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Inspection on 08/05/08 for Resthaven Nursing Home Limited

Also see our care home review for Resthaven Nursing Home Limited for more information

This inspection was carried out on 8th May 2008.

CSCI found this care home to be providing an Adequate service.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Resthaven offered a welcoming and relaxed atmosphere, and provided a homely and clean environment for the residents. The more recently constructed part of the home has been built and equipped to a good standard, providing easily accessible, light and spacious accommodation. We saw that residents benefited from positive relationships with the staff, with many saying that staff were caring, helpful and kind. The home did not impose any restrictions on visitors to the home, and many visitors confirmed to us that they felt welcome here and were happy with the standard of care their relative was receiving. We saw evidence of medical reviews and healthcare being appropriately sourced, and there were many examples seen of residents receiving good care and support. In the main staff remained mindful of residents` privacy and dignity, and also of their choices as much as possible. We found they demonstrated a good awareness of individual residents` needs, and those spoken to directly appeared a caring, motivated and interested team. They were very aware of the rights of the residents and also of the complaints and safeguarding procedures to protect the vulnerable residents in their care. Residents themselves told us that they felt safe here and had faith and trust in the home. The competence of the staff group was being developed through a structured induction-training programme, although the manager was still pursuing ways to improve the overall standard of this training so that it met the national common induction standards, as had previously been required. We found ongoing staff development being promoted through regular training in topics relevant to the needs of the residents, including the National Vocational Training (NVQ) programme for care workers.

What has improved since the last inspection?

The home had worked hard to meet the large number of statutory requirements that were issued at the last key inspection, with just one exception, which had to be repeated on this occasion. Staff have been working closely with the Care Home Support Team (CHST) in order to consider and develop ways to improve the quality of the care they provide to residents. The home had recognised that there was room for improvement with the residents` social activity programme since the previous activities coordinator had left. It had successfully addressed this with a new appointment to this role, and this person appeared enthusiastic and committed to improving the social aspects of residents` lives. We found catering to be better, with menus reflecting a greater degree of choice for people. Many residents told us that the standard of food was good, with one saying that things had improved in this area recently. Nutritional risk assessments had been recorded for each resident, and the cook had attended relevant training to meet the needs of the residents living in the home. Changes had been made to the home`s fire safety procedures and level of staff training so as to incorporate evacuation procedures, and to promote the safety of the residents.

CARE HOMES FOR OLDER PEOPLE Resthaven Home Of Healing Pitchcombe Nr Stroud Glos GL6 6LS Lead Inspector Mrs Ruth Wilcox Unannounced Inspection 8th May 2008 08:30 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.V359818.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.V359818.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.V359818.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th May 2007 Brief Description of the Service: Resthaven is situated in quiet countryside overlooking the surrounding valley. The home completed a major new build and part refurbishment in 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, which is used for prayer and worship. At the front and side of the building there is ample car parking, and access for wheelchair users. 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 the basic local authority rate of £342 up to the private nursing rate of £710 per week. Hairdressing and Chiropody are charged at individual extra costs. Resthaven Home Of Healing DS0000016559.V359818.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. 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 2008. 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. Survey forms were issued to a number of residents, visitors and staff to complete and return to CSCI if they wished. A number chose to respond, and their comments have informed this report. Some residents were also spoken to directly in order to hear their views and experiences of the services and care provided at Resthaven, and 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 safeguarding the rights of vulnerable residents were inspected. The arrangements for the recruitment, training 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. This home was also considered as part of a Commission for Social Care Inspection’s Thematic Probe inspection into safeguarding vulnerable adults. We required an Annual Quality Assurance Assessment (AQAA) from the home, which was provided, the contents of which informed part of this inspection. Resthaven Home Of Healing DS0000016559.V359818.