Inspection on 08/07/08 for Simonsfield

This inspection was carried out on 8th July 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Simonsfield 14/02/08

Simonsfield 29/10/07

Simonsfield 22/01/07

Simonsfield 21/10/05

Simonsfield 21/10/04

Simonsfield 26/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Simonsfield 1a Sunbury Road Liverpool Merseyside L4 2TS Lead Inspector Julie Garrity Unannounced Inspection 09:45 8th July 2008 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 DS0000059308.V363556.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. DS0000059308.V363556.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Simonsfield Address 1a Sunbury Road Liverpool Merseyside L4 2TS 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) 0151 260 7918 0151 260 0319 simonsfield@europeanwellcare.com European Wellcare Homes Ltd Diane Moon Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places DS0000059308.V363556.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 36 nursing beds and 36 personal care in the overall number of 36. Date of last inspection 14th February 2008 Brief Description of the Service: Simonsfield is registered with CSCI to provide nursing care and personal care for 36 residents aged 65 or over. Although registered for nursing care the home does not currently provide nursing care, as they do not have sufficient nursing staff employed within the home to provide this service. It is a purpose built care home with several sitting areas for residents to socialise, sit quietly or entertain visitors and friends. A separate smoking lounge is provided. Bedrooms are located on all three floors in the home and there is a passenger lift that provides access to all the floors. There are gardens located at the rear and side of the home and large parking area at the front of the building. Simonsfield is located on a quiet residential road near to Stanley Park. There are bus stops within 10 minutes walk on a main bus route to and from Liverpool. The home is owned by European Wellcare Homes Ltd, which owns several homes that provide a variety of care and support to residents living in them. The manager has worked in the home for several years and is registered with CSCI. The fees for the home are £322 week and an additional £14.71 paid for by a third party (not the person living in the home or social services). DS0000059308.V363556.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 one star. This means the people who use this service experience adequate quality outcomes. The site visit was carried out over a period of one day. We (the commission) arrived at the home at 9:45 and left at 17.40. The inspectors spoke with 12 people who live in the home, 1 visitor, 6 staff and the acting manager. We completed the inspection by a site visit to Simonsfield, a review took place of many of the records available in the home and CSCI offices. These included individuals care plans, assessments, accident records, staff rota, staff files, maintenance records, menus, staff rota, questionnaires, staff training, medications, information sent to CSCI by Simonsfield and a self-audit completed by the home. This site visit included discussions with people who live in the home, visitors, staff and management. A pharmacy inspector, who specialises in the management and safe practice of medications, reviewed medications separately. We also received information from Social Services and this is also used within this report. We followed an inspection plan that was written before the start of the inspection to make sure that all areas identified in need of review were covered. All of the Key standards were covered in this inspection, these are detailed in the report, additional standards were identified before and during the inspection these were also reviewed and detailed in the report. Feedback was given to the manager and the operations manager during and at the end of the inspection. The arrangements for equality and diversity were discussed during the visit and are detailed throughout this report. Particular emphasis was placed on the methods that the home used to determine individual needs, promote independence and support to make informed decisions in line with individual choices. What the service does well: Simonsfield has a caring staff team. Staff have good verbal communication skills and discuss the care of the people who live in the home on a daily basis. People who live in the home made positive comments about the staff these included, “caring staff”, “staff work very hard” and “helpful caring staff”. DS0000059308.V363556.R01.S.doc Version 5.2 Page 6 The Service has several different areas that individuals can choose to sit in. There is a smoking lounge that allows those who smoke to make the choice of where to sit. The majority of individuals spoken with enjoyed the food that was available and said there was choices available. The management outside the home has recognised that the service needs to improve and has put plans in place that when fully completed will increase the quality of the service over time. What has improved since the last inspection? What they could do better: Although there have been some improvements in the service in particularly in areas relating to the safety of the people who live in the home progress has been very slow. There have been four managers in the last 12 months and this has impacted on the continuity of care and the morale of both the people who live in the home and the staff. Recently the service has appointed a manager with a good history of raising quality who identified to us a number of areas that need to improve. At present the acting manager is not registered with CSCI and the home has not had on site a manager registered with CSCI for nearly six months a manager who will work towards improving quality and registered with us needs to be in place. We agree with the manager that the priorities are in raising the safety of the people who live in the home further this includes good risk assessments for activities that may place individuals at risk such as smoking and