CARE HOMES FOR OLDER PEOPLE
The Grove 48 Lode Lane Solihull West Midlands B91 2AE Lead Inspector
Lesley Beadsworth Key Unannounced Inspection 11th July 2007 10:15 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 DS0000004519.V340296.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. DS0000004519.V340296.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Grove Address 48 Lode Lane Solihull West Midlands B91 2AE 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) 0121 705 3356 0121 713 2110 grovesolihull@yahoo.co.uk The Grove Residential Home (Solihull) Mrs Lyndon Green Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places DS0000004519.V340296.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th July 2006 Brief Description of the Service: The Grove is a mid Victorian building with an extension added. It consists of three storeys and is located on the main route to the Coventry Road from Solihull. Solihull town centre is easily accessible from the home. The home is near places of worship and is on a main bus route. There are two main lounges, a small visitors room and a dining room. The home caters for 30 older adults and all bedrooms are of single occupancy. Access for wheelchairs is available with ramps at the front and rear of the building. The homes garden is accessed by a ramp from one of the main lounges. DS0000004519.V340296.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection included a visit to The Grove. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment (AQAA), which is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Some of the information contained within this has been used in assessing actions taken by the home to meet the care standards. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to them their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the deputy manager, staff, visitors and residents. The inspection visit took place between 10.15am and 07.30pm. What the service does well:
The home provides sufficient information to assist prospective residents to make a choice about living there. Pre-admission assessments are carried out and the prospective resident is informed of the outcome of that assessment. Care files also included the daily routine of each resident, entitled “How I like My Day”, personal and family history and any known funeral arrangements that had been completed with the assistance of the resident and/or their family. Health care needs were met with evidence of health are professionals either visiting the home or appointments made for the resident to visit them. Evidence was seen of the management being pro active in ensuring that residents’ health care needs were met. Risk assessments were included in each care file for the occurrence of pressure sores (a break in the skin due to pressure, which reduces the blood supply to
DS0000004519.V340296.R01.S.doc Version 5.2 Page 6 the area), nutrition, falls and moving and handling in order to minimise the risk in these areas. The medication administration process is carried out in a safe and efficient manner. Records are maintained of receipt and disposal of medication. All residents were seen to be cared for in a respectful manner. The residents and visitors spoken with confirmed this. Residents were occupied and stimulated on the day of the inspection visit and those spoken with said that they had enough to do during the day. Activities offered include Bingo, outings for pub lunches and shopping in Solihull, board games and quizzes. The AQAA and staff spoken with said that outside entertainers were contracted to perform at the home, including Movement to Music. There are regular church services held at the home with a Church of England service and a multi-denominational service both held once a month. Visitors spoken with said that they are made welcome and that visiting was at any reasonable time. Meals are enjoyed by residents and are varied and nutritious with ample choice. They are taken in an attractive dining room with appropriate supervision and assistance, with the choice of eating in the lounges if they wished. The home has appropriate policies and procedures related to complaints and vulnerable adults to safeguard residents. Staff have undertaken training that gives them the knowledge and skills to be able to identify abuse and to safeguard residents from it. The home offers the people living there comfortable, attractive and generally well maintained surroundings. All communal living areas have been redecorated and refurbished fairly recently and to a good standard and residents said they enjoyed the improved surroundings. The home was seen to have good infection control practices thereby reducing the risk of cross infection. Suitable protective clothing was readily available for staff to use when were dealing with personal hygiene needs or when serving food, preventing contamination. Rotas, discussion and observations showed that there were sufficient care staff provided to meet the needs of the residents with five members of care staff on duty in the day, four in the evening and two during the night. Ancillary staff including laundry, domestic and catering staff are also provided in sufficient numbers. DS0000004519.V340296.R01.S.doc Version 5.2 Page 7 More than 50 of care staff have achieved National Vocational Qualification (NVQ) Level 2 or 3. Ancillary staff have also had the opportunity to achieve NVQ, with catering staff having NVQ Level 2 and 3. This indicates that staff have been assessed to be competent to carry out their role. Training records showed that new staff had undertaken appropriate induction training and this was further confirmed by staff spoken with. Staff had undertaken a substantial amount of training in a variety of subjects including all health, safety and welfare areas and specialist needs. This training gave the staff the knowledge and skills they needed to meet the needs of the residents and to ensure a safe living and working environment. The registered manager is a registered nurse and has National Vocational Qualification Level 4 and the Registered Managers Award. Staff spoken to said that they felt supported by the management and that they felt the home was well run. In her absence at the inspection visit the deputy manager presented as professional and aware of all aspects of the service. All staff files looked at and discussion with the deputy manager and other staff confirmed that regular staff supervision had been undertaken. This gives staff the opportunity to discuss care and training issues, their own development and to be able to affect the service offered at the home. A random check was made on health and safety and all checks and servicing had been maintained. This included the related requirement and recommendation from the last inspection report. What has improved since the last inspection?
