Inspection on 12/06/06 for The Close

This inspection was carried out on 12th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 01/11/07

The Close 05/12/06

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 Malcolm Kippax Key Unannounced Inspection 12th June 2006 10:10 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Close (The) DS0000028334.V298526.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.V298526.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) 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.V298526.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3 October 2005. A further visit was made to the home on 7 February 2006 to follow up previous inspection requirements and recommendations. 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 service users’ 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 a smoking area and can be 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 service users. 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 scale of charges as at 22 May 2006 was £379 - £455. Close (The) DS0000028334.V298526.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included two visits to the home. One, which was unannounced, took place on 12 June 2006 (between 10.10 am and 5.10 pm). A second visit was arranged with the owners and this took place on 27 June 2006. Evidence was obtained during the visits through: • • • • • • Observation Discussion with service users and visitors to the home Meetings with two members of staff Discussion with the owners A tour of the accommodation Examination of records, including three of the service users’ personal files. Medication arrangements in the home were looked at by a pharmacist from the Commission on 12 June 2006. Other information has been received and taken into account as part of this inspection: • • • A pre-inspection questionnaire about the home that was completed by the owners. Reports and notifications received by the Commission from the home since the last inspection. Comment cards received from two relatives and visitors. The judgements contained in this report have been made from evidence gathered during the inspection, including the visits to the home. The evidence gained from an earlier visit to the home on 7 February 2006 has also been taken into account. What the service does well: The service users’ relatives and visitors are welcomed into the home and they appreciate the care and support that is provided. The home works closely with the local district nurses who visit on a regular basis. One of the staff members has responsibility for liaising with the district nurses and for passing on information to the rest of the staff team. Service users are protected by the home’s procedures for dealing with medicines. Close (The) DS0000028334.V298526.R01.S.doc Version 5.2 Page 6 Service users are encouraged by staff to take part in activities and to exercise choice. The service users enjoy the food that is served and there is good flexibility in the meal arrangements. Relatives feel that issues can be resolved without the need for recourse to a formal complaints procedure. The accommodation is generally homely. Service users have a variety of sitting areas. There are communal rooms that provide the opportunity for service users with different needs and personalities to spend time apart from each other. The staff team includes carers who know the service users well and have good experience of meeting their needs. The relationships between service users and staff during the visits looked friendly and positive. Six care staff (over 50 of the staff team) have now achieved NVQ level 2 or above. What has improved since the last inspection? What they could do better: The care plans lack detail in some important areas. This may result in inconsistent care being received by service users. Some service users have a high level of physical care needs; their assessments and care plans should be more detailed and provide better guidance for staff. The plans do not reflect the home’s intention to provide holistic care and the use of dementia care mapping. In particular, the service users’ social needs need to be better highlighted in their care plans. There is a lack of individual planning and the current activities programme is not benefiting all the service users. The service users’ right to privacy is not always upheld. There are serious shortcomings in the home’s procedures, which mean that service users are not well protected from abuse. Service users continue to be put at risk by a lack of robust recruitment checks on new staff. In particular, checks with the Criminal Records Bureau are not being undertaken as required. This may result in the Commission taking enforcement action to ensure that service users are not put at risk because of the employment of unsuitable staff. Close (The) DS0000028334.V298526.R01.S.doc Version 5.2 Page 7 The accommodation is let down by some poor décor and a lack of upkeep in some areas. Service users would benefit from improvements to the facilities. Staffing levels are at a minimum, which puts pressures on the staff team. New staff do not receive the level of induction that is required. The management of the home does not adequately protect the service users’ health and welfare. A number of requirements and recommendations have been made about the need for up to date assessments to be completed and for a more pro-active approach to ensuring that the service users are safe. Changes to the care homes regulations mean that in future the home will need to have a more comprehensive system in place for evaluating the quality of service being provided. The system will need to look at how the home has responded to the recommendations made or the requirements imposed by the Commission. The management of the home should also be reviewed at this time to ensure that the necessary systems and skills are in place. 