Inspection on 17/07/07 for Southfield

This inspection was carried out on 17th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Southfield 23/05/06

Southfield 02/11/05

Southfield 21/04/05

Southfield 20/12/04

Southfield 05/07/04

Southfield 12/02/04

Similar services:

2 Perhaver Park

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Poldhu

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

CARE HOMES FOR OLDER PEOPLE Southfield Victoria Road Devizes Wiltshire SN10 1EY Lead Inspector Ms Sally Walker Unannounced Inspection 09:35 17th July 2007 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 DS0000028318.V335166.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. DS0000028318.V335166.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Southfield Address Victoria Road Devizes Wiltshire SN10 1EY 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) 01380 723583 01380 728647 manager.southfield@osjctwilts.co.uk The Orders Of St John Care Trust Valerie Weston Care Home 42 Category(ies) of Dementia - over 65 years of age (12), Learning registration, with number disability over 65 years of age (2), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (8), Old age, not falling within any other category (42), Physical disability over 65 years of age (2) DS0000028318.V335166.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd May 2006 Brief Description of the Service: Southfield is a purpose-built residential home for 42 older people, some of whom may have dementia or be experiencing mental health difficulties. The home was formerly owned and run by the local authority, but has for some years been provided by the Orders of St John Care Trust. This is one of a number of homes provided by them in Wiltshire and elsewhere. Accommodation is all in single rooms, located on two floors, with a passenger lift to the first floor. All bedrooms have wash hand basins and two have ensuite facilities. Toilets and bathrooms are located conveniently. There are sitting rooms on each floor, whilst behind the home are extremely attractive and secure gardens, including a patio area. The dining room overlooks the gardens. The home is located in a residential area a short walk from Devizes town centre, where shopping and social facilities are available. There are good bus links to neighbouring towns, whilst the home has its own adjacent car park. Weekly fee levels range between £410.00 and £485.00, according to assessed dependency. DS0000028318.V335166.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 17th July 2007 between 9.35am and 5.10pm and on 18th July 2007 between 9.10am and 6.05pm. Mrs Weston, registered manager, was present during both days. Mrs Jill Mitchener, Locality Manager, came on the second day for the feedback. The inspector spoke with 7 residents and 4 staff. The care records, medication administration records, risk assessments, complaints log and residents cash arrangements were inspected. A tour was made of the building. As part of the inspection process comment cards were sent to the home to distribute to residents, relatives, staff and healthcare professionals. Comments can be found in the relevant sections of this report. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: Without suitable pre-admission assessment paperwork the manager endeavours to ensure that potential residents have all of their care and support needs assessed. Mrs Weston was using a range of methods to gain that essential information. The organisation’s new recording systems are currently being piloted in some of their other homes. Staff pay special attention to making sure residents are well groomed throughout the day. Staff engage with residents and good relationships are established. Staff respect residents bedrooms as their private space. Residents spending their day in their bedrooms have regular hot drinks delivered to them and a fresh supply of juice or water within reach. The ‘resident of the day’ system does compliment the keyworker role, helping to ensure that rooms are cleaned and care plans reviewed. Care plans had good details of residents preferred routines for personal care giving. The organisation provides a good range of inter-home activities and social events. The home provides a good range of nutritious food suitable to the tastes of older people. The vast majority of meals are cooked ‘from scratch’ including home made biscuits, soup and cakes. DS0000028318.V335166.R01.S.doc Version 5.2 Page 6 Systems were in place for residents, families and staff to make comments or complain about the service. Residents were aware of who to take any concerns to. Staff showed confidence in knowing that they would always report any allegations of abuse. There was a robust recruitment procedure in place. Staff who were on duty were identified on a board outside the dining room. Nearly 68 of the staff had NVQ Level 2 or above. All staff are trained in dementia awareness, not just care staff. Mrs Weston was well known to residents. What has improved since the last inspection? What they could do better: The introduction of a comprehensive assessment tool, currently in pilot, should improve the gathering of relevant information, particularly when assessing those potential residents with a dementia or mental health need. Care plans were not consistent in the level of detail recorded. Care plans must give up to date information of residents current care needs. There must be detailed guidance to staff on how they are to meet those needs. If specific monitoring is indicated then it must be stated in the care plan. The care plan must also state who is responsible for monitoring, how often and when. This is essential for blood glucose monitoring, fluid intake, diet and pressure damage risk assessments. Staff who have been trained by the district nurse in taking blood glucose levels must not delegate this training to other staff. This is the responsibility of the district nurse. If residents’ fluid