Inspection on 22/08/07 for Rheola

This inspection was carried out on 22nd August 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

Rheola 21/09/06

Rheola 29/11/05

Rheola 25/05/05

Rheola 14/12/04

Rheola 20/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Rheola Broad Leas St Ives Cambridgeshire PE27 5PU Lead Inspector Don Traylen Key Unannounced Inspection 10:00 22 & 23rd August 2007 nd 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 Rheola DS0000015108.V337666.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. Rheola DS0000015108.V337666.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rheola Address Broad Leas St Ives Cambridgeshire PE27 5PU 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) 01480 375163 01480 375160 Rheola Healthcare Ltd Jeanetta McNally Care Home 42 Category(ies) of Dementia - over 65 years of age (13), Old age, registration, with number not falling within any other category (32) of places Rheola DS0000015108.V337666.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st September 2006 Brief Description of the Service: Rheola is a care home registered to provide for a total of 42 elderly people including 13 people with Dementia related care needs. Originally a Local Authority care home it was acquired by Excelcare Holdings in 2001. The home is situated a few minutes walk from St Ives town centre. It is a large house that has been converted to a care home and has had an extension added to the rear of the building. There are well kept gardens to the rear and side of the property. The home is divided into four units Rose and Thistle suites are located on the ground floor and Shamrock and Daffodil are on the upper floor. Each suite has a separate dining room, lounge, kitchen, toilets and bathroom. Rose suite is a single storey extension that provides accommodation for 10 people who have extra care needs related to dementia. Thistle and Shamrock suite each have 12 bedrooms whilst Daffodil suite has 8 bedrooms. Each bedroom has a washbasin. Twelve rooms have full ensuite facilities. The home has a contractual agreement with Cambridgeshire Primary Care Trust to provide 5 respite care places and to provide up to 3 Interim Care places. Fees for the services offered at Rheola range from £351 to £500 per week. Inspection reports about the home are available in the entrance lobby of the home and can be accessed on the CSCI website Rheola DS0000015108.V337666.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector conducted this inspection over two days and lasted 6.5 hours. The recently appointed acting manager was present throughout the inspection. Four care staff were spoken to and 12 people living at the home were spoken to and observations of the interaction between care staff and people living at the home were undertaken. A tour of the home allowed further observations of the level of activity and interaction taking place A Pre- Inspection Questionnaire was returned by the home and 34 survey/ comment forms from people living at the home and 10 from relatives were completed. Only a few surveys contained any free text comments. Most survey forms indicated people were satisfied with their care, although many of the survey forms had been completed in the same handwriting. What the service does well: Twelve of the seventeen requirements made in the last inspection report have been met or met in part. Visitors to the home are made welcome at any time and were seen to be acknowledged and greeted politely. People who use the service said that staff were polite and treated them respectfully. There were good examples of meaningful communication between some of the care staff and people living at the home. The recently appointed acting manager leads by example and demonstrated an awareness and attention to the quality of care and a realistic and determined approach to improve the home in the future. The service has a high turnover of people living at the home because they provide short-term respite care arrangements and short-term Interim care placements. Two care staff showed they were eager to continue their training and undertake an NVQ level 3 award. They were both eager to further their knowledge of dementia related care. The home is spacious and has adequate bathrooms and toilets and communal rooms and areas were people can be private. Rheola DS0000015108.V337666.R01.S.doc Version 5.2 Page 6 Staff receive regular supervision. The organisation has management procedures in place to conduct regular and diverse audits and carries out satisfaction surveys with relatives and people living at the home. What has improved since the last inspection? What they could do better: One comment written in the survey forms related to contracts was, “residents have little option in honouring their side of the contract, but I am afraid the other side fall very short regarding theirs”. The organisation’s quality surveys conducted in since Jan/Feb 2007 indicated areas to be improved included: • Unpleasant odours in corridors • Windows are in need of extreme cleaning • Drinking water in rooms is not changed frequently enough • Laundry is not ironed and clothes disappear • More frequent residents and family meetings requested and the ‘Meal Satisfaction Results” survey conducted in May-June 2007 showed comments about the level of service and waiting for meals. An unexplained delay in serving a meal was observed during the inspection and is an aspect of care that should be improved by simply talking to them and explaining the situation rather than staff not communicating at all. Rheola DS0000015108.V337666.R01.S.doc Version 5.2 Page 