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. Close (The) DS0000028334.V298526.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.V298526.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 was not looked at during this inspection. Standard 6 does not apply to this home. EVIDENCE: There have been no new admissions since the last inspection. The owners reported that one service user has moved into the home during the last year. The arrangements made for this person’s admission were looked at during the inspection on 3 October 2005. Standard 3 was met at that time. Close (The) DS0000028334.V298526.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made from evidence gathered before and during the visits to the home. Aspects of the care plans are improving although they lack detail in some important areas. This may result in service users receiving inconsistent care. Service users are protected by the home’s procedures for dealing with medicines and staff are being trained to a suitable standard. The service users’ right to privacy is not always upheld. EVIDENCE: Each service user had an individual care plan, which set out a number of needs under the heading of ‘problems’ and gave guidance about the action to be taken by staff. The care plans were being reviewed each month, as had been recommended at a previous inspection. Several amendments had been made to the plans during May 2006. Close (The) DS0000028334.V298526.R01.S.doc Version 5.2 Page 11 There was a ‘Daily Reports’ section in the service users’ files. This included information about the care provided and about people’s day to day welfare. Some of the needs referred to in the plans concerned physical conditions that required interventions from staff and care for service users at particular times of day. These significant needs were not highlighted within the care plan format. Some other records were being maintained, for example toileting and bowel charts. There was no systematic approach to recording when staff had provided the care that was needed, as indicated through their care plan or risk assessment, e.g. when a service user needed to be checked for ‘soreness’ on a daily basis. Information about the service users’ needs was also recorded under a ‘Risk assessment’ section. This identified service users who may be at risk, for example because of their skin condition or because they are prone to falls. There was some guidance for staff about how to support service users, although detailed assessments had not been undertaken in response to particular needs such as moving & handling and pressure sore prevention. One service user had a ‘Patient Handling Assessment’ form on their personal file, but this had not been completed. Two service users had pressure sores, which were being treated by the district nurse. The nurse was in the home during the visit on 12 June. She said that the staff team followed her instructions and that concerns were being appropriately followed up with health professionals. One of the home’s carers said that she had responsibility for liaising with the district nurses and passing on information. Visits to health care professionals were recorded on a ‘Medical treatment log’ in the service users’ personal files. Recent entries had included appointments with GPs, district nurses, chiropodist and diabetic clinic. In their comment cards, the two relatives confirmed that they are satisfied with the overall care provided and feel that they are consulted about this. Medication is stored securely and taken round the home in a locked trolley. Records are completed appropriately. Printed medication administration records are attached to the NOMAD storage boxes or loose for those residents who do not have one. A system of checking to ensure that all service users have received their medication would be useful as the records are not all in one file. The use of medication prescribed on an ‘as required’ basis is supported by care plans. Five members of staff have completed a ‘Safe handling of medication’ training program and three more are in the process of taking it. Photographs aid identification of service users and additional information about their preferences when being given medication is available. Evidence of district nurse involvement in the administering of some medicines is recorded. Service users have appointments to review their medication with Close (The) DS0000028334.V298526.R01.S.doc Version 5.2 Page 12 the doctor regularly. The home’s policy includes information about training, supervision and record keeping. There were two shared bedrooms. One of these rooms had single occupancy at the time of the visits. Furniture had been used to provide some privacy for the service users who shared a room. There was no screening around the commodes, one of which was near to the door. There were two toilets opposite the lounge, which did not have locks fitted. During a tour of the home with Mr Roche, one of these toilets was occupied, but the door was opened from the outside without it being known whether the toilet was engaged or not. Close (The) DS0000028334.V298526.