moving and handling. Other areas regarding safety include bedrails management, fire safety and general risk assessments for the environment that also maintain the safety of the staff. Care planning is also in need of developing as care plans do not give staff the information they need in order to provide care that always meets the needs of the people who live in the home. Staff need to be involved in care planning and have training in how to write care plans that meet the needs of individuals. DS0000059308.V363556.R01.S.doc Version 5.2 Page 7 Staff training needs to be monitored in order to make sure that suitable training is available, staff remain up to date and a determination that staff are skilled in supporting the people who live in the home. At the site visit it was not possible to determine whether staff were up to date with their training or skilled in areas such as medications, care planning and assessments. Although a quality system is in place that is meant to identify the strengths and weaknesses of the service this has not been done for a significant amount of time. Without making sure that quality can be increased the service cannot maintain quality and all the hard work that has gone into increasing quality over the last few months will be lost. 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. DS0000059308.V363556.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 DS0000059308.V363556.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): Standards reviewed were 1, 2, 3, 4 and 5. Standard 6 is not applicable. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Assessments are not all completed in sufficient detail to make sure that individuals’ needs can be fully identified. The lack of full assessments and information does not support individuals to make an informed decision about moving into Simonsfield. EVIDENCE: Progress in increasing the quality of this outcome area has been slow. The management do have plans as to how they will make sure that all individuals will receive good information and an assessment that will help them decide if the service can meet their needs. Information available to the people living in the home has changed. The management team explained that they are still developing this to make sure that it meets individual needs. A copy of the information is available in each person’s bedroom and although out of date does give individuals an idea as to what services Simonsfield supplies. All new DS0000059308.V363556.R01.S.doc Version 5.2 Page 10 individuals have to pay a “top up fee”, this is additional money above the fees paid by social services. There was no information available to say that this had been discussed with the person wishing to move into the home or their relatives, contacts were not available that detailed this fee. All individuals who have their stay paid for by Social Services have a copy of a social services assessment before they are admitted. Copies of these were seen in the individual files. The assessments viewed were not always completed fully or accurately. The management team discussed that the assessments covered too much about the individuals physical needs and although areas such as social needs was available this was a very small section and very little information could be written in it. Without fully completed and accurate assessments staff and individuals will find it difficult to decide if the home can meet their needs. The management of the home have recognised further improvements need to be made to ensure documentation is up to date especially around assessments. This continues to be an area of improvement to ensure people’s needs can be fully recognised and thus met. DS0000059308.V363556.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): Standards 7, 8, 9 and 10 were reviewed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans have been simplified but are still disorganised and not in sufficient detail to describe to staff the actions they need to take to meet the needs of individuals. The management of medications has improved since the last site visit and individuals now receive medicines correctly. There remain areas that need to improve in order to maintain the safety of people living in the home. EVIDENCE: Five care plans were looked at, care plans all had a signatures of individuals or their relatives that agreed to the care plan when it was first written. All the individuals spoken with had not seen their care plan for some time or did not recall seeing it at all. Staff spoken with did sometimes read the plans the majority relied on the verbal conversations that they had with each other to tell them the different needs of the people they supported. Staff spoken with DS0000059308.V363556.R01.S.doc Version 5.2 Page 12 found them of limited value in some cases information in the plans did not tell them what they needed to know. Care plans did not describe how staff were to meet individual needs and describe a summary of the individuals needs without instruction to staff as to how to meet their needs. One individual had developed a pressure ulcer and district nurses were regularly attending this to. There was no information in the plan as to how staff were to prevent a further deterioration in the condition of the individual and information was very confusing with one plan detailing that the individual had a condition with medication control and another not mentioning it at all. These plans were contained in the folder for the same person and would confuse staff. Discussions with staff showed that they were aware that the individual did have this condition. Without accurate care plans that give clear instructions to staff individual care will not be consistent and runs the risk of not meeting their individual needs. The acting manager explained that she was aware of the issues and felt that it staff involved in care plans needed to have training in writing these. The service is considering a number of options as to how to make the care plans easily accessible and containing relevant information. Several of the plans now