Inspection on 01/05/07 for The Abbeys

This inspection was carried out on 1st 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Abbeys 09/05/06

The Abbeys 11/11/05

The Abbeys 12/05/05

The Abbeys 28/10/04

The Abbeys 11/05/04

The Abbeys 27/01/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE The Abbeys High Street Rawmarsh Rotherham South Yorkshire S62 6LT Lead Inspector Mrs Marina Warwicker Key Unannounced Inspection 1st May 2007 08:40 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 DS0000003069.V331734.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. DS0000003069.V331734.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Abbeys Address High Street Rawmarsh Rotherham South Yorkshire S62 6LT 01709 719717 01709 710149 theabbeys@schealthcare.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Cross Operations Limited Alison Tripp Care Home 80 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (80) of places DS0000003069.V331734.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Nursing clients are admitted to the Abbeyhill Unit only. Date of last inspection 9th May 2006 Brief Description of the Service: The Abbeys are situated just off a main road in Rawmarsh, Rotherham with public transport to the town centre. It comprises of two separate buildings Abbey Hill and Abbey Dale. Abbey Hill is a two- storey building with 55 bedrooms. It is divided into three units. One unit with 10 bedrooms to provide care for older people with dementia. The remaining 45 bedrooms are registered to provide 19 nursing and 26 personal care for older people. Abbey Dale is a three -storey building for older people requiring help with personal care only. Passenger lifts give access between the floors and there are level entrances and ramps to the buildings including those giving access to the gardens. In total up to 80 people can be accommodated at The Abbeys. All rooms are single occupancy and some have en-suite facilities. The weekly fees ranged from £343 to £640, at the time of the visit. There was information with regards to the service was available in the form of service user guide and statement of purpose. DS0000003069.V331734.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was carried out on Tuesday 1st May 2007 between 8.30am and 4pm. Eleven people who use the service, a visiting professional, two relatives were consulted and ten staff were spoken to. A further seventeen service users/ relatives, seventeen staff and five visiting professionals were contacted by post to obtain feedback about the service. Comments received from the surveys have been included in the body of the report. Time was spent observing and interacting with staff and the service users. The manager was present during the inspection. The premise was inspected which included bedrooms of service users and the communal areas inside and the outdoors. Samples of records were checked. Care plans, medication records, some service reports and staff recruitment and training files were checked. The fee for a week at ‘The Abbeys’ is between £343 and £640 at the time of the site visit. I would like to thank the service users, the relatives, the staff and the manager for their contribution towards this process. What the service does well: Prospective people who wish to use the service and their representatives have the information needed to make an informed choice. The information ensures that the home will meet their needs. The people have their needs assessed and a contract is drawn telling them about the service they will be receiving at around the time of admission. The principles of respect, dignity and privacy are put into practice by the staff working at the home in order for the residents to feel comfortable and safe. The staff offer support to the residents so that they are able to maintain their life skills and thereby sustain independence as long as they are able to. People who use the service are able to express their concerns and have access to a complaints policy. The people are protected from abuse, and they are able to use their rights during their stay at the home. DS0000003069.V331734.R01.S.doc Version 5.2 Page 6 The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence and peace of mind. On the whole the staff are trained and skilled to support the people who use the service. The management and administration of the home is based on openness and respect. There are quality assurance systems, which are used by the manager and her team. What has improved since the last inspection? What they could do better: All of the information documented in care plans must be as far as practicable accurate and reflect the person’s need. There needs to be a system to audit accuracy of information. Inaccurate documentation will result in inappropriate interventions. A person had refused to take medication in tablet form. Although the staff had consulted the general practitioner there was no indication as to how this person was receiving the prescribed medication. It is expected that the person be offered the medication in a suitable form and this needs to be recorded in the care plan. The staff need to receive training on palliative care or end-of life care. The formal training gives the staff confidence and enables them to give practical assistance to relatives & advice on death & dying to the people and their representatives. There were opportunities for staff to attend training in their own time if they so wish. DS0000003069.V331734.R01.S.doc Version 5.2 Page 7 Those people using wheelchairs to help with their mobility must be offered a suitable dining chair when having a meal at the dining table. This would help the person to sit comfortably and