Inspection on 25/07/08 for The Check House

This inspection was carried out on 25th July 2008.

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

The Check House 15/07/09

The Check House 30/08/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOMES FOR OLDER PEOPLE The Check House Beer Road Seaton Devon EX12 2PR Lead Inspector Michelle Oliver Unannounced Inspection 25th July 2008 09:30 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 The Check House DS0000069119.V365136.R03.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. The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Check House Address Beer Road Seaton Devon EX12 2PR 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) 01297 21858 01297 625496 The Check House Limited Post vacant. Care Home 49 Category(ies) of Old age, not falling within any other category registration, with number (49) of places The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May admit a maximum of 4 people who require nursing care between the ages of 45 - 64 years The maximum number of persons accommodated at the home at any one time shall not exceed 49 30th August 2007 Date of last inspection Brief Description of the Service: The Check House is owned by The Check House Ltd and an application has recently been made to the Commission to register a person as manager of the home. This application is currently being processed. The Check House is a nursing home providing hotel style accommodation, care and nursing for up to 49 older people and for people who do not require nursing. The home does not offer intermediate care, and there are smoking restrictions. The house is a detached Grade II listed property in Seaton, East Devon with outstanding views of the sea across a sweeping garden with terraces. Residents accommodation consists of 43 single rooms and 3 double rooms over three floors. The home has its own minibus. The home’s statement of purpose and service user guide, which includes details about the philosophy of the home and details about living at the home, is available to all residents and visitors, on request. A copy of the most recent inspection report is available for all to read in the entrance hall of the home. Information received from the home indicates that the current weekly fees are currently £866.00 single room and £1071.00 double room. Fees for respite accommodation are currently £ 131.50 single room and £205.00 double room per night. All fees quoted above are for accommodation only Nursing fees will be additional to these quoted. Services not included in this fee include Hairdresser, Chiropody, Toiletries, Optician and Dentist. There is no charge for the use of the minibus. The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. As part of this key inspection the manager completed an Annual Quality Assurance Assessment (AQAA), which contained general information about the home and the people living and working there. With the information provided, CSCI surveys were sent to people living at the home, their relatives, staff and outside professionals, in order to hear their confidential views of the service, prior to our unannounced site visit. Prior to this inspection we sent surveys to 10 people living at the home, 10 staff and 10 health care professionals. We received completed surveys from 6 people living at the home, 3 staff and 9 health care professionals expressing their views about the service provided at the home. Their comments and views have been included in this report and helped us to make a judgement about the service provided. This inspection was undertaken over 2 days by one inspector. We spent 8 hours at the home on the first day and 5 hours on the second. We spoke with people living there and staff and also spent time observing the care and attention given to people by staff. To help us understand the experiences of people living at this home, we looked closely at the care planned and delivered to three people. Most people living at the home were seen or spoken with during the course of our visit and three people were spoken with in depth to hear about their experience of living at the home. We also spoke with 12 staff, including the manager, and ancillary staff, individually. A tour of the premises was made and we inspected a number of records including assessments and care plans and records relating to medication, recruitment and health and safety. Finally the outcome of the inspection was discussed with the manager and matron What the service does well: People living at this home were generally very happy with life at the home; one person told us, “ couldn’t be in a better place” and “ we are all very fortunate to live in a place where we are so well cared for”. The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 6 Staff are recruited robustly to ensure that people are protected. Many people praised the staff team for their caring approach and attitude. People spoke highly of the staff; and told us “Overseas staff are wonderfully kind and patient”, “I find them sensitive and caring people” and “Staff are very nice”. Relatives also praised staff saying, “They are so kind”, “Very welcoming, cheerful staff” and “Staff are very caring on the whole”. During our visit staff were attentive and friendly in their approach to people living at the home. We saw staff skilfully meet the needs of individuals and ensure that individuals were offered choices. Good information is available to people to help make a decision about whether this home would suite their needs. A good admissions process ensures that the home can meet people’s needs. People’s health care needs are well met and the home works with other professionals, such as GPs and nurse specialists to ensure people have access to the care they need. People can be assured that caring staff will respect their privacy and dignity and enable them to make choices within their daily lives. People were generally happy with activities provided and most felt their social needs were met. People spoke highly of the food served at the home, which is of good quality and nutritious. The home can cater for various diets. Several people described the atmosphere at the home as warm, friendly and welcoming. People feel confident that their complaints or concerns will be addressed. The environment is clean, comfortable and safe. People were very happy with their accommodation. The home has sufficient aids and equipment to support the need of the people living there. Overall, health and safety is well managed and people are safeguarded from harm. Comments included in questionnaires returned by health care professionals included, “ always has good routine for patient care and social outings”, “Generally good care” and “Excellent level of care. Well managed”. What has improved since the last inspection? People considering moving to The Check House receive written confirmation that their assessed needs can be met by the home. The Check House DS0000069119.V365136.R03.