Inspection on 26/01/08 for Sotwell Hill House

This inspection was carried out on 26th January 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

Sotwell Hill House 16/01/09

Sotwell Hill House 15/01/07

Sotwell Hill House 02/03/06

Sotwell Hill House 30/09/05

Sotwell Hill House 25/01/05

Sotwell Hill House 21/07/04

Sotwell Hill House 20/01/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Sotwell Hill House Brightwell Cum Sotwell Wallingford Oxfordshire OX10 0PS Lead Inspector Delia Styles Unannounced Inspection 26th January 2008 10:45 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 Sotwell Hill House DS0000013135.V348395.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. Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sotwell Hill House Address Brightwell Cum Sotwell Wallingford Oxfordshire OX10 0PS 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) 01491 836685 Mrs Joy Patricia Butterfield Mrs Joy Patricia Butterfield Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th January 2007 Brief Description of the Service: Sotwell Hill House is a late Victorian converted country house set in attractive and extensive grounds and provides accommodation for those older people who require day-to-day supervision and care. The home does not provide nursing care. Independence is encouraged and the layout of the grounds enables service users to take exercise in safety. Service users are able to visit the nearby town of Wallingford and other outings are arranged on an occasional basis. Cost of the service provided by Sotwell Hill House is between £570 and £750 each week. Sotwell Hill House DS0000013135.V348395.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 inspection of the service was an unannounced ‘Key Inspection’ during which the inspector assessed a number of the standards considered most important (‘key’) by the Commission out of the 38 standards set by the government for care homes for older people. The overall quality (‘star’) rating is arrived at through a ‘rules based’ approach, with the emphasis on three sections of the report that look at the safety and management of the home: Health and Personal Care, Complaints and Protection, and Management and administration. The inspector arrived at the service at 10:45 am and was in the service for 6½ hours and returned on the following day to complete the assessement of two key standards at a time when the person who has a specific responsibility for training was available. This inspection was a thorough look at how well the service is doing. It took into account information provided by the service’s managers in the form of their Annual Quality Assurance Assessment (AQAA) and any information that we have received about Sotwell Hill House since the last inspection. The AQAA includes a self-assessment of how well the home feels they are meeting the standards of care for people living at the home. Prior to the visit the commission sent out questionnaires (surveys) for a number of residents and relatives/friends/advocates to complete to give us their views about the home and the service they receive. Surveys were received from 8 residents and 3 relatives/friends of residents. The inspector saw all areas of the home and looked at a sample of records and documents relating to the care of the people living here. The inspector spoke to a number of residents, the proprietor/registered manager, Mrs Butterfield, and other members of the management team during the visit. The inspector gave feedback about her findings to the home’s proprietor and members of the management team at the end of inspection. We would like to thank the residents, managers and staff for their welcome and assistance during the inspection process. Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Though there is evidence that the home has worked to improve the written plans and records of residents’ care, these must be further developed to make sure that people’s changing care needs are reflected in their care records. There must be accurate, up to date information, written in enough detail for Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 7 care staff to follow, so that they provide the right level of support and assistance needed to meet each resident’s care needs. There should be written evaluation of people’s care to show to what extent the care given has matched the resident’s expectations, and if not, what agreed changes have been made to the planned care. The homes system for administration of residents’ medicines is basically sound but we have made recommendations about improving the security of access to the medicines, staff training, and monitoring of standards of administration to further safeguard residents. We recommend that the range of activities provided in the home is reviewed and extended to ensure that those residents with visual or hearing impairment, and/or memory problems have more opportunities to be involved in varied, stimulating and meaningful activities. Most residents and their relatives said they were confident that managers would deal with any complaints promptly and satisfactorily. However, the formal policies and procedures of the home need to be improved so that all staff are aware of and can put into practice, the safeguarding procedures that are agreed locally for the protection of the people who live here. The hot water temperature in some communal bathrooms is excessive and poses a potential risk of scalds to residents. The water temperatures should be routinely monitored and regulated at all hot water outlets accessible to residents unless the home can demonstrate through individual risk assessment, that uncontrolled water temperature does not endanger people. Risk assessments should be reviewed and updated regularly – for example there was no risk assessment in place for use of oxygen in a resident’s room, and no individual risk assessments for people who wish to, and are able, continue to manage their own medication. Doors in the kitchen area and laundry drying room were wedged open. Doors should not be held open because in the