Inspection on 03/03/09 for Scaleford Retirement Home

This inspection was carried out on 3rd March 2009.

CSCI found this care home to be providing an Adequate service.

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 10/09/08

Scaleford Retirement Home 14/08/07

Scaleford Retirement Home 02/08/06

Scaleford Retirement Home 02/02/06

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Scaleford Retirement Home Lune Road Lancaster Lancashire LA1 5QU Lead Inspector Marian Whittam Unannounced Inspection 3rd March 2009 09:30 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.V374310.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.V374310.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 Dementia - over 65 years of age (32) registration, with number of places Scaleford Retirement Home DS0000064565.V374310.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home only - code PC, to service users of the following gender:Either. Whose primary care needs on admission to the home are within the following categories: Dementia over 65 years of age - Code DE (E) Up to 3 named service users can be accommodated in the category of OP. The maximum number of service users who can be accommodated is: 32 Date of last inspection 10th September 2008 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. The home is registered 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. 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. All people living at Scaleford have their own General Practitioners who are responsible for their medical needs. Those residents requiring nursing support have the services of the District Nurses made available to them and other healthcare professionals as required. The current weekly fees range from £407.50 to £420.00. There are additional charges for hairdressing, dry cleaning, private chiropody, public transport, incontinence aids and toiletries. This information and information about the service is available in the service user guide and statement of purpose. A copy of the latest inspection report is also available for people to read. Scaleford Retirement Home DS0000064565.V374310.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This site visit to Scaleford Retirement Home forms part of a second key inspection. It took place on 03.03.09 and we (The Commission for Social Care Inspection, CSCI) were in the home for five hours. A site visit to the home is just one part of the inspection of the service, we also looked at other information we had about the home. Information about the service was also gathered in these different ways: • Annual Quality Assurance Assessment (AQAA) completed by the manager identifying what the service does well and what could be improved. This was returned to CSCI before the first visit. As this was the second key inspection for this service we did not ask the provider for a new AQAA We looked at the service history of the service and the way the manager had dealt with any incidents or complaints in the home. We talked with people who live in the home and visitors to the home and visiting health care professionals to get their views and opinions on the service. We spent time in communal areas of the home watching the daily activities and interaction between people living there and staff approaches. • • • During the visit we spent time with people living in the home and talking to them about their experiences. We looked at care planning documentation and assessments to ensure the level of care provided met the individual needs of those living in the home. We made a tour of the building to inspect the environmental standards. Staff personnel and training files were examined and a selection of the service’s records required by regulation. The CSCI pharmacist inspector also visited with the two inspectors on the same day and assessed the handling of medicines through inspection of relevant documents, storage and meeting with the nursing staff and residents. The pharmacy inspection took almost five hours. Scaleford Retirement Home DS0000064565.V374310.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Overall we found that the handling of medicines was much improved so that residents received safe and effective treatment. The service has taken seriously the concerns raised at the last pharmacy inspection and has worked to improve the way medicines are handled to protect the health of people living there. The manager has reviewed the way medicines are stored and administered so that medication is moved safely around the building and administered as prescribed. Regular audits of medication are being done to monitor the management of medicines and to keep people safe. Care plans for the administration of ‘when required’ medication are much improved so that staff were able to administer and monitor the effects of these medications. Care plans and care planning have been improved and recording and assessments of needs more individualised and easier to monitor. This has included improvements in assessing risk of pressure areas, people’s psychological needs, their behaviour monitoring and management, people’s personal care, nutritional screening. These are significant changes that had resulted in improved care and support for people. The manager needs to make sure these improvements are maintained and continue to be developed in the long term. We saw improvements in the way staff were being used around the home and 2 more domestic staff were working in the home. This allows care staff to spend more of their time supporting and caring for people living there. Staff changes have also allowed care staff to give greater emphasis to individual support and supervising and organising activities. Scaleford Retirement Home DS0000064565.V374310.R01.S.doc Version 5.2 Page 7 We spent time in communal areas and going around the home and could see that staff were spending more time with people on a one to one basis. As a result staff were providing a higher level of supervision in communal areas than at our last visit. The manager has made improvements in menus and choice and now uses pictorial formats for menus to promote people’s understanding and choice of food and drinks available to them. People living there are now able to have a cooked breakfast if they want this such as bacon sandwiches