All care files looked at had a pre-admission assessment from which a care plan had been devised. There was evidence to show that prospective residents are sent a letter to inform them of the outcome of their assessment. A new care plan format has been introduced that makes it easier for staff to extract information. A Home Remedy policy enables staff to give ‘over the counter’ treatment safely for minor ailments without the need to contact the GP on each occasion. The home has purchased a new and larger medication trolley that houses all the multi dose system blister packs. The deputy managers advised that as was required at the last inspection hot water outlets where residents have access had been fitted and were checked at regular intervals. These will maintain hot water temperatures at around 43°C and protect residents from accidental scalding.
DS0000004519.V340296.R01.S.doc Version 5.2 Page 8 There have been improvements made in the décor and fabric of the home thereby offering the people living at the home more comfortable surroundings. The home has been provided with a disinfector for cleaning commodes since the last inspection. All fire recommendations have been carried out. The deputy manager also advised that the home’s fire risk assessment had been approved by the fire service. The home therefore further safeguarded residents in the event of a fire. What they could do better:
Not all assessments had been dated and signed to validate them. Care plans were also not all signed by the member of staff completing the plans. Where practicable these also need to be signed by the resident to show that they have been involved with drawing them up and have given their approval. Some care plans had not been brought up to date despite them having been reviewed monthly. This creates the risk of needs not being met. The GPs should evidence that the new home remedy policy meets with their approval in order to safeguard residents. Minimum, maximum and current temperatures of the medication fridge must be taken and recorded, using an appropriate thermometer. This will ensure that the correct storage temperature is maintained to prevent the medication becoming unstable. Handwritten Medication Administration Record Sheets should be checked and signed by two members of staff to ensure that there are no errors in the written instructions, thereby safeguarding the residents’ welfare. There must be evidence from the district nurse to show that designated staff have been taught how to draw up and administer insulin and that they are competent to do so. The home is generally well maintained with just a small number of minor concerns. These were - the laminate trim on the hairdressing vanity unit needed repairing; a small area of wallpaper needed replacing around the alarm unit in the reception area; the hearth tiles on one of the lounge fireplaces needed refixing; bedroom 17 was in need of redecoration; the large screen television in one of the lounges had very poor colour that needed attention. The corridor leading to the laundry was in need of decoration and the deputy manager advised that this was planned. DS0000004519.V340296.R01.S.doc Version 5.2 Page 9 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. DS0000004519.V340296.R01.S.doc Version 5.2 Page 10 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 DS0000004519.V340296.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is adequate. Prospective residents have sufficient information to make a decision about living at the home. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met. Staff have the knowledge and skills to meet residents’ needs. Some effort is made to meet specialist, cultural and religious needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the home’s Statement of Purpose and Service User Guide were made available to prospective residents and the deputy manager advised that copies were provided in each bedroom. This was confirmed during the tour of the home and in conversation with people living at the home. Three care files were looked at as part of the case tracking process. All of them included a pre-admission assessment that had been recorded on the home’s standard format. Each assessment included appropriate and current information for the home to assess if the prospective resident’s needs could be
DS0000004519.V340296.R01.S.doc Version 5.2 Page 12 met by the home. Care plans were devised from these assessments. Assessment summaries from care or health services were included in care files of residents referred by these services. There was evidence in the care files to support that prospective residents are advised in writing of the outcome of the assessment. Not all the assessments seen had been dated and signed although the time and duration of the assessment was recorded. The pre-admission assessment form included space for information regarding cultural and spiritual needs. Although the AQAA and deputy manager advised that there were no residents at the time of the inspection with specific ethnic needs, whether cultural, religious or social, the deputy manager also advised that community contacts and appropriate support would be made available as required. It was evidenced in previous inspection reports and in the AQAA that this had been the case in the past when the home has assisted people with diverse religions “to follow their chosen faith”. DS0000004519.V340296.R01.S.doc Version 5.2 Page 13 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. There are shortfalls in care plans that carry the risk of residents’ needs not being met. Residents have access to health care professionals and are cared for in a respectful manner. The home has a safe and effective medication process but with some shortfalls that may put some residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans devised from assessments of needs were available in the three care files looked at for case tracking purposes. Those looked at generally appropriately identified current needs. However there were some observations made at the visit that had not been included or updated despite there being evidence that all care plans are reviewed each month. For example one resident whose care plan stated that only supervision of mobility was required whereas was using a walking frame during the day; a resident was having difficulty passing through doorways and required specific management to assist in negotiating them; a resident was said by staff to have become
