CARE HOMES FOR OLDER PEOPLE
Talbot View 66 Ensbury Avenue Ensbury Park Bournemouth Dorset BH10 4HG Lead Inspector
Carole Payne Key Unannounced Inspection 11th January 2007 11:10 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 DS0000003899.V325635.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. DS0000003899.V325635.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Talbot View Address 66 Ensbury Avenue Ensbury Park Bournemouth Dorset BH10 4HG 01202 537571 01202 547328 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) www.care-south.co.uk Care South Mrs Anne Lippitt Care Home 59 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (29) of places DS0000003899.V325635.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. One service user (name known to the CSCI) in the category MD(E) excluding learning disability or dementia - over 65 years of age may be accommodated Three service users (names known to the CSCI) in the category LD (Learning Disability) may be accommodated. One service user (name known to CSCI) in the category of LD(E) (Learning Disability - over 65 years of age) may be accommodated. One service user (name known to CSCI) in the category of DE (Dementia) may be accommodated. 23rd February 2006 Date of last inspection Brief Description of the Service: Talbot View is part of the Care South (formerly Dorset Trust) group of homes and is managed by Anne Lippitt. The Dorset Trust was established in 1991 having leased several homes across Dorset from the local authority, the Trust has now expanded and provides care in homes Dorset and Somerset resulting in the name change to Care South. Care South is a non-profit making organisation. Talbot View provides accommodation for a maximum of 59 older people who require personal assistance due to old age and frailty and or dementia type illnesses, with approved conditions of registration to accommodate service users outside these categories as detailed in this report. The premises were purpose built by the Trust in 2000 and provide accommodation in 59 single rooms, all with en-suite facilities on ground and first floor levels. The first floor is reached by a passenger lift or one of three stairways. Accommodation is arranged in four houses; Wareham Way and Lollipop Lane accommodate people with dementia care needs, Butlers Brook and Highmoor Heath accommodate older people with general personal care needs. Both dementia care houses have keypad entry systems to ensure residents safety. Each house provides single room accommodation and shared, communal areas consisting of lounge and dining room areas. The current fee range is £515 to £625. The manager advised that fees would be revised in April 2007. See the following website for further guidance on fees and contracts: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_peop le_choos.aspx DS0000003899.V325635.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out on the 11th January 2007 and took a total of 10 hours, including time spent in planning the visit. The inspector was made to feel welcome in the home during the visit. This was a statutory inspection and was carried out to ensure that the fifty-seven residents who are living at Talbot View are safe and properly cared for. Requirements and recommendations made as a result of the last inspection visit and key standards met at the last inspection on 23rd February 2006 were also reviewed. The premises were inspected, records examined and the daily routine observed. Time was spent in discussion with ten residents living in the home and five staff members on duty. Sixteen resident survey forms were received by the Commission for Social Care Inspection prior to the visits; three comment cards from health and social care professionals who visit the home; fourteen relative / visitors’ comment cards and one comment card from a General Practitioner. The home also returned a detailed pre-inspection questionnaire prior to the visit. Throughout the inspection and following the visit the management and staff team demonstrated a positive and proactive commitment to addressing any issues raised and improving the quality of life for people living at Talbot View. What the service does well:
The home made survey forms available to people involved with the life of the service, so that they could say what they feel about the quality of the service provided. Comments received from health and social care professionals visiting the home included: ‘Always find carers / managers helpful.’ ‘The standard of care is high.’ ‘They are always striving to improve their service.’ Comments from relatives / visitors to the home included: ’10 out of 10’. ‘Well run home with a welcoming and happy ambience.’