7 Improvements to medication records must be made. Staff should be encouraged and facilitated to make more effort to communicate verbally with people living at the home as a matter of basic respect and as an important aspect of any approach to providing care. It is recommended that as an activity in daily living the home take measures to adopt a more definite approach to include people in meaningful and ordinary everyday activities and to acknowledge them by greeting or talking to them and not ignore them. It is also recommended that people are consulted about the activities or interests they would like to participate in. Environmental issues: Consultation with The Fire Safety Officer to assess the fire doors in Rose suite that were kept locked, must be requested by the home. Unpleasant odours must be eradicated. The building must be appropriately and adequately heated and ventilated, so that people are not expected to smell unpleasant odours or lack fresh air and regular ventilation of the environment. People who live at the home must have easy access to suitable and safe external areas. The observed routines of the home was that nobody apart from people living in the ground floor Shamrock suite were free to walk in and out of the gardens or the external areas of the home. The area of Rose suite was especially restrictive to an internal small communal area, although it was a socially alive environment, made so by the good communication and attention of the two care staff working at the time of inspection. Management issues: Staff training and performance must be monitored; staff should be trained in falls prevention to ensure they are prepared for and have a greater awareness of the danger of falling. The advice and guidance and any training should be sought from the Cambridgeshire PCT Falls Prevention Nurse. Staff training in Dementia related care should be provided for all care staff and at a higher level for staff who wish to be trained in this topic, especially as the home are registered as a dementia care provider for up to 13 people and as the home has stated in a ‘Pre-Inspection Questionnaire’, they had 20 people with dementia related care needs living at the home. Staff should be trained so they are better able to communicate with people who are dependent upon the assistance. This vital aspect of care should consider any language barriers to communication as more care staff are recruited from countries where English is not the primary language. Training in continence care and nutritional care should be provided for all care staff. Training in NVQ awards should be promoted by the home. All training for staff should be accurately evidenced and shown on a current training plan or matrix chart. To provide an effectively trained group of staff who are able to provide care to 42 people living at the home, the training opportunities and arrangements need to be continuously and regularly planned Rheola DS0000015108.V337666.R01.S.doc Version 5.2 Page 8 and made available to all staff and in some instances the training topics should be at a higher level. Quality Assurance surveys carried out by the home should try to include a larger number of respondents than the 18 who were included in the two surveys referred to in this report. The organisation’s management of their audits and satisfaction survey should evidence how they have responded to these findings and how they have brought about any improvements for people who use their service. Because the service provides short term respite care and as a consequence has a has a high turnover of people living at the home and in light of the comments made in this report about staffing number the home must provide adequate numbers of care staff at all times. 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. Rheola DS0000015108.V337666.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 Rheola DS0000015108.V337666.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): 1,3,6, Quality in this outcome area is good. Admission arrangements ensure people are assed prior to moving into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home always receives assessments made by Care Managers or themselves undertake assessments if care is privately arranged. Most people have been assessed by Cambridgeshire PCT Care Managers. Adequate information is received to ensure the home can make a judgement whether they are able to meet people’s needs. There were 40 people living at the home on the day of inspection. Some comments written in the surveys claimed that they had little choice in deciding to live at the home and this appears to have been an issue about the placement and commissioning arrangements made by the PCT Care Managers. Rheola DS0000015108.V337666.R01.S.doc Version 5.2 Page 11 One comment about contracts made by a person living at the home was, “residents have little option in honouring their side of the contract, but I am afraid the other side fall very short regarding theirs”. The service has a regular and a ‘high turnover’ of people living at the home because they provide short term respite care arrangements and short term Interim Care placements The acting manager stated there are three places supplied as a block purchased arrangement with Cambridgeshire PCT for Interim Care and not the more intensive needs associated with Intermediate Care arrangements. One person, who was staying at the home for short term Interim Care, explained that he was going home the day following the inspection and had been staying at the home after a hospital discharge arrangement. However, he said the Physiotherapist (or Occupational Therapist) had not adequately informed him and assured him of his home care arrangements. There appeared to be a lack of communication in this Interim Care plan, where the home expect the integrated care management team to deal directly with the person regarding the arrangements for returning to their own home. In this instance and during the inspection, the manager decided to intervene on behalf of the person to determine exactly what his care arrangements were. Rheola DS0000015108.V337666.