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The home had worked hard to meet the large number of statutory requirements that were issued at the last key inspection, with just one exception, which had to be repeated on this occasion. Resthaven Home Of Healing DS0000016559.V359818.R01.S.doc Version 5.2 Page 7 Staff have been working closely with the Care Home Support Team (CHST) in order to consider and develop ways to improve the quality of the care they provide to residents. The home had recognised that there was room for improvement with the residents’ social activity programme since the previous activities coordinator had left. It had successfully addressed this with a new appointment to this role, and this person appeared enthusiastic and committed to improving the social aspects of residents’ lives. We found catering to be better, with menus reflecting a greater degree of choice for people. Many residents told us that the standard of food was good, with one saying that things had improved in this area recently. Nutritional risk assessments had been recorded for each resident, and the cook had attended relevant training to meet the needs of the residents living in the home. Changes had been made to the home’s fire safety procedures and level of staff training so as to incorporate evacuation procedures, and to promote the safety of the residents. What they could do better: We found that the standard of pre-admission assessment was not consistent and was in places superficial in terms of detail. This posed a risk of residents’ needs not being properly identified so to ensure that this home would be the right place for them. There had been significant improvements in the standard of documented care planning, with staff having received training and support in this area from the CHST. However we found some significant recording omissions in some of them that could pose a degree of risk to the residents concerned if not completed fully. The medication systems were generally well managed, but some isolated aspects of associated recording require closer attention to detail. Some residents and visitors commented on the communication difficulties they were experiencing with some of the staff that this home recruits from overseas. We saw evidence of an improved recruitment procedure being implemented, however the home had failed to provide a relatively new worker with adequate supervision whilst awaiting the return of their full Criminal Records Bureau disclosure. Resthaven Home Of Healing DS0000016559.V359818.R01.S.doc Version 5.2 Page 8 We found that the home had a system for monitoring the quality of its services, which took account of the views of the residents and their families, however there were some who told us they would like to see an improved level of management communication. The original part of the home has yet to be upgraded, although the Trustees acknowledge this, and have definite plans to carry out this work. Following certain safety breaches identified by the Fire Safety Officer there are some fire safety issues still to address at the time of this inspection. 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.V359818.R01.S.doc Version 5.2 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.V359818.R01.S.doc Version 5.2 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. 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. Shortfalls in the pre-admission processes have meant that people living in this home cannot be fully assured that the home will be able to meet their needs. EVIDENCE: The manager routinely carries out assessments on prospective residents prior to their admission to the home, and an example of one such assessment was seen. The assessment had apparently been conducted at the person’s previous location, but was undated, unsigned, and contained only superficial details, with additions apparently made at a later stage. Despite this, comprehensive admission notes had been made in the daily records when the person came into the home, which were informative to staff. Resthaven Home Of Healing DS0000016559.V359818.R01.S.doc Version 5.2 Page 11 Caring for this person, particularly in terms of promoting their safety, was proving a challenge for the staff, and there were concerns that the placement here was not going to be entirely appropriate. The manager stated that there had been an agreement with the placing authority and the family that the placement would be based on an initial trial period, and that this was due for review. A second assessment had not been completed by the manager, but reportedly by one of the home’s nurses, and it was unclear when, how and exactly by whom this had been carried out, or that it had been done prior to admission. Furthermore it was not clear whether this person had had a needs assessment done initially by the local authority either. The manager stated that new pre-admission assessment forms were to be implemented, and that these would be an improvement on the existing assessment tools in use. Evidence of confirmation of placement letters being issued was seen in some files. Resthaven does not provide intermediate care. Resthaven Home Of Healing DS0000016559.V359818.R01.S.doc Version 5.2 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. 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. People living in this home have their health and care needs met in a way that is mindful of their privacy and dignity and through a mostly well managed system for administering their medications, although gaps in recorded care planning are posing a small degree of risk in this regard. EVIDENCE: Each resident had their own personal plan of care that had, in the main, been drafted on the basis of an assessment of their needs. Overall there had been a lot of improvements in the standard of assessment and care planning, but there were some plans that were superficial and did not exactly match the needs of the person. In one case a resident had been assessed as having mental health issues, and although these seemed to be taken into account there were no recorded plans of care to address this particular need. Resthaven Home Of Healing DS0000016559.V359818.R01.S.doc Version 5.2 Page 13 In the same case the person was assessed as being at risk nutritionally, and had lost a small amount of weight. There was no recorded plan of care to address this, although staff were mindful of her needs in practice. Assessments were recorded in each case to identify the degree of risk residents were at from falls, developing pressure sores, nutritional issues and manual handling. In two particular cases some of the assessments had not been reviewed for some time. One of the pressure sore risk assessments had not taken account of all the inherent risk factors, which actually would have resulted in a higher risk factor being identified. In the other case the pressure sore