Inspection on 23/08/06 for The Downs Care Centre

This inspection was carried out on 23rd August 2006.

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 Downs Care Centre 20/11/08

The Downs Care Centre 28/05/08

The Downs Care Centre 05/10/05

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE The Downs Christian Nursing Home Laburnum Avenue Hove East Sussex BN3 7JW Lead Inspector Liz Daniels Unannounced Inspection 23rd August 2006 11:45 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 Downs Christian Nursing Home DS0000065252.V300200.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. The Downs Christian Nursing Home DS0000065252.V300200.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Downs Christian Nursing Home Address Laburnum Avenue Hove East Sussex BN3 7JW 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) 01273 746611 Trinity Care (Hove) Limited Vacant Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places The Downs Christian Nursing Home DS0000065252.V300200.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users to be accommodated is twenty-five (25). Service users must be older people aged sixty-five (65) years or over on admission. Service users requiring nursing care only to be accommodated. That four named service users under sixty-five (65) years of age, are accommodated. 5th October 2005 Date of last inspection Brief Description of the Service: The Down’s Christian Nursing Home is situated in a residential area of Hove. The entrance is shared with the South Downs Health Trust, which provides an inpatient facility in a separate area of the building. The home, which was purpose built in 1999, is set out over three floors and a passenger lift enables access to each floor. Nursing and personal care are provided in single room accommodation for up to twenty-five residents. All rooms have en-suite facilities and there is a lounge and dining room on the two floors where there is resident accommodation. All areas are accessible for those with limited mobility and the home has hoists and bath hoists for those who are less mobile. There are also grab rails and disability aids in the bathrooms and toilets. Well-maintained gardens surround the building and the relatives’ room and garden room provide additional relaxation areas for residents and their visitors. There is a large parking area to the front and side of the building. The home welcomes prospective residents or their representatives to view the premises, discuss their needs with the Registered Manager and spend time with the staff and residents. Weekly fees, as at 23/8/06, are £700.00 for full nursing care. The fees do not include hairdressing, chiropody, residents’ telephone calls and any sundries, such as newspapers: these are charged as extras. Information about the service is available on the organisation’s website (Southern Cross Healthcare Limited) and from the home’s Manager. The Downs Christian Nursing Home DS0000065252.V300200.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced. It included a visit to the home by an Inspector, which began at 11.45am and lasted for just under eight hours. The new Manager facilitated the visit: she had recently been appointed and had taken up her position three weeks prior to the inspection. The visit provided the opportunity to talk with her and another member of staff, before spending time with several residents in the lounge and meeting four of them in the privacy of their own room. Many of the residents are frail and it was therefore difficult for the Inspector to seek their views in any detail. Two visitors were also available to meet with the Inspector. The Inspector toured the premises and examined records that included resident’s files, staff files, the accident log and complaints log. Evidence contributing to this inspection has also been gathered from previous inspections, surveys circulated to residents and their relatives (ten of which had been returned to the Inspector) as well as from data provided by the Deputy Manager for the home and Operations Manager for the organisation. All of the key standards, together with those where concerns had been raised at the last inspection, were inspected. There were 24 residents on the day of the site visit. What the service does well: What has improved since the last inspection? A new manager has recently started at ‘The Down’s’ and has been well received by both staff and residents. She is introducing small changes but her priority by the inspection had been to ‘get to know the residents, relatives and staff’ and to ensure that some of the monitoring and processes that had lapsed were re-introduced. However she has recently introduced a ‘comments book’; this is in the main hallway for any relative or visitor to complete, with either positive or negative comments. The Manager hopes this will enable her to be aware of any concerns as soon as they occur and work with the relative, resident or professional to resolve them. Alternatively the individual can The Downs Christian Nursing Home DS0000065252.V300200.R01.S.doc Version 5.2 Page 6 remain anonymous if they prefer. The fire equipment has also been recently reviewed, missing fire extinguishers and fire blankets have been replaced and the signage for the fire exits has been improved. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Downs Christian Nursing Home DS0000065252.V300200.R01.S.doc Version 5.2 Page 7 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 Downs Christian Nursing Home DS0000065252.V300200.R01.S.doc Version 5.2 Page 8 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): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Good information about the service provided at ‘The Down’s’ has been produced, and is being updated. A thorough assessment of prospective residents takes place, ensuring a resident’s individual needs can be met. EVIDENCE: At the last inspection, the Resident’s Guide for the home was found to be out of date and to not include the contact details for the Commission. The Manager believes it may have been updated but it has not been amended to reflect the new manager at the home and it still has the name of the original organisation. The Manager explained that it is currently with the organisation being revised and that, although all rooms do not currently therefore have a guide, she wishes to wait and circulate the updated version to each resident. Although new to the home herself, she explained that it is her aim to ensure that a Resident’s Guide is sent out to enquirers and given to any prospective residents who look round the home. The Downs Christian Nursing Home DS0000065252.V300200.R01.S.doc Version 5.2 Page 9 Past inspections have found that it is usual practice that, following an enquiry, prospective residents or their relatives are invited to visit ‘The Downs’ if at all possible and to spend time with the Manager and staff, view available rooms and discuss the home’s suitability. If it is then appropriate to pursue an admission, the Manager or her deputy undertakes an assessment in the person’s own home or if they are in hospital, they visit them there. A comprehensive pro-forma is completed. The Manager confirmed that she also plans to ask for information from the prospective resident’s Care Manager, or from nursing and medical staff if the person is in hospital. Their written assessment if available then helps underpin the home’s pre-admission assessment. If the home is suitable and once funding has been agreed (if it is needed), they are then admitted for a trial period. The resident is then provided with a statement of the terms and conditions of occupancy, identifying the services provided. The care files for four residents were viewed during the inspection. All had been assessed prior to admission although the information was not in the resident’s care files. The remainder of information for the residents could not be readily located until later in the visit whereby the pre-admission assessments could not then be examined in detail. However, past inspections have found satisfactory pre-admission assessments in place. The information gathered is used to underpin a plan of care for each resident. Each of the four residents had also had physical and social assessments, as well as various Risk Assessments. ‘The Downs’ does not provide Intermediate Care, although residents are admitted for planned respite care. Very occasionally, emergency respite care is also provided. The Downs Christian Nursing Home DS0000065252.V300200.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 good. This judgement has been made using available evidence including a visit to the service. Care plans promote individualised health and personal care for the residents and the practises in place encourage residents to be cared for with respect and dignity. They must be updated between the monthly reviews if any care changes, to ensure they remain contemporaneous. EVIDENCE: The care files for four residents were inspected. All had individualised care plans and risk assessments that had been reviewed monthly and there was evidence that they had been updated. Each day the staff also complete a ‘Daily Report’ for each resident, whereby any significant events are recorded. However with the records seen, one resident’s air mattress had been removed and another had small skin sores; these were recorded in the daily record with the care that was given, but the information had not been transferred into the care plan as both matters fell between the monthly reviews. The care plans therefore appeared at risk of not being contemporaneous. Any changes in care are also passed on verbally in the handover between each shift. The Downs Christian Nursing Home DS0000065252.V300200.R01.S.doc Version 5.2 Page 11 The Manager confirmed that the staff explain to each resident on admission that they will have a care plan, discussing the care that is required with them and their relatives. However in practice the care plans are not then routinely shared with residents although any care given is explained and any new care introduced is discussed with them and/or their relative. The residents do not sign that they have been involved with drawing up their care plan and that they agree with it. The condition of residents’ skin is assessed and monitored, any pressure areas are recorded and if a sore develops the treatment and outcome is documented. The Manager confirmed