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. Care plans and the management of medication are adequate although both topics could be improved to ensure people using the service are supported in a more person centred manner. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two care plans were read and the care arrangements for one person placed at the home for Interim Care. These showed they had been presented and recorded in an improved format. The manager said she was upgrading all care plans. Two plans both contained good descriptions of the person and their need derived from their assessment details provided by PCT Care Managers. The manager is intending for care workers and families to have greater input into recorded care plans in the future. The two care plans read contained health needs, District Nurse attendances and arrangements for CPN involvement. One person staying at the home through an Interim Care Rheola DS0000015108.V337666.R01.S.doc Version 5.2 Page 13 arrangement did not have all the details recorded of his progress although he did have a basic care plan. Plans and arrangement for his return to his own home were being managed by the Interim Care Team’s Occupational Therapists and hospital based Care Managers and the home was not kept informed of all of the arrangement being made on his behalf. This is an issue that the home should discuss with PCT Care Managers. Following the comments and requirements made in the last inspection report for the visits made on 21st September & 18th December 2006, training in medication had been provided in January, May, June and August 2007 to eight staff nominated to administer medication. A workbook was read for this training that covered aspects of administering medication. The Service Manager for the organisation assesses the competency of staff to administer medication. The home’s policy entitled ‘Safe Handling of Medication’ was read but did not cover PRN prescribed medication. Medication was observed being given in Rose suite during midday. Keys to medication trolleys were observed to be held by the designated person who was administering medication. The trolley was secured and locked to a fixed wall point. Records were kept on the rear of the Medication Administration Record (MAR) sheet for some people who were asleep at the time their medication was prescribed to be given and this was correctly recorded as not given and with the reason. However, one person prescribed for a cream to be applied twice daily had not been recorded for a few days and no explanation was recorded. Another prescribed cream for the same person stated on the MAR sheet “as directed” but there were no directions supplied. Checks of the amounts of remaining medication for the same person showed they had been accurately recorded and the numbers of remaining medication was accurately accounted for. Care staff were observed to speak encouragingly and with respect to people in Rose suite. However, this was not a regular feature of staff interaction in other areas of the home, where people were left to lead more independent lives and there was a lack of acknowledgement and communication by care staff towards people living at the home. Rheola DS0000015108.V337666.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Quality in this outcome area is adequate. People experience daily life as routine, quiet and pleasant. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Family contacts are maintained and visitors are made welcome and contacts can be made at all reasonable hours. A “meal satisfaction” survey carried out by the home in May/ June 2007 showed most of the responses made by 18 respondents, were positive. The menus and choices and the lunchtime meal was observed and considered to be a good standard of food and nutritionally valuable and well presented. Observation made during lunch in the upper floor dining room showed that care staff made minimal conversation with people who were seated at the dining tables waiting for their lunch. Whilst people were seated and waiting to be served their lunch, there was no verbal explanation or verbal exchange to inform them of the reason for the delay. This atmosphere appeared ‘tense’ and lacking in stimulation and did not appear to be a socially active or a Rheola DS0000015108.V337666.R01.S.doc Version 5.2 Page 15 respectful experience. Care staff were observed to speak encouragingly and with respect to people in Rose suite. However, this was not a regular feature of staff interaction in all parts of the home, where people were generally more independent, but there was often a lack of presence of care assistants and a lack of acknowledgement and communication by care staff. For instance, on the morning of the 22nd August, three people who were in the Thistle part of the home were not acknowledged or spoken to by staff when care staff went to the kitchen/dining room. An activities co-ordinator is employed for three hours each day from Mondays to Fridays. There was a marquee erected in the garden at the rear of the home that had been recently used for a Barbecue with a musical