contain a life history and describe in brief detail some support needs. Although this does not fully explain to staff how to support an individual it is an improvement on previous information seen. Although people’s needs are being met and the management of the home are looking into improving care planning records, this remains an area of improvement to ensure that people’s care needs are set out in a effective plan. Individuals are supported to choose their own GP or stay with their current GP. All individuals spoken with said “if I am ill staff make sure that I see the nurse or a doctor” and “staff are great they help me get to the dentist if I need. Records in general regarding healthcare were improved and now describe what actions the external professional had asked for. In all cases this had not been included in the care plan. An external professional spoken with had noted a significant improvement in staff actioning changes in medications and treatment and said “communication and team working had significantly improved”. This approach means that individuals health care needs are now addressed rapidly with appropriate advice and support put into place Staff were observed during the day, in many cases they maintained the dignity of the individuals they support. One person spoken with at the site visit stated that this had also improved saying, “staff are more aware of individual dignity needs” and had been observed, “taking their time to support people living in the home in a manner that maintained their dignity”. As part of the inspection a pharmacist inspector looked at the handling of medicines because previous site visits had identified weaknesses that were putting the people who live in the home at risk. We looked at the recording of medicines and we found some major improvements in the records of receipt, administration and disposal. Handwritten records were much clearer and more DS0000059308.V363556.R01.S.doc Version 5.2 Page 13 information about how medicines were to be given was available. Records of external medicines and nutritional supplements were more detailed and showed that they were being given to individuals correctly. All medicines could now be fully accounted for and detailed checks showed that medicines were usually being given to individuals correctly. However, we found some errors with some inhalers that showed that they had been occasionally missed. We looked at the times medicines were given and found all medicines were now given at the correct and best time for individuals. Giving medicines at the right time helps ensure they work correctly. We looked at the arrangements for medicines storage and found these clean, tidy and secure. However, on arrival at the home we found the medicines trolley unattended and unlocked, this meant that the medicines were not securely kept which could lead to them being mishandled or misused. We looked at how controlled drugs (medicines that can be misused) were handled. Suitable storage and recording arrangements were in place that help make sure controlled drugs are not mishandled or misused. In the previous month a strong pain relief patch had been replaced two days late but the homes’ own checks had highlighted this and suitable actions had been taken to help prevent this happening again. We looked at how medicines were checked and audited. Although suitable paperwork and procedures were in place we found that they had not been carried out as planned. The managers said that action had been taken to make sure audits would be carried out regularly in the future. Having good audits helps ensure medicines are administered and recorded correctly and helps ensure staff are and remain competent. DS0000059308.V363556.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): Standards 12, 13, 14 and 15 were reviewed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been an improvement in the variety of activities available to individuals. The committee started and run by the people who live in the home help make sure that in the future individuals will have their personal preferences and choices used to influence their daily routines. EVIDENCE: Of the five care records viewed three had a social assessment in place and two had a menu questionnaire, which asked what kinds of food they liked to eat. There is an inconsistency in the information available about individual personal preferences that will not influence the meals available or activities. Neither of these records have been passed to staff responsible for forming activities programmes or menus and as such personal preferences have not yet been used to influence these areas. The acting manager stated that menus have been altered as people living in the home requested that they were changed. As yet menus do not detail any DS0000059308.V363556.R01.S.doc Version 5.2 Page 15 special diets such as diabetes, vegetarian, low salt as examples. The management team described how they intend to make sure in the future that all people living in the home will be aware of any special diets. Individuals spoken with did say that, “the food is lovely”, “There’s plenty to eat and always a choice” and “I like most of the food”. Observations over the lunchtime showed that all the individuals were offered a choice. Information to individuals about their options of meal that day was available on a notice board, on a menu on the table and several individuals were asked what they wanted during the day. Individuals less able to express a choice were having a choice made for them based on what staff’s knowledge is. This is not always the best way forward as it relies on staff’s ability to remember all individual choices and communicate that to each other. We looked at the range of activities available for people living in the home and noted that there has been a significant improvement in the amount of activities available. There is now a full time co-ordinator who spent a lot of time during the site visit outlining some very good plans for the future. A committee has been set up that is run by the people who live in the home. Although minutes are taken these are not yet widely circulated and plans include developing the minutes and a monthly newsletter. The activities co-ordinator also intends to write a profile of everyone who lives in the home that looks at their personal preferences, choices and routines and use this to help develop the activities available. All the people who live in the home spoken with had noticed a significant improvement in activities several said, “so much more to do now” and “its much better”. DS0000059308.V363556.