CARE HOMES FOR OLDER PEOPLE
Spetisbury Manor Spetisbury Blandford Dorset DT11 9EB Lead Inspector
Carole Payne Key Unannounced Inspection 09:30 22 and 25th May 2006
nd 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 Spetisbury Manor DS0000026768.V296842.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. Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Spetisbury Manor Address Spetisbury Blandford Dorset DT11 9EB 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) 01258 857378 01258 858384 Country House Care Limited Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. A maximum of four bedrooms from those listed may be used for shared occupancy at any one time: 1, 11, 15, 16, 19, 20 or 21. One named person (as known to CSCI) in the category of PD may be accommodated to receive care. Date of last inspection Brief Description of the Service: Spetisbury Manor is registered to provide personal care for a maximum of 25 older people in 21 rooms, 4 of which may be used as shared rooms by residents who have made a positive choice to share with each other. Mr Kevin Ellis is the Responsible Individual; he also owns another registered care home, Glenhurst Manor in Bournemouth. Spetisbury Manor has been without a registered manager since September 2004. However an application is currently being processed for Mrs Sally Scott to become the registered manager of the service. The home is situated on the outskirts of the small village of Spetisbury. Some residents frequently travel in the homes courtesy car to go shopping in Blandford, Wimborne and Poole. Spetisbury Manor stands in four acres of grounds laid to attractive gardens leading down to the river Stour. The accommodation is on three floors with a passenger lift serving the first and second floors. Eighteen bedrooms have en-suite hygiene facilities, and there are assisted bathrooms and toilets on each floor. Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out on 22nd and 25th May 2006 and took a total of 13 hours, including time spent in planning the visit. Carole Payne and Chris Main, pharmacist inspector, carried out the inspection. This was a statutory inspection and was carried out to ensure that the seventeen residents who were living at Spetisbury Manor were safe and properly cared for. Requirements and recommendations made as a result of the last inspection visit were reviewed. The premises were inspected and records examined. Time was spent in discussion with people living at the home, the management team and staff members on duty. Five residents and five staff members were spoken with and residents were observed enjoying the communal areas and spending time in individual rooms. Six service user survey forms were received, three relatives / visitor comment cards and two comment cards from members of the multi-disciplinary team serving the home. The pharmacist inspector checked five residents’ medicines with the records to see if they were given as prescribed and recorded correctly and spoke to the manager, one senior carer and a resident who was self-medicating. What the service does well:
Prospective residents feel that they receive the information that they need to make an informed choice about where they would like to live. The manager understands the importance of carrying out a thorough pre-admission assessment and in welcoming people to experience the service prior to making a decision regarding moving in. People can; therefore, feel confident that the home they enter will meet their needs. People living at the home are treated with care and respect, and their privacy and dignity is upheld. People living at Spetisbury Manor enjoy a variety of social, cultural and religious opportunities, which offer choices and meet with personal preferences. Residents spoken to agreed that the home is a pleasant place to be and offers a lifestyle which suits the individual. The service welcomes the involvement of family and friends and supports independence. Three comment cards were received from relatives / visitors to the home and all agreed that they feel welcome when they visit the service; that they can visit and meet in private with their friend or relative. Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 6 Residents receive a wholesome, appealing and nutritious diet, in pleasing surroundings. The ‘food is good.’ People who live at Spetisbury Manor and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Residents at the service enjoy the delightful surroundings of the Manor and its well-maintained gardens. All rooms have a unique character, and are furnished to a high standard. Matching soft furnishings complement each room, which are refurbished as they become vacant. The home has a good ratio of care staff who have achieved National Vocational Qualifications and has introduced the Skills for Care Induction training; thus working to ensure that residents are in safe hands at all times. One resident said that staff members ‘are very helpful.’ People living at Spetisbury Manor are satisfactorily supported and protected by the home’s recruitment policy and practices. The home presents as an open environment, where people work together to provide a special and supportive service. What has improved since the last inspection?
