Inspection on 23/05/06 for Southfield

This inspection was carried out on 23rd May 2006.

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

The inspector 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 17/07/07

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 Roy Gregory Key Inspection 9:30 23 May 2006 rd 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 Southfield DS0000028318.V295174.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. Southfield DS0000028318.V295174.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 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 (1), Mental of places disorder, excluding learning disability or dementia (1), Mental Disorder, excluding learning disability or dementia - over 65 years of age (7), Old age, not falling within any other category (42), Physical disability over 65 years of age (2) Southfield DS0000028318.V295174.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd November 2005 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, 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 one has en-suite 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 £390 - £460, dependant on assessed dependency. Southfield DS0000028318.V295174.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The regulation inspector Roy Gregory visited Southfield unannounced on Tuesday 23rd May 2006 and returned the following day, spending a total of 12 hours at the home. During this time there were interviews and conversations with several residents, including sharing lunch times each day. The manager Val Weston was available throughout, whilst there were also discussions with care leaders, care and housekeeping staff. Records consulted included those concerning provision of activities, staff training, fire precautions and staff recruitment; and a sample of residents’ assessments, care plans and reviews. The inspector toured most parts of the home. In advance of the visit, questionnaires were sent to a sample of residents, six having been returned at the time of writing. Contact has also been made with the relatives of some residents while additional feedback on how the home is experienced has been obtained from a social worker who responded to a request for feedback from the local Adult Services team. In December 2005 it was necessary to make two additional visits to the home in connection with a complaint (subsequently investigated by the provider) and a vulnerable adults referral notified to the Commission. These visits yielded information that has been referred to in this report. At the request of the inspector, the manager had provided basic information about the resident and staff groups prior to the visit being made. The pharmacist inspector visited unannounced on 16th May 2006 to assess the handling of medications. The judgements contained in this report have been made from evidence gathered during the inspection, which included the visit to the service and taking into account the views and experiences of people using the service. What the service does well: Of the 25 National Minimum Standards assessed at this inspection, all but three were met. Various strands of evidence, including residents’ perceptions and experiences, show that indicators of decline in health or wellbeing are swiftly recognised by staff, and lead to prompt referral to external professional or emergency services. A social worker commented on two reviews she had recently attended at the home. At one: the keyworker and Manager attended, all were well informed about the resident, their medication, how the needs were being met and actions taken to overcome problems. At the second: The keyworker was able to answer any queries I had and I felt that Southfield was certainly meeting this particular resident’s needs. Southfield DS0000028318.V295174.R01.S.doc Version 5.2 Page 6 Survey questionnaires returned, mostly anonymously, by residents indicated high levels of satisfaction. During the inspection visit, there were many compliments about the attitudes and competency of both care and ancillary staff. One resident considered the home to be more homely and less institutional in feel than a three-bedded service from which they had transferred. A group of residents in the sitting room spoke of the degree of personal choice available, and lack of “rules”. The dining room provided a pleasant setting for meals, which were of high quality, whilst there was also an efficient service of meals to residents who preferred to take them in bedrooms. High standards of cleanliness were evident, and had been when the inspector had visited in December 2005. What has improved since the last inspection? What they could do better: The pharmacist inspector identified that medications prescribed for use “as needed” were being routinely offered and often “refused”, rather than used when their use was indicated. Protocols for use of such medicines need to be described in individual care plans, with only actual use being recorded. The continuing concern for Southfield is how to recruit and retain sufficient staff. Notifications to the inspector, as required at the previous inspection, have shown that on eight occasions, the number of care staff on shift has fallen to three, a dangerous level for 42 residents. These notifications must continue to be made. In many other instances, shortfalls have been made up by use of agency staff, resulting in inconsistent care to residents, and existing staff being sidetracked to inducting and supporting agency staff. Recruitment was clearly in progress, but meanwhile efforts to uphold staffing levels must be maintained. Several residents spoke in various ways of the impact of low staffing levels, from feeling isolated because of lack of staff time, to having much wanted baths postponed or seeing slips in staff members’ usual Southfield DS0000028318.V295174.R01.S.doc Version 5.2 Page 7 standards of courtesy. A respondent to the survey wrote: Sometimes I ask for stuff from staff and if they are busy they may forget. Recommendations made to enhance daily life for residents, include provision of sauces at the dining table, using appropriate signs to enable residents’ orientation around the home (e.g. to identify toilets), and looking at how to widen occupation opportunities for those residents less able or disinclined to join group activities. Care could be improved by considering changes in risk of pressure damage as part of the “resident of the day” scheme, and by seeking mental health awareness training for staff (i.e. additional to dementia training). 