoke with the inspector, did not think they had received written information about the home, in the form of a service user guide. Another person felt that the information given to them about specialist provision for people with visual Read House DS0000017916.V349644.R01.S.doc Version 5.2 Page 9 impairments, and what was provided for people generally, had not fully matched their experience. During the inspection someone thinking of coming to live at Read House was taken to talk with one of the residents about their experience. This was good admission practice. Pre-admission documentation was sampled for three people who had come to the home since the last inspection. In each case, the medical pre-admission form, completed by respective GPs provided basic details and medical information. This was accompanied in one case by a comprehensive, preadmission needs assessment, supplemented by further information gathered on the person’s arrival at the home. There was a commissioning of care document, too, showing that Social Services had also completed an assessment of need. Despite this, the person concerned said that their relative had arranged the admission and they would like to have been more involved in the process themselves. The second assessment sampled had been completed on the person’s arrival at the home. (According to discussion and information supplied by the home, some initial assessments were conducted by phone, if the prospective resident lived too far away to be visited, and then followed up when the person arrived.) The person in question said they felt their assessment had not fully covered their recreational and social needs and aspirations and this was confirmed from the records. The assessment did not include a profile, giving a full picture of the person, their background, interests and what was important to them. Three out of four files sampled were for people who had come to the home this year and did not include individual photographs for identity purposes. The home confirmed that, wherever possible, they now write to people before they move in, confirming that the home would be able to meet their needs. Read House was not providing an intermediate care service at the time of inspection, therefore national minimum standard 6 does not apply. Read House DS0000017916.V349644.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People could expect their personal and healthcare needs to be met according to an individual plan, although they might experience some oversights with respect to detail. Some aspects of medication administration could lead to error but arrangements for supporting people generally promoted their privacy and dignity. EVIDENCE: People living at the home said in their surveys that they ‘always’ or ‘usually’ received the care and support they needed; all 4 relatives and representatives indicated that the home ‘always’ gave the support that was expected or had been agreed. Read House DS0000017916.V349644.R01.S.doc Version 5.2 Page 11 Care and risk management plans were in place on the four files sampled, although they varied in the amount of detail. One resident, who spoke with the inspector, said they sometimes had to remind staff to carry out one aspect of the care that had been agreed. The task was clearly stated in their care plan. They expressed disappointment with the way the home was addressing their visual impairment and socialisation needs. These were less adequately covered by the care plan. Another person said that staff were not consistent in the way they gave support with mobilisation; in this case, too, the care plan could have been more detailed about the help required. (Information provided subsequently by the home indicated that guidance to staff for assisting individuals with their mobility was kept in their room, separate from the care plan.) Some of the writing in these care plans was almost illegible, which would make them difficult for staff to follow. A person, new to the home, expressed full satisfaction with the way they were being supported. Their care plan, incomplete at the time of inspection, will need to be developed to ensure this level of satisfaction continues. Daily reports showed that a range of daily living activities was being monitored, including mobility, well-being and leisure. It was evident from staff surveys and discussions that the home had in place a number of mechanisms for keeping staff up to date with the changing needs of people living at the home. This was not always reflected in people’s care plans. One of the four care plans sampled had not been updated since August 06 and there was also a gap in monthly evaluations between January and June this year. Information sent to the Commission by the managers since the last inspection (both in the form of the annual quality assurance return and statutory notifications) showed that the home continued to take appropriate steps to promote the health of residents. Observation and discussion during the site visit, corroborated this. Care plans and records of contact with medical professionals showed that people’s health care needs were understood and met. One situation known to the Commission showed that the home worked conscientiously to promote the health of the individual concerned and, in the course of respecting their wishes about medication and treatment, appropriately liaised with various health care professionals. People who answered surveys said they always received the medical support they needed. One person said their relative ‘has various medical problems and it is clear that the care s/he is receiving is good as her/his condition is as good if not better than when s/he was at home’. Records, and discussion with a person living at the home, showed that people were supported to self-administer medication, where they were able to do so. Individual photographs were held with medication administration records to avoid mistakes in identifying residents. Read House DS0000017916.V349644.R01.S.doc Version 5.2 Page 12 Records and information given by staff indicated that the home continued to arrange medication training (distance learning and refresher courses) for staff, involved in medication administration. One member of staff held responsibility for ordering and returns and generally overseeing all aspects of medication. Procedures for ordering and returning medication, and for storing, administering and recording