DS0000003899.V325635.R01.S.doc Version 5.2 Page 6 ‘High level of personal care and consideration.’ ‘Good individual attention.’ Thorough pre-admission procedures ensure that no resident moves into the service without having their needs assessed. Prospective residents and their families and / or representatives are fully involved in the assessment process and can, therefore, feel confident that Talbot View is able to meet their needs. Two relatives said that they had been recommended to the home. People are encouraged and supported to visit the home and assess the environment and its facilities, before making a decision about moving in. Care is taken to meet the healthcare needs of residents living at the home, promoting their well-being. The home has efficient processes in place for auditing medications held at the home, so that there is a regular check of practice and any issues are responded to appropriately. Residents are treated with care and sensitivity, protecting the privacy and dignity of people living in the home. One relative / visitor to the home returning a comment card said that residents are treated with ‘respect and dignity.’ Another said that staff members are ‘kind’ and ‘helpful.’ Residents’ social and religious interests and needs are recorded and suitable events and activities are organised. People living at Talbot View are supported to enjoy relationships that are meaningful to them. Residents are supported to exercise choices and thereby to experience control in their daily lives. People who live at Talbot View receive a varied and nutritious diet, which promotes well being. Meals are unhurried and sensitive support with eating is given when needed. People are encouraged to say what they think about the meals that they receive and their comments are listened and responded to. An open ethos to the receipt of complaints supports a service where people feel able to raise issues, which concern them and be confident that they are listened to, thereby continuously improving the standard of care and support. The home has procedures and training in place, which supports the protection of residents from abuse. The home is maintained to a good standard of decoration, supporting residents to live in a safe, clean and hygienic environment.
DS0000003899.V325635.R01.S.doc Version 5.2 Page 7 The numbers of staff on duty at the home satisfactorily meets residents’ needs. Talbot View is managed by a person who is highly qualified and competent and able to ensure that the home is run in the best interests of people living in the home. What has improved since the last inspection? What they could do better:
A number of the issues highlighted during the visit and therefore included in this report had already been recognised by the manager, who was acting to address them. It is a reflection of the home’s commitment to consistently improve and respond to issues raised. Some issues raised on the day of the visit have already been addressed by the home. At the time of the visit care plans did not adequately reflect the personal, health and social care needs of residents. However, the manager is currently completing assessments, which will inform the development of care plans, supporting the individualised care, which is provided to residents living at Talbot View. A care plan must be in place for any resident who suffers from epilepsy, as to how care is to be provided. Residents’ plans must also be kept under regular review. The team is acting promptly to address issues raised during the visit in order to promote the protection of residents by the use of safe medication practices in the home. In order to ensure that all residents’ needs are fulfilled an activities coordinator should be recruited, so that the individual and general needs of residents can be identified and fully met. The home is making progress in ensuring that residents are fully protected by the home’s recruitment procedures. Photographs, which were not on individual files at the time of the visit, are now in place and the manager intends to ensure that these are provided as a means of identification. These, as well as
DS0000003899.V325635.R01.S.doc Version 5.2 Page 8 evidence of a Protection of the Vulnerable Adult’s Register, must be obtained prior to staff members starting work in the future. Staff members receive regular training and the home has developed a detailed internal summary of training. This needs to be satisfactorily monitored so that training needs can be identified in the future. A written record should be kept of staff members’ progress in meeting competencies in line with Skills for Care Induction Standards, reflecting progress in developing the skills to provide care which protects residents and promotes their health and well being. By ensuring that all entries are made in ink on records of financial transactions, this will support the scrupulous procedures that the home has in place to ensure that residents’ monies are efficiently handled. The organisation, management and staff team work hard to ensure that residents’ health, safety and welfare are promoted. When it was highlighted that checks of electrical wiring had not taken place, the service responded expediently to ensure that the necessary checks are carried out. These must be routinely carried out five yearly. 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. DS0000003899.V325635.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000003899.V325635.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Thorough pre-admission procedures ensure that no resident moves into the service without having their needs assessed. Prospective residents and their families and / or representatives are fully involved in the assessment process and can, therefore, feel confident that Talbot View is able to meet their needs. People are encouraged and supported to visit the home and assess both the environment and its facilities. EVIDENCE: Two relatives said that a person who had visited the service had recommended them to the home. They had been ‘impressed.’ The relatives said that they had been able to come and look around the home. The manager confirmed that whenever possible people are invited to come and spend time at the service
DS0000003899.V325635.R01.S.doc Version 5.2 Page 11 and experience the life of the home and assess its facilities. One resident, she said, who had recently moved in had visited the home with a relative and had a cup of tea. The home has a welcoming reception area, which includes a notice board with relevant information about the home and the manager’s office and administrative area is located off the main reception, ensuring that there is someone available to welcome visitors and the manager is always accessible. All of the sixteen resident survey forms stated that people had received enough information prior to moving into the home. Pre-admission assessments were seen for two residents who had recently moved into the home. A detailed history had been recorded, which included, where relevant, information from other health and social care professionals. Records also included information regarding medical history and personal choices and preferences regarding lifestyle. The resident, or their representative, are involved in the assessment and the details are agreed. A letter was seen on one file confirming that, according to the assessment, the home was able to meet the person’s needs. Another communication from a resident’s representative stated that, although the person had only been at the home for a short time they were ‘pleased with the care received.’ DS0000003899.V325635.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. At the time of the visit care plans did not satisfactorily reflect how the personal, health and social care needs of residents were to be met. However, the manager is currently completing assessments, which will inform the development of care plans, which support the individualised and special care provided to residents living at Talbot View. Care is taken to meet the healthcare needs of residents living at the home, promoting their well-being. The inclusion of how specific healthcare needs are to be met in relation to a resident with epilepsy will support this. The home has efficient processes in place for auditing medications held at the home. The team has acted promptly to address issues raised during the visit in order to promote the protection of residents by the safe administration of medicines. Residents are treated with care and sensitivity, protecting the privacy and dignity of people living in the home.