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. Southfield DS0000028318.V295174.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 Southfield DS0000028318.V295174.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Key Standard 6 does not apply to Southfield) Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents are only admitted to the home on the basis of a professional assessment that demonstrates their needs can be met. EVIDENCE: Those residents admitted relatively recently varied in their recall of the admission and pre-admission process. As often, there was a tendency to view the process as having been steered by family members and care managers. However, it was ascertained that pre-admission visits were offered. Records showed that detailed assessments were carried out, usually by the manager, and that these led into establishing care plans and providing comprehensive information to staff on duty at the time of admission. Community care assessments and hospital information were clearly used as main sources, added to direct meeting with potential residents. A dependency level was decided around the time of admission, to assist care planning and fee setting, and this was reviewed after the first month of residence, with the resident Southfield DS0000028318.V295174.R01.S.doc Version 5.2 Page 10 involved, at which time the longer-term suitability of placement was also confirmed. The manager spoke of encouraging social workers or community psychiatric nurses, wherever possible, to facilitate visits to the home by people for whom respite stays were being considered. She had identified that respite needs were often identified a long time before actual applications were made, and was hopeful that earlier contacts would now be made with the home, to improve the assessment process for potential respite residents and the related care planning in the home. Concerns arising from an emergency placement in December 2005 might have been averted had actual admission been delayed until after a formal assessment by a representative of the home (the manager being away at the time), although it is in the nature of such situations that a speedy placement may be necessary. Southfield DS0000028318.V295174.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 - 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Individual care plans receive regular review and direct care across a spectrum of need. There is prompt awareness of and response to health needs, including good liaison with health professionals and emergency services. Systems and practice in handling medications are mainly good, but use of “as needed” medicines has not been sufficiently accountable to ensure it is appropriate and safe. The approach to the care task is based on respect for diversity and privacy. EVIDENCE: A number of care plans were sampled and compared with the experiences of the residents to whom they related. They gave guidance on the principal needs of individuals. Many residents were able to identify areas of care and support needed that gave rise to their placement, and recalled review meetings in which these had been considered. A recent development in the home was a “resident of the day” scheme. This meant that each day, all care and housekeeping staff gave specific attention to the needs of one identified resident, including review of their care plan. With the number of permanent Southfield DS0000028318.V295174.R01.S.doc Version 5.2 Page 12 residents, they received this individual attention every five to six weeks. This way of working, in its second month of operation, resulted in much positive feedback to the inspector from residents and staff alike. In all care plans there was a plan in respect of tissue viability, so that at least there was routine monitoring of skin condition, with staff aware of signs that would trigger referral for attention by the district nurses. Little evidence was seen of pro-active planning to minimise risk of pressure damage, e.g. by encouraging nutrition or mobility, although for a wheelchair-bound person such planning was in place. Checking on weights was now one of the facets of “resident of the day”, and was thus consistent, in contrast to the situation at previous inspection. Staff were seen to replenish soft drinks availability in communal and individual rooms as appropriate, and to watch and record unusual food and fluid intakes. For a few residents there were intake charts in use, at the request of GPs or following concerns generated within the home. These were not calibrated, but were seen to act as prompts to staff to oversee how well somebody was eating or drinking, and to maintain encouragement. Daily notes about residents, together with notifications sent to the Commission provided evidence that staff were alert to indicators of ill health, and acted promptly to seek professional and/or emergency advice as necessary. Examples were seen where reviews had been arranged with external agencies in order to trigger further actions, e.g. referral to consultant or medication review. There was appreciation of outreach support provided from the community mental health team. A social worker gave their comments on liaison with the home as follows: I have recently carried out two reviews at Southfield. One involved the mental health team, this review went very well, the keyworker and Manager attended, all were well informed about the resident, their medication, how the needs were being met and actions taken to overcome problems. The other review was a scheduled one, the family and keyworker arrived. The keyworker was able to answer any queries I had and I felt that Southfield was certainly meeting this particular resident’s needs. The pharmacist inspector visited the home unannounced on 16th May 2006 and reports as follows: Medication was stored appropriately and records of receipts and returns kept. Some eye drops were labelled “as directed” on the bottle and the medication administration record. All medicines should have clear instructions. Some medicines which were prescribed “as required” (“p.r.n.”) were signed for as being regularly offered and refused. A protocol for the use of any “p.r.n.” medication should be drawn up to enable staff to administer it appropriately. The time of administration should be