Inspection on 19/01/08 for St Joseph`s Care Home

This inspection was carried out on 19th January 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Joseph`s Care Home 12/01/09

St Joseph`s Care Home 26/01/07

St Joseph`s Care Home 18/01/06

St Joseph`s Care Home 29/07/05

St Joseph`s Care Home 23/02/05

St Joseph`s Care Home 20/07/04

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

CARE HOMES FOR OLDER PEOPLE St Joseph`s Care Home St Joseph`s 38-40 Hindes Road Harrow Middlesex HA1 1SL Lead Inspector Clive Heidrich Key Unannounced Inspection 10:30 19 and 24th January 2008 th 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 DS0000038579.V354794.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. DS0000038579.V354794.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Joseph`s Care Home Address St Joseph`s 38-40 Hindes Road Harrow Middlesex HA1 1SL 020 8863 2868 020 8427 2146 vsaunders@hazelwoodcare.co.uk 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) Hazelwood Care Ltd Vera Saunders Care Home 19 Category(ies) of Dementia - over 65 years of age (19) registration, with number of places DS0000038579.V354794.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either whose primary care needs on admission to the home are within the following category: 2. Dementia - Code DE(E) The maximum number of service users who can be accommodated is: 19 26th January 2007 Date of last inspection Brief Description of the Service: St Josephs is a privately-owned care home for up to 19 older people who have dementia or related conditions. The home is part of the Hazelwood Care Organization. There were three vacancies at the time of this inspection. The home is a conversion of two semi-detached houses that interlink on the ground and first floor. Access at the front of the home can be assisted via a mobile ramp across the two steps. Resident accommodation is on the ground and first floors, with seven bedrooms downstairs including two double rooms. There is also accommodation provided on the second floor for four live-in staff. Access to the first floor is by stairs, or chair-lift on the house #40 side. The large lounge and dining area is split into two distinct sections. There is a private garden of a reasonable size to the back of the home. The home is situated close to local shops and transport facilities. There is a small, open forecourt at the front that has some parking facilities. Parking restrictions apply on the road outside the home. The Service User Guide and fee range are available from the home on request. At the time of finalising this report, the fees ranged between £485 and £630 a week. DS0000038579.V354794.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The service was requested to complete an Annual Quality Assurance Assessment (AQAA) well in advance of the inspection. This provides the service with the chance to explain how it meets the National Minimum Standards. The AQAA was duly returned to the CSCI in good time. Surveys were sent to the home after receipt of the AQAA. These were distributed by the manager. Surveys were returned from nine residents including some with help from relatives or staff. Surveys were also received from three relatives and three staff members. Their views have been incorporated throughout the report. The home received an unannounced inspection on Saturday 19th January that lasted for just under seven hours. During this period, the inspector met with residents, staff, and some relatives present. Most areas of the environment were checked. Two hours were spent observing the care being provided to some of the residents in communal areas, with consequent checks of relevant care files and further discussions with staff. A second and planned visit was then made to the home on Thursday 24th January, to meet with the manager to discuss findings, to check other records, and to provide overall feedback. This lasted just over four hours. The inspector thanks all involved in the home for their patience and helpfulness before, during, and after the inspection. What the service does well: There are good standards of interaction between staff and residents overall, with for instance residents always being listened to when they spoke. There was much positive feedback about staff, for instance one relative stating, “I know they are special staff and have seen how good they are with the elderly.” Another noted, “My mother says it all: They are very nice people here.” Feedback in general from relatives and residents was very positive. Residents’ health needs are generally addressed by the home, liaising with community health professionals where needed. Residents are protected by the home’s established medication procedures. DS0000038579.V354794.R01.S.doc Version 5.2 Page 6 Residents can expect to have their needs assessed, through a visit by the manager, before being offered admission. Management ensure that needs can be met before offering admission to the home. The converted building provides residents with a comfortable, warm and clean environment with reasonable communal space and washing areas. A number of environmental adaptations are installed, including a walk-in bath and a chairlift. Residents benefit from a good standard of leadership and management in the home, including through a manager who is spends time with residents, and who provides good support for staff. As one relative noted, “In my opinion the manager and staff do an extremely good job.” What has improved since the last inspection? There are a significant number of improvements. A couple of relatives noted, “The manager seems to be making lots of improvements which I notice from time to time”, and “New manageress had made some improvements to the good.” Activities are now provided to residents in both the morning and the afternoon. As one relative noted, “They try their best to keep them happy and give as