The service has made progress in bringing information together into a detailed service user’s guide. The format used for the pre-admission assessment has been updated since the last inspection. The new record more clearly examines and identifies the needs of prospective residents, and, therefore, the suitability of the service to meet their needs. Two comment cards were received from multi-disciplinary team members, and highlighted that, the home, in the past, had delayed contacting external services regarding the meeting of people’s needs with a mental health problem. One member of the healthcare team was spoken with and confirmed that, since the appointment of the new manager, their concerns had lessened, and that there was confidence in the capacity of the new manager to identify and refer needs when necessary. The new manager, supported by senior staff working in the home, has developed a new system of care planning, which now includes clear records identifying how a person’s health, personal and social care needs are to be met. Care plans are regularly reviewed on a monthly basis, or according to changing needs.
Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 7 Weights are now monitored and there was evidence of starting to monitor nutritional needs. The manager intends to resource a nutritional risk assessment tool to support the identification of risks, which are currently being monitored through the pre-admission assessment and within detailed care planning. Medicine allergies are now recorded on the Medicine Administration Record (MAR) charts. The manager had done one audit to check on administration of medication. The manager has updated the application form in use since the last inspection to meet legislative requirements and is currently reviewing the reference form in use to ensure that it clearly states the position of the person providing the reference. The home has been without a manager for sometime and has benefited from the appointment of Mrs Sally Scott, who has worked with the responsible individual and staff members at Spetisbury Manor to address requirements and recommendations. An application has now been received and is being processed for Mrs Scott to become the registered manager of the service. The manager has developed communication within the home and quality assurance to ensure that the home is run in the best interests of residents. What they could do better:
Individual risk assessments had not been completed on one of the files seen and the importance of completion as soon as possible after admission was discussed. The home should monitor fluid intake for residents at risk of dehydration in order to identify, monitor and respond to changing needs. The home’s policy for medication needs improving so that staff members have clear procedures to follow for all aspects of the handling and administration of medicines. There was concern about medicines being given on the day without reference to and recording on the Medicine Administration Record (MAR) chart and an immediate requirement was made that staff must follow correct procedures for giving medicines so that residents are not put at risk of their medicines being given incorrectly. The home is putting in place appropriate procedures and training, which will support the protection of residents from abuse. Risk assessments must be completed for radiators, portable heaters and water outlets, which present a risk of scalding and appropriate action taken according to the outcome.
Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 8 It is required that the laundry room be enlarged and improved to ensure that the home has sufficient facilities for laundering and control of infection. The Responsible Individual must arrange for the home to be visited at least once each month to inspect the premises, interview, with their consent, residents and staff and must provide to the Commission a written report on the conduct of the home. This is an outstanding requirement and the inspector agreed to forward proposed formats to complete the reports. The manager confirmed that a lot of mandatory areas of training currently require updating. She intends to produce a summary sheet of the current status of care staff working in the home, so that training needs can be identified and a learning and development plan put in place. The manager has started to hold supervision with staff members and as part of this is looking at reviewing training needs and planning future provision. The new Skills for Care induction programme has been implemented in the home. The manager discussed the reflection of progress within the record keeping, rather than simply signing off competencies. Hazardous substances must be securely stored at all times and an environmental risk assessment must be completed to promote the safety of people living in the home. 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. Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Prospective residents feel that they receive the information that they need to make an informed choice about where to live. The service has made progress in bringing this information together into a detailed service user’s guide. The home emphasises the importance of carrying out a thorough preadmission assessment and in welcoming people to experience the service prior to making a decision regarding moving in. People can; therefore, feel confident that the home they enter will meet their needs. EVIDENCE: There has been an outstanding requirement regarding the provision of information in a service user’s guide. Most of the items detailed in the relevant regulation and standard are provided as part of the home’s pre-admission process. The manager provided records, which are made available to potential residents; these include the home’s statement of purpose, terms and
Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 11 conditions, the complaint’s procedure and the address and telephone number of the Commission. Since the inspection the manager has submitted copies of the service user’s guide and statement of purpose, which include the outstanding items required by regulation. These revised documents will be provided to prospective residents. The home is in the process of producing a larger document, which will be the home’s service user’s guide. Resident survey forms returned confirm that people feel that they receive sufficient information about the home prior to moving in. The format used for the pre-admission assessment has been updated since the last inspection. The new record more clearly identifies the needs of prospective residents, and, therefore, the suitability of the service to meet their needs. Three pre-admission assessments were viewed for people who had recently moved into the home. Information had been obtained from the hospital with regard to the care needs of one resident. The manager had not gone to meet with the person and carry out the assessment. The manager said that she had learnt from this experience, that, wherever possible, it is essential that an assessment is carried out by meeting with prospective residents. Two other residents had visited the service on more than one occasion, and had the opportunity to experience what it is like to live at Spetisbury Manor before making a decision regarding moving in. During the inspection visit, a person came to look around and the manager took time to show, and discuss with the person, the home’s facilities. She also outlined that she must undertake an assessment and meet with the prospective resident, prior to being in a position to offer a place. Letters were seen of dialogue between the manager and people who were considering Spetisbury Manor, as a place where they would like to live. From the letters people feel that Spetisbury is very welcoming and that opportunities to spend the day, have tea, or generally experience the service, is helpful in enabling them to make a decision about moving in. Letters were seen on individual files, confirming with residents, that according to the assessment carried out, the home was able to meet their needs. Two comment cards were received from multi-disciplinary team members, and highlighted that, the home, in the past, had delayed contacting external services regarding the meeting of people’s needs with a mental health problem. One member of the healthcare team was spoken with and confirmed that, since the appointment of the new manager, their concerns had lessened, and that there was confidence in the capacity of the new manager to identify and refer needs when necessary. Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home is developing good record keeping practices. These support staff members to meet residents’ health, personal and social care needs. The home has a proactive approach to meeting people’s healthcare needs. The home is making progress in addressing recommendations made regarding the safe administration of medicines at the last inspection. The medication policy and some procedures for handling and administering medicines need improving to protect residents. People living at the home are treated with care and respect, and their privacy and dignity is upheld. EVIDENCE: Care plans were reviewed for four people living in the service. Three had recently moved in and one resident had been living at the home for some time, prior to the new manager starting work.
Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 13 The new manager, supported by senior staff working in the home, has adopted a new system of care planning, which includes clear records identifying how a person’s health, personal and social care needs are to be met. Care plans are regularly reviewed on a monthly basis, or according to changing needs. There was direct evidence on two of the files of involvement of the resident, in looking at risks and making choices regarding care to be provided. Relative / comment cards state that if their relative / friend is unable to make decisions for themselves they are consulted about care. Individual risk assessments had not been completed on one of the personal files seen and the importance of completion as soon as possible after admission was discussed. However, the care planning process clearly identifies both individual and specific risks and how the home is going to implement care to ensure that these risks are minimised, whilst considering residents’ rights to make choices about daily life. Residents’ healthcare needs were included in care planning and, where appropriate, there were records of consultation with outside external healthcare professionals. For example the home liaises with a local rehabilitation team. In relation to specific healthcare issues the home looks at how it can respond to those issues and adopts a preventative and proactive approach, promoting well-being. Weights were monitored in records seen and there was evidence of nutritional monitoring and response to identified dietary requirements, for example in relation to the provision of a specialist diet. The manager intends to resource a nutritional risk assessment tool to support the identification of risks, which are currently being monitored through the preadmission assessment and within detailed care planning. The manager agreed that the monitoring of fluid intake for residents at risk of dehydration would