Inspection on 13/09/06 for Seymour House

This inspection was carried out on 13th September 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

Seymour House 14/08/07

Seymour House 27/09/05

Seymour House 25/04/05

Seymour House 19/01/05

Seymour House 19/08/04

Seymour House 10/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Seymour House Monkton Park Chippenham Wiltshire SN15 3PE Lead Inspector Ms Sally Walker Unannounced Inspection 9:20 13 September 2006 th 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 DS0000028133.V308101.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. DS0000028133.V308101.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Seymour House Address Monkton Park Chippenham Wiltshire SN15 3PE 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) 01249 653564 The Orders Of St John Care Trust Ms Anna Lovesey Care Home 42 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (8), Old age, of places not falling within any other category (34) DS0000028133.V308101.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th September 2005 Brief Description of the Service: The home is situated on the outskirts of Chippenham near to the park. The building was originally built by the local authority in the 1970s and is the subject of an ongoing programme of redecoration and refurbishment. Residents accommodation is to the ground and first floors accessed by a lift and two staircases. 42 registered beds provide accommodation for older people, eight of whom may have a mental disorder. The home provides 1 of these beds for respite care. All of the residents’ accommodation is single bedrooms. The home also provides a 12 place day service during the week which is separately staffed. The staffing rota provides for a minimum of 4 care staff and a care leader for the mornings, 3 care staff and a care leader for the afternoon and evenings and 2 waking night staff and one member of staff sleeping in. Staffing levels are reduced at weekends. Anna Lovesey is the registered manager. The fees for the home are between £390.00 and £460.00 per week. DS0000028133.V308101.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on 13.9.06 between 9.20am and 5.05pm and continued on 15.9.06 between 9.30am and 2.00pm. Ms Lovesey was present on both days. Six residents and 3 staff were spoken with. A tour of the building was made. The care records, medication records, staffing records and fire logbook were inspected. As part of the inspection process comments were requested from relatives and GPs. One relative said they were happy with the care provided, that the staff were supportive and kept them up to date with the resident’s progress. Another relative said the resident was happy which was important to them. They said the staff were fond of the resident and the relative was satisfied with the care and support provided. One relative talked about ongoing concerns which they were putting in a letter to the manager. One relative said they were very pleased with the quality of care. Another relative said they had always found the staff helpful and they had found no faults in the home. One GP said their patients were all extremely well looked after. Another said that they had no adverse comments to make about the care given to their patient. Three comment cards were received from residents. One had had a contract, the other had not and one was not sure. Two had information about the home before they came to live there and the other had not. One resident said they usually received the care and support they need and the other two said they sometimes did. One said staff listened to them and the other said there were staff shortages. One resident said staff were usually available when needed and the other two said they were sometimes available. One resident said the meals were very good, one said they were usually good and the other said they sometimes liked the meals. One resident was unsure who they could talk to if they were not happy or needed to make a complaint. The other two residents knew who to go to. All three residents said they sometimes received medical support they needed. Two residents said that activities were sometimes available that they could take part in, the other said they were usually arranged. One resident said the home was always clean, one said it was usually clean and the other said it was sometimes clean. The fees for the home were between £390.00 and £460.00. Items not covered by the fee would include: clothing, toiletries, chiropody and hairdressing. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: DS0000028133.V308101.R01.S.doc Version 5.2 Page 6 The home visits prospective residents to carry out a detailed assessment of their care before a place is offered. Many of the residents administer their own medications and the system for administering medication was well managed. Although many residents said that the home was short staffed, all residents were well groomed and attention was made to ensure that their spectacles, teeth and clothing were cleaned. Those residents who were in their bedrooms had their call bells within reach and access to refreshments. Residents were well supported by the local surgeries with regular visits from the district nurses and GPs when needed. Residents were treated with respect and their privacy respected. The home provides a very good range and variety of meals with choices at each meal and a salad in addition to the 2 choices for lunch. The majority of the residents enjoyed the meals and some said that the cook consulted them about their preferences