Inspection on 01/11/07 for The Close

This inspection was carried out on 1st November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Close 18/09/08

The Close 05/12/06

The Close 12/06/06

The Close 03/10/05

The Close 26/04/05

The Close 17/01/05

The Close 07/07/04

The Close 24/02/04

Similar services:

Fairfields Country Rest Home

Fairfax House

Claremont Nursing Home

Doveridge Care Home

Dunmore

Chatsworth

Dunraven Lodge

Eastleigh Care Homes, South Molton

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Close (The) The Close Littleton Panell Devizes Wiltshire SN10 4ES Lead Inspector Sally Walker Unannounced Inspection 09:20 1 November 2007 st 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 Close (The) DS0000028334.V350552.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. Close (The) DS0000028334.V350552.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Close (The) Address The Close Littleton Panell Devizes Wiltshire SN10 4ES 01380 812304 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) theclose@hotmail.com Mr John Roche Mrs Aurora Roche Mrs Aurora Roche Care Home 12 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (12) of places Close (The) DS0000028334.V350552.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th December 2006 Brief Description of the Service: The Close is a privately run home that provides personal care and accommodation for up to 12 people with dementia. One of the owners also manages the home. Both the owners are closely involved with the home on a regular basis. The Close is situated in the village of Littleton Panell, which is close to Devizes. There are local shops, pubs and a GP surgery nearby. The Close is a detached house set in its own grounds. The residents’ bedrooms are on the ground and first floors. A passenger lift is available. There is a lounge that is also used as a dining room. Access to a smaller dining room and a conservatory is either through the kitchen or off the main hallway. The conservatory is used to receive visitors. There are eight single bedrooms and two shared bedrooms. None of the rooms have en-suites, but all have hand washbasins. Commodes are provided in the bedrooms. There are three bathrooms, one of which has a hoist. There are six toilets for residents. There are at least two staff working during the day. At night there is one waking staff member and another person who provides ‘sleeping-in’ cover. The current scale of charges can be obtained directly from the home. Close (The) DS0000028334.V350552.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 1st November 2007 between 9.20am and 6.20pm. Mr Roche was present during the inspection and Mrs Roche came to the home at lunchtime. A tour was made of the building. Three residents and three staff were spoken with. The care records, statement of purpose, staff records and menus were examined. Following the last inspection of 5th December 2006, we set out in an improvement plan what the home had to do in order to address requirements not actioned following previous inspections. We asked the home to send us their action plan showing what they had done and were doing in order to comply with the regulations. The action plan was received on 28th February 2007. Actions taken are reported upon in the relevant sections of this report. As part of the inspection process survey forms were sent to the home to distribute to residents, families and healthcare professionals for their views on the service. Comments can be found in the body of this report. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? Close (The) DS0000028334.V350552.R01.S.doc Version 5.2 Page 6 The home has complied with the improvement plan in that they do not admit anyone without obtaining their care management assessment. There is now a pre-admission assessment form in which the home gathers information from a variety of sources involved in the potential resident’s care. The home has complied with the improvement plan to ensure that all residents have their risk of developing pressure damage assessed. The toilet door with a lock, which could not be accessed from the outside in an emergency, has been drilled through so that the lock can now be opened. Quality assessments have been made and an action plan drawn up. What they could do better: The statement of purpose needs to clearly set out the criteria for emergency admissions. The statement should be dated for reviewing purposes. Although much information is gathered before residents are admitted, not all information is transferred to their care plans. Not all residents or their representatives had been consulted about who provides intimate personal care. Information in the detailed assessment documents is not always included in the care plans. There is little guidance to staff on how these assessed needs are to be met and monitored. Care plans must identify how those residents with a diagnosis of diabetes have their care provided and monitored. Care plans must also identify the care, support and equipment for those residents assessed as being at risk of developing pressure damage. The home must keep their own records of interventions and progress, not rely on district nursing notes. Some care plans must be more specific and not use vague terms, for example, “unacceptable behaviours”. Risk assessments and care plans must identify whether residents can bathe alone or must never be