event of a fire they would not act as a barrier to the spread of smoke and flames. The fire officer must be consulted about fire protection measures in the home and fire safety guidance must be followed to minimise the risks to residents, staff and visitors. There are no mobile hoists in the home so that, should a resident have a fall to the ground for example, staff would have to manually lift the person. This may put the resident and staff at additional risk of injury. It is strongly recommended that the home has at least one mobile hoist, and regular practice based training in safe moving and handling. Managers and staff do not have broadband computer access in the home. This means that they are disadvantaged because they are not able to promptly access up to date information about changes in legislation and good practice Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 8 guidance available on the Internet on a range of issues relating to management and administration of the home, and health and well-being of residents. It is strongly recommended that managers have Internet access within the home to improve communication with other care providers, health and social care organisations and regulators. The AQAA was incomplete and did not provide sufficient information and evidence about what the service has done in the past year, areas that they still need to improve and how they plan to do this. In particular the questions relating to residents and equality and diversity are poorly completed and parts of the data section are left blank, so that the AQAA does not provide a reliable picture of the service. The AQAA is the provider’s opportunity to inform us about their service and how well they think they are performing and should give a regular, measurable update that will show how improvements are being made. 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. Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3. Standard 6 does not apply, as the home does not provide intermediate care. Quality in this outcome area is good. Peoples needs are fully assessed prior to admission so that the individual and the home can be confident that the staff skills and facilities will meet the needs of the prospective resident This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents’ written survey comments and responses during the visit confirmed that they had received enough information about the home before deciding to live here. One person wrote that they had had a two-week stay and then went home before making the decision to become a permanent resident. Others had been told about the home and its good reputation by friends and this had influenced their decision to consider coming here. People appreciated the written information about the home: ‘the contract [terms and conditions of residence] are written in layman’s terms and easy to understand’; ‘I appreciated the brochure I received’ Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 11 By looking at the pre-admission information for 3 recently admitted residents it was seen that the necessary information about peoples’ care and support needs had been gathered before they came to live here. Where necessary information is also included from the prospective resident’s family and health and social care professionals. Prospective residents are invited for an initial visit and there is a trial period of at least a month during which the individual and the management can decide whether the home is likely to meet the person’s assessed care needs and preferences. Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. Residents’ health and personal care needs are generally satisfactorily met and the home respects and promotes the rights, dignity and independence of residents in the area of their health and personal care. Though improved since the last inspection, the systems for planning, recording and reviewing of care are not sufficiently robust. This means that care staff do not always have sufficient information about residents’ care needs and not all residents can be sure that their health and personal care needs will be fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care records of three residents were examined. The managers said that they have undertaken considerable work to improve the care plans since the last inspection, in particular ensuring that they are regularly reviewed and that risk assessments for example, in relation to falls and bathing are completed. Personal care sheets list the physical care needs of people and are displayed in the bathrooms of individual residents. Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 13 However, from the sample looked at, the care plans and daily accounts of care lack detail about the resident’s individual care needs and the actions that care staff need to take to support and assist them effectively. Some key information was missing from care records, for example, for a person at risk of developing pressure-related skin damage (‘pressure sores/ulcers’) there were no specific instructions for staff about how to assist the person to change their position in bed or into a chair. A pressure-relieving mattress had been provided by the community nursing service for this resident but there was no pressure relieving equipment for use in the person’s armchair. The home does not have a mobile hoist to assist residents who may need additional help in the event of a fall or if they become acutely unwell. It is recommended that the home should have this equipment, to reduce the risk of injury to the resident or staff. There was no care plan reflecting the last care wishes for a resident receiving palliative care with the support of a visiting district nurse. Though there was evidence from discussion with managers that they had discussed the individual needs of residents with them and had a good and detailed knowledge of these, this was not set out in the care plans. There is a risk that care staff rely largely on verbal exchanges of information at handover reports and that important changes in residents condition