DS0000003899.V325635.R01.S.doc Version 5.2 Page 13 EVIDENCE: The manager has identified that some care plans are not being reviewed at least monthly, due to staff absence and details within the care plans is consequently very sparse. For example care plans for meeting the needs of two residents in relation to physical health simply stated to encourage taking medication and ensuring the resident is happy. Mental health needs were to be met by keeping calm and reassuring the resident. Care needs were being met by the home and it was evident that the staff members had immense understanding and empathy of individual mental health needs, which they utilised in a variety of ways to meet residents’ needs. The manager recognised that the skills, care and support that staff members give residents needs to be supported by thorough care plans. At the time of the inspection the manager had commenced the process of review by completing new risk assessments for residents, which detail measures in place to reduce presenting risks. The home is in the process of reviewing and updating care plans to reflect residents’ individual needs. Following the visit the manager confirmed that all care plans are in the process of review and updating. One senior member of staff has been away and one set of care plans seen had not been reviewed since July 2006. The resident had complex care needs. Reviews previous to this were dated and signed without any details of the contents of the review. Another care plan had last been reviewed in October 2006. The manager was already putting in place a change to the management structures in the home, to ensure that in future reviews are followed up and recorded. Handover on the day of the inspection to the afternoon staff was detailed with thorough information given regarding the care support required by residents living in the home. Staff members observed showed skill and knowledge in care giving of the needs of the residents accommodated. However, the high standard of individual care seen must be supported by care planning systems. There were no written guidelines in place regarding action to be taken in the event that a resident who suffers from epilepsy suffers a seizure. From two files seen for people living in the home, there is close monitoring of the medical needs of residents, thus promoting well-being. Contacts with healthcare professionals had been sought as appropriate and there had been monitoring of food and fluid intake as necessary. Records of medical contacts are stored together to support regular and accessible recording. Handover to the afternoon staff on the day of the visit, included reference to medical and healthcare needs. Eight residents responding in a resident survey form said that they always receive the medical support that they need; eight residents said that this was usually the case. A General Practitioner and three health and social care professionals said that they are satisfied with the overall care DS0000003899.V325635.R01.S.doc Version 5.2 Page 14 provided by the home. Emergency transfer sheets are kept so that should a resident be admitted to hospital full information is available to medical staff. The home has generally efficient processes in place to ensure that medicines are safely handled in the home. There are efficient processes in place for auditing medications at the service to ensure that they are safely received into the home and that, at any one time, the amounts of any medicine can be tracked and supported by a thorough audit trail. Medicines requiring refrigeration are suitably stored and the temperature of the drugs fridge is monitored and recorded daily. The home has a controlled drugs cabinet. Temazepam is appropriately stored as a controlled drug and amounts held are recorded as good practice. There were some omissions on the Medication Administration Records, when staff had either failed to sign for medicines given or to explain the reason for omission. There were four gaps on one resident’s records. It is important that efficient recording of the administration of medicines is maintained. There was one handwritten entry on a medication record chart. However there was no signature of the staff member making the entry or a staff member signing to verify the entry. One resident who administers their own medication keeps the medicines locked in their room. Records of returns to the pharmacy are made. Throughout the visit staff members were observed giving sensitive care and support to residents. The manager showed the inspector around the home; and asked the permission of residents prior to showing the inspector the relevant room. Staff members gave sensitive support to residents mobilising around the home and an empathetic approach was taken to a resident who was feeling concerned and anxious. The manager knocked on residents’ doors before entering. One relative / visitor to the home returning a comment card said that residents are treated with ‘respect and dignity.’ Another said staff members are ‘kind’ and ‘helpful.’ DS0000003899.V325635.