left to bathe alone. Recording of regular weighing of residents should be consistently entered into residents’ files. Confidential information about residents must be securely kept to ensure that no unauthorised person has access. Residents have little opportunity for accessing the wider locality. Some areas of the home were in need of re-painting through chipped woodwork. The new carpet in the sitting room had become stained and discoloured in some areas. The side gates need repair and replacement so that residents can safely access the back gardens without risk of going onto the main road. There must be a programme of guarding all the radiators to ensure residents are protected from scalding. Close (The) DS0000028334.V350552.R01.S.doc Version 5.2 Page 7 Residents should have their own toiletries and topical creams. Items in the bathrooms must not be for communal use. Discoloured plastic jugs in bathrooms must be discarded. Commode pots must be emptied, cleaned and returned to the same resident. Consideration must be given to whether it is appropriate for staff to always wear disposable blue plastic aprons, even when not needing to protect their clothing. The staffing rota must show full details of the staff responsible for sleeping in. Staff must never start working with residents without a check on the Protection of Vulnerable Adults list to see if they are suitable to work with vulnerable people. “To whom it may concern” testimonials must not be accepted as references. The home must follow up references themselves. 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. Close (The) DS0000028334.V350552.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 Close (The) DS0000028334.V350552.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. Standard 6 is not applicable as the home does not provide intermediate care. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The statement of purpose outlines most of the information prospective residents and their representatives need when considering what the home offers. The detail about emergency admissions is limited. Although the contract for people who fund themselves gives details of their terms and conditions, the covering letter will inform the person of the fee-paying arrangements. All potential residents have their needs assessed before they are admitted. EVIDENCE: No action had been taken to address the requirement we made on 5th December 2006 and in the improvement plan, that the statement of purpose is amended. This means that it should clearly specify the criteria for admission, including the home’s policy for emergency admissions. The home told us in Close (The) DS0000028334.V350552.R01.S.doc Version 5.2 Page 10 their action plan, received on 28th February 2007, that the statement had been amended to show this information. However this was not the case. Mr Roche hastily amended the statement during the inspection with a sentence referring the reader to the policy, without any clear details. Mr Roche showed us the policy file in which the statement of purpose was included. Clearly this is insufficient information for prospective residents and their representatives who will not want to read through policies when initially considering the home. The statement of purpose needs further amendment to show details of emergency admission criteria. We advised that the statement should be dated for reviewing purposes. Action had been taken to address the requirement we made on 5th December 2006 and in the improvement plan, that the home must not provide accommodation to anyone unless a copy of the care management assessment has been obtained. This is to ensure that the home can meet their needs. This referred to the home admitting residents, one as an emergency, with only limited details of their care needs being obtained over the telephone. The home told us in their action plan that a pre-admission assessment form had been produced. At this inspection there was evidence of pre-admission information gathering in the home’s own assessments. There was also information from hospitals and consultants. The assessments showed who had completed the assessment and who had provided the information. The forms had different headings to assess nutrition, behaviours, skin condition, mobility, communication, sleeping, risks, medical and social history. In December 2006 we recommended that residents’ contracts clearly set out the cost of their stay. Mr Roche said that details of this would be either in the placing agencies contract or if privately funded, the covering letter sent to the resident with the terms and conditions. One of the relatives told us during the inspection that they had chosen this home having looked at a number of homes. They said that their relative had settled in well. Another relative said that the family had looked at a number of homes and chosen this one because staff were more friendly and were talking to residents. They said they had probably been given a service users guide but could not remember. In a survey form one of the relatives wrote: “The overall physical health and appearance have greatly improved since taking up residence at the Close. They look at the individual and get to know them how to relax them and make them happy and comfortable. [the resident] is able to feel that [they] are at home and that it is [their] home. Physical health has much improved and [they have] put on weight since arriving at the Close.” Close (The) DS0000028334.V350552.