support the home to identify, monitor and respond to changing needs. Recommendations made regarding the safe administration of medicines were reviewed. Handwritten entries seen on Medication Administration Records sampled had been signed and dated by the writer and countersigned. The home now has copies of guidance issued regarding medication, their purpose and possible side effects, which are stored collectively. The home has not currently resourced suitable training for some staff in the safe handling of medicines. The manager described how this means that medicine is put out for one resident, who is due medication in the evening as the member of staff is not trained in the safe handling of medicines. The manager said that to avoid secondary dispensing the medication would be given by a trained member of staff leaving the home following the evening shift, or the live in carer if the medication needed to be given later. The home has a medicines policy but it does not provide guidance for staff on some aspects of the handling and administration of medicines. Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 14 Three residents were self-medicating and one seen kept their medicines safely. There was no risk assessment or record of regular monitoring and guidance on this provided. MAR charts were not signed to record that the morning medicines had been given on 25th May 2006 but the doses were missing from the blister packs. The carer who had given medicines said that there was a problem at breakfast time so she had given the medicines but did not take the charts with her to refer to and sign. Medicine allergies were recorded on the MAR chart and a second member of staff had countersigned to indicate that handwritten entries were checked. One that was not correct was amended the same day and had not been given incorrectly. This resident’s medicines were received in loose strips without labelled directions and there was no written confirmation of the medication they were currently taking but staff said they had checked with the pharmacy. The quantities of some medicines received were not recorded to provide an audit trail. Another resident’s medication was provided in a cassette that was not filled and labelled by the pharmacy or dispensing doctor. There was one tablet missing each day according to the labelling on the cassette. The medicine was not signed as given on the last few days but there was no explanation. The senior carer agreed to check whether the doctor had stopped this medicine. When a choice of dose was prescribed staff did not record the dose they gave except for warfarin. There was no record of when packs of warfarin were started so I couldn’t confirm that it was given correctly as recorded. Staff had recorded a discrepancy in one resident’s medicines on return from holiday but they should record the quantities of all medicines leaving and received in the home to complete the audit trail. The home keeps witnessed records of Temazepam but does not have a Controlled Drugs (CD) record book and advice on obtaining one was provided. Medicines were stored securely but there was no secure fridge storage or means of monitoring the temperature if residents had medicines needing refrigeration. One of 8 staff members, who give medicines, has done a medication course and the manager said that others have been trained in the home but there was no assessment of competence. The home had reference books on medicines for staff to refer to. Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 15 The home keeps a good record of errors or problems identified with medication. The manager had audited medication and a report of her findings and follow up action was seen. Throughout the visit staff members were observed treating residents with great care and respect; promoting privacy and dignity. Staff members knocked on residents’ doors before entering, consulting with residents regarding their choices and preferences and used residents’ preferred term of address. Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. People living at Spetisbury Manor enjoy a variety of social, cultural and religious opportunities, which offer choices and meet with personal preferences. The service welcomes the involvement of family and friends and supports choice and independence in daily life. Residents receive a wholesome, appealing and nutritious diet, in pleasing surroundings. EVIDENCE: The home has a varied range of social and recreational opportunities available for residents to enjoy. On the day of the visit, several residents had gone out on a shopping trip. One resident was enjoying a visit from a relative and they were spending time together in the person’s room. Another was enjoying reading the papers and taking in the delightful views out across the home’s gardens, to the river and hills beyond. Residents spoken to agreed that the home is a pleasant place to be and offers a lifestyle which suits the individual. Five of the six survey forms returned agreed that people do what they would like to during the day. A monthly plan of activities is produced and is
Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 17 displayed in the home and a copy given to each resident. Events available include exercise classes, quizzes, Holy Communion and visits from singers and entertainers. The recording of individual participation in activities and interaction was discussed, so that the home can monitor individual needs and respond appropriately to those needs identified. Three comment cards were received from relatives / visitors to the home and all agreed that they feel welcome when they visit the service; that they can visit and meet in private with their friend or relative. Residents’ choices about the care they receive were reflected in care plans seen; for example in relation to discussing with the resident how best to minimise a presenting risk and the reflection of personal social interests within the care planning process. In considering risks the completed risk assessment, involved the resident in making personal choices and exercising control over their lives. Rooms visited had been personalised with special possessions. On the day of the visit, the lunch menu was displayed. Some residents enjoyed eating in the home’s dining room. Tables were well presented and there was a pleasant atmosphere as residents enjoyed sharing a meal together. Dietary needs are assessed prior to admission and inform the process of planning supportive care in relation to any specialist needs; for example for those residents needing a diabetic diet. Residents’ views are listened to regarding the food provided. Records of resident meetings showed that the views of people living in the home are taken into consideration in future planning of menus. One resident survey form had highlighted that the person felt that it was a long time between supper and breakfast. The manager said that snacks are available on request, and that she would ensure that the issue was raised at the next residents’ meeting. Although one resident said that they did not feel that there was a choice of menu, the manager confirmed that residents are asked each morning if they would like the meal available or an alternative and records of meals provided supported this. She confirmed that residents would be reassured of this. Spetisbury Manor DS0000026768.V296842.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 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 adequate. This judgement has been made using available evidence including a visit to the service. People who live at Spetisbury Manor and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. The home is putting in place appropriate procedures and training, which will support the protection of residents from abuse. EVIDENCE: Information regarding how to make a complaint is displayed in the home’s reception area. A complaints’ log is also maintained. One complaint had been received since the manager had taken up her post. The record of the complaint was clear and the manager said that she intended to ensure that information regarding the outcome of the complaint is recorded, with particular regard to the settling of any issue to the satisfaction of all parties involved. All six resident survey forms returned said that people know who to speak to if they are not happy and how to make a complaint. Relatives and visitors also agreed that they were aware of the homes complaints procedure. The home has an adult protection policy, which at the time of the inspection was under review. The manager has undertaken to remove a reference to allegations of abuse being investigated by the person in charge, which conflicts with later guidance regarding referral, as appropriate, to social services for
Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 19 investigation. The policy must reflect the local guidance. Staff members have been undertaking an adult protection course, which is supported by a questionnaire. The manager confirmed that, so far, five members of staff have completed the course and four remain to undertake the training. Spetisbury Manor DS0000026768.V296842.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. People living at Spetisbury Manor live in delightful surroundings. Attention to areas of safety within the environment is required within this report; uncovered radiators, portable heaters and hot water from basin outlets potentially compromise safety and put residents at risk of scalding. The home is very clean and pleasant, and presents with the warmth of ‘home.’ The laundry facilities are, however, inadequate. EVIDENCE: Residents at the service enjoy the delightful surroundings of the Manor and its well-maintained gardens. All rooms have a unique character, and are furnished to a high standard. Matching soft furnishings complement each room, which are refurbished as they become vacant. The home’s maintenance
Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 21 person was on duty on the day of the visit, and clearly takes great pride in his role, which also includes driving the home’s vehicle. The manager outlined plans to refurbish the home’s dining room and create an orangery. Some radiators in the home remain uncovered and it was noted that one radiator in a residents’ room was too hot to touch. The position of the radiator presented a risk of scalding. The manager took immediate action to adjust the temperature of the radiator. A portable heater was also seen in a suite of rooms, in one area where the central system is not adequate to keep the room at a comfortable temperature. The use of the portable heater and exposed radiator surfaces must be risk assessed and action taken to protect residents from the risk of scalding and to ensure that adequate fixed heating provided. The manager confirmed that all bath and shower water outlets have been fitted with temperature control valves. The water emitted from one basin water outlet in the en suite of an empty room was very hot to touch. Individual water outlets must be risk assessed and according to the outcome, valves fitted to control the temperature to a safe level. All areas of the home visited were clean, hygienic and free from offensive odours. The home has a very small laundry, with little space to manoeuvre. There is one domestic washing machine and tumble dryer. Some folded laundry was in the corridor. A recommendation has been made in the last six inspection reports, regarding enlarging the laundry facilities. Feedback during the visit was that the facilities are inadequate. It has been noted that there is insufficient room to safely prevent cross contamination. Given that the home is registered for twenty-five residents, one domestic washing machine and the limited space available is inadequate to meet the needs of people living in the home. This could potentially compromise infection control procedures; provision of adequate facilities is a requirement in this report. Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 22 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The number of staff working in the home meets residents’ needs. The home is making progress in identifying training needs, and implementing a plan of statutory training. The home has a good ratio of care staff who have achieved National Vocational Qualifications and has introduced the Skills for Care Induction training; thus working to ensure that residents are in safe hands at all times. People living at Spetisbury Manor are satisfactorily supported and protected by the home’s recruitment policy and practices. EVIDENCE: On the day of the visit the manager was on duty with four healthcare assistants. A member of domestic staff was not on duty, so the responsibility for undertaking cleaning was being undertaken by care staff members. The manager said that she is currently monitoring staffing levels, as occupancy levels are increasing. Cover from five to eight has been put in place in addition to a further two staff members on duty during this period. Currently there is one awake and one sleep in member of staff on duty at night. The manager said that this currently satisfactorily meets the needs of residents accommodated; none of whom require the assistance of two people with
Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 23 activities of daily living. Feedback cards from relatives and visitors state that in their opinion there is always sufficient staff on duty. At the time of the visit six staff members held a National Vocational Qualification of the ten care staff working in the home. A further member of staff has started an NVQ programme at level 2. Three staff files were seen. The files contained items as required by legislation. The manager has updated the application form in use since the last inspection to meet legislative requirements and is currently reviewing the reference form in use to ensure that it clearly states the position of the person providing the reference. The importance of acquiring a reference from the person’s last employer was discussed. The manager has started to look at training needs of care staff working in the home. She confirmed that a lot of mandatory areas of training currently require updating. She intends to produce a summary sheet of the current status of care staff working in the home, so that training needs can be identified and a learning and development plan put in place. The manager has started to hold supervision with staff members and as part of this is looking at reviewing training needs and planning future provision. The new Skills for Care induction programme has been implemented in the home. The manager discussed the reflection of progress within record keeping, rather than simply signing off competencies. Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 24 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, 32, 33, 35, 37, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home has been without a manager for sometime and has benefited from the appointment of Mrs Sally Scott; working with the responsible individual and staff members at Spetisbury Manor, it is clear that there have been areas of significant improvement. The manager has developed communication within the home and has looked at areas of operation to ensure that the home is run in the best interests of residents. Residents’ financial interests are safeguarded. Aspects within the environment, failure to promote safe working practice at all times and the absence of an environmental risk assessment potentially compromise the health, safety and welfare of residents. Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 25 EVIDENCE: The new manager, Sally Scott, has submitted an application for registration. Mrs Scott is an experienced practitioner, with health and social care qualifications. From discussions with staff on duty and Mrs Scott she has quickly established a good rapport both with staff and residents. Both she and senior members of staff working in the home are working together to address requirements and issues raised in previous reports. The home presents as an open environment, where people work together to provide a special and supportive service. The manager has introduced a variety of tools with which to audit the service and enhance the quality of care provided. Regular meetings are held with residents and staff members. From minutes recorded, comments and issues raised are taken forward and used in future planning. As part of this inspection the manager distributed feedback forms to people who are involved in the life of the service. A small number of internal questionnaires had also been returned since the last inspection. The manager intends to review the format and content to focus on key areas of the home’s operation, to collate and distribute the results of audits, with an action plan, where necessary. The responsible individual has not completed Regulation 26 visit reports as required in previous inspection reports. The manager confirmed that