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made from evidence gathered before and during the visits to the home. Service users are encouraged by staff to take part in activities and to exercise choice. However a lack of planning may result in the service users’ individual needs not being fully met. Service users maintain contact with relatives who are welcomed into the home. Service users have food that they enjoy and there is good flexibility in the meal arrangements. EVIDENCE: The majority of service users were spending time in the lounge. Others were having periods of bed rest or were not well enough at the time to use the communal areas. Staff were occupying service users in the lounge with some informal activities during the morning. These included ball games and conversation. The service users not directly involved were either watching or snoozing where they sat. A chat about animals resulted in one staff member offering to bring in her pet Close (The) DS0000028334.V298526.R01.S.doc Version 5.2 Page 14 kittens, which was well received by a service user. Staff responded to events during the morning in a friendly and positive manner. When one of the service user’s visitors was seen approaching the home, a staff member asked the service user in the lounge if she would like to meet the visitor at the front door. There was a ‘Daily Activity’ record which gave details of the planned activity session that takes place between 1.45 pm and 2.45 pm. Sessions included ball throwing, singing and jigsaws. Some service users were reported as ‘looking tired’, ‘sleeping’ or on ‘bed rest’ at the time of the sessions. The service users’ individual care plans focussed on physical care needs and there was a lack of information about social needs and interests. Mrs Roche acknowledged that the use of the term ‘problem’ in the care plans may mean that social needs and goals are not well included. The home’s brochure stated that ‘care is based on the holistic approach with tailored individual plans using dementia mapping’. This approach was not evident from the care plans. A number of service users had relatives who visited on a regular basis. In their comment cards, both relatives stated that they are welcome to visit at any time and can spend time with service users in private. This was also the view of three relatives who were met with while they were visiting the home. The relatives appeared to have good relationships with staff and were able to take an active role in the home. The daughter of one service user said that she chose to help her mother with having lunch, which needed to be specially prepared. Service users and relatives made positive comments about the food. Some service users had lunch in their own rooms, but the majority of people stayed in the lounge, either eating where they had been sitting during the morning, or moving to the dining table. The more dependant service users tended to stay in their lounge chairs; a staff member said that they preferred to do this. One staff member attended to service users at the dining table and another stayed with those people who were sitting in their lounge chairs. Staff members assisted service users well; the meal was described to service users and they were asked if they would like assistance with cutting food up and eating. It was not assumed that help would be needed and one service user was asked if he would like to manage by himself. His wish to do so was respected although staff kept an eye on how well all the service users were progressing with their meals. Lunch was an unhurried meal and service users finished eating in their own time. Close (The) DS0000028334.V298526.R01.S.doc Version 5.2 Page 15 Copies of the home’s menus were seen, which showed a varied range of meals served throughout the week. Supper consisted of soup, followed by a cooked dish and a sweet course. It has been recommended at previous inspections that the home employs a cook in order to free up the manager and staff members’ time. This recommendation has not been actioned. Close (The) DS0000028334.V298526.R01.S.doc Version 5.2 Page 16 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgement has been made from evidence gathered before and during the visits to the home. Formal complaints are not being made although a complaints procedure is readily available if needed. Staff members receive information that helps to safeguard service users. There are shortcomings in the home’s procedures, which mean that service users are not well protected from abuse. EVIDENCE: In practice, many service users would need support with making a complaint. Relatives confirmed that they were aware of the home’s complaints procedure, but had not needed to make a complaint. The complaints procedure has been amended to include timescales for dealing with complaints, as had been recommended at a previous inspection. A complaints file was kept in the home. No complaints had been reported since January 2005. The Commission has received no complaints about the home during the last year. The two staff members met with had attended a day’s course on abuse awareness and been given a copy of ‘No Secrets in Swindon & Wiltshire’, providing guidance about the reporting of suspected abuse of vulnerable adults. The home’s policies and procedures file also contained guidance about the reporting of abuse allegations. Close (The) DS0000028334.V298526.R01.S.doc Version 5.2 Page 17 A requirement has been made at previous inspections about the need for all staff to complete a CRB check and a POVA First check (if they are to be employed prior to CRB check and will be supervised) before their employment has been confirmed. The staff employment records showed that these checks have not been undertaken as required (see ‘Staffing’ section of this report). As a result, service users have not been protected from staff who may be unsuitable to work with vulnerable adults. Close (The) DS0000028334.V298526.