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): Standards 16 and 18 were reviewed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live in the home feel that their concerns will be dealt with. The service is aware that staff still do not have a full understanding of how serious concerns are dealt with and that complaints are not clearly investigated. The lack of staff knowledge and good records runs the risk of complaints and concerns not being dealt with properly. EVIDENCE: Records were reviewed regarding complaints. There have been two complaints and one major concern since the last site visit. All complaints had records detailing what the concerns were. Both the smaller complaints did not have any records that detailed what investigations had taken place or how the concerns were resolved. We spoke to both individuals who had raised the concerns and they stated that these had now been resolved. A recent committee meeting run by the people who live in the home raised concerns regarding the changes in management. There was no records or evidence that this had been discussed with the committee or how the service was to reassure individuals. Some of the individuals spoken with were prepared to “see how the new manager gets on”, others were “still concerned as to all the change. Further discussions with the people who live in the home showed that they had a good understanding of how to raise concerns. One DS0000059308.V363556.R01.S.doc Version 5.2 Page 17 individual described an incident with a senior member of staff no longer in the home. At the time they did not feel that they could raise their concerns. Since then they have been told what they can do if they are ever uncomfortable or unhappy. The individual said, “I know what I can do now and know that someone will do something”. There has been one concern that was sent by the home to social services, as it was serious in nature. We were also informed and the service took appropriate action to make sure that this issue could not happen again. Staff have received training in recognising potential abuse, however in discussion they were not aware of the responsibility of social services or of the social services policy. Their lack of knowledge ran the risk of preventing a proper investigation into serious concerns. The homes policy and procedures in these areas also did not detail how complaints of this nature should be dealt with, the policy in the home did not support the manager to deal with complaints of this nature in the same manner as detailed in social services policy. Discussions with the manager and staff detailed that they had no training in investigating complaints and there was no procedure in place to guide them. The management team said that they were aware of these issues and A training programme that includes making staff aware of how concerns are to be dealt with is to commence in the near future. DS0000059308.V363556.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): Standards 19, 20, 221, 22, 23, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The main corridors of the home have been redecorated and these make the home appear much cleaner and brighter. There remain several areas in need of redecoration and refurbishment. Not all the equipment in the home such as fire doors meets the people living in the homes needs or properly maintains their safety. EVIDENCE: A review of the environment showed a number of areas have been redecorated this has included all main corridors, the bedrooms on the top floor and new furniture in the dining room. There are still a number of areas in need of repair and redecoration. These included bedrooms currently occupied, bathrooms with cracked and damaged tiling and ripped and damaged furniture as examples. There is no plan in place that informs the individuals about any DS0000059308.V363556.R01.S.doc Version 5.2 Page 19 redecoration or consults them about their views. The organisation is slow to arrange changes. As an example all corridors were completely redecorated but there are no pictures on the main corridors. It is the policy of the organisation that owns the home that three quotes be obtained before purchases can be made. This has meant a delay in replacing the decorations and prevents the people who live in the home from using the redecoration of the home as a part of their social activities. Such as a shopping trip to buy the pictures for the corridors and other areas themselves. The home does not have policies available that details the prevention of infection, it was noted that some areas in the home were in need of cleaning including the dining room floor. There are no records available that staff have received training in the prevention of infection. Staff spoken with said that they did not recall this training. Disposable protective clothing such as gloves and plastic aprons were noted as available during the site visit, staff were seen to use these as appropriate. A review of the laundry did not show any arrangements for dealing with soiled items such as special laundry bags. Additional there were boxes of stockings, net pants (used with continence aids), socks and flannels none of these were named or a system in place that meant individuals were not wearing intimate items or using face clothes that belonged to another. This practice does not prevent infection from spreading from one person to another. We looked at individual’s bedrooms, in most cases these were personalised and included items from individual own homes. Individuals spoken with said that they “liked their bedrooms”. Several people said that they would really like their bedrooms redecorated. Some of the bedrooms had furniture that was worn and damaged and in two cases flooring that was not in keeping with the kind of flooring that a person would have in their own home. We noticed that some of the bedroom doors did not close properly and as these are fire doors that must close without gaps this presents a risk to individuals should a fire occur. During the day we noticed that several of the more independently mobile people living in the home struggled to open the doors into the dining room, lounge and on the main corridors. These are fire doors and as such need special attention to maintain safety. We also noted that the fire door to the laundry room did not close properly. Fire doors need to be suitable to the needs of the people who live in the home and maintain their safety at all times. DS0000059308.V363556.