Inspection on 26/02/07 for Salvete

This inspection was carried out on 26th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Salvete 13/10/05

Salvete 09/06/05

Salvete 02/12/04

Salvete 13/07/04

Salvete 23/06/03

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Salvete 15/17 Rothsay Place Bedford Bedfordshire MK40 3PX Lead Inspector Katrina Derbyshire Unannounced Inspection 26th February 2007 12:00 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 Salvete DS0000014962.V329740.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. Salvete DS0000014962.V329740.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Salvete Address 15/17 Rothsay Place Bedford Bedfordshire MK40 3PX 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) 01234 261991 01234 405600 Mr Tushar Bhatt Dr Lata Bhatt Mrs Beverly Catlett Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30), of places Physical disability over 65 years of age (30) Salvete DS0000014962.V329740.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th October 2005 Brief Description of the Service: Salvete Residential Care Home is registered to provide residential services for 30 older people who may have physical disabilities and/or dementia. The home has been created from the combination of two, two-storey high houses with an internal link corridor through a garage. The garage is used for the homes office as well as a drug cupboard. The home is situated on a quiet culde-sac road. The main road leads to the river. There is also ready access to local shops and the town centre. The building includes a large communal lounge with a new conservatory. The home has all the necessary facilities and staffed to operate well. The fees for this home vary from £424.87 per week, to £525.00 per week, depending on the needs of the resident. Salvete DS0000014962.V329740.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of this visit was to undertake a key inspection. This unannounced visit took place on 26th February 2007. The Registered manager Mrs Beverly Catlett was present throughout the inspection. During the inspection communal areas and private rooms in the home were visited and the inspector spent time with many of the residents’ in the sitting areas of the home. The care of three residents’ was examined by looking at their records and interviewing the residents’ and staff who look after them. The views of residents were also received and their feedback has been used alongside information from the home through a pre inspection questionnaire to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit alongside their views. Observations of care practice and communication between the residents’ and staff was also made at the inspection. The focus of this inspection was to look at the key standards and to follow up on previous requirements. What the service does well: Both residents and staff at this home feel that the manager is thoughtful, committed and has the best interest of the residents as her main aim. One resident said, “ she is simply marvellous l can’t tell you how much she has helped me”. Another resident said, “ l moved here from another place and was feeling really nervous, but she was so kind to me, so helpful l don’t know how l can ever thank her enough for what she does”. Systems at this home for training staff are good. When we visited an assessor from the local college was also at the home, she was there to assess one of the staff that was working towards their National Vocation Qualification in Care. The way the makes sure that staff undergo certain training, makes sure that they have sufficient understanding of the needs of residents. Staff at the home are also good at arranging access to health care professionals when the residents require their support. District Nurses for example visit the home when needed to provide care to residents who need their help. They also make sure that if a resident needs to attend a hospital appointment, then transport is arranged or other arrangements are made. This means resident’s benefit from access to medical services when they need them. Salvete DS0000014962.V329740.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Salvete DS0000014962.V329740.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 Salvete DS0000014962.V329740.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&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff at the home obtain information on the needs of the residents prior to their admission to ensure they have sufficient knowledge to be able to decide if they can meet the residents needs. EVIDENCE: Documentary evidence was seen within the individual care records of residents to show that information about the residents needs had been obtained, prior to them moving into the home. Documents were seen that described the past medical history of the resident alongside other information for example social interests, family contact information and personal preferences concerning their daily routines. Salvete DS0000014962.V329740.R01.S.doc Version 5.2 Page 9 In addition documents were also seen of assessments undertaken by the funding authority that provided additional information as to the residents, physical, social and emotional needs. Intermediate care is not provided at this home. Salvete DS0000014962.V329740.