Inspection on 25/07/07 for Remyck House

This inspection was carried out on 25th July 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 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

Remyck House 15/07/09

Remyck House 28/09/06

Remyck House 18/05/06

Remyck House 10/10/05

Remyck House 28/09/04

Remyck House 22/04/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Remyck House 5 Eggars Hill Aldershot Hampshire GU11 3NQ Lead Inspector Tim Inkson Unannounced Inspection 25th July 2007 09:15 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 Remyck House DS0000012099.V341126.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. Remyck House DS0000012099.V341126.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Remyck House Address 5 Eggars Hill Aldershot Hampshire GU11 3NQ 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) 01252 310411 Mr Thedchanamoorthy Kandiah Mrs Shanthini Kandiah Pauline McIntyre Care Home 29 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places Remyck House DS0000012099.V341126.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - (OP) 2. Dementia (DE)(E) The maximum number if service users to be accommodated is 29. Date of last inspection 28th September 2006 Brief Description of the Service: Remyck House is a care home that provides personal care and support for up to 29 older people. The home also provides a service for people who may have dementia. Mr & Mrs Kandiah own Remyck House. The home is located on the outskirts of Aldershot town centre and is close to local amenities and bus route. The home has three communal lounges and a communal dinning room. People that are interested in living in Remyck House are provided with a copy of the home’s “Service Users Guide” that contains information about the facilities and service provided at the establishment. They are also invited to visit the home and spend some time there meeting people and sampling a meal. A copy of a report of the most recent inspection of the home by the Commission for Social Care Inspection (“the Commission”) is included in the Service Users Guide and a copy is also readily available in the home. At the time of this site visit the scale of charges for the home was £450 - £490 per week and this did not included the cost of chiropody, hairdressing, toiletries, newspapers and journals and confectionary. Remyck House DS0000012099.V341126.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was part of the process of a key inspection of the home and it was unannounced and took place on 25th July 2007, starting at 09:15 and finished at 16:10 hours. During the visit accommodation was viewed including bedrooms, communal/shared areas and the home’s kitchen and laundry. Documents and records were examined and staff working practice was observed where this was possible without being intrusive. People living in the home, visitors and staff were spoken to in order to obtain their perceptions of the service that the home provided. At the time of the inspection the home was accommodating 24 people. Of these 5 were male and 19 were female and their ages ranged from 71 to 93 years. No resident was from a minority ethnic group. The home’s registered manager was present throughout the visit and was available to provide assistance and information when required. People living in the home, relatives/representatives and health care professionals with patients at the home were canvassed for their views about the establishment using questionnaires before the site visit took place. The responses were taken into consideration when producing this report. Other matters that influenced this report included. An Annual Quality Assurance Assessment completed by the registered provider which she set out how it was believed the home met and planned to exceed the National Minimum Standards (NMS) for Care Homes for Older People and evidence to support this. A “Dataset” containing information about the home’s staff team, and some of its managements systems and procedures. Information that the Commission for Social Care inspection had received since the last fieldwork visit made to the home on 28th September 2006, such as statutory notices about incidents/accidents that had occurred. The atmosphere during the visit was relaxed and on several occasions’ friendly banter was observed taking place between staff and people living in the home. The time spent observing the home’s daily life and staff care practices indicated that staff were very patient, empathetic and they always asked individuals questions rather than making decisions for them about what help they wanted. People were encouraged to be active, but could also sit quietly if that was their wish. What the service does well: The home obtained information about people who wished to move into the home before they did so in order to establish whether they could provide the help that they required. Remyck House DS0000012099.V341126.R01.S.doc Version 5.2 Page 6 Positive relationships had been established with health care professionals who had confidence in the ability of the staff and home to look after people living there. The home’s routines were flexible and people living there were able to pursue their chosen lifestyle including their spiritual /religious beliefs. People living in the home were positive about the food that the home provided and a range of activities were organised in which they could participate. There was a commitment to staff training and development to ensure that staff were able to fulfil their roles and responsibilities and meet the needs of people living in the home. Some management systems and procedures in the home worked well including, the administration of medication and staff recruitment. 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. The summary of this inspection report can be made available in other formats on request. Remyck House DS0000012099.V341126.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 Remyck House DS0000012099.V341126.