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. The Check House DS0000069119.V365136.R03.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 The Check House DS0000069119.V365136.R03.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 & 6. Quality in this outcome area is adequate. Systems are in place to ensure peoples’ needs are assessed before they move into the home. Prospective residents would benefit from the assessments being more personalised with consideration being given to their individual needs, concerns and anxieties. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of people spoken with were happy with their choice of home. Comments from people included, “No complaints”, “ couldn’t be in a better The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 10 place” and “ we are all very fortunate to live in a place where we are so well cared for”. Several of the people spoken to during the inspection were unable to recall the admission process to the home or whether they had been given enough information. They said that family members had arranged everything for them. The manager said that people are given the choice of visiting the home with the opportunity to stay for the day and/or arrange a respite in order to make an informed decision. Comprehensive information about the home is included in the home’s Statement of Purpose and Service User Guide, both of which are clearly displayed in the hall for people to read and are given to all who make enquiries about moving to the home. A copy of the most recent inspection report is also available, for all who wish to read it, in the entrance hall of the home. The manager told us that it is considered essential to ensure that before a person is admitted to the home careful consideration is given to their ability to meet all the needs of the prospective resident without compromise to their rights under equality and diversity. We looked at the assessment undertaken for a person who was admitted to the home for a period of respite, who later decided to make the Check House their home. The assessment included basic care needs including details of whether they needed chiropody, information about diet, nutrition, hearing and the number of staff needed to assist when transferring them. However, there was little information relating to the person’s abilities, what they hope for and want to achieve and the support they need or the persons choice of how they wished their care to be provided. The person lived out of the county so the assessment was done through phone calls with people involved in the persons care, as the person did not find it easy to communicate over the phone. The manager told us that they plan to review the pre admission assessment to make it more comprehensive. The assessment will include individual health, welfare and social care needs, emphasising peoples abilities as well as their needs and will address any equality and diversity issues. Prior to admission the home promotes peoples’ rights by confirming details such as fees; admission date and whether or not people’s identified health and social care needs can be met at the home. When people who have chosen to make the Check House their home, they are The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 11 welcomed with a pack containing the service user guide, a letter of welcome and a sheet notifying them of the week’s activities. The home does not admit residents for intermediate care. The Check House DS0000069119.V365136.R03.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 & 11 Quality in this outcome area is good. Systems in place generally inform staff about peoples’ care needs, although lack of adequate detail in some care plans may prevent truly individualised care for everyone. Keeping records of when individuals are encouraged to be involved in the planning, reviewing or development of their care plans needs to be improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a system in place to ensure that all people have individual plans of care, which are kept in the matrons’ office and are readily accessible for all staff to refer to. The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 13 Individual “condensed” care plans are also available on each floor for staff to refer to. These include information such as past medical history, whether the person uses hearing aids or wears dentures, whether they need assistance to eat, what crockery and cutlery is used, how many staff are required to provide personal care or assist with transfers and allocated bath days. However, no information is recorded of how people chose to have care delivered, their likes or dislikes, preferences or communication needs. For instance, how does a person choose to be washed, what abilities they have or do they have a preference in relation to the gender of carers assisting them. Staff told us that they did not find these plans particularly helpful and were able to speak about individual needs in detail and how personal care is carried out paying attention to individual choice. Checklists are also included in these plans such as whether hair brushes; toothbrushes, toiletries, spectacle or hearing aids need replacing or cleaning. A record is kept of the delivery of personal care, which is checked and countersigned by either care officers, for people who do not receive nursing care, or a registered nurse for those who do. The manager told us this is to ensure that all required tasks are undertaken as planned. We looked at three people’s care plans in detail during this inspection. Risk assessments were in place and generally reflected behaviour or