Inspection on 15/05/07 for St Leonards

This inspection was carried out on 15th May 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St Leonards 15/05/08

St Leonards 19/06/06

St Leonards 12/01/06

St Leonards 05/07/05

St Leonards 04/01/05

St Leonards 30/06/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE St Leonards 86 Wendover Road Aylesbury Bucks HP21 9NJ Lead Inspector Mike Murphy Unannounced Inspection 15 May 2007 09:00 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 St Leonards DS0000023023.V330959.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. St Leonards DS0000023023.V330959.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Leonards Address 86 Wendover Road Aylesbury Bucks HP21 9NJ 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) 01296 337765 01296 339529 N/A www.bmcare.co.uk Colley Care Limited (Trading as B & M Care) vacant Care Home 45 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (22) of places St Leonards DS0000023023.V330959.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th June 2006 Brief Description of the Service: St. Leonards is a purpose built care home providing personal care and accommodation for 45 older people. It is divided into two units. One unit caters for older people requiring general support, the other for older people with dementia. It is owned by B & M Care, which is a private care organisation. The home is located on the outskirts of Aylesbury, close to shops, pubs, a post office and other amenities. Public transport is easily accessible. The home was registered on the 19th April 2000 and consists of two floors. All bedrooms are single with en suite (WC and hand basin) facilities. Three rooms have an en-suite shower. There is a passenger lift. The home has a secure garden to the rear that is accessible to residents. Fees range from £400.00-£650.00 per week. Additional charges are made for hairdressing, chiropody, newspapers and toiletries. St Leonards DS0000023023.V330959.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector on a weekday in May 2007. The inspection methodology included consideration of information supplied by the home in a pre-inspection questionnaire (PIQ), examination of records, observation of practice, discussion with managers, staff and residents, and a tour of the home. The inspection finds that the home is providing a service which is valued by residents. Its systems for assessing the needs of prospective residents are thorough and aim to ensure that it can meet the needs of people who accept the offer of a place. Care planning procedures are good but are spread over four documents. Some rationalisation should lead to the creation of a more integrated system, with care staff and residents having easier access to key information. The new manager is aiming to develop a new care plan tailored to the needs of people with dementia and a review of care planning more generally might dovetail with this work. The home provides a range of activities and it seemed clear that residents gain great benefit from these. However, it seemed that to a large extent these depend upon the work of the activities organisers. On the day of the inspection visit it was noted that many residents tended to sleep when an activity was not taking place. While this must always be a matter of resident choice, it did seem a little disproportionate and might reflect a need to re-assess the availability of appropriate activities when the organisers are not present. Care staff were attentive to the needs of residents, were supportive and caring in their approach, and there seemed to be a good relationship between staff and residents. The environment is well maintained and standards of cleanliness were good. The quality of the food appeared good. The cook knows the residents well and seeks their views on the food. Lunch was well organised and staff provided assistance with care where required. The laundry system appears to work well. Overall, the home provides a pleasant and supportive environment for residents. The organisation had acquired a comprehensive quality assurance system and it was about to ‘go live’ in June 2007. This should address some of the matters noted as requirements or recommendations in this report. St Leonards DS0000023023.V330959.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The home has carried out a quality assurance stakeholder survey. The results of the survey should enable the home to meet the changing needs of residents and other stakeholders. Staff meetings and one-to-one staff supervision sessions are taking place on a regular basis. This should ensure that staff have the qualities and skills necessary to meet the needs of residents and that staff are adapting their practice to changing circumstances. The activity programme has been reviewed. The review should ensure that the programme is relevant to the needs of both individual residents and the resident group as a whole. St Leonards DS0000023023.V330959.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. St Leonards DS0000023023.V330959.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 St Leonards DS0000023023.V330959.