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Much effort is made to regularly assess residents’ care and health needs. However much of this information is not transferred to the care plan to show how these needs are to be met or monitored. Healthcare records are poorly kept with the home relying on district nursing notes rather than keeping their own. All of the residents were assessed as not able to manage their own medication. Residents had no choice about who provides intimate personal care. Staff treat residents with respect and their privacy is upheld. EVIDENCE: All residents had a care plan. Relatives are encouraged to sign the care plan where the resident’s medical condition prevents them from doing so. The care plans showed little information in comparison to the wealth of information gathered during the assessment process. As a matter of good practice a preadmission assessment identified where one resident did not want male staff providing intimate personal care. However this information had not been Close (The) DS0000028334.V350552.R01.S.doc Version 5.2 Page 12 included in their care plan. Other care plans for female, or indeed male residents, did not show whether they or their representative had been consulted about who provides intimate personal care. Care plans identified detailed social history and family trees. Each file had assessment documents with scores for physical health, mental health, falls, nutrition, behaviours, pressure risk assessments and moving and handling. However the care plans did not always detail guidance to staff on how these assessed need were to be met or monitored. The care planning document heading was “problem” rather than need. The care plans did however give good information on giving personal care, support with eating and nutrition and some behaviours. There was good evidence on how to communicate with one resident. Another care plan stated that staff must take their time to explain to the resident what was going to happen when giving personal care. Another care plan detailed that the resident liked large helpings at meals times; there was a list of treats that they could eat. It was not possible to establish from the records how those residents with a diagnosis of diabetes were having their care managed. Mrs Roche said that the district nurse had trained herself and one of the staff to carry out blood sugar testing at the end of last year. However there was no written evidence of this. We advised that healthcare professionals remain responsible for monitoring any nursing procedures delegated to staff. We also advised that if the district nurse is unwilling or unable to give certificates of this training, the home must keep a record. This must include the name of the staff receiving the training, the date training was delivered together with the name and designation of the person giving the training. The records for one resident showed that blood sugar levels had not been recorded for some time. There was no evidence as to why this was not being recorded. There was no record in the care plan of blood sugar parameters for wellbeing of the resident or any guidance on what to do if the levels were higher or lower than they should be. We advised that advice must be sought from either the diabetic nurse or the district nurse, whoever was reviewing the resident’s care. The care plan must state the resident’s needs in terms of how diabetes affects them together with strategies for monitoring and managing their care. One care plan stated “unacceptable behaviours”. There was no indication as to what this meant. The guidance for managing behaviours stated that staff were to encourage the resident to do activities that they liked. There was no reference to what activities the resident liked, or what other strategies to use if the resident did not want to do an activity. Close (The) DS0000028334.V350552.R01.S.doc Version 5.2 Page 13 The care plans or risk assessments did not state whether residents could bathe alone or whether staff must never leave residents alone in the bath. Mrs Roche said that residents were never left alone in the bath. Care planning files were varied in monitoring residents’ weights. Some had a page where monthly weights were entered to easily show any significant loss or gain. There was a separate book showing that each resident was weighed each month. However each page showed all residents weights rather than a page for each resident for easy monitoring. Action had been taken to meet the requirement of 5th December 2007 and the improvement plan, that all residents have their risk of developing pressure sores assessed. This had been an outstanding requirement of the inspection of 12th June 2006. In their action plan the home told us that all residents have regular reviews of care plans to ensure their health and welfare needs are being met. However the care plans of those residents who had been assessed as being at risk of developing pressure sores gave little information on how the risks were being reduced, or how the care was monitored. Mrs Roche said that this information was in the district nursing notes kept in residents bedrooms. We advised that the home must not rely on district nursing notes. Individual care plans must identify healthcare needs and interventions together with monitoring of