Inspection on 14/05/07 for Resthaven Nursing Home Limited

This inspection was carried out on 14th May 2007.

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 12/06/06

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 14th May 2007 09:00 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.V332951.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. Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 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 01452 812192 Resthavenhome@AOL.com 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.V332951.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th November 2006 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 £355 to £650 per week. Hairdressing and Chiropody are charged at individual extra costs. Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 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 May 2007. 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 three residents being closely looked at in particular. The management of residents’ medications was inspected. A number of residents and relatives were either surveyed or spoken to directly in order to gauge their views and experiences of the services and care provided at Resthaven. Some of the staff were also interviewed during the course of this inspection. 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, 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 Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 6 Resthaven provides a very pleasantly appointed care home for residents, in a picturesque and tranquil setting. It is reasonably clean, well maintained and safe. The newer extended part of the home has been purpose built, and provides accommodation and facilities for residents at a high standard. Residents are admitted on the basis of an assessment of their needs, and their visitors can expect a welcoming approach from the staff. One relative spoke of the home having a ‘happy atmosphere’. Residents and their relatives generally spoke well of the home, the staff and their care, although there were those who said that ‘some staff were better than others’. Care staff were certainly seen being very attentive to the residents during the course of this visit, and peoples’ needs were being tended to in a timely way. The systems for managing residents’ medications are good, although there remain very isolated aspects of recording that could still do with some improvement. Resthaven provides good opportunities for residents to maintain social contacts, with a varied programme of social activity and entertainment, with regular trips out. The designated activity coordinator knows the residents well and regularly consults with them in a personal and friendly way. There is a stable core group of staff here, despite regular changes among the rest of the group. Core members of this team seemed to know and understand the needs of the residents. Once inducted, staff have access to regular training, enabling them to learn the skills they need for their role. Very isolated gaps in this related to just a few staff not having undergone a recent fire drill and updated adult protection training. Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: It is of some concern that there are some unmet statutory requirements following this visit. There are also some areas of non-compliance arising about which information has been given to the manager on previous occasions. The manager must adopt a more conscientious approach towards achieving the home’s compliance in relation to any shortfalls identified. The home informs prospective residents that they can accommodate their needs verbally, and must now also do this in writing before admitting them to the home. Recording on pre-admission assessment forms should also be fuller. Although there are good arrangements for managing residents’ medications, the manager has made only partial progress towards devising a written medication policy relevant to the home, and has yet to complete this work as was previously required. There was inconsistency amongst the standards of care planning documentation for the residents, despite previous statutory requirements to make improvements. Records generally contained some good risk and overall assessments, with residents’ needs clearly identified. Some records were completed well in relation to how residents’ needs were to be met by the staff, however there were many gaps with this, with no clear direction or planning provided as a consequence of assessed needs. Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 8 Not all aspects of care plans were adequately reviewed either. It must be reported however, that these shortfalls seemed to be in recording primarily, with staff able to meet residents’ needs in practice. Although staff appear respectful in most regards towards residents’ wishes and choices, there are some areas where an improvement could be made. It was mentioned by visitors that television is often turned on too loud, and that residents may not always be consulted about what they want to watch, as children’s programmes were sometimes on. Staff were also observed smoking in the conservatory adjacent to one of the residents’ lounges, and the odorous impact of this was detectable on occasions. The main area of concern regarding residents’ abilities to make choices was in relation to the menus. The menu format is largely inaccessible to residents, and the opportunities for them to select a meal option from it are not available. A number of residents said that they did not know what they were having for a meal until it arrived in front of them. The kitchen was clean and orderly, but there is a hygiene issue with the cook not wearing appropriate clothing such as a catering uniform. Food records must also be recorded more thoroughly and comprehensively. It is accepted by the home that significant parts of it need refurbishment and upgrading; the facilities in the original part of the home are fatigued and very basic. There