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): 3, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of prospective residents are assessed prior to admission. Prospective residents are invited to visit the home to meet staff, residents and to view its facilities. The process aims to ensure that the prospective resident is comfortable in accepting the offer of a place and that the home is able to meet the person’s needs. EVIDENCE: There are two routes of referral to the home; direct, for people who are selffunding, and, indirect, through care management arrangements, for people whose place is funded in whole or part by a local authority. In both cases, enquirers are provided with a brochure and are invited to visit the home, view its facilities and meet the manager and senior staff. A care manager is involved for people whose place is supported by the local authority. Where an enquiry progresses to a referral the prospective resident is invited to tea or lunch, and if they wish, to experience activity in the home. The process St Leonards DS0000023023.V330959.R01.S.doc Version 5.2 Page 10 of assessing the person’s needs begins at this point. Where the person is unable to visit the home then an experienced member of staff visits the person at their present place of residence to conduct the assessment and answer any enquiries the person may have. Relevant information may be acquired from other agencies - most often the person’s GP or care manager. In the case of the care manager the home will receive a copy of the care management support plan, which outlines the person’s needs and the services required to meet those needs. The information gathered during this process is considered and a decision made on whether the home is likely to be able to meet the person’s needs. Where it believes it can, then an offer of a place is made. A date for admission is agreed. The first six weeks of admission is considered a ‘trial period’, a time to allow both parties, the new resident and the home, to decide if the home can meet the person’s needs and if the person can settle there. The home does not offer intermediate care, therefore standard 6 does not apply. St Leonards DS0000023023.V330959.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents care plans are based on assessment of needs and support the provision of appropriate care. Liaison with healthcare agencies is good. Together, these ensure that residents’ healthcare needs are met. Arrangements for the control, storage and administration of medicines are satisfactory and aim to ensure that residents receive medicines as prescribed and to minimise the risk of errors in administration. EVIDENCE: There are four key care planning documents for each resident: first of all, a file containing pre-admission information, a copy of the contract, and related correspondence; secondly, the care plan; thirdly, daily reports; and finally, a file for recording contacts with health care professionals. The home has developed this form of documentation over time. It might now benefit from review with a view towards rationalisation and a reduction in the number of documents involved. St Leonards DS0000023023.V330959.R01.S.doc Version 5.2 Page 12 The four care plans examined on this inspection were considered to be of a good standard. In most cases the plans included biographical information on the person, personal details, a useful summary of the person’s life history which, where possible, was signed by the person, notes of allergies or sensitivities, falls risk assessment, moving and handling risk assessments, guidance on mobility, individual ‘care plan’ for communication, sight and hearing, elimination, and personal care. There were notes on eating and drinking, skin care, leisure interests, a body chart for recording bruises or lesions, and notes on sleep and rest. Some had a photograph of the person, other not. There was some variation in the mix of forms included in files and to a lesser extent in the content of forms. It was noted that risk assessments did not include an assessment of pressure sore risk. This was done by visual examination and recording of any lesion or other signs on the body chart. Overall however, the standard of care planning was good and liaison with health professionals appeared good. The quality of reports in the daily records file varied. All those examined were legible, signed and dated. They included recording of care provided by staff but not many references to the care plan. There also seemed to be a bias towards recording the physical care given by staff and very much less to psychological and social aspects of the person’s life in the home. There was little difference between those reports relating to residents in the ‘dementia’ unit and those in the ‘residential’ unit. The manager said that he intends to develop a dementia care plan and is in discussion with the Alzheimer’s Society about this. All residents are registered with a GP. The home has a contract with a GP practice in Bedgrove. This supports the provision of a good service to residents including a weekly ‘round’. The home has regular contact with district nurses and community psychiatric nurses (CPNs). The latter can facilitate access to a psychiatrist specialising in the care of older people where necessary. Other health services are accessed through the GP or by direct contact as required. A chiropodist visits regularly. All residents are weighed monthly unless otherwise indicated - weight in Kilogram’s and BMI (Body Mass Index) is recorded. It was noted that weight charts also include a reference to ‘MUST’ (Malnutrition Universal Screening Tool). The benefits of this practice could not be fully assessed because the relevant file was not available on the day of inspection. The deputy manager has a lead responsibility for practice in relation to the control and administration of medicines. A medicines policy is in place. Staff are trained in the home and are assessed competent after being observed to administer medicines correctly on three occasions. All staff involved in the administration of medicines have undertaken a distance-learning course on the safe handling and administration of medicines. St Leonards DS0000023023.V330959.R01.S.doc Version 5.2 Page 13 A list of signatures of staff authorised to administer medicines is maintained. Medicines are prescribed by the resident’s GP and are dispensed by Rowlands pharmacy in Aylesbury. The home does not have a ‘homely remedies’ policy because it wants all medicines to be prescribed by the GP. The home’s arrangements are audited by the deputy manager on a fortnightly basis (soon to be monthly now that greater consistency in practice has been achieved and fewer errors noted) and were last audited by a pharmacist in 