intake is to be monitored, totals need to be made each day. Measuring all the liquid content of the different drinking vessels would help with monitoring. Staff must be regularly trained in subjects relevant to the care and support needs of the residents and the categories for which the home is registered. DS0000028318.V335166.R01.S.doc Version 5.2 Page 7 This should include diabetes, visual awareness, pressure sore prevention, nutrition and other conditions associated with the ageing process. Staff need to be aware of what they are writing about residents in the daily records and care plans. Judgemental and unclear statements were discussed during the inspection with some of the staff. Bathing risk assessments must state whether residents can bath alone and if so for how long. Staff who are administering controlled medication must make sure that they pay attention to proper record keeping. The organisation only provides 20 hours a week [currently 10 whilst an appointment is made] for activities for 42 residents. Whilst it is recognised that a good range of activities is provided in this time, there is not sufficient time for those residents who do not necessarily want to join in groups. The time allocated does not allow sufficient individual attention or for residents to go out in the locality. Attention needs to be paid to cleaning of the undersides of some bath hoists and toilet surrounds, which are not always visible. It was some residents’ experience that they did not get the attention they wanted. This was either with personal help, keyworking or responding to requests. 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. DS0000028318.V335166.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 DS0000028318.V335166.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The organisation’s statement of purpose gives potential residents information about what the home provides. Current assessment documentation did not enable full exploration of potential residents care needs unless the assessor had the skills to know what questions to ask. EVIDENCE: The statement of purpose is now a corporate document across the organisation. Individual homes put their own information about what they provide in the document. The inspector advised that inserts could be dated for reviewing purposes. The home was using a printed format for assessing potential residents. This required some expertise in assessment, knowing what to ask the person, their family or others involved in their care. There was no specific formula for DS0000028318.V335166.R01.S.doc Version 5.2 Page 10 assessing individual needs, particularly the often complex care needs of those people with dementia or mental health needs for which the home is registered. There was no evidence as to who had provided the information. The assessment document for the most recently admitted person was dated on the day they came to the home. There was also a great deal about the person written in the daily report rather than in their care plan. There was a further assessment tool for determining fees. As this is a numbering system it cannot report on what is actually required by the person in terms of their care. Mrs Weston and the care leaders were supplementing the documents with their own notes about potential residents and their care needs. Mrs Mitchener later confirmed that agreement had been given for the home to use the new preadmission assessment tool that was currently being piloted in some of its other homes. Mrs Weston or one of the care leaders do all the assessments as some of the senior staff do not drive. She went on to say that other care leaders accompany her on assessments of potential residents so that they were aware of the process. Potential residents and their families were encouraged to visit the home to meet the residents and staff. Where residents are funded by a local authority, a copy of their assessment was obtained. One resident described how they had come to the home for 2 weeks to see how they liked it and decided to stay. In a comment card, one resident said: “due to being partly social services funded there was not any choice but Order of St Johns – Devizes being the nearest to my daughter. The home was helpful when we called to look around.” DS0000028318.V335166.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans do not always detail the complex care and support needs of the residents. Guidance in the care plans is not always clear. Monitoring systems are not always in place or completed. Poor recording of controlled medication puts residents at potential risk. Residents had good access to healthcare professionals but the records could not always evidence this. Residents were treated with respect and staff ensured that residents were well groomed. EVIDENCE: All residents had a care plan. Care plans were variable in the levels of detail recorded. Not all of residents’ personal and health care needs were recorded in their care plan. One resident’s care plan identified them as having diabetes. The care plan stated that the GP was to be alerted if their blood glucose was too high or too low. However there was no indication of the parameters for the wellbeing of the resident. Staff were taking daily blood glucose levels for those residents with a diagnosis of diabetes and recording the results in the care DS0000028318.V335166.R01.S.doc Version 5.2 Page 12 plan. It was reported that one of the staff was responsible for training other staff in these tests, not the district nurse. Another resident’s healthcare notes stated that their leg had been redressed. There was no record of this in the care plan. Another care plan did not mention that the resident had a pessary. This care plan stated that the resident must have their weight recorded and blood test recorded. However there was no guidance on where these results must be recorded. Other care plans had good detail on the residents preferred routine with regard to