much attention as they need.” Efforts have been made to find activities that individuals enjoy, and much equipment has been bought to try to meet those preferences, for instance a karaoke machine, new games, and a DVD with preferred films. This all helps residents’ well-being. Life histories of residents are being better explored with relatives and friends. This helps to understand behaviours, and to provide more-individualized care. Environmentally, there are new carpets in the lounge, more-attractive radiator covers, a designated visitors’ room upstairs, and antibacterial hand-gel units in key areas to help prevent cross-infection. Much redecoration has also taken place. As one relative noted, “They have been improving the home recently i.e.: bedding, duvets and painting. They made my mum’s room look much nicer.” A professional quality-auditing service has been purchased. This independent auditing of care, including through consultation with residents, relatives, and staff, should help identify strengths and weaknesses of the service. There has been much training provided to staff, including in the areas of medication, manual handling, and abuse-prevention. Half of the staff team have also worked through a specific dementia-care qualification via a local college, all of which should enable improved standards of care for residents. DS0000038579.V354794.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000038579.V354794.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 DS0000038579.V354794.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 5. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. Prospective residents and their families are provided with a good standard of written and face-to-face information before making decisions about moving in. This includes through the home’s management visiting, and making assessments of needs, preferences, and life-history. People are encouraged to visit the home to assess its suitability for the prospective resident. People who move-in can expect to have their individual needs met. EVIDENCE: The manager explained that prospective new residents and their families are invited to the home, for coffee or a meal, to see how they like it, and to see how people interact. She noted that she always visits the prospective person and their representatives to assess needs and preferences, regardless of receiving official paperwork about the person, so as to have a clearer picture of the support that person would need. There was paperwork within individual DS0000038579.V354794.R01.S.doc Version 5.2 Page 10 residents’ files to reflect these pre-admission assessments, and a relative was able to confirm about these assessment and visiting processes as much as possible. There was reasonable evidence, within care files of new residents, that detailed life histories are being better sought. The manager showed a specific form that was recently introduced, via their new quality assurance package, from which to acquire considerably more detail and hence plan better services based on the increased likelihood in dementia care for past history to influence present behaviours. For instance, it helped to identity that one new resident likes to read the newspaper in bed and get-up later in the morning. These forms have also been circulated to representatives of current residents, which is encouraging, as it should enable better understanding and more-individual services to current residents. Survey feedback from residents and relatives found good levels of satisfaction about receiving enough information in advance of making decisions about moving into the home. The manager confirmed that the home’s written Service User Guide is provided before the decision is made, which is informative. The Guide has been updated to reflect the new manager and alterations to care approaches including information about dementia care. Feedback from relatives and residents found satisfaction about residents’ needs being met in the home. For instance, one relative stated that, “They care for my relative very well” whilst another explained how their partner had made significant improvements since moving into the home. The inspector noted also a good general standard of ongoing training for staff including a specific and detailed long-term dementia care course that half the team have completed. The observations during the visit established that it was rare for residents to show lengthened signs of negative well-being. This reflects positively on the care practices provided at the home. The overall evidence suggests that the home is capable of meeting individual needs of people who move in. DS0000038579.V354794.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. Each resident’s main needs are set out in an individual plan of care that is kept up-to-date. Health needs are generally monitored and responded to, albeit that pro-active monitoring is not always effective in acquiring the desired outcome for some residents. Medications are appropriately looked-after. Residents are generally treated respectfully, however shortfalls with respect to the most dependent residents are identified. EVIDENCE: The care plans and files for three residents were checked. Each was found to have a summary care plan stating needs and support, backed by more detailed information that included such things as how faith needs are met, how to address key health needs, and what to do if the person becomes confused. There were assessments of risk for skin care, manual handling, physical dependency, and falls. These all generally had monthly reviews taking place, although there tended not to be any significant changes noted. DS0000038579.V354794.R01.S.doc Version 5.2 Page 12 It is recommended that staff receive training on how to use care plans to achieve better personalized outcomes for residents, as individual care files did not always