and fried egg sandwiches, which they enjoyed. What they could do better: Although the medicines administration records are much improved the service must take care to ensure that they are accurate for all prescribed medication to reduce the risk of errors that could affect health. The manager does regular spot checks on medication and staff competence. However, these checks need to be more comprehensive and structured so that the quality of care is reviewed thoroughly and regularly. The manager should also check that the safe used for the storage of Controlled Drugs complies with regulations and if not a suitable cabinet should be obtained for their safe storage. The manager should make sure that all staff training and development records and annual training plans are up to date so it is clear for all staff and people can be certain that all staff have up to date and relevant training to do their work and fulfil their roles. This includes ensuring training on safeguarding adults to make sure all staff have this information to promote resident’s welfare and safety, training on current infection control best practice. This area of management was raised at the last visit also and the manager needs to address this as they have with other areas identified as needing improvement. As part of the training planning the manager should source further training in the specialist administration of medication for the relief of seizures that includes an assessment of staff competence. The home has one stair lift at one end of the premises giving access to the first floor. The manager should make sure they consider in their individual assessments with people the additional distance people may have to walk to bedrooms furthest away from the stair lift. Accommodation provided needs to in line with people’s needs and abilities assessed before they came to the home and as their needs change. This will help reduce any negative effects, from the location of the stair lift, upon their independence in the home. As we walked around the home we did note that there were some small items of general maintenance that should be attended to promptly to make sure all areas are safe and comfortable. For example there was a broken plastic pipe Scaleford Retirement Home DS0000064565.V374310.R01.S.doc Version 5.2 Page 8 with a jagged edge in one ground floor toilet, some unpainted exposed plaster, damaged wallpaper, missing light shades and marks on some walls. These should be taken care of promptly so all parts of the home are safe, pleasant and homely for people. We saw some areas of the home had steep steps that could pose a risk to people with physical frailty or who tended to wander about due to their dementia. The manager must make sure that all parts of the home to which people living there have access are kept, as far as reasonably practicable, free from avoidable risks and hazards to their safety. The manager must ensure that appropriate risk assessments are done and put into place to minimise any potential risk to people’s general and individual safety. 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. Scaleford Retirement Home DS0000064565.V374310.R01.S.doc Version 5.2 Page 9 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.V374310.R01.S.doc Version 5.2 Page 10 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): NMS 1, 3, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People moving into Scaleford Retirement Home are provided with general information about the home and have their needs assessed so they will know if their needs can be met there. EVIDENCE: The home has a statement of purpose and service user guide that can be provided to anyone thinking of using the service to help them in making a decision about living there. A copy of the last inspection report is also available for people to read. Both of these are available from reception for people when they visit or come to have a look around. This way prospective residents and their families can have access to information about the service. The manager confirmed that the information could be made available in different formats if needed to suit individual needs. There was also information for people at the reception area on local advocacy services, on fees, powers of attorney and Scaleford Retirement Home DS0000064565.V374310.R01.S.doc Version 5.2 Page 11 General Social Care Councils (GSCC) codes of practice that care staff must work to. There was a file with survey forms for people coming to the home to complete to give feedback to the manager and for making any complaint a visitor may wish to raise with management. We looked at the care plans and pre admission assessments of people living there and of four people who live there in more detail. These contained basic information and assessments from which to begin to develop a person’s care plan with them. The registered manager confirmed that she or senior care staff visit people to do pre admission assessments so that an informed decision can be taken over whether the home can meet their identified needs. These are done to assess people’s needs and expectations before they come to live in the home and make sure the service can meet their needs. The service uses a pre admission booklet to record information about people and their needs. In addition the service retains any care management plans provided by social services and works with other healthcare professionals, who provide information about individual’s needs. Prospective residents and their relatives are able to visit and look around if they want to and spend some time there meeting staff and other residents. This service does not provide intermediate care. Scaleford Retirement Home DS0000064565.V374310.R01.S.doc Version 5.2 Page 12 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): NMS 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A care planning and review system is in place and the personal, social and health needs of people living there are being assessed, monitored and generally met in the way they want. EVIDENCE: All people living at Scaleford retirement home have an individual care plan, based on their initial needs assessments and risk assessments. Since the last inspection the level of detail and individual information has been improved to make these