safely at the table. At the same time the movement from the wheelchair to the dining chair would help with the pressure area care and tissue viability of the person. The number and the types of hoists available at the home needs to be audited in line with the dependency levels of the people. All care staff need to receive regular supervision so that all aspects of their practices could be discussed and the managers are able to help with their career development and empower the staff to carry out their daily duties competently and confidently. Although the manager had carried out supervision of the senior staff this has not been cascaded to the junior workers yet. The people living at The Abbeys and their representatives should be aware of 1. Their Terms & Conditions applied by the home. 2. Their right to be involved in the planning of care. 3. The choice of activities available at the home and whom they should contact if they wanted to know more about them. 4. Why the commonly used food supplements were not in use and the home uses ‘Smoothies’. 5. What meals are offered and the menus and the choices available. How to find out how much their relatives were eating and drinking if there were to be any dietary problems. Although all of the above information was in place, it needs to be more efficiently communicated to the people and their relatives/ representatives. The staff should be provided formal time for the handover between shifts and the management should not expect the staff to come earlier in their own time in order to take handover before they start duty. The number of shifts worked by a staff was found to be excessive and could lead to health and safety issues. This is an ongoing problem and the management is expected to monitor this to prevent tired staff working long hours and putting the people and their colleagues at risk. 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. DS0000003069.V331734.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 DS0000003069.V331734.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4&5 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. Prospective people who wish to use the service and their representatives have the information needed to make an informed choice. The information ensures that the home will meet their needs. The people have their needs assessed and a contract is drawn telling them about the service they will be receiving. EVIDENCE: Feedback forms for fifteen surveys, consultation with the residents, the staff and the visitors were used to assess this outcome area. The manager had copies of the service user guide and the statement of purpose. They had the relevant information for prospective residents so that they were able to get a good picture of the set up at the home. DS0000003069.V331734.R01.S.doc Version 5.2 Page 10 One of the relatives mentioned that they were not aware of a contract being agreed. Another person said, “Can not remember signing for a contract.” On the site visit the manager said that often the Terms & Conditions / contracts were agreed by the social services and showed a resident’s contract which confirmed that there was agreement with the paying authority. The relatives and the staff said that people were accepted into the home only after receiving their individual needs assessments and/or following the home’s own assessments (this for those who self fund their care). The copies of the assessments were found in the residents’ personal files. The surveys confirmed that the people and their relatives were confident that the staff at the home would meet their needs. Comments from other professionals confirmed that the people were able to have temporary placement or trial period before accepting a permanent place. One relative made the following comment.“ When we went into see the home, the staff said that my X could come for a trial before making our mind up. This was comforting for us.” The trial period gave the prospective resident and the ones living at the home opportunity to meet and get to know each other. DS0000003069.V331734.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, 10&11 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. On the whole the health and personal care of those who live at The Abbeys are based on their individual needs. So that the care reflects each individual’s needs. The principles of respect, dignity and privacy are put into practice by the staff working at the home in order for the people to feel comfortable, safe and part of the community. EVIDENCE: Three individual care plans were checked. The staff on duty were observed and consulted with regards to them delivering care and support to the people who live there. Feedback from the surveys were also considered when assessing this outcome area. DS0000003069.V331734.R01.S.doc Version 5.2 Page 12 The individual care plans had been generated from an assessment, which had been drawn up with the help of residents and their representatives. These documents provided the basis for the care to be delivered. However, there were some inaccuracies noted in the information and the examples were highlighted to the manager of the home during the site visit. There was evidence that the care plans had been reviewed by staff and the changes had been recorded. However, the following comments were received from the relatives and residents “Can we have access to personal records of our father/ mother?”