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 good. This judgement has been made using available evidence including a visit to this service. The systems at this home for arranging access to healthcare are good therefore promoting better health for the residents. EVIDENCE: Care plans that were examined showed that there was a plan in place for the needs that had been outlined in the assessment of the resident. Brief instructions were noted to be in place that identified in broad terms the support that staff should offer. However these still require further development to expand in the guidance that they give to staff to ensure continuity of care. Staff when interviewed demonstrated a differing level of knowledge relating to the needs of the residents, in increasing the guidance within the plans all staff would have the same level of knowledge on the care that should be provided. Salvete DS0000014962.V329740.R01.S.doc Version 5.2 Page 11 Residents through discussions spoke of their continued use of medical services, following their admission to the home. District Nurses maintained documents and care plans for the care that they provided in the home, and staff reported good working relationships with these health care professionals. One resident spoken to described the support from the manager in accessing specialist support concerning their sight, and had several items to assist them in their daily lives following this. Documents were also seen to be in place that showed residents had also benefited if needed from physiotherapy and other clinics at the local hospital. Medication was noted to be stored in a locked cupboard opposite the managers office. Medication administration records contained signatures to show the times that medication had been given, and no gaps were seen. The amount of medication in stock was recorded on the medication records and documents were seen to show the returns of any medication not in use. Staff confirmed that training in the administration of medication was undertaken prior to them being allowed to undertake this role in the home. The balances of 14 medication’s was checked and 13 were seen to match the amount recorded on the medication record. The one incorrect balance was explained by the manager to be caused by the fact that staff had not carried forward the balance correctly from the month prior. Residents through discussion confirmed that they felt that their privacy and dignity was maintained by staff at the home. Staff were seen to use the term of address preferred by the resident and spoke to them in a courteous manner. Staff were also seen to knock on residents doors before entering. Salvete DS0000014962.V329740.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems and support to residents in maintaining personal relationships is good, and enhances the resident’s standard of life. EVIDENCE: Daily activities are on offer in the home, all activities are advertised on a notice board. Outside entertainment, for example the provision of music, also is available in the home. Residents said that they were satisfied with the level of activity available. Residents are encouraged to join in, but can choose whether or not to participate. Activities specifically designed to assist residents with maintaining levels of mobility are also available. Residents are able to bring personal possessions into the home and the evidence of this was seen in resident’s individual rooms. Residents confirmed that they are consulted and are given choices as to how they conduct their lives within the home; choices offered included meals, activities and relationships. Salvete DS0000014962.V329740.R01.S.doc Version 5.2 Page 13 Nutritional risk assessments were seen within the residents care records. A choice of meals is available, an observation of the lunchtime meal showed it to be unrushed and enjoyed by the residents from their positive comments. One resident said, “ l find the food lovely”. Residents also commented on the support staff gave them to maintain contact with friends and family members. Documents were seen in the file of one resident that gave specific information on how the resident should be supported to maintain a close personal relationship. They could see their relative in private and felt that the home were good at keeping them up-todate on any changes concerning their family member. Salvete DS0000014962.V329740.R01.S.doc Version 5.2 Page 14 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. Systems in place for residents to complain are good so residents feel enabled to raise concerns and feel that they will be listened to and their concerns acted upon. EVIDENCE: The home has a complaints procedure that makes clear how residents can complain and the timescale is given for the home to respond to them. All feedback received from residents said that they were aware of the complaints procedure and were happy to complain if they felt that they needed to. Staff through interviewing them were able to demonstrate a good understanding of the homes complaints procedure, and what they should do if they themselves were to receive a complaint. Training had been undertaken by staff in the protection of vulnerable adults. Staff through interviewing demonstrated that they had a sufficient level of knowledge of abuse and what they should do if they suspected any abuse of a resident. The manager also through discussion demonstrated a good understanding in this area and was aware of the local guidance in reporting procedures. The home did have a policy on abuse and a copy of the local protection of vulnerable adults policy. Salvete DS0000014962.V329740.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements are needed to the décor and carpeting in some areas of this home to ensure the environment is homely for the residents to live in. EVIDENCE: Residents rooms that were seen contained personal items for example photographs and pictures. Assisted bathrooms are in place and grab rails were also in place to assist residents with their mobility. The sitting areas in the home were clean and tidy and no odours were detected throughout the home. However several areas require redecoration for example the walls along the main corridor on the ground floor were very scuffed and had raised wallpaper Salvete DS0000014962.V329740.R01.S.doc Version 5.2 Page 16 in some areas. The carpet in the main lounge of the home was faded, worn and stained, although the manager confirmed that cleaning schedules were in place. The owner of the home stated that a replacement had been purchased but that it had not yet been fitted. This must be done. Alterations to some of the bedroom areas were being undertaken at the time of this visit. This would also provide ensuite shower rooms in these rooms. The area had been cordoned off for safety reasons. Cleaning schedules were seen to be in place