situations which may cause harm to people, for example poor mobility, falls and the use of equipment such as bed rails. Moving and handling assessments and plans, skin care and tissue viability and continence assessments were in place and generally provided staff with the instructions needed to deliver care. We saw assessments that had been undertaken for two people who had rails attached to their beds. This is good practice as the use of bed rails does present risks e.g. a person may try to climb over the rails or may be at risk of injuring themselves if moving around when in bed. However, it was not clear why bed rails were being used for these people or whether they had been consulted before they were used. There was history of either of the people falling from bed. Care files showed that people have access to outside professionals such as G.P, specialist consultants, palliative care team; chiropodist and optician in order to ensure their health care needs are met. Those people, who do not require nursing care at the home, have access to the community nursing service. The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 14 Plans of individual care needs, why and how the care needs will be carried out and the outcome of the care delivered have not been undertaken consistently. For instance, there was no plan to inform staff how to care for a person who has been catheterised, or for a person who has problems with communication. Another person told us they had lost their appetite and lacked any interest in food. They said that they were feeling very unhappy and would like more attention and assistance with meals. A relative of this person has voiced concerns about the deterioration in this person but no plan relating to the persons needs has been undertaken. This lack of care planning puts people at risk of not having their care needs met or monitored. Information received from the manager prior to this inspection included confirmation that care plans are undertaken with the involvement of the service users, relatives and/or their advocates. We saw nothing to suggest that people are involved in either the initial drawing up of or subsequent reviews of their individual plans of care. Several people spoken to during this inspection were unaware of having a plan of how their care should be delivered at the home. People living at the home, or their representatives, must be consulted as to how they wish their health and welfare needs to be met and kept informed when plans are reviewed. The manager told us that a complete overhaul of the care plans is due to be undertaken with the emphasis being not only on medical needs but also in relation to people’s right to equality and diversity, incorporating race, gender identity, disability, sexual orientation, age, religion and beliefs. Staff told us that they ensure that people are treated with dignity and that their privacy is protected. We saw several examples of this being carried out throughout this inspection. For example staff were observed being discreet in offering to provide personal care or assistance, all personal care was carried out in private and people confirmed that they wear their own clothes which are very well cared for. During our tour of the building we saw a notice on a persons door instructing all staff “to put on gloves and aprons before entering and remove before leaving. This does not apply to delivery of tray at mealtimes and drinks”. We discussed this with the manager and Matron as this potentially puts this person at risk of their privacy and dignity not being fully respected. We were told that the notice was originally put up when the person had an infection. We discussed infection control procedures at the home. [Please refer to “staffing” standards 27-30] The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 15 Comments in questionnaires returned by health care professionals included “I always have to ask for resident to be taken to a private room to be examined” and another “Always offered a quiet private room to see people”. During this inspection we saw staff assisting people to their private rooms when being visited by health care professionals. Staff demonstrated a good knowledge and understanding of the importance of the safe handling, storage and recording of medications and carries this out to a good standard. Medicine Administration Records (MAR) were looked at; where hand written entries had been made two signatures had been obtained to ensure accuracy, this is good practice. Where variable doses of medication are needed, accurate records were available with the actual dose given. Some people are prescribed creams to be applied daily. In some cases records were poorly complete indicating that this may not be happening. Not all medication, with a limited ‘shelf life’ once open, had been dated to ensure they were used within the timescale suggested by the manufacturer. The home has a “Homely Remedies” policy, agreed by doctors, relating to medication s that can be bought “over the counter” and given to people if indicated. This includes named medications, such as paracetamol, the reason for administering it and how long it may be given before a doctor is consulted. This means that people living at the home benefit from safe management of medication. Prior to this inspection we sent questionnaires to people living at the home and staff to help gather information about the home. We received responses from 6 people currently living at the home. Three people confirmed that they always or usually receive the care and support they need. Three members of staff returned questionnaires. Two agreed that they are sometimes given up to date information about those living at the home. Comments made included: “ Sometimes care plans aren’t updated as the needs of SU’s change. If we make suggestions to our care officers they don’t seem to listen. We carers are the main frontliners who give care and attend to the daily needs of our clients”. Nine health care professionals returned questionnaires. One doctor commented that: Sometimes [the home] request visits for trivia”, another commented, “They [staff] always seem to take note of the advice they are given”, “Generally good care” and “Excellent level of care. Well managed”. The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. Routines