Inspection on 31/08/05 for Regent

This inspection was carried out on 31st August 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Regent 14/11/06

Regent 15/12/05

Regent 30/11/04

Regent 19/05/04

Regent 24/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Regent School Road St Johns Worcester WR2 4HF Lead Inspector Yvonne South Unannounced 31 August 2005 1.50pm 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 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. Regent E52 S30248 Regent V244729 310805.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Regent Address School Road St Johns Worcester WR2 4HF 01905 337100 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) regent@heartofengland.co.uk Heart of England Housing and Care Ltd Sandra Ann Dixon Care Home 60 Category(ies) of DE(E) Dementia (over 65) - 60 registration, with number OP Old Age - 60 of places PD(E) Physical Disability (over 65) - 60 Regent E52 S30248 Regent V244729 310805.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: There are no other conditions of registration in addition to those recorded on the previous page. Date of last inspection 30 November 2004 Brief Description of the Service: Regent is a purpose built home situated in a residential area of St Johns on the outskirts of the city of Worcester. It is well placed for access to local amenities and transport. The two storey building has sixty single bedrooms, all with en-suite facilities. In addition there are communal lounges, dining rooms, toilets and bathrooms on each floor. Shaft lifts facilitate mobility between floors and there is ground floor access to a pleasant enclosed garden. The home is owned by Heart of England Housing and Care Ltd and managed by Mrs Sandra Ann Dixon. A service is offered to a maximum of sixty people of either sex over the age of sixtyfive years who have needs associated with old age including physical disabilities and dementia illnesses. Two places are availble for people requiring respite care and the other fifty eight are available for people needing permanent residential care. Regent E52 S30248 Regent V244729 310805.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook this routine unannounced inspection over four hours during the afternoon. The inspection focused on the standards relating to care, staffing and management and checking compliance with the requirements and recommendations that were made following the last inspection. Discussions took place with four residents, two visitors and the registered manager and care service manager. Observation of work practice took place and records, documents, policies and procedures were assessed. What the service does well: The home provides detailed information about the services they offer and assessments are carried out to ensure that the home is able to provide the correct care for the people who move in. Staff are very knowledgeable about individual residents’ care needs and they monitor health and seek advice from the primary healthcare team whenever necessary. All residents have care plans that describe the care they need and they are able to contribute to the plans and express their wishes concerning the care and support they receive. Residents’ privacy and dignity is maintained and relationships between staff and residents were warm and affectionate. Comments about staff included “marvellous” and “very kind”. Residents are able to follow their own routines in the home and do what they choose during the day. The provision of food gives residents’ choices and comments about the food included “too good”, “on the whole pretty good” “not spectacular” “today’s meal could be better”. The home is purpose built and provides well for residents with physical disabilities. Regent E52 S30248 Regent V244729 310805.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Regent E52 S30248 Regent V244729 310805.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Regent E52 S30248 Regent V244729 310805.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, 4, The home provides information about its services and an opportunity to visit, which helps prospective residents and their families to make an informed choice about whether the home can meet their needs. EVIDENCE: The statement of purpose and service user guide was available for prospective residents and is due to be updated. A copy was available in different formats for residents with sensory impairment. Assessments on individual residents’ needs were carried out prior to them being admitted to the home although one was seen not to be dated. The handover observed indicated that staff have a thorough knowledge of individual residents needs. Regent E52 S30248 Regent V244729 310805.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 10. The recording systems in place for meeting residents’ needs are comprehensive, but they are not consistently filled in by staff, which could put residents’ health and welfare at risk. Personal support is offered in a way, which promotes the privacy and dignity of the residents. EVIDENCE: Care plans were in place for all residents and were initially completed with good detail and attention to promoting independence and dignity. However there were some shortfalls in changing the care plans as residents’ needs changed. For example, the monthly review notes indicated that a residents’ continence needs had changed and they were requiring more support from staff, but the care plan still indicated that the resident managed this. Another care plan did not reflect the levels of challenging behaviour being presented by one resident, and how this was to be managed by staff. Regent E52 S30248 Regent V244729 310805.doc Version 1.40 Page 10 The home operates short-term care plans for residents who are unwell and which reflect the sudden change of needs during this period. This is very good practice. However, it was noted that one resident who remained unwell and whose health had deteriorated, did not have the initial short-term care plan updated to show the increased frailty. The supplementary records kept by staff clearly indicated that the residents’ needs were being met to a high standard. Some moving and handling risk assessments were not being regularly reviewed to show changing needs. Specialist health care was sought for residents as needed and regular visits by the primary healthcare team were recorded. One resident had not been weighed as regularly as the care plan indicated necessary. Information leaflets about health issues affecting older people were freely available. Observations made and comments received from residents indicated that staff were respectful and promoted the residents’ dignity. Comments received included “staff are marvellous”, “very kind” and “very good.” Regent E52 S30248 Regent V244729 310805.