and care needs may be missed if they are not documented. Though there was some evidence of reviews of care records having been undertaken, this was in the form of brief and non-specific statements. Some entries in the care records had not been signed by the staff members who had written them. It is important that records of care are signed and dated so that there is an ‘audit trail’ showing that residents have received consistent and appropriate care. The care records do not accurately reflect whether the care provided has met the person’s assessed care needs. There is no evidence to show that there has been any involvement by residents (or their representatives, if they are unable) in contributing to their care plans or in discussion when changes need to be made to their plan. There was no indication from the homes AQAA document or from discussion with members of the management team that they know about and are following the code of practice set out under the Mental Capacity Act (MCA) that came into force in October 2007. The MCA protects the rights of people whose ability to take some or all decisions for themselves is limited and all staff should have training in it and how it affects their work. The MCA means that Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 14 people who use care services (and their families and representatives) can be confident that they will continue to take decisions over their own lives whenever possible and will be included in such decisions at all times. Comments in the sample of surveys received and from observation and discussion with residents during the inspection, showed that people were very satisfied with the practical support and assistance from staff and the local medical centre (when people were unwell). All eight of the residents who completed surveys felt that they received the care and support they needed, and seven out of eight said that they ‘always’ received the medical support they needed (one person felt this was ‘usually’ the case). Some of the comments made included: ‘All my care needs are met by kind polite staff …when I was ill the GP was called and I was given extra TLC until I recovered’ ‘They [staff] appear to be meticulous about medication and day to day comfort’. One out of the three relatives’ comment card responses received indicated that the individual was not wholly satisfied with staff members’ skills and experience to meet their loved ones needs (this was ‘usually’ the case); or the homes ability to meet the different needs of people (‘usually’); and the way in which the care service supports the person to live the life they choose – ‘sometimes’. Two out of the three were ‘always’ satisfied with these aspects of care and support provided in the home. Residents are able to visit the GPs at the local health centre – three of the 5 homes’ managers are available to escort people to and from the surgery in Wallingford if requested, or people can use the local taxi or public transport. General practitioners and community nurses will also visit the home and to provide medical and nursing care and advice when residents are unwell. The AQAA states that the home has ‘an excellent rapport with [our] medical practice’. The system for administration of medicines is well established and was reviewed as satisfactory by a CSCI pharmacy inspector in 2005. During this current inspection, the medicines storage room and a sample of residents’ medication administration record (MAR) charts were looked at. A senior member of staff explained the system: two staff check each resident’s prescribed medication from the boxes/containers in their individual compartment of a shelving unit in the medicine storage room. The prescribed tablets for each person are checked by two care staff and are put it into an individual pot labelled with the resident’s name and then taken to the individual. The MAR pages are printed by the home. They do not have code letters for staff to use to denote the reason for not giving a prescribed medication – for Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 15 example, ‘H’ – the resident is currently in hospital. We recommend that an agreed system of code letters are added to the MAR pages so that staff can accurately account for non-administered doses. The MAR pages did not contain information about the circumstances when prescribed ‘as required’ medicines may be safely given, for example, the maximum dose of Paracetamol that may be taken in a 24 hour period. This should be discussed with the dispenser to request that this supplementary information is added to the MAR pages. The home should keep an up to date record of the usual signatures and initials of all staff authorised to administer medicines in the home: this is a good practice recommendation to enable accurate audits and checks of the MAR records to verify that residents have received their prescribed medication correctly. Medicines are dispensed from the local Medical Centre in Wallingford. Any unwanted medicines are listed in a returns book and taken to the dispensary by staff for safe disposal; the dispenser signs the returns book on receipt. It is recommended that the staff who check and list the names and quantity of returned tablets should both sign the book to provide an accurate audit trail of any unwanted/unused tablets as an additional safeguard that tablets are not mislaid or misappropriated. It was not clear whether all staff who administer medicines in the home have successfully completed an accredited training course for the safe management and administration of medicines. The training certificate for one care assistant showed that this individual had completed a training course that meets the required standard. One manager and the administrator/supervisor said they had also completed this course although the administrator does not administer medicines in the home. The home practice is that new care staff receive training only after they have been employed in the home for at least 6 weeks and are not allowed to administer medications for 6 to 8 weeks after their induction in the home. Senior staff said that they regularly check that care staff are administering medicines in accordance with the homes internal policies and procedures. The national minimum standards for care homes have a standard that covers staff training for medicine administration that points out that: The training for care staff must be accredited and must include: • basic knowledge of how medicines are used and how to recognise and deal with problems in use; • the principles behind all aspects of the homes policy on medicines handling and records. Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 16 It is essential that all care workers have had the appropriate level of training before being allowed to administer medicines. The home must ensure that the arrangements for the training, and on going monitoring of staff practice are in place to safeguard residents and that there are written records to support the training and audit systems. Two residents manage their own medicines. However, there appears to be no individual assessment of risk or review in place, to make sure that people who wish to and are able, can continue to self-medicate. Care providers should assess any risk to the person who looks after his/her own medicines and the potential risk to other people in the care home. This assessment must be reviewed regularly. During the inspection it was noted that the keys for the medicine storage room are kept in an unlocked drawer in an open office. Key security is an important part of medicines security and only people authorised to handle medicines should have access to the keys and preferably the person on duty who is responsible for medications should carry the keys on their person. The home should review and improve the key security and access to medicines. Managers were advised about how to access the information about medication and staff training on the CSCI Professional Internet website. Observation of care practice showed that residents are encouraged to remain as independent as possible by providing appropriate levels of support to maintain peoples’ privacy, dignity and independence. Staff were seen to provide personal care in a discreet and sensitive manner and polite and courteous to users at all times. Staff routinely knock and wait until they are invited in, before entering residents’ bedrooms. Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 17 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 adequate. The activities planned within the home and community do not provide all residents with a sufficient range of opportunities to participate in stimulating and motivating activities (in particular those residents who are more dependent on staff). Meals and mealtimes are an enjoyable social occasion for residents and the menus reflect residents’ preferences, offering varied and nutritious food choices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes AQAA states that they have responded to residents’ suggestions about the types of outings and activities that they would like provided in the home. They acknowledge that they could improve by having a more structured activities programme and plan to employ an Activities Co-ordinator. . Of the eight residents’ who completed the survey/questionnaires sent out by the Commission, 3 felt that there are ‘always’ activities arranged by the home that they can take part in; 4 stated that this was ‘usually’ the case and one person felt this was only ‘sometimes’ so. Several of the residents spoken to on the day of the inspection were satisfied with the activities and said that they felt that there was enough to do; most Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 18 people spend time in their rooms listening to music, reading their newspapers or watching television during the morning. After lunch a small group of residents enjoy getting together to complete crosswords. Residents were very appreciative of the lovely grounds and the duck pond and enjoyed looking out or walking in the grounds if they were able. Residents said there are occasional musical entertainments and weekly film shows. People are kept informed of forthcoming entertainments through the residents meetings and the newsletter. Larger social events involving families and friends, such as the summer Strawberry Teas, were much appreciated. There are opportunities for residents to attend a weekly coffee morning at the local village church hall and to be taken into Wallingford. Activities and social events are advertised on a notice board near the kitchen. The next planned activity was a music and movement exercise class run by the Falls service. (The Falls service is a countywide initiative aimed at reducing the risk of falls and injuries for older people. It includes assessment of those people particularly at risk of falls – looking at trip hazards in their environment, poorly fitting foot wear, or medication that may affect peoples balance, for example – and suggesting measures that will help reduce these risks. Regular gentle exercise programmes can help improve peoples’ balance and muscular strength). Outings to local places of interest are organised, though the home managers said that it is often difficult to plan outings and trips away from the home as often people change their minds about participating at the last minute. The home is run flexibly around the needs of its users, within a semistructured framework. Meals tend to be at set times but can be adjusted to meet the needs of individuals. One resident said ‘It’s very good here – no ‘rules’ really. We do what we like. Except lunch times – we are expected to be here for lunch’. A relative’s comment card indicated that there is flexibility – ‘all the staff are very welcoming when I take [my relative] back after visits out and very attentive in matters of ensuring that e.g. lunch is available if [s/he] has missed it’. Relatives confirmed that they are kept well informed about the health and welfare of their loved ones. They are made welcome when they visit: ‘Visitors are made welcome in a casual non-obstructive way and my family and I feel able just to drop in, as we would were my [relative] in [their] own home.’ There appeared to be less attention to making sure that staff encouraged and provided ‘ad hoc’ activities, company and conversation with those residents whose mental frailty or sight and hearing loss limit their abilities to join in with group activities. Managers said that they do use ‘reminiscence cards’ to stimulate conversation and engagement with residents with dementia and that Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 19 staff are supposed to spend individual time with residents who might otherwise feel isolated or excluded. However, residents’ individual care records do not include information about how staff plan to meet peoples’ social and recreational care needs or sufficient detail about their usual social networks – for example, whether they have family and friends to visit and if not, whether they would like, and have been offered access to advocacy and/or a ‘befriending’ service. Residents say that the food is good and they are able to make suggestions and have individual choices for their meals. One person wrote ‘I am fed so well I have gained much needed weight in [the time] I have lived here’. Five out of 8 residents’ surveys showed that they ‘always’ liked the meals; 2 ‘usually’ and 1 ‘sometimes’. There are alternatives to the main course at each mealtime and special diets can be catered for including diabetic, gluten-free or vegetarian meals. A choice of homemade soups is available at lunch and supper times. The chef confirmed that he adapts meal choices to individual resident’s preferences and that residents can and do influence the menu choices – for example, people do not like spicy foods such as ‘faggots’ or ‘haggis’ (it was Burn’s Night on the day of the inspection) and generally like plain traditional British dishes. Breakfast is served at about 0800, lunch at 12:30 and supper at 17:30. Hot drinks and biscuits are served at 19:00 and 21:00. The national minimum standards for care homes for older people covering meals and mealtimes state that ‘a snack meal should be offered in the evening and the interval between this and breakfast the following morning should be no more than 12 hours’. The proprietor has pointed out since the inspection that ‘all residents are offered a choice of sandwiches during the late evening if requested’. Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 20 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 adequate. The home has a satisfactory complaints system. Residents feel their views are listened to and acted upon. However formal processes in relation to adult safeguarding need to be further developed so that the home’s procedures are available to all staff, are understood and consistently applied. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes complaints procedure is available to all residents and is included in the folder of information about the home and the Service Users Guide. From the residents’ and relatives’ comments it was clear that people living here have every confidence in the management to respond promptly and effectively if they are not happy about anything to do with their care. The Commission is aware of one formal complaint made against the home in March 2007. The homes’ AQAA states that the home has only received one complaint since the last inspection and this was ‘not upheld’. The complainant wishes to be assured that the issues raised through their complaint have been addressed by the home and will not recur. The manager confirmed that they had ‘learned a lot’ through investigating this matter. Discussion with the member of the management team who coordinates staff training, and with the registered manager showed that the management team were not conversant with the local Oxfordshire Adult Protection/safeguarding Procedures and did not have copies of this guidance. This means that if managers are not aware of the advice about responding to and reporting abuse Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 21 then it is unlikely that care staff would know how to report any concerns that a vulnerable adult has suffered or been placed at risk of harm as a result of abuse or neglect. Managers were informed about the local Safeguarding Adults Board and how they could obtain copies of the Adult Protection/Safeguarding Adults procedures for staff to refer to in the home. It is strongly recommended that the management team should attend a more intensive training about safeguarding in order to ensure that all the homes staff are aware of and follow the agreed procedures. However, there is evidence that care staff have received training in adult safeguarding matters – the most recent ‘Alert to Abuse’ training session was held in November 2007. Managers confirmed that new care staff have an induction programme that includes information about safeguarding, in line with the national training body – Skills for Care’ – induction training standards. Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 22 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 excellent. The home provides a very attractive, clean and well-maintained environment so that residents live in comfortable, homely and hygienic surroundings. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of residents’ survey responses were very positive about the standards of cleanliness maintained in the home with 6 out of 8 people stating that is always ‘fresh and clean’; two people answered that this was ‘usually’ so, with one person adding that their mattress should be turned more regularly and the skirting boards in their room were sometimes dusty. Residents’ rooms are spacious, light and airy, and have en-suite facilities. Some vacant rooms looked sparsely furnished, but this is because residents are encouraged to bring in their own small pieces of furniture and pictures and ornaments to personalise their rooms. Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 23 The home was very clean, tidy and smelled fresh throughout. Communal areas are spacious and attractive with large windows overlooking the grounds. From a tour of the building and overview of the gardens it was evident that the proprietors take great pride in the home. Residents particularly enjoy the views over the gardens, grounds and the lake. There are extensive gardens and the 20 acres of grounds look out over surrounding countryside. At the time of the inspection further work was going on to improve the pathways around the grounds. Access to the grounds has been improved by the addition of a large paved patio area: residents using walking frames or wheelchairs can now go out via the large conservatory room. The laundry area is clean, tidy and well managed. A separate drying room provides additional indoor drying space. Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 24 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 and 30 Quality in this outcome area is adequate. There are enough experienced staff to meet the needs of residents. The service has a recruitment procedure that protects residents by ensuring that people employed are suitable to work at the home. The induction and training of staff should be improved to ensure that all staff are supported through a comprehensive training and development plan. The management team has plans to improve training. This capacity to improve should result in better outcomes for people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are three shifts of care assistants covering 08:00 – 14:00; 14:00 to 20:00 and night duty from 20:00 to 08:00. There are 4 care staff on duty throughout the daytime and 2 care staff overnight. In addition, Mrs Butterfield and/or other managers are available and on call 24 hours a day. The home employs a full time supervisor/administrator and a part-time administrator. Domestic staff and a cook/catering manager complete the staff team. These staffing levels appear to meet the needs of the residents and the service. Residents’ survey responses and comments during the inspection visit were very complimentary about the staff and the support and care they provide. Some of the comments were: ‘I am happy to be here, I would like to thank the staff for their help’ ‘I think the service received is performed cheerfully and is good’. ‘We want to say – the staff are very good here, they really are. Couldn’t be better’. Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 25 Five out of the 8 residents who completed surveys stated that there are ‘always’ staff available to assist them when needed; the remaining 3 said that this is ‘usually’ the case. Many of the care staff have worked here for many years and managers feel that this is one of the strengths of the home – a consistent and loyal staff team and the availability of the registered manager and other members of the management team on a daily basis. The home does not use agency staff, which is another factor that improves continuity of care and support for residents. Examination of a sample of 3 staff files evidenced that the selection and recruitment procedures at this home are robust and protect residents from workers who are unsuitable from working with vulnerable adults. A written staff induction information document outlines the expectations of new staff and describes briefly the emergency procedures, work routines and rotas etc. New care staff members ‘shadow’ an experienced care assistant for a number of shifts. One of the managers decide which member of staff is likely to be most suitable to mentor the new worker, though this may be a different person for different shifts. The manager will get informal feed back about the new staff member’s abilities. There appeared to be no written record of competencies for the new care worker and the manager/mentor to work through to evidence that the new staff member is safe and competent to work without supervision. The training manager said that new workers have feedback about their work, progress and development needs during regular supervision meetings. Staff whose first language is not English are offered language classes to improve their communication skills. The records of training and induction for staff were not well organised, so that there was no written evidence of a structured induction training plan for new staff that covers all the topics required under the national training body standards. One member of the management team who works part-time oversees the induction and training of care staff. She explained that the home is in the process of having an analysis of skills and training needs for staff undertaken. This will assist the home to identify the kind of training and development needed for each employee and sources of training for a range of topics. The records of staff training in core health and safety topics such as fire safety, first aid and moving and handling, were in different files in the office and it was not possible to identify whether all staff have regular updates/refresher sessions to keep up to date. As pointed out at the last inspection, it is important for staff to have training and that managers have systems in place to monitor staff practices to make sure they are adhering to safe work practices for their own and residents’ protection. Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 26 The registered manager said it was disheartening that so many carers do their National Vocational Qualification (NVQ) training in the home and then leave. Also, many of the long-standing care staff do not wish to embark on NVQ training. Plans for improvement in staff training outlined in the homes AQAA, are to continue to ‘encourage staff to attend in-house meetings and ensure all staff make a firmer commitment to obtain their NVQ Level 2 qualification’. However, according to the homes AQAA completed in July 2007, nine of the 19 permanent care staff have achieved NVQ level 2 and two more staff are working towards this, meaning that the home has almost achieved the required proportion (50 ) of care staff with NVQ Level 2 or above. Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 27 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, 37 and 38 Quality in this outcome area is adequate. Residents benefit from an established and family-run business: members of the management team are accessible to residents and the management style meets the needs of the service. However, more work is needed to make sure that all the staff team are aware of the plans, policies and procedures of the home and there are systems in place to make sure these are consistently applied. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mrs Butterfield, the proprietor and registered manager and all of the managers (family members) live on site in neighbouring houses and are on-call in an emergency. Mrs Butterfield has run the home for the last 25 years and is highly experienced but has not got any formal qualifications in care; a good practice recommendation was made at the last inspection that she should undertake the Registered Managers Award (RMA) and NVQ Level 4 in Care – Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 28 the formal qualifications that all registered managers are expected to have. Mrs Butterfield said that she does not intend to do these courses but one of the managers is intending to enrol so that she can augment Mrs Butterfield’s practical experience by keeping the management team informed about changes in legislation and regulation that affect the management and running of the business. Residents and their relatives are highly complimentary about the qualities of the staff and management. They confirm that the home operates an ‘open door’ policy and that there is always someone available to deal with their enquiries. They say that management are courteous and approachable. Residents confirm that they are regularly consulted on issues that affect them and feel that their views are always taken into account. From examination of the minutes of residents monthly meetings it is clear that when requests are made or concerns expressed in the meetings the issues raised are followed up promptly by management. One resident said that ‘They [the managers] are very good here – we [residents] tell them what is working or not’. The homes AQAA gives an example of the action taken in response to residents’ and relatives’ suggestions - improving the paved area and pathways to improve access to the grounds. Since the last inspection the home has followed up a good practice recommendation to set up a formal system of quality assurance, by sending out questionnaires to all residents and relatives annually and analysing the feedback. The next cycle of questionnaires is due to be sent out early in 2008. It was not clear how those residents with dementia and sensory losses are enabled to share their opinions and suggestions. The home should include the views of other professional and voluntary organisation staff in their quality monitoring reviews and should publish the results of surveys in an accessible form, to current and prospective residents and their representatives. The homes staff are not involved in the management of residents’ personal finances and allowances. If residents do not wish to, or are unable to manage their own financial affairs, a relative or an independently appointed representative acts on the resident’s behalf. The homes AQAA was not complete in all sections (for example, the data section showing when the last review of policies and procedures for the home were undertaken) and did not give sufficient information about the areas where they still need to improve or the plans for how they intend to achieve these improvements. The homes supervisor/administrator receives updates in policies and procedures affecting the management and organisation of the home and reviews and updates the homes policies and procedures accordingly. It was not clear how these updated policies are shared with, and put into practice by, Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 29 care staff. The manager needs to improve and develop systems for monitoring staff practice and compliance with the policies and procedures of the home. Lack of Internet access has resulted in the proprietor and managers not keeping up to date with changes in regulation and how we inspect care homes. During the inspection the inspector explained the new processes and gave Mrs Butterfield a copy of the ‘Key lines of regulatory assessment – KLORA’, that we use to make judgement statements, and arrive at the overall quality rating for care services. Also, the managers were not up to date with some of the legislation affecting how the home should be run, for example, in aspects of adult safeguarding and the Mental Capacity Act. The registered manager must ensure that she and all the staff keep up to date and ensure that theory is translated into practice. Information is readily available through the Commission Internet website The AQAA and spot check of some records showed that routine servicing and testing of equipment is undertaken at appropriate intervals to maintain equipment in a safe working condition. Examination of a sample of the accident records and fire safety logbook indicated that they were up to date. The homes recording of accidents should be improved by recording whether relatives had been informed about accidents affecting residents and any followup and resolution of injuries. Mrs Butterfield said that this ‘always’ happens, but was not evident from the written records seen. There were indications that staff use potentially unsafe moving and handling techniques; for example, by manually lifting someone off the floor following a fall. The home does not have a mobile hoist and in the event of a resident having fallen or being temporarily unwell and unable to weight bear, staff do not have appropriate equipment to help them. It is recommended that the home has a mobile hoist for emergency and short-term use. The training manager said that care staff watch a video about safe moving and handling. The proprietor confirmed that care staff also have practical training and courses are arranged ‘as and when required’. All staff should have