recorded clearly to ensure that an overdose cannot be given. Residents’ records showed blood tests and other interventions from healthcare staff, but some doctors’ visits and medication changes were not recorded. Southfield DS0000028318.V295174.R01.S.doc Version 5.2 Page 13 Safety signs for the use of oxygen were not displayed, but this was remedied at the time of the inspection. Clearer official signs should be used, which are available from the oxygen supplier. The inspector observed part of a medication administration round. The care leader undertaking this was not involved in any other tasks, and discharged the duty in an unobtrusive and sensitive fashion. All residents spoken to were complimentary of the respectful approach of all staff. They considered their personal rooms were seen as private. Questionnaires returned gave a similar picture. Whilst the inspector was in a room with a resident, a member of staff entered without knocking to collect a cup. The resident said this was most unusual, for all staff and the particular one, and thought it a reflection of the low number on duty that morning, causing staff to rush. Others commented that pressure on staff could occasionally lead to slippage of normally high standards of regard for privacy and dignity. One resident considered the degree of choice and respect meant the home was less institutional in feel than their previous placement in a three-bed care home. Southfield DS0000028318.V295174.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 - 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home has developed regular activities provision that has scope for further development. Within daily life, residents are able to exercise many choices. Community and family contacts are encouraged. Meals are of good quality. EVIDENCE: Since the previous inspection, the role of activities co-ordinator has been filled on a job-share basis (10 hours each) by two existing members of care staff. It was not possible to discuss their role with either of them during the inspection visit, but their record keeping demonstrated that an organised activity was offered every day. This was usually a game of bowls, skittles, darts or a quiz. Those residents who regularly joined in these activities were very appreciative of them, but it was evident that it was the same relatively small group of people benefiting from a rather restrictive range of options. It is of course early days for this aspect of care at Southfield, and the need now is to see how best to encourage occupation for a wider range of residents, particularly by building on the information residents and their families have provided about interests and past lives. A number of residents told the inspector of a preference to spend most time in their own rooms, or outside the home when possible, rather than with groups of other residents. For them, organised activities were Southfield DS0000028318.V295174.R01.S.doc Version 5.2 Page 15 not attractive, but many would welcome more engagement on an individual level. Meanwhile, a programme of larger special events was sustained, and these were clearly greatly enjoyed by a majority of the residents. There had recently been a hundredth birthday party in the home, in respect of which there was a very complimentary letter from the centenarian’s relatives. During the inspection, there was a skittles match held in the dining room, involving visitors from three other homes in the Trust. This was subject of much keen anticipation and enjoyment. Some residents were accustomed to going out of the home, to town or to visit relatives. Most considered they had wide ranging choices about things such as when to get up or go to bed, where to spend different parts of the day and where to take meals. Some commented to the inspector on the welcome lack of “rules”. One resident felt sometimes prevailed upon to go to the dining room for breakfast against their wishes, which the manager undertook to investigate. No-one encountered any difficulties in respect of receiving visitors. Staff said the small upstairs sitting rooms were sometimes used for this purpose. The bar had become the one area where smoking was permitted, and was conducive to that function. The dining room had benefited from provision of new tables and chairs and was a very attractive setting for meals, which belied the number of people there. There was considerable reliance on agency staff in the kitchen, but neither residents nor staff had seen any impact on the high standards of catering. Two hot options were offered each lunchtime, with some residents exercising the further choice of a salad. A vegetarian resident expressed satisfaction with the arrangements made for them, which included gelatinefree jelly, and diabetics were also well catered for. Service, even on a belowstrength shift, was polite and efficient. An improvement would be to make sauces and condiments routinely available, as options such as breaded chicken with vegetables were slightly dry. Many lunches and breakfasts were seen to be delivered to individual rooms in an efficient manner. Southfield DS0000028318.V295174.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. There is good provision for receipt of and response to complaints, which are used as tools for quality assurance. Staff and management understand and exercise responsibilities in respect of keeping residents safe, with full cooperation shown towards multi-agency enquiries. EVIDENCE: Trust procedures for responding to complaints were available in the manager’s and care offices, and care leaders confirmed their awareness of how to receive complaints and refer them for managerial attention. One complaint had been received by the home since the previous inspection. It concerned an omission that might well have been recognised and dealt with had the “resident of the day” scheme been running at the time. Nevertheless, the manager had recorded her systematic approach to investigating the complaint, which was upheld. The complainant, a relative, was satisfied with a final telephone rather than written response. Residents indicated verbally and via questionnaires that they would find no difficulty raising any concerns directly with the more senior staff on duty at any time, rather than being overtly aware of the formal process followed in response to any complaint. Two matters, each concerning respite residents, came to the attention of the