Inspection on 12/06/06 for Resthaven Nursing Home Limited

This inspection was carried out on 12th June 2006.

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

Other inspections for this house

Resthaven Nursing Home Limited 08/05/08

Resthaven Nursing Home Limited 14/05/07

Resthaven Nursing Home Limited 21/12/05

Resthaven Nursing Home Limited 14/07/05

Resthaven Nursing Home Limited 31/01/05

Resthaven Nursing Home Limited 12/08/04

Resthaven Nursing Home Limited 16/03/04

Resthaven Nursing Home Limited 09/12/03

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Resthaven Home Of Healing Pitchcombe Nr Stroud Glos GL6 6LS Lead Inspector Mrs Ruth Wilcox Key Unannounced Inspection 12th June 2006 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 Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 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. Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Resthaven Home Of Healing Address Pitchcombe Nr Stroud Glos GL6 6LS 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) 01452 812682 Resthavenhome@AOL.com Resthaven Home of Healing Limited Mrs Jayne Elizabeth Claire Roberts Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st December 2005 Brief Description of the Service: Resthaven is situated in quiet countryside over looking the surrounding valley and the woods behind. Some residents have particularly chosen this Home for the surrounding countryside and its wildlife. The Home completed a major new build and part refurbishment in 2004/2005 and now benefits from new bedrooms and facilities. The older part of the Home is yet to be refurbished. Resident accommodation comprises of single bedrooms that all meet the National Minimum Standards of which many enjoy superb views. There is also ample communal space. The Home has its own chapel attached to the Home, which is used regularly for prayer and worship. At the front and side of the building there is ample car parking and access to the Home for wheelchair users is at the front and side of the building. The Home has a qualified nurse on duty at all times and provides access to other health care services. Specialised equipment is available if required. Information about the home is available in the Service User Guide, which is issued to all prospective residents, and a copy of the most recent CSCI report is available in the home for anyone to read. The charges for Resthaven range from £334 to £650 per week. Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. One inspector carried out this inspection over two days in June 2006. A check was made against the requirements that were issued following the last inspection, in order to establish whether the home had ensured compliance in the relevant areas. Care records were inspected, with the care of four residents being closely looked at in particular. The management of resident’s medications was inspected. Fourteen residents and four visitors were spoken to directly in order to gauge their views and experiences of the services and care provided at Resthaven. Survey forms were also left in the home for a number of residents, visitors and staff to complete and return to CSCI if they wished. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, training and supervision and provision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. What the service does well: Resthaven provides a pleasant environment, in a picturesque rural location for the residents living there. The original building forms part of the home, with a new part constructed in the last two years. The new part provides good standard accommodation, with appropriate adaptations and aids. The original part has yet to be refurbished however. The home is cleaned to a good standard. Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 6 The home provides an information brochure to each prospective resident to assist them with their choice about moving there. Residents speak positively about the standard of care they receive, and about the staff group caring for them. There is a good standard of home-cooked food here, with residents able to exercise choice in this regard. Residents, without exception, confirmed their satisfaction with the standard of meals provided. However, in view of the teatime meal being served quite early it has been recommended that staff routinely offer an evening snack to residents. The home employs a Social Activities coordinator, and there are opportunities for residents to engage in group or one to one activities. Residents are also encouraged to pursue personal hobbies and interests where possible. Visitors are made welcome here at any time. Staff spoken to during this visit were very aware of residents’ needs and care, and appeared to be a hard working group of people. There is an accessible complaints procedure should any resident or visitor need it, and those spoken to confirmed that staff have been receptive, and have responded to concerns when they have had to raise any. Although residents are encouraged to be as independent as possible when managing their affairs, the home can offer secure facilities should anyone wish to place any money or valuables with them for safekeeping. What has improved since the last inspection? There have been some changes within the staff team recently, following the departure of some members. The previously reported difficulties within the staff team, resulting in certain divisions within, are now resolving. Staff reported more cohesive working now, although more team building is still needed, and there is a much improved atmosphere in the home. The home has met with the Primary Care Trust with a view to enhancing the skills and competencies of the nursing team, in order to meet certain specific needs of the resident group. Updated medication training has been provided since the last inspection. Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 7 What they could do better: Residents are admitted to the home on the basis of a pre-admission assessment, but it is important that the home’s assessor completes a full and detailed record in every case. The home should also ensure that access to CSCI reports is made easier for interested parties in the home. Written care plans require further improvement, so as to include clearer guidance for staff, and additional risk assessments for each resident. The management of residents’ medications is generally satisfactory, however there were isolated shortfalls in practice on this occasion, which must be rectified. Although the home has policies and procedures regarding the protection of the vulnerable residents in their care, the principles of which staff are aware, the home has yet to provide prevention of abuse and adult protection training to all its staff. Clinical waste collection bins are required in the sluice areas, as collection bags are currently placed on the floor, posing a cross infection risk. Shortfalls remain in the home’s staff recruitment practices, and these can pose risks to the residents unless there are improvements. This has been raised with the home previously and the CSCI will take enforcement action if improvements are not seen. There is only limited progress towards achieving NVQ qualified carers here. The home is considering options for providing this training however, as there is some interest amongst carers to achieve the care qualification. A range of other training is provided for staff, which includes an induction training, although gaps in this provision must cease, with all new staff receiving formal induction training, so that all are adequately trained for their role. Formal staff supervision must also be recommenced as this has been allowed to lapse again. The home has previously received a Formal Enforcement Notice from CSCI concerning this. Further enforcement action will be taken if this is not rectified. The home has adopted certain systems for monitoring the quality of its service, however they must collate results into a report, which can be used to action and drive any improvements needed. It is recommended that residents and visitors have the opportunity to attend meetings so as to discuss issues and offer feedback on the services at Resthaven; two written survey responses from visitors indicated a degree of concern about access to, and sufficient numbers of staff, on occasions, with one of these being concerned about communication between staff recruited from overseas. Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 8 Hot water temperatures at outlets in residents’ rooms in the original part of the home are beyond what is considered safe, and pose a risk to those residents who have access to it. Risk assessments must be carried out, with any action necessary taken to protect residents whilst a decision is taken by the management to install hot water blending devices; it is recommended that this be done as soon as possible. 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. Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents have access to information about the home to assist them in making their choice about moving there. Assessments must be carried out consistently if residents are to be assured prior to admission that the home can fully meet their needs. EVIDENCE: All prospective residents and their representatives are provided with information about Resthaven, in the home’s Service User Guide, referred to as the Residents’ Handbook. A copy of the most recent CSCI report is available for people to read in home, although this is only on asking, and is not readily accessible. Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 11 Pre-admission assessments are carried out on all new residents. The standard of pre-admission assessment recording seen during the case tracking exercise on four particular residents was variable, with one being recorded in only superficial detail. A new admission took place during this inspection. In the absence of the home manager having conducted her own assessment directly, only having done so in consultation with involved healthcare professionals by telephone, had relied upon assessment and care plans from the placing authority. However, this assessment information arrived late in the home, being received just ahead of the person actually arriving. Resthaven does not provide Intermediate Care. Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care planning system in place needs improvement if it is to adequately provide staff with the written information they need to meet residents’ health and personal needs; omissions in recording have not compromised residents’ health needs being met at this time. The systems for the administration of medications are generally good, however isolated failures by staff to observe them consistently could pose a small risk to the safety of residents. Care and support is offered in such a way as to promote the privacy and dignity of the individual. EVIDENCE: Residents’ care plans are safely stored in the nurses’ room; as part of the case tracking exercise four were examined in detail on this occasion. Each contained an assessment of the resident’s individual needs; one assessment form, called the ‘Activities of Daily Living Profile’ was particularly Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 13 informative, and each had been regularly reviewed. However, these forms were being utilised as the care planning system also, and are insufficient for such a purpose in terms of planning, recording and reviewing care in a dynamic way for staff to follow. There were a few examples of care plans, although these contained only minimal detail, and had not been reviewed for some time. Records contained risk assessments for pressure sores, although some of these had not been completed in full, resulting an artificially low level of risk being identified. However, appropriate support equipment and appropriate care was being delivered to these individuals in this area. Although Resthaven provides a good amount of manual handling equipment, which was evidently in use, the records did not contain documented manual handling risk assessments. Nutritional risk assessments were recorded, and residents’ weights were monitored and charted. Two people appeared to have lost some weight over recent months, and the nurse planned a review of this. Those at risk of falling were identified, and appropriate medical interventions had been sought for one particularly at risk person. Daily records contained evidence of residents’ access to external health care services, with visits and consultations documented with a range of health care professionals according to individuals’ needs. There were isolated examples of where the daily record had not been completed in one particular case. Staff themselves were very conversant in the care of individual residents, and despite the shortfalls in record keeping, clearly understood individuals’ care needs and preferences. Residents spoke very positively about the care they received. Without exception, each spoken to said that their care was delivered well, promptly and with kindness. Care was being delivered in the privacy of residents’ own bedrooms. One lady commented that staff knock on her door before entering. Residents can have private telephone lines in their rooms. A visitor commented how happy he was with the standard of care his relative was receiving. Written survey responses from some visitors confirmed their satisfaction with the standard of care given to their relative. There are safe systems for the management of medications, with clearly printed medication administration records and secure storage. Stock levels are appropriate and are clearly well controlled. However despite adopting the good practice of dating individual items on opening to ensure Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 14 items are not used beyond their expiry date, some eye drops were actually in use beyond such a date. There were some handwritten prescriptions that had not been signed by the author. The Royal Pharmaceutical Guidelines were available for reference, but there is no written medication policy and procedure specifically for Resthaven. Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that residents have the opportunity to participate in a social activities programme according to their choice, and that they can keep close contact with their families and friends. Dietary needs of residents are adequately catered for, with a selection of food available that meets their tastes and choices. EVIDENCE: The home has a designated activities co-ordinator, who consults with residents about their ideas and preferences for social activities. Records, although not seen on this occasion, are maintained of all activities offered and participants’ enjoyment. Interactive and inclusive activities were observed on each day, involving a number of residents. The co-ordinator adopts an open, uplifting and sensitive approach to the residents’ needs. On the second day of this inspection, residents in the conservatory of the new part of the home were spending time quietly with the radio and newspapers; staff were present. The activities co-ordinator adopts a more one-to-one approach to activities in this area, though on a less frequent basis. Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 16 At least three residents are able and are encouraged to pursue their own hobbies whilst living here. There is due regard to equality for those individuals with diverse cultural or religious needs. Resthaven has its own chapel where services are regularly held. Outings are organised on a regular basis; one written survey response indicated that these trips are excellent. Resthaven adopts an open-house policy for visitors, and visitors were seen coming and going at various times. Residents confirmed their visitors were made welcome at any time, and this was further confirmed by speaking with a visiting relative and from written survey responses. Staff were heard to offer another visitor some refreshment. Respect is shown by staff towards residents being able to pursue personal choices and maintain some control in their lives. This is evident in that residents are able to manage their own affairs if they are able, and in the way they can personalise their rooms, spend their time, and select favourite choices of food. Residents in the main confirmed that they feel respected, with one or two saying that they can do what they like. A range of helpful information is available in the home regarding advocacy and advice services for residents should this be