controlled medication, promoted safe practice. Since the last inspection arrangements had been made for people to receive their eye/ear drops after the meal, in their own rooms, instead of in the dining room. This enhanced their privacy and dignity. One person suggested that medication trolleys might be taken to each floor so that people could also have their oral medication in the privacy of their rooms. However, the managers felt that this would increase the possibility for errors and omissions. The inspector observed the administration of lunchtime medication. Dining room assistants had cleared away some people’s cups and the person administering medication had to break off what she was doing to get clean ones so that people had a drink with their medication. They also had to call people back who were being escorted from the dining room before they had had their medication. These situations were not conducive to the person’s concentration or accuracy in administration and recording. The person administering the medication did not adhere fully to good practice guidelines, to reduce the risk of errors in administration and recording. The home had 2 trolleys in use but, at lunchtime, only one was brought from the medication room to the dining room because it contained most of the medication required. Items from the second trolley had been decanted into little pots. This is not acceptable practice as it considerably increases the risk of an error occurring in the administration of medication. The person administering the medication did not follow best practice procedures by a) checking the name of each item extracted from the monitored dosage cards against the named medication on the Medication Administration Record; b) staying to observe whether medication was taken before signing the record; c) making an entry in a person’s record that a tablet had been dropped (spoiled) at the time of this happening (to ensure that the record did not get overlooked). Relatives responding to the Commission’s survey were positive about the manner in which people were cared for. One person described the home as providing ‘a good balance of care without intrusion’. This was confirmed by observation. Staff were observed to treat people with respect and to promote their privacy on entering bedrooms. Two situations made known to the inspector showed that the home recognised and supported people’s need for intimate relationships. There were also a number of small communal lounges, where people could take their visitors. Lists on display in the dining room contained details of what each person would eat and drink. Fire checklists on display on the first floor, whilst Read House DS0000017916.V349644.R01.S.doc Version 5.2 Page 13 commendable from the point of view of fire safety were in a public area, giving information about individual mobility. These notices did not fully promote people’s privacy and dignity. Read House DS0000017916.V349644.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 this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The quality of people’s daily lives was enhanced by attention to their diverse needs and wishes, the provision of activities and enjoyable meals. EVIDENCE: Activities scheduled for the week of the inspection included a card game, newspaper reading, quiz, hairdresser, manicure and hand massage, exercises, discussion, church service and mini bus outing. This programme varied from week to week. One person commented enthusiastically about the programme displayed on the notice board. 3 out of the 4 people living at the home, who responded to the Commission’s survey, were fully satisfied with arrangements for activities and the other person thought the home usually arranged activities they could take part in. A relative wrote, ‘The ‘entertainment’ daily is wellreceived, staff ensure (person living at the home) has access to large print books and talking books. S/he can explore the garden and from time to time goes out under supervision’. Another commented that arranging ‘activities’ and outings to shops etc was one of the things the home did well. A member of staff said they felt that the employment of an activity coordinator and the Read House DS0000017916.V349644.R01.S.doc Version 5.2 Page 15 contribution of two volunteers to the activities programme, had improved the quality of life for people living at Read House. One person living at the home said they did not feel that their expectations had been met in respect of activities for people with sensory impairment. They also felt that the home had not found out about their background and aspirations so that they could be introduced to like-minded people and that opportunities for socialisation had been lacking because people tended not to use the small lounges. The person’s care plan did not provide any information about their background or aspirations but there was some correlation between a subsequent review decision and the individual record of activities. The general manager said that they would consider serving afternoon tea in the various lounges to encourage people to socialise. A number of activities on the programme were suitable for people with visual impairments and audio-facilities were available for individual use in people’s rooms. Activities were also publicised in different ways to take account of varying needs, including individual contact with the activity coordinator, who went round the home letting people know the main activities for the day. Discussions during the site visit and comments received in surveys showed that the home supported and respected friendships that developed between people living at the home. It was evident that, as part of this support, the home also endeavoured to safeguard the interests of the individuals concerned. One relative said that welcoming visitors was one of the things the home did well. All 4 representatives responding to the survey felt they were kept up to date with important issues affecting their friend/relative and those who thought it was applicable to their situation, said the home helped their friend/relative to stay in touch with them. Information provided by the home in respect of their visiting policy was confirmed during the site visit through discussion and observation: Flexible arrangements were observed, with people being able to visit in the evening. One couple said the home had arranged a volunteer