or diabetic diet. The majority of the residents knew who to complain to and staff were trained in the local Protection of Vulnerable Adults procedure. New staff could not start work without a negative Criminal Records Bureau certificate and a robust recruitment procedure was in place. Any money held on residents behalf was being properly managed with records kept of all transactions and regular internal audits. Residents could have access to their money at anytime. Staff had good relationships with residents and respected their privacy. Great improvements have been made with the ongoing programme of upgrade of the building. Residents have a comfortable clean environment. What has improved since the last inspection? What they could do better: The date that pre-admission assessments were carried out should be recorded on the document together with the source of the information. The care plans were varied in their content. Care plans must provide more detail on how residents care needs are to be met with all needs identified. Although training had been undertaken in tissue viability, residents’ risk of developing pressure sores had not been assessed. Although the organisation had not provided a format for assessing these risks, the home must complete the assessments using the risk assessment format already in place. The early indicators of risk identified in the training must be taken into consideration. The district nurse should then be contacted to do a clinical assessment and any advice given noted in the care plan. Care planning and risk assessment should improve DS0000028133.V308101.R01.S.doc Version 5.2 Page 7 when a head of care from one of the organisation’s other homes is seconded to assist with this project. Consideration must be given to the care needs of those residents with a visual impairment, both in providing staff training and consideration of the activities, which these residents may wish to be involved with. Staff need to consider that residents with a visual impairment will need to have information about the day to day events in the home and be mindful of letting residents know where things are placed or what is about to happen. A policy needs to be in place with regard to the giving of intimate personal care by staff of a different gender to the resident. Male staff must be aware of the parameters of their role with female residents. Whilst a member of staff with responsibility for provision for activities for 20 hours a week had been appointed and the amount of activities had improved, the staff was due to leave. Many of the residents said that there was not much to do during the day and that staff did not always have time to speak with them. A thirty-five hour care support role had been allocated to the home to make beds, clean and help with meals. However housekeeping staff only worked during the mornings and the laundry person only worked Monday to Friday. Care staff were expected to carry out these duties at other times. 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. DS0000028133.V308101.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 DS0000028133.V308101.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): 3, 6 was not applicable. The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home carries out good assessments with prospective residents although many are known from attendance at the day service. Residents were not being admitted outside of the categories for which the home is registered. EVIDENCE: Some of the residents spoken with said they had previously attended the day service so had known what to expect before they came to live at Seymour House. Others said they had come to visit or that their family had selected this home from a number of visits. The pre-admission assessments were very detailed and gave a good picture of the prospective residents care and social needs. However the organisation’s form did not allow for the person completing it to sign and date it or record where the information was sourced. Care management and hospital assessments were on file. One of the residents said that Ms Lovesey had come to see them in their own home. The requirement that consideration of the Categories for which the home was registered must be undertaken had been actioned. Ms Lovesey had carried out DS0000028133.V308101.R01.S.doc Version 5.2 Page 10 a review of all the residents care needs and established that none of the residents had a diagnosis of dementia for which the home was not registered. DS0000028133.V308101.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 The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Not all care plans show detail of how residents care needs were identified, monitored and reviewed. However a head of care has been seconded to work on care plans. Residents’ health care needs were being met. Many of the residents could manage their own medication. The system for administration of medication was well managed. EVIDENCE: The requirement that care plans were reviewed and revised as needs changed with the care plans directing the care was in progress. Staff had done training in care planning and had discussed issues at staff meetings. There was still some work to do on making sure that all the information for managing residents’ care needs was available. Care plans were variable in the information they provided. One of the newly admitted residents did not have a care plan, a photograph and they had not been weighed for their moving and handling assessment and tissue viability risk assessment. One resident’s care plan had no detail