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People wishing to move into the home may not be able to make a properly informed choice because the home’s Service Users Guide omits some details about the special needs that the home caters for. The help that people needed who wished to live in the home was identified before they moved in to ensure that the level of support and care they required could be provided. EVIDENCE: The home’s registered manager had arranged to have a document holder installed in every bedroom in which a copy of the establishment’s Service users Guide was placed. This ensured that information about the service that the home provided was readily available to the people accommodated at the home to refer to. The guide required updating as it failed to refer to the special needs that the home catered for i.e. people with dementia and how they were met. The home’s Service Users Guide that was provided to people interested in moving into the home contained among other things the following statements: Remyck House DS0000012099.V341126.R01.S.doc Version 5.2 Page 9 “Each resident will be assessed and an individualised care plan will be made according to his or her needs … Potential residents are invited to have lunch and spend an afternoon at Remyck House to see whether we meet their requirements”. A sample of the records of 6 people living in the home was examined including documents specifically concerned with the actions that the home took to identify the help and care that people needed. Where individuals had moved into the home through arrangements made by the Adult Services Department of the local authority. There was evidence that the type of help that the individual concerned required had been identified and documented and the information provided to the home before that person moved in. There was evidence from these documents and discussion with people living in the home and visitors, that the admissions to the home of the individuals concerned had all been planned and that staff with appropriate knowledge and skills were involved in the process. It was also apparent that the process included either visiting people who wished to move into the home or arranging for them to visit the home in order to ascertain the level of support that they needed before they moved into the establishment. The home’s pre-admission assessments were complemented by more thorough and comprehensive assessments of a person’s needs when they actually moved into the home. Responses in questionnaires completed by relatives/representatives indicated that 50 believed that the home always or usually met the needs of the person they were related to or represented. Responses from people living in the home indicated that 82 thought their needs were always met and 18 usually. There was documentary evidence that assessments of the needs of people living in the home were reviewed regularly and were usually revised as necessary when an individual’s circumstances had changed. The home does not provide intermediate care. Remyck House DS0000012099.V341126.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had systems in place to ensure; the personal and healthcare needs of people living in the home were met and their medication was managed safely. Staff working practice helped to ensure that residents’ privacy and dignity was promoted EVIDENCE: The care plans were examined of the same sample of 6 residents as in the section above i.e. “Choice of Home”. In each case there was a plan with information about most of the help, assistance and support that that the individual needed. Assessments of individuals needs carried before people moved into the home in order to identify what help they required generally informed these plans. These were complemented by other assessments following the admission of individuals to the home and they included identifying some potential risks to health and welfare such as mobility; pressure sores; falls; moving and handling. It was pointed out that the way the documentation the home used to record this assessment information was not always linked to the plans of care. Some of the assessments were completed in isolation e.g. risk of pressure sore. These used a scale to indicate the level of risk and where such risk was indicated there was no reference in the plan or assessment document about Remyck House DS0000012099.V341126.R01.S.doc Version 5.2 Page 11 how this was to be addressed. The registered manager agreed to ensure that that all information was recoded in assessment documents was appropriately included or referred to in plans of care. She also agreed that where a plan of care indicated that an individual was to be checked at specified intervals e.g. every 2 hours at night that she would implement a chart/record to monitor that such checks were done. Information in care plans included details about how the foot care needs and oral hygiene of people was to be met e.g. arrangements for regular chiropody and instructions for staff to soak dentures overnight. Plans indicated where relevant, how a specific need was to be met or what specialist equipment a person required e.g. Zimmer frame; hoist for assisted bathing In those cases these were observed to be available or confirmation provided by the people concerned that this help was given. There was evidence from documentation and discussion with people living in the home that some individuals and/or their representatives had been involved in reviews of and in developing their plans of care. • “I know all about my Mum’s care plan”. Records also indicated that care plans were reviewed at least monthly. Staff spoken to were very familiar with the needs of the individuals whose records were sampled and they were able to describe the contents of the care plans. Comments from people living in the home and their relatives/representatives about the abilities of staff the care and support that they provided included: • “It is all right really and the girls