that in general, staff within the home manage any wounds but advice may also be sought from a nurse specialising in tissue viability. There are various types of pressure relieving mattresses and cushions, including air overlay mattresses, to support the management of pressure areas at ‘The Downs’. Resident’s dependency is also assessed and the risk of falling is identified. The home has electric hoists and hoist-assisted baths for those with reduced mobility. Grab rails are fitted in the toilets and raised seats are available; there are also adjustable beds. Residents have a continence assessment as part of their admission and continence advice is sought if needed. Nutritional screening is also undertaken and resident’s weights are monitored. The chiropodist visits the home and arrangements are made for residents to see a dentist or optician as needed. Where possible residents remain registered with their own GP or they register with a GP of their choice. As there has recently been an extensive medication audit by the organisation, medication was not examined in great detail at this inspection. One resident currently self-medicates, as has been the practice at past inspections. A resident’s medication is discussed at their pre-admission assessment and they are assessed as to whether it is appropriate for them to self medicate if they wish to do so. This is then recorded as a Risk Assessment. The medications for the home are stored in a clinical room, with some stock in a wall cupboard, but most in a medicine trolley. The ‘Controlled Drugs’ (CDs) are stored appropriately, there is a drug fridge and the temperatures are recorded daily. The name of residents with their photo, accompanies their Medication Administration Record (MAR chart). The trained nurses at the home administer medications and either they or the carers assist the residents with taking them, although carers are not involved in the administration of CDs. Medication ready for disposal is then recorded and signed for by two trained nurses. Medication is reviewed as part of the home’s internal monthly audit and a local pharmacy also carries out audits of the MAR charts; this was last undertaken on 4th July 2006. The Downs Christian Nursing Home DS0000065252.V300200.R01.S.doc Version 5.2 Page 12 The Manager confirmed that the staff aim to support residents by providing personal and nursing care where needed, but at the same time they endeavour to maintain their privacy and dignity; during the visit, staff were observed to be attentive and courteous. One resident who met with the inspector commented that ‘I’m well looked after’ and another confirmed that ‘they look after us’. The Downs Christian Nursing Home DS0000065252.V300200.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 good. This judgement has been made using available evidence including a visit to the service. There is a good programme of recreational pursuits available and residents are enabled to continue with their own interests whereby their social, cultural, religious and recreational needs are met. EVIDENCE: There are lounges on the lower ground and ground floor at ‘The Downs’, enabling the residents to sit together and watch television, read or meet with their visitors. Videos and various games are available, as well as a selection of books. The garden is also accessible for residents, from the garden room on the lower floor. An Activity Co-ordinator plans a programme of activities, publicising them on the notice board by the lounges on each floor. A monthly newsletter is circulated highlighting the planned activities and also any resident’s birthday during that month. A hairdresser also visits the home each week. The home has a chaplain who is also attached to the inpatient unit next door; a service is held each week and communion is also available. The home currently celebrates the Christian festivals, as there are no residents with other religious interests or from a different cultural background. However there are The Downs Christian Nursing Home DS0000065252.V300200.R01.S.doc Version 5.2 Page 14 several nurses and carers employed from overseas and the off duty is arranged whereby they can celebrate their festivals or have a period of leave to enable them to visit their families at home. The Manager is confident that the home can meet the needs of residents with varying social and cultural needs. One resident continues to be employed and their bedroom adapted to enable there to be a computer and the necessary equipment to either work from the home or to go to the office, as the resident chooses. The times they receive their personal care and meals are adjusted dependant on the plan for the day. Friends and relatives are encouraged to visit at any time that suits the resident concerned and details of external advocacy services are available. Resident’s meetings have been arranged in the past but the Manager confirmed that attendance had been poor. However she had arranged a meeting, to include relatives, for the week following the inspection. The aim was to provide an opportunity to formally introduce herself as the new Manager. She also saw this as an opportunity to hear any outstanding concerns. Social and emotional