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is mostly adequate and poor in places. This judgement has been made from evidence gathered before and during the visits to the home. The accommodation is domestic in character but let down by some poor décor and a lack of upkeep in some areas. Service users would benefit from improvements to the facilities. EVIDENCE: Originally a large, residential property, The Close has been adapted and extended for use as a care home. Parking was available close to the front door, from where there was easy access to the communal rooms. A tour was made of the home on 12 June, when the accommodation was seen with Mr Roche. Most service users were in the main lounge, which was spacious and had a dining area at one end. The kitchen was nearby. There was another, smaller sitting area, which led onto a conservatory. These rooms provided the opportunity for service users with different needs and Close (The) DS0000028334.V298526.R01.S.doc Version 5.2 Page 19 personalities to spend some time apart from each other. The rooms generally looked homely and lived in, although some areas were affected by ‘wear and tear’ and were in need of refurbishment, decoration or replacement. These included the lounge carpet, which was threadbare under the doorway. Several of the lounge chairs looked unhygienic, with grubby arms and backs. The walls were marked from where the backs of the chairs had rubbed against them. The furniture in the conservatory looked better with a relatively new threepiece suite in place. The owners will be asked to provide the Commission with an appropriate timescale for completing the decorating and refurbishment work identified during the inspection. One of the toilets opposite the lounge had some corroded pipes. Other items in need of attention included a damaged rubber seal on a fridge / freezer and a damaged electrical socket, which Mr Roche said was about to be repaired. The need for clearer signs in the home has been identified at previous inspections and this remains the case. A sign on the toilet doors, for example would show when the toilet is engaged, if locks are not being used. Covers have been fitted to the radiators in some locations, but not in the majority of bedrooms and bathrooms. One of the bedroom self-closing doors shut with excessive force and was relatively hard to open. It may be possible to adjust the self-closure device to improve the way it closes, although an automatic closing device is recommended as being the most convenient type for service users. There was no significant odour in the home. A cleaning schedule in kitchen had been ticked to show that tasks had been completed up to 10 June 2006. An investigation by environmental health officers was on-going at the time of this inspection. Close (The) DS0000028334.V298526.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made from evidence gathered before and during the visits to the home. A minimum level of staffing is maintained. Service users benefit from the attention of individual staff members, although pressures on the staff team may reduce their effectiveness. Service users continue to be put at risk by a lack of robust recruitment checks. Staff training has improved in certain areas, but some staff are not receiving the level of induction that is required. EVIDENCE: Mrs Roche said that there were at least two people working throughout the day, with an additional person working from 12 pm – 1.30 pm and from 5 pm – 6pm. This was reflected in the written staff rotas that were seen. The rotas did not show how staff were deployed or changed their roles during the day. Staff members said that sometimes staff needed to switch from caring duties to other work, such as getting a meal ready that had been prepared earlier in the day or had come out of the freezer. Mrs Roche and Mr Roche were shown on the rota at specific times, although Mrs Roche said that she spent other time in the home, sometimes working as a carer, which was not recorded on the rota. The rota showed that at night there was one person on waking duty. The rota did not show who covered the ‘sleeping-in’ duty. Close (The) DS0000028334.V298526.R01.S.doc Version 5.2 Page 21 Staff members said that some service users were spending more time in their own rooms, which had increased the need for individual support at certain times. In their comment cards, the two relatives confirmed that in their opinion there are always sufficient numbers of staff on duty. The staff team included eleven care staff members. The two staff members met with had both worked in the home for a number of years. They were knowledgeable about the service users and covered all the keyworker duties between them, each being in the role of keyworker to five or six people. Other members of the staff team were less experienced and did not have the same level of responsibility. One relative commented that staff knew her mother’s needs well, in spite of her mother not being able to communicate verbally with them. One of the staff members met with had achieved NVQ level 2 in care and was undertaking NVQ at level 4. Mr and Mrs Roche provided information about the current number of qualified staff. Six care staff (over 50 of the staff team) have NVQ level 2 or above. The staff members confirmed the training that they had received. Training in dementia care and medication had recently been undertaken, which was a requirement from previous inspections. Previous training courses had included care practice, first aid, moving & handling and food hygiene. Infection control was due to be done, which was confirmed by Mrs Roche. A requirement had been made at previous inspections about the type of induction training that is available to new staff and how this is evidenced. Progress had been made with this when it was looked at again during the visit on 7 February 2006, although not all staff had received the level of induction that is expected. There has been a national review by ‘Skills for Care’ (part of the Sector Skills Council) of the induction and foundation standards that apply to staff working in a care home. ‘Skills for Care’ are now making changes to the induction standards that the home will need to be aware of for the future and put into practice. Some details of courses attended were included in the staff members’ individual files. Other in-house activities were recorded in a ‘Training & Discussion’ book, which included details of observations, talks and demonstrations involving Mrs Roche and members of the staff team. Similar information was also recorded in a ‘Supervision & Training’ book. The inclusion of all training and supervision information within a single format for each staff member would provide a clearer, chronological record of the activities that have taken place. Close (The) DS0000028334.V298526.R01.S.doc Version 5.2 Page 22 The employment records were looked at for a newly employed staff member and for two staff members who were appointed in 2005. One staff member had recently been employed without an up to date C.R.B. and P.O.V.A. check having been completed. The two other staff members only had evidence of police checks completed in another country. An immediate requirement notice was issued to Mrs Roche, confirming the need for C.R.B. and POVA checks to be made and for assessments to be undertaken of the staff members’ continuing employment, to ensure that service users are not placed at risk. Some staff members have come from abroad. The owners were applying for one staff member’s work permit to be amended following a change of employer. This is to be discussed further with owners. Close (The) DS0000028334.V298526.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is poor. This judgement has been made from evidence gathered before and during the visits to the home. There has been some improvement but the management of the home does not yet adequately protect the service users’ health, safety and welfare. The views of the service users’ relatives and others have been sought, but not yet acted upon. The service users’ financial interests are safeguarded with the involvement of their relatives and representatives. EVIDENCE: It was reported at the inspection on 3 October 2005 that management tasks were not being completed regularly or appropriately. Close (The) DS0000028334.V298526.R01.S.doc Version 5.2 Page 24 This has been the subject of further discussion and correspondence with Mr and Mrs Roche. The possibility of a change in the management of the home has been raised. Mr Roche and a senior staff member, rather than Mrs Roche, were undertaking NVQ at level 4. However, under Regulation 10(3) of the Care Homes Regulations 2001, the registered manager is also required to undertake such training from time to time as is appropriate to ensure that they have the experience and skills necessary for managing the care home. No additional requirements were made as a result of the follow up visit that was made to the home on 7 February 2006. Six of the nine previous inspection requirements had been met and four of the seven recommendations had been met. One new recommendation was set at the time. Further requirements have been identified at this inspection, which raise concerns about the standard of management and the need for a more proactive approach to managing the home. Quality assurance was discussed with Mrs Roche. A requirement about this has been made at previous inspections. The owners have since provided information about a quality assurance survey that was carried out in 2005. This stated that 50 surveys had been sent out to relatives and outside professionals, of which 45 were completed. Most of the people surveyed were reported to have given positive scores in their responses, although the décor was an area of the home that scored less well. Mrs Roche said that some decorating and refurbishment work had since been carried out and that the lounge was next to be done. The information provided about the surveys and their outcome did not include a report of the quality of care and there was no annual development plan. The arrangements being made for quality assurance in 2006 will also need to take account of the amended care homes regulations that came into force on 1 July 2006. This requires the registered persons to have a system in place for evaluating the quality of the services being provided and to supply the Commission, at their request, with a report that is based upon the system. Mrs Roche said that the owners had no involvement in the service users’ financial affairs, as the service users’ relatives or representatives dealt with these. The staff members spoken with felt that the manager was supportive and available to discuss things with if needed. They described occasions when they met with the manager and had their work commented on. This was reflected in the ‘Supervision & Training’ book, which included a record of occasions when staff practice had been observed by the manager and some training had been given. A recommendation was made at the last inspection about supervision, which included holding evidence on supervision with individual staff members. Some evidence of supervision was available in the ‘Supervision & Training’ book, but this did not include the recommended one to one meetings at least 6 Close (The) DS0000028334.V298526.R01.S.doc Version 5.2 Page 25 times a year. The home’s policy on supervision stated that there would be ‘formal supervision of at least one hour every two months’. This is not happening in practice. There has been a staff meeting since the last inspection. These should continue on a regular basis. The two relatives who completed comment cards were both positive about their experience of the home. There was a Health & Safety folder, which included C.O.S.H.H. information and risk assessment records. One of the risk assessments concerned the radiators, several of which were uncovered. This assessment was not dated and the list of service users mentioned was not up to date. It is expected that all radiators and pipe work are guarded or have guaranteed low temperature surfaces. This is to be discussed further with the owners. A ‘General Risk assessment’ had been reviewed in June 2006. Another assessment, about fire had been carried out in July 2003 and had a date to be reviewed in 2004. The outcome of the review was not shown and there had been no further review. Fire instruction to staff, drills and alarm tests were recorded in the home’s fire log book. Accidents were being recorded on individual forms. When looking at one of the first floor bedrooms it was seen that a chain was being used to limit the opening of one of the windows. This left the window open by about 30cms, which is over the recommended limit for when a window opening needs to be restricted for safety reasons. There was no regular health & safety check being carried out and recorded. This would help identify areas in need of attention and show that action is being taken accordingly. Close (The) DS0000028334.V298526.