Inspection on 27/07/07 for Rock House

This inspection was carried out on 27th July 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Rock House 07/06/06

Rock House 21/10/05

Rock House 23/05/05

Rock House 11/10/04

Rock House 04/05/04

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Rock House Austenwood Lane Chalfont St Peter Bucks SL9 9DF Lead Inspector Stephen Webb Unannounced Inspection 27th July 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000023015.V345547.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. DS0000023015.V345547.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rock House Address Austenwood Lane Chalfont St Peter Bucks SL9 9DF 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) 01753 882194 01753 893395 office.rockhouse@btinternet.com Gold Hill Housing Association Limited Susan Shadloo Care Home 38 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (38) of places DS0000023015.V345547.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th June 2006 Brief Description of the Service: Rock House is a care home for older people, offering personal care and accommodation for thirty-eight service users who are elderly and physically or mentally frail, of whom up to ten may have dementia. The home is owned by Gold Hill Housing Association, a Friendly Society and is located in Chalfont St Peter, at the top of Gold Hill Common. It is close to shops, public houses, the post office and other amenities. The home has a strong Christian ethic. Rock House was developed from two large semi-detached houses and has three floors. Access to all floors is via a passenger lift. The home has thirtysix single bedrooms and one double bedroom, of which twelve have en suite facilities. The home has its own landscaped garden. As at July 2007, the fees ranged from £545 - £600 per week. Additional charges are made for manicures, hairdressing, chiropody, newspapers, dry cleaning, additional care provided through a buddy system and transport to external events. Information about the home can be obtained by visiting or telephoning the home, or by visiting their website www.rockhouse.org.uk . DS0000023015.V345547.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced site visit from 10.00 until 19.00 on the 27th of July 2007. This report also includes reference to documents completed and supplied by the home, and those examined during the site visit. The report also draws from conversations with some of the staff members on duty, and discussions with the deputy manager and chief executive. The inspector spoke to a number of the residents during the inspection, and the interactions between residents and staff were observed at various points during the inspection and over lunch with the residents. The inspector also toured the majority of the premises, including some of the bedrooms. The home had responded positively to the issues raised in the previous inspection report, demonstrating a positive approach to the inspection process. There was a positive atmosphere in the service in general, and the supportive and enabling day-to-day involvement of the new chief executive was evident. What the service does well: Prospective residents are provided with the necessary information to make an informed choice about coming to live at Rock House, and are subject to a detailed preadmission process, which identifies their needs and wishes. Residents and families cite the Christian ethos and strong church links of the service as a positive factor in the decision to move into the home. Care plans and supporting documents are detailed and subject to regular review, and the healthcare needs of residents are met by the home. The home has an appropriate system for managing and recording the administration of residents’ medication. Residents feel they are treated with respect and examples of their dignity and privacy being upheld, were noted during the inspection. A good range of activities and opportunities for social stimulation are provided, and the home provides well for the spiritual needs of residents, from various Christian denominations within its overall Christian ethos. Contact with family and friends, is encouraged wherever possible and the home has positive links with the local community via the local church and its befrienders. DS0000023015.V345547.R01.S.doc Version 5.2 Page 6 Residents are supported to make choices in their daily lives and follow their chosen lifestyle wherever possible. They are provided with a balanced and varied diet, meeting specialist dietary needs where indicated. The home has an appropriate complaints procedure, of which residents and relatives are aware. Issues raised are appropriately investigated. The home has systems in place to protect residents from abuse including staff training and a thorough recruitment vetting procedure, and any issues are investigated appropriately where they arise. The home provides residents with a well-maintained and homely environment, for the most part, and a range of specialist adaptations and equipment are available to meet the needs of the residents. Standards of hygiene in the home are good and the home has an appropriately equipped laundry facility. The numbers and skill mix of the staff team meet the current needs of the resident group. The home has an appropriate recruitment and vetting procedure in place for new staff, and very good records of this are in place. The staff receive the necessary core training to perform their role, and an effective rolling programme of core training is being developed. The home has an effective and competent management team in place, supported by the new chief executive. An appropriate quality assurance system is being developed and a survey of residents and relatives’ views has already been undertaken. An annual development plan for the home was in place. The home safeguards the financial interests of residents and does not manage these from day-to-day. The health, safety and welfare of residents are promoted and protected for the most part. What has improved since the last inspection? All of the requirements made at the previous inspection have been addressed, though in a few cases, some related issues still remained at this inspection. Where this is the case, new requirements or recommendations have been made accordingly. The planned dementia care mapping is a positive development to further develop and individualise the care provided for residents with dementia. The availability of daily choices of meals have been improved. DS0000023015.V345547.R01.S.doc Version 5.2 Page 7 The number of staff having attained or almost completed their NVQ has increased. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000023015.V345547.R01.S.doc Version 5.2 Page 8 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 DS0000023015.V345547.R01.S.doc Version 5.2 Page 9 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): Standards 1, 3 and 6: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with the necessary information to make an informed choice about coming to live at Rock House, and are subject to a detailed preadmission process, which identifies their needs and wishes. Standard 6 is not applicable since the home does not provide an intermediate care service. EVIDENCE: The home has an improved preadmission assessment system, which is part of the integrated care planning and records tool now in use. The completed assessment format includes the identification of physical, emotional, social, cultural diversity and spiritual needs, as well as providing information on an individual’s life history, interests, preferences about how they are supported and levels of self-care ability in various areas. DS0000023015.V345547.R01.S.doc Version 5.2 Page 10 Each resident now has a contract/terms and conditions, which outlines the provisions of the service, and is signed by the resident or their representative wherever possible. Residents now also receive a copy of the current User’ Guide, which is an informative document, though it does lack a date of production, to enable transparency in terms of its review at annual intervals. The home also has an up-to-date Statement of Purpose, which was last reviewed in May 2007. DS0000023015.V345547.R01.S.doc Version 5.2 Page 11 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): Standards 7, 8, 9 and 10: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of each resident are detailed within their individual care plan and supporting documents, and these are regularly reviewed. The healthcare needs of residents are met by the home. However, there is room for some further improvement in recording systems as detailed below, in order to fully evidence the care given. The planned dementia care mapping is a positive development to further develop and individualise the care provided. The home has an appropriate system for managing and recording the administration of residents’ medication, though some aspects of medication storage which needed further improvement, were discussed during the inspection, and appropriate action agreed. Residents felt they were treated with respect and examples of their dignity and privacy being upheld, were noted during the inspection. DS0000023015.V345547.R01.S.doc Version 5.2 Page 12 EVIDENCE: Residents care records consist of a loose-leaf cardboard folder for background information, correspondence etc, and a separate proprietary integrated care plan system comprising a standard set of components and formats, bound together for each resident. Each care plan consists of a detailed long-term needs assessment document covering the relevant social, emotional, cultural and spiritual aspects, admission information, details of communication with family, GP and multidisciplinary healthcare professionals notes and the care plan itself, subdivided into relevant sections, and a range of risk assessment tools for pressure sores, moving and handling, falls and nutrition, and a dependency profile. There was evidence of regular review within each section of the care plan and a review summary sheet indicted also periodic review with the resident and/or next of kin. Where residents had been assessed as needing bed-rails, this had been recorded in the care plan and consultation had taken place with the next of kin, however, there is also a need to record an individual risk assessment of their use in each case. (Requirement made under Standard 22 later in report). The multidisciplinary healthcare consultation records examined contained few entries, and one appointment, noted elsewhere in records did not appear in the healthcare record. All contact with external healthcare professionals should be recorded within the healthcare record to enable effective monitoring. There was also no readily monitored record of the various aspects of personal care delivery relevant to each individual, and it is recommended that some personal care monitoring record is re-established, as this provides evidence and accountability for the care provided. Staff initials within a monthly spreadsheet format as discussed during the inspection are one effective way to achieve this. Completed sheets could then be filed within the background file. The current background files were not to a standard format and nor were the individual papers secured in two of the three files examined. In some cases, older entries, containing useful information were handwritten to no particular format, and were often undated. It is suggested that a standard format be adopted for these files with a front-sheet, index, and category separators. In any event, all papers relevant to the individual resident must be appropriately and securely filed. (Requirement made later under Standard 37). Some improvements had been made in medication practice, where issues had been