progress. One assessment for risk of developing pressure sores stated that the resident had a “tendency to develop pressure sores”. However the score was identified as low. Another stated “tends to be red and sore at times on sacral area”. The assessment stated: “special assistance required” but no reference to what this meant. In another part of the file it was documented that the GP and district nurse were to be informed of progress. Pressure relieving equipment was in place and was identified in care plans. There was evidence in staff supervision notes that discussions had taken place about prevention of pressure sores. The care records were kept in the dining room on a side table. We advised that the care plans and other confidential information relating to residents must be kept securely so that they are only accessible to staff. The care plans are headed with the statement: “Confidential document please file away”. One of the staff showed us the arrangements for residents to have regular eye test from a visiting optician. Residents were well groomed. Some action had been taken to address the requirement about privacy and dignity, outstanding since 12th June 2006. The improvement plan of January 2007 required that new signs were put on toilet doors and new locks fitted, so that staff could open the door in an emergency. In their action plan the home stated that one of the doors had been fitted with a lock. They reported difficulty in obtaining a lock for the other door as it is not standard. Large Close (The) DS0000028334.V350552.R01.S.doc Version 5.2 Page 14 printed engaged and vacant signs, which could be turned to show occupancy, had been hung on the doors. One toilet door had been fitted with a new suitable lock. The other door had been cut through to the original lock so that a screwdriver could be used to open the lock in an emergency. This was tested out with Mrs Roche and found to be an adequate arrangement. Staff had received training in medication administration. The medication was safely stored. All of the current residents were assessed as not able to administer their own medication. Medication is administered to residents generally at mealtimes. The monitored dosage packs are transferred to a lockable trolley, which is taken to residents around the home. Where compliance with taking medication deemed essential for a resident’s wellbeing by their GP, the GP had signed what was entitled a “covert medication policy”. The GPs instructions were that this medication could be placed in food if it was refused or spat out. There was guidance in the care plan about what triggers an administration of medication prescribed to be taken only when required. Residents medication was regularly reviewed with their GP. In a survey form one of the GPs wrote: “I feel The Close provides a caring environment for its patients[sic].” In a survey form one of the nurses wrote: “Mrs Roche will contact me immediately if she requires advice regarding individual residents….[or] the GP or emergency services if that is required. All residents at The Close have all their physical psychological and social health cares addressed and met. Each individual has their own care plan and are cared for according to their need. All residents receive respect for their privacy and dignity. All personal care is managed away from other residents and in an appropriate setting ie bathroom toilet bedroom. Due to the severity of the cognitive impairment of the majority of residents it is not practical for the individuals to be responsible for the administration of their medication. If the care staff are faced with a problem and do not feel that the skills they have are adequate, the manager or carers always contact those people who do have the skills needed for guidance. All residents both male and female are cared for in a dignified manner. My feelings of the care at the Close are that all the individuals receive the highest and most professional care I have seen. The manager and her staff treat the residents as family and offer them the care and attention, which they would want their own elderly relatives to receive. As a qualified Registered Mental Health Nurse with 30 years experience I can honestly say that the Close is the most happy and caring establishment that I have visited. Dignity is always maintained. Unlike some residential/nursing homes there is never any nasty aroma’s from bodily functions. Any physical or psychological changes are always reported either to the GP or the mental health team.” In a survey form one of the care managers wrote: “[the home makes] appropriate referrals to GP, hospital and Community Mental Health Team as required. Have responded appropriately to reviews. Managing behaviours Close (The) DS0000028334.V350552.R01.S.doc Version 5.2 Page 15 labelled challenging – dealing with client aggression [does well]. Valuing client as an individual. Encouraging independence in skills client retains.” One of the relatives told us during the inspection that they were kept informed of their relatives health and welfare. Another relative said that the home phones them if issues arise. Close (The) DS0000028334.V350552.R01.