wanted. Written survey responses indicated that in cases where a resident is unable to make decisions about their care, that the relative is kept informed of important matters and is consulted about their care. However, one written survey response indicated that, despite asking staff to take their relative into the dining room for meals, the meals are generally served to her in the television room instead. Some residents are clearly more reliant on the staff in terms of being dependent upon their assistance to pursue choices. However, on discussing this with staff and residents, there appears to be a general appreciation and sensitivity to residents’ wishes from staff in this regard. Menus are displayed, which are planned by the cook one month in advance. Residents are consulted about their likes and dislikes, and special diets are catered for. One relative commented how much better his relative was doing with her liquidised diet. Menus contain a main dish, with a vegetarian option, although the cook will prepare alternatives if wanted. All residents have the opportunity to set the menu according to their favourite meal on one day of each week. Choices are also reflected at the breakfast and teatime meal. The tea is served quite early and staff should remain mindful of the long period between this meal and the next day, and ensure that all residents have the opportunity to have evening snacks if they wish; snacks are available, but are not routinely offered, except for a hot drink. Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 17 Home made cake is prepared each day for afternoon tea, and residents’ birthdays are observed with a special birthday cake. The kitchen was clean and orderly, with appropriate monitoring checks, record keeping and storage. The preparation and service of the lunchtime meal was seen, and the good portions of home-cooked food looked appetising and nutritious. Residents said that they enjoyed their food very much, indicating that it was always of a good quality and quantity. There are a very significant number of residents who require help with feeding here, and in order for staff to attend to this task, a number of the meals tend to get served well in advance of others, making them quite early by comparison. Eating aids are provided in some cases in order to promote the individual’s independence. Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system, with evidence that residents and visitors feel that any concerns they may have are listened to and acted upon. Staff’s understanding of Adult Protection issues, although satisfactory, will be enhanced with further training, and endeavours to promote a safe environment to protect residents from abuse. EVIDENCE: Three survey responses from visitors indicated their lack of awareness of the home’s complaints procedure, but confirmed they had never had cause for complaint. However the written complaints procedure was clearly displayed on the notice board; the contact detail of the Commission was incorrect, showing the NCSC instead of the CSCI. The home administrator resolved to address this straight away. Residents and a visitor confirmed that staff are attentive to them, saying that staff listen, and will do what they can to help them. All, without exception, said that staff would address any concerns and queries. Another relative spoken to outside of the home said that any concerns that the family had raised on previous occasions had been satisfactorily addressed. Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 19 The home has a Whistleblowing procedure in place, which there has been cause for staff to use in recent months; this has been effective to date, although a resolution to some staff disciplinary issues has yet to be fully achieved. The outcome of this is to be communicated to CSCI at its conclusion. There has been some training for staff which covered certain adult protection issues, however a previously issued requirement for all staff to attend specific training on Adult Protection and Abuse of Older Persons is currently in place since the last inspection, and the home manager has sourced this through the local Adult Protection Unit; the training has not yet taken place, and the home is currently awaiting a date from them for all staff to attend. Staff, although hesitant or unaware of the term ‘whistleblowing policy’, were able to say what would constitute abusive practices, and had awareness of the steps to follow if they had any concerns. Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 20 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 the following standard(s): 19 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment at Resthaven, although of variable standard, is satisfactorily maintained and decorated, providing residents with a comfortable and clean place in which to live. EVIDENCE: The home employs a part time maintenance person, but uses external contractors for all major servicing and safety checks of utilities and equipment. Records of maintenance are kept, and staff are able to liaise with the maintenance person when issues for attention arise. The newer part of the home provides good standard accommodation and facilities, with a light, safe, pleasant and purpose built environment for the residents. Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 21 The original part of the home is old, and many areas require upgrading in terms of facilities, particularly bathrooms and toilets, and decoration. The Care Provider already accepts this, and there are plans to address it, although timescales are unclear at this stage, due to their commitment to the improvements carried out in other areas of the home. One written survey response indicated that a repair to a water leak in their relative’s room had taken too long for the home to address on a previous occasion. Builders were present during this visit carrying out works in the new part of the home. There is a ‘contracted out’ arrangement for cleaning the home. This is very successful, as the environment is clean and odour free throughout. There is a good supply of personal protective equipment for staff, with gloves, aprons, liquid soap, sanitising hand gels and paper towels provided. The laundry room is clean and orderly, and has washing machines capable of providing sluice and disinfection programmes for foul linen. There are three sluice rooms, each of which contains a disinfector for commode pans. The home has a clinical waste contract for the segregation and collection of all grades of clinical waste, however two of the sluice rooms do not have a collection bin; yellow collection bags had been placed on the floor. Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Despite some temporary and unavoidable reduction in regular staffing, the provision is adequate to meet the care needs of the residents currently living in the home. The failure by the manager to observe rigorous recruitment practices is placing residents at risk. The arrangements for the induction and development of staff, though good in some areas, are applied inconsistently, which may affect some staff’s ability to have a good understanding of their role. EVIDENCE: A staff rota is maintained, which allows for one registered nurse to be on duty at all times, with seven care staff in the morning, four in the afternoon and evening, and two overnight. At present there is significant agency usage, particularly of nurses, due to the gaps left by some staff who have now left the home. The manager is carrying out nursing duties on some days in an effort to provide some stability and continuity, and provide support to the one remaining daytime Registered Nurse at this time. Catering, cleaning, laundry, maintenance staff, and an administrator provide ancillary support to the care and nursing team. Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 23 Previous divisions and rifts within the staff team appear to be resolving, with staff indicating a positive attitude about their work and working conditions. A small number said that more team building is still needed at this time. Each of those spoken to was well informed about the needs of the residents, and displayed a caring and hard working and committed attitude. Residents, without exception, spoke very well of the staff. Each of those asked, confirmed that staff are always around, and respond promptly to their needs. The majority of written survey responses indicated that the respondents felt there were sufficient staff on duty; one response indicated that the care of their relative had been affected as a consequence of some staff changes, but that this was now better, and that Resthaven was generally a good home. Another respondent said that at times it could be difficult to locate a member of staff, with another indicating their feeling that, in their opinion, more staff are needed on some occasions. There are only three care staff who are qualified to NVQ level 2. There is interest amongst the other care staff to undertake NVQ training. The home does not have its own NVQ assessor, and is currently exploring options to provide this essential training to its care staff. A selection of staff files was chosen for inspection, on the basis of recent recruitment. Records contained application forms, including employment histories, two written references, any necessary medical information, and records of interviews held before appointment. However, there was no direct evidence of CRB and POVA disclosures to inspect, apart from the application numbers, as disclosures were reported to have been destroyed before they could be checked. It was established that CSCI should have the opportunity to access the home’s recruitment procedure in respect of CRB disclosures, before they are actually destroyed in future. In certain cases, the person had previously worked with vulnerable adults in their last position; reasons why they had left that position had not been sought. Any gaps in employment history had not been explored. There were no photographs of workers, and proof of identity had not been kept in each case. A criminal convictions declaration had not been signed in two cases. Documentary evidence of qualifications, although reported to have been seen, had not been kept. Training records show that a range of mandatory and optional training is provided for the staff. Manual handling training is due to be updated, and this is scheduled for next month. Fire safety training has been held earlier this year, and this is updated in between times with the use of a Fire Safety video and fire drills. Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 24 A requirement was issued at the last inspection for all staff to receive Adult Protection and Abuse training; this has been sourced, but has yet to be provided. Compliance with this will be followed up at the next inspection. Arrangements have been agreed in conjunction with the Primary Care Trust for a nurse at the home to gain competencies in specific areas such as venepuncture, management of male or supra-pubic catheters, and syringe drivers, each of which can be needed at the home. Some new staff, who have been recruited from overseas, have received a full and structured induction with an external care training provider, and records confirm they have also had in-house instruction, with competencies assessed. One written survey response raised a concern about some staff members from overseas conversing between themselves in the language of their country of origin in front of residents. Training records for other new staff did not reflect the same level of induction training however, with either nothing recorded, or only a limited checklist having been ticked. Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 25 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are some shortfalls in the management practices of this home, which potentially compromise the well being of the residents. EVIDENCE: Resthaven’s manager has been in post for over five years. She is a first level nurse and has additional qualifications in caring for older people. She has achieved the Registered Manager’s Award with a local college and is registered with the CSCI for her position. The home manager has not carried out sufficiently robust recruitment practices when employing new staff to work with residents, the detail of which is reported under standard 29 of this report. Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 26 There have been previous instances when particular individuals have compromised the team ethos at Resthaven, and this has had a significant impact on the management. As such issues are being addressed, the manager, with the support of the Trustees, is now endeavouring to raise her profile in the home in an effort to reassure residents, visitors and staff and to increase her accessibility to all. As a result of these issues, as part of a quality monitoring exercise and review of the organisational structure of the home, a business consultant has been engaged in order to revise job descriptions for all staff. Despite some surveys being issued to residents and their families as part of a quality monitoring exercise, little progress has been made in terms of collating and analysing results in order to produce an action plan for improvements on this basis. A statutory requirement to do so has not been complied with, and has been issued again on this occasion. The home does not offer residents and relatives the opportunity to have regular meetings at which issues and feedback on services could be raised. As regards to the team and management issues reported above, residents and their families have been invited to contact the Chairman of the Trustees if they wish to discuss anything; some have taken this opportunity. The home is able to offer facilities for secure storage of residents’ money and valuables if this is wanted by anyone, however it is the home’s policy to encourage people to manage their own affairs independently as far as possible. There is only one person who has placed a small amount of money with the home for safekeeping, and there is a written record of this, which the resident or their representative will be asked to sign to acknowledge receipt on its return to them. Further to previously issued statutory requirements and regulatory action by CSCI earlier this year, the rudiments of a formal staff supervision programme were implemented. Unfortunately, the manager has not ensured that a formally recorded system continued to develop. There is no programme or timetable for carrying out a programme of staff supervision. However, in order that care staff receive a degree of supervision during care practice, staff are now allocated in accordance to skill mixes and abilities; this is so that a less experienced member of staff can be monitored by a more experienced member. Staff themselves confirmed this arrangement, but said that they had not had formally recorded supervision for some time. Each of those asked confirmed that they get very good information and guidance during shift handovers. Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 27 There was evidence that health and safety issues are addressed satisfactorily in the majority of areas, with written policies, procedures and risk assessments, provision of necessary equipment and staff training and fire drills. Some staff are currently qualified to provide First Aid. Hot water temperatures at outlets in residents’ rooms in the original part of the home are in excess of safe limits, and pose a risk of scalding injury to residents. There are no documented risk assessments to address this whilst the provision of blending valves is considered by the Trust. Hot water temperatures are checked and recorded only every three months. Appropriately qualified engineers undertake all necessary safety checks and maintenance of equipment and utilities in a timely fashion. All external doors in the building are alarmed and connected to the call system, so as to alert staff to any security problems. A notice at the front door states that doors are locked at 4pm, although this can be later in the summer months. Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 28 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 3 X 2 x X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 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 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 1 X 2 Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 29 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 OP3 Regulation 14(1) Requirement The Registered Manager must complete pre-admission information in full prior to residents’ admission to the home. The Registered Manager must ensure that care plans are written in full, so as to clearly show how residents’ needs in respect of all aspects of their health and welfare are to be met. The Registered Manager must ensure that care plans are regularly reviewed. The Registered Manager must ensure that pressure sore risk assessments are complete and documented in full. The Registered Manager must ensure that care plans contain a manual handling risk assessment for every resident. The Registered Manager must ensure that: • Medications are dated, and not used beyond their expiry date • Handwritten entries on DS0000016559.V291853.R01.S.doc Timescale for action 30/06/06 2 OP7 15(1) 31/07/06 3 4 OP7 OP7 15(2.b) 13(4.c) 31/08/06 31/07/06 5 OP7 13(5) 31/07/06 6 OP9 13(2) 30/06/06 Resthaven Home Of Healing Version 5.1 Page 30 7 OP9 13(2) 8 OP18 13(6) 9 OP26 13(3) 10 OP28 18(1.a) 11 OP29 19 medication administration charts are signed in full by the author. The Registered Manager must devise a written policy and procedure for the management of medications, which is specific to the home. The Registered Manager must provide and ensure that day and night staff receive training in Adult Protection and Elderly Abuse. The Registered Manager must ensure that appropriate clinical waste collection bins are provided in the sluices. The Registered Manager must ensure that NVQ training is provided for care staff, in order that some can be working towards achieving such a qualification. The Registered Manager must ensure the following criteria are met obtained prior to an individual starting work at the Home: • Proof of identity, including a recent photograph. • Details of any convictions or cautions given by a constable. • Two written references, including, where applicable, a reference relating to the person’s last employment, which involved work with children or vulnerable adults, of not less than three month duration. • Where a person has previously worked in a position, which involved contact with children or vulnerable adults, written verification of the reason DS0000016559.V291853.R01.S.doc 30/09/06 30/06/06 31/07/06 31/10/06 31/07/06 Resthaven Home Of Healing Version 5.1 Page 31 12 13 OP30 OP33 18(1.c)(i) 24(1) (2) & (3) why he/she ceased work in that position unless it is reasonably practicable to obtain such verification. • Documentary evidence of any relevant qualifications and training. • A full employment history, together with a satisfactory written explanation of any gaps in employment. • An enhanced Criminal Record Bureau (CRB) clearance and clearance against the Protection of Vulnerable Adults list (POVA). • A statement by the person as to his/her physical and mental health. • Details and evidence of registration with, or membership of, any ‘professional body’. (Previous timescale of 01/03/06 not met) The Registered Manager must 31/07/06 ensure that all new staff receive a structured induction training. The Registered Manager must 31/07/06 devise a system that enables the care and services provided by the home to be evaluated and improved upon, whilst taking into account the views of residents, relatives and other visitors to the home. A report on the above must be submitted to the CSCI and made available to residents/representatives for consultation. (Previous timescale of 01/06/06 not met) The Registered Manager must recommence the formally recorded staff supervision DS0000016559.V291853.R01.S.doc 14 OP36 18(2) 31/07/06 Resthaven Home Of Healing Version 5.1 Page 32 15 OP38 13(4.a) programme, and forward a timetable of proposed supervision dates for all staff to the CSCI. The Registered Manager must ensure that assessments are carried out and recorded for each resident accommodated in rooms where there are no hot water blending valves fitted, so as to assess the risk of scalding injury to the resident, taking any action necessary to reduce the degree of risk identified. 31/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP1 OP7 Good Practice Recommendations The Registered Manager should put an ‘insert’ into the home’s brochure, which advises the reader of access to read the CSCI report in the home. • Care plan reviews should be carried out at least monthly • Daily records should be completed every day in each case. Hand written entries on medication administration charts should be witnessed and signed by a second person. Staff should routinely offer a snack to residents in the evening. The home should have at least 50 of the care staff qualified to NVQ level 2 standard. • The report referred to in standard 33 of the requirements should be produced annually • The home should organise regular opportunities for meetings for residents and their representatives, in order to discuss issues and give feedback on services. Formal staff supervision should be given at least six times each year. • Hot water blending valves should be fitted to outlets DS0000016559.V291853.R01.S.doc Version 5.1 Page 33 3 4 5 6 OP9 OP15 OP28 OP33 7 8 OP36 OP38 Resthaven Home Of Healing • in the original bedrooms Hot water at outlets should be checked for safe temperatures at least every month. Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 34 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Resthaven Home Of Healing DS0000016559.V291853.R01.S.doc Version 5.1 Page 35 - 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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