highlighted at the last inspection and following further discussion during the inspection, further improvements were agreed with regard to the storage DS0000023015.V345547.R01.S.doc Version 5.2 Page 13 of controlled drugs, larger stocks which cannot easily be held in the drug trolleys, and any returns awaiting collection. The manager is requested to confirm that these changes have been actioned. The home has an appropriate medication recording and management system in place. The medication administration record (MAR) sheets, provide the required audit trail in most cases along with returns records. The amounts of each medication received by the home are recorded and initialled on the MAR sheets and the standard codes for completion were in use, though one or two gaps in recording were still evident. The MAR sheet files contained specific guidance regarding the administration of some medications. Changes to MAR sheets were reportedly either entered on the MAR sheet by the GP, or covered by a faxed/e-mailed confirmation by the GP. Controlled drugs were recorded appropriately in a separate bound log for the purpose, and a double signatory system was in place. The inspector observed the two drug trolleys to be locked and appropriately secured, when not in use. The home does not administer homely remedies, only those medications specifically prescribed for the individual residents. Observed administration practice was appropriate, and staff avoided handling the tablets, using dosage cups and spoons to pass medication to residents. The files indicated evidence of the provision of individual privacy and dignity in some cases, for example a resident who had chosen to have their own private telephone in their bedroom, for which they are individually billed. It is understood that residents have also been offered the facility of a lockable mini-safe in their bedroom, in addition to the lockable drawers already provided. Two of the residents who spoke with the inspector commented that the staff were careful to respect their dignity and privacy and staff were seen to knock on bedroom doors before entering. The toilets and bathrooms all had appropriate locks fitted. The visiting friends/relatives of two of the residents also expressed satisfaction regarding the care provided by the home. One commenting that the staff were particularly attentive to the needs of blind residents. During the inspection the staff member supporting residents over lunch in the activities room was heard, describing his lunch in detail, to a blind resident, DS0000023015.V345547.R01.S.doc Version 5.2 Page 14 including the location of its various elements on his plate, to enable him to maintain his dignity and feed himself. This was very good practice. The activity coordinators’ records contained useful biographical details on each resident, which could usefully be updated, typed and included within each resident’s file. One of the activities coordinators and the deputy manager had attended training on dementia care mapping and were in the process of completing these for the residents, with the aim of maximising the care provided to those residents experiencing dementia. DS0000023015.V345547.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): Standards 12, 13, 14 and 15: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a range of activities and opportunities for social stimulation, and provides well for the spiritual needs of residents, from various Christian denominations within its overall Christian ethos. Contact with family and friends, is encouraged wherever possible and the home has positive links with the local community via the local church and its befrienders. Residents are supported to make choices in their daily lives and follow their chosen lifestyle wherever possible. They are provided with a balanced and varied diet, meeting specialist dietary needs where indicated, and the opportunities for daily choice of meals have been improved. EVIDENCE: The activities coordinators maintain both collective, and individual monthly records of the activities provided to residents, which indicate the provision of a good range of social, spiritual and emotional support to residents. DS0000023015.V345547.R01.S.doc Version 5.2 Page 16 The records include evidence of one-to-one time spent with residents as well as group activities, since not everyone likes to join in with the latter. It is suggested that where a resident declines to take part in an activity, this is also recorded to assist in analysis of the popularity of various activities, and the identification of individual needs. A wide range of activities is indicated, including musical movement, crosswords, card games, scrabble, bingo, reading newspapers to/with residents, art and craft sessions, bible readings, music sessions, songs of praise, and one-to-one chats. The home also has a library of old films. Some of the relatives bring their dogs in and residents enjoy petting them, and a choir has also visited, as well as a travelling farm. Residents have visited a local garden centre. It is recommended that competed individual activity records are copied to the residents’ case record files as evidence of the provision of social, spiritual and emotional support to residents. Individual cultural and spiritual diversity needs are identified in the care plan where applicable in order that they can be addressed. The home is linked to the local church and befrienders have taken residents to church services. Regular services, prayers, communion etc. also take place in the home from a range of Christian denominations. Around 60 of residents were said to have regular family/friends contact, but many of the remainder have little or no outside contact. Visiting is encouraged and one visitor said they often came twice a day and were always made welcome by the staff. Another visitor said they had been impressed by the care and