Inspection on 29/09/07 for The Dell

This inspection was carried out on 29th September 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 Dell 11/03/09

The Dell 17/01/07

The Dell 16/02/06

The Dell 03/12/05

The Dell 03/02/05

The Dell 28/07/04

The Dell 09/03/04

Similar services:

Claremont House

Chesham House

Oak Ridge

Argyll House

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

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

CARE HOMES FOR OLDER PEOPLE The Dell The Dell Nelson Way Beccles Suffolk NR34 9PH Lead Inspector Mary Jeffries Unannounced Inspection 29th September 2007 02:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Dell Address The Dell Nelson Way Beccles Suffolk NR34 9PH 01502 712683 01502 712683 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) Suffolk County Council Mrs June Ann Gill Care Home 38 Category(ies) of Dementia - over 65 years of age (12), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (27) The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate one named service user with Mental Disorder as detailed in the variation application dated 26/2/06. 17th January 2007 Date of last inspection Brief Description of the Service: The Dell is a purpose built home owned and managed by Suffolk County Council. Situated on the outskirts of the market town of Beccles in a residential area with shops and other facilities nearby. The home has access to a tail lift mini bus. The home has a landscaped garden with car parking and an attached day centre, which is run separately but available to residents of the home. The home is set out on two floors and divided in to four houses, Balmoral, Windsor, Homelea and Gloucester house. Each house other than Balmoral, which also has it’s own laundry, has bedroom, sitting and dinning rooms, a kitchen, bathroom and toilet facilities. There is a central main kitchen and laundry servicing the home and day centre. The Dell is registered to provide care to 38 older people, the places in Balmoral House are offered to people with a diagnosis of dementia. Hairdressing, private chiropody, and newspapers are not included. Residents are responsible for purchasing their own clothing. Some transport is charged for. The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection. An Annual Quality Assurance Assessment (AQAA) was provided by the home prior to the inspection. The senior team leader facilitated the inspection. A number of other members of staff were spoken with and gave assistance. The inspection occurred on an afternoon and early evening in September 2007 and took six and a half hours. The senior team leader facilitated the inspection, and other staff participated. Three residents were tracked, one on Balmoral, one on Windsor and one on Homelea. One of these residents who had been recently admitted was spoken with, the other two were observed; one had dementia and one was very poorly. Observations of staff and resident interaction took place and, and a number of documents were examined including residents’ care plans, medication records, training records and records relating to health and safety. Four relatives who were visiting the home were spoken with. What the service does well: All residents can expect to be fully assessed before being offered a place at the home, and to have the opportunity to visit the home before they decide whether to take up their placement. Staff have a good knowledge of residents and are caring in their attitude and manner towards them. Residents have good access to appropriate medical services, and appropriate aids available to them. The Dell has provides a clean comfortable and homely environment, and a bright and friendly atmosphere. Health and safety standards are well maintained in the environment. Relatives are made to feel very welcome within the home. Residents enjoy a good choice of home cooked meals. The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 6 Residents have access to and feel able to use a good complaints system. Staff have been trained to recognise abuse and are aware that residents have a right to be respected at all times. What has improved since the last inspection? What they could do better: The Service User Guide requires updating to comply with new legislation requiring full details of fees to be included. All residents with confirmed places must have a signed contract. The home had taken action on most requirements and recommendations made to the last inspection and overall compliance with key standards had improved significantly. However, care plan recording and reviewing remained inadequate. Resident’s plans need to be completed within a short period of admission, and signed and dated on all sections. There needs to be evidence of regular full reviews of care plans, particularly where the resident’s circumstances have changed. Medicinal creams’ application on one of the units was poorly recorded, and it is not possible to ascertain whether this was being administered correctly by care staff. Where it is recorded that a G.P. has given advice for change to a prescription, the entry on the MAR chart must be signed and dated by the team leader who amends the sheet. The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 7 Update training in food hygiene must be provided for all staff who are involved in handling food. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to have had an assessment prior to admission to the home. They cannot be assured they will have a signed contract in a timely way. EVIDENCE: The Service User Guide provided was dated July 2006. The document stated what items were not included in the basic costs of the home, and stated that residents’ fees would be dependent on their income and capital and would be assessed. The basic fee was not included, and must be. All three residents tracked had pre admission assessments undertaken by the Dell and Community Care Assessments on file. A resident who had been recently admitted advised that they had had the chance to go to other homes and that they went round to see a number and liked The Dell the best. They had a Service User Guide. The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 10 The AQAA states that visits are arranged to the home prior to admission to enable residents and their families to see where they will be living and meet other residents and staff. It also states that there had been no placement breakdowns in the last twelve months. One of the residents tracked had a contract on file dated 2nd July that had not been signed. The AQAA had identified the need to ensure contracts are signed under the section – what we will improve in the next twelve months. The other resident tracked whose place had been confirmed did have a signed contract on file. The Dell DS0000037196.V352253.R02.