risk assessment had not been reviewed for many months, and this person was receiving care for a sore area that had developed due to pressure. Appropriate support equipment had been provided, but the wound care plan was not currently reflective of the pressure area care plan. In another case the care plan was well drafted to meet all the person’s needs, and had been regularly reviewed. Consideration had been given to some significant risk factors, with staff receiving good direction to take account of these. The home had been working in conjunction with The Partnership for Older People Project (POPPs), with a view to supporting staff in implementing more effective care planning. However certain shortfalls remained in some of the documented care planning that will continue to need further focus to improve. In practice staff were observed being attentive to residents and efficient, and knew how to meet their needs. Equipment was provided in accordance with assessments, and there was evidence of multi disciplinary working with other healthcare professionals to meet the needs of the residents. Residents who responded to surveys or who were spoken to in person all confirmed without hesitation, that staff were kind, caring and considerate. Some said that they ‘felt well looked after’. Nearly all of the relatives who responded to surveys confirmed their satisfaction with the care their relative received, with comments received such as; ‘there are professional standards of care shown to my mother’, and ‘my relative is fond of the patient and caring staff here’. Another person said that their relative’s mental health had improved since coming here. Four of the visiting health care professionals to the home responded to surveys, and each was very positive about the care they had witnessed and experienced in the home for their patients. Two general practitioners said that Resthaven Home Of Healing DS0000016559.V359818.R01.S.doc Version 5.2 Page 14 ‘good care was provided’, and there was ‘good communication between the home and the surgeries’. The home confirmed that it had supported some residents to manage their own medications in the past, and that this had been within a risk management framework, however there was no-one currently able or wanting to do this. Medications were being supplied to the home each week by the pharmacy, the majority of which were in a monitored dosage system. All medications were securely stored. Scheduled drugs were appropriately stored, checked and recorded. There were appropriate contractual arrangements for the disposal of unused medication. Medication administration charts were clearly printed, and in the main were fully recorded by the staff. One administration gap was identified, and in some cases the amount of variable dosages was not recorded when administered. Hand written entries were signed in full by the author in most cases, although this was not entirely consistent. Three random audits were carried out on some boxed medications, and in two cases there was a slight discrepancy, with one tablet left in excess of what there should have been on that date. This could not be fully explained at the time, but it was thought to be a dating issue when the box was actually opened and first used. The home stated that the Care Home’s Support Team Pharmacist was currently reviewing all of the residents’ medications in collaboration with the general practitioners. Staff were seen as being polite and considerate with the residents. Each appeared mindful of residents’ dignity, although one resident was seen being hoisted in a manner that did not protect her dignity completely throughout the manoeuvre in the lounge. One relative said they were ‘amazed by the consideration shown towards residents’, and that they had ‘never seen any resident treated with disrespect’. Another commented that ‘encouragement was shown to residents, but that their privacy and choices were always respected’. Resthaven Home Of Healing DS0000016559.V359818.R01.S.doc Version 5.2 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. 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. People living in this home have the opportunity to remain socially active, exercise choice, and have a nutritious diet that offers choice and variety. EVIDENCE: The home had only recently appointed a new social activities coordinator, after a period without one. Some of the residents and their relatives had noticed a decline in the provision of social activities during that period, however the new coordinator was enthusiastic and committed to driving improvements for the benefit of the residents in this area of their lives. Residents had been consulted about their ideas and interests, and new records were being phased in to demonstrate this. A newsletter was being produced, and there was a variety of photographic evidence available of organised social events and activity that had taken place recently. Resthaven Home Of Healing DS0000016559.V359818.R01.S.doc Version 5.2 Page 16 The activity programme showed a good range of activity was being developed that residents could participate in if they wished, but this depended on individuals’ choice. Some elected to remain in their room, watch television, listen to the radio or read their newspaper on this day. One lady was helped to pursue her particular interest in knitting, whilst others played a game of bingo. At one point it was noted that the television and the radio were both playing in one of the communal lounges, which was not ideal and was distracting. The coordinator appeared mindful of individual abilities, and sometimes provided social opportunity on an individual basis as well as on a group basis. One relative said that he would like to see large print reading books available, whilst another said the home should provide more opportunity socially for those with specific mental health needs. Another said that staff ‘encouraged their relative to remain socially active’. A resident said that ‘activities were great fun’ and that the coordinator ‘does really well’. Seasonal events and special celebratory dates were being observed, and there were regular religious services in the home’s integral chapel. Regular