the Christian ethos of the home, and one was complimentary about the range of activities on offer. Only two of the current residents manage their own finances, with others being managed by family or through power of attorney arrangements. The home does not take responsibility for managing residents’ finances, though they do support one resident in managing these for themselves. Residents are able to make choices within their daily lives about such things as meals, participation in activities, whether to spend time in the lounge or their bedrooms, their clothing and times of rising and retiring. They are encouraged to personalise their bedroom and can bring in any items that can safely be accommodated in the room. The bedrooms seen during the inspection were individualised with a variety of personal items. DS0000023015.V345547.R01.S.doc Version 5.2 Page 17 The home has consulted with a dietician since the last inspection, resulting in improvements to the menus. Daily typed menus are now produced, which detail the choices now available at mealtimes. The day’s menu was displayed on each dining table. Residents are asked, in advance, to choose which option they would like. A resident was asked to say grace before lunch in accordance with the Christian ethos of the home. Individual specialist dietary needs are provided for, where necessary. One resident has a soya diet, replacing milk products, and several residents require pureed or part-pureed meals. Where this is required, items are pureed separately to retain variety of taste and texture and improve presentation. The residents commented favourably regarding the food, with one noting the improvement in available choices. As already noted, the staff member who was present over lunch, provided positive verbal support to a blind resident, to enable them to eat their lunch. At lunchtime, various individual requests for gravy, smaller portions, etc. were met patiently, and in timely fashion by the staff. The mealtime was relaxed and unhurried, allowing individuals to eat at their own pace. The use of the activities room as a second dining room has been effective in providing improved space for dining. However, the room would benefit from some decorative input to offer an improved dining environment. Residents are consulted about the food, through food surveys and quality assurance questionnaires and the chef meets with residents face-to-face to obtain more immediate feedback. DS0000023015.V345547.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): Standards 16 and 18: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives are aware of the complaints procedure, and the issues raised are addressed appropriately. Some improvements in recording are recommended. The home has systems in place to protect residents from abuse including staff training and a thorough recruitment vetting procedure. Issues are investigated appropriately where they arise, though some improvements to the associated policies and procedures are required. EVIDENCE: The home has a complaints procedure in place, and a complaints log is maintained, which details the nature of the complaint, together with the action take to address it. However, any papers associated with a complaint have been stapled into the complaints log, making the log bulky, and risking the possible loss of these documents, as well as presenting issues regarding confidentiality. It is strongly recommended that only brief details regarding a complaint are entered in the log itself, without identifying individual staff, and that the entry is cross-referenced to a confidential record containing any related correspondence, statements taken, etc, within which individuals can be identified. DS0000023015.V345547.R01.S.doc Version 5.2 Page 19 The log only needs to record the date of complaint, and brief details of its substance, the action taken, and outcome. In this way confidentiality can be maintained. The complaints log indicated a number of complaints to the home since the last inspection, on a range of subjects, which had been investigated and addressed appropriately. No complaints about the service have been received by the commission, for forwarding to the provider since the last inspection. The provider had devised a new “complaints, compliments and views” leaflet / form, which is going to be made available to residents and visitors in the entrance hall, without the need for recourse to staff. This is good practice in terms of openness, and enables issues to be raised anonymously if preferred. The residents and relatives who spoke to the inspector indicated they were aware of the complaints procedure and would speak to the manager if they had any concerns. A copy of the local Buckinghamshire vulnerable adults safeguarding policy/procedure was available as well as a generic organisational policy/procedure for the provider, dated June 2007. However, the latter is largely comprised of extracts from the former document, and needs localising to be relevant to the specific service, to name the designated person responsible for “safeguarding” issues, and to include guidance on the day-to-day implications for staff. Some of the relevant aspects are covered within the Rock House policy on protection of residents, within the policy document, but this needs additional input to meet the required standard. The home has a whistle-blowing policy/procedure in place, which also needed improvement via the addition of further clarification of the responsibilities and duties on employees with regard to whistle-blowing. The majority of staff had received Protection of Vulnerable Adults, (POVA) training, either in 2006 or 2007, and further training was booked in August, for managers and staff. Where POVA-related incidents have arisen since the last inspection, they were appropriately reported, investigated and addressed by the provider, and notified to CSCI. The home’s thorough recruitment and vetting procedures for prospective staff also provide protection to the vulnerable residents. DS0000023015.V345547.