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. Residents can expect to have a care plan but cannot be assured that all relevant aspects of it will be completed or fully reviewed as required. They can expect that they will be treated with dignity and respect. EVIDENCE: All three residents tracked had care plans. The AQAA stated that care plans are being replaced with a new format. Plans included manual handling risk assessments. The team leader advised that most residents with dementia now had life story books in their rooms, but that this depended on co-operation and input from the family and in one case the family had not been helpful. The care plan of one of the residents tracked was not dated on four of the separate sheets, and not signed either on two of these. The resident’s care had been reviewed with the social worker present, six weeks after placement and then in April. The review sheet for April stated that aspects of the plan needed to be signed and dated, but this clearly had not been actioned. The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 12 This resident had dropped a stone in the last six months, they were not underweight, and it is arguable a nutritional screening was not necessary, however, the sheet in their care plan on diet had not been completed either. There was a sheet that showed the resident’s food likes and dislikes only. This was discussed with a carer who advised that they had never done nutritional screening and did not know what it was. They advised that this resident had been holding food in their mouth. This resident was very ill and receiving TLC – tender loving care - at the time of the inspection. Records showed that the G.P. had visited weekly over the last three weeks. The district nurse was attending twice a week. After the April review, the next review on file was dated 24 July 2007, when the care plan had been updated. The night care plan had been reviewed in August; the sections of the care plan reviewed in July, included continence, oral hygiene and communication, but the section on diet had not been completed. Given that the resident’s circumstances had changed significantly the lack of a recent full review of the daytime care meant that the plan did not detail the resident’s needs adequately. The daily records contained a recent record that the resident was not taking food, and that sips of a supplement were to be given. The carer advised that the resident was on liquidised food and had eaten half a yoghurt at teatime. The care plan for the other two residents tracked were complete and one contained a nutritional screening. The care plan for the resident who had been in the home for some time had been regularly and adequately reviewed. A relative spoken with advised that when their mother had come to the home around last Christmas, from hospital, that they couldn’t walk. They were very pleased with the progress that they had made in the home. The relative explained that the home gets a doctor in quickly if one is needed. One resident was taken ill on the day of the inspection, the carer described this as the resident having “taken a turn.” The resident’s relative was with them and remained with them whilst a doctor was called. Three other residents all on Balmoral unit were unwell and were in bed during the day. Staff were making half hourly observations on these residents. A district nurse attended the home to see one of the residents. A relative who was spoken with advised that the district nurse had seen their relative three weeks ago and that the home had called the duty doctor in as their relative was no better. Through out this, they advised, the home had kept them fully informed. Records showed that residents tracked had also seen the chiropodist. A team leader who had taken on responsibility for ordering and auditing medication was spoken with. They advised that all team leaders and three senior carers administer medicines, and had received Boots Pharmacy training. The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 13 They advised that the senior team leader checks the medicines and administration on a weekly basis, and that they are audited very four weeks. The sheets for medicinal creams were held in one folder on each unit; the team leader advised that these were also subject to monitoring. Medicinal creams with active ingredients were found to have been dated when opened. The medicinal creams administration sheets of the residents on Homelea and Windsor were inspected. On Homelea, these records were found to be lacking, so it was not possible to tell whether the creams had been administered on several occasions. The records covered the day of the inspection and the previous two days; all three were prescribed a medicinal cream, none of them were “ as required” medications. On Homelea, one record had three gaps without signatures or entries on the day of the inspection, another resident’s record had two gaps on the 27th Sept and two gaps on the 29th, and a third had nothing recorded for the day of the inspection, one gap on the 28th and two gaps the 27th. On Windsor the records were complete. At the time of the inspection an investigation by senior managers at Social Care Services was taking place regarding a missing drug that is treated as a controlled drug. This had been reported to the CSCI. The team leader administering medication had a good manner with residents, respecting their choices but encouraging them. The administration of teatime medications was observed. One resident required eye drops; the team leader advised she would come to them after tea to administer these. One resident did not want to take their medication, the carer waited whilst