match the individualized care being received by residents. It was encouraging that all nine resident surveys stated that they always receive the medical support that they need. Notifications to the CSCI showed prompt responding to health issues and of no hesitation to call an ambulance. Staff were aware of any minor ailments that any residents had, according to feedback at the visit. An ongoing record of communication about such issues is kept within a designated book for staff. There were observations of the use of pressure care equipment for individual residents, and of staff addressing and prompting residents for continence needs throughout the visit. One resident was seen to have extended toe-nail growth during the first day of inspection. Staff fedback about the ongoing efforts to acquire professional chiropody care for this person, which the manager confirmed on the second day of visiting along with stating that a professional had now visited to address the issue. She was looking at long-term methods of acquiring better care in this area for all residents. This must be established, so that foot care for each resident is consistently addressed when need arises. The resident above did not have any clear records of chiropody input within their care records. All residents have a health section in their care files, which showed involvement of the psychiatrist, optician, and the GP within the three files checked. The manager holds a separate appointments book, to monitor overall concerns and professional input, which showed much more evidence of GP involvement for such things as infections and other signs of illness. However there was often no record of this involvement, or the outcomes, within the health section of residents’ files. This could affect the consistency of care for the resident, which must be addressed. The home continues to use a blister-pack medication system for medication that is looked after for residents. No-one self-medicates, although that option is available under assessment. The medication was seen to be securely and tidily stored, with no evidence of stockpiling. Checks of three residents’ medications against record sheets found all prescribed medications to be available and records to be up-to-date. Records also included about delivery and returns, in sufficient detail to audit medication straightforwardly. Prescribed medications for individual residents on an as-needed basis are used but should have details of exactly what the medication is for, to assist staff to provide it at an appropriate time. Over-the-counter medications are also available when needed, for which individual guidance that is GP-approved is in place, and for which appropriate records are kept. DS0000038579.V354794.R01.S.doc Version 5.2 Page 13 All applicable staff received additional competency training from the pharmacist during 2007. This training will be provided annually, with the pharmacist contracted to inspect medication systems twice a year. The feedback about care provided in the home was very strongly positive. Residents spoken with during the visits praised staff. Surveys found all resident surveys stating that staff are available when needed, and that staff always act on what the resident says. Observations during the visit confirmed this, for instance staff asking and guiding a resident with what to do to stand up, and staff always responding when a resident asked a question or spoke to them. Relatives’ surveys found that the home always provides the support expected, one person for instance stating, “Most important of all is the care they show for the residents.” Observations, feedback and records established that there are a few residents who walk around a lot in the home, by day or by night. It was encouraging that residents were free to walk around as they wished, with staff being aware of where individuals were but seldom discouraging the resident by for instance telling them to sit down. There was also feedback about work with community professionals and amongst the staff, which had enabled one resident to sleep for some hours at night instead of being awake throughout. Conversely, it was also evident that a few residents walk in and out of others’ rooms, for instance to look out of the window at the street outside. There were recent records of one resident being distressed about another coming into their room at night. Observations of care practice also found some concerns with how the most dependent residents are treated. Whilst it was clear that these residents were included in what was going on, there were instances observed of staff undertaking care tasks for more-dependent residents without talking to them, of staff asking residents questions but not waiting for the answer, and of one resident with a tea-stained top not having the top changed with taken to the toilet. It was also found that more-dependent residents tended to receive less interaction from staff, or anyone else, over time. These shortfalls of privacy and dignity were discussed with the manager. There were in context many strong aspects of care and interaction, with lessdependent residents clearly receiving and initiating many positive interactions with staff and other residents for instance. However, it was clear that more could be done to alter the environment which might help with privacy intrusions and assist mobile residents to orientate themselves better, and for staff to be better aware of meeting the needs of more-dependent residents. DS0000038579.V354794.