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15. The relaxed atmosphere and flexible routines allow residents to live their lives as they choose. Information regarding activities is not well provided. There is a limited range available that does not suit some of the residents. These people would benefit from the stimulation provided by a larger choice of individual and group activities. Dietary needs of residents are well catered for and the varied selection of food available meets their taste and allows for them to have choices. EVIDENCE: There was a programme of activities on display in the separate units in small type. It was recommended that a large font be used. Residents commented; “they fall down on activities”, “nothing to do” and one resident said that she did not want to participate in anything organised. Staff said that they carried out activities in the afternoons and this included cards and videos. Regent E52 S30248 Regent V244729 310805.doc Version 1.40 Page 12 The registered manager stated that she felt this was an area, which could be developed further, and this would be achieved when an activities co-ordinator was appointed. The home was currently advertising the post. Residents confirmed that there were no restrictive routines operating in the home. Visitors confirmed that they were able to visit when they chose and were able to see their relatives in private. They also said that they were kept up to date with any information. One visitor said that that the home took care of the visitors as well as the residents. There was a choice of three main meals at lunchtime and residents were regularly consulted about the menus. Comments received about the food served included, “too good”, “on the whole pretty good”, “not spectacular”, “today’s meal could be better”. Food was available on each unit for snacks between meals. Cold drinks were continually available. Regent E52 S30248 Regent V244729 310805.doc Version 1.40 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17,18, Information and support is made available to assist people in raising any concerns they may have. Residents are able to exercise their legal rights. Residents are protected from abuse by the policies, procedures, training and action of those employed in the home. EVIDENCE: A corporate complaint procedure was available. Copies were displayed in the reception area and on each floor. In addition the manager said that a copy was given to each resident in his or her admission pack. During residents’ meetings and reviews additional copies were made available and people were advised how to express their concerns. Residents confirmed that they felt they could confidently make their concerns known. The staff had access to policies and procedures advising them how to respond to any complaints they received. An analysis of compliments and complaints was sent to the home’s ‘central office’ every quarter. The record indicated that no complaints had been received since the last inspection and 36 compliments had been received of which 32 had concerned care practice. Regent E52 S30248 Regent V244729 310805.doc Version 1.40 Page 14 The manager confirmed that all residents had been registered on the electoral roll and those who wished had been assisted to the polling station to vote or use postal votes. Policies and procedures regarding whistle blowing and the protection of vulnerable adults were readily available in the reception area and the records indicated that staff had read them and understood them. The home responded well when concerns arose and promptly took appropriate action. Staff had been supported through staff meetings and supervision sessions. A recent incident had been well managed to the credit of staff and management. Most of the residents had personal monies held in safekeeping or they had their personal monies managed for them by the home. There was acceptable security and well kept documentation. Residents were informed that they could have access to their monies during office hours Monday to Friday and at other time by arrangement with the managers. Regent E52 S30248 Regent V244729 310805.doc Version 1.40 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 25, 26. The home provides a safe and attractive environment for the residents. EVIDENCE: The home was been purpose built to meet the national minimum standards required for individual and shared space. It was generally well laid out and well maintained. There were attractive and accessible gardens for the residents to sit in. The home was clean and residents confirmed that their bedrooms were regularly cleaned and beds changed. A cleaning rota in one of the unit kitchens had not been signed to indicate that cleaning had taken place although the kitchen was acceptable. The carpet in St Clements dining area was worn and detracted from the pleasant surroundings. Regent E52 S30248 Regent V244729 310805.doc Version 1.40 Page 16 Toilets and bathrooms were adapted to meet the needs of residents with physical disabilities. It was noted on the day of the visit that the ground floor of the home had a faint malodour. Staff were observed carrying out good hygiene practices and residents confirmed that staff wore gloves and aprons when providing personal care. Regent E52 S30248 Regent V244729 310805.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 The home is appropriately staffed to meet the current needs of the residents. The recruitment process and training programmes ensure suitable staff are employed to protect and care for those who live in the home. EVIDENCE: A staffing roster was maintained that indicated that sufficient staff were available to meet the current needs of the residents. There was an acceptable mix of seniors, staff and skills. In total there were 46 care staff employed of whom 12 had qualified to NVQ level 2 or 3. A further 10 were currently undertaking courses. This will achieve fractionally under the 50 required by the standard by the end of the year. However the manager said that staff were eager to undertake training so the number was expected to rise. Recruitment and equal opportunities policies and procedures were available. Two files of recently appointed staff were inspected. They were complete and they indicated that the procedure had been acceptably implemented. Recruitment was underway to fill four staff vacancies. Regent E52 S30248 Regent V244729 310805.doc Version 1.40 Page 18 An excellent training display was hung in the office from which individual’s training achievements and needs could be seen at a glance. From this, training programmes had been developed and were being implemented by the management team. In addition each person had an individual training