Inspection on 14/12/06 for Romney House

This inspection was carried out on 14th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Romney House 01/02/06

Romney House 31/08/05

Romney House 07/03/05

Romney House 13/12/04

Romney House 30/10/03

Romney House 08/05/03

Romney House 11/06/02

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

CARE HOMES FOR OLDER PEOPLE Romney House Romney House 11 Westwood Road Trowbridge Wiltshire BA14 9BR Lead Inspector Stuart Barnes Unannounced Inspection 14th December 2006 14:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Romney House DS0000028215.V322193.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. Romney House DS0000028215.V322193.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Romney House Address Romney House 11 Westwood Road Trowbridge Wiltshire BA14 9BR 01225 753952 F/P01225 753952 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) Mr Gary Wesley Mrs Renate Wesley, Ms Anita Hampson Ms Anita Hampson Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Romney House DS0000028215.V322193.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st February 2006 Brief Description of the Service: Romney House is an adapted and extended family house on the outskirts of Trowbridge town. It is set in 1/2 an acre of well maintained gardens that includes a shaded patio area. The home provides care and accommodation for up to 20 people aged over 65 years. It also offers 2 day-care places for local people aged over 65 years. The accommodation is on two floors connected by a lift and 2 staircases. All bedrooms are single rooms. Fourteen of them provide ensuite toilet facilities. The service offers long term care as well respite care for 2 weeks. Communal rooms consist of a spacious reception hall, 2 conservatories, a sitting room and a dining area. The home is typically staffed by three care staff in the mornings and 2 care staff covering the late afternoon and evening. At night there are two awake care staff working. The home also employs housekeeping, catering and clerical staff. The home does not provide care to people with dementia or provide nursing care. The service is run as a family business. It is a condition of residency that the home is a no smoking home and pets are not allowed. Romney House DS0000028215.V322193.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgments contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This inspection was carried out over 3 days totaling 15 hours days of which the first day was unannounced. Time was spent examining various, policies, procedures and case documentation as well as randomly selected files relating to staffing. Four residents were interviewed in private. All residents were invited to give their views in a “Have Your Say” comment form of which 7 were completed. Four staff were also interviewed in private. Time was spent with the owner and the deputy manager. Informal comments from residents were also obtained when sitting in communal areas or touring the premises. The Commission also obtained some pre inspection details. In total 26 out of 38 national minimum standards were inspected of which 6 showed a minor shortfall, 13 were fully met and 7 exceeded the required standard. What the service does well: What has improved since the last inspection? What they could do better: Care needs to be taken that loose-leaf paper is not used for recording care plan details. The home needs to have better communication with the local social services department when service users bruise extensively and easily or allege past abuse. The service needs to ensure that 50 of the care workers have a relevant National Vocational Qualification at level 3 or above and that Romney House DS0000028215.V322193.R01.S.doc Version 5.2 Page 6 the manager of the home also completes National Vocational Qualification (level 4) in the coming months. Supervisors need to ensure all care staff have the opportunity to meet in private with them to discuss work related achievements and problems, including residents needs. Staff induction for newly appointed workers needs to be more structured and meet the relevant skills council criteria. The views of more people need to inform the quality assurance system. 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. Romney House DS0000028215.V322193.R01.S.doc Version 5.2 Page 7 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 Romney House DS0000028215.V322193.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. 4. (Standard 6 is not applicable to this service) Quality in this outcome area is excellent. This continues to be a home with high levels of service user satisfaction and very good standards of care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three case files were examined. Since the last inspection the assesment of need and planning of care has much improved, with the introduction of a new assesment format. It includes all the areas listed in the relevant standards. The information recorded was found to be well presented, comprehensive in its detail and linked to the daily plan. However service users who stay for short periods or are admitted from hospital indicate that they do not always get enough information about the home in advance of taking up a bed. Care plans identify people’s personal care needs. They use respectful and sensitive language and illustrate what the residents want to do for themselves Romney House DS0000028215.V322193.R01.S.doc Version 5.2 Page 9 and what help