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): Standards 19, 22 and 26: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a well-maintained and homely environment, though the safety of residents could be compromised by the lack of self-closers on some of the fire doors. The provider agreed to address this as a priority. A range of specialist adaptations and equipment are available to meet the needs of the residents, however, individual risk assessments must be completed where bed rails are in use. Standards of hygiene in the home are good and the home has an appropriately equipped laundry facility. EVIDENCE: The home has been adapted from a pair of semi-detached period houses and is operated by the Gold Hill Housing Association as one of a range of services to older people, including sheltered housing and a Domiciliary care agency. DS0000023015.V345547.R01.S.doc Version 5.2 Page 21 The home offers two lounges and an additional quiet seating area, as well as a dining room and a separate activities room. As noted already the dining facilities have now been split into two rooms, with the use of the activities room in addition to the dining room, in order to provide more space. This has been successful, though the dining ambience of the activities room could be improved by its redecoration. There is an attractive, enclosed rear garden with ramps provided at access points to facilitate wheelchair access to the areas of level paving and patios, where seating and tables are provided as well as sun umbrellas. The bedrooms in one ‘wing’ are all equipped with pressure relieving mattresses since the more physically frail residents tend to be accommodated here, and the home has additional specialist mattresses available to use where these are needed for other residents. A small number of bedrooms had been provided with non-slip vinyl flooring as an alternative to carpet, to assist with managing the needs of residents. Bed rails are in use for some residents, with family consent having been obtained. However, their use must also be subject to an individual written risk assessment. The bedrooms seen on this occasion were appropriately furnished and decorated and contained a range of residents’ own items to personalise them. The handyman was in the process of redecorating an empty ground floor bedroom in preparation for an existing resident, whose frailty was increasing, to move down into it from upstairs. It was noted that a number of the bedroom doors, and some other doors in communal areas did not have the required self-closing devices installed, consistent with their function as fire doors. The provider agreed to address this as a priority and must ensure that self-closers are installed to any designated fire doors where absent. Where it is felt necessary for any fire door to be held open during the day to facilitate residents’ mobility around the building, this must only be achieved through the fitting of an approved fire door restraining device, which allows the door to close freely on sounding of the fire alarm. The provider is advised to consult the fire authority to confirm the proposed arrangements in detail. One resident commented that she enjoyed her bedroom and had brought in a lot of her own familiar things to make it homely. DS0000023015.V345547.R01.S.doc Version 5.2 Page 22 The kitchen is appropriately equipped and appropriate temperature monitoring regimes are in place for equipment and meals. The home has a range of appropriate bathing facilities including three adapted baths with hoists, an adapted shower and one un-adapted bath in a small bathroom, which cannot be used by any of the residents. It is suggested that the conversion of this small bathroom into an additional level entry shower facility be considered to augment the existing facilities. It is understood that the provision of a height-adjustable bath with an integral hoist, is being considered in the main ground floor bathroom. Subject to advice from an OT, it is likely that this would be a positive benefit to the home as it provides additional protection to staff, in terms of reduced risk of back injuries, whilst also meeting the needs of residents. The observed standards of hygiene in the home were good, with no evidence of lingering odours. The laundry is appropriately equipped to meet the needs of the home. The deputy manager said that staff had been instructed to only half-fill soiled laundry bags in response to previous inspection concerns. DS0000023015.V345547.R01.S.doc Version 5.2 Page 23 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): Standards 27, 28, 29 and 30: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff complement and skill mix of the team meets the current needs of the resident group, though ongoing attempts to recruit to the vacant posts should be made to reduce the reliance on agency staff. Once the current group of staff complete their NVQ, the home should reach the required minimum proportion of NVQ qualification, but there should ideally be a contractual expectation of completing NVQ within the employment contracts of all new staff to continually maintain and improve standards. The home has an appropriate recruitment and vetting procedure in place for new staff, and very good records of this are in place. The staff receive the necessary core training to perform their role, and an effective rolling programme of core training is being developed. EVIDENCE: The regular staffing complement was said to be six carers on each of the day shifts, one of whom is a senior, and three carers at night. In addition the home has a receptionist who answers telephone calls and the front door, and two activities workers, who also support the care where necessary, (particularly over the lunchtime