are very obliging. They help me with bathing ... If I am unwell they arrange for me to see a doctor. I see a chiropodist about every 6 weeks. They can arrange for an optician or you can do it yourself”. • “They help me in the morning, bring me my clothes that I have in the wardrobe. They are very helpful. You could not want for a nicer group of people. If anything goes wrong they are straight on the spot. They check on you at night, they do all that and bring water to your bedroom they never forget”. • “The home takes good care of my mother”. • “They are quick to get medical help and are kind when the residents are unwell”. • “X is always clean and dressed in clean clothes” Documents examined indicated that individuals weight was recoded regularly, a range of healthcare professionals visited the home and that arrangements were made for treatment for service users when it was necessary. People living in the home said that they saw and received treatment from among others, doctors, podiatrists and opticians and when required. When specialist equipment (pressure reliving aids; continence products) was required or specialist healthcare support was needed the registered manager Remyck House DS0000012099.V341126.R01.S.doc Version 5.2 Page 12 liaised with the necessary individuals and/or agencies including; community psychiatric nurses. A visiting healthcare professional said: • “I have been visiting the home for about 9 years. I have never had a problem … They are good and contact us if they have any concerns or want advice … They always escort me to see a patient and I always see them in their room or somewhere like a bathroom in private …”. Responses in questionnaires received from health care professionals (2) with patients at the home indicated that they thought the home always (50 ) or usually (50 ) sought advice to improve individuals’ health. The same breakdown was the response, as to whether the home met people’s care needs and whether staff had the right skills and experience to support people living in the home. One doctor stated: “I have only just started as GP here but I have only seen good service to date”. The registered manager said if she had instructions from a doctor to ensure that an individual’s fluid intake was important i.e. push fluids. She would use a fluid chart to monitor the amount that the person consumed to ensure that they were having enough. The home had written policies and procedures concerned with the management and administration of medication. Medication was kept in a locked metal medicine trolley that was stored in a locked room. Medicines requiring storage at a low temperature were kept in a lockable medical refrigerator. The home operated a monitored dosage system. A local pharmacist provided most prescribed medication every 28 days in blister packs for each person concerned. Other medicines that could not be put into blister packs because they could spoil, such as liquids or those that were to be taken only when required were dispensed from their original containers. There was evidence from training records and discussion that all staff that gave out medication had received appropriate training. • ““I shadowed the deputy for about 3 months and she watched me do it, it is only in the past few weeks that I have been able to do it on my own. I did “Redcrier” training in medication and got 21 out of 22 and we are also doing training with the pharmacy and we have a booklet that we must complete”. Records were kept of the ordering, receipt, administration and the disposal of medicines and these were accurate and up to date. A member of staff was observed giving out medication and the procedures used were appropriate and medicine was given to individuals in a sensate manner. Although the home promoted the independence of people living there and this included self-medicating subject to an assessment, at the time of the site visit no individual was managing their own medication. Remyck House DS0000012099.V341126.R01.S.doc Version 5.2 Page 13 Good practice noted during the site visit included: • Recording the temperature of the refrigerator used for storing some medication • The dating of some medicine containers when they were opened. Some of the individuals living in the home had been prescribed “Controlled drugs”. The home did not have a metal storage cupboard that met the expectation set out in standard 9.5 of the National Minimum Standards for Care Homes for Older People. It is recommended that the home install a suitable cupboard that complies with standards set out in the Misuse of Drugs (Safe Custody) Regulations 1973. During the fieldwork visit care staff were observed treating the people living in the home with respect and sensitivity and this included knocking on bedroom doors and waiting for a response before entering. Individuals spoken with said that staff were polite and promoted their privacy. At the last inspection of the home on 28th September 2006 it was noted that there was not a procedure for staff to follow if a death occurred in the home. It was also noted that service that the wishes of people living in the home concerning arrangements after death were not routinely recorded. Subsequently the home’s registered manager had either discussed the matter with individuals or had written to their relatives/ advocates to obtain the necessary information about funeral arrangements and had developed a written procedure for staff to follow when a death occurred in the home. Remyck House DS0000012099.V341126.