Inspection on 21/06/07 for Salmonsbury House

This inspection was carried out on 21st June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Salmonsbury House 08/03/06

Salmonsbury House 23/08/05

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Salmonsbury House Station Road Bourton-on-the-water Cheltenham Glos GL54 2BQ Lead Inspector Mrs Ruth Wilcox Unannounced Inspection 21st June 2007 11:00 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 Salmonsbury House DS0000064587.V334989.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. Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Salmonsbury House Address Station Road Bourton-on-the-water Cheltenham Glos GL54 2BQ 01451 820821 01451 822517 manager.salmonsbury@osjctglos.co.uk 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) The Orders of St John Care Trust Mrs Beryl Ann Ratcliffe Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th March 2006 Brief Description of the Service: Salmonsbury House is a purpose built care home located close to the centre of Bourton-on-the-Water. It is registered to provide nursing and personal care to forty residents over the age of 65 years. The Home is managed by The Orders of St John Care Trust. Salmonsbury House has thirty-five single rooms on the ground floor and a further five bedrooms on the first floor; four of the rooms have en suite facilities. A shaft lift has been installed to provide access to the upper floor. The residents have the benefit of large comfortable communal areas and attractive private gardens. Information about the home is available to prospective residents and interested parties in the printed Service User Guide, and a copy of the most recent CSCI report is available in the home for anyone to read. The charges for Salmonsbury House range from £539 to £742 per week. Hairdressing, chiropody, toiletries, magazines and newspapers, transport and holidays are extra costs. Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. One inspector carried out this unannounced inspection over two days in June 2007. A check was made against the small number of requirements that were issued following the last inspection in order to establish whether the home had met these. Care records were inspected, with the care of four residents being closely looked at in particular. The management of residents’ medications was inspected. A number of residents and relatives were spoken to directly in order to gauge their views and experiences of the services and care provided at Salmonsbury House. Some of the staff were interviewed. Survey forms were also issued to a number of residents and visitors to complete and return to CSCI if they wished, and some of their comments are featured in this report. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, training and provision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. What the service does well: Salmonsbury House provides a very comfortable and pleasant home for its residents. It is immaculately clean, safe and well maintained. Residents have access to a good amount of information about the home when making their choice about it, and are admitted on the basis of an individual Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 6 assessment, so that they can be assured the home can meet their particular needs. Each has their own individual care plan to meet their personal and health needs, and is assured of good access to all health services, with the appropriate medical interventions and treatments when required. Residents’ visitors are welcomed into the life of the home. Resident and visitor comments were overwhelmingly favourable about the home, its services and facilities, the standard of care and the staff. There is a respectful approach towards residents’ privacy, personal choices, and preferences, and a varied and stimulating social activity programme is available to meet a variety of ability and interest. A good standard and variety of food is served in this home, and again residents spoke very favourably about this. Residents and their families can be assured that the home has a robust approach to addressing any complaints or concerns, and that the standard of care, services and facilities is regularly reviewed as part of good quality monitoring systems. Residents confirmed that they felt safe in this home, and that they had faith and confidence in the staff. New employees are recruited following strict pre-employment checks and good recruitment practices, and all have the opportunity to attend training appropriate to their work. There is a good focus on the National Vocational training programme. There is a stable and committed staff team here, which is of benefit in terms of continuity and good relationships for the residents. The home also has the benefit of strong leadership and committed, focussed management. What has improved since the last inspection? What they could do better: Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 7 Residents’ care plans are good in most respects, but there are isolated instances where an improvement to the standard of recorded planning is needed in terms of being more comprehensive and informative. Although there are some very good arrangements in relation to the safe management of medications, following this inspection the home should investigate the safety of one of the metal drug cupboards, with a view to certain regulations governing its wall fixing. There are also some aspects of the associated record keeping that now require some improvement. 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. Salmonsbury House DS0000064587.V334989.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 Salmonsbury House DS0000064587.V334989.