profile and the mangers monitored the situation each month to ensure everyone was receiving the training they needed and would meet or exceeded the required three-day minimum annual training. The requirement made in the previous report has therefore been met. It was suggested that the information available could also be used to keep up to date the section regarding staff experience and qualifications in the statement of purpose and service users’ guide. Each newly appointed member of staff received a comprehensive induction training manual and copy of the General Social Care Council Code of Conduct and Practice. They were allocated a senior mentor to guide support and train them through the course. It was acknowledged that the time scale of six weeks was not always achieved. When completed the manual was sent away for verification by the homes central office. A requirement was made in the previous report concerning the provision of foundation training. The organisation does not have a suitable programme. However the inspector was aware that changes to this standard were imminent and therefore this requirement has not been assessed or repeated during this inspection. The changed standard will be assessed during the next inspection. Regent E52 S30248 Regent V244729 310805.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36, 37, There is strong management and leadership in the home that ensures staff are well supported to provide an acceptable service for the well being of the residents. The policies and procedures are implemented to safeguard financial interests and the health and well being of residents. Record systems provide information and communication for the safety and well being of everyone in the home. People in the home are protected from the risk of fire through routine checks of safety systems and staff training. Regent E52 S30248 Regent V244729 310805.doc Version 1.40 Page 20 EVIDENCE: The manager of the home is appropriately trained and experienced, and is registered by the Commission. She is qualified to NVQ level 4 and is just completing the Registered Managers’ Award. The care services manager has achieved the Registered Managers Award and is just completing NVQ level 4. The managers were clear regarding the parameters of their authority and accountability and were supported by a responsible individual appointed to act for the registered provider. Staff confirmed that the management team was approachable and receptive to suggestions and new ideas. Residents and staff were able to influence the running of the home through meetings, reviews and supervisions. In addition there was the compliment and complaint procedure, the quality assurance process, suggestion boxes, a resident’s advocate/representative, annual questionnaires and an open door policy. The minutes of meetings indicated that they were a forum for exchanging information, training and discussing suggestions and ideas. A quarterly analysis of residents’ questionnaires indicated that comments and concerns were followed up and appropriate action had been taken. It was suggested that the views expressed by residents in the questionnaires could be anonymised and included in the service users’ guide. Questionnaires and suggestion boxes were also available for visitors and relatives to express their views. However the managers acknowledged that these were rarely used. It was suggested that a more proactive way of obtaining feedback would be to send a questionnaire to each next of kin each year. The quality assurance programme in use consisted of a range of audits that were regularly carried out and used to improve the service. Development plans were available and these were being drawn together into a new format that would demonstrate actions and outcomes. The policies and procedures were drawn up when the providers were first registered and several had been reviewed over the years. The manager confirmed that the Assistant Director of Care and the Head of Human Resources were now reviewing and where necessary up dating all of the documents. Regent E52 S30248 Regent V244729 310805.doc Version 1.40 Page 21 Financial matters were well managed according to the policies and procedures in place and the budget for the home was monitored each month by the managers and the responsible individual. Good records were maintained. Acceptable insurance and insurance information was in place. The manager said that the management team shared supervision of the staff. This was undertaken through 1:1 sessions, group meetings, return to work meetings, counselling and spontaneous discussions. A supervision programme was displayed that indicated sessions that were due and those that had taken place. Unfortunately it had not been kept up to date. However individual records for 1:1 sessions had been maintained. Information regarding the residents’ right of access to their records was included in the service users guide. Security was acceptable. Records that were required to be maintained by the legislation were in place. Health and safety was not assessed in full. However the Fire log was inspected and although some of the records could have been clearer it was observed that all routine checks were being regularly carried out and staff were receiving acceptable training. The fire risk assessment had been drawn up in May 2004 and was due to be reviewed. Regent E52 S30248 Regent V244729 310805.doc Version 1.40 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 2 3 x x x x 2 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 Standard No 16 17 18 Score 3 3 3 3 3 3 3 3 3 3 x Regent E52 S30248 Regent V244729 310805.doc Version 1.40 Page 23 No Are there any outstanding requirements from the last inspection? 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. 2. 3. 4. 5. Standard 7 8 12 20 26 Regulation 15 13(4) 16(2) 23(2) 16(2) Requirement All care plans must be updated to show the changing needs of residents. Risk assessments must be regularly reviewed. Arrangements must be in place for residents to take part in activities of their choice. The carpet in St Clements unit must be replaced. Systems must be in place to prevent poor odours occuring in the home. Timescale for action Immediate Immediate 31st October 2005 30th November 2005 Immediate 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 Good Practice Recommendations Regent E52 S30248 Regent V244729 310805.doc Version 1.40 Page 24 Commission for Social Care Inspection The Coach House John Comyn Drive, Perdiswell Park Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 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 Regent E52 S30248 Regent V244729 310805.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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