Inspection on 02/08/06 for Scaleford Retirement Home

This inspection was carried out on 2nd August 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Scaleford Retirement Home 17/11/09

Scaleford Retirement Home 03/03/09

Scaleford Retirement Home 10/09/08

Scaleford Retirement Home 14/08/07

Scaleford Retirement Home 02/02/06

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

CARE HOMES FOR OLDER PEOPLE Scaleford Retirement Home Lune Road Lancaster Lancashire LA1 5QU Lead Inspector Mrs Joy Howson-Booth Unannounced Inspection 2nd August 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Scaleford Retirement Home DS0000064565.V286291.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. Scaleford Retirement Home DS0000064565.V286291.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Scaleford Retirement Home Address Lune Road Lancaster Lancashire LA1 5QU 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) 01524 841232 Scaleford Care Home Limited Mrs Lynette Anne Owen Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Scaleford Retirement Home DS0000064565.V286291.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The service is registered to accommodate a maximum of 32 service users in the category OP (older persons over 65). 2nd February 2006 Date of last inspection Brief Description of the Service: Scaleford Residential Home is owned and managed by Mr & Mrs Owen who have over 15 years experience of managing a care home. Mr & Mrs Owen have recently registered the home as a limited company. Scaleford is situated in a residential area of the Marsh in Lancaster and overlooks the River Lune. It is close to local amenities. There are three lounges and a dining room, these are used for a variety of purposes and provide residents with a choice of where to sit and who to sit with. There are 32 single rooms, 7 of which have ensuite facilities. Bedrooms are situated on both the ground and first floor and the upper floor can be accessed either by stairs or by a stair lift. Residents are encouraged to retain links in the community and every effort is given to ensuring that relationships are maintained. A limited range of activities are organised within the home for those residents who wish to participate. Relatives, friends and visitors are made welcome at any reasonable time. All personal needs of residents are catered for by staff who have received training. All residents have their own General Practitioner who are responsible for medical needs. Those residents requiring nursing input have the services of the District Nurses made available to them and other healthcare professionals as required. The current weekly fees range from £320.00 to £360.50. Further details regarding fees can be obtained from the owner/manager on request. Scaleford Retirement Home DS0000064565.V286291.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first inspection that was unannounced so the registered owner/manager, assistant manager, staff and residents were not aware of the visit. The site visit forms part of the overall inspection for the home which makes sure people are being cared for properly and also makes sure the home is a safe place for people to live in. The site visit took place over one day and was undertaken by two inspectors – one inspector for the full day and the other inspector for half the day. The site visit included speaking with a number of residents, observing staff on duty performing the day to day routines, speaking with staff, examining documents held in the home and speaking with the registered owner/manager. The inspectors looked around the home to find out about the improvements made and to see if the home was comfortable, clean and safe for people to live in. This inspection report contains evidence obtained from the site visit, from comment cards received from residents, comments received from residents and a visiting relative and also from a pre-inspection questionnaire completed by the owner/manager. The site visit was positive with everyone welcoming, friendly and co-operative during the day. What the service does well: The service promotes equality by treating each resident with respect and dignity, with each person being cared for as an individual with their own personal needs and wishes being met. Staff are friendly and caring in their approach to care tasks. This was demonstrated during the site visit with residents being consulted with and staff looking after the residents in a positive and respectful way, offering choices and no one being hurried. Relatives are welcomed and encouraged to visit at any time and are treated as part of a large family by the owner/manager and other staff at the home. There is a very low turnover of staff – only two new staff have been appointed since the last inspection with most staff having worked at the home for a number of years. Scaleford Retirement Home DS0000064565.V286291.R01.S.doc Version 5.2 Page 6 Positive comments were received, not only from residents but also from a visiting relative and from comment cards received. Comments included : “staff are wonderful”; “staff have made my stay here good and they have asked me to come back to see them”, “food is good”; “food is excellent”; “the staff do what they can for you”; “it’s marvellous to see such young people caring for older people the way they do – so kind” and “Mr & Mrs Owen (owners) are very approachable. They listen to me and they are very good”. Positive comments were also received from two local GP surgeries regarding the care provided to their patients by the staff at the home. What has improved since the last inspection? What they could do better: A number of issues to do with the cleanliness of the home were again raised during this site visit and are included as requirements and recommendations in this report. The ongoing redecoration and refurbishment of the home must continue to ensure the home provides a well maintained and comfortable place for people to live in. The