of how their diabetes was being managed. Where blood sugar levels were being recorded for another resident and stopped months before, there was no written evidence of why the records did not continue. Management of skin condition was not recorded in one resident’s care plan. DS0000028133.V308101.R01.S.doc Version 5.2 Page 12 Another care plan had good detail which related to the resident’s own description of their care needs as described voluntarily to the inspector. There were other care plans which had good details of care management. Residents who had a visual impairment had little information in their care plans on how their needs were to be met or any risks identified given their impairment. There was no guidance on how staff might inform visually impaired residents of day-to-day events. One of the residents with a visual impairment said that not all staff understood their condition. They would not introduce themselves as requested, tell them where objects were placed, tell them what was for the next meal unless asked or report on the weather. Ms Lovesey had said at the start of the inspection that staff were working on updating the care plans as a priority. It was intended that the care leaders review and revise the care plans initially then the keyworkers should take responsibility. A head of care had been seconded from one of the organisation’s other homes for 4 months to help with this project. There was no policy on intimate personal care and whether residents could state their preferences in receiving personal care from a staff member of a different gender. There was no indication in residents care plans whether they had been consulted about who provided their care. One female resident told the inspector that the male staff did not provide any personal care to them and they thought this would apply to the other female residents. There must be a policy in place for the protection of residents and indeed male staff so that they are formally aware of any boundaries to their role. Ms Lovesey said that they were in the process of asking all residents about their preferences. Residents were well groomed with clean hair, teeth, glasses, nails and clothing. All of those residents who were spoken with in their bedrooms had their call bell and drinks within easy reach. Residents said they could have a bath when they wanted and were not restricted to one a week. Some residents had keys to their bedrooms. Picture boards had been produced by a resident’s family to successfully aid communication. The requirement that care staff were trained in tissue viability to assist them in documenting risk assessments, monitoring pressure areas, nutrition and interventions required was in progress. Training had been undertaken but risk assessments had not commenced. The organisation’s policy dated January 2006 stated that a Waterlow or Norton assessment should be completed. Ms Lovesey said that the Care and Nursing Advisor for the organisation was considering the local Tissue Viability Specialist Nurse’s recently piloted format for care homes. The inspector advised that residents potential for developing pressure sore must be assessed. This could be done on the regular risk assessment format by staff who had completed the training and had some DS0000028133.V308101.R01.S.doc Version 5.2 Page 13 knowledge of the initial indicators of risk. The inspector advised that whilst a format was awaited from the organisation, the home must carry out risk assessments with each resident. This must note the indicators given in the training to establish those residents at risk. Contact should then be made with the district nurse to discuss clinical assessments with those deemed at risk. One of the residents showed the inspector their “special mattress”. This had been provided to reduce pressure damage. Other residents had pressure relieving mattresses or cushions in place. It was reported that the district nurse had trained some of the staff in monitoring blood sugar levels for some residents. The inspector advised that a certificate of training and ongoing competence should be requested from the training nurse. The district nurse manages any administration of insulin and regularly monitors residents’ conditions. A district nurse had also provided some training to staff in working with someone who had had an ileostomy reversal. Ms Lovesey said that residents were well supported by the local surgeries. Some of the residents who were receiving regular treatments said the district nurse would treat them in the privacy of their own bedrooms. Residents said that the GP would also consult them in their bedrooms with or without a member of staff. The care leader with the responsibility for the administration and control of medication explained the system. New staff would have to familiarise themselves with the home and the residents before undertaking in house training to administer medication. Ongoing competency was regularly monitored. Staff had recently undertaken training in medication from the supplying pharmacist. Some of the residents were able to administer their own medication following a risk assessment and written confirmation from their GP. One of the residents explained to the inspector about the safe facilities in their bedrooms for storing their self-administered medication. They said staff would order the medication and deliver it each week and the residents signed for the medication. Staff were monitoring the medication for those residents who managed it themselves. Staff would check with a new resident’s GP to confirm whether they had brought their currently prescribed medication with them. Currently the GPs were reviewing all the residents’ medication. Satisfactory records were being kept of medication received into the home and unused or unwanted medication returned to the supplying pharmacist. There were no controlled drugs. There was good evidence that prescriptions would be filled immediately they were written by the visiting GP so that residents benefited from the new medication. The care leader talked to some of the residents about the medication they were given and observed whether it was taken in some cases. Other residents were asked if they needed their prescribed painkillers. The medication administration record was signed immediately after each administration. DS0000028133.V308101.