much more working documents. We looked at the care plans in use and four care plans in detail to assess if people’s need were being assessed, planned for and met with regular reviews being done. Personal hygiene charts were in place to record what care had been given. Care plans included assessments for moving and handling, falls and detailed information on dietary needs. We found from the care plans we Scaleford Retirement Home DS0000064565.V374310.R01.S.doc Version 5.2 Page 13 looked at that all people had pressure area risk assessments and more consistent psychological and behavioural monitoring than at the last inspection. The manager has reviewed and improved the information in the care plans with more effective management plans for identified behavioural problems. This improved planning and monitoring of behaviours means that vulnerable people living in the home benefit from improved staff supervision and prompt referral to specialist professionals. We saw that staff now had clear behaviour risk management plans in place to follow also noting risk factors and triggers to be considered. Overall we found that the handling of medicines was much improved so that residents received safe and effective treatment. Records for receipt and disposal of medication were good. Medicines administration records were also well completed. However, there were occasional errors that could affect the treatment received by residents. For example, we saw a medication that was discontinued around two weeks earlier but this was not stopped on the record and staff continued to sign for administration. We also saw occasional medicines kept for residents that were not recorded so that staff may not be aware they were prescribed. On other occasions medication was omitted but records failed to identify the reasons for this. We counted a sample of medicines and compared them with the records. With the exception of one discrepancy, this showed that medicines were administered as prescribed and could be accounted for. Care plans for the management of medicines were very much improved and gave instructions for staff to follow to make sure that residents received safe and effective treatment. Records of doctors’ visits were mostly well documented and changes to medication could be accounted for. We discussed a medication with very specific requirements for administration with a carer. The carer showed a good understanding of these special requirements and the reasons for them. The service stored medicines liable to misuse, called Controlled Drugs, in a safe. The manager should check that this safe complies with regulations for safe storage and this will be checked at the next inspection. Storage of other medication had improved. However, the medicines trolley must be fixed to the wall and we were assured that this would be done. Staff had received training in the safe handling of medication. The manager had also sourced training on the specialist administration of rescue medication for the treatment of seizures. However, this did not include assessment of competence of the procedure that is necessary to show that staff are able to treat residents safely and effectively. The manager did regular spot checks on medication and staff competence. However, it is recommended that these checks are more comprehensive and structured so that the quality of care is reviewed thoroughly and regularly. Scaleford Retirement Home DS0000064565.V374310.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): NMS 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides some social activities within the home, supports people to make choices in their daily life and there is variety and choice in the food on offer to residents. EVIDENCE: Scaleford encourages people’s relatives and friends to visit and visitors we talked to said there were no restrictions on when they can visit. We spoke to a visitor who said their friend had settled in well. They said their condition had improved since coming in and was glad to see that her friend was, “always so smart and well dressed, that was always very important to her”. The visitor was pleased to see that the hairdresser had done her friends hair that morning and she had been given a manicure by a carer as well. Care plans generally have information about people’s preferred social and religious activities and some useful personal profiles and preferences. This is useful information that could be used effectively in promoting a person’s own perspective on recreation particularly for those with dementia who have Scaleford Retirement Home DS0000064565.V374310.R01.S.doc Version 5.2 Page 15 difficulty communicating their thoughts and feelings. There was a range of information available in the home for staff on providing recreation for people especially those with dementia. There were general guidelines from the ‘Alzheimer’s Disease Resource Centre’ on the approach and type of activities to try with people suffering from this condition. There is a programme of daily activities on display and activities records showed that a range of activities have been developed and are provided for people, including, weekly visits from the hairdresser, table top skittles and games, organ music, quizzes, games, music, walks, ‘sing-a-long-a-Geoff musical entertainment’ (twice a month), drawing, craftwork, use of musical instruments, bingo and individual attention, when possible such as manicures. We saw staff spending time in the lounge with people, supporting them in both group and one to one activities. Changes have been made in the way staff work in the home and staff now spend more time in the lounges with people. This provides a greater level of supervision and support for people with more challenging behaviour. We joined people living at Scaleford in the dining room at lunchtime and found the meal to be a sociable and relaxed occasion. The food was served straight from the kitchen and was hot and well presented. We saw that staff helped people with their meals and offered assistance discreetly and offered a variety of drinks to people to drink with their meal and afterwards. Staff members sat at tables and chatted with people and were particularly supportive with a person who was unsettled and agitated during the meal. We looked at the menus in use and the planned meals were varied and nutritious. The manager has introduced a wide range of pictorial formats for menus to promote people’s understanding of the choice of food available to them. People living there are now able to have a cooked breakfast if they wanted this and people’s individual records showed what they had asked for such as bacon sandwiches and egg sandwiches, which they enjoyed. Scaleford Retirement Home DS0000064565.V374310.