owner/manager was told about how the medication was seen to be given out and given advice to improve this. Whilst care plans have improved, where a resident has a particular healthcare need or programme which needs to be followed this must be written in their care plan. Also, some weight recording has not been done on a monthly basis as the care plan states. A number of residents talked about their unhappiness with the laundry and how their personal items of clothing are going missing or they are being given other peoples’ clothes by mistake. Scaleford Retirement Home DS0000064565.V286291.R01.S.doc Version 5.2 Page 7 Training is ongoing in the home but there is also a need for staff to be given training in infection control. Not all accidents have been recorded in the official accident book. This means that accidents may not be known about or appropriate action taken to make sure another accident does not happen. The owner/manager was advised that the Commission for Social Care Inspection must be told about any death, illness or other event that occurs in the home. A number of recommendations were also made and are included in this report. 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. Scaleford Retirement Home DS0000064565.V286291.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 Scaleford Retirement Home DS0000064565.V286291.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Anyone who is considering entering Scaleford is supplied with enough information to help them make that decision and information is gathered by the home to enable them to be clear as to whether or not they can meet the needs. This means that people can make a choice about whether Scaleford is the home for them. EVIDENCE: The registered owner/manager confirmed that there have been no changes to the Statement of Purpose or Service User Guide since the last inspection and these conform to the requirements. A visiting relative was spoken with who confirmed that they had received information about the home and had been to visit and have a tour around. Comment cards received both confirmed that the residents had received enough information to make a decision as to whether Scaleford was the home for them. Scaleford Retirement Home DS0000064565.V286291.R01.S.doc Version 5.2 Page 10 Comment cards received and discussions with a visiting relative confirmed that contracts are provided by the home. Pre-admission assessment were examined for three new residents and these are written in a narrative style which is easy to read and understand. Information is also usually provided by the social worker, although for one recent emergency admission this had not been supplied, although the home had obtained their own information. The registered owner/manager was advised to ensure that all the information as outlined in Standard 3 of the National Minimum Standards is obtained. Pre-admission booklets are also completed which provide more information about specific areas – for example, dietary preferences. The home does not provide an intermediate care facility. Scaleford Retirement Home DS0000064565.V286291.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s health and social care needs are met and residents are treated with dignity and respect by staff at this home. EVIDENCE: 5 current care plans were examined and found to be much improved with evidence of regular reviews. Importantly it was seen that the residents are also involved in reviews, particularly over care, meals, activities, etc. However, residents spoken with confirmed they knew they had a care plan but they had not seen them. It is suggested that when a review takes place the resident is able to see their care plan and be fully involved so that they are aware not only of the existence of the care plan but also its content and be reassured that their views have been sought and included. For those care plans examined, it was seen that the pre-admission information had been transferred onto the care plan and risk assessments had been carried out. The resident’s relative had signed one care plan. The registered Scaleford Retirement Home DS0000064565.V286291.R01.S.doc Version 5.2 Page 12 owner/manager was advised to include spiritual and religious preferences, for example, the home has a visiting minister who provides communion once a month but this was not reflected on the care plans of those who attend. Also the care plans do not provide information over last wishes. One care plan (and daily records) reflected that the resident concerned enjoyed making Indian food and was taken by staff to purchase items and then supported to make an Indian meal. From feedback this was clearly enjoyed. From the care plans examined it was seen that healthcare needs are met within the home. Information supplied by the home confirms that residents have access to a range of healthcare professionals, including – GP, District Nurse, Chemist, Community Psychiatric Nurse, Occupational Therapist, Dietician, Speech Therapist, Dentist, Audiologist, Optician, Physiotherapist and Chiropodist. There is evidence of GP, District Nurses, Optician, Chiropodist, and Physiotherapist involvement. The registered owner/manager was advised that although one resident’s file talked about “doing exercises as advised by the physio” the actual exercise programme was not included in the care plan – this should be done so that all staff are working consistently and following the guidance of the physio. The registered owner/manager was advised that weight recording was not carried out consistently. One care plans stated that the resident needed to be weighed monthly but there was no weight recorded for April, May or June 2006. The registered owner/manager has recently advised that residents healthcare needs will be reviewed to ensure timely and appropriate interventions and equipment are provided, as required by the resident concerned. Comment cards received from two local GP surgeries confirm that the home communicates and