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ social and religious interests and needs are recorded and suitable events and activities are organised. In order to ensure that all residents’ needs are fulfilled an activities coordinator should be recruited, so that the individual and general needs of residents can be identified and met. People living at Talbot View are supported to enjoy relationships that are meaningful to them. Residents are supported to exercise choices and thereby to experience control in their daily lives. People who live at Talbot View receive a varied and nutritious diet, which promotes well being. Meals are unhurried and sensitive support with eating is given when needed. People are encouraged to say what they think about the meals that they receive and their comments are listened and responded to. DS0000003899.V325635.R01.S.doc Version 5.2 Page 16 EVIDENCE: The home has not had an activities coordinator in place since the middle of 2006; however several members of staff have come forward and provide both general activities and time spent in individual companionship. Two files seen included detailed records of people’s interests and hobbies and a family history. On the afternoon of the visit six residents were enjoying a game of bingo. A notice had been displayed regarding forthcoming entertainment in the home. One resident said that they were looking forward to it. Three residents returning survey forms said that there are always suitable activities arranged by the home; four said that this was sometimes the case and four said never. One resident said that this was because they did not wish to participate. One resident said there were no activities currently. The manager is determined to find the right person to fulfil the important role to coordinate activities in the home, promoting the quality of life of residents. Residents’ religious needs were recorded on one of the files seen and religious services are conducted meeting the needs of people of different denominations living in the home. Two relatives spoken with said that they always feel welcome when they visit the home. Personal records include details of relatives and friends who are important to the resident, and contact details. The two relative spoken with said that they are always contacted should the home have any concerns of which they wish to make them aware. Residents spoken with said they are given choices about what they would like to do during the day. Preferences regarding what and when people would like to engage in daily activities are recorded within personal records and are discussed before residents move into the home. One resident spoken with said that they were very ‘contented’ with their life in the home, that they could do what they wanted during the day, enjoying visits from friends and outings; they enjoy reading the paper, sitting in the lounge and spending time in their own room. There is a sensory garden, with seating for residents to enjoy in warmer weather. Lunch looked appetising on the day of the visit. Some residents were sitting in a dining area and enjoying lunch together. Lunch for those people who need help with eating is served first so that staff can spend time supporting residents. Pureed food is served separately so that residents who need a pureed diet can enjoy the textures and colour of different foods. A four-week menu plan is followed. However, from food served it was evident that the particular needs and requests of residents are respected. One of the chefs was in the kitchen preparing tea. Food, which was being kept, was labelled with the day of opening. Records of residents’ choices were seen. One resident said that
DS0000003899.V325635.R01.S.doc Version 5.2 Page 17 they are asked what they would like the following day. Six residents returning survey forms said that they always like the meals; one said they ‘enjoy the food. There is a good choice.’ Five people said that they usually like the food; four said sometimes. One resident said that the ‘food could be better’, and it is not ‘properly cooked.’ The chef said that he visits residents to discuss their particular needs and makes every endeavour to accommodate them, with consideration for the overall needs of the home. From the pre-inspection questionnaire three main meals and a suppertime snack are served at flexible times. DS0000003899.V325635.R01.S.doc Version 5.2 Page 18 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An open ethos to the receipt of complaints supports a service where people feel able to raise issues, which concern them and be confident that they are listened and responded to. The home has procedures and training in place, which supports the protection of residents from abuse. EVIDENCE: The home has a clear complaints’ procedure, which is displayed in the main reception area of the home and is included in the home’s service user’s guide. A complaints’ record book is maintained which includes a summary of details of complaints received and action taken and any communications received and sent regarding the complaints. Details reflected the home’s open ethos to the receipt of comments regarding the service, whereby any issues raised are used to improve the overall service in the home. Twelve visitors / relatives returning comment cards said that they are aware of the complaints’ procedure; two said that they are not aware of the procedure. The home has clear procedures in place in respect of protecting vulnerable adults living in the home. The manager confirmed in the pre-inspection
DS0000003899.V325635.R01.S.doc Version 5.2 Page 19 questionnaire submitted that relevant polices are in place to support safe practice. Regular training is organised to ensure that staff are aware of the protection of vulnerable adults living in the home. DS0000003899.V325635.R01.S.doc Version 5.2 Page 20 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is maintained to a good standard of decoration, supporting residents to live in a safe, clean and hygienic environment. EVIDENCE: On the day of the inspection all areas of the home seen were clean and free from offensive odours. Individual rooms visited were personalised and spacious. Communal areas are arranged in a homely way, to afford pleasant seating areas for residents, with views in some rooms over the home’s gardens. Assisted bathrooms are kept clean and are maintained to a good standard. DS0000003899.V325635.R01.S.doc Version 5.2 Page 21 The home has confirmed in the pre-inspection questionnaire that most maintenance has been completed as part of the routine maintenance of the building. (See Management.) The manager has stated verbally that items highlighted in the last Environmental Health report have been completed satisfactorily. The home had a fire in the laundry on the 1st January 2006 and the fire officer has been in following the fire to investigate. The home had not received written details of the outcome of this investigation at the time of the visit. The fire officer has confirmed that the fire was the result of a local electrical fault in the tumble dryer. Care staff members seen during the visit wore gloves and aprons appropriately and washed their hands between tasks. Files viewed showed evidence that infection control training has taken place in the home since the last inspection, as required. DS0000003899.V325635.