personal care, regular shaving, eating and managing anxiety. Another had clear guidance on whether staff or the district nurse was responsible for different aspects of their catheter care. One care plan had good detail on how to communicate with the resident. Another had details on the resident’s use of a nebuliser and its maintenance. One resident whose food intake was described as poor, had food supplement drinks and these were noted in their bedroom. Their care plan stated: “push fluids and record”. However at 1.10pm their care chart was inspected; it was recorded that they had had a cup of tea at 7.00am with nothing recorded since. There were no totals recorded on any of the fluid charts so fluid intake was not being monitored. The inspector advised that the charts should identify how much fluid is required by individual residents. In addition, all the different drinking vessels should be measured so that totals can be made. One resident’s care plan stated “normal diet” but there was no guidance on what this meant or what the resident preferred to eat. Residents were regularly weighed. The home had a set of scales with a seat to facilitate those residents who could not stand on scales. The home operates a ‘resident of the day’ system. This, amongst other areas, extends the keyworker role to make sure appointments are made, rooms spring cleaned, and records reviewed. The recommendation that the ‘resident of the day’ system was used to consider whether obvious risks to pressure areas had increased, for example, by a person having become more sedentary, and new details added to tissue viability care plans had not been actioned in full. Not all of the residents were being assessed as to their risk of developing pressure damage. The last person admitted had not had their risk assessed. Care plans were poor in recording how to reduce risk of pressure damage. One care plan stated: “to observe and record and inform district nurse”. Others referred to informing the district nurse when red marks, or in one case sores, appeared; clearly too late as damage may have already occurred. Staff had received training in pressure area care in November 2006 in the form of a video and multiple-choice questions. The evidence suggested that staff did not have a good understanding of preventative measures. Since the inspection whilst discussing another matter, Mrs Weston said that Waterlow pressure damage risk assessments had been provided by the organisation together with training on how to use the documents. She went on to say that body maps would also be used. DS0000028318.V335166.R01.S.doc Version 5.2 Page 13 The inspector advised that bathing risk assessments should state whether residents could be left alone when bathing and for how long. Staff need to consider the appropriateness of some of the language recorded in care plans and daily reports, for example, “became aggressive”, “suffers from incontinence”. The inspector discussed at length the purpose of record keeping and the need for accurate recording with some of those staff on duty. All of the residents spoken with were well groomed. Staff were seen to support residents with good grooming at different times of the day, either with continence issues or just doing buttons up properly. One resident said they had a bath once a week. Many of the ladies were wearing make up and jewellery. All of those residents spoken with in their bedrooms had fresh supplies of drinks within reach. Residents could help themselves to cold purified water from an appliance just outside the dining room. Those residents in their bedrooms had easy access to their call bells if they could not easily get to the unit on the wall. The care leader with the delegated responsibility for the administration and control of medication explained the arrangements. Staff may only administer medication following induction, training and assessment of their competency. Competency is regularly assessed every 6 months. Two staff check the medication against the medication administration record printed by the supplying pharmacist as it is delivered to the home each week. Records were kept of all unused or unwanted medication returned to the pharmacy. Handwritten entries in the medication administration record when medication was changed or discontinued were witnessed, signed and dated. Residents were able to manage their own medication following a risk assessment. There was a medication trolley for each floor so that administration did not take too long. There were concerns over the poor recording of the controlled drug register. In some instances balances did not tally and amendments to the record were unclear. The records were checked against the stock with the care leader and no medication was missing. Some staff were entering administration into the wrong record and corrections were unclear. Two staff are required to witness all administrations then both sign and date the record. The records evidenced that some staff were not witnessing the correct entry into the log. Administrations were being recorded against different residents names and entries were crossed out with little explanation recorded. The evidence suggested that some staff were not paying attention to procedures. Staff need to ensure that accurate records are kept for the administration and receipt of controlled medication. Mrs Weston said that this was to be followed up with those members of staff involved and action taken if necessary. DS0000028318.V335166.R01.S.doc Version 5.2 Page 14 The inspector gave advice on recording medication to be administered in adhesive patches to be applied to the body. Body maps should be used to identify the site together with a daily record of the changes of sites. The requirement that protocols must be available for medicines used on an ‘as required’ basis had been actioned. It was also required that the medication administration records must accurately reflect their use. All of the care