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home were able to choose their own life style, social activities and maintain contact with families and fiends. Social, cultural and recreational activities generally met individuals’ expectations. The food provided was healthy, varied and nutritious and generally according to the choices and preferences of those living in the home. EVIDENCE: Plans of care that were examined (see section above, “Health and Personal Care”) included details of the social and leisure interests and life style/personal preferences of the individuals concerned. The home employed an activities organiser who was available 6 mornings a week and she liaised with care staff who were assigned to provide support and care to a number of individuals every day. The care worker was responsible for ensuring that those people had the opportunity to participate in some form of stimulating activity. During the site visit several different organised activities were observed taking place both during the morning and afternoon. Some involved groups of people but staff were also observed spending one to one time with some individuals. The registered manager said that there had been a planned programme of specific activities but as people changed their minds about what they wanted to do there was no regular programme but the activities organiser helped care workers with ideas. There was information about activities that would be Remyck House DS0000012099.V341126.R01.S.doc Version 5.2 Page 15 suitable for people with the range of needs that the home accommodated and materials/resources such as board games and skittle, beam bags etc. Outside entertainers also visited the home regularly. Responses in questionnaires received from people living in the home about activities organised in the home indicated that, 64 were of the view that there was always something organised that they could take part in, 27 usually, 9 sometimes. There was evidence from plans of care and discussion with people living in the home that routines were flexible and that individuals were able to maintain links with families and friends and their personal spiritual beliefs and practices were supported. Comments about these aspects included the following: • “I think that they make it quite homely. They make birthdays special for residents” (relative) • “It is alright … if I had a complaint I would say so. I think that the food is all right … I have enough anyway. I am expecting to see the priest next week” (person living in the home). • “I have breakfast I my room. We can do more or less what we want to. I do some things to help out … I get the Irishmen’s’ rise … Visitors can come at any time …” (person living in the home). • “I have a television in my room but I prefer to watch this one in the lounge …” (person living in the home). • “ … . No one interferes with me. I keep to myself doing my drawings. My daughter comes to see me” (person living in the home). • “I can come at any time there are no restrictions on visiting” (visiting relative). There was information in the entrance of the home and in the home’s Service Users Guide about organisations that could provide impartial advice, information and guidance to people living in the home and/or their families about matters such as finances and power of attorney. At the time of the site visit no person living in the home was managing their own financial affairs. The responsibility had been delegated to either their relatives or representatives. Individuals were able to bring small items into the home with them and it was apparent from observation during a tour of the building that many people had taken some trouble to personalise their bedroom accommodation. Sensitive information that the home held about people living there was kept securely and the home had written policies and procedures about maintaining confidentiality and the right of individuals to access their personal files and case notes. Responses in questionnaires from people living in the home about the food that it provided in indicated that 64 always liked the meals and 36 usually. Discussion with people during the site visit about the subject provoked generally positive views and they included: • “The food is not bad. I would not say that it was marvellous”. Remyck House DS0000012099.V341126.R01.S.doc Version 5.2 Page 16 “The food is quite nice. We have breakfast, tea mid morning, lunch and afternoon tea, we have a tea meal about 5 pm and a sandwich or something for supper”. • “The food is just like home. It is lovely”. The home had a 4 - week rotating menu and it indicated that the food was nutritious and there was a range of meals provided with an alternative to the main meal every day. In addition special diets and individual preferences and needs were catered for e.g. vegetarian and diabetic. Information about the meals that were provided was clearly displayed on a large board in the home’s dining room. The home’ s chef said: • “I know what people like … I speak to the residents about menus and they give me feedback about what they like and don’t like… we have a vegetarian and someone who does not like garlic and also some diet controlled diabetics … we get fresh fruit on a Thursday and it is put out in the fruit bowls”. The main meal of the day was observed and it was unhurried and staff were patient, sensitive and polite when providing assistance to those individuals needing help. The ready availability of fluids throughout the home was noted. There were large jugs of fruit juice/squash that were replenished during the visit located in the lounge and in the bedrooms of those individuals who preferred to spend time in their personal accommodation there were jugs of water. • Remyck House DS0000012099.V341126.