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): Standards 27, 28, 29 and 30 were reviewed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The monitoring and development of staff training is not always sufficient to make sure that staff have the skills they need to support the people living in the home. All staff are recruited properly and checked that they are suitable before they start work. EVIDENCE: We looked at four staffing files. A recently recruited staff member’s file was viewed. This was better organised than those seen in previous site visits. All relevant checks were in place but there was little evidence that the member of staff had received a full induction. There was no evidence that they had been informed of the people who lived in the services needs and how to meet them. All of the other files viewed were well organised and contained evidence that all members of staff had been properly checked before they were employed. Staff spoken with listed training that they have received and the majority have completed or are attending a training course in care (known as an NVQ), others have undertaken diabetes, others have done training in Alzheimer’s. However the home has individuals with a variety of needs including DS0000059308.V363556.R01.S.doc Version 5.2 Page 21 Parkinson’s, epilepsy, dementia and behavioural needs. There was no training plan in place that identified what training staff needed and when they would receive the training. Additionally there was no evidence of training being monitored to make sure that health and safety training such as infection control, first aid, fire, moving and handling and food hygiene were all in place. Several staff spoken with said that they would like training in a number of areas such as those detailed above. Since the last site visit all of the staff responsible for medications have had training this includes night staff were at previous site visit there was no staff overnight trained in giving out medications. The service also has plans for all staff to have training in medication awareness in order for them to be able to recognise and deal with any issues from medications such as side effects. As yet the service has not been able make sure that staff have competency (that staff are skilled) in the areas of care that they provide and there is evidence within this report that competency for some staff is still not fully developed. Although most staff has completed or, in the process of completing NVQ training and other training has taken place, staff training continues to be an area of development. There should also be a system in place to check staff’s understanding and ongoing competency through formal supervision and appraisal. People who live in the home said that they were “very happy”, “staff are very nice, some obviously better than others” and that they had noticed that staff seemed “a little more confident and relaxed lately”. Staff spoken with said that morale had been very low for a time as there were so many changes in manager and in some instances they had found the managers “unresponsive” and “difficult to work with”. All said they were looking forward to a future with the new acting manager and hoped to see more things get better. Staff were observed during the day to be unhurried and relaxed in their approach. DS0000059308.V363556.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): Standards 31, 32, 33, 35, 36, 37 and 38 were reviewed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An a increase in quality has been slow, however progress has been made and individuals living in the home have had the risk of receiving poor quality service that placed them at risk reduced. There remains significant areas of weak practice that need to be developed in order that the people who live in the home get support that fully meets their needs. EVIDENCE: There have been four different acting managers in post in the last 12 months. The organisation recognised the lack of development in quality from some of the managers and have made arrangements for them not to manager DS0000059308.V363556.R01.S.doc Version 5.2 Page 23 Simonsfield anymore. People who live in the home found this very unsettling, as they need to see a consistent service. The organisation has recently put a fourth manager into post and expressed to us confidence in their ability to increase the quality. The acting manager had been in post for a week at the time of this site visit. In this time she was able to recognise the areas that need to have quality increased in and had reviewed staff recruitment organising each file to make sure that staff had been fully recruited. Given the acting managers awareness of the areas that need to increase in quality it is anticipated that further good practice will be noticed in the future by the people who live in the home. Senior management anticipate that a full application for a registered manager will be submitted to us and the advent of a stable management team will help increase the quality of the service. There are a number of tools available in the home that look at the quality of the service. These include questionnaires to people whom in the home