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. Residents’ lifestyle choices are generally very well respected, with only safety considerations occasionally causing restrictions. The home provides an excellent standard of recreational opportunities, clearly understanding the link between involvement and well-being. Reasonable contact with the local community is enabled, and visitors are made very welcome. A choice of homecooked meals is provided based around residents’ preferences. EVIDENCE: Residents’ surveys fedback very strongly about the activities arranged by the home, everyone stating that they can join in. One person stated that there are “new activities I enjoy.” This tallied with the paperwork supplied in advance, which noted about there being new activities through exploration with residents, that something takes place every morning and afternoon, and this helps improve and maintain well-being amongst residents in general. During the first day of visiting, it was evident that there was a lot of staff support for providing residents with activities. The main provision was a DS0000038579.V354794.R01.S.doc Version 5.2 Page 15 singing and percussion session in the morning, with songs such as ‘My Old Man’ and ‘Underneath the Arches’, which most residents joined in with. Some residents clearly led the way at times. In the afternoon, the main dining table was full with residents, a visitor and a staff member playing bingo. Residents were also seen to go outside for a cigarette, chat amongst themselves and with staff, throw balls with staff, be led by staff for arm exercises, and walk around. Staff were keen to inform the inspector about a new karaoke machine that has proved popular with many residents, and in general about improved activities. The manager noted that much effort has been put into this area, for instance with providing skittles, a much larger snakes and ladders board for ease of use, and a DVD with older films. She noted the garden will be more used this summer, as games and a gazebo are ready to be used. She noted also that activities in the community need to be developed further in particular. One relative confirmed that some residents are taken to the local supermarket just down the road. During the morning it was noted that in the main lounge, there was a clash of noise from the television and the radio. Good practice in dementia care includes the need for there to be areas of communal space that are quiet, which would not have been possible at this identified time. Consideration should be given to lounge arrangements, so that residents can move to consistently quiet areas if so wished. The manager noted that residents’ anniversaries are celebrated. For instance, a private meal with candles and other atmospheric touches was recently provided for one resident and his wife. Birthdays are similarly celebrated. A local church is getting involved to provide a befriending service to residents who have less contact with family and friends. This is in addition to regular visits of a priest for communion, which one relative confirmed happens every Sunday. The manager noted that a cellist played to residents on Christmas Day, through liaison with a local church. The home continues to have an external entertainer visit every fortnight, for songs and dancing. A couple of relatives noted that the home is always welcoming of visitors. This was observed during the visits. Staff were seen to enable residents to have choice and control over their lives. Residents were kept informed, for instance about a planned visitor when it was confirmed that the visitor would be coming. Staff spoke to residents when making requests of them, and generally listened to and respected responses. The manager fedback about, for instance, carpet samples being acquired to enable residents to make a choice of colour for the new lounge carpets, about one resident’s wish not to have male carers for their care being respected, and about residents’ meetings. Staff noted that some residents forget that they’ve had a drink or a meal just recently. Rather than attempts at orientation that DS0000038579.V354794.R01.S.doc Version 5.2 Page 16 could cause anxiety, the requests are provided for. Relatives’ surveys indicated that residents are able to live the life they choose where possible. Checks of bedrooms and discussions with staff established that most residents have personal toiletries and items such as toothbrushes kept individually but separately in a designated area of the home. This was discussed with the manager as it fails to enable independence, and as staff explained that it is partially a response to one resident who goes into rooms and rearranges things. The manager noted other safety issues behind the decision, but agreed that there were no records of discussion and agreement about this. Each resident’s personal items must be available to them and kept in their room, unless there are clear safety reasons to do otherwise, which must then be discussed with the resident or appropriate representative and recorded about within their care file. The menu for the day, a choice of two meals, was written on a marker-board during the midmorning. The options for lunch were minced beef and onions with creamed potatoes, carrots and gravy, or beef burgers with potatoes and peas. Home-made dessert was also provided. Residents tended to eat the meals fully, whether with staff support or by themselves. One resident confirmed that they are asked what they’d like to eat, which was the general attitude observed of staff across lunch. Residents reported overall that they like the meals in the home. It was also apparent that residents could ask for and receive snacks in-between meals, and that a choice of meals has been introduced for the evening in addition to lunch. . DS0000038579.V354794.