practical training in the use of equipment such as hoists and glide sheets, and in safe techniques when moving people or objects, to protect themselves and residents from injury. A check of the hot water temperature in a bathroom in the first floor of the new extension showed that the temperature was excessive – it was almost 60ºC. To prevent risks from scalding, temperature-regulating valves should be fitted to provide a water temperature of close to 43ºC. One of the managers who is responsible for repairs and maintenance confirmed that he would take action to have the water temperature reduced. The hot water temperature in all areas of the home accessible to residents should be regularly checked and Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 30 recorded to ensure that hot water is held and distributed at the correct recommended safe temperature. There were wedges or objects holding doors open in the laundry drying room and kitchen areas. Doors should not be held or propped open because, in the event of a fire, the open doors will not provide the intended barrier to slow the spread of smoke and flames and residents, staff and visitors are put at avoidable risk. The fire officer should be consulted and his/her approval sought about the fire precautions in the home and prior to fitting suitable automatic door closers. There was no risk assessment in place for the use of oxygen in one resident’s room. Oxygen is a recognised fire risk and staff and visitors should be informed about the additional precautions needed. The oxygen cylinder was not in a portable holder; again, there is a risk of injury or explosion should the cylinder get knocked over. Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 31 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 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 2 2 Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 32 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 Timescale for action 31/05/08 2. OP38 23 (c) (i) Ensure that care plans are sufficiently detailed to provide staff with enough information to effectively meet users’ needs. The timescale (15/02/07) for meeting this requirement made at the last inspection in January 2007 has not been met. Consult with the fire authority 31/05/08 about the provision of suitable equipment/arrangements for containing fires 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 OP7 Good Practice Recommendations * Ensure that care plans are drawn up with the involvement of the resident and signed by them whenever capable and/or representative (if any). * Care plans should cover all aspects of the health, personal and social care needs of residents. DS0000013135.V348395.R01.S.doc Version 5.2 Page 33 Sotwell Hill House 2. OP9 3. OP12 4. OP18 5. OP30 6. OP37 * The appropriate moving needs (and risks) should be included in the personal care documentation of the individual. * Amend the Medication Administration Record (MAR) pages to include agreed code letters to indicate the reason(s) for non-administration of prescribed medicines; and add supplementary information about circumstances when ‘as required’ medicines may be safely given. * Maintain an up to date list of the usual signatures and initials of all staff authorised to administer medication. * Improve the security of keys to access medicine storage areas. * Ensure that there are written risk assessments in place for those residents who wish to, and are able to continue to manage their own medications. Review, improve and document the range of activities available to residents with cognitive or sensory problems to ensure that they have opportunities to be engaged in meaningful and enjoyable activities. * Ensure that all staff are aware of, and implement the safeguarding policies and procedures in accordance with written policies. * Copies of Oxfordshire Adult Protection/safeguarding procedures should be available to all staff in the home. and be incorporated in the homes own policies and procedures. * Managers should attend further training in safeguarding to ensure that their leadership and management of investigations into alleged abuse (where appropriate) are carried out in line with published guidance. * Improve the written records of induction, foundation and core training programmes for staff to evidence that all staff are competent, confident and safe to carry out the work that they are employed to do in the home. * Ensure that staff have regular practical training in the use of equipment and safe moving and handling techniques. * Policies and procedures for the home should be reviewed and updated in the light of the latest legislation and good practice guidance. Policies and procedures should be discussed with staff and residents. * The AQAA document should be fully completed and have sufficient detail and evidence to support statements made and to provide an accurate and reliable picture of the service. * It is recommended that, as part of keeping up with current regulatory, legal and professional guidance topics, there is Internet access for managers and staff working in DS0000013135.V348395.R01.S.doc Version 5.2 Page 34 Sotwell Hill House 7. OP38 the Sotwell Hill House. * The accident records should be improved to include actions taken in relation to communication with residents’ families/representatives and any follow up care required following injury. * The hot water temperature in all areas accessible to residents should be regularly checked, recorded, and adjusted where necessary, to reduce the risk of scalds * Risk assessments should be reviewed and updated to reflect the current situation – for example, the temporary use of oxygen in a resident’s room. * All staff should have regular training in moving and handling and the use of techniques for moving people and objects that avoid injury to services users or staff. Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Sotwell Hill House DS0000013135.V348395.R01.S.doc Version 5.2 Page 36 - 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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