needs are not well identified in the care plans. However the staff that spoke with the Inspector felt the residents are encouraged to maintain any hobbies they may have, if possible and there are activities for them to join in with as they wish. This was also born out by the service user surveys. Of the ten surveys returned to the Inspector prior to the visit, nine of the respondents said there are ‘always’ activities for them to take part in and one said ‘usually’. The residents in the lounge and those in their rooms who spoke with the Inspector during the visit were enthusiastically discussing the cheese straws they had just made and describing other events that had been organised. One of the current residents manages their own financial affairs; in general relatives or solicitors act on the resident’s behalf. The home does not act as the appointee for any resident. Previous inspections have found the food provided at ‘The Down’s’ is varied and enjoyed by the residents. Meals can be eaten in the dining room on either floor; alternatively some residents prefer to eat in their own rooms. The menu seen by the Inspector was nutritious and varied. Several choices are available and there is also a small kitchenette area in each dining room where extra drinks or light snacks can be prepared. One resident who met with the Inspector described the food as ‘very good – lovely meals’. In the surveys returned, two responded that they ‘always’ like the food, six said ‘usually’ (with one comment that it could be more varied) and two said ‘sometimes’. The kitchen was not inspected at this visit, but previous inspections have not raised any concerns. However, since the last inspection part of a complaint received by the Commission for Social Care Inspection related to unacceptable food being provided for a resident needing a pureed diet. This was investigated by the organisation and appropriate action taken to reach a satisfactory outcome. The Downs Christian Nursing Home DS0000065252.V300200.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to the service. ‘The Downs’ has a satisfactory complaints procedure and residents are confident that their views are listened to and acted upon. Safe procedures regarding action to take if a resident suffers abuse are in place; however all staff must have training in the protection of vulnerable adults to ensure residents are protected. EVIDENCE: The home’s complaints procedure is displayed in the main entrance and is included in the Resident’s Guide. There is a policy within the home that clearly identifies timescales for any concerns or complaints to be investigated and a response to be given. The outcome of any investigation is fed back to the complainant. The residents who spoke with the Inspector during the site visit and the service user surveys received, expressed confidence in the Management Team overall; seven of them responded that they ‘always’ know who to speak to if not happy and three said ‘usually’. Nine then responded that they ‘always’ know how to make a complaint and one said ‘usually’. The CSCI had received one complaint about the service since the last inspection. This was referred back to the organisation and following a full investigation on their part, it was closed having reached a satisfactory outcome for the complainant. The details of this were recorded in the home’s complaints log. A ‘comments book’ has also just been introduced. This is in the main hallway for any relative or visitor to complete, with either positive or negative comments. The Manager hopes this will enable her to be aware of any The Downs Christian Nursing Home DS0000065252.V300200.R01.S.doc Version 5.2 Page 16 concerns as soon as they occur and work with the relative, resident or professional to resolve them. Alternatively the individual can remain anonymous if they prefer. Adult Protection policies and procedures continue to be in place and Criminal Record Bureau (CRB) Disclosures are applied for as part of the recruitment process. It is unclear how many of the staff have been trained in ‘Adult Abuse’ within the last twelve months as there was no summary of staff training available during the visit. None of the four staff files that were reviewed had a record of training in Adult Abuse. A copy of the multi agency guidelines is available in the home and the organisation has recently undertaken an investigation under Adult Protection Procedures, working with Social Services as the lead agency. The Downs Christian Nursing Home DS0000065252.V300200.