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had procedures in place to address the concerns of people living in the home and to protect them from the risk of abuse . However failure to report the actions of a member of staff that may have compromised the safety of people living in the home to the relevant authority in accordance with the appropriate legislation, could result in people in other services being exposed to similar risks. EVIDENCE: The home had a written policy and procedures about how complaints could be made about the service that it provided. A copy was prominently displayed in the home as well as being included in the Service Users Guide that was issued to everyone that lived in the home and readily available in all bedrooms. Responses in questionnaires received from people living in the home and their relatives/representatives about their knowledge of how to make a complaint about the home indicated that 91 of the former and 17 of the latter knew what to do. At the last inspection of the home on 28th September 2006 the following was noted that the home’s records about complaints lacked sufficient detail. On this occasion there were detailed records about 2 complaints that had been made to the home during the intervening period. There were details recorded about what action the home had taken and the outcome. Both complaints had been resolved. There had been 2 complaints received by “the Commission” during the same period and both had been investigated by the relevant personnel and resolved. Remyck House DS0000012099.V341126.R01.S.doc Version 5.2 Page 18 One of the complaints referred to above had resulted in a member of staff being dismissed. The circumstances for the dismissal were such that the registered provider should report the individual to the Secretary of State under section 82 of the Care Standards Act 2000 in accordance with the protection of vulnerable adults requirements. Within two days of the site visit the home’s owner confirmed that this would be done. This is to ensure that a person who has placed at risk vulnerable adults is not able to obtain employment in a position that could result in other people also being put at risk. The home had written policies and procedures concerned with safeguarding vulnerable adults and a copy of the procedures issued by the Adults Services Department of the local authority, which is the statutory agency with the lead responsibility in such matters. Staff spoken to said that they received training about protecting vulnerable adults and an examination of staff training records confirmed this. They were also able to demonstrate an awareness of the different types of abuse and the action they would take if they suspected or knew that it had occurred. Remyck House DS0000012099.V341126.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s environment was generally comfortable and well maintained with the exception of the odour in 2 bedrooms. The safety people living there could be improved by implementing additional checks as well as assessments of the risk of using some equipment and systems in the home. EVIDENCE: At the time of this site visit the exterior and interior of the premises, its décor, furnishings, fittings and equipment were clean and in reasonable repair. The home had written policies and a procedure about the maintenance of the premises that included a weekly check/audit of the condition premise. If remedial work or replacement of any item was required the registered manager submitted a requisition to the registered provider. She was also able to contact relevant contractors if any emergency repairs or work was needed e.g. plumber, electrician. There were some adaptations and equipment installed or available in the home to promote the independence of people with disabilities including: • Grab rails, frames and raised toilets in WCs. Remyck House DS0000012099.V341126.R01.S.doc Version 5.2 Page 20 Passenger lift and chairlift providing access to the first floor of the building There was also some signage to help people with orientation including pictures of the occupiers of each bedroom on its door to enable the individual concerned identify or find their room. It was suggested that the use of symbols/pictures depicting WCs. The lift and communal room could assist those people who were unable to read. There was an enclosed rear garden that people living in the home could use in good weather, however they may be discouraged from doing so because the garden furniture comprised a wooden bench and 9 light plastic chairs that were not particularly sturdy. There was no furniture available to provide shade from any sunshine. This lack of suitable/appropriate garden furniture could deter or be a disincentive and prevent people from using the outside area. It is recommended that enough suitable garden furniture be obtained to ensure that should people living in the home wish to use the garden they can do so in comfort and safety. The home had taken precautions to prevent people living there from being burned or scalded by covering all radiators with guards and fitting all hot water outlets with mixer valves to ensure it was delivered around 43º C. It was suggested that a programme of regular checks of the efficacy of the valves be implemented and recorded as they can fail. The use of a supplementary oil-filled heater in one bedroom was noted. The registered manager was strongly advised to ensure that any risk associated its use and position was comprehensively assessed and the result recorded. There were written procedures in place concerned with infection control and records examined indicated that most staff had received recent training in the subject. It was noted that in accordance with best practice all communal WCs that were seen were provided with liquid soap dispensers (that were full and working) and paper towels. There were also alcohol gel disinfectant dispensers in various locations in the home. Protective clothing was readily available and staff were observed using gloves and aprons appropriately. The home had a sluice and also two laundry rooms and they were both was appropriately sited and equipped and effective procedures were in place for the management of soiled laundry items. Responses in questionnaires from people living in the home indicated that 100 thought the home was always fresh and clean. One individual spoken to said, “There are cleaners and they keep the place clean”. There was however some unpleasant odours noted in two bedrooms and responses received from some relatives in questionnaires indicated that some had concerns about the cleanliness of the premises and particular reference was made to the condition of the carpet in the lounge. At the time of this site • Remyck House DS0000012099.V341126.R01.S.doc Version 5.2 Page 21 visit it appeared clean although as with some other carpets in communal areas of the home there was some staining. The home’s registered manager said that she as attempting to address the cause of the unpleasant odours in the 2 bedrooms that were identified and said that the home had carpet-cleaning equipment. She also said that the night staff cleaned the carpets in the communal areas. At the time of the inspection the home employed one member of staff dedicated to cleaning tasks and she worked from 08:00 to 15:00 6 days a week. The home’s registered manager said that she was in the process of recruiting another cleaner. Remyck House DS0000012099.V341126.