visitor because the family was not local enough to visit frequently. Two out of 4 representatives, who took part in the Commission’s survey of views, indicated that the home always supported people to live the life they chose, 2 said they usually did. All 4 thought the home responded to the different needs of individual people. One person wrote about the home’s regard for people’s individuality and preferences, describing how their relative’s friendship with another person living at the home had been supported in an appropriate manner. It was evident from observation and discussion that people living at the home could choose to spend time in their rooms or any of the communal areas and could exercise some control about when they got up and went to bed and where they ate their meals. The inspector received differing accounts of what choice people had about where they sat in the dining Read House DS0000017916.V349644.R01.S.doc Version 5.2 Page 16 room. Management stated in the information provided to the Commission that seating arrangements in the dining room were reviewed regularly so that residents were happy where they sat but this had not been the experience of one person living at the home, who told the inspector that they had been placed at a particular dining table without consultation. Comments about meals showed that people enjoyed the food that was prepared for them. 3 out of 4 residents indicated by survey that they always liked the meals at the home; 1 said they usually did. One person wrote that the food was good and the meals ‘regular and well-provided’. A relative answering the survey question about what the home did well wrote that it ‘attended to people’s (food) fancies’. A person living at the home told the inspector the food was ‘superb’. Someone said they had found tea a ‘bit light’ and not always enough to sustain them until breakfast at 7.30 am but were satisfied to find they could order a snack for the evening. This was confirmed during the site visit, when a number of orders were prepared for people to take to their rooms. Information provided by the managers indicated that staff were trained to help people to identify the food on their plates, if this were needed. Observation of mealtime showed that a number of staff were on hand to support people and that this was done sensitively. Notices for staff, displayed in the dining room were not homely, particularly for those people sitting against walls bearing the notices. The breakfast lists on display showed that a variety of food and drink were available and that people had been consulted about their preferences. A member of the care staff said that the information was intended only as a guide for staff and that residents could vary their breakfast from day to day, if they wished. Another notice, in very large, bold print, pointed out the limits of choice available to people on the teatime menu. Staff agreed that the tone of this notice could be construed as meaning that other requests would not be tolerated and the notice was taken down. Read House DS0000017916.V349644.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 this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s views, complaints and protection are taken seriously by the home and appropriate action is taken to promote good practice in these areas. The home has become more proficient in handling complaints and allegations. EVIDENCE: Information provided by the managers indicated that all people living at the home, and their representatives, were given a copy of the complaints procedure. A couple of people who spoke with the inspector did not think they had received written information about making a complaint but people living at the home and relatives, who completed the Commission’s survey, said they knew how to make a complaint. One person wrote that the manager had carefully explained the complaints process to them when their relative moved into the home. Residents also said that they knew who to speak with, if they were not happy and that staff listened and acted on what they said. Information provided by the home showed that 4 complaints had been received in the 12 months prior to July 2007, 2 of which had been upheld. In November 2006, since the last inspection, the Commission was informed by an advocacy service that a former resident of Read House was unhappy with the care they had received and the way their complaint had been handled by the Read House DS0000017916.V349644.R01.S.doc Version 5.2 Page 18 home. Further enquiry showed that the home had taken the person’s concerns seriously and tried to address them. The various incidents had been recorded in detail in the person’s care plan on pages headed ‘confrontational situations’ but none of the underlying issues had been logged as complaints. The responsible individual was advised at the time that, if someone expressed dissatisfaction with an aspect of the service or their treatment, this needed to be recorded in the complaints log. It may be helpful to incorporate this point in the home’s complaints policy, which, last reviewed in May 2004, was due for reappraisal. Comments and surveys showed that people in the home felt well treated. People used words to describe staff such as ‘patient’ and ‘kind’. One person quoted their relative’s own words: ‘They are very kind here, I really am content and couldn’t be in a nicer place’. All but one member of staff completing the Commission’s survey said they had received safeguarding adults training. This confirmed information supplied by the home, which stated that the majority of staff had received formal POVA (Protection of Vulnerable Adults) training, in addition to what they had covered during their induction. The responsible individual and registered manager had also attended training in respect of a manager’s responsibilities vis a vis safeguarding adults. In the light of this training and the fact that local safeguarding adults guidance and protocols have been revised, the home should update its own policy on safeguarding adults and the prevention of abuse, as it was last reviewed in December 2005. The home sought the Commission’s advice in respect of a situation involving a person living at the home that they were finding difficult to resolve. The person claimed that a particular member of staff was entering their room at night and disturbing them by shining a torch. Initial investigations by the