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to the service. ‘The Downs’ provides a comfortable well-maintained home for residents to live that is clean, pleasant and hygienic. EVIDENCE: The Downs is a purpose built property situated in a residential area of Hove. Accommodation is arranged over three floors that can be accessed by a shaft lift. The lower ground and ground floor both have their own lounge/dining room where pastimes are available or residents can meet together. A relatives’ room and garden room provide additional relaxation areas for the residents and their visitors. The bedrooms are all single with en-suite facilities; those resident’s bedrooms that were seen contained personal possessions and staff were seen to be respecting residents’ privacy by knocking before entering. Well-maintained gardens surround the building. The Downs Christian Nursing Home DS0000065252.V300200.R01.S.doc Version 5.2 Page 18 All radiators are guarded and emergency lighting is provided throughout the home. Thermostatic controls are fitted to the water outlets in the bathrooms and en-suite facilities. The home is well maintained, the premises well decorated and all the furniture seen appeared to be in good condition. The garden surrounding the building has been well maintained, providing a pleasant area for residents to look out on or sit in. Past inspections have found that the organisation has an Annual Development Plan whereby the physical environment remains in good order. As with past inspections the home was found to be comfortably furnished, clean and free from any odours. Laundry facilities were not viewed at this visit as previous inspections have found the standard of laundering and the organisation of the housekeeping team to be good. The Inspector saw evidence that this continues and the residents, as well as feedback from the service user survey, confirmed it. All of the respondents answered that the home is ‘always’ fresh and clean and one wrote a comment that it is ‘always fresh and clean – excellent’. Policies are in place for managing infected linen and it is washed separately to other laundry. There are also sluice facilities containing a disinfector. The Downs Christian Nursing Home DS0000065252.V300200.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using evidence including a visit to the service. Residents are protected by the home’s recruitment procedures, but insufficient care staff are appropriately qualified and staff have not all had their required training. However with the good processes in place to ensure this improves, the residents are in safe hands. EVIDENCE: ‘The Downs’ has a registered nurse on duty, supported by care staff, for the full 24-hour period. The aim is that there are six staff on duty each morning, five in the evening and three waking staff at night. These numbers appear adequate for the number of residents that the home is registered for. Agency staff are used to cover incidental absence. An Administrator, catering, kitchen and cleaning staff, maintenance and gardening staff are also employed. Of the fifteen care staff, three have obtained the National Vocational Qualification (NVQ) level 3 and 1 has NVQ level 2. One new member of staff who is starting imminently, also has NVQ level 3 and a further 2 are starting their NVQ level 2 in September. The Manager’s aim is that she will discuss NVQ training when recruiting care staff in future, whereby they will be aware that it is her expectation that, once they have completed their foundation training, they will undertake their NVQ level 2 if they do not already have it. Agency care staff are employed at ‘The Down’s’; there is no record of whether they are trained to NVQ level 2. The Downs Christian Nursing Home DS0000065252.V300200.R01.S.doc Version 5.2 Page 20 Three staff files were inspected during the site visit and found to have the required documentation for recruitment. It is usual practise for the home to employ, once a ‘Protection of Vulnerable Adults first’ (POVA first) has been received. The individual then works under supervision until the Criminal Records Bureau Enhanced Disclosure (CRB) is received. One person had been in post in another care home within the organisation and had recently transferred to ‘The Downs’. It is the organisation’s policy that it allows CRB portability for transfers within the organisation. Similarly the individual’s references had been applied for prior to her employment in her last post. The Manager agreed that a statement of the individual’s performance and competence during her last post would be compiled and held on file. Copies of birth certificates and passports were available and each had a copy of the contract with terms and conditions of employment. An annual training programme has been in place for both the trained nurses and the care staff. However there was no training matrix available on the day of the inspection, to assess the progress of staff training. The Manager confirmed that all new staff have an induction into the home and then undertake further training dependent on their individual need, although a formalised foundation programme is not in place. Training is held within work time and staff therefore receive three paid days training in a year. The Downs Christian Nursing Home DS0000065252.V300200.R01.S.doc Version 5.2 Page 21 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 and 38 Quality in this outcome area is good. This judgement has been made using evidence including a visit to the service. ‘The Downs’ is now being well managed by the Manager and her deputy. Although some monitoring has lapsed in recent months, there are robust processes being put in place to enable the home to be run in the best interests of residents, ensuring they are kept safe. However the water temperature from the outlets must be monitored and recorded to ensure the residents’ safety and welfare is not