2006. Reference books available for staff include a BMA text dated 2004 and a British National Formulary of 2005. Copies of patient information leaflets are also retained. Medicines are stored in a cupboard on the ground floor, in a portable trolley and in a medicines fridge. A small sample of medicines administration records (‘MAR’ charts) were examined. All were generally in good order and no gaps or errors were noted. It was noted that some handwritten entries (transcribed from the prescription sheet but not yet typed up on the MAR chart by the dispensing pharmacy) had not been countersigned by two members of staff. This would be advisable. Notes of the fortnightly audits by the deputy manager, her findings and action notes were seen. Overall, the home’s practice in relation to the administration of medicines was of a good standard. Arrangements for maintaining the privacy and dignity of residents appear satisfactory. The home has a ‘Knock and Wait’ policy before entering resident’s rooms. Residents are referred to by their preferred name. Medical examinations are conducted in the person’s own room. All rooms are single. Staff were observed to treat residents with care and sensitivity. Residents in the dementia unit appeared well cared for and a resident in the residential unit said that it was “a good place”. The home has a form for recording resident’s wishes regarding terminal care and arrangements after death but many of those on file had not been not completed. The manager said that many residents do not like discussing such matters. St Leonards DS0000023023.V330959.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): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ well being and quality of life is maintained through the home’s diverse programme of activities, contact with the local community and choice and quality of food. However, the benefits of this may be compromised through a relative lack of stimulation at some points in the day. EVIDENCE: The manager said that the home has a “no waking policy”. Breakfast is served around 9:00 am but could be served later in a resident’s room if desired. On the day of this inspection visit most residents appeared to be up by 09:30. The activity programme is arranged by the activity organiser. Most activities take place in the afternoon. According to the service user’s guide ‘Families and friends can visit at anytime that suits and it is not necessary to make an appointment’. Resident’s interests may be included in the ‘life history’ section of care plans and in information recorded by the activities organiser. The home has two part-time activities organisers – in total around 38 hours a week. Generally, activities tend to be late morning or in the afternoon. The activity programme St Leonards DS0000023023.V330959.R01.S.doc Version 5.2 Page 15 is discussed and reviewed periodically with residents. ‘Sing-a-longs’, quizzes and large flip chart crosswords were said to be particularly popular. It was said that “anything musical” tends to be held in the dementia unit because that is of particular value to residents with dementia and the presence of residents from the other unit adds to the value of the occasion. Outings to local places of interest are often arranged. These have recently included a trip to Wendover woods to see the bluebells in spring, regular trips to a local garden centre and occasionally joint activities with other organisations including the Royal British Legion and the Women’s Institute. The activities organiser publishes a newsletter three or four times a year. A copy of the January 2007 edition which described the busy programme for the winter 2006 period was provided for this inspection. This outlined a wide range of seasonal activities including a firework display, Christmas cooking, church services, entertainment (including a dancing display, school choir and afternoon concert) and Christmas carols. The programme outlined some of the activities being planned for the spring quarter. It was observed on this inspection visit that residents tended to sleep more than would normally be expected in between activities. This observation was made at a number of points over the course of the day, from mid morning, through mid afternoon, to early evening. Care staff were mainly involved in providing individual care or in supporting residents in the time leading up to, or after a meal. Residents became quite involved in the activities led by the activities organiser. However, there did appear to be a distinct lack of activity – or of stimulation – at certain periods over the course of the day. It would be advisable for managers to explore this with residents, staff and the activities organiser. As mentioned elsewhere in this report staff were observed to be caring and supportive in their interactions with individual residents. It was said that an activity trolley has been left out for staff to use when the activity organisers are not on duty but that care staff do not have the time to use it. There were no references to residents’ participation or response to activities in the daily records examined on this inspection. As stated above breakfast is served at around 9:00 am. Morning coffee and biscuits are served at 10:30 am. Lunch is served around 1:00 pm. Afternoon tea around 3:00 pm. The evening meal, ‘Tea’, is served at 5:00 pm. A supper of sandwiches, cakes and biscuits and a hot drink is served around 8:00 pm. Drinks are available at all times. The cook has worked in the home for a number of years and said that she spends quite a bit of time with the residents and gets to know their tastes quite well. The quality of the food has been favourably rated in the home’s own quality assurance surveys. One month’s menus were provided for the inspection. Lunch is the main meal of the day. Fish (poached or in batter) is always served on Fridays and a roast (beef, turkey, pork or chicken) is always served in Sundays. Other lunch