manager and responsible individual indicated to them that this could not be happening. The home was advised to consult with the person’s social worker and the Safeguarding Adults Team. A subsequent strategy meeting, coordinated by Social Services, did not clarify the situation or substantiate the claims the person was making. The manager and responsible individual cooperated fully in this process and accepted that the situation had warranted earlier consultation with the Safeguarding Adults Team, according to locally agreed safeguarding adults procedures. As indicated under the section headed Health and Personal Care, any arrangement for the care of individuals that acts as a restraint by limiting their movement, needs to be clearly documented, explaining why the decision was taken and evidence of appropriate consultation. One person was observed in a chair that limited movement. The responsible individual explained that they were happy using this and would not be able to get out of any chair independently. However, the use of such chair should be explained in their care plan. Read House DS0000017916.V349644.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 and 26. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People, living at Read House, benefited from clean and well-maintained surroundings, suitable and safe for their needs. Small adjustments would increase the homeliness of people’s surroundings. EVIDENCE: People case-tracked for the purpose of this inspection were very positive about their surroundings, the facilities of the home and their individual accommodation. The home employed a maintenance person for 30 hours per week and a gardener for 15 hours. A log was kept of repairs and small jobs needing the attention of the maintenance staff, including requests from people living at the home. Read House DS0000017916.V349644.R01.S.doc Version 5.2 Page 20 Generally the home and garden appeared to be well maintained. It was noted that one of the bathrooms on first floor needed refurbishment (replacement of bath panel and some wall tiles). There was a notice about the danger of loose tiles in this and other bathrooms. Other notices to staff and certificates displayed about the home did not seem homely. These should be kept in staff areas and not on public view. One notice and an insurance certificate were out of date and showed that the home needed to review the information on display. The home had provided contrasting mats and tablecloths to help people with impaired vision. The arrangement of the dining area meant that some people sat at individual tables, against a wall. One individual table was positioned against another table storing crockery and a wall bearing notices for staff. This would not be very homely or congenial for anyone sitting there. The home was suitably equipped for the general needs of people with limited mobility and also to suit the needs of individual residents. For example, one person had rails to assist them to get out of bed independently. This supports a comment from a member of staff, who wrote in their survey, ‘If a client complains the bed is hard, we buy a new mattress. If they want a higher toilet seat, we buy them one. Whatever our clients’ needs are, we cater for them.’ Information provided by the home showed that it had received satisfactory reports of fire safety and environmental health inspections. Respondents to the survey were unanimous in their view that the home was always clean and fresh and this was found to be the case on the day of the site visit. Laundry facilities had been upgraded and were fit for purpose. The provision of paper towels, liquid soap and antibacterial alcohol in communal areas helped to avoid the risk of cross infection. According to information provided by management, domestic staff were undertaking NVQ Level 2 in infection control and the home was extending formal training in infection control to everyone. The home demonstrated by its response to a particular situation that it sought advice, and took action appropriately, in respect of infection control issues. Read House DS0000017916.V349644.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 this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People at the home were generally well served by the home’s staffing levels, recruitment and training practices. EVIDENCE: Discussions with people living at the home and responses in surveys showed that, on the whole, they felt that staff were available when they needed them. 3 out of 4 respondents to the survey said that this was always the case; 1 said ‘usually’. Staff said that levels on each shift gave them enough time to meet the assessed needs of people living at the home. Rosters showed that 6 care staff covered the daytime shifts and, 4, the night shift. In addition, the home employed a number of ancillary and maintenance staff, including chefs and kitchen and domestic assistants. Rosters showed that domestic and kitchen staff were reduced to a minimum at weekends. One person living at the home commented that it ran with a ‘skeleton staff’ at weekends and bank holidays, although care staff still responded promptly if they were called. Staff said they had more visitors and phone calls to attend to at weekends. A member of staff said that weekend arrangements worked well if they were fully staffed and it had become easier for care staff now that they had at least one domestic on duty at weekends, who could attend to basic hygiene cleaning. Rosters showed care staff occasionally worked a double shift. Read House DS0000017916.V349644.R01.S.doc Version 5.2 Page 22 The responsible individual said this happened to provide continuity of care, which they could not achieve by calling on agency staff, but that staff working double shifts always had an hour’s break in between. Recruitment records were sampled for 3 relatively new members of staff. The files containing them were well organised with a helpful checklist at the front. Records showed that, in all three cases, full pre-employment checks had been carried out. Records and discussions with staff showed that the home was using the Skills for Care Common Induction Standards for new staff to good effect. Staff had undertaken a variety of short courses and distance learning to promote good and safe practice and to increase their awareness of working with visually impaired people. Information provided by the managers indicated that staff were working for National Vocational Qualifications in care at all levels, with more than 60 having achieved Level 2 and others working towards Levels 3 and 4. Staff commented favourably on the training they received; they indicated that it was relevant to their role, helped them understand and meet individual needs of residents and kept them up to date with new ways of working. People living at the home were positive about the ability of the staff to meet their needs. Their representatives also indicated that staff had the right skills and experience to look after people properly. These comments were supported by observation during the inspection, except in respect of medication administration, where some practice issues were identified. Read House DS0000017916.V349644.