. “ They tell me if anything changes.” “ No, I am not consulted. I don’t have anything to do with it.” These comments were shared with the manager and she said that people at the home and their relatives were involved in the care plan reviews and they were asked to sign the documents if they so wish. The feedback from the surveys, direct observation and the documentary evidence confirmed that the staff promoted health care by accessing appropriate support from the general practitioner and other health care professionals. It was noted that on one occasion the documentation following general practitioner’s visit did not explain the outcome and what changes were made to the care of that person with regards to the identified issue/s. For example, a resident was prescribed eye drops. There was no reason recorded as to why this was prescribed and what happened following administration of the eye drops. Another resident was observed to have a bruise on the arm and there had not been any follow-up documentation. A relative made this comment. “Could do with a personal book with doctor’s visit etc. If the staff are busy they may not always remember to explain what is going on or what has happened.” The manager was made aware of this. Although the staff carry out nutritional screening the records of daily intake were not always maintained for those who were at risk. The following comments were made in the feedback. “ The home does not get any food supplements any more and this is a problem”. “Unlike before the staff don’t give out food supplements”. During discussion the manager said that due to the present ethos of ‘balanced diet including fresh food’ the residents are encouraged to have ‘smoothies’ instead of ready-made food supplements. The people had access to hearing and sight tests according to their needs. The staff were observed administering medication during the day and the people were helped by the staff to take their medication. During case tracking it was noted that a person had refused to take medication in the form of tablets. Although the staff had sought advice from the general practitioner there was no documentation to say how the person was taking the medication at present. Discussion took place with regards to this with the manager. DS0000003069.V331734.R01.S.doc Version 5.2 Page 13 During staff interviews it was ascertained that they had received management of medication training and updates by the supplying pharmacists. The manager said that the pharmacist carried out audits. On the day of the site visit the staff demonstrated that they ensured that peoples’ privacy and dignity were respected at all times. It was observed that the people looked comfortable and happy. Their clothing was clean and there was plenty of interaction between the people and the staff. The care staff said that they have had experience caring for those at the end of their lives. Some comments from the staff were as follows; “I will not be treating the dying person any different. Their needs are just like us.” “We try not to leave them alone if the family are not at the bedside.” During feedback the manager informed that the care staff had access to the McMillan support services and the staff were able to attend training at the local palliative care centre. But the training records of the individual nurses and the carers checked did not have any formal training records on palliative care or practical assistance & advice on death & dying or bereavement counselling. Discussion took place with the manager with regards to formal training for all care staff on end-of –life care. DS0000003069.V331734.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 &15 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. People who use The Abbeys are on the whole able to make choices and influence the decisions made for them about their life style by the staff at the home. The staff offer support to the residents so that they are able to maintain their life skills and thereby sustain independence as long as they are able to. Social, cultural and recreational activities in the main meet individuals’ expectations. The people and the relatives will benefit by the information on the activities being readily available. Most of the time the meals are served and presented in a manner, which is attractive and appealing to the residents. Not all residents are made comfortable at the dining table during meal times. This practice prevents people enjoying the meals and being comfortable and safe during meal times. DS0000003069.V331734.R01.S.doc Version 5.2 Page 15 EVIDENCE: The comments from the surveys, consultation with the manager and the staff on the day of the site visit confirmed that the routines of daily living and activities made available were flexible and varied to suit the expectations, preferences and capacities of those who live at The Abbeys. The following are some of the comments made with regards to the activities provided to the people. “The home tries hard to do things well but if resources or time is not available it is impossible to do things, like social time with residents.” “They need stimulation not just sitting watching TV.” “Those who are unable to get out of bed the entertainment & social aspect are limited.” “I would like some stimulation for my X. Some one to one. For example Aromatherapy, Massage, reading newspaper or discussions of what is happening in people’s life or area news. This has been requested. But I do not know if and when this may happen” “The only thing I can find wrong is there is not enough recreation.” “They have plenty of company, play bingo etc. and are well looked after in general.” “There is always plenty to do if I want.” “The bus is not used enough by the home. They need more staff to take people out.” The manager was informed of these mixed comments. It was established that plenty of activities were offered to people. However, there may be a need for the residents, relatives and other