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The recruitment, training, deployment, level and skill mix of staff ensured that the needs of people living in the home were met and their safety was promoted. EVIDENCE: At the time of the site visit the staff team working in the home comprised, 16 care staff, 1 chef, 2 kitchen assistants, 1 cleaner and 1 activities co-ordinator. Out of the care staff, 9 i.e. 56 had obtained at least National Vocational Qualifications (NVQ) at level 2 in Care and 4 were working towards the award. This compared with 4 care staff (25 ) having the qualification at the last inspection of the home on 28th September 2006. The registered manager obtained NVQ level 4 in care and was working towards completing an appropriate management qualification. At the time of the site visit the care staff rota setting out the minimum number deployed in the home at any time was as follows: 08:00 to 14:30 3 14:00 to 20:00 3 20:00 to 08:00 3 wakeful No concerns were expressed by people living in the home who were spoken to or by relatives/representatives who returned questionnaires to “the Commission” or who were spoken to during the site visit, about the sufficiency of the number of staff on duty. Some concerns were however expressed by relatives about some aspects of staffing suggesting that some staff did not take responsibility but blamed another shift if something was overlooked e.g. Remyck House DS0000012099.V341126.R01.S.doc Version 5.2 Page 23 waste bins being emptied, or they were not contacted if their relative in the home was unwell. There was no evidence from discussion with staff of any serious conflicts and all those spoken to seemed to be well motivated and enthusiastic. There had however been a considerable turnover of staff in the previous 12 months i.e. 29 . Staff changes can be unsettling and seriously affect the continuity of the service provided to people living in a home. There was some suggestion from discussing working conditions with staff that one factor could be staff salaries that for care staff only just exceed the statutory minimum wage level. Records were examined of the staff that had been employed to work in the home since the last fieldwork visit to the 28th September 2006. It was apparent that in all cases the necessary pre-employment checks to ensure among other things that they were suitable to work with vulnerable adults had been completed before they had started work in the home. At the last inspection of the home on 28th September 2006 as on this occasion there was evidence that the home was committed to ensuring that its staff were trained and competent to undertake their duties and were able to meet the needs of people living there. It operated a comprehensive training programme provided through a nationally recognised training organisation and this included an induction programme for new staff as well as training in various topics e.g. First aid; Moving and handling; infection control; dementia care; legislation; diet and nutrition; aggression; medication; Protection of Vulnerable Adults; Basic Food Hygiene; risk assessment; fire safety; health and safety. One member of staff who had worked in the home for some considerable time said, ““I have been here about 22 years. I got NVQ level 2 this year. I did not want to do it, but I learnt quite a lot from it. We are doing Redcrier training in dementia care. We have worksheets that we read and then complete questions and they are marked. I am just finishing training about abuse …”. At the last inspection of the home on 28th September 2006, it was noted that not many staff had completed any training in dementia care. On this occasion form discussion with staff and records examined it was apparent that only the most recently appointed staff had done so. One member of staff spoken to was very positive about the training that the home arranged. • “I worked for an agency before I came her. I have been here about a month. I am working through my induction programme and also doing dementia care. I have also done something about abuse, fire safety and first aid. It is lovely … The training is excellent”. Remyck House DS0000012099.V341126.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s registered manager provided effective leadership There were systems and procedures in place for monitoring and maintaining the quality of the service provided, supporting staff and promoting the safety and welfare of everyone living and working in the home. EVIDENCE: The registered manager had been responsible for the day-to-day operation of the establishment for some 13 months but she had only been formally registered in respect of the home since May 2007. She had started working at the home in 2002 initially as a care assistant and then as deputy manager. Her previous employment had been in finance. Although she had some 6 years experience working in a care home before that. She had obtained an NVQ level 4 in care and was half way through the registered managers award. She also hoped to start a course to be an NVQ assessor at a local college. In discussing her management style she said that the staff described her as strict and she added, “They know when