outings were organised. Apart from a recent brief period when visiting had to be restricted for valid reasons on health grounds, restrictions were not imposed on visitors, and they were welcomed into the life of the home. This was confirmed by a number of people, with some regular visitors making comments such as ‘the staff are friendly’ and ‘there is a family atmosphere’. One person said that he ‘visits every day, feels welcome and enjoys good relationships with the staff’. Residents’ choices were being observed and respected, with people largely spending their time how they chose, and with regards to their meals and drinks. They had been supported to personalise their own room with their own belongings. One resident said that ‘I’m free to choose what I do’, whilst another said that ‘the staff are well mannered and offer me choices. No one dictates to us’. The breakfast and lunchtime meal was observed, and appeared to be of good portion size, nutritionally balanced and appetising. Where necessary some were being assisted to eat and drink by staff. Residents spoke favourably about the quality and quantity of food, with some saying they had a good choice. One said they ‘would like more fruit’. Another resident and her relative said that ‘the standard of food had improved recently’. Resthaven Home Of Healing DS0000016559.V359818.R01.S.doc Version 5.2 Page 17 A visitor said that their relative was a vegetarian and that the home suited her needs very well, whilst another commented adversely on the fact that the home used plastic drinking beakers instead of glass ones. The main cook had received specific Chef’s nutritional training, and more in depth nutritional risk assessments were documented for residents. One of the visiting health care professionals commented on a survey that the home had worked hard to make nutrition a high priority for the residents and to address any nutritional concerns. The cook on duty during this inspection served meals in accordance with a list of choices that residents had made from the day’s menu. She was aware of special dietary requirements. Catering records were maintained and the kitchen was clean and orderly. Food stocks were noted to be quite low in places, however there was still a lot of fresh produce in stock, and there was a large food order reported to be due the following day. Resthaven Home Of Healing DS0000016559.V359818.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home have confidence in the staff to help resolve their concerns, and can be reassured regarding the policies to protect their rights and prevent abuse. EVIDENCE: A copy of the home’s complaints procedure was displayed, with one family confirming it had been issued to them in an information brochure. The home’s AQAA confirmed that one complaint had been received in recent months, and the record for this was seen in the home’s complaints register. The complaint was referred to the home for investigation by CSCI, and was in relation to the quality of food. A number of actions had been taken by the home in order to effect the necessary improvements in this area. Residents generally said that they felt able to raise concerns with staff, and that they listened and acted on their concerns; one resident said that they had needed to ask on ‘several occasions’ however before getting a satisfactory response. Visitors also confirmed, with just one exception, that they knew how to raise concerns or complaints if they had any. Resthaven Home Of Healing DS0000016559.V359818.R01.S.doc Version 5.2 Page 19 The home had policies and procedures for safeguarding the vulnerable residents, which included whistleblowing procedures and local contacts should the need arise. The manager and the majority of staff had received training in safeguarding vulnerable residents; there were isolated staff who had not, having done it with their previous employer, and who were knowledgeable in this area already. A refresher course was planned for them all later this year. The manager had attended training in the Mental Capacity Act (MCA), and had obtained a copy of the MCA Code of Practice for the home; she said that MCA training would be made available for staff. Staff spoke knowledgeably about safeguarding procedures and felt confident regarding the use of whistleblowing procedures if they had any concerns. All had been supplied with their own copy of the ‘Alerter’s Guide’. One particular visiting healthcare professional commented in a survey about the home that ‘staff give good care, and acknowledge residents’ rights, beliefs, likes and dislikes’. Residents themselves spoke of having ‘faith and trust’ in the staff, saying that they ‘felt safe here’. Resthaven Home Of Healing DS0000016559.V359818.R01.S.doc Version 5.2 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. 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. Although there are some significant improvements needed and planned to the original part of the home, people living here are provided with a reasonably maintained and clean environment. EVIDENCE: The home comprises of two parts, one of which is a relatively new building that provides accommodation for residents to a good standard, and which is spacious, light and well equipped. The old, original part of the home is in need of work, and is part of a planned refurbishment and upgrade programme. Some of the visitors commented on this issue in their survey forms to CSCI. Resthaven Home Of Healing DS0000016559.V359818.R01.S.doc Version 5.2 Page 21 It was fully acknowledged by the care provider that this work is needed, and a clear commitment was demonstrated on their part to progress this as soon as possible. Architectural plans for this were seen during this visit. The home employs a maintenance person for routine maintenance and decorative issues, and external contractors were employed for maintenance and servicing contracts. The home contracts with a cleaning company, and all areas were clean, fresh and odour free. There were plentiful supplies of gloves, aprons, liquid soaps, sanitising hand gels and paper towels for staff to use as part of infection control procedures. The laundry room was well organised, and sluicing and disinfection-washing programmes for foul laundry were being observed correctly. Clinical waste was correctly managed, with different grades segregated and collected by a designated contractor. Some residents commented on the home being ‘fresh and clean’. A visitor to the home said that the home ‘provided good care in a pleasant, calm, clean environment’. Resthaven Home Of Healing DS0000016559.V359818.