they need from others. There was evidence too of acknowledging people’s personal frustrations or limitations including little hurts and discomfort they feel. It was observed that the deputy manager ‘picked up’ a care worker for not mentioning every resident at the daily handover meeting advising this person the importance of ensuring everyone is considered. In one plan staff were reminded to use picture cards to aid communication. Another indicator is the good rapport and caring qualities shown by staff towards the residents. It was noted how intuitively staff bend their heads to get physically and emotionally closer to the residents so as to be better able to make an emphatic connection when they spoke to them. Service users report very good levels of satisfaction. For example one woman wrote in their, “Have Your Say” questionnaire; “I have at all times received the necessary support I need – there is always some there to listen to you- there are three staff I could go to see at any time who would listen to me … I have been here since 1996 and have been perfectly happy and content, which I have been since day one.” Another male resident said that; “[Living here] is very agreeable…there are men here to be friendly with so that helps. The staff are good.” While another said. “The staff are caring and compassionate – if you ask them they will do anything for you. The food is good. There are no rules as such. The staff will phone for a doctor if needed and [they] help me with my personal care”. Someone else reflected on when they first arrived at the home. They said that; “At first I wanted to go back home, it was hard but this is the best place for me. You can do what you like and the staff get me a doctor when I need one, and I have made a good friend here” A fifth person said, “I wouldn’t want to be anywhere else” and was able to verify that the staff are caring and compassionate. Throughout the inspection it was observed that staff were especially, respectful, considerate and kind when engaging residents. Comments in case notes also show evidence of ‘pampering’ residents and them having quality time with care workers e.g. having a hand/feet massage. A visiting relative was overheard telling another person how wonderful the care at the home was. Examination of the case files shows that service users are supported to access a range of services, including specialist services. No residents or their relatives have made any adverse comments about this home. Romney House DS0000028215.V322193.R01.S.doc Version 5.2 Page 10 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 excellent. Care planning is much improved and is now good. Service users get the support and encouragement they need to access the medical and support services they need. The care given by staff is dignified and respectful and medication is well managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three case files were examined. They show that each service user has a care plan that outlines preferred routines and individual needs. Plans include routines in relation to personal care including the degree of privacy the service requests when using the bathroom and any history of falls. Other important information was included such as; preferences re meal times, management of medication, previous/recent medical history, weight charts, access to flu vacinations, information re sleep patterns and which days to change the bed linen (these are individually determined). Two areas of improvement were identified during the inspection; Romney House DS0000028215.V322193.R01.S.doc Version 5.2 Page 11 Better formatting of the information recording what medication people had. • Some care plans would be further improved if they were formatted using a designated form rather than being a selection of hand written looseleaf papers. Before the inspection ended the manager had actioned the method of recording medication needs. A feature of the case documentation is how well it captures those important small considerations and kindnesses that affirm good quality care. Examples include;• Ensure the call bell is near at hand • Make sure specs are clean • Ask each day if this lady wants help cleaning her teeth • Provide two small jugs of milk on the breakfast tray • Specific help needed to get into/out of the bath. Not only was this gentle, personal and dignified approach to meeting the needs of elderly people evident in case records; it was observed and witnessed in other ways during the inspection. Case documentation also stated what help people did not need - a good way of helping to ensures peoples independence and dignity. There was evidence to show that care plans/assessment documentation are periodically reviewed Case files seen verify that these residents are supported to access a range of medical services if needed including; general practitioners, community nurses, chiropodists, physiotherapists, opticians as well access to flu vacinations. Further more there is evidence to show that when residents say they would like or need to see a medical specialist staff advocate for them. The approach to keeping records about general well being and health care needs is discrete. It includes periodic weight checks, episodes of poor health including allergies, medical appointments including any tests and where known their results. Promoting healthy eating options and exercise also encourages life style benefits. There is a written policy on managing medication. It details the procedures