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 & 15 The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Most residents were able to follow their own routines. Although there was a member of staff who provided an activities programme for 20 hours a week, residents wanted more, particularly in the locality. Those residents who were able, could have a degree of control over their daily lives and staff had attended a talk on advocacy. Residents enjoyed the range and quality of the choice meals provided. EVIDENCE: Most of the residents were able to choose where they spent their day, either in the sitting rooms or in their bedrooms. Some of the residents joined in with the activities provided by the day service. Residents could stay in bed later during the day without being ill. Most residents said they did what they pleased. One resident said they were bored because there were not many activities provided during the day, only the day centre. Another resident said there was nothing much going on during the day. One resident said they would like to go to bingo but it was held too soon after lunch for them. The requirement that residents’ social interests and access to the community facilities were maintained as per their wishes had been actioned in that a member of staff had been appointed to take responsibility for 20 hours each week. However that member of staff was leaving. One of the relatives said DS0000028133.V308101.R01.S.doc Version 5.2 Page 15 they ran a quiz night on some evenings. There was a stroke club which residents could attend in the town. Other activities were: “knit and natter”, card and board games, films, manicures, beetle drive, music workshop, singing, a sherry evening with music and crafts. Activities were offered 7 days a week. There were some trips out; to a local pub for lunch paid for by the amenity fund, Longleat, a café in the town and visiting other homes in the organisation for competitions. Ms Lovesey said they had to drop out of the skittles tournament as there were not sufficient staff to go with residents and to staff the home. There appeared to be few activities geared to those residents with a visual impairment, although they did have their own radios and tape machines. Ms Lovesey said that the local advocacy service had run a training session for staff. Residents had a choice of different juice drinks with their lunch and some residents were having wine or beer. Fresh fruit was also available for residents to help themselves. There was an extensive menu with a choice of at least 2 dishes at each meal for each course. Diabetic diets were catered for and the cook would talk to residents about what they liked or disliked. Salad was available daily. Each resident was asked what they wanted at the beginning of each course. Staff showed each course to the residents so they could see what they were choosing. The lunch was well presented and served according to each individual’s appetite. Most of the residents said they enjoyed the meals. One resident described how their diabetic diet was managed. Another resident talked at length about various different meals that they had enjoyed recently including the range of items for breakfast. Second helpings were available. Those residents who needed support with eating were being fed at the residents pace. Some residents were having their lunch in their bedrooms through their choice. Staff withdrew to the side of the dining room but were vigilant in watching if anyone needed their help. The only detraction was that staff were very noisy when giving out the meals, talking loudly across the dining room. This was discussed with Ms Lovesey who would discuss it with the staff. Ms Lovesey said that the home was working to the organisation’s newly published catering manual. Managers had received training and would be cascading the information to the staff. Food supplement drinks were available for those residents where indicated. It was not possible to establish whether there was a rationale for some residents sitting in the wheelchairs that had brought them to the lunch table rather than in a dining room chair. There was no rationale in care plans and clearly the wheelchairs were not all designed specifically for that person. DS0000028133.V308101.