plans inspected had clear guidance on when painkillers or other ‘as required’ medication was to be given. The requirement that doctors’ visits and medication changes must be recorded in the residents’ records in such a way as to enable easy reference had been actioned. Residents had good access to healthcare professionals. One resident said they would go to the office to ask to see their GP and that staff would arrange a visit. In a comment card, one resident said: “They have always called a Dr when necessary.” Staff treated residents with respect and their dignity was respected when giving personal care. This was evidenced in the daily records and from observations. DS0000028318.V335166.R01.S.doc Version 5.2 Page 15 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. This judgement has been made using available evidence including a visit to this service. The hours allocated to providing activities does not allow those residents who do not wish to join in with group events to have sufficient one to one time for activities both at the home and in the locality. Choice and decision making was restricted to those residents who could decide for themselves. Residents enjoyed a very good range of meals made from fresh ingredients. EVIDENCE: When the inspector arrived at the home on both days, some residents were having a leisurely breakfast in the dining room. The atmosphere was quiet although it was a busy time of the day. Those residents who could choose spent their day as they wished. Others relied on staff to suggest where and how they spent their day. There was little evidence in records of how residents were encouraged to make decisions. One resident said they did not have to go and spend their day in the sitting rooms or to meals. Another resident said they liked to spend their day in their bedroom reading. They said they helped themselves to the books provided by DS0000028318.V335166.R01.S.doc Version 5.2 Page 16 the local library, kept in one of the sitting rooms. One resident said they only went to the bingo sessions. One resident said they went to a day service twice a week on the bus. In a comment card one resident said: “I haven’t joined in much [activities] because of bad sight and hearing.” There was a list displayed of all the religious, cultural and anniversaries celebrated during the year. Visitors were welcomed and they could see residents in the sitting rooms or in their bedroom if residents wanted. The recommendation that consideration was given to identifying and providing for occupation needs for those residents unable or disinclined to join group activities had not been actioned. A member of staff was employed for 10 of the 20 hours allocated each week to provide activities. The person providing activities said there were 3 activities a day. Some of the care staff helped with these activities, which were group and one to one time. They said they provided games such as cards, scrabble or dominoes. They also spent time talking with those residents who did not necessarily want to join in. They said they would talk about different topics with each resident and would spend at least half an hour with them. Mrs Weston said she was advertising for a 20hour post. This was not an extra post as the member of staff said they would return to their care post when the 20 hours post was filled. It was recognised that the member of staff provided some residents with a good range of activities in the time allowed. However 10 hours each week, or even 20 hours that is proposed, cannot provide the published activities programme unless care staff are taken away from their work. The amount of time allocated cannot provide 42 residents with sufficient one to one time. Mrs Mitchener, locality manager, said that it is part of all care staff’s job description to participate in activities as part of the keyworker role. The organisation does promote individual activities and events between homes. However there is little opportunity for residents to have single trips out. Some of the residents had gone to another home to take part in a quiz. Other competitions in homes included: skittles, beetle drives, darts and bingo. The home had joined other homes in the organisation for a 50’s event at the Civic Hall in Trowbridge. The following week residents had been invited to a garden party at Bowood. Mrs Weston said that residents could also join in with the activity programme provided by the day service. She went on to say that some entertainers regularly visited the home. Some singers had been giving a show to the residents and the day service on one of the afternoons of the inspection. One resident described themselves as being ‘happy as a bird’ when asked about living at the home. Another resident said that staff would bring the telephone to them when they wanted to talk to their daughter. Another resident said staff would do their shopping although there was a trolley that staff took round on a regular basis. This contained sweets and other small items. DS0000028318.V335166.R01.S.doc Version 5.2 Page 17 The menu for the day was displayed on a notice board in large print by the dining room. There was a choice of 2 hot dishes for lunch and evening meal with a salad available at lunchtime. Fresh fruit was available for residents to help themselves. Bacon and eggs was served at the weekends and eggs in a variety of ways during the week. All of the cakes, biscuits and the soup for the evening meals were home made. Soup was available at other times but it would be canned. The home provides a varied range of traditional meals suitable to the tastes of older people. Mrs Weston said that the vast majority of meals were prepared from scratch. Although the meal time was relaxed and served to residents according to their appetite, the atmosphere was spoiled by the amount of noise and talking coming from the kitchen. Residents were either asked what choice they wanted at the table, or shown the plated choices. Staff were encouraging those residents who needed support with eating. The recommendation that sauces and condiments should be provided at table as appropriate to the meal being served had been actioned. All of the residents spoken with said they enjoyed the range and quality of the meals provided. In a comment card one resident said: “I have a small appetite but the food is hot and fresh”. DS0000028318.V335166.