alongside clinical and domestic type waste contracts. Protective clothing such as gloves and aprons are used by staff and hand washing facilities were situated throughout the home. Salvete DS0000014962.V329740.R01.S.doc Version 5.2 Page 17 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 poor. This judgement has been made using available evidence including a visit to this service. Systems in place for the recruitment of staff are not sufficient to protect residents and places them at risk. EVIDENCE: Staff files were examined and at this visit contained application forms and evidence of identification. However the three most recently employed staff members had actually commenced their employment prior to the home receiving their second written reference and Criminal Records Bureau checks, this information was only secured after they had worked at the home. Through discussion the manager confirmed that she believed this to be sufficient. This places the residents at risk and a requirement has been made relating to this. Staff training records show that staff have attended a variety of courses and workshops including health and safety, food hygiene and management of medication. Staff through interviewing described other training that they had undertaken including the National Vocational Qualification in Care. Salvete DS0000014962.V329740.R01.S.doc Version 5.2 Page 18 Staffing rotas showed that the number and skill mix of staff were sufficient to meet the needs of the residents. Residents and staff felt that there were enough staff to care for the residents, it was reported that at times residents would need to wait for assistance if help was being offered to another resident but that this would normally only be for a few minutes. Staff through discussion demonstrated that they were aware of the needs of the residents as recorded within their care records and were able to describe the individual, although some had a better understanding than others and this has been raised in section two. It was observed that the interaction between the staff and residents was positive and showed that supportive relationships between them had been established. Salvete DS0000014962.V329740.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The systems at this home for managing health and safety are good protecting the residents through reducing risks in this area. The records confirm that the process of recruitment of staff falls significantly below the expected standard which places service users at risk from staff who have not been appropriately vetted. EVIDENCE: The manager has not maintained her knowledge of the requirements for appointing staff so that service users are protected. Staff where employed prior to any checks being undertaken. This breaches the regulations on staff Salvete DS0000014962.V329740.R01.S.doc Version 5.2 Page 20 recruitment. Discussion with the manager evidenced that her knowledge and practice in this area was outdated, legislation changed in July 2004. The last 3 staff recruited had commenced work without a POVA first check in place. This check is the minimum check required before staff start work, even with this check in place staff must be fully supervised until a full check has been received. The manager was not following this process. Guidance and advice regarding regulatory matters are published on the commission’s website and considerations needs to be given by the manager to reviewing the site on a regular basis to keep updated. This is particularly important with significant changes having taken place over the last 12 months and these will continue. The manager advised that the home had sought the views of residents and their relatives through the use of questionnaires, however these had not been undertaken recently. This needs to be carried out and an explanation on how the home has then used these views to influence and change practice in the home. Documents pertaining to the management of Fire, environmental Health and internal safety checks were seen. All were up-to-date and demonstrated that required safety measures were in place to meet the relevant legislation in this area. Staff and their training records confirmed that they had been trained in a variety of Health and Safety areas including moving and handling, food hygiene and infection control. Monies managed on behalf of residents by staff at the home were examined. Balances were noted to be correct and documents were in place to ensure an audit trail was in place. Residents reported that they found the manager to be a very good listener and all felt that she was very easy to talk to and that they trusted her. Staff said that they found the manager to be very committed to the care of the residents and approachable. Residents said that the manager was nice and their comments suggested that they felt confident in her abilities. The manager had undertaken management courses in care. Salvete DS0000014962.V329740.R01.S.doc Version 5.2 Page 21 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 2 3 Salvete DS0000014962.V329740.R01.S.doc Version 5.2 Page 22 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 Requirement Care plans must contain sufficient guidance to staff on the support that they should provide to ensure continuity of care for the residents. Repair and redecoration of some areas in the home must take place to ensure residents have a homely environment in which to live in. Timescale for action 30/04/07 2. OP19 23 31/05/07 3. OP19 23 Carpet must be fitted in the main 15/04/07 lounge in the home to ensure residents have a homely environment in which to live in. The home must not commence the employment of staff prior to securing two references and the relevant CRB check to protect the residents. 30/03/07 4. OP29 12(1)(a) & 19 Salvete DS0000014962.V329740.R01.S.doc Version 5.2 Page 23 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 Salvete DS0000014962.V329740.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Salvete DS0000014962.V329740.R01.S.doc Version 5.2 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!