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): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers of staff on duty at the home satisfactorily meets residents’ needs. Staff members receive regular training and since the visit the home has developed a detailed internal summary of training undertaken to ensure that training needs can be satisfactorily monitored and identified. The home is making progress in ensuring that residents are fully protected by the home’s recruitment procedures. EVIDENCE: The home maintains computerised records of rosters. Staff members are allocated in the home with specific reference to the needs of residents. During the shift, staff members are moved in order to ensure that residents’ needs are responded to fully and in an unhurried manner. Staff seen working demonstrated an understanding of their roles and duties, together with a commitment to the service. Records submitted with the pre-inspection questionnaire and discussions with the manager, reflected that there is some agency usage in the home. The manager said that as much as possible
DS0000003899.V325635.R01.S.doc Version 5.2 Page 23 continuity is sought in the agency workers coming into the home to help the staff working at the service. One member of staff said that she had come to the home as an agency member of staff and had decided that Talbot View was the place that she wanted to work at the most. Three members of care staff are awake at night and a sleeping member of staff on call. The manager said that the management team are currently considering having four awake members of staff at night, with reference to the dependency levels of residents. At the time of the visit there were ten care staff on duty, the manager and the deputy. Two Care Team Managers were on duty. In addition to this three members of domestic staff were working in the home. The manager said that there are normally four members of domestic staff during the day. At the time of the visit fifteen care staff working in the home possessed a National Vocational Qualification in Care (NVQ) at level 2; four possessed a qualification at level 3. In addition to this eight members of staff were registered at the time of the visit to undertake an NVQ. Three recruitment files were seen. Completed application forms were on the files. There was no record of a Protection of Vulnerable Adults check (POVAFirst) for one member of staff. This check has to be made prior to employment; a member of staff may then work under supervision until the Criminal Records Bureau check is returned. The organisation takes up these checks normally as part of efficient recruitment checks. A copy of the check needs to be kept on file, as evidence that it has been carried out. There was also no photo for identification on the file. The manager had already identified that no photos were held for some staff. If possible this must be photo identification. A list of staff for which no photo is held had been compiled. Since the inspection the manager has confirmed that photos for identification purposes, have been obtained for all members of staff currently working in the home. Photos will be obtained as part of the home’s recruitment process in the future. At the time of the inspection there was no summary of training available in the home. A copy of this is held at Head Office. Following the visit the manager has compiled a spreadsheet so that training needs can be monitored and identified. The home maintains a training folder for staff members where copies of certificates and verifications of attendance are held. From records seen routine updating of mandatory training takes place. The manager confirmed that the organisation has adopted the new Skills for Care, the National Training Organisation’s induction programme. There were no completed files to view; however, a copy of the previous induction programme was seen for one staff member. Competencies had been signed off. There was no written record of the course of the learning process, whereby the staff member had progressed from observation, and supervision to competence. DS0000003899.V325635.R01.S.doc Version 5.2 Page 24 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Talbot View is managed by a person who is highly qualified and competent and able to ensure that the home is run in the best interests of people living in the home. Good procedures are in place to ensure that residents’ financial interests are safeguarded. By ensuring that all entries are made in ink on records of financial transactions, this will support the scrupulous procedures that the home has in place to ensure that residents’ monies are efficiently handled. The organisation, management and staff team work hard to ensure that residents’ health, safety and welfare are promoted. When it was highlighted that checks of electrical wiring had not taken place, the service responded expediently to ensure that the necessary checks are carried out.