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. People using the service are confident that any concerns and complaints would be acted on appropriately. Residents feel safe in the home. There are procedures in the home to protect residents from abuse and to respond to any concerns in this respect. EVIDENCE: The home has an established complaints procedure that is available for viewing within the Service User Guide. Surveys established that residents capable of providing answers generally know how to make complaints and raise issues if unhappy. Relatives’ surveys were entirely positive about what to do with a complaint, and that concerns are generally responded to appropriately, one person for instance noting, “If necessary they are there for you and will do their best.” It was noted that there have been no complaints recorded about in the home since the last inspection. The manager noted that they could make improvements in the area of complaints by keeping records of small, day-to-day grumbles that residents may make, and of the actions taken to resolve these issues. This would be evidence of good practice in this area. DS0000038579.V354794.R01.S.doc Version 5.2 Page 18 Residents spoken with confirmed that they feel safe in the home. One resident said, “There’s nothing to worry about.” A relative also felt that residents are safe in the home. They explained that there can be occasional squabbles between residents, which staff deal with appropriately. One staff member spoken with was able to explain clearly what would happen if they witnessed abuse, noting that the manager and provider are available by phone at all times. They stated that they’d had recent refresher training in this area. The training grid supplied by the manager showed that eleven of the seventeen staff, including the manager, received training on abuse awareness in July 2007. Two others have had previous training, with four having had none. It was also found that the last staff meeting included a reminder for staff on whistleblowing and abuse-awareness. Copies of local council’s safeguarding policies are in place at the home. The manager had sufficient awareness of what reporting procedures are needed should an allegation of abuse occur. Recruitment procedures were also seen as sufficient to prevent any inappropriate people from working in the home. DS0000038579.V354794.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. Residents are provided with a safe, clean, and homely environment that has benefited from a number of recent improvements to the décor. Residents are provided with specialist equipment to help with independence, however there was no effective staff-call system in place at the time of the visit. EVIDENCE: The home is a conversion and merging of two large residential houses. Since the last inspection, a significant number of improvements have been made to the environment. One relative’s comments on this were, “They have been improving the home recently i.e.: bedding, duvets and painting. They made my mum’s room look much nicer.” Bedding and curtains in particular have all been replaced to improve on the homeliness of the environment, and many areas of the home have been repainted. DS0000038579.V354794.R01.S.doc Version 5.2 Page 20 There are new carpets in the lounges. The manager explained that their design has better enabled people using Zimmer-frames to get around smoothly and without occasional bumps, which is encouraging. Other carpet changes, especially in the hallways, are planned, which will benefit these areas as the carpets there are starting to show signs of wear. The home now has a visitors’ room, which was converted from a second office. It provides a quiet area on the first floor for residents and their visitors to meet in private if wished for. Access to the first floor is currently by stairs or chairlift. Toilet doors now have a large yellow rectangle at eye-level on them, similarly for bathrooms but the colour purple. This is to help mobile residents with accessing correct facilities more easily, which the manager stated has helped. There was ample evidence that wire radiators have been upgraded to morehomely and secure wooden versions in most areas of the home. The manager reported that the home’s weighing-chair is used to assist with weight-monitoring of most residents. It broke down for a while during the summer, but was duly fixed. Checks of the staff-call system in one room found that it hardly made any noise and so wouldn’t be easily heard if used. Most residents would not be able to make the decision to meaningfully use the bell, however those that could would probably get no response under the current arrangements. A review of the system must promptly take place, to establish if there is any resident who is getting a poorer service through the system being faulty, with then appropriate and proportionate actions to fix the system taking place. Issues around privacy are noted under standard 10. It is recommended that locks with emergency override facility, or other ways of promoting roomprivacy, be provided on all bedrooms doors unless specifically discussed with the resident and their representatives and agreed as not in their best interests. Most residents fedback through surveys that the home is always fresh and clean. The manager noted that there are improved standards of cleaning throughout the home. A new steam-cleaner has assisted this process. The home’s domestic worker, the same person as at the previous inspection, has begun an NVQ qualification in cleaning. Antibacterial hand-gel units have been installed in key areas around the home, to assist with the prevention of cross-infection. This is encouraging. DS0000038579.V354794.R01.S.doc Version 5.2 Page 21 The home has a washing machine and tumble-drier, both of an industrial standard, within a utility area around the side of the house. The room also has a sink for washing hands, although staff noted that it is also used to soak soiled laundry. This process should be reviewed, to allow soiled laundry to go straight into the washing machine in an appropriate manner, as per updated infection control guidelines. DS0000038579.V354794.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. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. Residents are provided with enough staff to meet their overall needs. Staff are provided with reasonable training, with the training for the team improving particularly in the specific area of dementia care. A minority of staff have formal qualifications relevant to care work. Recruitment processes protect residents appropriately. EVIDENCE: Residents spoke positively about staff during the visit, one person for instance calling staff “tip-top.” One relative spoken with felt that there is usually enough staff working, and that there is always someone available. Residents’ and staff surveys noted that there are always enough staff working. Relatives’ surveys found that staff usually have the right skills and experience to look after people properly, one person for instance stating, “They all seem caring, smile, and try to make them laugh if looking depressed.” Recent staffing rosters showed that there are three carers working between 7am and 7pm, reducing to two up until 9pm, then one overnight with on-call from live-in carers if needed. Additionally a cook always works in the morning up until lunch is finished, and a cleaner works at least three hours each day DS0000038579.V354794.R01.S.doc Version 5.2 Page 23 including weekends. The manager is additionally present from early morning until mid-afternoon throughout the week. It should be noted that the staffing levels expected are for four care staff to work during the morning. However, the manager noted that three were being used due to there being three ongoing resident vacancies. No-one has raised concerns about staffing levels as part of this inspection, and there was no sense of rushing amongst staff from the start of the inspection, with almost all residents up and dressed. Hence there are no identified shortfalls for residents with this temporary staffing reduction. The manager provided the inspector with a training grid about the staff team. This gave good information about completed courses. For instance, virtually all staff received updated training on manual handling, 1st aid, and medicines, during 2007. Virtually all staff have valid training in food hygiene and fire safety. Seven staff including the manager passed an intensive and assessed dementia care course via a local college in November, having been working towards this since May 2007. The manager noted that all other applicable staff would be attending this course shortly. The two-tier approach has enabled a continuity of care, whilst the in-depth training is seen as very beneficial for residents. Training shortfalls are identified in the area of health & safety. Eight staff have had no formal health & safety training, and another four last had it as far back as 2003. The manager noted that further training is planned for, to include infection control awareness and positive responses to aggressive behaviours of residents. The training grid showed that, of the fifteen staff who provide care, one has a relevant NVQ qualification with four having some form of nursing qualification. The manager noted that the cook and cleaner are both undertaking NVQ courses in those areas currently. The manager was aware of the need to meet NVQ standards across the staff-team. Records showed that new staff work through the National Training Organization’s relevant induction standards, with the manager signing off the paperwork when completed. Training certificates were also found to be in place, matching information on the training grid. Staff reported satisfaction with training opportunities, through feedback and surveys. For instance, when asked what the service does well, one staff member stated that it “provides the updates of the training we need to refresh our knowledge for providing the good and better comprehensive care.” The recruitment files of two newer staff were checked through. It was found that Criminal Record Bureau checks were appropriately in place, and that all necessary recruitment checks had been made before allowing the person to DS0000038579.V354794.R01.S.doc Version 5.2 Page 24 start working in the home in a supervised capacity. This addressed shortfalls of the previous inspection. Full employment histories are now acquired and a reference is acquired from the last care position the person worked in. The manager noted that people are interviewed, and taken around the house to meet people, before decisions are made on recruitment. Recruitment processes are therefore judged as appropriate overall. DS0000038579.V354794.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. The service at the home is managed by an appropriately qualified and experienced person who has altered a number of systems in the home to the overall benefit of residents since her arrival a year ago. This includes through ensuring that staff are regularly supervised, and through the implementation of a formal and accredited quality-auditing system. Residents are protected through the home’s health & safety systems, and through processes of managing their finances by the home where needed. EVIDENCE: The manager has around ten years’ experience of managing care homes for people with dementia, including this home for the last year. She has a DS0000038579.V354794.R01.S.doc Version 5.2 Page 26 qualification at NVQ level 4 in management. She has become quickly registered as the manager for this home since the last inspection. She presented as very resident-centred, responding to residents individually, and keen to enable staff to respond appropriately. She was able to provide many examples of how the service has enabled better outcomes for individual residents. There was positive feedback about the manager from staff, noting for instance that she has caused a “turnaround for the better” and that the “manager is very fair” and approachable. Relatives’ feedback about the manager was also positive, such as “In my opinion the manager and staff do