event. Bingo is played regularly at the home and musical evenings are planned. A recent trip to the seaside was provided for a few of the people living at the home. There was no observed evidence of any activity on the days of inspection. One lady commented that she does not get out enough and would like to go out of the home more regularly. It is recommended that as an activity in daily living the home take measures to adopt a more definite approach to include people in meaningful and ordinary everyday activities and to acknowledge them by greeting or talking to them and not ignore them. It is also recommended that people are consulted about the activities or interests they would like to participate in. Rheola DS0000015108.V337666.R01.S.doc Version 5.2 Page 16 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. People living at the home are protected from abuse although further empowering steps can be achieved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Most survey forms returned indicated that people were unaware of the complaints process or policy and had not had cause to make a complaint. The complaints procedures and information was located at the main entrance to the home. The home has a policy and procedures and contact telephone numbers for staff to report an allegation or suspicion of abuse should they need to. It is recommended these same contact numbers are made available throughout the home so that any person living at the home or visitor or family have this same opportunity and protection and so enabled to report any concern about abuse they may have. All staff, bar one, have received, or are at the point of receiving, training in Safeguarding (Protecting) Vulnerable Adults from Abuse. One member of staff who was spoken to did not know the procedure for reporting abuse and it is recommended that repeat training is provide for all staff in this topic and that the procedures for reporting an allegation of abuse by staff are assessed by for competency. Rheola DS0000015108.V337666.R01.S.doc Version 5.2 Page 17 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): 19,20,21,23,24,25,26, Quality in this outcome area is adequate. The home has generally clean communal areas although there is a distinct lack of adequate ventilation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Whilst the home is reasonably clean and decorated there are some issues that need attention such as the condition of the paintwork on the windows that was dirty and loose at the edges of the window frames. Survey forms indicated that as a majority, people were satisfied with the environment and thought it “fresh and clean”. However, the corridor to the entrance to Rose suite smelled stale and had an unpleasant stale and musty odour. There was no fresh air ventilating the corridor and the central heating was turned on during a day when the external temperature was very warm. The long corridor to the Rose Rheola DS0000015108.V337666.R01.S.doc Version 5.2 Page 18 suite is made mostly of glass and becomes hot quite rapidly and increases the intensity of any unpleasant odours. This was pointed out to the acting manager, as was the general lack of fresh air in other parts of the home and that very few windows were open. It was surprising and less than adequate that no staff had opened any windows on such a warm day and that it was the acting manager who had to arrange for this to be carried out after it was brought to her attention. Adequate ventilation and appropriate heating must be provided for all people living at the home at all times. Two fire doors in Rose suite were locked and the Fire Safety Officer must assess these. The external area was a concrete area without any cover on a day that was very hot and nobody had access to the garden. There was a marquee erected in the rear grassed garden area that is used by some people but the specific safe area for people living in Rose suite is a concreted space. Huntingdonshire District Council’s Environment and Community Health Service Officer’s report dated 10th May 2007 raised the question of potential slips or falls because of the worn bathroom flooring. The home have not altered or replaced this worn flooring or provided the recommended slip mats. On one of the days of inspection the bathroom floors were wet and had yellow signs warning of wet floors and although these were placed across the doorways, there was no guarantee that anyone would be prevented from entering these rooms and be at risk of slipping on the wet and worn flooring. On the morning of the 22nd August the laundry room was left open when unattended despite a clear sign attached to the door “to be kept locked at all times”. Washing and drying machines were in operation and there were clothes waiting to be washed on the floor. The room was generally fairly crowded with trolleys holding clothes to be washed and with baskets of clean and ironed clothes and various other laundry equipment, washing powders, mops and brooms. The home has an adequate number of toilets and bathrooms equipped with specialist baths and adaptations and aids. Individual rooms furnishings vary according to personal possessions used by different people although each room is adequately furnished, clean and comfortable. The kitchen was generally clear although not as clean as it could be. Only one person was working in the kitchen on the morning of 22nd August. Rheola DS0000015108.V337666.R01.S.doc Version 5.2 Page 19 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. There is a mixture of a low number of staff working plus a training plan that needs to be improved before