visitors to be made aware of the choice of activities available at the home and whom they should contact if they wanted to know about them. Residents said that they were able to receive visitors in private and that there were no restrictions on visiting. The staff ensured that the visitors sign in the ‘visitors book’ to maintain safety of the residents who live at the home and also to help with the fire safety. This was witnessed on the day of the site visit. On the day of the site visit the visitors were seen entering the home and being welcomed by the staff. During the tour of the premise it was noted that the residents had brought in their own possessions and many had personalised their bedrooms. Each resident was offered three full meals each day. Hot and cold drinks were also made available to all. Those residents who were able to make their own drinks were encouraged to do so by the care staff in the residential part of the home. DS0000003069.V331734.R01.S.doc Version 5.2 Page 16 The residents were observed during breakfast and lunchtime. Staff were around offering assistance discreetly to residents requiring help with feeding. Meal times were not hurried and the residents were given sufficient time to have their meals. The consistency of the meat dish at lunchtime was too runny and it was served with gravy. This did not look appetising and people made comments to such effect. This was discussed with the cook and the manager. The following comments were received from the surveys sent out by the Commission for Social Care Inspection. “ Meals are cooked too early and kept warm for a period of time. Meals could be served soon after cooking”. “Pay more attention to diet when the patient is frail. Make the menus more interesting and food in general could be more improved.” “I requested approx. 12 – 18 months ago for a weekly menu to be provided but not come to light as yet, although they agreed that this was a good idea.” “The staff ask the residents for their choice of meal several days before and on the day they have no idea of what they had ordered. Can’t they be reminded each day what they are going to have for dinner?” On each unit there were copies of the menus displayed at the notice board. But the people were not in the habit of checking the boards. On the day of the site visit it was observed that the meals were prepared prior to each meal. The heated trolleys were used to transport the meals to the different units. Some of the people who occupied ‘The Abbeydale’ were asked whether they knew what they were to have for lunch that afternoon. Four people said that they could not remember and one said, “I am sure it will be something nice.” The people who used the wheel chairs to mobilise were having their meals seated in the wheel chairs at the dining tables instead of being transferred into the dinning chairs and made comfortable. This practice resulted in one resident sitting too far from the table and another one too low from the table. The staff were shown and questioned about such practice. The manager was also informed of this and highlighted issues surrounding people who were not given the choice and also the consequences of such practice as leaving people in the wheel chairs during the day i.e. This could cause problems with the individuals’ tissue viability/pressure areas. DS0000003069.V331734.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&18 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. People who use the service are able to express their concerns and have access to an effective complaints procedure. They are protected from abuse, and able to exercise their rights whilst living at the home. EVIDENCE: There was a copy of the complaints procedure available to residents and the visitors. The manager had a record of all the concerns and complaints made to the home. The records suggested that complaints had been dealt with effectively and action taken by the staff at the home to remedy it. A comment received from a relative said, “I would just like to say my B and I are satisfied with the care and if we do come up against any problems we take them to the manager and she deals with them satisfactorily.” During formal interviews the staff were able to say what actions they would take if they received a complaint from a visitor. The feedback from the surveys and the consultation with residents and staff confirmed that for those lacking capacity the staff arranged contact with the advocacy service if the residents did not have anyone else to represent them. The four staff files checked and records of staff having received training on Protection Of Vulnerable Adults. DS0000003069.V331734.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22,23,24,25&26 People who use this service experience good, quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: The location and the layout of the home suit the stated purpose. The home provides personal care, with the stated number of nursing beds and dementia care accommodation. The 10-bedded EMI unit had been made into a unit, which was resident friendly. A suggestion was made in one of the surveys that building a conservatory would give the older people the opportunity to enjoy the good weather without getting the wind and the rain. The manager was informed of this request. DS0000003069.V331734.R01.S.doc Version 5.2 Page 19 Passenger lifts gave access between the floors and there were level entrances and ramps to the buildings including those giving access to the gardens. Grounds were kept tidy and accessible to residents. The use of CCTV cameras was restricted to the entrance areas for security purpose. The maintenance person had records of daily repairs