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service has procedures for dealing with complaints and safeguarding vulnerable adults but poor records of staff training on protection and challenging behaviour means some staff may not have up to date knowledge to support and protect people. EVIDENCE: The manager keeps a record of any complaints, incidents and events using a system that is part of their ‘ISO 0991’ quality assurance system. The forms for recording the complaint are in the foyer. The service has a complaints procedure that is in a written format and displayed in the hall, it is also in its service user information. There have not been any complaints recorded since the last inspection but the manager has now a separate system for recording any complaints outside the ISO system so it will be easier to monitor the progress of the complaint or if timescales are being met to address them. This will help make the process more transparent and clear when in use. The service has information on advocacy services and contact numbers for local support organisations and displays this information in reception. The service has a policy statement on responding to and protecting people from abuse and has a copy of the Department of Health guidance, ‘No Secrets’. Scaleford Retirement Home DS0000064565.V374310.R01.S.doc Version 5.2 Page 17 There are procedures in place, that have recently been reviewed, to help protect vulnerable adults from abuse. Improvements in behaviour monitoring, risk assessment and behaviour management plans have also had the effect of helping to make sure challenging behaviour and difficult situations are better managed by care staff and this promotes people’s safety. The manager has informed us of events in the home and when referring onto the appropriate agencies to protect people. The home also has procedures in place for staff guidance on gifts and preventing involvement in service user’s wills. Staff training plans and records need to be improved and updated to ensure all staff have had appropriate training on protecting vulnerable adults and managing challenging behaviour. From the existing records and evidence of training we looked at it was not possible to easily assess if all staff had done this and some staff may be getting missed. We could see that some staff have been given training on safeguarding vulnerable adults and records indicated that staff had an update on abuse at the last staff meeting but in no detail, just the policy and how to refer on. Also some more training had been done for some staff on challenging behaviour. We recommended to the manager that she maintain clear and up to date records of all the training and practice updates given to staff on safeguarding procedures, recognising abuse and managing challenging behaviour. This way the manager will be able to see easily who has had training, in what areas, when it was given and when it needs updating to maintain up to date practices to promote the best interests of people living in the home. The manager was able to provide us with evidence that she is attending a ‘Train the Trainers’ two day course on safeguarding vulnerable adults run by the local authority. This will allow her to provide this training for staff within the home when she has done the course. Scaleford Retirement Home DS0000064565.V374310.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19, 20, 22, 24, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally clean and tidy and the premises are being maintained but the layout of the home may restrict some peoples independence. EVIDENCE: The ongoing redecoration and refurbishment of the home is continuing and one of the lounges is still being refurbished and new more easily cleanable furniture is being purchased. When completed this will improve the environment and improve access to the safe garden area for people living there. This lounge is not in use whilst work is being done and residents are using the smaller lounge, dining and reception areas. Windows in the lounge have been replaced and a door put in to allow residents safe access into the enclosed garden. The owners have also purchased new garden furniture for the garden area for people to use. Scaleford Retirement Home DS0000064565.V374310.R01.S.doc Version 5.2 Page 19 As we walked around the home we did note that there were some items of general maintenance that should be attended to promptly to make sure all areas of the home are well maintained. For example there was a broken plastic pipe with a jagged edge in one ground floor toilet, some unpainted exposed plaster, damaged wallpaper, missing light shades and marks on some walls. These should be taken care of promptly so all parts of the home always safe, pleasant and homely for people. There is a large and light dining room that is attractive and suitably furnished. We saw that residents also used the dining area for doing their drawing and crafts with plenty of space for them to work in. All the bedrooms are single occupancy and some are in the process of being redecorated and improved. The décor in some bedrooms was in need of updating and when the redecoration of bedrooms has been completed the environment should be further improved for people and make it more homely. People may bring in some of their own personal items if they wish to help personalise their rooms and we saw that many people had done this. The majority of bedrooms do not have en suite facilities but all rooms have a hand basin for people to use. We found that most areas of the home were generally clean and tidy with a slight smell of urine in some areas. The reasons for this were known and cleaning staff worked to address this. The laundry area was less cluttered and untidy than at the previous visit and new laundry bins provided to ensure the appropriate separation of laundry and keep it