period). There is also the manager, whose hours are not DS0000023015.V345547.R01.S.doc Version 5.2 Page 24 included on the rota, and the deputy manager, who works a mix of shifts and office hours. Examination of a sample of the rotas indicted that the above staffing levels were maintained for the most part, though with considerable recourse to agency staff on occasions, with as many as three of the six staff being agency on a few shifts. Whist the home uses regular agency staff who are familiar with the residents wherever possible, ongoing attempts need to be made to recruit additional permanent staff to reduce the dependency on agency staff. The home has not recruited any new staff recently, but had two full time care staff vacancies at the time of this inspection. Feedback received from residents and visitors indicated they felt there were usually sufficient staff available in the home, and feedback was positive about their approach and attitude. One visitor commented that the staff were hardworking, friendly and open and that they were always available to answer a question, or would find someone who could do so. The AQAA (pre-inspection questionnaire), indicates that four of the care staff have attained NVQ level 2 and a further eleven staff have almost completed this. The deputy has also attained NVQ level 4. Examination of a sample of the most recent recruitment records indicated that an appropriately rigorous recruitment and vetting system is in place to provide protection to residents. Staff recruitment records were held in an orderly and consistent file format, with a recruitment checklist, making it easy to monitor for compliance. Sufficient CRB information was available to verify that POVA first checks had been undertaken and that CRB checks were undertaken at the required enhanced level. Copies of photo ID were also retained as well as details re visa and entitlement to work, where applicable. A system of three-monthly supervision and annual appraisals had been established, and records of these were maintained. In due course the frequency of supervision should be increased to ensure that each care staff member receives a minimum of six supervisions per year. Improved individual records of staff training are maintained together with course-by-course details to allow monitoring of required updates. Good progress in the provision of required core training has been made. DS0000023015.V345547.R01.S.doc Version 5.2 Page 25 The home manager and the head of the provider’s Domiciliary-care team are now accredited trainers for moving and handling, first aid, POVA, dementia, infection control, health and safety and food hygiene, and the deputy manager is to become accredited for medication training, which should enable an effective in house rolling programme of core training to be developed. It will be essential for trainers to maintain their knowledge via regular training updates in order to maintain their accreditation to train in these areas. The majority of staff have now received the required core training and some details of upcoming courses were provided to demonstrate a rolling programme to address remaining shortfalls. All care staff had received manual handling training in response to a previous inspection requirement and the majority had received POVA training, with another course booked in August for the remaining staff. A further first aid course was also scheduled for August. DS0000023015.V345547.R01.S.doc Version 5.2 Page 26 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): Standards 31, 33, 35, 37 and 38: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an effective and competent management team in place, supported by the new chief executive. An appropriate quality assurance system is being developed and a survey of residents and relatives’ views has already been undertaken. Further development of the system to include surveys of staff and external stakeholders are planned. An annual development plan for the home was in place. The provider needs to ensure that required monthly regulation 26 monitoring visits take place and the resulting reports are copied to the manager. The home safeguards the financial interests of residents and does not manage these from day-to-day. DS0000023015.V345547.R01.S.doc Version 5.2 Page 27 Residents’ case record files need to be secured appropriately and maintained in better order. The health, safety and welfare of residents are promoted and protected for the most part, though improvements are needed in accident recording, and a number of fire doors need to be fitted with self-closers. EVIDENCE: The manager is appropriately qualified and experienced to manage the home, having extensive experience and having attained her NVQ level 4 and being a member of the Chartered Management Institute, and is supported by her deputy, and the new chief executive who plays an active part in the service. The residents spoken with by the inspector, felt that the manager was available and approachable, and this was also confirmed by one of the visitors. The service undertook a quality assurance survey of residents and relatives, concluding in June 2007, and the completed forms and summarised results were available for inspection. Feedback about the service was generally positive. The chief executive indicated that quality assurance questionnaires for staff were being devised, and that they would go on to develop suitable ones for other stakeholders such as external healthcare practitioners and care managers. It is important to survey as widely as possible given the limitations on the level of resident feedback available and the benefits of seeing how the unit and its service is perceived through the eyes and experience of others. Examination of the records of Regulation 26 monitoring visits suggested either that these were not being completed on a monthly basis as required, or that the required