DS0000003899.V325635.R01.S.doc Version 5.2 Page 25 EVIDENCE: Throughout the visit the manager of the home demonstrated effective management skills in organising and responding to the daily management needs of the running of the home. The manager possesses a Diploma in Social Work, a degree in Health and Social Studies as well as the Registered Manager’s Award. The deputy manager is also about to embark on the NVQ level 4. The home is well organised with Care Team Managers taking delegated responsibility for the efficient running of specific areas of the service. Senior carers are also being appointed to ensure that practical work is carried out to the high standards the home sets. During the visit staff members consulted the manager appropriately and the manager had time to listen to all the staff members who needed her time and advice. The home undertakes regular quality assurance, seeking people’s opinions about the life of the service. A detailed pre-inspection questionnaire was returned as part of this inspection, comment cards were also distributed to people involved with the life of the service and a good response was received. The manager said that recent staff absences had meant that the home had fallen behind in staff meetings, but that these would be back on course. This will be reviewed at the next inspection. Throughout the visit staff were observed listening to the views of residents and taking these into consideration in providing help and support. Since the last visit the home has set up an audit system for medication. The manager acts as an appointee for one person living in the home. Efficient records are maintained. Sampled entries corresponded with a bank statement. Receipts are also kept of expenditures. It was advised that as legal recording entries should be made in pen, currently they are made in pencil, so that mistakes can be easily corrected. Some residents’ personal monies are held by the home. The manager confirmed that these monies are stored separately and a running total kept of payments in and out. Efficient records are kept of the check of fire equipment at the service. Staff members receive fire training from an external training provider. The five yearly check of electrical in the home had lapsed and was drawn to the manager’s attention as a result of the visit. The organisation has taken expedient action and at the time of writing this report has already confirmed that the checks are underway and will be henceforth routinely renewed. Training records seen reflected that routine updating in areas of safe working practise take place. DS0000003899.V325635.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 2 X X 2 DS0000003899.V325635.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Timescale for action The registered person shall, after 30/04/07 consultation with a resident, or their representative, prepare a written plan as to how the resident’s needs in respect of his / her health and welfare are to be met. A care plan must be in place for any resident who suffers from epilepsy, as to how care is to provided. The resident’s plan must be kept under regular review. 2. OP9 13 The registered person shall make 31/01/07 arrangements for the safe recording of medicines received into the care home. When a medicine has been administered it must be signed for at the point of administration. If a medicine has been omitted, the reason for omission must be recorded. The member of staff checking
DS0000003899.V325635.R01.S.doc Version 5.2 Page 28 Requirement the medication must sign handwritten entries of medicines onto Medication Administration Records. Another member of staff must also sign to verify the medicine received. 3. OP29 19 The registered person shall not employ a person to work at the care home unless: Evidence of a check of the Protection of Vulnerable Adults register is on the applicant’s file, in which case the person may work under supervision until a satisfactory Criminal Records Bureau check is received. Photograph identity is held on file. 4. OP38 23 The registered person shall ensure that the premises safely meet the needs of residents accommodated in the home. Electrical wiring must be routinely checked every five years. 31/01/07 31/01/07 DS0000003899.V325635.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 OP12 Good Practice Recommendations In order to ensure that all residents’ needs are fulfilled an activities coordinator should be recruited, so that the individual and general needs of residents can be identified and fully met. It is recommended that a written record is kept of staff members’ progress in meeting competencies in line with Skills for Care Induction Standards, reflecting progress in developing the skills to provide care which protects residents and promotes their health and well being. All entries into records in the home must be made in pen, so that it cannot be altered and any amendments are clear. 2. OP30 3. OP35 DS0000003899.V325635.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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
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