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Systems were in place for residents and relatives to comment and make complaints about the service. Staff had been trained in the local Adult Protection procedures. EVIDENCE: Many of the residents spoken with knew how to make a complaint or bring something that they were not happy with to the attention of their keyworker or Ms Lovesey. The home works to the organisation’s complaints procedure. A log is kept of all complaints together with records of investigations, outcome and response to complainants. Training had been given to managers on how to respond to and investigate a complaint. The home had copies of the local Vulnerable Adults policy and procedure. Staff had watched a video on abuse and were joining with another home for some further training later in the week. Ms Lovesey was familiar with the procedure for referring staff to the Protection of Vulnerable Adults list if sufficient concerns were noted. She said that staff did not commence duties until a negative Criminal Records Bureau certificate had been confirmed. DS0000028133.V308101.R01.S.doc Version 5.2 Page 17 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 & 26 The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Great improvements have been made to the comfort of the environment for residents with an ongoing programme of refurbishment. The home was cleaned to a good standard although care staff were expected to cover cleaning and laundry duties when housekeeping staff were either not on duty or on leave. EVIDENCE: There had been great efforts made to improve the quality of the environment for residents with redecoration, new carpeting, new furniture and a bathroom refurbished with an accessible bath. The dining room and small sitting rooms had been refurbished. The 2 handymen were involved in various redecoration and restoration projects. The organisation’s surveyor was considering outstanding works for the completion of the refurbishment programme. New carpets were being laid that day from the main hallway along the corridors and up the stairwells. A new hairdressing salon was due to be installed. All the bedrooms were personalised. DS0000028133.V308101.R01.S.doc Version 5.2 Page 18 The requirement that adequate cleaning was carried out to infection control standards, including those areas which were not always visible, had been actioned. The bathrooms and toilets were very clean and staff had received training in infection control. Ms Lovesey had requested budgeting for more housekeeping hours to cover the afternoons and weekends. The person who works in the laundry from Monday to Friday each morning was on leave and their post had not been covered. Staff were providing this service as well as caring. One resident said the laundry was “all upside down” this week as the staff did not have time to return the clean laundry. They described the good service provided by the laundry person who was on annual leave. There had been discussions at a previous inspection regarding the provision of ventilation for the laundry area as one wall was mainly glazed and the area would be extremely hot in the summer. Ms Lovesey said that there were plans to install blinds to the windows to reduce the heat of the sun. Cooling machines had been used during the hot weather. Ms Lovesey said that the home was working to the organisation’s newly published housekeeping manual. DS0000028133.V308101.R01.S.doc Version 5.2 Page 19 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 & 30 The Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Residents did not feel there were sufficient numbers of care staff on duty. The housekeeping rotas only provided cover for mornings and care staff were expected to undertake cleaning and laundry at other times. Although residents said that staff were too busy to spend time with them, they said that they had good relationships with staff especially their keyworkers. EVIDENCE: The staffing rota showed that, during the week there was a minimum of 4 care staff on duty with a care leader during the mornings, 3 care staff and a care leader, during the afternoons and evenings. Three care staff and a care leader at the weekends. Currently there were 2 waking night staff and a member of staff sleeping in. A waking night vacancy was being recruited for. There had been 35 extra hours allocated for care support hours to assist with bed making, some cleaning and helping serve meals to allow staff to concentrate on caring. Many of the residents spoken with said that the home was short staffed. Two residents said the staff were always too busy to talk to them. Another said there were more staff on duty when the home was run by the local authority. One resident said they had had to wait for over an hour when they rang their call bell with a specific request, a member of staff came initially but said they would be back as they were dealing with something else. They did not return. Another resident said that staff were busy and their tablets were given later than they should have them. However another resident said they always DS0000028133.V308101.R01.S.doc Version 5.2 Page 20 received their medication on time. Although many of the residents complained about the home being short of staff, they all said that they had good relationships with staff, that they were friendly and helpful and especially their individual keyworkers. The housekeeping, laundry and kitchen support at the weekends was reduced. Care staff would have to carry out these duties at the weekends. The requirement that consideration must be given to the allocation of care and support staffing hours to ensure that residents care needs were met and administrative duties were exclusive of the care provision had not been actioned. A robust recruitment process was in place in line with the organisation’s policy on recruitment and retention of staff. All the required documents and information required by regulation were on file. All new staff were inducted into their role. One staff talked about their past experience of working in care both in homes and with