the resident took a drink and tried again; the resident agreed. Another resident who was poorly on bed did not want to take their medication; the carer persisted, but when the resident tried again and only took half of the liquid the carer accepted this. One resident had a medication that had been changed to teatime rather than nighttime on the Medicine Administration Sheet. There was a note in the office to show that the GP had been consulted on this, but the entry on the MAR sheet had not been signed, and must be. One of the residents tracked had a risk assessment for self-administration of medicines. Records of the oral medication were inspected for two units; these covered all of September 2007 and were found to be complete. Twenty-eight residents completed the survey conducted within the home during the previous twelve months. Not all answered very question. Twenty-six residents thought the staff were always helpful. Twenty-Five residents thought staff always allowed them to be as independent as possible. Twenty-four felt that their needs were fully met. Twenty-five thought that staff always listened to them. A recent dementia mapping exercise had been carried out by external professionals, to evaluate the well being of residents on Balmoral unit. The The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 14 report noted that “On the whole staff appeared very caring.” It noted that two staff observed were very skilled at connecting with the residents using appropriate touch, eye contact, and giving them time. It noted that choices were given at all times, including residents being asked where they would like to sit, use of picture menus, morning drinks. The report identified some scope for improvement. It was suggested that better validation of residents with dementia could occur, in that staff sometimes responded factually to seemingly irrelevant statements made by residents which actually communicated the residents’ feelings. During the inspection staff interaction with residents on Balmoral was seen to be very good; carers established eye contact when speaking with residents, getting down to their level when they were seated. Staff advised that they had more time on this day for these residents, because of the number of residents who were poorly. The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to enjoy a good quality of daily life, enhanced by the quality of attention given to them by staff, and that their relatives will be welcomed into the home. EVIDENCE: The visitor’s book showed that there had been seven visitors to the home on the morning of the inspection, and twelve the previous day. The dementia mapping report noted that resident’s well being was seen to increase during the afternoon of the exercise when visitors, including children were welcomed into the unit, and that a very homely atmosphere was apparent. It noted that on Balmoral, lots of positive events were seen and that residents displayed high to varying degrees of well being. The report suggested that more involvement in household chores would be a benefit to residents. Staff spoken with advised that they had started involving the residents in domestic chores, which they enjoy, such as hanging out washing and setting tables, and that this had been well received by residents. Although the televsion was put on after tea, it was not on during late afternoon of tea time The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 16 on Balmoral, and the atmsphere on the unit was relaxed, comfortable and pleasant. A carer spoken with on Balmoral said; “ I love this unit.” There was also a good atmosphere on Homelea and Winsor units. One resident on Winsor who was tracked had retired early on the day of the inspection; they said that they had asked for an early night, and staff had told them of course they could have it. The resident commented “ staff are ever so obliging.” They went on to say, “ I love my life in here.” Residents are able to attend a weekly church service and a monthly Holy Communion. The AQAA states that one resident attends their own church, and that some have links with their own churches that vist them at The Dell. The home employs an activities worker for three days a week. A full activities programme was in place and actvities attended were logged on residnet’s files. They included manicures, hand massage, coffee mornings, music and singing, dancing, and craft. Some local outings are organised in conjunction with the day centre. A file of activities available was on display in the foyer of the home. Twenty seven residents responded to the question on the home’s last survey, “Do you feel your relatives are welcomed.? All twenty seven answred “always.” A relative spoken with advised that they were very happy with the home, and were always welcome. They commented that the home had just got some new clothes for their relative. One relative who was vsiting their spouse commented that their spouse was verty happy, and joked, “ I keep trying to book in.” Another relative said “It’s lovely and inviting.” Items for the menu on the dementia uinit are on a picture menu which the kitchen staff take round each day to assist these residents make their choices. Four residents on Balmoral unit sat up to the table for tea which was soup, sandwiches and a choice of cakes. A bowl of grapes was taken in afterwards. The main choice for lunch that day had been sweet and sour pork with fresh vegetables, and the alternative cauliflower cheese. Tables on this unit were nicely set, with napkins. During the early evening, residents were offered a glass of sherry. One confirmed that they usually had this. The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17, 8. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect the home to be responsive to their concerns, and also to be able to make complaints and for these to be dealt with appropriately. EVIDENCE: A relative spoken with at the inspection advised that; “Any little thing you say, they get onto it straight away.” They advised that they hadn’t needed to complain about anything but that they knew how to. Another said that if they weren’t happy they would just see one of the carers or the manager; they were aware that there was a formal complaints system. Information on the complaint system was available in the foyer of the home. The home’s AQAA states that the home had received five complaints in the last twelve months, that all had been dealt with within 28 days and that two of the complaints had been upheld. The home maintained a complaints book, which included an outcome column, which shows the outcome of the complaint and actions undertaken. At the last inspection it was recommended that advocacy be enlisted for one resident who had no family; this resident now receives a visiting service from their previous employer. Although advocacy was not in use, all other residents have family or close friends. The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 18 The home’s AQAA states that no safeguarding referrals had been made in the previous twelve months, and that all staff had undertaken the No Secrets training and completed questionnaires. Staff records inspected showed that they had received training in safeguarding. Abuse was discussed with the two carers on the dementia unit, who were aware of the types of abuse that could occur, the range of seriousness of types abuse, and the actions they had to take. One advised that if they were concerned about the manner of another carer, they would speak to them directly, but if it were repeated or unacceptable they would report this to management. At the time of the previous key inspection the home had been dealing with an allegation of abuse, the senior team leader advised that this had led to a sucessful prosecution. The home had taken all approprate steps in that instance. The AQAA stated that there had been no safeguarding referrals made since then, and the senior team leader confirmed this to be the case. The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 19 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): 19,22,24,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to enjoy a homely, clean and well-maintained environment. EVIDENCE: All twenty-eight residents who responded to the homes last survey indicated that they thought the home was always warm, welcoming, clean and tidy. The home is a two storey building with an easily accessible lift. The home is divided into four units which are designed for small group living. There are dining and lounge areas on all units, and there are also communal areas and quiet rooms for residents to socialise or meet in private with their visitors. The views from upstairs windows look over the Waveney Valley. The childrens’ playground is visible from Balmoral unit. The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 20 Since the last inspection the three mainstream units had all had their bedroom doors linked to the fire alarm system. Individual rooms on Balmoral had been linked to the fire system when it was converted to a special needs unit. Since the last inspection, appropriate door locks had been fitted onto bedrooms doors on the special needs unit. These could be locked from the inside, and a team leader spoken to confirmed that staff could override the lock with a key from the outside if necessary. The individual room doors had the residents’ names in large print, rather than any sort of picture. A carer spoken to advised that some residents hadn’t been able to tell what the pictures were of, that the residents could find their rooms better and remember where their friends were. The photographs of the two carers on shift were displayed on the unit. The senior team leader advised that specialist equipment used to be provided after an Occupational Therapist assessment, but that homes now had to pay for the equipment. Residents were seen to have special mattresses and tilting beds where needed; this included a resident who was tracked and who had a pressure area. A repose mattress was in place for this resident. The home was clean and odour free. The AQAA stated that two carpets had been replaced to alleviate a lingering odour that was found at the last inspection. Different coloured bags were used for soiled and clean linen, and protective gloves and aprons were available in the home. Communal toilets were clean and had liquid soap, paper towels and bins. A member of staff spoken with had a good knowledge and understanding of infection control. The procedures used for caring for one resident who had a particular need for good infection control practices were discussed with them. They advised that in addition to using red laundry bags, they had to fully change their own clothes every day, and that in addition to protective clothing they had worn over socks, least any soiled material had been on the floor. The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to be cared for by properly recruited staff who have good manner with them. There may be times during the evening when the level of staffing is below the planned staffing level. EVIDENCE: Two staff were on duty on Balmoral throughout the day of the inspection. One member of staff was on duty in each of the other three units. The home also employs floating carers who work across the different units during the morning and evening. On the day of the inspection there had been two floats on duty during the morning, one from 7-11 am and one from 8-1 pm. One float was working between 5 and 9 pm. The staff duty sheet showed that the previous day one of the morning floating staff had been unwell and that their shift had been covered. Household staff also work on units, including a domestic and the kitchen staff. The home has a duty team leader on duty at all times, day and night, and sometimes there is also a senior team leader on duty between nine and five pm. The AQAA stated that there was a need for more relief staff at the home. A carer spoken to advised that the availability of a floating carer makes a big difference, but that they do not always have one, and that there had been two occasions that week when they had not had a float on duty. The senior team The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 22 leader spoken with advised that the home has all of its allocated posts covered and that they always try to get the late float shift covered. If it is not covered, this would be due to last minute sickness and unavailability of agency. At