choices included Sausages and Mash, Shepherds Pie, Lamb Chops or Honey St Leonards DS0000023023.V330959.R01.S.doc Version 5.2 Page 16 Roast Gammon. All served with potatoes and vegetables. Desserts included Bread and Butter pudding, Cherry Pie and Custard, and Treacle Sponge and Custard. There seemed to be a bias towards meat dishes in the menus seen but that is said to reflect the preferences of current residents. Pureed or liquefied meals are prepared as required and the serving of those was discussed with the cook. The cook had found that many residents had expressed a preference for these to be served together rather than as separate items on the plate. It was agreed that the most important point was that the residents received adequate nutrition, had choice and that their preferences were recorded in the care plan. The serving of lunch was indirectly observed in one unit. The meal was served at an unhurried pace, the residents seemed satisfied with the food, and staff supporting residents sat down while providing assistance. St Leonards DS0000023023.V330959.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, 17 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s policies and procedure on complaints and on the protection of vulnerable adults aim to protect residents from abuse. However, these could be reinforced by including contact details for relevant external agencies and by providing training in the understanding of aggression and violence. EVIDENCE: The home has a complaints procedure, a copy of which is included in a pack given to each resident. The procedure staff that staff should make every effort to resolve ‘…adverse verbal comments, concerns or complaints at the time….’. It then says that if the complainant is not satisfied they should put their complaint in writing. Target time scales for resolution are given – both at the level of the home or at head office level. Complaints received at head office are entered into the ‘..Head Office Complaints Register…’ and..given to the responsible director and to the Chairman’. There is no mention of CSCI in the policy. CSCI has not received any complaints about this service since the last inspection. The manager said that all residents are registered to vote and that most tend to use a postal vote at election time. The home provides guidance for staff on the protection of vulnerable adults in a document ‘Working with Abuse’. The document provides a brief overview of the subject. The manager has attended training provided by Buckinghamshire St Leonards DS0000023023.V330959.R01.S.doc Version 5.2 Page 18 County Council aimed at enabling those who attend to cascade the training to staff working in care settings. The staff training programme shows that all staff attended training on ‘abuse’ and ‘POVA’ (Protection of Vulnerable Adults) in June and July 2006. Staff spoken to during the course of this inspection visit had knowledge of the subject and expressed confidence in managers to investigate any reports. Linked to its policy on abuse but wider in scope is the home’s policy on ‘Whistle blowing’. The document briefly outlines circumstances which a member of staff may observe and which ought to be reported. It outlines a line of confidential reporting within the organisation and also includes (handwritten) contact details for the local CSCI office in Oxford. It is noted that it does not include reporting to social services or to the confidential Buckinghamshire ‘Careline’ number (0800 137915) To date, the service has not offered training in understanding and responding to verbal and physical aggression. St Leonards DS0000023023.V330959.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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides an accessible, clean and well-maintained environment which provides residents with a comfortable and safe place to live. EVIDENCE: The home is a pleasant purpose built building located just off the main road between Aylesbury and Wendover, about one mile from Aylesbury town centre. The nearest rail stations are Aylesbury or Stoke Mandeville. The home is on bus routes to and from Aylesbury. Parking is available to the front of the home. The accommodation is on two floors. Stairs and a passenger lift link the ground and first floor. The home is divided into two units – a 22 place residential unit for general care and support and a 23 place unit for people with dementia. St Leonards DS0000023023.V330959.R01.S.doc Version 5.2 Page 20 All bedrooms are single and have en-suite (WC and hand basin) facilities. Three bedrooms also have showers The home has a range of aids to support residents including grab rails, walk-in baths, conventional baths, hoists, stand-aid, and a lift. All areas used by residents are accessible by wheelchair. All areas of the home were considered to be well maintained and standards of cleanliness were very good. An odour was noted in one area and possible reasons for this were discussed with the deputy manager. The home has an ongoing programme of redecoration – a bedroom and communal lounge were about to be completely redecorated a couple of days after this inspection. Communal areas were bright and comfortably furnished and the home seemed to comfortably accommodate a range of activities over the course of the day. Bedrooms were of a reasonable size and residents may bring personal possessions with them if they wish. The kitchen was well maintained, clean, tidy and in good order. The cooker, insectocutor, fridges, freezers and sinks were all clean and in good order. The kitchen had been inspected by an environmental health officer in December 2006. The laundry was clean and tidy and equipped with two washing machines, one tumble dryer, a roller iron, and hand iron. A second tumble dryer was expected to be installed soon after this inspection. Residents in the dementia unit have direct access to a secure garden area, a facility which is important to the well-being of such residents. St Leonards DS0000023023.V330959.