people living at the home are assured of the skill mix and numbers of staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Comments made in survey forms by people living at the home showed that some people felt there were not sufficient staff working, especially at night time and that there is language barrier with some staff employed from non English speaking countries. The staff rota showed that at night between 8pm and 8am there are three night care staff working at any one time and there are six care staff working 8am to 8pm. A team leader and the acting manager work between the hours of 8am and 8pm Monday to Fridays. Two care staff are dedicated to the extra care, Rose suite during the daytime hours of 8am to 8pm. When staff take their meal breaks there is a depletion of staff on duty and this means that a reduced ratio of care staff are available at periods throughout the day and night. Although the team leader may provide cover for these breaks during the daytime hours of 8am to 8pm, there was no evidence on the day of inspection that this cover was provided and means that at least 3 Rheola DS0000015108.V337666.R01.S.doc Version 5.2 Page 20 hours cover each day and 1.5 hours cover at night should be provided when staff take their breaks. There is no arrangement for any cover at nighttime. As the building is large it is difficult to ensure that staff can be aware of all people, especially in Thistle, Shamrock and Daffodil suites, where four staff are allocated to these three suites, on two floor levels, that provide accommodation for 32 people. It is considered that the home do not employ sufficient numbers of care staff at all times and this was given as feedback to the acting manager during the inspection. There are usually two domestic workers each day, a cook and one or two kitchen assistants working and a laundry worker. The training Matrix showed that arrangement had been made for six-monthly fire training and Moving and Handling. All bar one member of staff had received training in Protecting Vulnerable Adults and arrangements had been made for this person to be trained in September 2007. Training in infection control had been received by approximately 505 of staff and arrangements for training the remainder of the staff had been arranged for November 2007. However the cook had not been trained in POVA and had not been trained in Infection Control or Health and Safety since 25/04/1991, according to the records. The training matrix also showed only one person had received training in continence care and nobody had received training in pressure care, or falls, or nutrition training. One person who was spoken said she had received continence care and catheter care training but this was not shown on the training matrix. It was encouraging to see that at least one person had undertaken training in the Mental Capacity Act 2005. The Environment and Community Health Service officer report dated 10 May 2007 raised the question of potential slipping because of the worn bathroom flooring. Although all staff had been trained in Moving and Handling, they should be trained in falls prevention so they have a greater awareness to protect people from the causes of why some people might fall. Two care staff showed they were eager to continue their training at a higher level for dementia care and undertake an NVQ level 3 award. As a consequence of the above, it cannot be certain that people are in safe hands at all times, or that all staff are adequately trained. There were no records made available to show who had been trained in NVQ awards. Recruitment processes for two care staff were read and found to be almost satisfactory. The acting manager had improved the process and the records. The files were neatly presented and contained clear evidence of the recruitment process, including application forms, interview records, records of start dates, CRB disclosure and letters of offers of employment and acceptance. The acting manager has ensured that no staff commence employment before a full CRB and POVA First check have been obtained. The records of one overseas care worker showed two references addressed, “to whom it may concern” and these were assessed as unacceptable because they Rheola DS0000015108.V337666.R01.S.doc Version 5.2 Page 21 had not been requested or addressed to the home. The manager agreed to immediately apply for these references. All other documentation for the person was satisfactory, whose accommodation had been provided by the organisation that owns the care home. A more structured 3-day induction programme has been provided for new staff on the very first day they are employed, followed by a longer, Skills for Care based Induction. This is an improvement and a good base for newly recruited care staff to be adequately trained. However, so that an effectively trained staff group are able to provide care to 42 people living at the home, the wider range of training arrangements and opportunities need to be continuously and regularly planned and made available to all staff and in some instances the training topics should be at a higher level to ensure staff development and to ensure adequate standards of care are ensured. Training in communication skills is recommended for all care staff. Rheola DS0000015108.V337666.R01.S.doc Version 5.2 Page 22 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. Aspects concerning health and safety training arrangements and staff competencies are not appropriately assessed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager stated she is in the process of applying to become the registered manager