the time of the inspection there was one vacancy on Balmoral, two vacancies on both Homelea and Gloucester and one vacancy on Windsor. In total the home was accommodating thirty-four residents. The AQAA stated that seven residents require two carers to attend to assist with their care needs by day and night. During the inspection the home was fully staffed; call bells were responded to in a reasonable time and residents attended to in an appropriate and unhurried manner, but staff were busy. The AQAA states that over 50 of staff hold an NVQ level II qualification and that team leaders have or are working towards Level III. The AQAA states that all Staff are employed through the Suffolk County Council (SCC) Recruitment process and CRB clearance is received before start dates are confirmed. Also that the induction received by all staff includes both in house induction and Suffolk County Council induction, and that staff receive 2 days manual handling training. Three staff files were inspected, including a file for a recently recruited member of staff. The recently recruited worker had all appropriate pre-employment checks on file, these had been completed prior to them commencing work. They had received a full induction and manual handling training. A team leader spoken with advised that they and a carer were going to undertake a three day training in dementia at Kerrison which includes a project, in October. She had done this before some time previously; for this worker the training was an update, in response to a recommendation made at the last inspection. The team leader advised that they also attend Kerrison for manual handling training as they do the risk assessments for this within the home, whereas other staff receive it in house. They advised they had also received an update on control of hazardous substances, (COSHH). A carer spoken with confirmed that they had had a recent manual handling update. Staff records inspected showed that all had had manual handling training. The AQAA stated that there was a need to ensure that all staff had had food safety update training. The most recently recruited member of staff had received food hygiene training. There was no record of training on food hygiene for the other two staff members. The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a safe environment and for their views to underpin service development in the home. EVIDENCE: The Certificate of Registration was on display and properly described the residents provided for. Information on the residential review being undertaken for Suffolk County Council owned homes was also available in the home’s reception. The home’s public liability insurance was displayed and was in date. The AQAA stated that the manager was due to complete their NVQ4 in August or September but they were not on duty so it was not possible to establish if The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 24 this had happened. Evidence has been seen previously that the manager holds a management qualification. The AQAA states that residents have lockable drawers for safekeeping their valuables or personal papers, and that their personal allowances can be paid into a personal account and withdrawn on their behalf at any time. A lockabe draw was seen in the room of a resent who was observed. No individual monies are kept in the home, but copies of the expenditues and receipts were in place in the home; these are then forwarded to the central administation to be reconciled with accounts. A good range of quality assurance methods were employed and the results of these had been acted on. Regulation 26 monthly monitoring visits had been taking place. Additionally, as noted in thesection headed daily life and social activities, a dementia mapping quality assurance audit had been undartaken in Juy 2007, by external managers. Developments on the dementia unitreflecetd the recomedations of the dementia mapping exercise. The home had underaken a residents’ satisfaction questionnaire in October 2006 and had compiled the results. An outcome of this was that residents felt that they would like more say in the running of the home; quarterly residents’ meetings were set up. Regulation 37 reports had been received by the CSCI in a timely way. The home maintained a current list of residents in the home for fire safety purposes. Fire Extinguishers had been serviced in January 2007. A new call bell system had been installed to replace the two different systems that had been in place. No health and saftey hazards were identidifed during the inspection. Wheelchairs seen in use in the home had footplates. The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5 Requirement The Service User Guide must include full details of charges so that residents have all of the information they require to make an informed choice about going to live at the home. Every resident must have a contract signed by both parties. This is for the protection of both parties. Care plans must be completed in a timely way to ensure all needs have been identified and are addressed in an agreed way. This is a repeat requirement from the inspection of February 2006. Care plans must be regularly and thoroughly reviewed, to ensure any changes are considered and agreed responses put in place. . This is a repeat requirement from the inspection of February 2006. Any alteration made to a MAR sheet upon doctor’s instruction must be signed by the person amending the sheet to ensure any changes to medication given DS0000037196.V352253.R02.S.doc Timescale for action 30/11/07 2. OP2 OP37 5(1)(b) and (c) and (3) 15(1) 30/11/07 3. OP7 30/11/07 4. OP7 15(2) 30/11/07 5. OP9 13(2) 31/10/07 The Dell Version 5.2 Page 27 6. OP9 13(2) 7. OP30 18(1)(c)(i ) have been authorised. Medicinal creams must be 29/09/07 applied as per prescription and full records must be maintained to demonstrate this. Food safety training updates 31/12/07 must be provided to care staff to ensure that they correctly handle food on the units. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Colchester Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Dell DS0000037196.V352253.R02.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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