reports were not being copied to the manager to action any identified issues. Only reports for July and December 2006 and June 2007 were present on file. Regulation 26 monitoring visits must be undertaken monthly and a copy of the resulting report must be provided to the unit manager. The home has a development plan in place, dated June 2006, which indicates good progress in some areas and plans for ongoing improvements in a range of areas. Only two of the current residents are able to manage their own money, one of whom is supported in this by staff. The finances of other residents are DS0000023015.V345547.R01.S.doc Version 5.2 Page 28 managed by family or through power of attorney arrangements. The home does not undertake to manage residents’ funds. Where a resident requires something the family are either asked in advance to obtain it, or it is purchased by the home and a receipt presented for later reimbursement, by prior agreement. As noted earlier in this report, the residents’ case record files were composed of loose papers and plastic sleeves without a consistent order and mostly unsecured. This makes monitoring difficult and increases the risk of documents being lost or misfiled. Each resident’s case record file must have the relevant papers secured appropriately, and it is recommended that a consistent, indexed format is adopted, with category separation, in order to simplify filing and the location of specific records. A range of fire safety issues identified in an earlier visit, were being addressed by the provider, though the identified issue around fire door self-closers needs to be given some priority. (Requirement made earlier under Standard 19). It is suggested that the smoking policy be reviewed in light of the recent changes in legislation to ensure compliance. The unit’s fire risk assessment had been reviewed in June 2007, and a series of room-by-room generic risk assessments were on file including residents’ bedrooms. Examination of a sample of health and safety-related service certification indicated that electrical appliance testing had taken place in August 2006 and it was confirmed that the five yearly electrical installation, testing certificate was also up to date though the certificate could not be located. This certificate should be located and copied to the Commission. No other certification was examined on this occasion owing to time constraints. Examination of the accident recording system indicated that the appropriate tear off pad was being used but that photocopies of blank forms were held awaiting completion rather than using the original form and then copying it to the appropriate place. However, the forms were sequentially numbered to provide an audit trail. Completed forms were filed together comprising the required collective record of accidents, but copies were not being filed on the residents’ individual files as part of their case record. Copies of each completed accident form must be filed within the resident’s case record as well as collectively for monitoring. DS0000023015.V345547.R01.S.doc Version 5.2 Page 29 One staff accident was also recorded within the sequence of forms. In order to maintain clear statistics it is suggested that a separate tear-off pad be used for staff/visitor accidents. DS0000023015.V345547.R01.S.doc Version 5.2 Page 30 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 2 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 2 2 DS0000023015.V345547.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No 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 OP18 Regulation 13(6) Requirement The provider/manager must ensure that the policies / procedures on the protection of vulnerable adults and whistleblowing are amended as described, to fully address the relevant areas. The provider must ensure that all designated fire doors are fitted with appropriate selfclosing devices. The manager must ensure that the use of bed rails is supported by an individual risk assessment in every instance. The provider must ensure that regulation 26 monitoring visits take place monthly and that a copy of the resulting report is provided to the manager. The manager must ensure that residents’ file records are properly secured and in good order. The manager must ensure that copies of completed accident forms are also filed within the relevant resident’s case record. Timescale for action 27/09/07 2 OP19 23(4) 27/09/07 3 OP22 13(7) & 23(2)(n) 26 27/08/07 4 OP33 27/08/07 5 OP37 17 27/10/07 6 OP38 17(1)(a) & Sched. 3.3(j) 27/08/07 DS0000023015.V345547.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP7 OP8 OP9 Good Practice Recommendations The manager should consider improvements in the recording of the individual care provided to residents as discussed. The manager should consider improvements to the healthcare recording as discussed. The manager should confirm that the additional changes discussed with regard to medication storage, or other appropriate arrangements, have been made, to ensure the proper secure storage of all medication. The manager should consider filing copies of the completed individual monthly activity records within case record files as evidence of the range of activities provided. The provider/manager should consider redecoration of the activity room to support its use as a second dining room. The provider/manager is recommended to separate detailed complaints investigation records from the basic information within the complaints log to maintain appropriate confidentiality. The provider is advised to consult with the fire authority regarding the installation of any approved fire door holdback devices. 4 5 6 OP12 OP15 OP16 7 OP19 DS0000023015.V345547.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 DS0000023015.V345547.R01.S.doc Version 5.2 Page 34 - 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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