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. This judgement has been made using available evidence including a visit to this service. Residents take part in a range of activities at the home. There is little opportunity for residents to access facilities in the locality. Visitors are welcomed. Those residents who are able to choose can retain a degree of choice over their lives. Residents enjoy the varied meals provided. Residents nutrition is monitored. EVIDENCE: Activities are provided every afternoon. Residents were involved in a quiz during the inspection. The sitting room had been decorated for Halloween the night before. The residents files contained a report on which activities each resident had been involved in each day. We recommended at the last inspection that residents were given opportunities to access the local and wider community. There was no evidence of this happening in the records kept of activities in each residents file. Mrs Roche said that she often took some residents shopping in Devizes. However the individual care plans or risk assessments did not relate to anyone going out in a car. Close (The) DS0000028334.V350552.R01.S.doc Version 5.2 Page 17 Those residents who could choose, spent their day either in their room or in the sitting room. Other residents relied on staff for direction. In a survey form one of the relatives wrote: “Residents have choice. Allows residents to live a fully supported life as they wish. The best run home I have visited.” In a survey form one of the nurses wrote: “Where ever it is safe to do so individuals are encouraged to do the things they choose. However due to the psychological difficulties the residents at The Close have most activities require supervision. For example, going out for walks or shopping. Privacy is respected at all times. Religious needs are managed with visits from the different faiths. Diet is appropriate to that faith and any disabilities are taken into consideration when caring for that person. The food is freshly cooked and wholesome. Fresh fruit is available and fluids are always on hand. ” In a survey form one of the care managers wrote: “Client is allowed to choose daily activities, ‘challenges’ are accepted as communication of refusal/choice where appropriate. [Could do better:] Provision of activities to stimulate clients – on 1 – 1 basis and responding to telephone requests for review. The Close has a homely atmosphere. My client is valued as an individual. The Close have never said that problems are unmanageable.” One of the relatives told us during the inspection about some of the activities that the home provided including music and games. One of the staff prepared the lunch which had been pre-cooked. The evening meal had been taken out of the freezer ready to be reheated. The menus show a range of traditional dishes suitable to the tastes of older people. The evening meal is soup and a hot dish. Those residents with whom we could communicate said they liked the meals. Some residents had their meal at the table in part of the sitting room. The meal was well presented and the residents said that they liked the food. Those residents who needed support with eating had their meal in the sitting room, in the separate dining room or in their bedroom. Staff were supporting these residents individually with eating at the residents own pace. They were talking to them about the food and encouraging them to eat. One of the residents at the table said that the meal needed more salt. There were no condiments on the table for residents to help themselves. Staff said that residents had been offered condiments as the meal was served. Staff went to the kitchen and returned with condiments which they sprinkled on the resident’s meal. One care plan identified that the resident ate slowly and that their food was not to be taken away. This was seen to be adhered to by staff. This resident’s care plan also identified that they liked to drink more than one cup of tea. Residents were given cups of tea as they asked, in addition to those given at regular intervals during the day. Close (The) DS0000028334.V350552.R01.S.doc Version 5.2 Page 18 In a survey form one of the residents said: “[meals] very good.” In a survey form one of the staff wrote that: Service users need more fruit.” One of the relatives told us during the inspection that the food was “quite good”. They said they were always made welcome and given tea and cakes when they visited. Another relative said that they could visit at anytime and were always made welcome. Close (The) DS0000028334.V350552.R01.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 adequate. This judgement has been made using available evidence including a visit to this service. Relatives and healthcare professionals are confident that any complaints will be taken seriously and acted upon. Little effort has been made to consider how residents can be supported to make a complaint. Systems are in place to ensure residents are protected from abuse. EVIDENCE: We recommended at the last inspection that the home should ensure that residents are fully aware of how to complain. We acknowledge that some residents would need support with this. We asked Mrs Roche how she would support residents to make a complaint and how she and her staff would know that some residents were expressing dissatisfaction. Mrs Roche said she knew the residents sufficiently well enough to gauge when they were unhappy. There was little evidence that the home had considered how to support residents to make a complaint. No complaint had been received by the home since the last inspection. Staff had