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are considered satisfactory, procedures for the recruitment of new staff are generally satisfactory and staff have access to a range of training opportunities. This aims to ensure that there are sufficient numbers of appropriately trained and supervised staff to meet people needs. EVIDENCE: The present staffing of the home provides for four care staff in the unit for people with dementia in the morning and evening and two care staff at night. It provides for three care staff in the general care unit in the morning and evening and two care staff at night. There is one domestic member of staff on duty in each area in the morning. In addition to care and domestic staff there is a cook on duty between 8:00 am and 6:30 pm plus a part-time kitchen assistant. There is funding for two part-time activity co-ordinators. The home has a part-time administrator. Maintenance staff are provided through the relevant departments at the company’s offices in Hemel Hempstead. At the time of this inspection visit the home had 11 care staff who had completed NVQ2 with 5 staff pursuing the course. It had 2 members of care staff who had completed NVQ3 and 2 staff pursuing the course. The home did not quite meet the 50 target figure for NVQ trained staff. Two care staff were qualified nurses in Bulgaria. St Leonards DS0000023023.V330959.R01.S.doc Version 5.2 Page 22 New staff are recruited through advertising in local newspapers or via “word of mouth”. Applicants complete an application form, equal opportunities form, provide full details of previous employment, two referees, and evidence via a questionnaire that they are fit for the job. Candidates are interviewed by managers and those appointed do not take up their post until the results of a ‘POVA First’ check or Enhanced CRB certificate is received. The manager said that staff appointed under a ‘POVA First’ are considered supernumerary until the Enhanced CRB is received. Examination of staff files provided evidence of the above but in a number of cases the level and date of the CRB certificate could not be confirmed because only the top third of the certificate was retained on file. Details of staff training for 2006 and 2007 were supplied and show that the organisation provides ongoing training in the ‘mandatory’ subjects of food hygiene, moving and handling, health & safety, fire safety and infection control. In addition training is provided in care planning, dementia (via Milton Keynes College), medicines administration, abuse and POVA, and NVQ training at level 2 and 3. The manager was keen to develop staff skills in dementia care. Staff spoken to during the course of this inspection visit were positive about the home. The manager was described as “approachable” and “good at problem solving”. The home was compared favourably with homes run by other organisations which staff had previously worked in. Staff acknowledged that it provided many opportunities for training. Teamwork was described as good. Staff meetings and supervision were considered to be constructive. It was felt that the atmosphere was relaxed, that staff turnover had reduced, that opportunities for training had increased, and that overall, this all led to improved care to residents. St Leonards DS0000023023.V330959.R01.S.doc Version 5.2 Page 23 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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is a well managed home, which has good arrangements for consulting residents and other stakeholders. Residents should benefit by having their views taken into account and having some influence on the service provided. Arrangements for health and safety are satisfactory and aim to ensure the safety of residents, staff and visitors. St Leonards DS0000023023.V330959.R01.S.doc Version 5.2 Page 24 EVIDENCE: The acting manager had recently taken up his post in the home having previously managed other B&M services in the area. The manager had worked in the home in the past and was appropriately experienced and qualified for the post. The manager has submitted a registration application to CSCI which was being processed at the time of this inspection. The manager had acquired the Registered Managers Award (RMA). Over the past year the manager had completed a certificate level course in dementia mapping at Bradford University and was pursuing further studies in dementia care. Over the previous two years the manager had also attended training in equal opportunities, supervision, update training in mandatory courses, and in becoming a moving and handling trainer. Lines of accountability, both in the home and within the larger organisation are clear. The manager reports to an operations manager. The deputy manager, team leader and senior care workers report to the manager. The deputy manager had also acquired the RMA. The home carries out periodic surveys of the views of residents, relatives and other stakeholders on the quality of the service it provides. A copy of the home’s own ‘Quality Control Report August 2006’ was provided for this inspection. The report summarised the results of surveys of ‘visiting professionals’, ‘relatives, and ‘service users’ carried out in 2006. The report summarised the views of the respondents and the overall results were favourable. Visiting Professionals reported a good level of satisfaction with the home. Relatives reported satisfaction with almost all aspects of the service reported on. These included ‘staff service’, maintenance, security, comfort, meals, entertainment, cleanliness, treating residents with dignity and respect, management and response to complaints. The one section where there appeared to be a wider spread of views was ‘smell’. Overall, the report states that relative respondents indicated that the home ‘.has a caring atmosphere’ and ‘…is a happy home’. The survey of residents looked at activities, cleaning and