Inspection on 24/07/08 for Sea Point

This inspection was carried out on 24th July 2008.

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

Sea Point 25/06/09

Sea Point 02/08/07

Sea Point 25/07/06

Sea Point 22/11/05

Sea Point 07/06/05

Sea Point 19/11/04

Sea Point 20/07/04

Sea Point 06/03/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

CARE HOMES FOR OLDER PEOPLE Sea Point 14 Adelphi Road Paignton Devon TQ4 6AW Lead Inspector Rachel Proctor Unannounced Inspection 24th July 2008 9:30 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 Sea Point DS0000018423.V365984.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. Sea Point DS0000018423.V365984.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sea Point Address 14 Adelphi Road Paignton Devon TQ4 6AW 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) 01803 556899 01803 556 899 Paignton Guild of Social Services Housing Associations Limited Mrs Glenis Mary Rees Care Home 12 Category(ies) of Old age, not falling within any other category registration, with number (12), Physical disability over 65 years of age of places (12) Sea Point DS0000018423.V365984.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 02/08/07 Brief Description of the Service: Sea Point is registered to provide accommodation and care for a maximum of twelve service users who are over sixty-five years of age and who may also have physical disabilities. The home is situated in a quiet area of Paignton and is within a short and level walking distance of the sea front, town centre, bus and railway stations. Information about the service is available from the home in a Statement of Purpose and in a brochure. Copies of inspection reports will be made available on request or can be obtained from the CSCI website. The current fees range from £300 to £375 a week. Additional charges are made for optional extras including professional hairdressing and chiropody, personal toiletries, newspapers and magazines. Sea Point DS0000018423.V365984.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 was a key unannounced inspection, which took place on 24th July 2008. The manager provided an (AQAA) Annual Quality Assurance Assessment for the Commission prior to this inspection. This provided information about how the home manager viewed the services provided at the home and what planned improvements would take place in the next 12 months. Two people living at the home had their care followed. Discussion with the manager, staff team and people living at the home took place during the inspection. Surveys were returned from 3 people living at the home, 1 relative and 2 staff members prior to this inspection. Some comments made in the surveys and some comments made during the inspection have been included in this report. A tour of the home was completed and some records were inspected. What the service does well: The registered manager is very experienced and has a good understanding of the needs of the people living at Sea Point. She carries out needs assessments with prospective new people and their representatives to ensure that the home can meet their individual needs. The people who use the service are satisfied that the service provided meets their needs. The residents are offered a choice of meals and the quality of the meals provided is good. People asked said they enjoyed the food, some saying they looked forward to meal times. Complaints are listened to and taken seriously and policies are in place to protect the service users from abuse. The complaints policy is easily available for people in the service users guide. The people who use the service find the staff willing and helpful and feel that they are treated with dignity and respect. Sea Point is ideally located for access to the beach and to the town centre. The service users accommodation very comfortable and has a homely appearance. People said they liked living at Sea Point Sea Point DS0000018423.V365984.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Some health and safety issues could be managed better. These included providing COSHH (Control of Substances Hazardous to Health) information for the chemicals used in the home. By not providing this information people will be put at risk if they spill or accidentally ingest the chemicals used, because the information regarding how these should be managed was not provided. Risk assessments had not been completed for the environment to reflect current people’s risk. This may mean that all the risks in the environment people have access to may not have been reduced because they have not been identified. A quality assurance/quality monitoring system needs to be introduced to enable people living at the home, their representatives and the staff to contribute to the ongoing development of the service. The registered manager had not recorded all care staff’s formal supervision. This would show support for staff to do their job and identify any additional training needs they have. Not recording supervision may mean staff are not given the opportunity to discuss their work and development in a formalised way with the manager. It should be noted that since this inspection the provider has written to tell the Commission that all the Requirements made as a result of this inspection have been addressed. Please contact the provider for advice of actions taken in response to this Sea Point DS0000018423.V365984.R01.S.doc Version 5.2 Page 7 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. Sea Point DS0000018423.V365984.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 Sea Point DS0000018423.V365984.