Commission, leading to unannounced visits in December 2005. There was a complaint about a poor welcome process and unacceptable room, where a relative had refused to agree to the respite stay going ahead. Whilst the Southfield DS0000028318.V295174.R01.S.doc Version 5.2 Page 17 inspector found the room in good order, and happened to see a very well handled admission of a respite person, the specific complaints were investigated and upheld by the Trust county office. The second matter was referred through inter-agency Vulnerable Adult procedures to consider whether there had been insufficient or neglectful care. Records and staff testimony showed there had been mostly attentive care, and the resident concerned was satisfied with the care they had received, but the events in question did highlight the impact of low staffing levels on quality of care, whilst a lack of assessment in this instance (due to emergency referral) also meant care planning for the individual was compromised. Management and staff were entirely co-operative with the above enquiries and drew learning outcomes from them. Recent revised guidance (March 2006) to inter-agency Vulnerable Adult procedures had not yet been supplied to the home, and so the manager arranged to order these at once. Southfield DS0000028318.V295174.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The environment provides for comfort, choice and security. Some residents may find orientation difficult. Use of various communal spaces is encouraged, providing for choice and variety. Bedrooms are individualised but some remain in need of modernising. There are high standards of hygiene. EVIDENCE: There were many improvements to the fabric of the home since the previous inspection. Corridors had been re-carpeted and redecorated, and there were firm plans to complete re-carpeting downstairs within the current year’s budget. The upstairs sitting rooms had received imaginative attention, including provision of new furniture, resulting in attractive, comfortable rooms, which were said to be attracting more use by residents. It was planned to use one of these rooms for activities in particular. The main sitting room, downstairs, was shortly to receive new carpets and décor, and carpet samples were left in the room to enable regular users of the room to state their Southfield DS0000028318.V295174.R01.S.doc Version 5.2 Page 19 preferences. The hairdressing room had benefited from a makeover, much to the pleasure of the hairdresser and residents. The garden looked superb and was widely commented on. All bedrooms seen had been personalised by their occupants to varying degrees. Residents were very satisfied with individual rooms. Some of those seen had been recently decorated to a high standard, but others remained in need of attention. The handyman was concentrating on refreshing rooms as they became vacant, as each one represented quite a project. Many rooms had been provided with new commodes and armchairs. One resident complained they had not been consulted about having a new chair, which they found less comfortable than the one it replaced. A comment was made that additional seating near the entrance to the dining room would provide a resting place after what is a significant walk for some residents. The quality of cleaning all around the home was exemplary. An odour problem at one location was receiving continuous attention. Residents commented on the diligence of housekeeping staff in their attention to daily cleaning of bedrooms and toilets. Night care staff undertook some cleaning duties. During unannounced visits by the inspector in December 2005, good cleaning standards had also been observed. The “resident of the day” checklist requires review of and attention to many environmental factors in the resident’s room. A new call bell system had been installed, resulting in a visibly more efficient response. Staff considered this an enhancement that was benefiting residents. The environment will benefit from some signage to assist new residents, and especially those with dementia, in identifying toilets and, in some cases, own rooms, as these were identified only by numbers, albeit attractive ones. One resident was seen to have difficulty recognising their precise whereabouts. Southfield DS0000028318.V295174.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. A good level of developmental training has been maintained amongst care staff but actual numbers of staff delivering care fall to unacceptable levels, creating risks for residents. Regular use of agency staff results in inconsistency of care. Recruitment practice is good. EVIDENCE: This remains the area where the home is struggling to maintain a full service to residents. The provider Trust has increased funding for care hours by 55 hours per week, but there has been difficulty in recruiting and not all staff are in a position to offer to work beyond their contracted hours. Thus despite rotas aiming to provide for five or six care staff on shift, in reality the number on duty is often only four. Since the previous inspection, there have been eight notifications of the number falling to three, i.e. a ratio of one carer to fourteen residents. When one member of staff is involved in administering a medication round, it can be seen that availability to residents is stretched to an unacceptable level, and becomes inevitably focussed on the most immediately pressing tasks. These occasions arise mostly at weekends, as a result of late notifications of sick absence, when other staff or agency staff are unavailable to cover at short notice. As it is, the home has been making a lot of use of agency staff to uphold shift numbers. The inspector saw at first hand the procurement of agency staff at short notice. It is rare that agency staff are familiar with the home, and so there are problems about consistency for Southfield DS0000028318.V295174.R01.S.doc Version 5.2 Page 21 residents, and permanent staff having to spend time guiding and supporting the agency staff. In person and through questionnaires, residents made several references to staff being of good quality but under severe pressure of time. One had been let down on promises of being helped to take a bath during the absence of their key worker. Several said many staff still found time to offer a few minutes of conversation, but two who by choice spent most time in their rooms complained separately of feeling isolated by