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The management structure, ethos and style fostered positive working relationships and good outcomes for people living at the home. EVIDENCE: The combined management team held a range of qualifications (Registered Managers Award, Diploma in Management, and NVQ and Manual Handling Assessor) and years of relevant experience. Discussions with staff, and their surveys, indicated that they had good working relationships with management and that the division of roles within the management team worked effectively. People living at the home indicated that the management team were not remote but approachable and active in supporting them. Read House DS0000017916.V349644.R01.S.doc Version 5.2 Page 24 The home’s Annual Quality Assurance Assessment, (AQAA - a self-assessment of performance against the Care Homes Regulations and National Minimum Standards, that all registered care services must provide for CSCI) was completed in detail and showed that the management team had given a lot of thought to all aspects of their service. Evidence gathered during the course of this inspection generally supported the information in the AQAA and showed that the management team had dealt with it in an open and professional manner. The AQAA showed that some of the home’s policies had not been reviewed for several years, for example the concerns and complaints policy was last reviewed in May 2004 and food safety in December 2003. It is good practice to review policies and procedures as part of annual quality monitoring to ensure that they contain up to date good practice guidelines and reflect what is happening in the home. Staff affirmed that they had regular one to one meetings to discuss their work. One person said, ‘My care manager has always been supportive. I can discuss anything with her, not only at supervision and appraisals, but any time. Another person affirmed the availability of the manager to deal with any questions or problems that might occur, and said they were asked on a regular basis how they were managing their role within the home and what training they needed to support them at work. One set of file records showed that the member of staff had received one to one supervision twice in the last year, which does not meet the standard of 6 times annually. The carer concerned said they often consulted and had informal meetings with the person who supervised them and felt they were well supported in this way. The general manager / responsible individual continued to keep records of all transactions relating to residents’ personal money held for safe-keeping by the home. These have previously been shown to be meticulous and there has been no occasion to doubt the ongoing integrity of the arrangements. Records showed that staff had received training in the key areas of health and safety, that installations and appliances were routinely inspected and serviced and that water safety checks and a fire risk management analysis had been carried out in June and April 07, respectively. The maintenance person regularly tested emergency lighting and water temperatures. Individual risk assessments had been completed in respect of each person’s bedroom. The name of the appointed person for first aid was displayed showing that there was one identified for each shift. No hazards were identified during the tour of premises. The fire log inspected only went up to May 07 and the current one could not be located; the person with overall responsibility for health and safety, and for maintaining the fire log, was not on duty. Read House DS0000017916.V349644.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Read House DS0000017916.V349644.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement Arrangements for the administration of medicines in the care home must comply with safety requirements and relevant legislation so that, as far as possible, mistakes in administration are avoided. This requirement has not met the agreed timescale of 31/10/06. Timescale for action 31/10/07 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. Refer to Standard OP3 Good Practice Recommendations Health and social care assessments should include information about the individual’s interests and aspirations, so that these can be taken into account in the plan of care. They should also be easily legible. Seating arrangements in the dining room should be reviewed to ensure they are pleasant and promote dignity and choice for everyone living at the home. DS0000017916.V349644.R01.S.doc Version 5.2 Page 27 2. OP9 OP10 OP15 Read House 3. OP14 The home should be able to show that they have consulted with appropriate healthcare professionals about use of chairs that involve some kind of restraint for the person concerned. Key policies and procedures should be regularly reviewed to ensure they continue to promote best practice and are in line with new guidance and legislation. When people express dissatisfaction with an aspect of the service, this should be recorded in the complaint log as well as in their personal file, for quality monitoring purposes. Staff notices should not be on general view because they do not make for a homely environment. Risk assessments should be completed in respect of any oxygen used by residents and open balconies. In the absence of the person responsible for health and safety issues, this was not inspected. 4. OP16 OP18 5. 6. OP20 OP7 OP38 Read House DS0000017916.V349644.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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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