staff must follow. The home uses a local independent chemist, who also undertakes twice yearly checks on the way medication is managed. There was a report of the last check made by the chemist. It was dated 16/11/06 and gave an excellent rating. Services users who wish to administer their own medication can do so, subject to undertaking a risk assessment that it is safe and which for additional protection their general practitioner has endorsed. The method of storing medication and the way it is administered was found to be satisfactory. It includes keeping a record of any unused or unwanted drugs returned to the chemist. It is policy that no ‘over the counter’ drugs such an Romney House DS0000028215.V322193.R01.S.doc Version 5.2 Page 12 • aspirin or indigestion tablets are given to service users unless their GP has okayed it. The medication records of two residents were checked and were found to be in order. It was noted that where service users decline or refuse prescribed medication this is recorded in the person’s case documents. There was also evidence to show that when medication is delivered to the home the staff check it and sign for it. The manager reports that there are plans for 10 staff to undertake a distance learning training package in the safe handling of medication commencing March 2007. There are records to show that supervising staff check each day that drugs are being administered correctly. Records also show that local chemist undertakes periodic medication audits; the last one was undertaken in July 2006. Staff who administer medication are trained by the manager who herself was trained by the chemist. Service users confirm that they get the medication they need. There is evidence to show that residents see their care plan and verify them, by signing, that the plan is meeting their needs. A visiting social care worker highly praised the home for its high standards of care and good staff saying that on her visits she finds it is a friendly place with happy residents. This inspection confirms as other inspections before it have done that the service is very good at providing care and attention that is respectful, dignified and ensures the right to privacy. An example of this was seen during the inspection when the owner reminded a supervisor to inform a care worker of the need to tie back their hair. There was an example seen when a resident raised a private issue in the reception area and the staff member invited the person to “discuss it later in a more private place.” Staff interviewed as part of the inspection were able to verify how they ensure respect and privacy. They gave several practical examples, i.e.; • “I would always ask a resident if they needed me to stay with them in the toilet or bathroom even it was part of the care plan that I should” Another said; • “I make sure the door is shut if talking in private, and by being discrete” – a behaviour that was observed. Service users that were spoken to during the inspection conveyed their appreciation of how much staff respect them. Romney House DS0000028215.V322193.R01.S.doc Version 5.2 Page 13 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 excellent. This continues to be a happy care home where residents are supported and encouraged to go out and about, to be active and to be sociable. Staff work hard to ensure suitable activities are provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A feature of this inspection was the way the home had embraced Christmas as a participatory festival. Not only was there open house for coffee and mince pies, on another day a visiting theatre group put on a festive play. A small party of local school children were also invited to home. On a different day a carol concert took place at the home and the local blind club were invited for a coffee morning. The highlight was a Christmas party with approximately 80 guests. This outward, positive ‘life is for living’ approach was good to witness. Planning a quiet ‘do nothing’ weekend for some respite – thus ensuring a good balance between being active and recuperation, followed it. Romney House DS0000028215.V322193.R01.S.doc Version 5.2 Page 14 It was commendable that service users were observed to go out with their visitors or un-accompanied as they wish. When residents returned they were warmly welcomed by the care workers on duty sharing important ‘small talk’ as a way of re introduction and checking out all went well or not as the case may be. The home also puts on in house activities such as an ‘exercise class,’ craft sessions and occasional bingo for those who want to partake. Another feature of the home was that at least three residents spoke about finding agreeable companionship and friendship with other residents. Such opportunities helps residents to be less emotionally dependent on the staff and to feel more in control themselves. When asked what is like living at the home one resident summed up what others also echoed. He said, “The are no irksome rules; its all pretty free and easy and we all seem to get on.” Another resident put it in a different way. She said; “here you can do what you like – even go to sleep when you want to. The staff won’t let you suffer- they get a doctor. They put you at ease.” It is the policy of the home not to manage resident’s financial affairs, except to assist people who may need help with looking after small amounts of money for personal spending. There is a planned menu, which rotates every 4 weeks. Residents confirm