are flexible and people are supported to exercise control over their daily lives. Social activities generally meet peoples’ expectations and preferences and people enjoy a balanced diet which takes into account the likes and dislikes of individuals. People benefit from contact with their family and friends, which is encouraged and supported by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection a Group Activities Manager who has undertaken specialised training and is able to draw on the other home’s experiences for improvement has been introduced into the home. People living at the Check house are provided with a 6 day activities programme to enable them to choose what they take part in. Activities include gentle exercise sessions, netball, bingo, discussion groups, crosswords, board The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 17 games and quizzes. Staff spend time with those people who choose not to take part in activities and prefer to stay in their rooms’. During this inspection several people took part in an exercise session, a gentleman was playing a piano in another lounge and another person was singing along. Friends and relatives are encouraged to visit the home at any time. We spoke to one person who said whenever they visit they are always made to feel welcome. Throughout this inspection we saw a number of people visiting the home. We asked the manager and staff whether people living at the home are given the choice of receiving visitors. We were told that they were not as staff were not always about when visitors entered the home. The manager said that the home is considering putting a polite notice beside the visitors’ book asking visitors to check with a member of staff before visiting a person. This means that people will be able to exercise choice in relation to whom they see. People are given the choice of being served their meals either in their rooms, the lounge, and conservatory or in the comfortable dining room where they are served by “waiting” staff. Daily menus are displayed on one of the notice boards as well as on each table in the dining room for people to refer to. A choice of meals is always available at lunch and the evening meal, providing for personal requests and a vegetarian option is always available. However, during this inspection a person who had lost their interest in food told us that they had requested a particular fish and had described how they wanted it cooked but had not yet been given it, 2 weeks later. Lunch served during this inspection was well presented and nutritious. People told us that the “meals are wonderful”, “superb” and “ first class”. All meals are cooked on the premises and use mainly fresh ingredients. Hot and cold drinks are available throughout the day. The kitchen was well stocked with supplies, including fresh fruit and vegetables and a good supply of dried goods. The cook told us that all food was of “fantastic quality” and that the home does not “scrimp” on food. We were told that several people needed assistance with eating. When being assisted with breakfast we were told that one member of staff assists up to 5 people in the dining room. This is not considered acceptable practice; people who require assistance should be assisted individually to promote their privacy, dignity and safety. We discussed this with the manager who was unaware of The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 18 this and assured us that arrangements will be made to ensure that this practice ceases. People spoken to say they are supported and encouraged to make choices in their daily lives such as the times they get up and go to bed, what they wear and where they eat their meals. It was not clear how people who are less able to make their choices known, or find communicating difficult are afforded this choice. We received 6 responses to questionnaires sent to people living at the home. One person confirmed that there are always activities arranged that they can take part in and one commented, “The arrangements for activities cannot be faulted”. Two people confirmed that the meals served at the home are always or usually enjoyable. One commented “Meals are 4*. Excellent in choice, quality and quantity”. The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 19 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. The home has a satisfactory complaints process with evidence that complaints are listened to and acted upon. Staff are aware of the procedure to follow to protect people from abuse or harm but would benefit from up to date training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is displayed in a concise and clear notice in the entrance hall at the Check House. People living at the home know who to speak with should they have any concerns or complaints and most were aware of the complaints procedure. One person told us, “I have nothing to complain about but would soon tell them”, and another “I could talk to any one about concerns”. Comments made in response to questionnaires included “I have not had to make a complaint. If I need a member of staff I have a bell in my room, which is answered by a member of staff”. The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 20 The home has received two complaint/concern since the last inspection, and records show that one was dealt with in a professional manner and that people were happy with the outcome. However, one person who made a complaint to the home was not satisfied with the way the complaint was dealt with or the outcome. The complaint related to allegations of poor care and was referred to Social Services Safeguarding Adults team for investigation. The outcome was that although allegations made could not be substantiated the manager agreed that there were some issues that needed to be included in future staff training. These issues generally related to record keeping. Staff are required to watch the “No Secrets” video to promote the Protection of Vulnerable Adults during the first week of employment at the home. Staff spoken with confirmed they had watched a video to help them recognise any poor practice or evidence of abuse and all were aware of their responsibility to report any concerns. The content of the video was not discussed with staff after it had been watched