Mr Ellis visits the service regularly and takes a continuing interest in the day-to-day operation of the service. CSCI guidance has been forwarded to the manager regarding regulation 26 reports. Efficient records are kept for monitoring fire systems in the home. The manager has reviewed documentation for the maintenance of equipment and facilities in the home and ensured that up to date servicing of all items has been satisfactorily undertaken. An audit of accidents had been undertaken and the manager had taken action as a result of trends observed and made staff members aware of the results of the audit. As noted previously the manager intends to undertake an audit of staff files and plan future mandatory training in areas of safe working practice in the home. (standard 30.) Hazardous substances were stored in an unlocked cupboard in the kitchen. No one was in attendance in this area. The door to a steep stairwell on the ground floor corridor was also unlocked. This potentially presents a hazard to residents. The manager had placed instructions on both these doors that the entrances be kept locked at all times. Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 26 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 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 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 2 3 x x x x x 1 1 STAFFING Standard No Score 27 3 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 x 3 x 1 1 Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Timescale for action The registered person shall make 25/05/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received in the care home including: Recording the administration of medicines at the time they are given and the dose if a choice is prescribed. This was issued as an immediate requirement at the time of the inspection. 2 OP9 13 Staff must record the quantity of all medicines received in and leaving the home and the audit trail for medicines must be able to evidence that medicines are given as prescribed and recorded. There must be a risk assessment for residents who self- medicate
Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 28 Requirement 30/06/06 3. OP18 12 The Registered person must ensure that there are robust and up to date procedures in place for responding to the suspicion or evidence of abuse. Information must be available regarding No Secrets, Public Information Disclosure Act 1998 and contact details for CSCI. Two previous timescales for this requirement have not been met. The manager confirmed that she was aware of this and will be addressing it. Failure to comply may result in enforcement action. Progress is being made in meeting this requirement. The timescale for meeting this requirement has not lapsed. Risk assessments must be completed for radiators, portable heaters and water outlets, which present a risk of scalding and appropriate action taken according to the outcome. The Registered Person must ensure that foul laundry is appropriately sluiced prior to washing. The laundry room must be enlarged and improved to ensure that the home has sufficient facilities for laundering and control of infection. This has been recommended in six previous inspection reports. This is now a requirement. A summary of training must be compiled and according to the outcome, a learning and development plan produced and implemented to include updating in all aspects of mandatory training.
DS0000026768.V296842.R01.S.doc 30/06/06 4. OP25 13 30/09/06 5. OP26 13 30/09/06 6. OP30 18 30/09/06 Spetisbury Manor Version 5.2 Page 29 7. OP37 26 The Responsible Individual must arrange for the home to be visited at least once each month to inspect the premises, interview, with their consent, residents and staff and must provide to the Commission a written report on the conduct of the home. The timescale for meeting this requirement has not lapsed. Hazardous substances must be securely stored at all times. An environmental risk assessment must be completed. 30/06/06 8. 9. OP38 OP38 13 13 15/06/06 30/09/06 Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 30 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 Nutritional screening must be undertaken on admission and on a periodic basis, a record maintained of nutrition & appropriate action taken. Progress has been made in meeting this recommendation. The home should monitor fluid intake for residents at risk of dehydration in order to identify, monitor and respond to changing needs. The home should follow guidance from the Royal Pharmaceutical Society including: a) The medicine policy should be updated (see guidance provided). b) The home should have written confirmation of a resident’s medication on admission (e.g. hospital discharge summary or copy of their prescription) and any changes to it during their stay e.g. fax, or a copy of the new prescription. c) Staff should not re-label medicines or give medicines from containers filled other than by the pharmacist or dispensing doctor. d) The home should have a CD record book for recording CDs. e) The home should have a medicine fridge, or means of storing medicines needing refrigeration securely, and monitor the maximum and minimum temperature daily when in use. f) Staff members, who give medicines, should have training appropriate to their role and be assessed as competent. There should be a written summary of all medicines prescribed for each resident, describing purpose and possible side-effects. The home has made progress in meeting this recommendation. 2. 3. OP8 OP9 4. OP9 Spetisbury Manor DS0000026768.V296842.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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