are plans to address this. Although the home has suitable arrangements to dispose of clinical waste, this does not apply to all types being produced here at the moment, and this now requires some consideration. There are some good, caring staff at Resthaven, but it is fair to report that a number are recruited from overseas on a regular basis, and that this practice not only impacts on reassuring consistency for residents but also poses significant language and communication barriers for them. The home does make efforts in this regard however, with conversational English lessons made available for staff for whom this is an issue. The recruitment procedures in this home have been poor, with serious omissions in implementing them posing risks to residents here. This is another area in which the manager has been given support and information in order to make things better, so it is of some concern that shortfalls have arisen. Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 9 New staff receive induction training, but the programme in use is basic, and the home has so far failed to comply with a requirement to review it so that it can be in line with the National Common Induction Standards for Care Workers. There is a staff supervision programme, but this does not meet the minimum standard for at least six sessions in a twelve month period, and also the home should devise a recording system for planning and monitoring the programme’s implementation. 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. Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 10 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.V332951.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A pre-admission assessment process helps to provide residents with an assurance that their needs will be met in the home. EVIDENCE: In the three residents’ care records that were inspected as part of the case tracking exercise, each had been admitted to the home following an assessment process that had identified their care needs. Written recording by the home’s assessor however, was done in a brief way, with minimal detail, and some sections incomplete. Despite this, pre-admission assessments were supported by a good degree of information provided by other health and social care professionals previously involved in the care of the individual. Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 12 The home confirms being able to accommodate a person’s needs verbally, but does not provide written confirmation of placement offers following assessment, as is required. Resthaven does not provide intermediate care. Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The majority of the care planning documentation needs much improvement if it is to adequately provide staff with the written information they need to meet residents’ health and personal needs. Despite this shortfall there is knowledge and understanding among the staff in relation to individuals’ needs. The systems for managing medications are generally good, with appropriate safeguards for the protection of residents. Efforts are made by staff to promote the privacy and dignity of the residents. EVIDENCE: Residents have their own personal care records, referred to as their care plan. Five were selected for closer scrutiny, as part of the case tracking exercise. Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 14 The needs of each person had been identified using a variety of assessment tools, including risk assessments. The Activities of Daily Living Assessment identified very specific needs of each individual under a series of headings. Due to a subsequent range of tick boxes under each heading, these assessments did provide some degree of guidance for staff in relation to what was needed in order to care for the individual. However, there were no specifically drafted plans of care that provided clear guidance for staff regarding the aspects of care needed to meet their needs. Using observation and by talking to residents and staff during the case tracking exercise, there was evidence that care was being delivered appropriately in relation to the needs that had been seen on assessment. The meticulously hand written admission notes for one particular resident provided good clear information for staff in relation to the individual’s health and personal needs. Assessments contained reference to whether the person had a history of falling, but in some cases there were no specific risk assessments recorded in this regard, whilst others contained very good risk assessments and plans to manage the risk of falls. Risk assessments for the use of bed rails was in place. Risk assessments for developing pressure sores were recorded for all residents, and where risks were identified, the appropriate support equipment had been introduced, and the appropriate medical interventions had been sought. Again though, none of this was recorded within a specific plan of care, apart from brief references to such issues on assessment forms. There were good, detailed risk assessments for any nutritional needs and moving and handling needs, and residents were regularly weighed. Continence assessments had been carried out where needed, and at least one of these was seen directly. Appropriate equipment had been provided and was in use, but again as before, recorded care planning to support this was missing. In one particular case, the resident was at serious nutritional risk, and although special dietary considerations were in place with appropriate medical interventions previously sought in this case, the risk assessment had not been reviewed for several months, and there was no food-monitoring chart in place. The risk assessment for the use of bed rails for this person had not been reviewed for over two years. Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 15 One resident required a significant amount of wound management for ulcers in relation to their medical condition and due to pressure sore vulnerability. There were clearly written and informative plans of care to provide clear guidance as to how to provide the necessary care and interventions; records confirmed there had been regular medical consultations in this case, with good access to a range of community health care services. Other care plans were seen to address very specific health needs, and these had been drafted meticulously, and were under regular review. The system for handling residents’ medications is safe and well managed in the main, with appropriate storage and records. There is no readily accessible, specifically written medication policy for this home, despite one having been required at the previous inspection, although there is now one in draft format near to completion; a copy of this is required by CSCI following this inspection. Residents are able to self-medicate if they wish and are able, but there is noone currently opting or able to do so. It is important when this arrangement is undertaken, that it is on the basis of a documented risk assessment for the individual, which is recorded in their care plan. There are clearly printed Medication Administration Records from the supplying pharmacist, which are thoroughly recorded by the staff. Staff have failed to comply with a previously issued requirement for hand written entries on charts to be signed in full by the author; it is also further recommended that a second person sign such entries as a witness. Stock is well controlled and is dated when opened. There was one item in the drug refrigerator which had an illegible pharmacy label; the nurse agreed to get this replaced as soon as possible. Three random audits were carried out on three medications, and in each case there were no discrepancies noted at all. There are appropriately detailed records for receiving and disposal of all types of medication. The home has the proper arrangements for the collection of disposed drugs by a licensed contractor. Residents themselves spoke of good care from the staff, although a small number said that ‘some staff were better than others’. Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 16 One frail resident said that one of the male carers had hurt her that morning, by being a ‘bit rough’ when helping her change position. She said that this worker had ‘done things better afterwards’, when told about it. Residents’ needs seemed to be met in a timely way during this visit, although isolated survey responses said that residents are ‘sometimes kept waiting if carers are busy elsewhere when they ring for help’. Carers were observed being very attentive to residents, and were certainly heard being respectful towards them. Care was delivered in the privacy of individuals’ bedrooms, and there was due regard for residents’ dignity throughout this visit. Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resthaven provides residents with opportunities to participate in a social activities programme according to their choice, and ensures that they can keep close contact with their families and friends. Although the quality of food is good for the residents, the way in which the menus are planned and selected does not allow for them to make sufficient choices. EVIDENCE: There is a good emphasis on providing opportunities for residents to engage in social and recreational activities. The home employs a designated activities coordinator, who is enthusiastic about the role, and who knows the residents well. Residents and visitors commented that there is a good variety of social activity, and that it is well organised. Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 18 There are regular trips out, although inevitably sometimes the numbers that can attend may be limited, and there is regular entertainment. Residents’ views and ideas for social activities and things that would be of interest to them have been sought and considered. Records of events and activity are maintained. An organised activity is usually held in the lounge of the original part of the home, although the activity coordinator crosses to the new part of the home to see if there are any residents there who would like to come across to join in; very few seem to though. She also goes across to the new part of the home to spend some quality oneto-one time with certain residents in the afternoons, reading or chatting to people where wanted. Other than that residents were seen spending time quietly, either in the lounges or in their rooms watching television or resting. Some of the care staff were present in the new lounge, and although often occupied in miscellaneous non-care tasks in the integral kitchenette, were providing some social contact with the residents in there. Visitors are free to visit this home according to their wish, and there are no restrictions placed upon them. They are encouraged to join in the life of the home if they wish, and open invitations are issued in the event of any social occasions. One written survey result said that Resthaven generally had a happy atmosphere. One visitor who was spoken to in person said that he was made to feel very welcome here, and that he was regularly invited to stay to have a meal with his wife if he wanted it. Information notices were displayed on notice boards for people, and these included information about a variety of funding arrangements and support agencies such as advocacy organisations, which may be of particular interest to some. Some residents were much frailer than others, with some being cared for in bed, and many being very reliant on staff in every way. None the less, staff were heard offering choice to people in a variety of ways, with respect shown towards individual wishes. Residents’ bedrooms appear individual to some degree, as residents are enabled to introduce their own treasured items in order to make them more personalised and homely. Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 19 However, one resident said that in her experience, although most of the staff were very nice, she had little opportunity for choice, with little say about when she could have her hair washed and no say over what food she ate. One survey response said that the communal televisions were often on very loud, and that sometimes were tuned to children’s programmes, which of course would not be appropriate for most people. Staff were observed using the conservatory adjacent to one of the residents’ lounges to take their breaks, and were smoking in there. The effects of this could be detected occasionally in the lounge where residents were sitting, and is not acceptable. This will become even more of an issue when the new Smoking Regulations come into force in July of this year. Weekly menus are devised, and there is one day each week when a resident can decide what the menu will be for everyone. Apart from this, there is very little choice on it. It was also noted that there are many abbreviations on the menu, which could make what is actually on it very difficult for some to understand. A breakfast menu does not feature, although from other recorded information it was clear that residents could choose from hot and cold options, but usually only on one day of the week. Lunch is one main meal, with a vegetarian option indicated, and there is one pudding. Supper options were not shown, with only a hot option for those residents needing a soft or blended diet indicated. On further investigation it appeared that residents are offered a choice of food from a supper trolley, and that this includes an array of sandwiches, hot soup and a pastry-based item. However, this was the same every evening and did not vary. Residents said that they never knew what lunch was going to be; they are never consulted, and do not have the chance to choose from a menu. A visitor also made this observation. In contrast, one visitor survey said that the cook was very good at catering for her relative’s personal preferences. When interviewed, the cook certainly seemed aware of individuals’ likes and dislikes, and certainly demonstrated an eagerness and intent to provide people with what they wanted. The service of the lunchtime meal was seen in each area of the home. The meal was served to residents in the dining room, with some needing to be fed in their rooms. Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 20 Staff were sitting to eat with the residents, although they did confine themselves to one table and did not mix with the residents as such. The food was transported from the kitchen in the original part of the house to the dining area in the new part, whilst contained within large plastic insulated boxes. Although this presentation is not ideal, and a heated trolley would be much more preferable, the plated food when removed from the boxes was hot. The food looked wholesome and nutritious and was well presented on the plates. There was a hot diabetic pudding available, although some staff expressed reservation about whether there was always sufficient choice for diabetic puddings. Staff were wearing aprons to serve the meal, as was the cook. However, apart from this, it was noted that the cook wears civilian clothes, and does not have a catering uniform. The kitchen was very clean and tidy, and food was hygienically stored. Catering records were maintained, although it was noted that there were some gaps in the necessary food safety control measures. This seemed to be due to a failure in monitoring and recording refrigerator and deepfreeze temperatures, and not recording certain aspects of the cleaning schedule as she should. It was also clear that judging from the foods that are served, at supper in particular, food records are not fully maintained as is required, as there was no record of all that had actually been served. Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 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 system for dealing with complaints, with evidence that the majority of people feel any concerns they may have are listened to and acted upon. The home’s Adult Protection policies help to provide a safe environment for the residents. EVIDENCE: Resthaven has a clearly written procedure for dealing with any complaints or concerns that are raised, a copy of which is displayed in the entrance hall of the home, and is provided to each resident and their representatives in the home’s information brochure. There is a system for recording any complaints, with specifically designated records, and at the time of this visit there were none to inspect as none have been received. Residents and visitors all confirmed that staff were helpful and receptive to any concerns raised, and would do anything they could to help. Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 22 However, there were isolated opinions that whilst most staff would listen and act on concerns raised, there were certainly others who were less helpful in this regard. The home has written policies and procedures for the protection of vulnerable residents, and has provided training in abuse and adult protection for the staff. However, there are still at least six carers who, although had received some inhouse instruction in this area, had still not attended a formal training course. The manager agreed that these people were still to have more structured training, and that she would access a course in the immediate future. Staff spoken to during the visit confirmed they had had adult protection training, and were confident in this area. The home has staff disciplinary procedures to address issues of concern, poor performance and poor practice, but there have been none carried out recently. Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Despite some areas of concern in relation to the originally built and older part of the home, Resthaven provides a reasonably maintained, clean and safe environment for the residents. EVIDENCE: Resthaven comprises two areas, one of which is the original older part of the home, the other is a purpose built new part. The newly built part provides accommodation and facilities to a high standard. The original building provides more basic accommodation, with communal bathrooms and toilets in particular being very bare, and would benefit greatly from upgrading. This is accepted by the home, and there are definite plans to address this in an ambitious phased refurbishment programme. Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 24 Since the last inspection some items of new furniture, including chairs, beds and commodes, and hoisting equipment have been purchased, and certain areas in the original building have been redecorated. The exterior is currently being redecorated, with remedial action being taken to address any breaches in external wall coatings; this has become of some importance, as there continues to be a noticeable damp odour around the ground floor lounges, with visible damp penetration on the corridor wall near to the lounges. The home uses regular contracted cleaners, and generally the environment is kept quite clean and hygienic. The new part of the home is immaculate, whilst the older part is slightly more challenging to keep clean. Survey responses from residents and visitors said that the home was kept clean in their opinion. The laundry room was clean and organised, and appropriate infection control measures were in operation there. There were plenty of hand washing facilities, with liquid soaps, paper towels and sanitising hand gels. Staff were provided with aprons and gloves to use whenever needed. The home has a contract for the disposal of certain grades of clinical waste, but does not have a contract for the disposal of soiled wound dressings, and is currently producing such waste. It was explained to the manager, that incontinence waste (grade E) requires a different method of disposal than that of wound waste (grade A), and both are currently being disposed of in the same way, using the same waste bags. Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing provision is adequate to meet the needs of the residents currently living in the home. The standard of vetting and recruitment practices for new staff has not been carried out robustly, and has left residents at risk. Despite some improvement needed to the quality of the induction programme, staff are generally encouraged to train and develop in order to learn the necessary skills for their role. EVIDENCE: There is a stable core group of staff at this home, whilst other members of the team are ever changing. Qualified nurses have been recruited from overseas, and these people undergo a nursing adaptation course whilst in the home, receiving mentorship from the manager in order to gain registration as a nurse in this country. A significant number of carers are also regularly recruited from overseas, and because of this there are certain language barriers that unfortunately exist between residents and staff. This was not only evident from speaking directly Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 26 to residents and visitors, but also featured in survey responses, and was witnessed directly by the inspector. The manager has sourced language support courses for these staff from a local college, and ‘pairs them up’ for working with other staff for whom communication is not an issue. Despite this, there seemed to be some very nice, caring and committed carers. Staff were deployed between each area of the home, and apart from isolated comments about residents sometimes having to wait a while before their call can be answered by staff, residents’ needs were being met appropriately. There were occasions when residents were unattended in lounges, and particularly whilst in their rooms. Residents and visitors spoke very well of the staff group in the main, but did have reservations about certain unidentified members who were ‘not as good as others’. The home has made good progress towards getting as many care staff as possible, to qualify with a National Vocational Qualification (NVQ) level 2. There are currently three carers already qualified, with another seven carers just completed the award. One other carer was being signed up to do the training. The home has judged qualified nurses recruited from overseas, who are working as carers whilst on the adaptation course to nurse in this country, as having an ‘equivalent’ qualification. After viewing these peoples’ applications the inspector made clear that they could not be judged as ‘equivalent’, as their training and experiences had been very clinical, and were not based on social care. The random selection of four newer staff recruitment files showed that the procedures for carrying out the required pre-employment checks on new staff had not been adhered to robustly at all, and that some risks had been posed to residents because of it. Application forms had been received in each case, and these included an employment history. There were no records of interviews, with the exception of one case, so it was not possible to assess whether any gaps in work history had been explored. The applicants, despite the application form asking for it, had not completed criminal conviction declarations, as is required. None of the records contained evidence that a written statement had been sought from the applicant regarding their physical and mental health, apart from a question about any disabilities. Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 27 Proof of identity, plus a recent photograph was on file for each person. Written verification of why they had left their last employment had been sought and obtained on a reference. Proof of qualifications had been sought, and had been held on file. In two cases there was only one written reference on file instead of the required two, and in the other two cases the references appeared to have been written by work colleagues, but described as ‘friends’; this puts a degree of doubt on their authenticity. Criminal Records Bureau (CRB) disclosures had been obtained at the correct level, and these included a check against inclusion on the Protection of Vulnerable Adults (POVA) list. Each of these workers had commenced working in the home ahead of the receipt of the full CRB disclosure, and a POVA First check had been carried out. However, it is of serious concern that the POVA First check had not been done on any of the workers prior to them actually starting work, and this decision had placed residents at significant risk, and was in direct contravention with regulations and Department of Health guidance. Records of training for staff were available, and recent training has included a range of mandatory and optional courses that are appropriate for staff to learn and understand their role. External training providers are brought in to deliver appropriate training for staff, and the home is currently taking part in an ‘End of Life’ project, with six staff participating in extended training and learning in care and best practice of residents at the end of their life. New staff receive induction training, but the programme is basic and has not been reviewed so as to be in line with the National Common Induction Training Standards for Social Care Workers devised by Skills for Care, as was required following the last inspection. Staff have been provided with the General Social Care Council Code of Conduct, and should now be encouraged to maintain their own personal and professional portfolio. Staff said they had received good support from other experienced staff, and were working in a supervised way. The identity of a new worker’s supervisor is identified on the daily work allocation sheet. Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 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 safety and interests of the residents in certain areas. EVIDENCE: The manager has been managing this home for over six years, is a registered nurse, and has achieved the Registered Manager’s Award. She has been registered by CSCI for her role. It is of concern that the management decisions taken during recruitment of new staff have not been robust, and have been in contravention with Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 29 regulations. Such decisions have posed a degree of risk to the residents living in the home. This particular issue of concern will remain under closer scrutiny from CSCI. Questionnaires are very occasionally distributed to residents and visitors, in order that the home can assess the quality of its services. The most recent of these focussed purely on social activities, with the previous one, over one year ago, focussing on food and catering. Sourcing peoples’ views in this way does not happen very regularly, but there are other more informal methods used, such as conversations with staff, in particular the experienced activities coordinator, who then feeds back any points to the manager. Residents’ meetings do not take place in a group sense. There is reported to be an ‘open invitation’ issued to residents and their families to attend Resthaven’s Annual General Meeting, but rarely do any take up this opportunity. Recorded minutes of the regular Resthaven Partnership meetings were seen, and these demonstrated that issues of quality are discussed with the staff, and that any actions for improvement are identified. The Registered Care Provider conducts regular unannounced visits to the home, and carries out monitoring checks on the standards here, which also takes into account the views of the residents; a written report is compiled on this basis. Because of the failure in this home to carry out the required pre-employment checks on new staff, as part of this process the Registered Care Provider will now be required to incorporate in their report a review of any new recruitment process that has taken place in the home, as any new staff have been employed. They are also required to provide a copy of each monthly report to CSCI from now on. Safe facilities are available for those residents wishing to place money or valuables with the home for safekeeping. There were two residents who had chosen to do this, although records showed that the balance had remained the same for some considerable time, with no transactions carried out on their behalf. The record book kept for these arrangements was very basic and rudimentary, and advice was given that in the event of transactions, full and detailed records with receipts are kept, and that two signatures are recorded. A sample of an old record showed that residents or their representatives have signed to acknowledge return of their money, as is required. Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 30 The manager has made progress to implement a staff supervision programme, as this was another area that required improvement. Staff have received formal supervision, and are due to attend another session soon. There is no matrix or recorded plan for this programme, and keeping one of these would assist the manager in planning and monitoring the programme. On current performance staff will not be receiving the recommended standard of at least six formal supervision sessions in a twelve month period. Health and safety issues are addressed in this home, with written policies, procedures and risk assessments and provision of necessary equipment. An outside consultant is assisting the home in relation to its Fire Safety risk assessment, and is looking into issues pertaining to the environment generally, and to staff training. Staff have received Fire Safety training, which encompassed the home’s procedures, and so far this year there has been one practice fire drill. This has not involved night staff, and this must now be addressed. Staff have received training in First Aid, and there are now eight staff with a First Aid qualification. Accident records are maintained, and the manager reviews each incident. All necessary safety checks and maintenance of equipment is undertaken in a timely fashion, and meticulous records are kept in these areas. Electrical safety was assured as part of the new building, and upgrading to electrics in the old part will take place during the planned refurbishment. Control measures are in place for the risk of Legionella, and water sampling has recently taken place. Checks or risk reducing measures have not taken place on the cold water storage. Hot water at outlets is blended in parts of the home to ensure safe temperatures for the residents. However as before, the remainder of outlets not blended in the old part will be addressed during the planned refurbishment. In the meantime risk assessments have been carried out on each individual for whom this may be a concern, and hot water warning signs are displayed where necessary. Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 32 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.d) Requirement Timescale for action 30/06/07 2 OP7 15(1) The Registered Manager must confirm in writing that the home is able to meet a prospective resident’s needs, once an assessment has been carried out. The Registered Manager must 30/06/07 ensure that care plans are written so as to clearly show how residents’ needs in respect of all aspects of their health and welfare are to be met, including all needs identified on activities of daily living assessments and risk assessments. This requirement has been repeated from the last inspection. 3 OP7 15(2.b) 4 OP9 13(2) The Registered Manager must ensure that all care plans and risk assessments are regularly reviewed, with the outcome of such reviews documented in the care plan. The Registered Manager must ensure that: Handwritten entries on DS0000016559.V332951.R01.S.doc 30/06/07 30/06/07 Resthaven Home Of Healing Version 5.2 Page 33 medication administration charts are signed in full by the author. This requirement has been repeated from the last inspection. 5 OP9 13(2) The Registered Manager must devise a written policy and procedure for the management of medications, which is specific to the home. A copy of this completed policy must be supplied to CSCI. This requirement has been repeated from the last inspection. 6 OP14 OP15 12(3) 16(2.i) The Registered Manager must ensure that a varied choice of food is offered to residents, in order that they can exercise choice and the home can take into account their wishes. The Registered Manager must ensure that records of food are kept, which contain sufficient detail to determine the diet is satisfactory in relation to nutrition and special diets. The Registered Manager must ensure that the cook wears suitable clothing in the kitchen in the interests of hygiene, and in order to prevent any infection control risks. The Registered Manager must inform CSCI of the arrangements and planned date regarding delivery of POVA training for the remaining staff who have not yet attended a formal session. The Registered Manager must make arrangements for the safe disposal of all grades of clinical waste produced in the home; This is with particular reference DS0000016559.V332951.R01.S.doc 30/06/07 30/06/07 7 OP15 17(2) Schedule 4(13) 30/06/07 8 OP15 13(3) 31/07/07 9 OP18 13(6) 30/06/07 10 OP26 16(2.k) 30/06/07 Resthaven Home Of Healing Version 5.2 Page 34 11 OP29 19 Schedule 2 12 OP30 18(1.c)(i) to the wound dressings waste that is currently being produced. When recruiting new staff the 30/06/07 Registered manager must ensure the following are obtained: • The reasons in writing for any gaps in employment history • A signed criminal Convictions declaration from the applicant • A statement as to the physical and mental health of the applicant • Two written references, and be satisfied as to their authenticity • A POVA First check before starting work, in cases where a worker commences work pending receipt of a full CRB disclosure. The Registered Manager must 31/08/07 ensure that induction training incorporates the Common Induction Standards for care staff. This requirement has been repeated from the last inspection. The Registered Provider must 30/06/07 compile written reports required under this regulation that include a review of the recruitment process for any new staff, and provide such reports to CSCI every month. The Registered Manager must 31/07/07 ensure that all staff, including night staff, receive fire safety training on a regular basis, which must include regular fire drills. The Registered Persons must 31/07/07 consult with the appropriate authority regarding Environmental Health issues DS0000016559.V332951.R01.S.doc Version 5.2 Page 35 13 OP33 26(5.a) 14 OP38 23(4.d.e) 14 OP38 23(5) Resthaven Home Of Healing regarding the Legionella controls necessary for cold water storage tanks. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP3 OP7 OP8 OP9 OP15 Good Practice Recommendations Consideration should be given to recording pre-admission assessment forms in full detail. Consideration should be given to reviewing all parts of care plans every month. Consideration should be given to maintaining foodmonitoring charts in cases where a concern is identified. Consideration should be given to hand written entries on medication administration charts being witnessed and signed by a second person. Consideration should be given to: • Purchasing a hot trolley for the serving of hot food • Devising menus that are written in a format that is accessible and understandable to all. Consideration should be given to having at least 50 of the care staff qualified to NVQ level 2 standard. Consideration should be given to maintaining a written record of the interview process when recruiting new staff. Consideration should be given to having residents’ meetings on a regular basis. Consideration should be given to: • Staff supervision being given at least 6 times each year • A matrix being devised to plan and monitor the progress of the programme. 6 7 8 9 OP28 OP29 OP33 OP36 Resthaven Home Of Healing DS0000016559.V332951.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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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