and has just received her CRB disclosure. She stated that she intends to focus on people’s needs as the central aim of her role as acting manager. Rheola DS0000015108.V337666.R01.S.doc Version 5.2 Page 23 Two surveys about meals and satisfaction with care had been conducted since February 2007. Any actions taken in response to the findings were not made clear but were stated to be included in the Home’s Action Plan. Discussion with the one person working as cook on the 22nd August said that food temperatures were not recorded of the cooked meats, although they were taken. The same food probes or gauges are used to record fridge and freezer temperatures. There were no thermometers placed in the fridges or freezers that did not have integrated thermometers to record the temperatures. A recent Food Standards Agency file and diary has been maintained and visit by a consultant agency for food safety had been made. The area outside of the kitchen back door used for deliveries was used as a storage area for delivery trolleys, some rubbish from packaging and other items. This accumulation of items may become an obstacle or a potential fire risk, although at the time there was a clear exit. Staff performance in moving and handling techniques were not monitored. Staff skills in Moving and Handling techniques should be monitored by the home to ensure the recommended moving methods are used and that people living at the home are safe. Staff ability to report abuse was not adequate and must be assessed for competency. Regular staff supervision takes place. Regular fire alarm testing and fire equipment tests are in place. Rheola DS0000015108.V337666.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X 3 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 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 3 X 3 3 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X N/A 3 3 1 Rheola DS0000015108.V337666.R01.S.doc Version 5.2 Page 25 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 OP9 Regulation 13(2) Requirement The home’s policy for the safe handling of medication must include the management of PRN prescribed medication. People who live at the home must have easy access to suitable and safe external grounds. The home must consult with The Fire Safety Officer about the safety of the locked fire doors in Rose suite, so that people living and working at the home are satisfactorily protected from the risk of fire. The door to the laundry room must be kept locked when not being used by staff so that unnecessary hazards to people living at the home are prevented. Adequate ventilation and appropriate heating must be provided for all people living at the home at all times so they are comfortable and do not experience any unpleasant odours and have a safe temperature in which to live. DS0000015108.V337666.R01.S.doc Timescale for action 25/10/07 2 OP19 23(2)(o) 25/12/07 3 OP19 23(4) 25/12/07 4 OP19 13(4)(a)( b) 25/10/07 5 OP25 23(2)(p) 25/10/07 Rheola Version 5.2 Page 26 6 OP26 16(2)(k) 7 OP27 18(1)(a) 8 OP29 19(10) & Schedule 2 9 OP38 13(3) All parts of the care home must be kept free from offensive odours. The timescale of 31/12/06 made at the last inspection of the 21/09/06 has not been met. There must be adequate numbers of staff to meet the needs of the service users. The timescale of 31/12/06 made at the last inspection of the 21/09/06 has not been met. All staff must have two satisfactory references that are current and have been requested by the home and are addressed to the home, so that people are adequately safeguarded. The prevention of the spread of infection must be rigorously prevented at all times when handling, storing and washing people’s soiled or clean clothing. 25/10/07 25/12/07 25/10/07 25/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The home should ensure the ongoing Interim Care arrangements made by Cambridgeshire Primary Care Trust’s (PCT) Interim Care Team are made known to them, so that the person living at the home can be kept informed of the latest arrangements, when this is necessary. It is recommended that as an activity in daily living, the home take measures to adopt a more definite approach to include people in meaningful and ordinary everyday activities and to acknowledge them by greeting or talking to them and not ignore them. It is also recommended that people are consulted about the activities or interests they DS0000015108.V337666.R01.S.doc Version 5.2 Page 27 2 OP12 Rheola 3 OP18 4 5 6 7 OP18 OP27 OP28 OP30 8 OP38 would like to participate in. Contact telephone number for reporting abuse should be made available throughout the home so that any person living at the home, or visitor, or family, have this same opportunity and protection and are enabled to report any concern about abuse they may have. Staff competency to report an allegation of abuse towards a vulnerable person should be assessed. All staff should be trained in continence care. Training opportunities in NVQ level 2 awards should be arranged for all care staff. All care staff should be trained in communication skills and approaches for elderly persons, so they are trained to communication effectively, so that people living in the home are not ignored. Staff skills in Moving and Handling techniques should be monitored by the home to ensure that staff are competent and the recommended moving methods so that people living at the home are safe. Rheola DS0000015108.V337666.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI Rheola DS0000015108.V337666.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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