works in partnership with them; staff are able to demonstrate a clear understanding of the care needs of the individual residents; specialist advice is incorporated into the care plan and they are satisfied with the overall care provided to their patients. Comments received from residents and from comment cards received confirmed that healthcare needs are met. The medication stocks and records were examined and found to be accurately maintained. Observation was also made of the administration of the medication and comment made to the registered owner/manager to consider purchasing a medication trolley. This would help all the medications to be available at the time of administration, it would mean that they could be locked safely away if the person administering the medications needed to leave the medications for any reason, and would prevent the medications being put on the dining room tables in front of other residents – which currently raise concerns over respect and privacy. It was also noted that the administrator was not referring to the Medication Administration Record sheets prior to administrating but was relying on memory and medications in the trays and Venalink cards. On one daily diary sheet it was seen that a resident was unwell for a couple of days and staff gave Imodium. Advice was provided Scaleford Retirement Home DS0000064565.V286291.R01.S.doc Version 5.2 Page 13 that homely remedies should be checked with the resident’s GP, particularly in this case. For another poorly resident who was unable to swallow the medication the home asked the relatives about putting in yoghurt – it was advised that this is classed as covert medication and the Pharmacist and/or GP needed to be in agreement with any such arrangement. Only staff who have received training administer medications in the home. There are no controlled drugs in the home at present. Residents observed were seen to be cared for in a respectful manner and very good interactions were in evidence between residents and staff. Care plans demonstrated that one resident had asked for her room to be kept locked which staff were complying with. There are no shared rooms at the home. Comment cards received also confirmed that residents feel they are treated with dignity and respect. One resident commented “it’s marvellous to see such young people caring for older people the way they do – so kind”. Comment cards received from two GP surgeries confirmed that they are able to see their patients in private. Information provided by the home confirmed that there is a policy for a resident who may be dying and when death occurs. It has previously been noted that there is a need to record residents’ spiritual requirements and also their last wishes. Examination of a care file for a recently deceased resident evidenced that good care was provided with support and involvement of the resident’s GP and other healthcare professionals. Scaleford Retirement Home DS0000064565.V286291.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to enjoy their lifestyles, maintain contacts and have choices which means residents have a quality of life. Residents are provided with wholesome and nutritional meals in a relaxed and unhurried way. EVIDENCE: Residents at Scaleford are able to follow their own lifestyles and daily routines and this was evidenced by speaking with residents and from comments received. The home has a small number of residents who are able to go out into the community without support and one resident was about to go on a short break holiday. One gentleman spends time reading the paper in his room and this personal choice is reflected in his care plan. A variety of entertainment is provided during the month and an invitation for a summer trip out was seen on display. Leisure and social activities in the home continue to be developed. Notices were seen for activities organised. Residents spoken with enjoyed the activities put on to date, although comment cards received stated that activities were only “sometimes” things the residents could take part in. There is the opportunity to review the current activities and look at providing some more 1 to 1 type input, particularly for those residents who Scaleford Retirement Home DS0000064565.V286291.R01.S.doc Version 5.2 Page 15 need more staff support. All activities provided should be recorded so that the home can self monitor and evidence what the residents enjoy doing. Discussions with residents and staff confirmed that residents are able to have visitors at any time. Again, if the resident is able there are no restrictions on going out. Appropriate advice was sought by the registered owner/manager recently over one visitor to the home and indicates the welfare of the residents is put first by staff at the home. A number of residents spoke about the laundry system in the home. One resident stated that he had two shirts which had both disappeared, another resident said he was “fed up with buying clothes as they kept going missing”. Another resident said the laundry was “organised chaos”. These comments were fed back to the registered owner/manager who is to review the laundry system as a matter of urgency. It was confirmed that residents are able to manage their own money for as long as they are able to do so. Residents are able to bring in personal items to the home through discussion with the registered owner/manager. Information supplied by the home confirms that there is a policy on access to files by staff and residents. There is a clear note on each care plan to say that the records are private and confidential and only accessible to authorised persons. Residents spoken with and all but one comment cards received confirmed satisfaction with the meals provided. The other comment card indicated that the resident only “sometimes” enjoyed the meals – this may link to residents not being aware of what is to be served – see comments later in this section. Residents comments included “food is excellent” and “the food is good”. Discussions with the chef confirmed that dietary requirements and preferences are provided to him at the point of admission – this information is included in the pre-admission assessment booklet and these were seen in the kitchen. All cards were seen and were individual – one having “likes – coffee, water, whisky and curry”. Each resident has a breakfast card which indicates their choice for breakfast. The registered owner/manager confirmed that at each care plan review the resident concerned is asked about meals and if they would like any changes to their breakfast card. The chef confirmed that the food provided is home cooked, including cakes and puddings – a sample of cake was tried during the inspection and found to be delicious. The lunchtime meal was also eaten and found to be enjoyable. Observations at lunchtime found that residents were given their meals, and supported, with care and sensitivity. Although residents spoken with did not know what was being provided that day they did confirm that an alternative would be given if they did not like what was on offer. Similarly, residents were only offered the stated pudding and were not offered any choices. It was suggested that the menu could be displayed for each day so that residents can make a choice earlier on as it is sometimes difficult for a resident to ask for an alternative if the meal is in front of them. Staff go round in an afternoon and give the Scaleford Retirement Home DS0000064565.V286291.R01.S.doc Version 5.2 Page 16 choices on offer for tea time – again, the chef confirmed that he will try to provide whatever the resident asks for. Birthdays are also celebrated at Scaleford and the chef confirmed that he makes a birthday cake and birthday tea when residents are also offered an alcoholic drink in celebration. Snacks and drinks are available during the day and staff confirmed that during the very hot weather additional drinks were given to residents. There are a couple of people on soft diets at the home and the chef was advised that the meals could be improved by liquidising each portion separately rather than together which would mean the resident has different tastes and colours on their plate and would make a more appetising presentation. The chef also confirmed that aids are available for those residents who need them for eating. The menus were examined and found to be nutritionally good and offering a varied choice. The chef was advised to ensure that the records of meals provided were accurately kept and also a record of any alternatives provide was maintained – for example, where “sandwiches” are written it would be better to list what – egg, ham, cheese, or selection. The chef was also advised that the menus could may be have more fruit and veg – one way would be to have orange juice at breakfast. The chef also confirmed that the menus are reviewed at residents meetings when residents are asked for ideas and suggestions for the forthcoming months. The chef confirmed that he has accessed training – training records evidenced Food Hygiene, although update training is now needed. Some information over nutrition was given to the chef. Scaleford Retirement Home DS0000064565.V286291.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies, procedures and practices within the home make sure that residents and their relatives are able to make their views known and residents are protected EVIDENCE: Since the last inspection, two complaints have been received by the Commission regarding care provided in the home. These two complaints were investigated by the Commission and whilst the home was found to have acted appropriately poor record keeping was identified. From correspondence received from the home and also through discussions with the owner/manager at this site visit it is felt that the recent complaints have provided an opportunity to review the care records, care provided and make improvements as needed. For example, a strategy is in place for one resident who requires additional support and monitoring. A current allegation is ongoing and being investigated by the resident’s Social Worker. The owner/manager confirmed there have been no changes to the complaints procedure for the home and any complaints are held in a central home’s record book. Scaleford Retirement Home DS0000064565.V286291.R01.S.doc Version 5.2 Page 18 Discussions with the staff on duty confirmed that they have received updated Vulnerable Adult Abuse (VAA) awareness training recently which included actions to be taken should abuse be suspected. This was confirmed in the individual staff members’ training files. Discussion with staff also confirmed that the vulnerability of residents is known about and staff are clear as to what actions to take. The registered owner/manager confirmed that all daily records and diary entries are now reviewed once a month so that any concerns or issues can be highlighted by herself and dealt with appropriately. The registered owner/manager has also sought advice from the Commission and taken the appropriate action to safe guard residents. The registered owner/manager was advised to ensure that regular updates on VAA procedures are provided, particularly to anyone left in charge of the home who need to be fully conversant with the VAA procedures to be followed. Scaleford Retirement Home DS0000064565.V286291.