and there was no assessment of staff knowledge and understanding of the content of the video. Training updates have not been provided to staff that have been employed at the home for several years. We spoke to a registered nurse who had not received adult protection training, although was aware of guidance kept in the home about alerting the appropriate bodies in the event of an allegation of abuse being made. We discussed this with the manager who agreed that training will be provided and that relevant telephone numbers/ contacts will be made available in an easily accessible format. This means that people living at the home will be protected by staff up to date knowledge of preventing people being put at risk of harm or abuse. People spoken praised staff for their kindness described staff as “kind, caring, polite and friendly” and told us that they felt well cared for and safe living at the home. The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 21 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. People living at the Check House enjoy a good standard of accommodation that is attractive, clean, homely and well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Check House is well maintained and provides comfortable accommodation including 3 lounge areas, a conservatory and a dining room. The home has a programme for redecoration and improvement to ensure that people enjoy a good standard of accommodation. The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 22 Several individual bedrooms were visited, with people’s permission, during this inspection. Bedrooms were comfortable and personalised with sentimental items, photographs and small pieces of furniture. People are encouraged to furnish their rooms with personal effects including furniture where possible and all rooms have temperature controls. This means that people are encouraged to make their rooms personal to them and to be able to maintain a comfortable environment. The majority of the rooms at the Check House are single occupancy and have ensuite basins and toilets to ensure people’s privacy and dignity is respected. Rooms are refurbished regularly and all rooms seen during this inspection were well decorated and maintained. The home has the necessary equipment to assist people and meet their needs. Aids, hoists, and assisted toilets and baths are installed which are capable of meeting people’s individual needs. Staff told us they had the equipment they needed to ensure that care was provided safely. The home is furnished with high quality furnishing and fittings and is maintained to a high standard. The home employs two maintenance people; one who also takes care of the garden and the other who also undertakes driving duties. The home was clean and free from offensive odours throughout. We had a full tour of the building during this inspection and all the areas were extremely clean and fresh. Hand washing facilities are provided in all rooms and bathrooms to ensure good hygiene practice at the home. Staff have the necessary protective equipment, such as gloves and aprons. There is liquid soap and disposable towels in toilets and bathrooms to promote good standards. The Check House has a dedicated team of housekeepers to maintain the high level of cleanliness that is recognised by those living there and visitors. People responding with surveys said the home was “always” clean and fresh. People also commented on the flowers arranged around the home, one person said “There are always lovely flowers around the place which are bright and cheering”. People spoken with were happy with the accommodation provided, one person said, “This is a lovely place”, another said, “The gardens are a delight”. The gardens around the home are accessible and used by many people, weather permitting. A gardener is employed to keep the gardens and lawn looking nice. Flowers were picked on the day of this inspection for people to The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 23 use for “flower arranging” activity during the afternoon. Shady areas are provided in the grounds for people to sit and enjoy the views. All people living at the home enjoy views of the garden and the sea, which are available from several areas. The laundry is well equipped and managed by an experienced member of staff. The necessary equipment is available, such as two washing machines and two dryers. A red bag system is used for any soiled laundry ensuring staff are protected. The laundress takes great care with people’s personal items of clothing. People spoken with said they were very satisfied with the laundry service provided and that their clothes were taken care of and always nicely pressed and returned in good condition. Comments made in response to questionnaires returned by a health care professional included, “One of the communal rooms is cramped and full of customers-rather depressing. I’d prefer to see them nursed in smaller groups”. During this inspection this was not noted but the comment was shared with the manager. The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 24 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 good. Staff numbers and the skill mix are satisfactory and ensure peoples’ needs are met in a timely and proper way. People benefit from having experienced and friendly staff who have a good understanding of their needs. People would further benefit from being cared for by staff who were provided with training to enable them to meet some of the complex needs of people living at the home. People are protected by the robust recruitment practice followed at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Several people spoke highly of the staff. Comments included, “Overseas staff are wonderfully kind and patient”, “I find them sensitive and caring people” and “Staff are very nice”. Relatives also praised staff saying, “They are so kind”, “Very welcoming, cheerful staff” and “Staff are very caring on the whole”. The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 25 People told us that staff were “always” or “usually” available when needed and felt they received the care and attention they needed. When asked people told us that staff come as quickly as they could to answer bells, one person said, “I have all the help I need”, another said, “They (staff) are there when I need them, and another person told us, “I am very happy with care and help I get”, “there is the daily staff and a member of staff on duty at night, and a member of whom checks a couple of times or so now and again. My bell is at the side of my bed, which I can ring if necessary”, “All staff are very accommodating with all our needs” and “the carers are wonderful always cheerful willing and helpful”. The manager is generally on duty from 8am-5pm and aims to have the following number of staff on duty: Nine care staff, a care officer and a Registered Nurse on duty in the morning, five care staff a care officer and a Registered Nurse in the afternoon, six carers and a Registered Nurse during the evening and three carers and a Registered Nurse throughout the night. A cook, kitchen assistants, administrator, two activities co-ordinators and two maintenance people provide additional support. Information received prior to this inspection indicated that management undertakes regular monitoring of the staffing levels, rotas and allocations according to the needs of people living at the home. The manager also has flexibility to have additional staff on duty according to the activities being undertaken at any given time. The managers said that maintaining a safe ratio of staff to people living at the home at all times is a priority. Staff felt that generally staffing levels were adequate but were concerned that they often have to rush when assisting people in the mornings. We were told that a waiter used to come on duty at 7am and was responsible for delivering breakfast trays to people and making toast. Staff now have to do this, as the waiter does not come on duty until 9am. Staff are also concerned that they have less time to spend with people during the afternoon as they have one less staff from 2am to 4.30pm. One staff member said, “We do not have enough time not be rushed when giving care”. During our visit staff were seen to attend to people in a timely way. Bells were answered promptly and although busy during the morning, there was a calm and orderly atmosphere. Sufficient ancillary staff, such as kitchen staff, cleaners, laundry staff and a gardener is employed in satisfactory numbers to ensure that standards relating to food, cleanliness and the general environment are met. Staff morale at the home is not high and staff said they do not feel valued. Several people told us that they “always used to look forward to going to work in a very happy & friendly atmosphere, but things have changed lately” All staff stressed “Our priority is the people who live here” and “I feel they are well cared for and happy but they know that we are not happy”. The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 26 The home currently employs 30 care staff, 11 have attained, and 7 are working towards, a Nationally Recognised Qualification [NVQ] In response to questionnaires staff commented that they are not being provided with training relevant to their role, none to meet the needs of individuals care needs or keeping up to date with new ways of working. The manager told us that several people with Multiple Sclerosis have been cared for at the Check House. The Multiple Sclerosis Society has approached the management with a view to it becoming a “ specialist service” in this field. When we spoke to staff, although they were able to tell us how they cared for people with MS, they have received no training. The manager and a nurse have attended a Multiple Sclerosis awareness day presented by a nurse specialist and 7 staff have since attended a similar presentation at the home. This training provided staff with more of an awareness of the condition than a broader picture and how they actually care for people with the condition. The manager told us that this will be developed and if they are chosen to be a specialist centre the MS Society will be providing and subsidising staff training. The home has a number of people who have dementia but staff have not received any specific training in this subject either. This lack of training potentially puts people at risk of not being cared for by people who have been trained appropriately and are kept up to date with developments. Three staff recruitment files were looked at. These were clear and contained all the required documentation including satisfactory police checks to ensure that people living at the home are protected from unsuitable staff. All new staff receive a Welcome Pack containing the required documentation to include Terms and Conditions of Employment, Job Description and Staff Handbook. New staff are given a period of working as supernumery with a senior colleague prior to lone shift allocation. The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 27 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. The home has recently gone through a number of changes, which people living there and staff have dealt with well. The home has a management structure in place that together is working hard towards trying to make sure the home is run in peoples’ best interests. Health and safety is managed well. This judgement has been made using available evidence including a visit to this service. The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 28 EVIDENCE: Since the last inspection some changes have taken place at the home and the post of manager became vacant. The acting manager, who has recently applied to be registered with the Commission, was previously employed at the home as an administrator and worked closely with the former manager. She is currently working towards completing the Registered Manager’s Award and other relevant training to ensure the home is a “professionally run home of high standard with emphasis on the needs of those living at the home”. A Registered Nurse has been recruited as Matron. We were informed, prior to this inspection, that a development plan for the Matron, in regard to her position as Lead Nurse, with agreed timescales would be put into place. The Matron qualified as a registered nurse in 2006 and has been involved predominately in the care of the elderly since. The Matron is usually supernumery but during this inspection she was the only nurse on duty. Changes to the Company structure also includes the introduction of a Group Financial