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): 1&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home have access to a good amount of information about it, and are assessed prior to their admission so that they can be assured that the home will be able to meet their needs. EVIDENCE: The home has recently introduced a new and revised Statement of Purpose and Service User Guide, known as the Residents’ Handbook. The former is readily available in the entrance hall for anyone wanting to read it, and a copy of the latter, which contains all the information that is required, is issued to each prospective resident. Care records for two more recently admitted residents that were inspected as part of the case tracking exercise contained completed assessment forms that identified their care and social needs prior to admission to the home. Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 10 Some of the recording on these forms was quite basic, with very isolated aspects not completed at all. Assessments had evidently been carried out at locations convenient to the prospective resident, and were supported by information provided by other health and social care professionals previously involved in the care of the individual. One resident commented that their admission had been arranged in a ‘very sensitive way’. A relative commented that they had received very truthful and professional advice, and had had the ‘best quality information’. Prospective residents receive written confirmation of their placement in the home, as is required. Salmonsbury House does not provide intermediate care. Salmonsbury House DS0000064587.V334989.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): 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Despite some isolated recording omissions in care and medication records, people living in this home have their health and personal care needs met through good care delivery that is mindful of their privacy and dignity, and through a generally safe system for administering their medications. EVIDENCE: All residents have their own personal plan of care, which is kept under regular review. Four were selected for a case tracking exercise, and were scrutinised in closer detail. Each of these care plans was directly linked to a variety of assessments. These included general health, personal and social needs, and also a range of risk assessments, incorporating pressure sore vulnerability, manual handling, and falls and nutrition where applicable. Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 12 Records showed that the residents received regular medical support, advice and treatment from all community health care services. There were some gaps in recording however, with some assessed needs having no linked documented plan of care to address them. Despite this the case tracking exercise and interviews with staff demonstrated that the home is meeting such needs very well, and that this was purely an omission in recording. Examples of this included one resident whose assessment and care delivery in practice showed that he had some mental health needs with psychiatric interventions, and a high level of pressure sore vulnerability. Another example was a resident who had similar needs to these, and also was assessed as requiring help with hygiene and dressing, but had no written care plan in relation to this either. This particular person’s medical notes also made reference to a pacemaker, but this fact had not been incorporated into any part of the home’s own recording. There was evidence in the care plans that due regard should be shown towards individuals’ dignity, choices and preferences, and levels of independence. Residents themselves were overwhelmingly positive regarding the way in which they were looked after at Salmonsbury House. Comments received included ‘We get the highest quality care and support’, ‘We get first class attention’, and ‘We get a high standard of care and attention’. Visitors to the home were also overwhelmingly positive in their praise of Salmonsbury House. One commented that ‘the staff really understand people’s needs’. Another said that ‘their relative was very contented and very well cared for’. Although no-one was currently doing so, residents are able to manage their own medications if they wish and are able, and this is done on the basis of a documented risk assessment process. Storage for medications was secure, clean and well organised. Controlled Drug (CD) storage was provided and, despite one recent lapse now rectified, a meticulously recorded bound register was maintained. In order to comply with The Misuse of Drugs (Safe Custody) Regulations 1973 the CD cupboard must be rag/rawl bolted, through two pre-drilled holes in the reinforcing plate at the back of the cupboard, to a solid wall; although the cupboard certainly seemed solid and well bolted, there were no such bolts within the inner cupboard, and this will need further investigation by the home in case adjustments have to be made. Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 13 The receipt of medications was recorded on designated forms, and a separate register of returned items was kept. The supplying pharmacist clearly prints the medication administration charts. Any hand written entries on medication administration charts were signed by the author, with a second signatory as witness. Variable dosages were recorded. Some of the external medications were prescribed to be used to the ‘affected part’ or ‘affected eye’. Although some were linked to a written plan of care that gave instruction on how to use medications, particularly if prescribed for use ‘as necessary’, not all were. Furthermore one external preparation prescribed for usage three times each day had not been signed at all, and was in fact only being applied when needed. In cases such as this a review of the medication frequency should be undertaken and the necessary amendments properly recorded. There were a small number of medications that had been ‘struck through’, having been discontinued. At least two were seen that did not include when and by whom they had been stopped, which made it difficult to be sure of the circumstances. Boxed and bottled items were dated on opening as a precaution against using the item beyond its expiry date, and also provided a good means of conducting audits. A random audit was carried out on some boxed medication, and there was no discrepancy identified. A discrepancy that the staff had identified themselves was already receiving their full attention so that clarity and resolution could be reached. Staff were consistently observed being polite, courteous and sensitive in their approaches to residents. Residents themselves confirmed the respect they received from staff, with some saying that staff always knock on their door before entering. A visitor commented that staff consistently show respect towards residents’ privacy and dignity. In cases when particular manoeuvres were required in a communal space, using a hoist as an example, staff carried this out calmly, efficiently, and with due regard to the person’s dignity. Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People living in this home have good opportunities to remain as socially active as they are able and choose, and also have a nutritious diet that offers choice and variety. EVIDENCE: The home currently only has a relief designated activities coordinator, but is recruiting to this position as soon as possible. The residents have been consulted about their personal interests for social pursuits, and records of events and activities and of residents’ participation have been maintained. A range of activity has been made available to suit a variety of taste, ability and interest. Photographs and social activity programmes show trips out, musical entertainments and exercises, games, flower arranging and gardening. Some residents have been involved in hand crafting jewellery with ‘Art-Shape’, and items they have made are on display. Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 15 A mobile library visits the home on a regular basis. A multi-denominational religious service and communion is held regularly. A small number of residents are able to pursue personal hobbies, with one lady saying that she went out a lot, and visits local shops; this person also said she fulfils her love of reading and music. Another still manages to pursue a hobby of drawing. Residents are supported to maintain links within the local community, and have access to the local parish and community publications. Special occasions are observed and/or celebrated, and during this visit the staff were joining with the residents to enjoy the Ascot horse racing and fashion event. For those not wishing to participate with group events, choices are respected, and key workers endeavour to provide some quality social time with residents on a one-to-one basis. One resident said that the staff were ‘really bright and lively’, whilst another said that staff were ‘like family and friends’. One visitor commented that the outings and celebrations were ‘excellent’ and that her relative was ‘really spoilt by the staff’. Families and friends are very clearly welcomed into the life of the home, and there are no restrictions placed upon them. Visitors commented that the staff keep them well informed and ‘in touch’, and that they felt they were properly consulted and kept up to date with things. One particular visitor said that she was always made to feel most welcome by the staff when she visited. Residents confirmed that they felt fully respected in terms of their choices and of retaining control over their lives as far as possible. One lady commented that she ‘lived life just as she wanted’ and that she ‘had control over her life’. Some relatives commented that in their view the home was always most respectful to people’s diversity, and supported residents to spend their time as they chose. Residents were seen moving around the home as they wished, within the bounds of their abilities, whilst there were some who clearly were much more reliant on staff to meet their needs. Bedrooms had a degree of individuality, with residents having personalised their room with their own belongings and treasured possessions. Advocacy information, plus other useful information about advisory and support services was readily available. Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 16 Residents are offered a good amount of choice with their meals also, and are consulted each day about their choices for lunch and supper. One resident said that they could have anything they wanted for breakfast also, including a cooked one if they wanted. The service of lunch was seen on each day, and on both occasions the meal looked plentiful, wholesome, nutritious and appetising. The meals were very well presented in the spacious and peaceful dining room, or in some cases in the lounge or bedroom, wherever the resident was most comfortable. Residents spoke very positively about the quality and quantity of food, saying that food was ‘excellent’ and that ‘they enjoyed a lot of choice’. The cook seemed very flexible and accommodating and was well informed about individual requirements. Special diets and needs for adapted cutlery and crockery were observed where necessary. Staff were providing discreet and sensitive assistance if needed. The kitchen was seen during the lunchtime preparations. Although clearly busy, it was well organised. The kitchen area and storage was clean, with all appropriate catering records well maintained. Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home are able to express their concerns and are reassured by the home’s complaints procedure, and also feel safe and protected against abuse and have their rights protected. EVIDENCE: A comprehensive Complaints Procedure has been prepared for Salmonsbury House, a copy of which is provided to each prospective resident and/or relatives along with other information about the home. The written procedure is displayed in the home as well, although not very prominently. Most residents and visitors confirmed they knew how to make a complaint if they needed to, but there were isolated people who said they did not. However, without exception, all indicated that they would feel entirely happy to raise anything if necessary, as the staff are so approachable and helpful, and ready to listen and act on what is said. One family said that the manager regularly asked if things were ‘alright’ and if they had any concerns they would like to raise or that she could help them with. Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 18 The home has a good system for addressing any concerns that are raised, with appropriate recording when necessary, however there have been no complaints raised in recent months. The home provides fully documented policies to address all forms of abuse, which are readily available for staff to read. Abuse issues are covered in the induction training programme, which each newly appointed member of staff attends, and all staff have attended mandatory adult protection training in the past year. Staff themselves confirmed their training, with some appearing slightly more conversant in procedures than others, but all definitely with a ‘zero tolerance’ approach towards any abusive or bad practice should they witness any. Residents commented that they had great faith and trust in the manager and staff. Two ladies spoke of ‘feeling safe’ and of ‘having no concerns at all’. POVA (Protection of Vulnerable Adults) legislation has been correctly followed at Salmonsbury House during the recruitment of staff. Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home are provided with very comfortable and pleasant accommodation, which is suitable and safe to meet their needs. EVIDENCE: Salmonsbury House provides accommodation in light, pleasant and comfortable surroundings. Residents themselves commented upon the brightness and airiness of the home, and of how comfortable they were. It is well maintained and decorated throughout, and is a generally safe and accessible environment to meet the needs of the residents. Only four of the rooms have their own en-suite bathroom, but communal bathrooms are spacious and well equipped. Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 20 Items of new furniture have been provided in a number of areas, and a new assisted bath and shower facility has been installed. A committed maintenance person is employed at the home, and meticulous maintenance and safety checks were carried out, with thorough and detailed records kept. A small number of residents’ bedrooms do not have carpets, having been fitted with alternative flooring. One particular resident said that they did not mind this, and had never thought to request a carpet. The manager confirmed that carpets would be provided if the occupants coming into these rooms wanted one. The exterior grounds were attractive and well maintained. Everywhere was immaculately clean and fresh, with no odours detected anywhere. Some residents and visitors commented specifically on how clean and hygienic the home was. There were good infection control measures here, with liquid soap, paper hand towels, hand sanitising gels, gloves and aprons widely available. All grades of clinical waste were safely managed. The laundry room was well organised, despite the laundry assistant being absent during this particular visit. Washing machines are capable of disinfecting any foul laundry. There were three sluice rooms, each very clean, and with a disinfection machine in each. All chemicals were safely stored when not in use. Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 21 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 excellent. This judgement has been made using available evidence including a visit to this service. People living in this home receive care from a stable and competent workforce, and can be reassured by the stringent pre-employment checks carried out on new staff. EVIDENCE: Residents and visitors to the home were overwhelmingly positive about the staff group at Salmonsbury House. Without exception among those surveyed or spoken to directly, each said that staff were either helpful, understanding, skilled and experienced, or offered polite support. The home appeared calm, organised and running efficiently during this visit, with residents well attended, and call bells answered promptly. The staff on duty went about their responsibilities to residents quietly and professionally, whilst retaining a friendly and pleasant demeanour. The nurse in charge during the two days of this visit was very busy, with numerous calls upon her time, and was responding extremely well under the circumstances whilst continuing to remain approachable and supportive to the team. Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 22 A solid and capable ancillary team of cleaning, catering, maintenance, administration and laundry staff very ably supports the care and nursing team. The team and the residents benefit from a high level of stability among the staff group, although through either sickness or authorised leave, some agency staff have been used. The home was making excellent progress with the National Vocational Qualification (NVQ) training programme for care staff. There were eleven care staff qualified to at least level 2 at this time, with a further ten currently on a course to achieve their award. A further two had commenced the Modern Apprenticeship scheme. Personnel files relating to three members of staff who had been recruited in recent months were inspected. In each instance, the prospective employee had completed an application form providing details of their employment history. Medical information had been provided, although in one case it was not possible to have direct sight of this. Two written references had been provided in each case, including one from the last employer. Correct POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) screening had been completed for each person. There is an experienced and very competent training coordinator in the home, and good, clear records of all training undertaken by staff were kept. The training programme for staff comprised mandatory and optional training subjects, all of which bore relevance to their role. Certificates of learning were maintained and also issued to each member of staff, however to date care staff have not been actively encouraged to develop and maintain their own personal training and development file, and should now be advised to do so. Each worker had been issued with the General Social Care Council Code of Conduct. Newer staff had received induction training, and there were comments from some of them about the good level of support and supervision they had received during that time. They confirmed they had worked under the direct supervision of an experienced mentor during their induction period. Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 23 Induction training is delivered on a set day at a training centre, and also through the observation of a programme designed for use when actually working in the home. It is also delivered via an electronic induction-learning package that provides training in six modules, each of which incorporates the Common Induction Standards for care staff, including Principles of Care, Roles and Organisation, Health and Safety, Communication, Abuse and Neglect, and developing as a Worker. Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The people living in this home benefit from efficient, open and respectful management, in which a qualified and competent manager effectively monitors quality and standards. EVIDENCE: The manager of Salmonsbury House is a Registered Nurse, and has been managing the home for five years. She is registered with CSCI for her role, and has obtained the Registered Manager’s Award. Residents and staff indicated their confidence in her management and leadership. One resident said that the manager was ‘lovely’ and also ‘very helpful’. Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 25 There is a strong focus on monitoring the quality of the care and services at Salmonsbury House, with a clear intention to make improvements wherever the need is identified. Annual quality monitoring survey forms were issued to residents and their families last year, which are due to be re-issued again very soon, and these sought their views and experiences of the care, facilities and services. The manager made it her priority to identify any issues straight away and deal with them promptly, but other than that any actions that were needed to address any issues of concern were addressed through a written action plan, drawn up on the basis of the collated results. A residents’ meeting is organised regularly, and this gives residents a further opportunity to have their say about the way their home is run, and to give feedback on their views of the services. Salmonsbury House conducts a range of its own internal quality audits in areas such as medication management and the environment. Financial audits have also been carried out. External auditors have also assessed the home, and it is to the home’s credit that it has been awarded the ISO 9000 Quality Award and Investors in People Award. Many residents have placed personal money and valuables in the home’s main safe for safekeeping. Clear and transparent records for each person were kept, and these included transaction details, running totals, and receipts. Residents or their representative have access to their records, and can sign to acknowledge transactions, but this had not been possible in nearly all cases at this time, and two staff members had signed the record to witness on behalf of the resident. A regular audit was recorded on each of the records. Health and safety issues are addressed through written policies, procedures and risk assessments, staff training and provision of necessary equipment. Staff have received training in fire safety, and fire drills have been conducted periodically. Senior staff have also attended Fire Marshall training with the local fire department. Staff have received training in first aid, with two having done a full and more comprehensive four day course. First aid equipment is provided in the home. Accident records were seen for certain events that were identified during the case tracking exercise. Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 26 A full fire safety risk assessment throughout the whole building has been undertaken by an external assessor, with due regard to revised fire safety regulations; there remain certain issues the home has yet to address on that basis. Hot water temperatures are regularly checked for safe levels, and regular Legionella checks on the water supply have also been carried out, with the appropriate control measures in place. All the necessary safety checks and maintenance of utilities and equipment are undertaken in a timely fashion, and meticulous records are kept in these areas. The building was secure, with coded door entries in a number of locations. Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 27 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 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 3 Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15(1) 17(1.a) Schedule 3 (k) Requirement Timescale for action 31/07/07 2 OP9 13(2) 3 OP9 13(2) Care plans must be written to show how all needs identified in the range of assessment tools will be met. This is with particular reference to all cases where a pressure sore risk and any mental health needs are identified, and also for any treatment such as in the case of a cardiac pacemaker. Directions for the use of external 31/07/07 preparations and eye drops must be clearly recorded on the medication administration chart. This will ensure that all people living in the home who have these preparations prescribed will receive their medications correctly. Reviews of medications resulting 31/07/07 in items being discontinued must be clearly identified by recording the date and who made the change on the medication administration chart. This will ensure clarity for staff and safety for residents in cases where the item continues to remain on the printed medication administration chart. DS0000064587.V334989.R01.S.doc Version 5.2 Salmonsbury House Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Salmonsbury House DS0000064587.V334989.R01.S.doc Version 5.2 Page 31 - 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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