and renewals. Furniture and lighting in the communal areas were domestic in their appearance. During the tour of the premise it was noted that the individual’s bedrooms were personalised and many had the occupier’s personal items. The consultation with the residents and the feedback from some surveys indicated that there was an adequate number of hoists, aids and adaptations available at the home. One person commented,“ The patient is kept clean & made comfortable. The special bed mattress helps patient sit up when required. The patient is kept pain free and the room is clean.” However, some feedback highlighted the problems the staff were having since the dependency levels of residents had increased and as a consequence the demand for the aids had increased. They suggested that the home purchased another stand aid hoist and also arrange for the hoist, which had been out of order for some time to be repaired. Emergency lighting was provided throughout the home and the maintenance person had records of the regular checks he continued to carry out. These included hot water temperature at the point of residents’ contact and the stored hot water temperature. The home was centrally heated and the temperature on the day of the site visit was comfortable. Staff were able to explain how they prevented the spread of infection when handling soiled clothing and also on a day to day basis. They confirmed that they had received formal training on Infection control. On the day of the site visit parts of the home visited were clean, fresh and free from any offensive odours. DS0000003069.V331734.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28.29&30 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. On the whole the staff are trained and skilled to support the people who use the service, in line with their terms and conditions. However, to achieve adequate staffing levels and skill mix the staff are working extra shifts. It is perceived by the staff as offering continuity of care instead of using bank and agency staff. Staff see this as their contribution to the smooth running of the service. EVIDENCE: Feedback from the residents, the visitors and the staff has been used and also records kept by the home were checked to ascertain the judgement in this outcome area. On the morning of the site visit there were 70 residents, the manager, two second level nurses, 9 care staff, Activities co-ordinator, handyperson and a cook were present. DS0000003069.V331734.R01.S.doc Version 5.2 Page 21 (SCA- Senior Carer, CA-Carer, Nurse- Qualified first or second level nurse.) Name Number of occupancy/available beds EMI unit 9/10beds Wedgwood- Nursing 13/19 beds Rose- Residential 18/26 beds Abbeydale Residential 18/25 beds Staffing on morning shift 08:0014:00hrs. 1xSCA 1xCA 1xNurse 2xCA 1xNurse 2CA 3xCA Staffing on evening shift 14:00– 20:00hrs. 2xCA 2xCA 2xCA 1xSCA 3xCA Staffing on night shift 20:0008:00hrs. 2xCA 1xNurse 1xCA 2xCA 2xCA One of the relatives and a visiting professional questioned how many staff should be working on each shift. Therefore the above table has been provided to help understand the staffing level to the occupancy provided by the home on the day of the site visit. The following comments were received from the surveys. “Staffing numbers are sometimes a problem. The staff are under pressure at times and have little time to pay time to social aspects and sometimes only very minimal duties can be done” “I get the feeling that the staff are not as happy as they could be. Often they are working days off due to staffing shortages.” “More staff would improve one to one with residents.” It was noted that it is customary for staff to cover any shortfalls in shifts by them. Dialogue took place between the manager and the inspector with regards to the importance of the care staff having adequate time off between shifts for the benefit of their health & safety and also to prevent the effects of tiredness on staff morale and effectiveness when delivering care to vulnerable adults. During staff rota checks it was identified that a senior member of care staff was working a mixture of days and night shift totalling between 60 –72 hours per week. Staff were of the opinion if they had signed the disclaimer to work over 48hrs per week then they could work as many hours as they wish. However, it is the duty of the management to monitor the suitability and the capacity of the individuals to function efficiently when they work extra hours. The manager was asked to address immediately the problem of, the staff working such extra long shifts. This was identified during the last inspection. It was also ascertained that the staff were not given time for handover between the shifts and it is expected that the staff would come earlier before the start of each shift in order to take handover report in order to maintain continuity of care. DS0000003069.V331734.R01.S.doc Version 5.2 Page 22 The care staff said that they were encouraged by the manager to register on the NVQ awards and some have had completed Level2. Four staff recruitment files were randomly selected and checked. All staff files were up to date and contained all the necessary information required by the Care Home Regulation 2002. Four staff training records were checked. The four staff had received regular mandatory training and further service specific training such as customer care, challenging behaviour, dementia care, bed rail safety and care planning. DS0000003069.V331734.