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The cleanliness of the home is not maintained to a good standard which means the home is not clean and odour free. EVIDENCE: A tour of the home took place and whilst a noticeable improvement in some areas of cleanliness was seen and with some rooms being redecorated, there were areas of cleanliness that still require improvement. Specific examples were provided to the registered owner/manager as follows : A strong odour of urine was noted as the inspectors entered the home The reception room had a strong odour of urine and the carpet is stained and worn The dining room carpet is stained No table cloths were on some of the wooden tables for breakfast Scaleford Retirement Home DS0000064565.V286291.R01.S.doc Version 5.2 Page 20 Carpets in toilets 53, 54, 58 and bathroom 63 need replacing with non-porous, slip resistant floor covering to prevent odour. Bathroom 63 has a carpet that is rippled and poses a risk to residents Soap dispensers and paper towels were recommended at a previous inspection as these would help in infection control Bedroom 10 had a corner unit which was covered in dust. The bedroom cabinet drawer was open and was full of crumbs, dust, papers, etc. Underneath the sink taps in this room were dirty The blue lounge has some furniture that is looking tired and worn. A broken biscuit and food debris was seen down the side of one chair and a table was encrusted with food and debris Upstairs bathroom the toilet rim was dirty underneath the seat riser. The bathroom carpet needs replacing with a non-porous floor covering to remove the odour of urine The toilet next to room 24 is badly stained. No soap or towel was in this toilet for residents to use The ensuite in room 27 has a strong odour. The carpet piece at the side of the bed should be removed as it poses a trip hazard The carpet in room 29 is dirty and stained. The bed sheet needed changing as it was rippled and had what looked like faeces on it. The commode in this room had dirt and what looked like dried faeces encrusted in the side wicker work. Bedroom 25 needs redecorating and had a cracked window pane Shower room 51 has no lock on it to afford privacy A number of fire doors were wedged open Discussions with staff confirmed that they have not received infection control training, although one member of staff confirmed training in MRSA procedures. Scaleford Retirement Home DS0000064565.V286291.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are satisfactory and staff are trained to meet the needs of the residents. Recruitment practices mean that the residents are safeguarded. EVIDENCE: Comment cards indicated that staff are “always” and “usually” available when needed. No concerns were raised by residents over the level of staff on duty and staff spoken with confirmed they did not feel rushed and had time to spend talking with residents, although this was usually when they were providing personal care. The staffing rota has been provided by the owner/manager and clarification was given over shifts “ticked” on the form. As this is not clear, it was advised that the start and end of each shift be written in to enable this to be clearer. The management hours are now included in the staff rota. The owner/manager was again advised to review staffing levels particularly at particularly busy times because the two staff on duty may be providing hands-on care resulting in no-one being available for the other residents or to provide supervision. This is important for any resident who needs close monitoring and/or support. The owner/manger agreed to ensure this is addressed. Residents who commented were generally positive – “I am pleased with all that is done for me” and “the staff are wonderful”. It is acknowledged that there are a number of younger carers at the home who are viewed differently – one resident saying “staff are OK, some Scaleford Retirement Home DS0000064565.V286291.R01.S.doc Version 5.2 Page 22 are young and don’t have the same experience in life but they are alright” and another resident saying “it’s marvellous to see such young people caring for older people the way they do – so caring”. Confirmation was given all but one member of staff has achieved National Vocational Qualification (NVQ) Level II and three members of staff have achieved NVQ Level III. A further 3 members of staff are about to commence either NVQ level II or III training. The owner/manager confirmed that the two new members of staff have attended the Skills for Care (formerly TOPSS) induction. Only two staff have been appointed since the last site visit and it is positive that the home has such a low turnover of staff. This means that residents are cared for by staff who know them and their needs. The personnel files for the two staff appointed were examined and generally found to provide all the required information. Advice was given that employment histories should include a full history, with complete dates and ensure a reference is obtained from the last employer. Criminal Records Bureau (CRB) disclosure forms were also seen for those not previously seen and advice given that some CRBs for existing staff may need renewing. A selection of training records were seen which evidence that training is ongoing. The most recent training being adult abuse awareness training following a recent complaint. It was noted that refresher training is now required for some of the mandatory training previously provided to ensure staff are working to current legislation and good practices. One member of staff on duty confirmed that they had been provided with training about MRSA. Scaleford Retirement Home DS0000064565.V286291.R01.S.doc Version 5.2 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35. 