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Despite some isolated concerns in relation to supervision of staff, people living in this home receive care from a competent work force, who generally undergo full pre-employment checks, and who are supported to train and develop professionally. EVIDENCE: Staff rotas were maintained, and these demonstrated that one registered nurse was on duty at all times, with eight care staff in the mornings, five in the afternoon and evening and two overnight. This number was meeting the needs of the residents at this time, with staff working efficiently and calmly. The manager works in a supernumerary capacity. A team of ancillary staff support the nursing and care team, and comprise of administration, maintenance, cleaning, catering and laundry staff. The staff were responsible for catering duties at breakfast time. Residents and relatives indicated that staff were very good and caring, with one saying ‘they do a wonderful job’, and another saying staff ‘have a friendly touch’. However, several people raised concerns about difficult communication with staff recruited from overseas, of which there are a significant number, and one Resthaven Home Of Healing DS0000016559.V359818.R01.S.doc Version 5.2 Page 23 resident said that they had had to wait some time before staff responded to her call bell. The home operates a call bell print out system should any specifics arise that need to be checked on. Two people commented positively on how well the key worker scheme was working here. One person said that some of the overseas staff were ‘particularly dedicated’. One person reported that they had witnessed care staff at weekends, on a number of occasions, sitting together in a group in the dining room of the old part of the house, instead of being out amongst the residents, and seemed slow to respond to call bells. Staff were witnessed sitting to eat their meal together during this visit. When this was discussed with the shift leader she said she was unaware of any particular circumstances about such an incident, and confirmed that she would look into it, as in principle this would not be permitted. The home was making good progress with the National Vocational Qualification (NVQ) training programme for care staff. Although the number of leavers had included some qualified staff, eight staff still had the award, two of whom had achieved it at level 3, and a further five staff were currently on an NVQ training course. One of the staff was meeting with her assessor during this visit, and was doing the level 3 award. Three staff files of recently recruited carers were inspected. In each instance, the prospective employee had completed an application form providing details of their employment history. Interview notes were recorded. At least two written references had been provided in each case, including one from the last employer. Proof of identity and medical statements had been obtained. One worker did not possess any recognised photographic identity to supply, so the home had evidenced identity from other official sources and was taking its own photograph. Correct POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) screening had been completed for each person. In one particular case the worker had commenced employment on the grounds of a satisfactory POVA First check in conjunction with other completed preemployment checks being in place, whilst pending receipt of a full CRB disclosure. This person had worked under supervision as was required for the duration of her induction, however, despite the full disclosure still not yet returned the worker was being permitted access to work alone with residents, which was a breach of regulations. Resthaven Home Of Healing DS0000016559.V359818.R01.S.doc Version 5.2 Page 24 The home had previously been required to review its induction training programme for new care staff so that it could be delivered in line with the Common Induction Training Standards for care workers. In response to this, the manager confirmed that the home was going to deliver this training in collaboration with a local college in the future. An in-house induction programme was in place for two of the more experienced workers who had not required such in depth training. Staff said that they had good training opportunities, with newer members saying that they had been very well supported during their induction period, having received a good level of instruction and learning. One person said on a survey form that they received training that was relevant to their role, but would like to have more clinical updates for nurses. Training had been delivered in a number of areas, including dementia care and nutrition; the trainer said that staff were ‘highly motivated and keen to put new skills and knowledge into practice’. Records showed other training recently delivered for staff had included safeguarding vulnerable adults, first aid, food hygiene, infection control and manual handling. Resthaven Home Of Healing DS0000016559.V359818.