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 2 x 2 Close (The) DS0000028334.V298526.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 17(1)(a) Requirement A record must be kept of any treatment and care that has been provided to service users who are at risk from developing pressure sores, or have developed a pressure sore. A moving & handling assessment must be carried out in respect of each service user and guidance about safe handling produced for staff. Assessments must be carried out concerning the risk of service users developing pressure sores. Arrangements must be made which will ensure that the home is conducted in a manner that respects the privacy and dignity of service users. The care plans must show how the service users’ individual DS0000028334.V298526.R01.S.doc Timescale for action 01/08/06 2. OP7 15 and 13(5) 31/07/06 3. OP7 15 31/08/06 4. OP10 12(4)(a) 28/06/06 5. OP12 16(2)(m) 31/08/06 Close (The) Version 5.2 Page 28 social needs are to be met. 6. OP27 17(2) The staff roster must show full details of who has worked in the home and the capacity in which each person has been deployed. All staff must complete a CRB check and a POVA First check (if they are to be employed prior to CRB check and will be supervised) prior to employment being confirmed. (Requirement outstanding from last inspection). 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. The home’s system of quality assurance must ensure that it includes an evaluation of the quality of service provided and complies with Regulation 24 of the Care Homes Regulations 2001. The Commission must receive a report that is based upon the system. Assessments must be completed in respect of radiators and hot surfaces and the risk that they present to each service user. Remedial action must be taken where indicated by the assessments. Risk assessments must be kept up to date and reviewed at least DS0000028334.V298526.R01.S.doc 31/07/06 7. OP29 19(1)(b) 28/06/06 8. OP31 10(3) 30/09/06 9. OP33 24 31/12/06 10. OP38 13(4) 31/07/06 11. OP38 13(4) 31/07/06 Page 29 Close (The) Version 5.2 annually or more frequently if necessary. 12. OP38 13(4) Risk assessments must be carried out to identify specific locations where windows require some form of restriction on their opening and appropriate safety measures must be in place. 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations That a form of short term care plan is produced when a service user has a temporary, physical care need that requires care to be given by staff at regular intervals throughout the day. That there is better cross-referencing between the care plans, risk assessments and daily reports / charts. A checking system should be used to ensure that all residents have received their medication, as the medication administration records can be loose in the cupboard. That a care plan format is produced which reflects the home’s intention to provide a ‘holistic approach with tailored individual plans using dementia mapping’. The registered manager should consider employing cooks in the home, to alleviate some of the duties completed by the registered manager. (Recommendation outstanding DS0000028334.V298526.R01.S.doc Version 5.2 Page 30 2. OP7 3. OP9 4. OP12 5. OP15 OP27 Close (The) from previous inspections). 6. OP19 That an assessment is made of the signs in the home in order to identify locations where new signs are needed or would be useful, e.g. on the toilet doors. That the door closures are adjusted, or replaced with a different type as necessary so that the doors are easy to use and do not close with undue force. The occupational therapist’s report issued on 16/11/02 should be used to assess any equipment service users may need in the home. (Recommendation outstanding from previous inspection). That the details of staff training and related activities are maintained in an individual record for each staff member. 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. That the policy and procedure for quality assurance is amended to include the arrangements made for annual development and for reviewing the quality of service provided in the home, in accordance with Regulation 24 of the Care Homes Regulations 2001. The registered manager, or any senior staff member who provides supervision for staff working in the home, should ensure they have received training in this. Evidence of supervision should be held on individual staff members. This should take the form of a one to one meeting at least 6 times a year. (Recommendation outstanding from previous inspection). That a health & safety check is undertaken of the house and grounds on a regular basis. DS0000028334.V298526.R01.S.doc Version 5.2 Page 31 7. OP19 8. OP22 9. OP30 10. OP30 11. OP33 12. OP36 13. OP38 Close (The) Close (The) DS0000028334.V298526.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 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.V298526.R01.S.doc Version 5.2 Page 33 - 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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