laundry, health, personal care, and accommodation. The results reflected a good level of satisfaction with the quality of the service in each area. In the area of care for example the report says that ‘Service users feel that the care staff respect their privacy and speak politely to them. The overall opinion is that they feel safe and well cared for and that they don’t have to fit in with routines’. A copy of a working document ‘Quality Control Evaluation Sheets Satisfaction Questionnaire’ dated October 2006 which looked at 17 aspects of the service St Leonards DS0000023023.V330959.R01.S.doc Version 5.2 Page 25 again reflect an overall good level of satisfaction with the service. This work is evidence of the home carrying out appropriate monitoring and evaluation of the quality of its service. CSCI survey forms had been distributed by the home in advance of this inspection and completed forms had been received by CSCI. Unfortunately, they were not available for consideration at the time of this inspection visit and the writing of this report. The home is responsive to the requirements and recommendations of CSCI inspections. The home does not manage money on behalf of residents. Where residents are unable to manage their own money they need to make appropriate arrangements with their families or professional advisors. This inspection coincided with the imminent implementation of a comprehensive quality assurance system involving the introduction of a new procedure manuals, new forms, new recording and filing systems, new policies and new quality monitoring systems. The introduction of this new system was to be launched in tandem with changes to the organisation’s intranet. It was envisaged that this would replace a significant proportion of B&M’s current policies, procedures and forms and would ensure a higher degree of consistency in practice across all services. The system was due to “go live” from June 2007 – less than a month after this inspection visit. Systems for staff supervision are in place and all care staff have one-to-one supervision every two months. Staff interviewed confirmed that supervison takes place and gave positive accounts of it. The question of whether a staff meeting could be considered equivalent to a supervision session was raised during the course of the visit. The differences between a business meeting, which is focussed on an organisation’s current business, and a group supervision meeting, which is focussed on, care issues, but should allow time for reflection on care practice, were discussed. It was felt that the home should endeavour to maintain one-to-one supervision where possible. However, it was acknowledged that this requires sufficient numbers of staff who have the experience and training necessary to carry out the supervisor’s role effectively. Systems for maintaining safe working practices are generally satisfactory. A health and safety policy is in place. One member of staff has a lead role for health and safety matters. Arrangements exist for staff to attend training events in the mandatory subjects of fire safety, infection control, first aid, food hygiene and moving and handling. Generic risk assessments are carried out and recorded in a file which is accessible in the manager’s office. Specific risk assessment are in care files. It is expected that the new quality management system will support good practice in maintaining safe working practices. The date of the most recent visit by a fire officer was not available. Systems are in place for contractors to check fire safety equipment and emergency lighting. Evidence of testing the safety of portable electrical appliances was seen but the date of the last check of the home’s fixed wiring was not available. Dates of recent maintenance checks on hoists and baths were St Leonards DS0000023023.V330959.R01.S.doc Version 5.2 Page 26 provided. The home was inspected by an environmental health officer in December 2006 and the report of the inspector made available for this inspection. The date of the last check on the emergency call system was not recorded in the pre-inspection questionnaire (PIQ). The home is supported in maintaining the safety of its environment by B&M’s maintenance services department. St Leonards DS0000023023.V330959.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 St Leonards DS0000023023.V330959.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP16 OP29 Regulation 22 Schedule 2 Requirement The manager must ensure that the complaints procedure includes contact details for CSCI. The manager must ensure that staff records include the information required under this Schedule. Timescale for action 31/07/07 30/06/07 St Leonards DS0000023023.V330959.R01.S.doc Version 5.2 Page 29 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 The manager should review the home’s current care planning documentation and consider whether the number of documents which make up individual care plans could be reduced The manager should review levels of activity with residents, staff and other stakeholders with a view towards ensuring that appropriate individual and group activities are available throughout the day The manager should ensure that the complaints procedure conforms to standard 16.4 in stating that residents may refer a complaint to CSCI at any stage. The manager must ensure that policy and procedures relating to the protection of vulnerable adults includes clear procedures for reporting to senior managers and to relevant statutory organisations. The manager should ensure that care staff receive training in understanding and dealing with aggression at a level appropriate to the needs of the home’s residents. 2 OP12 3 4 OP16 OP18 5 OP18 St Leonards DS0000023023.V330959.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 St Leonards DS0000023023.V330959.R01.S.doc Version 5.2 Page 31 - 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. 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