compromised. EVIDENCE: The Manager at ‘The Down’s has been recently appointed and has not therefore been registered with the CSCI. She has considerable experience in caring for the elderly and has completed six of the modules towards her Registered Managers Award (RMA). She is accountable to the Area Manager for the organisation and is supported by the Deputy Manager to lead a team of carers and ancillary staff. The Downs Christian Nursing Home DS0000065252.V300200.R01.S.doc Version 5.2 Page 22 The home has previously undertaken service user surveys as part of its quality assurance. These are analysed and the results publicised within the home. The analysis is also fed-back to staff and any areas for improvement are discussed. The organisation has an Annual Development Plan for the home; and it has been found at past inspections that this is moulded and changed, dependant on current issues and the needs of the residents. The Manager confirmed that this ethos continues and that the organisation is responsive to the changing needs of the residents. One of the organisation’s managers undertakes a monthly, unannounced visit to inspect the premises, talk with staff and residents and ensure there are no ongoing concerns. The Manager and Area Manager also alternate a monthly internal audit. As stated earlier in the report, one resident manages his own financial affairs but in general relatives or solicitors act on behalf of the residents. Some residents choose to keep money in their room in a lockable cupboard or drawer, whilst others prefer that their money is held in the home’s safe. It is kept in separate envelopes and computerised records of any transactions are maintained. If staff are asked to shop for a resident, receipts are kept for any items purchased. The record of resident’s personal money and expenditure were not explored in depth at this inspection as previous inspections have raised no concerns and the same procedures and responsible personnel continue. The home is currently reviewing its maintenance arrangements and records were not therefore readily available to be examined in detail. The fire alarm is activated weekly to ensure the fire doors close appropriately; different alarm points are used each time. There have also been incidental fire drills; the last was on 4th August when 12 staff were present. A recent fire assessment on 9th August 2006 has resulted in the fire extinguishers, fire exit signs and fire blankets being reviewed and replaced as needed. Since the inspection the Manager has confirmed that the staff have not all had their mandatory training in ‘Moving and Handling’, fire training, food hygiene and First Aid. However a video has been ordered that will assist with training staff in Adult Protection and the sessions for ‘Moving and Handling’ training have been scheduled. Each water outlet has a thermostatic control. All the outlets have previously been checked monthly and the water temperature recorded, but this practice appears to have lapsed recently. A review of the records kept over the last few months showed the last check as 16th May 2006: checks prior to that did not demonstrate any variance in the temperatures. The Manager explained that she is in the process of re-delegating the monitoring of water temperatures to ensure it continues. Since the inspection she has sent evidence that part of the home has been checked and the water temperatures do not exceed 43C. The Downs Christian Nursing Home DS0000065252.V300200.R01.S.doc Version 5.2 Page 23 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 The Downs Christian Nursing Home DS0000065252.V300200.R01.S.doc Version 5.2 Page 24 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)(c) 5(1)(a)(2) Schedule 1 (1-4) Requirement Timescale for action 30/09/06 2. OP7 3. OP28 4. 5. OP18 OP19 6. OP31 The Statement of Purpose and Service User guide must reflect the current details of the organisation and the current management structure. A copy must be supplied to each service user and the CSCI. 15 (2)(b) The care plans must be updated to reflect changes in care recorded in the Daily Report, thereby remaining contemporaneous. 18(1) A minimum ratio of 50 trained members of care staff (NVQ level 2 or equivalent) must be achieved. This was a Requirement from the last inspection 13 (6) All staff must have training in the Protection of Vulnerable Adults. 13(4)(a)(c There must be a programme in ) place to ensure the water temperature from outlets is monitored and recorded to ensure it does not exceed 43C 8 The Manager must apply to be (2)(a)(b) registered with the Commission. 30/09/06 31/03/07 31/12/06 30/09/06 31/12/06 The Downs Christian Nursing Home DS0000065252.V300200.R01.S.doc Version 5.2 Page 25 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 Residents and/or their representative should be involved with drawing up their care plan and where possible should sign that they agree with it. The Downs Christian Nursing Home DS0000065252.V300200.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 The Downs Christian Nursing Home DS0000065252.V300200.R01.S.doc Version 5.2 Page 27 - 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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