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems were in place to ensure that residents, their families and staff could complain about the service. Staff had a good knowledge of the local procedure of reporting any allegations of abuse. EVIDENCE: The majority of the residents spoken with knew who to approach if they wanted to raise concerns. One resident said they would complain to whichever staff came to see them. They said that staff were always willing to discuss issues. Another resident said they would talk to Val [Mrs Weston] if there was anything they were unhappy about. They said she was always available to talk to. In a comment card one resident said: “I would ask a carer or my daughter to sort things out.” A relative commented: “Treats my relation and other residents with care, cheerfulness and respect. Always ready to listen to any concern or comment.” The complaints log showed a good record of investigating complaints, outcomes and responses to complainants. Staff were asked about how to respond to witnessing or being told of allegations of abuse. They responded appropriately to questions about hypothetical situations. Staff had received training in reporting abuse. Copies of the booklet entitled “No Secrets in Swindon and Wiltshire” were available in the office. DS0000028318.V335166.R01.S.doc Version 5.2 Page 19 Some residents were using the services of an Independent Mental Capacity Advocate. DS0000028318.V335166.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Significant efforts have been made to improve the physical environment for residents. Residents now have much more comfortable accommodation. The home was generally clean and there was no unpleasant odours. However the undersides of some hoists and toilet surrounds were not sufficiently well cleaned to infection control standards. Residents were pleased with an efficient laundry service. EVIDENCE: There had been major improvements to the environment for residents. Most of the communal carpets had been replaced save the back stairs. These stairs were covered with old and discoloured cork tiles, which were laid when the home was run by the local authority. This was in stark contrast to the rest of the newly carpeted areas. It was reported that these stairs were not used. DS0000028318.V335166.R01.S.doc Version 5.2 Page 21 However there were bedrooms near to the stairs. At least 2 residents were seen to use the stairs, stopping on the landing to look at the gardens. Since the inspection, whilst discussing another matter, Mrs Weston reported that an order has been placed by the organisation to have these stairs carpeted. Bedroom carpets were being replaced and bedrooms redecorated. One resident confirmed that they had asked for their bedroom to be refurbished after the New Year. Residents’ bedrooms were personalised. The bedrooms were gradually all being redecorated to the individual’s taste. One of the residents said that everyone had been given new beds. In a comment card one resident said: “They work hard to keep it nice.” There were three sitting rooms; two on the upper floor and one on the ground floor. There were also a number of chairs in one of the corridors opposite a large window so residents could see who was coming and going. Residents could have a key to their bedrooms. Staff had a master key to enter the bedrooms in an emergency. Staff respected residents’ private space. Mrs Weston said that one resident did not allow staff to enter their bedroom unless they were present to invite them. Their keyworker and cleaner had to make arrangements to visit. All of the wheelchairs were being stored with their footrests so that if they were used residents would not risk dragging their feet on the floor. Some residents were making use of the gardens in the intervals between very heavy rain. Patio furniture was laid out for residents use but restricted by the bad weather at the time of the inspection. Mrs Weston said that the gardens were enclosed so that those residents with dementia could make use of them without venturing out onto the road. There is a hairdressing room with a hairdresser visiting regularly to provide a service to residents. One of the residents said they went to the bar, which was used as a smoking room. The recommendation that suitable signage was provided to assist residents’ orientation, especially to toilet doors had been actioned. Rooms were numbered and some residents had put pictures or drawings on their doors to personalise them. It was noted that the underside of one bath hoist had a build up of lime scale, which needed attention. Some of the lifting aids surrounding some of the toilets had yellow drip marks. The top sides of these appliances were clean suggesting that only the areas that were visible were cleaned. One toilet had a fixed surround that had probably been installed when the home was built. Some residents, particularly wheelchair users, may now be used to this appliance for getting off the toilet, particularly wheelchair users, so there is no suggestion of it being replaced. However the appliance needs attention to DS0000028318.V335166.R01.S.doc Version 5.2 Page 22 ensure that the paintwork can be easily cleaned to reduce any risk of infection. The rest of the home was cleaned to a good standard and there were no unpleasant odours detected at any time during the two days. Soap dispensers and disposable towels were available in all of the toilets and bathrooms. Protective clothing and disposable gloves were available for staff. Arrangements were in place for disposal of clinical waste. One resident said that their bedroom was cleaned every day to their satisfaction. A relative in a comment card said: “a little more cleanliness in bedrooms.” In a comment card another relative said: “when a resident has to use a commode all the time it would be nice if a toilet was in the room.” All of the residents spoken with said they laundry service was good with clothing being returned promptly. Mrs Mitchener, locality manager, said that it was planned to employ a part time laundry person to take responsibility for this area. Currently housekeeping and care staff process the laundry. The laundry area was well managed and clean. There were facilities to deal with soiled or infected laundry. The home also employs a part time seamstress. DS0000028318.V335166.