an extremely good job.” The manager has appropriately notified the CSCI of key events affecting any residents, and it was evident that records in the accident book tended to match the notifications. Relatives’ surveys showed that they are always kept up-to-date about important issues affecting their relative, one person stating for instance, “I was notified when she had a cold.” There were good records of private supervision meetings for the one staff member checked on, at a rate of at least every other month. The supervisions covered care practices and training needs, and showed good evidence of considering the individual needs of the staff member. There were records of staff meetings being held at least every other month. There was a new, professional quality-auditing system in place. The process is monitored externally by the professional company, with for instance surveys for residents, relatives and staff being sent directly to that company for consideration. The care provided and ways of working are also assessed. This comes across as an appropriate method of self-monitoring, which in due course will help to identify strengths and weaknesses of the service. At a more informal basis, resident and relative meetings are held in the home every other month. They enable information about the service to be passed in both directions. Records are kept of the meetings, and are available to view in the visitors’ room. The manager explained that they look after money for residents as requested. This was currently the case for one person, where records showed appropriate accountability of the spending. The manager noted that for visitors such as hairdressers, she receives an invoice, which she then invoices individuals for as needed. The manager noted that the local environmental health department undertook a through inspection of the kitchen recently. The home received a 2-star rating (where 4 is the highest). Some minor issues needed addressing including DS0000038579.V354794.R01.S.doc Version 5.2 Page 27 around cleanliness, for which no concerns were evident at this visit. Records of the home’s pest control contactor were also seen. They visit every 2 months. A letter dating May 2007 from the fire authority confirmed no concerns around fire safety in the home following a visit. The home was seen to have an up-todate fire-safety risk assessment. The manager noted that there is a fire-safety log in place within which regular fire safety checks are recorded about. There was a professional record of a gas safety check in the home dating January 2008. Minor alterations are needed, but the premises is confirmed as safe. DS0000038579.V354794.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 DS0000038579.V354794.R01.S.doc Version 5.2 Page 29 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 OP8 Regulation 13(1)(b) Requirement Long-term methods of acquiring better chiropody care for all residents must be established, so that foot care for each resident is consistently addressed when need arises. Individual residents’ health records in their care files must be kept consistently up-to-date, to help ensure appropriate and consistent care. Previous timescale of 1/4/07 not met. Residents’ dignity and privacy must be respected at all times. (See also standard 10 and recommendations) Each resident’s personal items must be available to them and kept in their room, unless there are clear safety reasons to do otherwise, which must then be discussed with the resident or appropriate representative and recorded about within their care file. A review of the staff-call system must promptly take place, to DS0000038579.V354794.R01.S.doc Timescale for action 01/04/08 2 OP8 17(1a) s3 pt 3(k, m) 01/03/08 3 OP10 12 15/02/08 4 OP14 17(1a) s3 pt 3(q) 01/06/08 5 OP22 23(2)(c) 15/03/08 Version 5.2 Page 30 6 OP28 18(1)(c) 7 OP30 18(1)(c) establish if there is any resident who is getting a poorer service through the system being faulty, with then appropriate and proportionate actions to fix the system taking place. 50 of the care staff team must have the NVQ level 2 qualification in care (or equivalent). There must be enough carers with a relevant qualification, or at least registered on a relevant course, to meet the 50 target by the given timescale. Formal training in health & safety must be provided for any staff member lacking such training or for whom the training has become out-of-date, to help keep people in the safe. Previous timescale of 1/8/07 not met. 01/10/08 01/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations It is recommended that staff receive training on how to use care plans to achieve better personalized outcomes for residents, as individual care files did not always match the individualized care being received by residents. Prescribed medications for individual residents that are used on an as-needed basis should have written details on the administration sheet of exactly what the medication is for, to assist staff to provide it at an appropriate time. Consideration should be given to lounge arrangements, so that residents can move to consistently quiet areas if so wished. It is recommended that locks with emergency override DS0000038579.V354794.R01.S.doc Version 5.2 Page 31 2 OP9 3 4 OP12 OP19 5 OP26 facility, or other ways of promoting room-privacy, be provided on all bedrooms doors unless specifically discussed with the resident and their representatives and agreed as not in their best interests. The process of laundering soiled linen should be reviewed, to allow soiled laundry to go straight into the washing machine in an appropriate manner, as per updated infection control guidelines. DS0000038579.V354794.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000038579.V354794.R01.S.doc Version 5.2 Page 33 - 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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