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6. Quality in this outcome area is good. People are given sufficient information about Sea Point and it’s services to make an informed choice about whether the home can meet their needs. The assessment process adopted by the home manager should ensure that peoples care needs are adequately assessed and their care needs are meet. The home does not provide intermediate care This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Service Users Guide and Statement of Purpose had been up dated since the last inspection. The manager confirmed that people would have a copy of the Service Users Guide in their room. These were emailed to the Commission on 30.07.08. Four people/or their representatives spoken to during the inspection said they were given information about the home prior to admission, which had helped them to decide about staying there. Sea Point DS0000018423.V365984.R01.S.doc Version 5.2 Page 10 Two people had their care followed as part of the inspection. An assessment of need had been completed for both people. A care plan had been developed with the individuals from their assessment of need. One of these people had signed their care plan. The manager advised that the other person was unable to sign their care plan. One of these people said that staff had discussed their care with them to find out what was important to them. They also said they had not visited the home before admission but a relative had on their behalf. One person whose care was followed was being cared for in their room. Their assessment showed that they were more comfortable being cared for in their own room and preferred to stay in bed. Risk assessments for falls, pressure sore prevention and manual handling had been completed. One person who was using bed-guards had a risk assessment completed for there use. The manager advised that these had been fitted with the advise of the health team. However documentation to support the health teams involvement were not easily available at he time of the inspection. The manager advised that she had recently changed the care plans and said the information would be with the old style care plan records. The home does not provide intermediate care. However people can be admitted for short-term respite care if the accommodation was available and staff can meet their needs. Sea Point DS0000018423.V365984.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is good, The care planning provides clear information for staff on how they should provide peoples care. People receive the care they need from a staff team who try to provide their care in a way they would do themselves if they were able. Medication practices are generally safe. however by not recording a change of medication dose on a medication record the person may have been at risk of not receiving the amount of medication their GP intended them to have. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager advised that a new care planning system had been introduced recently. The care plan followed on from an assessment of need completed for individuals. Two people had their care followed. Both had care plans completed that identified their current care needs. Risk assessments for manual handling and falls risk had been completed. Sea Point DS0000018423.V365984.R01.S.doc Version 5.2 Page 12 Personal preferences for food had been recorded as well as the person’s interests. One persons care plan stated that they had poor sight and liked to be able to listen to the radio. When we spoke to them they said staff make sure it is easy for them to reach. When this person was visited in their room they were listening to their radio. The care plan also stated that they needed a hat to shade bright light. The person was wearing a shade on their fore head, they said they needed this because they found bright light difficult. They also said that the manager had helped them to get a phone for their room so they were able to keep in touch with family and friends. One element of care planning referred to depression/anxiety the care plan identified how staff should support this person if they were feeling anxious or depressed. Another person’s care plan indicated that they needed support for all aspects of personal care. They were being cared for in their room and had chosen to stay in bed. When asked they said they found it less painful to lye in bed than sit up in a chair. The manager advised that she had been working with the multi disciplinary team to look at other seating options and hoists to facilitate transfers. However she advised that the person was reluctant to use the hoist or sit out of bed. The involvement of the multi-disciplinary team in the decisions about how care should be provided was not clearly recorded in the new care plans. The manager advised that this had been recorded in the daily statement of the previous care plans. The persons care plan indicated that they preferred sandwiches rather than a cooked meal. When this person was spoken to they said staff provided sandwiches if they don’t like the meal on offer. The district nursing team were visiting this person on a regular basis. The daily records indicated that the GP had been called if there were any concerns about the person’s health. One person who completed a survey form said ” I have seen the speech therapist and the physiotherapist and staff helped me when I needed to do my exercises.” Another person commented in a survey form “ I was pleased staff were able to accompany me to an hospital appointment” Medication was being stored in a locked cupboard. Separate lockable space with in this locked cupboard was provided for controlled drug medication. The manager advised that none of the people living in the home were receiving controlled drug medication at the time of the inspection. A record of controlled drugs administered by staff had been kept for a person who was no longer in the home. The manager advised that she had asked the pharmacy for a new controlled drug record book. The manager advised that no one living at the home was able to manage their own medication. The medication records of the medication given had been completed and signed for each time medication was given. Codes for the reason why medication had not been given were also being used. One person who had had the dose of their medication changed had not had this clearly recorded on the medication chart. However a note had been placed on the blister pack of medication the GP had reduced the Sea Point DS0000018423.V365984.R01.S.doc Version 5.2 Page 13 dose of. The manager recorded this on the medication chart when it was pointed out. Staff were heard speaking to people respectfully using their preferred form of address, which had been recorded in their plan of care. Staff were seen knocking on peoples doors before entering their rooms. One person said “staff always knock before they enter their room and they appreciated this”. They also said staff are friendly and kind towards them. Sea Point DS0000018423.V365984.