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate, although relationships with residents and attention to good grooming was good. This judgement has been made using available evidence including a visit to this service. It was some residents’ experience that they did not have the input that they wanted. However other residents reported good relationships with staff. Nearly 68 of staff hold NVQ Level 2 or above. This is a robust recruitment procedure in place. Staff do not have access to a range of relevant training related to the needs of the people they support. EVIDENCE: The staffing rota provided a minimum of 1 care leader and 4 care staff during the mornings. The home also employs care support staff who are not involved in providing intimate personal care. They help with serving meals and bed making. It was later established that these support hours had been allocated from the existing housekeeping hours. As a matter of good practice, photographs of those staff who were on duty that morning were displayed on the wall outside the office. All staff have a delegated area of responsibility, for example, organising the respite calendar or medication. DS0000028318.V335166.R01.S.doc Version 5.2 Page 24 Mrs Weston kept a list of mandatory training undertaken by staff according to their role. This showed when different essential training was required or updated. All training is provided by the organisation. Mrs Weston said that a new computer system was being implemented which would, amongst other employment data, provide automatic indicators for when training was required. The records showed that some staff had received training in subjects associated with the ageing process but not since 2004. All the ancillary staff have access to the dementia care training half day. Thirteen staff had NVQ Level 2 and five staff had NVQ Level 3. Staff talked about their previous experiences of working in other care settings and training undertaken. One member of staff said they held NVQs Levels 1 & 2. They said they had had training in dementia about a year ago but nothing since. They had undertaken mandatory training such as moving and handling and fire prevention but had not undertaken any recent training. They said they had discussed training needs at supervision with the manager and were considering the new list of training on offer. Certificates of staff training were displayed on the wall outside the offices. Some of the staff had received training in visual awareness and 2 were booked to attend this course. Some tissue viability training had taken place in December 2006 in the form of a video and multi-choice questionnaire. Other training included death and dying, fire marshals, first aid updates and medication training from the supplying pharmacist. Mrs Jill Mitchener, locality manager, said that she had a meeting planned with the Altzeimers Society who had provided the current training pack, to look at a further, higher level training pack in dementia care. The recommendation that opportunities were provided for staff to receive awareness training in mental health issues besides dementia was in some progress. Some staff had attended a days training in January but nothing else showed on the training plan for the rest of the year. Mrs Weston said she had received training in the Mental Capacity Act 2005 and a leaflet had been given to staff. A robust recruitment procedure was in place with all the documents and information required by regulation on file. All potential staff were required to fill out an application form and declare any cautions or convictions. Two references were required together with evidence of qualifications. No staff commences duties with a negative POVAFirst confirmation as the Criminal Records Bureau certificate is requested. Mrs Weston said that her criteria for recruiting to care posts was a minimum of previous care experience. Comments from residents were varied about the care and support they received. One resident did not know who their keyworker was. Another said they did not see much of their keyworker. Another said that staff did not “make them feel like they were a nuisance”. In one comment card a resident DS0000028318.V335166.R01.S.doc Version 5.2 Page 25 said: “The carers are generally good and kind. I need help with hearing aids as I can’t see which is which in the boxes. They tend to forget to put them in and also leave them switched on at night, which uses the battery. I also need help to put on the TV which they don’t always remember.” Another said: “They do their best to remember what they are asked. I try not to bother them. I try not to ask them for anything until they are in my room anyway.” Another resident commented: “Generally I am happy here. Following up after handover shifts can be a problem for my personal problems. Some get it right some don’t and I don’t always remember to ask.” A relative in a comment card stated: “All the staff are very helpful. Nothing is too much trouble for them and my father is very happy. He can’t praise them up enough.” Staff were seen to engage with residents. Residents were greeted by staff as they were encountered along