I am here and if they have been Remyck House DS0000012099.V341126.R01.S.doc Version 5.2 Page 25 trained then I don’t expect silly errors. I think that they respect me. I will work alongside them if they need help”. From discussion with the staff, people living in the home and visitors it was apparent that she was well thought of and popular. Observation during the site visit indicated that she was sensitive and empathetic. Comments about her qualities and management approach included: “She is a very nice person and really helpful” (person living in the home). “ I think Pauline is a good manager. She is approachable and you can talk to her about anything”(member of staff). “I can go to Pauline at any time her door is always open. I can call her at home if I have a problem she is always available. She is very good because she has been a carer and she knows both sides. She would not ask us to do something that she would not do herself. She is prepared to come out and work on the floor. She has pulled the place up” (member of staff). “I get on really well with Pauline. If I have a problem I can talk to her. She is fair. I like working here, the pay is not great but the job is good” (member of staff). “She is flexible and she motivates the staff. She is easy to talk to” (member of staff). “She does a good job. She really tries her best. She is very attentive but she needs support because staff turnover causes a problem” (visiting relative). “ She seems very efficient … “ (visiting health care professional). The home had a range of written policies and procedures that informed practice. They were an “off the shelf” package but they had been customised to ensure they were appropriate for use in the home and there was evidence that they had been reviewed and some had been specifically produced for the home e.g. maintenance procedure. They included policies about the following subjects: • Continence promoption • Abuse • Personal care • Communication and dementia • Pre-service needs assessment Staff spoken to indicated that they found the ready availability of procedures helpful. • “… I would go to our policies they give us guidelines. They are there for us so we know what to do … “. The home used questionnaires twice a year to obtain the views of people living in the home and other interested parties. The results from the most recent survey were generally very positive. It was suggested that the results and outcomes be collated and published to enable people to see and know what happened to the information that they provided and see how it influenced life in the home. Remyck House DS0000012099.V341126.R01.S.doc Version 5.2 Page 26 There had been 3 requirements made as a result of the last inspection of the home on 28th September 2006 and there was evidence that all of them had been successfully addressed. The home looked after small sums of money for some residents that was left with or handed over by relatives or representatives. A sample of records of monies held on behalf of residents was checked and they were accurate and up to date. Records examined indicated that the home’s equipment, plant and systems were checked and serviced or implemented at appropriate intervals i.e. passenger lift and hoists; fire safety equipment portable electrical equipment; hot water system; etc. Local environmental health officers had visited the home on 26/02/07 to assess compliance with food hygiene and 23/03/07 to assess compliance with general health and safety matters. A number of items had been identified on both visits that needed addressing and the home had addressed most of them. This had resulted in the home being issued with a 4 –star certificate for food hygiene by Rushmoor Borough Council environmental health department. There was however an outstanding issue arising from the assessment of the home’s general health and safety. This was the need to complete an asbestos survey to ensure that there was none of this material present in the building that was potentially hazardous. The registered provider should ensure that all the items set out in the report of the local environmental health department are addressed without delay. Staff spoken to said and records examined confirmed that that they attended regular and compulsory fire and other health and safety training. There was a fire risk assessment for the premises and regular risk assessments of the premises and working practices were undertaken. Guards covered all radiators in the home and all windows above the ground floor were fitted with restrictors. There were hoists, and other equipment in the home to promote safe working practices. Remyck House DS0000012099.V341126.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X x Remyck House DS0000012099.V341126.R01.S.doc Version 5.2 Page 28 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 Standard OP1 Regulation 5 Requirement The home’s service users guide must be revised to included details about the special needs the home caters for and how it does that, specifically the those of people with dementia. 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 OP9 Good Practice Recommendations A Controlled Drugs cupboard, which complies with the Misuse of Drugs (Safe Custody) Regulations 1973, should be installed to provide for the secure storage of any Controlled Drugs, including Temazepam, which are prescribed for service users. Enough suitable garden furniture should be obtained to ensure that people living in the home who wish to use the garden can do so in comfort and safety. DS0000012099.V341126.R01.S.doc Version 5.2 Page 29 2 OP20 Remyck House 3 OP38 All items identified in the report of the local environmental health officer should be addressed to ensure that people living and working in the home are protected from the risk of harm Remyck House DS0000012099.V341126.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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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