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good, People who live at Sea Point are given the opportunity and encouragement to make choices about their day-to-day lives. Meal times are a pleasant experience for people who live at Sea Point. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) provided by the homes management team stated “It is good to report an opposite of what we reported last year. Due to increased activities and leisure opportunities we provide most service users are using the opportunities and not staying in their rooms but getting out and about as well as joining in group activities.” People living at the home who completed surveys indicated that they sometimes have activities arranged for them by the home that they can take part in. The manager provided a list of activities available for the week. This was dispalyed on the notice board in the home. Activities for the week of the inspection included, Residents out for a walk, Skittles in the loungue, Coffee and music in the loungue, Bingo and a Memory card game. In addition to this Sea Point DS0000018423.V365984.R01.S.doc Version 5.2 Page 15 two people said they enjoyed playing scrabble and dominoes in the loungue if someone was able to play this with them. One relative spoken to said they regularly play scabble with their realtive. They also said staff are trying to encourage their relative to take part in other activities in the home. The manager advised that staff provide activities for people in the afternoons. One resident said they had been asked about the type of activites they liked and the home manager had arranged some of the things they had discussed. The manager advised that she had discussed activities with the residents and was using what they had said they liked to plan future events and activities. The lunch time meal was unhurried with people eating their meals at their own pace. People were asked if they wanted more food during the lunch time meal. Six people had chosen to eat their meals in the dining room others had chosen to eat their meals in their own rooms. The manager advised that people are always given the opportunity to choose where they eat their meals. Six people asked said they enjoyed the food, one commenting there is always pleanty of it. Very little wastage was seen at the lunch time meal observed. Discussion with the housekeeper revealed that they regularly speak to people with the manager about the type of food they enjoy and the menu reflected the choices people have made. Sea Point DS0000018423.V365984.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is good, People who live at Sea Point can have confidence that any concerns they have will be dealt with sensitively by the staff team who care for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The revised Statement of Purpose and Service Users Guide have a copy of the homes complaints policy provided with them. The manager confirmed that all the people living at the home would have a copy of the Service Users Guide in their rooms. Four people living at the home spoken to during the inspection said they knew who to speak to if they had any concerns. They also said they had confidence that any concerns they had would be dealt with. One relative said that any issues they discussed with the manager were always dealt with promptly to their satisfaction. People spoken to said they liked living at Sea Point. Comments received from surveys returned to the Commission included: - “ I feel I can talk to all the staff members I feel very at home here”. “I have no complaints I am very happy at Sea Point” “They are always very prompt sorting out problem for my relative”. The home has a policy in place for staff regarding protection of vulnerable adults. The manager confirmed that staff had received training for this. The records of training seen during the inspection for staff confirmed this. The manager has a robust recruitment policy, which was followed to protect people Sea Point DS0000018423.V365984.R01.S.doc Version 5.2 Page 17 from unsuitable staff. Two staff files viewed contained the pre-employment checks expected. Sea Point DS0000018423.V365984.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26. Quality in this outcome area is good, Sea Point is clean, comfortably furnished and homely and provides a pleasant environment for people to live in. Access to parts of the home may be difficult for people who use wheelchairs. Not all windows above ground floor level had been restricted to the recommended 4 inches opening and risk assessments had not been completed to show this was safe. This means people may be at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Sea Point is situated in a quiet road that is a short and level walk from the seafront and the town centre. Limited off road parking was available and visitors may need to use the public car park, which is a five-minute walk from the home. There was an attractive and accessible garden to the back of the house. The AQAA (Annual Quality Assurance Assessment) provided by the Sea Point DS0000018423.V365984.R01.S.doc Version 5.2 Page 19 homes management team stated that the garden had been improved since the last inspection. The manager said they were considering replacing the garden furniture to provide seating for people to use in the garden. Five steps have to be negotiated to reach the front door of the home. Better access was provided to the side of the home for people who use wheelchairs, but this is not ideal, as people would have to negotiate a slope and a small step to gain access into their home. The manager advised that disabled access to the home was being discussed. However the changes would be dependent on feasibility as well as cost. The laundry room, sited on the lower ground floor has a small area, which was under the front steps. This had some areas of damp, which had been re-plastered since the last inspection. The manager confirmed that the laundry room was