corridors. Other staff were seen to chat with residents and it was clear that good relationships had developed. However one of the residents visited in their bedroom said that they did not see much of the staff. DS0000028318.V335166.R01.S.doc Version 5.2 Page 26 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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Mrs Weston has been a manager in the organisation’s homes for over 3 years. She keeps herself up to date with current practice through training provided by the organisation. Quality audits are carried out by the organisation. Residents’ cash is safeguarded with proper recording systems and regular checks. Systems were in place to ensure the health and safety of residents and staff. EVIDENCE: Mrs Weston had managed the home for over 2 years. Before that she managed another home in the organisation for a year. She has over 20 year experience of working in care homes for older people. Mrs Weston keeps DS0000028318.V335166.R01.S.doc Version 5.2 Page 27 herself up to date with current good practice through regular training provided by the organisation. She had recently undertaken 4 different courses in using the organisation’s different computer systems. She had also undertaken training in adult abuse and neglect, mental health and attended training by a nationally recognised trainer in dementia. Mrs Weston was well known to the residents. Those who could not necessarily identify her by name recognised her as the manager. Mrs Weston said that representatives of the organisation had undertaken a quality audit of the home. Questionnaires had been sent to residents and relatives to comment on the service. The results had been sent to the organisation’s chairman for consideration and an action plan returned to the home. Mrs Weston had also received feedback from the audit. She said that the locality manager then checks on compliance with the action plans. Regular residents meetings were held and the minutes showed the action taken on the issues arising from previous meetings. Some of the residents spoken with confirmed that they could take agenda items to the meetings. One resident said they were asked about the meals at the meetings. Residents could keep small sums of money in the home’s safe. Records and receipts were kept of all transactions. Residents could access the money at all times as there was always a senior member of staff on duty who could access the accounts. The manager and the administrator regularly audited the accounts. Mrs Weston was investigating individual savings banking for residents who did not have relatives. Some residents had difficulties opening accounts through lack of capacity or not having the documents required. Risk assessments had been carried out on the environment and any tasks. They had been regularly reviewed, revised and added to. Regular health and safety meetings were held with minutes kept and an action plan for any issues. The requirement that the correct signs must be displayed whenever oxygen was kept in the home had been actioned. DS0000028318.V335166.R01.S.doc Version 5.2 Page 28 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 X 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 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 DS0000028318.V335166.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15 Requirement Timescale for action 17/07/07 2 OP30 18 (1)(c)(i) 3 OP9 13(2) & 17(1)(a) Schedule 3 para 3[i] The person registered must ensure that all residents’ current care and support needs are recorded in their care plan. The care plan must record how those needs are to be met and how progress is monitored. This must include management and monitoring of those residents with diabetes, tissue viability, diet, site of administration of medication in adhesive patches, bathing and risks. The person registered must 30/09/07 ensure that the staff training programme includes subjects relevant to the care needs of the residents. Staff must be trained in: managing diabetes, prevention of pressure damage and tissue viability, mental health awareness and visual impairment. The person registered must 17/07/07 ensure that proper records are kept of the administration and control of controlled medication. Staff must witness each administration; sign and date the register making sure that the DS0000028318.V335166.R01.S.doc Version 5.2 Page 30 4 OP9 18 (1)(c)(i) details are entered onto the correct register. The person registered must ensure that only staff who have been trained to do so by the district nurse, carry out the test of residents’ blood glucose levels where indicated. The training must not be cascaded to other staff. If the district nurse is unable to provide certificates of competence for any reason, the home must keep a record of when the training was undertaken, by whom and the names of the staff undertaking the training. 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP8 Good Practice Recommendations Use resident of the day as an opportunity to consider whether obvious risks to pressure areas have increased, e.g. by a person having become more sedentary, and add any identified new detail to tissue viability care plans. Consider how to identify and provide for occupation needs for those residents unable or disinclined to join group activities. Seek opportunities for staff to receive awareness training in mental health issues besides dementia. Consideration should be given to the appropriateness of some of the language used in records. Staff should record only what is observed or said rather than their own DS0000028318.V335166.R01.S.doc Version 5.2 Page 31 2. OP12 3. OP30 4 OP37 5 OP8 projections. Measuring of different sizes of drinking vessels should enable better monitoring of fluid intake. Daily totals would also enable better monitoring. DS0000028318.V335166.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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