lack of contact, one of them observing further that residents with more obvious physical needs seemed to receive more attention than those with mental health needs. Some local Adult & Community Services staff expressed concerns during December 2005 about staffing levels, and staff retention, in the home, reflected in the complaints made at the time about levels of care and attention to residents placed for respite care. During the inspection there was interviewing in progress for a variety of posts. The manager was hopeful that a new Trust policy will tackle some of the absence issues and assist retention of staff. Another possibility being considered was introduction of a “head of care” post to support manager and care leader roles, enabling care leaders to spend more time delivering care alongside carers. The home had a current shortfall of one care leader, which was made up by other carers “acting up” to the role on some shifts. The manager agreed this necessity meant some watering down of competency in what is an important role. Twelve out of twenty-three care staff (day and nights) were NVQ qualified to at least level 2, with a further five working towards this and two working to achieve higher levels. All senior staff and the activities co-ordinators had received the Trust’s training course in dementia care, devised in association with the Alzheimer’s Society. Support to caring for people with other mental health needs was available from local community mental health resources on a needs basis, but formal awareness training would help staff to be alert to the more subtle needs that might be presented by some residents. It was established that recurrent mandatory training and staff supervision were being maintained despite the staffing pressures. For those staff recruited since previous inspection, there were detailed records of the interview process, statutory vetting procedures and induction. Staff spoken to considered their role to be very pressured, but were confident that the “resident of the day” scheme was acting as some guarantee that individual residents’ needs were not being overlooked. This development had the backing of both care and housekeeping staff. Another means of increasing care staff availability to residents was the use of a “care support” post, as part of housekeeping provision, to undertake tasks such as making beds. Southfield DS0000028318.V295174.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. 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. The manager gives a lead to how good standards can be attained, and demonstrates effective working relationships with staff at all levels. There is provision for safeguarding residents’ financial interests, where required. Provision for promoting health and safety is good, as are systems for seeking residents’ views on the service provided. EVIDENCE: Staff at all levels spoke highly of the lead they experienced from the manager, Val Weston, who also appeared to be familiar with the resident group. There was evidence of a sound working partnership between her and the administrator, who had just commenced duties at the previous inspection. All records were easily accessed. There is ongoing monitoring of management and care outcomes for residents by way of the provider Trust’s quality assurance Southfield DS0000028318.V295174.R01.S.doc Version 5.2 Page 23 systems, which include regular unannounced visits. One of these took place during this inspection. Six-monthly reviews for each resident provided management and key workers with good feedback on individual and whole home issues. It remained the manager’s intention to develop cluster group meetings for residents, but it was acknowledged that the staffing difficulties had hindered this process. The activities co-ordinators were said to be developing a newsletter to improve communication within the home. There was no change to the satisfactory arrangements for safe keeping of residents’ monies, where they or their families had requested this. A resident raised a query with a care leader about his financial arrangements. He received sympathetic reassurance, with reminders about paperwork that he had signed, and was then helped to see the administrator for further detailed explanation. In response to requirements made at the previous inspection, the home now had a delegated person to oversee fire safety. This had resulted in improved monitoring and thus attention to faults found, whilst staff fire training and experience of drills were up to date. An officer of the Fire Service conducted an inspection of the home during this inspection and was satisfied with arrangements and monitoring, subject to some change to the fire risk assessment. Provisions for other aspects of health and safety sampled in the home, such as environmental risk assessments and use of chemicals, were good. The “resident of the day” checklist included wheelchair and walking frame safety checks. Southfield DS0000028318.V295174.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 2 3 X 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Southfield DS0000028318.V295174.R01.S.doc Version 5.2 Page 25 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 OP9 Regulation 13(2) Requirement Protocols must be available for medicines used on an ‘as required’ basis. Medication administration records must accurately reflect their use. Doctors’ visits and medication changes must be recorded in the residents’ records in such a way as to enable easy reference. Correct signs must be displayed wherever oxygen is kept in the home. Timescale for action 30/06/06 2. OP9 13(2) 30/06/06 3. OP38 23(4)(b) 23/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 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 DS0000028318.V295174.R01.S.doc Version 5.2 Page 26 2. Southfield OP12 3. 4. 5. OP15 OP19 OP30 for those residents unable or disinclined to join group activities. Provide sauces and condiments at table, as appropriate to the meal being served. Apply suitable signage to assist residents’ orientation, especially to toilet doors. Seek opportunities for staff to receive awareness training in mental health issues besides dementia. Southfield DS0000028318.V295174.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Southfield DS0000028318.V295174.R01.S.doc Version 5.2 Page 28 - 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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