received training in abuse awareness. Staff are made aware of the procedure for reporting allegations of abuse at induction. In a survey form one of the residents said they would: “speak to the manager [when asked about making a complaint].” In a survey form one of the care Close (The) DS0000028334.V350552.R01.S.doc Version 5.2 Page 20 managers wrote: “no complaints from family members who visit. No evidence of physical, financial abuse.” In a survey form one of the nurses wrote: “During my visits should I have raised any concerns these are always taken seriously and advice I might give is accepted and used. Should a relative have any concerns again the staff listen and respond appropriately.” One of the relatives told us during the inspection that if they had any problems they would talk to the owners. Another relative said that they had no complaints but would talk to someone if there were. Close (The) DS0000028334.V350552.R01.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 adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from the home being kept clean and odour free. Some areas show signs of wear and need repainting. Residents are not protected by good infection control measures. EVIDENCE: A tour of the building was made. Not all of the bedrooms are numbered or named. The window blind in one of the bathrooms had broken, affording residents no privacy. Not all radiators are guarded. Risk assessments had been completed following a previous requirement. At the last inspection we strongly recommended that all the radiators are guarded given the frailty and confusion of residents. Mrs Roche said that she based her assessment of only guarding one radiator in one resident’s bedroom on her assertion that residents generally had poor mobility. A programme of guarding all the Close (The) DS0000028334.V350552.R01.S.doc Version 5.2 Page 22 radiators must now be implemented, starting with those seen as a priority in terms of risk to residents from scalding. No action had been taken to address the recommendation that areas in need of new paintwork were redecorated. There were areas by bedroom doors with paint chips, probably made by wheelchairs. Mr Roche said that he redecorated bedrooms as they became vacant. Indeed he arrived at the home at the same time as we did, carrying pots of paint. One of the shared bedrooms, with both beds made up, had a mattress placed by the side of the bed. Mr Roche said that this bedroom was not occupied and the mattress was being stored there. Mrs Roche said that the carpet in the large sitting room had been replaced as we recommended at the last inspection. However there were many marks and it would benefit from a deep clean. The home was generally cleaned to a good standard. There were cleaning schedules in the kitchen. However there was a build up of lime scale to the undersides of the bath hoists. One of the toilet surrounds had yellow drip marks underneath. However no unpleasant odours were detected at any time. Some staff had been trained in infection control. There were a number of toiletries in one of the bathrooms, which appeared to be for communal use. There were also topical creams in one of the bathroom cupboards. One resident’s bedroom had two different topical creams with the names of two different residents on; one written on the lid and one on a prescription label. Mr Roche was advised that any topical creams, whether prescribed or not, should be for single use only. One of the resident had a basket in their bedroom for toiletries. These baskets could be used for all the residents so they did not have to share items. One bathroom had 2 discoloured plastic jugs; one marked “hair” and one marked “urine”. Mr Roche was told to discard them so they are not used. There were a number of commode bowls in one of the baths. Mr Roche was advised that they should be emptied, cleaned and returned to individual residents rather than rotated to reduce any risk of cross infection. Staff had been trained in infection control. Close (The) DS0000028334.V350552.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are not protected by the home’s recruitment procedures. Staff have access to mandatory training, including NVQs. There is no programme for future training relevant to working with people with dementia. EVIDENCE: No action had been taken to address the requirement of 5th December 2007 and in the improvement plan, that the staffing rota shows full details of who has responsibility for sleeping in duties. In their action plan the home told us that the staffing rota had been amended. However the rotas showed only the waking night staff. There were two care staff and a cleaner together with Mr Roche on duty on the morning of the inspection. The home had not found the information recommended at the last two inspections about the changes made to induction standards by Skills for Care. Each staff did not have an individual training plan as recommended at the last 2 inspections. However there were individual folders containing individual training certificates. Staff had undertaken a days training on dementia awareness. There had been a follow up session lasting an hour from a dementia specialist physiotherapist. There was no future training plan. Close (The) DS0000028334.V350552.R01.S.doc Version 5.2 Page 24 One of the staff talked about their previous experience of working in care settings. They said they were