that meals can be taken either in their own room or in the dining area, as they wish. The inspector spoke with the cook on duty. This person impressed as loving her job and someone who likes the residents and knows their preferences; which she tries to meet. She reported that most residents like traditional English meals. Service users praised the meals. Typical comments by residents were; • “The meals are excellent.” • “Today we had fish and chips and the fish was beautiful fish.” • “I have breakfast in my room and the main meal in the dinning room. At night I always get asked if I want anything but mostly I don’t bother. I get a cup of tea at 5-30 in the morning. We can ask for one at any time” Case documentation also shows people food preferences or special dietary needs. A little touch, which typifies this home, is that when service users are offered a morning or afternoon tea/coffee it comes not only with a choice of biscuits, but some peeled fruit. Care workers were observed as going around asking residents their preferences e.g. mash or chip potatoes and what vegetable would they like. This was done in an unhurried way that enabled quiet interchanges and informal enquiries into a person’s well being or plan for the day. It was observed that residents are not only offered a choice morning tea or coffee they are offered 2 or more cups as they wish. Romney House DS0000028215.V322193.R01.S.doc Version 5.2 Page 15 Staff also praise the home and the management. Care workers described the home as a; “Happy sociable place; with a brilliant atmosphere – management is brilliant.” Another said; “The residents are nice and the staff are nice – management is good” Visitors were warmly welcomed. Romney House DS0000028215.V322193.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 good. This is a service that is very rarely complained about. When complaints are made the home takes them seriously and looks into them. Service users are protected from abuse, but there is scope to improve the communication with the local social services department about certain issues. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were two recorded complaints, the response to which appeared appropriate to the circumstances. One complaint was about the heating levels in a bedroom as a result of a broken thermostatic radiator valve and the other about a delay by staff in cleaning the toilet. Care workers were asked how they deal with any expressed niggles residents may raise. They responded by saying they endeavour to address any concerns when they are raised and if necessary they said they would inform the shift leader and/or manager. Care workers were asked to give an example of when they had done so. One example given was when a named resident said the breakfast tray was not as it should and was missing sugar so this was reported to the manager. This response links in with comments by residents that staff can’t do enough for you and that they are helpful and considerate. The owner and deputy manager Romney House DS0000028215.V322193.R01.S.doc Version 5.2 Page 17 confirmed that staff do pass on such concerns, though they were said to be few in number. Two staff were asked what responsibilities they have to prevent abuse and harm occurring to the residents. They both confirmed they would, “report anything even if only a little bit suspicious” and “discretely keep an eye open for bruising; even little bruises”. Care workers are provided with copies of the General Social Care Council’s code of practice and the local ‘No Secrets’ reporting procedures. Discussion took place about what to do someone has a medical condition that results in severe bruising or if they have a medical condition, which makes them confused and they allege past abuse or past infringement of their liberties. The home needs to ensure such issues are made known to the local social services department under the local adult protection protocols so that any concerns arising can be given full consideration. Reporting them to the person’s GP as evidenced in one case file is not sufficient in such circumstances. Romney House DS0000028215.V322193.R01.S.doc Version 5.2 Page 18 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. 25. 30. Quality in this outcome area is excellent. This is a safe, comfortable home with high standards of accommodation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been some small improvements made to the accommodation since the last inspection, including moving the office to a more central location. There are plans to further improve the accommodation by extending the home to include a larger office subject to obtaining the necessary consents. There are also plans to replace certain windows in the summer. Improvements have also been made to the communal areas by limiting the number of notices/certificates on display and by removing the inner conservatory door – thus improving access to the conservatory area. The fire logbook was examined. It shows that checks on the fire alarm system and the fire equipment are routinely undertaken (except for the month of Romney House DS0000028215.V322193.R01.S.doc Version 5.2 Page 19 October 06). Records show that fire practices are quarterly and staff receive basic fire safety training. As well as a recently updated fire risk assessment other risk assessments were in place i.e. use of bathrooms and shower facilities, the lift, use of the stair gates, storage of inflammable items, safe bathing, managing MRSA, pregnant staff. There is a detailed infection control policy in place which staff are expected to follow. The home was found to be exceptionally clean, with discrete notes and prompts by management to care workers to ensure a proper cleaning discipline. Seven i.e. 100 of the respondents who sent back a comment card all confirmed that the home is always fresh and clean. Care workers also confirm that they are provided with protective clothing and barrier products. Romney House DS0000028215.V322193.R01.S.doc Version 5.2 Page 20 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 good. The owners carefully select the staff. Staff impress as committed and caring. The home has yet to achieve 50 of the staff who have completed a relevant National Vocational Qualification level 2 or above but it is well on the way to doing so. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the first day of the inspection there were four care staff on duty until 2 p.m. and three care workers from 2 p.m. to 8 p.m. (for 17 residents), and excluding the manager and ancillary staff. Examination of the rotas shows a similar staffing pattern is maintained most days. Service users report in the “Have Your Say” leaflet that sufficient staff are available to meet their needs. The majority of respondents (five out of seven) said this was always the case, while two out of seven said it was usually the case there was enough staff. The three staff that were interviewed also confirmed there were sufficient staff on duty. The staff group includes a good balance of mature and experienced staff and new entrants to care work. While most care workers are woman the home does employ a male care worker. Romney House DS0000028215.V322193.R01.S.doc Version 5.2 Page 21 Records show that seven staff have successfully completed a relevant National Vocational Qualification and a further nine staff are currently undertaking this training. Records also show that care workers have undertaken training (or have it booked) in first aid, manual handling and food hygiene. Three staff files were examined. They show that in all cases a Criminal Record Bureau check (CRB) was obtained. For those staff appointed after the introduction of the Protection of Vulnerable Adults list (POVA 1st) such checks were also carried out. While applicants are asked to complete an application form some staff did not always fully answer each question or detail all their employment. The application form does not allow sufficient space to do so and does not prompt applicants to use a separate sheet. The reasons for gaps in their employment history are not adequately explained or detailed. Care needs to be taken to ensure job applicants are told they must detail all past employment using a separate sheet if needed. All files included two suitable references and proof of identification (ID) both in the form of a photo and other formal documentation such as copies of a birth certificate. Copies of No Secrets and the General Social Care Councils code of practice were available in the office and staff confirmed that had been provided with copies. The manager confirmed that when the home numbers were reduced to 14 residents the staffing levels were reduced accordingly but now they are increasing these numbers of staff are increasing; though at the time of the inspection there were 2 staff vacancies. The owner was able to confirm that they were awaiting two POVA 1st checks before confirming that two recently interviewed applicants could commence work at the home. The current method of inducting newly appointed staff does not fully meet the standard, as it is not compliant with the relevant skills councils guidelines. Another caring observation was a staff member informing a relative of the homes concern that a resident was not coping with some bad news and inviting the relative to a meeting to discuss this concern further; while at the same time promising to keep an eye on the problem. Romney House DS0000028215.V322193.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. 32. 33. 34. 35. 36. 37. 38. Quality in this outcome area is good. The home is well managed and provides very good outcomes for the residents. The manager needs to complete her National Vocational Qualification Level 4 training in the coming months. Formal ‘one to one’ staff supervision meetings needs to more frequent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is deemed by the Commission as a ‘fit person’ to manage this care home, but has yet to complete her National Vocational Qualification level 4. The manager said that she has successfully completed eight units and anticipated the remaining units will all be completed within six/nine months. Romney House DS0000028215.V322193.R01.S.doc Version 5.2 Page 23 A feature of this service is the way the owners and the management team effectively communicates the homes ethos. High standards are expected and based on what residents say and these are being consistently delivered. Great care is taken to ensure a compatible mix of residents. It was observed that one care worker was reminded of the importance of the dress code as a way of showing residents they are respected and valued. The management style is open and transparent, confirmed by those working at the home and evidenced in the minutes of staff meetings, where a number of business challenges were spoken about. Since the previous inspection progress has been made with ensuring and monitoring quality assurance. While there is no formal structure in place such as ISO 9002 or Investors In People genuine attempts have been made to check out customer satisfaction. This has been achieved in a number of ways. The owners and the management team discretely and sometimes directly ask residents if they are aright, happy or if they have any concerns and by inviting them to say if anything is troubling them. This approach, which was observed every day of their inspection and is the main stay of ensuring residents, are o.k. Other methods used include sending out questionnaires to current residents. Questionnaires for November and December covered meal arrangements. Examination of the responses shows only three negative comments i.e. 1. A preference for less mash potatoes. 