off the floor. A new washing machine with a sluice facility has been installed to improve the laundry services for people living there. The two new ‘chamber maids’ work alongside the housekeeper now to keep the home and laundry tidier. The additional domestic staff cover seven days a week and this frees the care staff to be with the people living there rather than attending to domestic duties. The cleaning staff have a cleaning rota and they record what is done in a cleaning log including linen changes and daily cleaning of the rooms. The service does have infection control policies and procedures in place. Training records were not up to date and indicated that while some staff had been given training on infection control this was some years ago and this important area needs to be updated to ensure staff are aware of current best practice. There is a stair lift one at one end of the building for people to use but its location may mean that people with their bedrooms furthest away at the other end of the building from stair lift have to go a longer distance and so access may be restricted for them if their mobility is poor. This could have a negative effect upon someone’s independence as they move around the home and use their bedrooms. We discussed this with the manager and recommended that the additional distance people would have to walk be considered when doing assessments of people’s needs and abilities before they came to the home and as their needs change. This way they can be offered accommodation that will promote their independence. Scaleford Retirement Home DS0000064565.V374310.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Suitable numbers of staff are in place to meet the needs of the people currently living in the home. Staff training and training records are inconsistent so staff may not always receive important training that they need to support people living there. EVIDENCE: We looked at staff rotas and observed the way care staff work around the home during the visit. We looked at the layout of the home, observed the way staff supported people and spoke with people about living in the home. At the current level of occupancy there were sufficient staff on duty to meet people’s needs and support them in their daily activities. We advised the manager of the importance of keeping staffing levels under review as occupancy levels and people’s needs changed. There is management cover on the rota for seven days a week and on the day of our visit there were four carers and Mrs Owen on duty attending to personal care needs, activities, medications and supervising the residents. This included senior care staff who attended to medication. There are 2 waking night staff, who also have some light cleaning duties. The rota shows that there is a Scaleford Retirement Home DS0000064565.V374310.R01.S.doc Version 5.2 Page 21 housekeeper who works with the two ‘chambermaids’ to provide domestic cover over 7 days. This is an improvement since the last inspection and the additional cleaning staff means that care staff do not have the same level of responsibility for domestic tasks and can spend more time providing care and support to people living there. The rotas in use were taking into account the individual needs and behaviours of people more appropriately than was evident at our last visit. Staff we spoke to felt that this improvement in staffing was working well. We could see as we spent time in communal areas and going around the home that staff were spending more time with people on a one to one basis and providing a higher level of supervision in communal areas that at our last visit. The atmosphere was much calmer than our last visit and we did not see any aggression between people living there as staff were in attendance to defuse situations. There has been some staff turnover in the last 12 months and we examined the recruitment procedures and records for the new staff. Overall these were satisfactory with staff having references taken and Criminal record Bureau (CRB) checks and Protection of Vulnerable Adults checks (POVA) in place. We could see that staff had job descriptions and terms and conditions of employment. This process helps to make sure that appropriate people are employed to work there. We looked at the records of training that has been given and the way that training is planned and monitored and discussed training needs with the manager. We found that training records were still lacking in detail, difficult to follow and existing records needed reviewing and updating to give an accurate picture of staff training and development and how this was monitored to ensure staff had access to all the training they need to do their work. Records of training in place indicated that some training had not been given or updated for some years. Consequently we could not easily assess how well staff were being trained and their competence maintained. The registered manager must ensure that there is a staff training and development programme in use that is consistently monitored and recorded to ensure all care staff receive the training they need to ensure they have all mandatory and relevant training for the work they do. The manager confirmed she provided some in-house training on dementia, having attended an Alzheimer’s Society training course herself. We spoke with care staff and looked at their records that showed 4 had updates on dementia care and Alzheimer’s disease but all staff need this. The training matrix was out of date and the manager was aware of the importance of getting training back on track and properly recorded and monitored and had plans to address this. Records indicate and staff on duty confirmed that a high percentage of care staff have completed NVQ level 2 in care and the ‘floor managers’ have NVQ level 3 qualifications in care. Scaleford Retirement Home DS0000064565.V374310.