a care agency. They said they had been inducted into the home and had good access to the training provided by the organisation. Ms Lovesey said that the organisation was installing computers in all its homes for residents and staff use. One of the applications would be for staff to complete training and learning on the internet. She went on to say that there had been a great deal of in house training recently; infection control, food hygiene and tissue viability. Staffing records showed further recent training in moving and handling and dementia. The home was joining with another home for training in mental health from the community psychiatric nurse. There was a training matrix showing essential and mandatory training for each role. There was no evidence that staff had received training in working with people with a visual impairment. DS0000028133.V308101.R01.S.doc Version 5.2 Page 21 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 & 38 The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents have benefited from having a permanent manager who is addressing many of the issues from the time when the home was without a permanent manager. The home is run in the best interests of the residents. Systems are in place to protect residents’ money held at the home. Staff were trained in safe working practices. EVIDENCE: Ms Lovesey had done much in her year in post to improve standards. Previously the home was without a permanent manager for more than a year. She was aware of the areas still to be developed and was due to be supported by a seconded head of care from one of the organisation’s other homes for 4 months. Questionnaires had been completed by families as part of the home’s quality audit. The returned information had been collated and Ms Lovesey was completing an action plan to address any issues. The organisation had also carried out a quality review of this service. DS0000028133.V308101.R01.S.doc Version 5.2 Page 22 Unannounced visit reports in line with Regulation 26 were available in the home. Residents may keep small amounts of cash in the home’s safe. Records were kept of all transactions which were regularly audited by the administrator. Residents can access their money at any time. Only management and senior staff had access to the safe. The administrator said that she deals with very few residents pensions directly and kept records of all pensions cashed. Residents, their families or solicitors managed residents’ finances. No valuables were kept on residents behalf. The administrator was aware of the procedure for reporting any allegations of financial abuse of residents. The requirement that regular fire drills were carried out and recorded in line with the requirements of the Fire and Rescue Authority had been actioned. Other tests and checks had been carried out in line with requirements of the Fire and Rescue Authority. There was no fire risk assessment in the file. Ms Lovesey said she intended that when the head of care was seconded to the home she would resume full supervision of the staff. There was a plan in place. The organisation contracts with suppliers for maintenance and service of systems and equipment. Staff were regularly trained in safe working practice and risk assessments were generally in place for each resident. DS0000028133.V308101.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 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 X X 3 DS0000028133.V308101.R01.S.doc Version 5.2 Page 24 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 OP7 Regulation 15 Requirement The person registered must ensure that care plans are reviewed and revised as care needs change. The care plans must direct the care. (In progress a head of care seconded to support this work). The person registered must ensure that service users social interests and access to the community facilities are maintained as per their wishes. (In progress but appointed activities staff leaving and residents still want more access to locality). The person registered must consider the allocation of staffing hours to ensure that service users care needs are met, with full provision of care and support staff. Management and administrative duties must be excluded from the caring hours. (35 support hours had been allocated but care and housekeeping hours were reduced at weekends). The person registered must DS0000028133.V308101.R01.S.doc Timescale for action 02/01/07 2. OP12 16(2m&n) 02/01/07 3. OP27 18(1)(a) 31/01/07 4 OP8 13(4)(c) 27/09/06 Page 25 Version 5.2 5 OP30 18(1)(i) 6 OP10 12(2)(3)& (4)(b) ensure that all residents have their risk of developing pressure sores assessed with outcomes and action to be taken identified in their care plan. The person registered must ensure that staff are trained in working with people who have a visual impairment. The person registered must ensure that a policy is in place with regard to the giving of intimate personal care by a person of a different gender to the resident. Male staff must know the parameters of their role. 02/01/07 13/09/06 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 2 Refer to Standard OP3 OP8 Good Practice Recommendations The date should be recorded of when a pre-admission assessment was carried out together with who supplied the information. A certificate should be sought from the district nurse to evidence that staff are trained in monitoring blood sugar levels. DS0000028133.V308101.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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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