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): 31,33,36&38 People who use this service experience good, quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The management and administration of the home is based on openness and respect. There is a quality assurance systems used by the manager and her staff manager. Effective communication is needed to inform the people at the home and their relatives the improvements, which had been made for the best interest of the people who live there. EVIDENCE: The registered manager was qualified, competent and experienced in the management of the home. She and her senior staff were familiar with the running of the home and there were clear lines of accountability. DS0000003069.V331734.R01.S.doc Version 5.2 Page 24 The staff and the manager said that regular quality monitoring and quality assurance had taken place. The manager said that they had regular relatives and residents meetings where the multidisciplinary staff joined in the meetings. As part of monitoring the residents’ call system is to be replaced in the near future. The Commission received the following comment. One person commented, “ There are a couple of environmental improvements that would improve the service. New ‘buzzer system’. A small quiet lounge for the upper floor and turn the present one into a dining room.” The manager said that the head office audited the residents’ monies. The senior staff had carried out the formal staff supervisions. However, not all staff had received regular supervision. The manager continued to supervise the senior staff however, this has not been cascaded through to all care staff working at the home. The manager had ensured so far as practicable the health, safety and welfare of the residents and the staff at the home. This has been achieved by training staff on health & safety, food hygiene, fire safety, moving & handling, Infection control and First aid. The staff had also been instructed to report all accidents, incidents of illnesses without fail. Regular service and maintenance of electrical and gas appliances had been carried out. The manager said that the operations manager carried out regular audits and she used these opportunities to discuss any matters relating to the running of the home. DS0000003069.V331734.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 X 2 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 2 x 3 DS0000003069.V331734.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP27 Regulation 19 (5c) Requirement Immediate Ensure that the number of shifts worked by staff is not excessive in order to prevent health and safety issues. Previous timescale 01/07/06 not complied. All of the information documented in care plans must be as far as practicable accurate and reflect the person’s need. Inaccurate documentation will result in inappropriate interventions. 01/05/07 Immediate Immediate When a person refuses to take medication in a certain form (e.g. tablets) The staff must ensure that the person is offered the medication in the form suitable for him/her. This must be recorded in the care plan. 01/05/07 Immediate Staff working in care homes must receive training on palliative care or end-of life care. DS0000003069.V331734.R01.S.doc Timescale for action 01/05/07 2 OP7 15. 15/06/07 3 OP9 13. 01/05/07 4 OP11 18. 01/10/07 Version 5.2 Page 27 5 OP15 13 The formal training gives the staff confidence and an insight into practical assistance to relatives & advice on death & dying to the person and their representatives and also enables them to offer basic bereavement counselling. 40 staff compliance by end of September 2007 and full compliance by end of January 2008. Immediate Those people using wheelchairs must be offered a dining chair when having a meal at the dining table. This would help with the comfort, safety and tissue viability of the person. 01/05/07 Immediate The number and types of hoist available at the home must meet the dependency and the assessed needs of the people. The repairing of the faulty hoist must be a priority. All care staff must receive regular supervision so that all aspects of their practices can be monitored and their career development needs can be identified. The management must be able to provide evidence. Supervisions enable staff to have a two way feedback from their line managers and assess their progress and empower themselves. 01/05/07 6 OP22 16,23 15/06/07 7 OP36 18 30/09/07 DS0000003069.V331734.R01.S.doc Version 5.2 Page 28 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. 2. 3. Refer to Standard OP2 OP7 OP12 Good Practice Recommendations All residents and their representatives should be aware of the Terms & Conditions applied to their stay by the home. The people living at the home and their representatives should be made aware of their right to be involved in the planning of care. The people at the home, relatives and other visitors should be aware of the choice of activities available at the home and whom they should contact if they wanted to know more about them. The people at the home, the staff and the relatives should be informed of offering those who need food supplement ‘Smoothies’ and whenever possible using natural produce to maintain a life style in line with healthy eating. There should be a system to inform the people what meals they would be receiving each day. The meals should always look appetising when served to people. The staff should be provided formal time for the handover between shifts and the management should not expect the staff to come earlier in their own time in order to take handover therefore they start duty so that they are able to maintain continuity of care. 4. OP15 5. 6. 7. OP15 OP15 OP27 DS0000003069.V331734.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 DS0000003069.V331734.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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