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 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 good management systems in place here to ensure that the interests, and health and safety of the residents are safeguarded, however there are isolated aspects that could potentially pose risk in some areas. EVIDENCE: The manager has been managing this home for over seven years, is a registered nurse, and has achieved the Registered Manager’s Award. She has been registered by CSCI for her role. It was the first time that the manager had been required to complete an AQAA for CSCI, and as such it is acknowledged that it was a new and unfamiliar tool Resthaven Home Of Healing DS0000016559.V359818.R01.S.doc Version 5.2 Page 26 for her to work with. However, the information contained within it was superficial, and did not provide us with all of the information we required. As part of the quality monitoring systems questionnaires had been distributed to residents and visitors, in order that the home could assess the quality of its services. Questionnaires gave residents and their families the opportunity to comment on issues that affected them such as care and support, food, the home generally and its management. The manager confirmed that the results of these quality surveys were to be collated and published in a report for the Trustees and the staff, so that anything necessary could be addressed. The home had begun to plan more regular meetings for residents and their families, and one such meeting had been held just prior to this visit. Some relatives commented on survey that they would like to see a much better level and standard of communication from the manager and the Trustees. Contrastingly three other people said that management was approachable, with one saying the home ‘responded well to suggestions, and that communication had improved’. The manager said that she carried out regular internal audits in a number of areas, such as medications, care planning and the environment. This process needed to be much more robust in relation to care planning, as shortfalls were identified during this inspection, and records to demonstrate the other audits were not available. A representative for the Trustees had conducted regular visits into the home, and had carried out monitoring checks on the standards here; written reports have been compiled on this basis, copies of which have been sent to CSCI as has been required. The home provided safe storage for residents’ valuables and money, however none had chosen to use this facility at this particular time. The home encouraged independence and autonomy in this area, perhaps with family assistance in some cases. There were agreed arrangements that in cases where the home had carried out transactions on behalf of a resident, a receipt for it, plus an invoice for reimbursement to the home was issued to the person’s representative. The home had health and safety policies and procedures, and provided training for staff in associated topics. Resthaven Home Of Healing DS0000016559.V359818.R01.S.doc Version 5.2 Page 27 The home had a fire risk assessment recorded by an external assessor, and had been inspected some months ago by the Fire Safety Officer. A number of concerns had been identified, and action was reportedly being taken to address them, although the Fire Officer had found it necessary to raise some of the fire safety concerns on two occasions. The manager said that the installation of self-closing devices to doors for the event of fire had now been identified as a priority for the home in order to promote the safety of residents, and that other issues had now been addressed. The fire procedure incorporated evacuation procedures, and training was scheduled for staff in fire safety and evacuation procedures. Evacuation sledges had been provided in the home to assist should this procedure ever become necessary. Regular checks had been carried out on the fire alarm system, the fire extinguishers and emergency lighting. Portable electrical appliance testing was overdue by five months, and this was being addressed. Hoists and lifts had been serviced and safety checked. Hot water temperatures were checked for safe levels, and in the old part of the house hot water warning signs were in situ until blending valves were installed as part of the refurbishment. Since the last inspection the home had consulted with the Environmental Health Department as was required, and reported that they were now commencing their own regular risk assessment work in relation to Legionella risks. All cold water was now being drawn direct from a mains supply and it was reported that hot water was stored in tanks at a sufficiently hot temperature to safeguard against Legionella colonisation. With the existing boiler being due for a service and safety check the provision of a new boiler was being considered. Resthaven Home Of Healing DS0000016559.V359818.R01.S.doc Version 5.2 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Resthaven Home Of Healing DS0000016559.V359818.R01.S.doc Version 5.2 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(1a) Requirement Timescale for action 30/06/08 2 OP7 15(1) The Registered Manager must ensure that a thorough assessment is conducted and recorded by a suitably qualified or trained person before admission to the home is agreed. The Registered Manager must 30/06/08 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; to include the nutritional and mental health needs identified on this occasion. 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. This requirement has been repeated from the last inspection. 30/06/08 3 OP7 15(2.b) 4 OP29 19(11) In circumstances where new staff commence employment pursuant to the receipt of a Criminal Records Bureau DS0000016559.V359818.R01.S.doc 30/06/08 Resthaven Home Of Healing Version 5.2 Page 30 disclosure the Registered Manager must ensure that: The home appoints an appropriately qualified and experienced ‘staff member’ to supervise the new worker, pending receipt of a satisfactory disclosure So far as is possible, ensure that the ‘staff member’ is on duty at the same time as the new worker; and Ensure that the new worker does not escort service users away from the care home premises unless accompanied by the ‘staff member’. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations Staff should ensure that: • Hand written entries on medication administration charts are signed in full consistently by all staff, and are witnessed and signed by a second person • The amount of a variable dosage is recorded on medication administration charts when given • The recorded date of opening a boxed medication should coincide with the time that the first dose is given to assist with auditing. Resthaven Home Of Healing DS0000016559.V359818.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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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