Advisor to ensure the continued accountability for robust accounting and financial procedures and a Group Development Manager to assist and promote the ongoing improvement to services and development. The acting manager told us that an “open door policy” operates at the home for people living there, their relatives and representatives and staff in all aspects of the running of the home. During this inspection we saw visitors, relatives and staff approaching the manager who responded well. The home is visited one a month by the group development manager who carries out an unannounced inspection of the home. The completed report is sent to the managing director and to the manager. This forms part of the home’s quality assurance system, which gather people’s views relating to the running of, and the quality of life experienced at the home. Other quality assurance procedures include sending surveys to people living at the home and their relatives/ visitors to gather information that includes standards of care, quality and variety of food, activities, cleanliness, laundry, privacy and management and administration at the home. The manager told us that no surveys have been undertaken since the last inspection but that plans to introduce a reliable service user survey with published results available to current and prospective service users within 3 months. The manager also told us she plans to hold “resident meetings” on a more regular basis trying to make them informative as well as a time for open discussion on the views and requests of the people living at the home and/or The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 29 their representatives. Staff told us that they did not currently receive regular supervision. They said when they had previously had supervision they had found it positive as it provided an opportunity for them to talk about their work and training needs. This was discussed with the manager who told us that she plans to re introduce this with care officers supervising care staff and the matron supervising registered nurses. We were told that regular staff meetings are held but not all staff are invited to attend. Care staff are asked to elect a person to represent them. Staff felt that by being able to attend the meetings it would give them the opportunity to be kept up to date with any relevant issues relating to people’s needs, work practices, training information and CSCI inspections. Comments included in a returned questionnaire included “If we suggest to have a meeting with the whole staff” it is refused. We discussed this with the manager who will consider opening the meeting up to all staff. The manager agrees that providing staff training is a priority and told us she will be undertaking a complete re-assessment of all staff training and a structured training programme will be set up for all staff to undergo required training using Red Crier and other training facilities. [Ref standard 30] The home manages some people’s finances. Where necessary relatives assist people to manage their finances. The home will keep a small amount of money for people who receive services such as hairdressing, chiropody and other personal items that may be needed. Clear records, and receipts are kept of all outgoings Health and safety at the home is generally well managed. During our tour of the building no immediate hazards were identified. Staff have received moving handling training but have not received up to date training in infection control or basic food hygiene. [Ref standard 30] Since this inspection was completed the manager has submitted an improvement plan of how some of the issues discussed at the time of this inspection will be addressed. The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 30 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 31 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. Standard Regulation Requirement Timescale for action 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 OP3 Good Practice Recommendations Assessments of people’s health, welfare and social care need, undertaken before they make a choice of home, should include information to inform staff all about them, what they hope for and want to achieve and the support they need. People living at the home should be involved or consulted when their individual care plans are compiled, consulted when plans are reviewed or kept informed of any changes to their care to ensure that they consent to changes and that their rights are protected. People should be aware that their care plans are available to them if they wish and plans should be written in a format that is accessible to individual needs. 2 OP7 The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 32 Care plans should include details of how individual health and social care needs will be met. This is to ensure that people needs are identified and met in a person centred way and to protect individuals rights. 3 OP9 When creams are prescribed a record should be kept of their application. Creams/ointments should not be used beyond their “ shelf life” once opened. People living at the home should be given the choice of whom they see and don’t see. People who need assistance with eating should receive this sensitively and individually. Although there was nothing to suggest that people living at the home are anything but well cared for it is recommended that all staff are provided with up to date training in Adult Protection and alerting any allegations made. All staff should be trained and competent to do their jobs. This relates to the need for staff to receive training in caring for people with dementia and multiple sclerosis. The views of people living at the home should be sought to ensure that the home is run in their best interests. The results of surveys should be published and made available to current and prospective users of the service, their representatives and other interested parties, including the Commission. Care staff should receive formal supervision at least 6 times a year. 4 5 6 OP13 OP15 OP18 7 8 OP30 OP33 9 OP36 The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 The Check House DS0000069119.V365136.R03.S.doc Version 5.2 Page 34 - 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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