and their families, auditing on key areas such as medications, staff training, care planning and safety. None of these had been used for some time, the acting manager intends to put these back in place within the next few weeks and write an action plan of the things that need doing to improve the service. Since the last site visit the organisation has had several meetings with us and have presented us with an up to date plan of how they will manage individual funds. This has not been fully activated as yet and there are still areas of confusion for all involved included people living in the home staff, managers and social services. We looked at the arrangements for health and safety in the home including risk assessments. The management could not locate environmental risk assessments such as a fire risk assessment, they suggested that due to the changes in management this had been misplaced. They intend to consult with the fire authority in order to update the fire risk assessment and make sure that all staff and people in the home are familiar with it. Individual risk assessments for activities undertaken by the people who live in the home have been developed. The activities co-ordinator makes sure that all activities particularly those outside the home are fully planned. Individuals who leave the home independently have had this assessed and as a result mobile phones have been purchased that can be taken with them to maintain their safety. Two of these assessments were viewed and noticed to be identical and as such not specific to individual needs. Further risk assessments needed are for people who smoking as it was noted that both had scorch marks in their clothing and therefore needed extra support. The acting manager also discussed with us the lack of information in some of the risk assessments in place such as moving and handling which made no mention of accessing bathing or toileting facilities or transferring from bed to chair and therefore gave staff and the individual little information that maintained safety. DS0000059308.V363556.R01.S.doc Version 5.2 Page 24 Although there have been some improvement in relation to risk assessment, this continues to be an area development and continued improvement specifically around ensuring a fire risk assessment is in place and risk assessments around the environment if these have not been completed. DS0000059308.V363556.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 2 2 3 3 2 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 2 2 2 2 DS0000059308.V363556.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP31 Regulation Requirement Timescale for action 30/09/08 2. OP38 8 (1) (a) An application for a registered (2) (a) (b) manager needs to be made and notification that the previous manager is no longer to be registered for Simonsfield sent to us. 23 (4) (a) The fire safety arrangements in 09/08/08 (b) (c) (i) the home need to be reviewed. (ii) (iii) This includes fire doors not (iv) (v) closing properly and a fire risk (d) (e) assessment. Arrangements need to be in place to support individuals to remain independent this is in relation to fire doors on the main corridors and dining room. Advice needs to be sought from the relevant expertise such as the local fire authority. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000059308.V363556.R01.S.doc Version 5.2 Page 27 1. Standard OP3 2. OP7 3. OP12 The arrangements for individuals being admitted to the home need to be reviewed. This includes information to individuals, the assessment process used and the training of staff undertaking assessments. Where individuals develop medical needs such as pressure ulcers that are checked and monitored by district nurses. The home still needs a care plan as to how it is making sure that the actioned advice from expertise and promotes an improvement in the person’s health. The assessments and social care plans available in the home need to be completed, kept up to date and used to influence the individuals lifestyle choices. This includes daily routine, menus available and activities programme. Complaints and whistle blowing policy and procedure need to be reviewed, made readily available and reflect the practice that the manager needs to take in order to address any complaints. Staff need to be supported to understand the roles and responsibilities of all the services that would be involved in any potential protection of vulnerable adults investigation. Staff training needs to be monitored and all gaps in training recognised and actions put into place to receive training appropriate to the needs of individuals living in the home and staff’s job role. The management should to continue to improve people’s assessment documentation to ensure these are fully completed and updated in order people’s needs can be fully recognised and thus met. The management should continue to develop effective systems to ensure people’s care needs are set out in an effective plan of care. Although most staff has completed or, in the process of completing NVQ training and other training has taken place, staff training continues to be an area of development. There should also be a system in place to check staff’s understanding and ongoing competency through formal supervision and appraisal. Although there have been some improvement in relation to risk assessment, this continues to be an area development and continued improvement specifically around ensuring a fire risk assessment is in place and risk assessments around the environment if these have not been completed. Arrangements for audits and quality assurance need to be DS0000059308.V363556.R01.S.doc Version 5.2 Page 28 4. OP16 5. OP18 6. OP27 7. OP3 8. 9. OP7 OP30 10. OP38 11. OP33 actioned. Regular audits that identify quality needs and actions to be taken need to be in place and monitored. DS0000059308.V363556.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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 DS0000059308.V363556.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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