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31, 33, 35, 36, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Procedures are in place to safeguard resident’s financial interests and gain people’s views of the service but the absence of some environmental risk assessments could put some people at risk. EVIDENCE: The home has a manager, Mrs Lynette Owen, who is registered with CSCI, has several years relevant experience working with older people is and has achieved the Registered Manager’s Award. The service has staff meetings and informal residents meetings and these are recorded. The home gives out an annual “customer satisfaction survey” to Scaleford Retirement Home DS0000064565.V374310.R01.S.doc Version 5.2 Page 23 relatives and advocates to find out their opinions and comments on the service being provided .The manager should look at ways to make sure the results of their satisfaction surveys are made available to current and prospective users of their service and any other interested parties. This way people taking part can also see what effect their views have had on the service. Policies and procedures are being reviewed and updated in the home when needed. The service has achieved compliance with the quality assurance standard ISO 9001 and uses these systems to audit its own systems and monitor their performance against ISO 9001. Their system audits training, administration medication and purchasing as well as security and domestic processes. The manager has reviewed the effectiveness of its audit process and audits are now being done on medication and care planning systems. This has been effective in reducing medication errors and improved the care planning records so any problems can be identified more promptly and dealt with. We recommend that the manager also look at doing regular auditing of the training and development of staff to improve the recording and monitoring of that. In this way people living there can be sure all staff have had the training they need to fulfil their roles. To ensure the health, safety and welfare of the people living and working there the manager should make sure that there are clear records of all mandatory training that is given to staff and when updates are due. Records indicate that servicing and maintenance of equipment is being done, that electrical testing of portable appliances lifts and hoists and alarms are being serviced, and that periodic electrical testing has been done. The home has had a fire safety audit carried out by Lancashire Fire Service and there are fire risk assessments in place. Records and talking to staff indicated that formal supervision is being done regularly with staff to help ensure that the home’s policies and procedures are being put into practice. Whilst walking around the home we could see that in some areas used by people living in the home there were flights of stairs that could pose a safety hazard for some people with physical frailty or who tended to wander about due to their dementia. The lock on the gate to one steep flight of stairs was not working. To ensure that all parts of the home to which people living there have access are, as far as reasonably practicable, free from avoidable risks and hazards to their safety the manager must ensure that appropriate risk assessments are done and put into place to minimise any potential risk to people’s general and individual safety. Scaleford Retirement Home DS0000064565.V374310.R01.S.doc Version 5.2 Page 24 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 3 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 X 2 X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 2 2 Scaleford Retirement Home DS0000064565.V374310.R01.S.doc Version 5.2 Page 25 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 Standard OP9 Regulation 13 (2) Requirement Records for administration of medicines must be complete and accurate to protect people from errors that could affect health. This is an element of a requirement that was to have been met by 18/10/08 Timescale for action 01/04/09 2. OP30 12 (1) 3. OP38 13 (4) The registered manager must 01/04/09 ensure that there is a staff training and development programme that is consistently monitored and recorded to ensure all care staff receive the training they need to ensure they have all mandatory and relevant training for the work they do. To ensure that all parts of the 01/04/09 home to which people living there have access are, as far as reasonably practicable, free from avoidable risks and hazards to their safety the manager must ensure that appropriate risk assessments are done and put into place to minimise any potential risk to people’s safety. Scaleford Retirement Home DS0000064565.V374310.R01.S.doc Version 5.2 Page 26 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 OP9 Good Practice Recommendations The manager should check that the safe used for the storage of Controlled Drugs complies with regulations and if not a suitable cabinet should be obtained. The manager should source further training in the specialist administration of medication for the relief of seizures that includes assessment of competence. Audits of medication should be done more thoroughly to monitor the management of medicines and to keep people safe. The manager should make sure that all staff have up to date training on safeguarding adults and managing challenging behaviour and keep records of this and any updates to make sure all staff have this information to promote resident’s welfare and safety. We recommend that the manager makes sure that general items of daily maintenance be attended to promptly to make sure all areas are safe, homely and pleasant for the people living there. The manager should consider, during assessments, the additional distance people may have to walk to bedrooms furthest away from the stair lift in line with people’s needs and abilities before they came to the home and as their needs change. This will help reduce any negative effects upon their independence in the home. We recommend that the manager does periodic audits of the training and development of staff to improve the recording and monitoring of that so people living there can be sure all staff have had the training they need to fulfil their roles. The manager should make sure the results of the home’s satisfaction surveys are made available to current and prospective users of their service and any other interested parties. 2. 3. 4. OP9 OP9 OP18 5. OP19 6. OP22 7. OP33 8. OP33 Scaleford Retirement Home DS0000064565.V374310.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Scaleford Retirement Home DS0000064565.V374310.R01.S.doc Version 5.2 Page 28 - 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!