in the process of being redecorated to make the walls easily cleanable. A small lift, which was not large enough to accommodate a person in a wheelchair, provides access between floors. The manager advised that one person who used a wheel chair had been able to use the lift by using a smallwheeled commode to sit on while they were in the lift. A tour of the home including most people’s individual rooms was completed with the manager. The home was fresh and clean in all areas entered. People who returned surveys indicated that the home was always fresh and clean and their rooms are cleaned regularly. The spacious lounge and dining room are situated on the ground floor, which people were using during the inspection. The dining room is next to the lounge. This room has a small room leading off it that has a sink, kettle and toaster in it so it could be used by people to make them selves a hot or cold drink and snacks. There is a food-warming unit in the dining room, which should be risk assessed because a touch test that was carried out found to be very hot. One window in the dining room, which opened above a low roof, had not been restricted. A chair had been placed in front of the window with a dining table. A risk assessment had not been completed to show that the window was safe. Two other windows in the home for rooms that were above ground level could be opened more than the recommended 4 inches. A risk assessment for window opening had not been completed for these rooms. The manager advised that the people using the rooms would need assistance to open the windows and staff were with people in the dining room. The majority of rooms have en-suit facilities or a toilet close to individual rooms or communal areas. One toilet on the first floor did not have a hand washbasin. The manager advised that people used the hand washbasins in their rooms to wash their hands. There are two bathrooms; the bathroom on the second floor has a ‘Bathmaster’ hoist and shower cubical. All of the bathrooms and communal toilets have been fitted with locks for privacy. The manager confirmed that water was regulated to close to 43 °C to reduce the Sea Point DS0000018423.V365984.R01.S.doc Version 5.2 Page 20 risk of accidental scalds. Radiators in the home were covered with guards. Individual people rooms had been fitted with locks; the manager advised that people are able to have a key for their room if they have been assessed as able to use this. People’s rooms entered had been personalised with items of the individuals choice. The manager advised that people are encouraged to bring small personal items when they enter the home. Although the home has shared rooms that could be used for two people these were being used for one person during the inspection. Sea Point DS0000018423.V365984.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good, Staff who work at Sea Point are given the opportunity to improve their knowledge and skills through training. This means that people have a knowledgeable staff team to care for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager provided the duty rota, which showed how many staff were on duty each shift. The pre inspection information (AQAA) (Annual Quality Assurance Assessment) provided shows that the home has more permanent staff than at the last inspection and the manager advised that she has more management time to allow her to complete management tasks in the home. The staff spoken to during the inspection said they had sufficient staff to meet the current peoples care needs. The information indicated that the same care hours as the last inspection were being provided. The AQAA (Annual Quality Assurance Assessment) indicated that eight of the eleven staff employed have achieved an NVQ (National Vocational Qualification) level 2 in care or above and a further three were working towards this qualification. This has increased since the last inspection and shows the homes management team are committed to ensuring staff have training that helps them to do their work. Sea Point DS0000018423.V365984.R01.S.doc Version 5.2 Page 22 Two staff files were viewed during the inspection. These showed that the manager follows a safe recruitment practice that protects people from unsuitable staff. Two references, an application form and a police check had been completed for these staff. The manager advised that the induction programme for new staff employed would be improved. Examples of the induction used in the past were available. This was a check list signed by the staff member and the senior staff member supporting their induction as they completed each area. The two staff surveys returned to the Commission prior to the inspection indication that the induction covered everything they needed to know about the job very well. The training provided for staff since the last inspection was discussed with the manager. She advised that staff had received manual handling, fire safety and food hygiene training up dates since the last inspection. She also advised that key staff had completed infection control and dementia care courses. The pre-inspection information indicated that the management team intend to further improve staffing management in the next 12 months. This included: Encourageing those staff with NVQ2 to complete an NVQ3. Improve on training opportunities for staff and encourage then to undergo training in other areas which will asist them in improving the care and service they give. Introduce Staff Development Plans for all members of staff. Sea Point DS0000018423.V365984.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38, Quality in this outcome area is adequate. The home was generally well run and managed by a management team that has several years experience. Staff say they are supported to do their work and receive relevant training. However documentation to support all staff are receiving formal supervisions was not being kept. A lack of attention to environmental Health and Safety risk assessments and hazard management could put people living at the home at risk of injury. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes Statement of Purpose identifies that the registered manager has twenty one years experience in care work. She has been the manager of Sea Sea Point DS0000018423.V365984.R01.S.doc Version 5.2 Page 24 Point for six years and said that she had nearly completed her Registered Managers Award. The manager advised that there had been a delay in completing the award because the course tutor/assessor had left and the training agency had taken a long time to find a replacement. The pre inspection information provided indicated that the managers role and responsibilities with in the home had been re-defined and staffing levels had improved to allow her more time for general management and administrative matters. The manager confirmed that she has more time to complete mangement tasks than she did at the last inspection. The Registered Provider is The Paignton Guild of Social Service Housing Association Limited. The members of the Committee carry out regular monthly visits to keep the Committee informed of the conduct of the home and to over see the management of the service. The chair of the organisation and one of the committee members were spoken to during the inspection. They confirmed that it was their intention to continue to improve the way people experience care at Sea Point. How the manager ensures the quality of care at Sea Point was discussed with her. She advised that there are residents meetings to enable people to influence what was provided at Sea Point. She also provided completed questionnaires that some of the people accessing the service had completed since the last inspection. However the results of the quality audit completed so far had not been made available to the people living at the home or the Commission. The manager advised that she held money for one person. The records of the money held and expenditure were being kept. Receipts for expenditure were being kept and the amount of money received recorded. However a running total of expenditure and balance of money held was not being kept. The manager provided a recording form that she intended to complete to record this. The way staff are supervised was discussed with the manager, she advised that she regularly worked alongside staff to assess their practice and staff discussions took place regarding care practices in the home. However although supervision appeared to be taking place a formal record of supervision and appraisal had not been completed for all staff employed. The manager provided an example of a supervision record she had started to use for staff. The pre inspection information indicated that completion of staff appraisals, which include training and development plans and supervision for all staff was a target for the coming year. Overall the home was well maintained. Staff training provision in health and safety related areas was good and policies and procedures are in place to promote safe working practices. However risk assessments for the environment had not been up dated to reflect the risks for the new people Sea Point DS0000018423.V365984.R01.S.doc Version 5.2 Page 25 living in the home since it was last completed. The use of window restrictors, which allowed windows above ground floor to open more than the recommended 4 inches had not been risk assessed. The manager was unable to provide the COSHH (Control of Substances Hazardous to Health) information for the chemicals used in the home. She advised that she would be contacting the suppliers to obtain the information as soon as possible. By not having this information people may be at risk if they spill or accidentally ingest the chemicals used because information on the correct action to take to reduce injury was not easily available. Sea Point DS0000018423.V365984.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 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 3 3 2 X X X X X 3 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 2 X 2 2 X 2 Sea Point DS0000018423.V365984.R01.S.doc Version 5.2 Page 27 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 OP36 Regulation 18 Requirement The registered manager must ensure that care staff are properly supervised to ensure they undertake their job in a professional manner. Previous timescale for compliance 25/11/06 and 02/10/07 not met. This has been further extended because evidence that this has been started was provided. 2. OP33 24 A quality assurance/quality monitoring system should be introduced, based on a systematic cycle of planning action - review, reflecting the aims and outcomes for service users. Previous timescale for compliance 02/11/07 not met. This has been further extended because evidence that this has been started was provided. 3 Sea Point Timescale for action 02/12/08 02/12/08 OP38 13(4)(a) (c) The manager must complete risk assessments for health and DS0000018423.V365984.R01.S.doc 01/10/08 Page 28 Version 5.2 safety with in the environment accessible to people living in the home and take necessary action to reduce the identified risks. Furthermore, the manager must ensure that information regarding the chemicals used in the home are provided for staff. 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 OP8 Good Practice Recommendations A new call bell system, preferably one that can only be cancelled at source, is installed as the current system is unreliable and cannot always be heard by the staff. Information relating to the involvement of the multi disciplinary team in the decision to use bed guards should be available in the new care plans. When a GP changes the dose of medication this should be recorded on the medication sheet. This is in addition to information on blister pack of the medication and the persons care records, which were recorded. The surface temperature of the food warmer gets very hot and should be risk assessed to ensure all possible actions to reduce the risk of people scalding themselves have been taken. The manager should keep a clear running total of expenditure and money received for people. 2 OP8 3. OP9 4. OP20 5 OP35 Sea Point DS0000018423.V365984.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Sea Point DS0000018423.V365984.R01.S.doc Version 5.2 Page 30 - 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. 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