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is generally well managed and provides a safe environment for the residents and staff. EVIDENCE: The owner/manager stated that she is continuing with her close supervision and management of the home and feels that areas that had lapsed are now under control and being dealt with. The assistant manager is being given guidance and support, and future management structures are being discussed. Confirmation was given by talking with residents that meetings are held, review meetings are held and feedback on the service is requested by the owner/manager. Relatives and now included in surveys of the service. The formal Investors in People quality systems are now being used more as a Scaleford Retirement Home DS0000064565.V286291.R01.S.doc Version 5.2 Page 24 means of self monitoring the service. One resident said that “Mr & Mrs Owen are very approachable. They listen to me and they are very good.” Financial records were examined for one resident which confirmed resident money is safeguarded. Further information was provided to the owner/manager. Staff confirmed that they are having regular supervision and these sessions are used to review care practices. The current sessions are looking at “choice”. One member of staff also confirmed that staff appraisals also take place in the home. Information supplied by the registered owner/manager confirmed that regular servicing and maintenance is carried out on equipment and facilities in the home. Mandatory training is provided but, as noted above, refresher training now needs to be provided for some staff. The home has written policies and procedures that are reviewed yearly (and updated as needed) as part of the Investors in People requirements. Risk assessments were seen on residents files. The accident book was seen and found to comply with the Data Protection Act 1998. From reading residents files two accidents had been noted in their daily diary notes but no accident form was in evidence. The owner/manager was advised of this. Discussion also took place over two incidents involving resident AF – the owner/manager confirmed that no Regulation 37 notice had been sent in and this was an oversight on her part. Further advice was provided. Scaleford Retirement Home DS0000064565.V286291.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 3 3 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 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 3 X 3 X 3 3 3 2 Scaleford Retirement Home DS0000064565.V286291.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP26 OP26 Regulation 23(2)(d) 23(2)(d) Requirement The carpet in the reception lounge must be replaced The carpets in the toilets identified in this report must be replaced with non-porous and slip resistant flooring The carpets identified in this report must be cleaned. The ripples in the downstairs bathroom carpet (no 63) must be removed and the carpet made safe. The carpet piece in room 27 should be removed as this poses a trip hazard The broken window pane in room 25 must be repaired Fire doors must not be wedged open The dining room must be cleaned An appropriate lock must be installed on the downstairs shower room The toilet next to room 24 must be replaced All parts of the home and the facilities used by residents must be kept clean and free from odour – with specific attention DS0000064565.V286291.R01.S.doc Timescale for action 30/09/06 30/09/06 3. OP26 23(2)(d) 02/08/06 4. 5. 6. 7. 8. 9. OP38 OP38 OP26 OP10 OP26 OP26 23(2)(b) 23(4)(a) 23(2)(d) 12(4)(a) 23(2)(d) 23(2)(d) 31/08/06 02/08/06 31/08/06 31/08/06 30/09/06 31/08/06 Scaleford Retirement Home Version 5.2 Page 27 made to the areas raised in this report 10. OP19 23(2)(b) 23(2)(d) The ongoing redecoration and refurbishment of the home must be completed – including redecoration of room 25 Staff must receive training in infection control Medication must be safely administered to residents as detailed by the Medication Administration Record Specific health programmes for residents must be in their individual care plan. Weight monitoring must take place as identified in the residents individual care plan Residents clothing must be laundered and returned to the individual residents they belong to Accident records must be kept for any accident that occurs in the home The registered person must inform the CSCI of any death, illness or other event as outlined in this regulation 30/09/06 11. 12. OP26 OP9 13(3) 13(2) 30/09/06 02/08/06 13. OP7 13(4)(c) 30/09/06 14. OP14 16(2)(f) 02/08/06 15. 16. OP38 OP38 17(2) 37 02/08/06 02/08/06 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 OP3 Good Practice Recommendations The owner/manager should ensure that all the required information is obtained prior to admission as outlined in National Minimum Standard 3 DS0000064565.V286291.R01.S.doc Version 5.2 Page 28 Scaleford Retirement Home 2. 3. 4. OP27 OP12 OP12 5. 6. 7. OP9 OP29 OP15 8. OP30 9 10. OP29 OP26 The number of staff on duty should take into account peak times of activity to ensure residents are appropriately supervised and supported Residents spiritual preferences and how these are to be met must be recorded on their individual care plan The activities in the home must continue to be developed to enable residents to have social stimulation as identified by their interests, abilities and preferences and also to help prevent the onset of depression. Staff should record activities undertaken and enjoyed by residents. The owner/manager should consider purchasing a trolley so that medications can be safely stored and administered with due regard to safety and privacy The owner/manager to ensure that a full employment history with dates is obtained from any prospective employee A menu board should be put up in the home so that residents know what is being provided for each meal and can ask for an alternative prior to sitting down to eat. The owner/manager should ensure that meals are fully recorded along with alternatives provided. Meals that require liquidising should be done separately so that the residents are given different tastes and to aid presentation The owner/manager should ensure that mandatory training is kept up to date and refresher training provided as needed. Refresher training should also be provided on policies and procedures in the home, particularly the adult abuse awareness for staff who may be left in charge Criminal Records Bureau checks must be carried out on any disclosures held for staff over 3 years old It is advised that soap dispensers and paper towels (or similar) are purchased for use in the home Scaleford Retirement Home DS0000064565.V286291.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 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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