2. A wish for the rice pudding to be more milky and 3. An occasion when the sugar was missed off the tray. Checks are also made that any requests for repairs and maintenance issues are promptly addressed. However this quality assurance system has not yet captured any wider appreciation of the views of relatives, health care workers and staff so it is regarded as partial. Not withstanding this there is evidence of relatives, health care professionals and other praising the home for its standards. The management team do however seek out service users views. Recommendation and requirements made at the previous inspection appear to have been diligently actioned resulting in further improved standards. Service users are encouraged to manage their own financial affirms including retaining there own money for person spending. If assistance is needed the home sets up an individual petty cash account where debits and credits are recorded. Receipts are kept. Three such records were checked of which two fully reconciled with the amount in the account with the written record. However in one other case the amount in the account was 13p more than the written record. The deputy manager thought some bus fare had not been accounted for. Not all residents have the option to have a lockable bedside Romney House DS0000028215.V322193.R01.S.doc Version 5.2 Page 24 cabinet to keep sums of money comparatively safe, in bedrooms, which do not have locks on the doors. The home welcomes the involvement of families, appointee, and solicitors. The deputy manager confirmed that formal ‘one to one’ supervision has not been sufficient or regular. Records show that some staff have only had one or two private meetings with their supervisor in the past year-considerable less than the standard of six such meetings. There has however been regular staff meetings incorporated into a coffee morning. Minutes of these meetings show that items discussed included; Christmas festivities, fire safety (a subject initiated by a resident who has a professional background in fire safety) and general management issues. Issues raised by residents in their meetings included a request for improved lighting in the dining area. This was provided. One meeting addressed some issues residents had about new staff being a bit slow with medication and breakfast trays. It was recorded that residents valued the explanation as why this some times occurs i.e. because new staff were learning and need more time to ensure mistakes wear not made. Overall this is a safe environment. Examination of the accident book shows low level of accidents or incidents occurring i.e. averaging approximately one every week most of which are reports of residents having trips, slips or falls. These are recorded even if there is no apparent injury. The response to such incidents seems appropriate to the circumstances. There is evidence to show that when staff in the home had concerns about the care provided by the ambulance service, these concerns were communicated to the appropriate department for further investigation. Romney House DS0000028215.V322193.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 4 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 3 3 2 2 2 Romney House DS0000028215.V322193.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? 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 OP30 Regulation 18(1)(c)(i ) Requirement The home must introduce an induction programme for newly appointed which meets the criteria laid down by the skills council for care Timescale for action 01/04/07 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 OP36 Good Practice Recommendations It is strongly recommended that one to one supervision meetings take place at least once every 2 months and such meetings from time to time consider the development of the skills, the knowledge and the understanding needed to adequately meet the health and welfare needs of those living at the home. (This recommendation is repeated from the previous inspection) So as to improve the protection of residents from abuse, harm or neglect the home should always inform the local social services department of all disclosures of abuse or any extensive bruising if it is a result of a a medical condition. DS0000028215.V322193.R01.S.doc Version 5.2 Page 27 2. OP18 Romney House 3 4 OP28 OP33 The home should ensure that at least 50 of staff are trained up to or beyond National Vocational Qualification level 2 It is recommended that when undertaking quality assurance surveys the views of relatives, health care staff, social work staff, and those working at the home are obtained Romney House DS0000028215.V322193.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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