undertaking training in infection control and had recently completed first aid training. The files of the most recently appointed staff were seen. Three staff had started working without a check on the Protection of Vulnerable Adults list to ensure that they are suitable to work with vulnerable people. The subsequent Criminal Records Bureau certificate were seen to be negative. However the residents are not protected by the home’s recruitment procedure. The home had also accepted “to whom it may concern” testimonials instead of following up their own references. In a survey form one of the GPs wrote: “Caring staff no concerns.” In a survey one of the nurses wrote: “The staff regularly attend training sessions to improve on their skills and expertise. Ongoing training for all staff is always beneficial to a care service as is regular supervision of the care staff in order to be aware of any shortfalls in heir knowledge and skills. This does already happen at the Close but there can never be enough of an improvement in knowledge and skills.” In a survey form one of the relatives wrote: [staff] always appear to be well trained. All staff give time/ attention to all residents. In a survey form one of the staff said that they were: “Learning something new every day. In a survey form one of the care managers wrote: “I am unsure of precise qualifications or experience of care staff.”. Another staff wrote: “If I will rate from 1 – 10 I will give 9 because all the carers are doing all their best to give the service users all the care they needs physically, mentally emotionally and spiritually. All the people involved including the owner and manager are always up to date what’s happening with regards to all service users. There are cooperation and all the carers are open for any suggestions that can be better for the safe for all the service users. You can always get support from the proprietors of this home.” Another staff wrote: “Staff meet the needs of all the service users and the management as well. Speak to them in a nice way, give a tender loving care.” Consideration should be given as to whether it is appropriate for staff to always wear disposable blue plastic aprons. This practice is acceptable when needing to protect clothing. However it is unacceptable when working with residents and not providing personal care. Close (The) DS0000028334.V350552.R01.S.doc Version 5.2 Page 25 Staff were seen to engage with residents, taking time to sit and chat whilst going about their other daily routines and duties. It was clear that good relationships had been established. Close (The) DS0000028334.V350552.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Mrs Roche as manager does undertake some training but does not intend to complete the Registered Managers Award. The home completed the Annual Quality Assurance Assessment required by regulation. There was an action plan following surveys to relevant parties. Staff benefit from regular supervision. Little action has been taken to ensure residents ongoing safety, health and welfare. EVIDENCE: Mr Roche was present for the majority of the site visit. Mrs Roche, the manager, came at lunch time after she had completed an assessment of a potential resident. Little action had been taken to address the requirement we Close (The) DS0000028334.V350552.R01.S.doc Version 5.2 Page 27 made on 5th December 2006 and in the improvement plan, that the manager must undertake appropriate training from time to time. This has been outstanding since 12th June 2006. Mrs Roche had not been available to discuss her training at the inspection of 5th December 2006. In their action plan the home told us that Mrs Roche had undertaken regular training courses. At this inspection Mrs Roche said that she did not intend to complete the Registered Managers Award. Mrs Roche showed us her training certificates. These were: infection control; October 2006, medication; 2006, dementia; April 2005, first aid; 2004, fire safety; 2003 and health and safety; 2003. Mrs Roche said that she had undertaken dementia awareness training as distance learning through Swindon College and was awaiting the certificate. She also said that she received regular information from The Royal College of Nursing. Mrs Roche gave us the impression during discussions, that she kept up with any training that was required to retain her PIN number as a nurse. However the Nursing and Midwifery Council on line check gives no record for her name. Mr Roche said that he and a member of staff had completed the Registered Managers Award but had not yet submitted the coursework. Action had been taken to address the requirement that the home’s quality assurance system must include an evaluation of the quality of the service. In their improvement plan the home told us that an annual questionnaire had been sent to the residents, their families, friends and other agencies. They went on to say that all concerns raised would be dealt with as far as possible within a timescale. Mr Roche gave us his action plan during this inspection. The Annual Quality Assurance Assessment had also been sent to us. Minutes of regular staff minutes showed discussions about good practice. Records were kept of regular staff supervision. The home does not keep any money on residents behalf. One gate to the side of the building was lying on its side. The other gate was reported to be faulty. One of the residents was having a walk in the garden at the beginning of the inspection. Staff had to leave the building to ensure that the resident did not walk down the driveway and onto the road. At the last inspection the home was strongly recommended to guard radiators to reduce residents risk of scalding. The risk assessments only related to residents’ mobility or the position of the radiator. No action had been taken to guard the remaining radiators. In a survey form one of the relatives wrote: “Always someone at the home to ask/help. Very supportive, kept informed. I am always kept ‘in the loop’ with decisions. Close (The) DS0000028334.V350552.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X N/A 3 X 2 Close (The) DS0000028334.V350552.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4(1)(a)(b) (c) Requirement The registered person must ensure the homes statement of purpose clearly specifies the criteria for admission including the homes policy for emergency admissions. (Mr Roche hastily amended the statement during the inspection. However actual details are required). The registered person must ensure the staff roster shows full details of who has responsibility for sleeping in duties. (This was a requirement at the last inspection and in the improvement plan). The manager must undertake training from time to time as is appropriate and must inform the Commission of the arrangements that have been made for this. This requirement has been carried forward from the last inspection. The timescale for compliance was originally 30/09/06. (Certificates were awaited for Dementia awareness training). DS0000028334.V350552.R01.S.doc Timescale for action 01/11/07 2. OP27 17(2) 01/11/07 3. OP31 10(3) 01/11/07 Close (The) Version 5.2 Page 30 4 OP25 13(4)(a)& (c) 5 OP7 15 6 OP10 12(2)&(3) 7 OP37 17 8 OP38 13(3) 9 OP29 19 10 OP38 23(2)(o) The person registered must ensure that radiators and pipe work are guarded so that residents are not at risk of scalding. The programme to complete this work must start with those radiators most at risk to residents. The person registered must ensure that care plans state all the residents’ needs together with guidance on how those needs are to be met and monitored. This must also include diabetes management and pressure damage prevention. The person registered must ensure that residents are consulted about who should provide their intimate personal care. The person registered must ensure that unauthorised people do not have access to confidential information about residents. The person registered must ensure that toiletries and topical creams are not for communal use. The discoloured plastic jugs in bathrooms must be discarded. Commode pots should be individually emptied, cleaned and returned to the same resident. The registered person must ensure that new staff never start working with residents without a check on the Protection of Vulnerable Adults list to establish whether they are suitable to work with vulnerable people. The registered person must ensure references are taken up rather than accepting testimonials. The registered person must DS0000028334.V350552.R01.S.doc 01/05/08 01/11/07 01/11/07 01/11/07 01/11/07 01/11/07 01/12/07 Page 31 Close (The) Version 5.2 ensure that gates intended to restrict residents from gaining access to the main road when walking in the garden are replaced and repaired. 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 OP30 Good Practice Recommendations The registered person should ensure that information is obtained from ‘Skills for Care’ (www.topssengland.net) about the changes that are being made to the induction standards and how this will affect the induction that new staff members receive in the future. The registered person should ensure the service user contract clearly reflects the cost of their stay. The registered person should ensure as far as possible service users are involved in the development of their care plan. The registered person should ensure service users are provided with opportunities to access the local and wider community. The registered person should ensure service users are fully aware of how to make a complaint. The registered person should ensure that areas in need of new paintwork are decorated. The person registered should keep their own records and not rely on those of the district nurse. The person registered should keep a record of named staff trained by the district nurse when healthcare interventions are delegated to staff. This record should also include the date and the name and designation of the trainer. The person registered should consider recording more detail in care plans rather than use terms, for example, DS0000028334.V350552.R01.S.doc Version 5.2 Page 32 2. 3. OP2 OP7 4. OP12 5. 6. 7 8 OP16 OP19 OP37 OP8 9 OP37 Close (The) 10 11 OP26 OP10 “unacceptable behaviour”. The person registered should consider regular deep cleaning of the new sitting room carpet. The registered person should consider residents dignity in whether it is appropriate for staff to always wear disposable aprons. Close (The) DS0000028334.V350552.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Chippenham Area Office 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 Close (The) DS0000028334.V350552.R01.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. 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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