DS0000004519.V340296.R01.S.doc Version 5.2 Page 14 increasingly anxious; the mental health needs of a resident presented as requiring specific management. None of these observations were included in the relevant care plans and whilst all the members of staff spoken with were fully aware of these needs it is necessary to document them if the risk of them not being met by all staff is to be minimised. The home was using a new care plan format that made it easier for care staff to extract information. Discussion with the deputy manager though suggested that the space for writing the care required for each area of need, including mental health, was limited and therefore the necessary detail was not always present. Care files also included the daily routine of each resident, entitled “How I like My Day”, personal and family history and any known funeral arrangements that had been completed with the assistance of the resident and/or their family. One of the “How I like My Day” sections looked at had not been completed but as they give staff important information it would be useful for all files to have this information. Although residents and/or their family had been involved in the family history and the daily routine records not all the care plans looked at had been signed by them to show their involvement and agreement in the care that was to be provided. Examination of records and discussion with staff and residents showed that health care issues were dealt with appropriately, with healthcare professionals such as the GP, chiropodist, optician, district nurse or mental health team either being visited by the resident or visiting the home. The GP surgery used by the majority of the people living at the home is only a few yards from the home and visits are made to the surgery, accompanied by staff, wherever possible. This was seen to take place on the day of the inspection visit. Discussion with the deputy manager, the AQAA and other documentation looked at showed that the managers had been pro active in attempting to improve the service related to the GP surgery, the results of tests and timely treatment where appropriate. There was further evidence to show that following complaints made to the dental and optician practices the home had succeeded in ramps being provided to enable wheelchair access to their premises. This shows that the home is further ensuring that the residents’ health care needs are met and that equality and diversity issues are addressed. Risk assessments were included in each care file for the occurrence of pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area), nutrition, falls and moving and handling in order to minimise the risk in these areas. Weights were recorded separately from the care file. This DS0000004519.V340296.R01.S.doc Version 5.2 Page 15 information needs to be transferred to individual files to comply with the Data Protection Act and for residents wanting to access their files. Medication was assessed during the visit. The home has a medication policy and the senior staff advised that this is given to all staff responsible for medication and is signed by them to say that the have received and understood it. A copy was also seen with the Medication Administration Record Sheets. There is now a Home Remedy policy that enables staff to give ‘over the counter’ treatment, such as paracetamol and senna for minor ailments without the need to contact the GP on each occasion. This included instructions as to when the GP should be contacted. Although the senior member of staff said that the policy had been approved by the GPs this had not been confirmed in writing. The ordering, receiving and disposal of medication is carried out by two of the senior staff who are always responsible for this task. These tasks were recorded appropriately. The home has been provided with a new, larger medication trolley to hold all the blister packs of the multi dose storage system. Other medication storage included a fridge. Temperatures of the fridge had been taken and recorded on a daily basis but to ensure the correct temperature for the storage of medication is maintained throughout the day the minimum and maximum temperatures should be taken and recorded using an appropriate thermometer. The senior member of staff said that a new medication fridge was soon to be provided that will be lockable thus safeguarding the security of the contents. Apart from a few external medications being stored with medicines taken internally, storage was appropriate. This included Controlled drugs, which are kept in locked cupboard within a locked metal cupboard. An audit of the controlled drugs was satisfactory. The medication trolley is taken to the residents at the times of medication administration. The process was carried out in a safe and efficient manner. There were no gaps in the Medication Administration Record Sheets or queries regarding the codes used for the reasons medication had not been taken. Some handwritten Medication Administration Record Sheets continued to be without two signatures against the instructions. Records looked, and discussion with senior staff showed, that all staff responsible for medication have had appropriate training in order to safeguard residents. The senior member of staff advised that designated staff had been trained to draw up and administer the injections of insulin but there is no record of this
DS0000004519.V340296.R01.S.doc Version 5.2 Page 16 training or proof of competence available. Staff responsible for this procedure must be named and be able to demonstrate that they are competent and the district nurse must be sure of this for each named member of staff and provide evidence to support it. The insulin pens are considered simpler to use than syringes and reduce the risk of an error being made. The home has a self medication policy but no residents at the time of the visit were self-medicating. All current residents chose to have, or required, the assistance of staff to take their medication. The pharmacist carries out pharmaceutical check every three months. The last report was looked at and was satisfactory. All residents were seen to be cared for in a respectful manner. The residents spoken with confirmed this. DS0000004519.V340296.R01.S.doc Version 5.2 Page 17 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. Residents were occupied and stimulated. Visitors were made welcome and their needs considered. Residents had choices and control over their daily lives. Residents enjoyed the nutritious and varied meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home does not employ a designated activity organiser and the home relies on a member of the care staff team to be responsible for providing activity during the day. On the day of the inspection visit residents were encouraged to join in a reminiscence quiz and later on a sing along, providing mental stimulation as well as entertainment and occupation. The notice board in a corridor displayed a list of that month’s residents’ birthdays in order that they could be celebrated. A list of activities that were able to be provided was also displayed and these included, aromatherapy, Bingo, board games, outings – for example to pub lunches and visits to Solihull shopping centre - and one to one sessions between staff and residents. The
DS0000004519.V340296.R01.S.doc Version 5.2 Page 18 activities appeared to be offered on an ad hoc basis as no programme was available but residents spoken with said that they were sufficiently occupied during the day. The manager discussed in the AQAA that attempts were made to assist residents to fulfil their ambitions with three residents having been to see a Ballet on stage in Birmingham and others taken on a trip to the Lickey Hills. Also that entertainers were contracted to perform in the home including Movement to Music. The notice board also displayed the times of church services – a Church of England service and a multi denominational service being held each month – and the days of the hairdresser visits and the pricelist, to inform residents and visitors of these events. Residents meetings are held at regular intervals although the notice advising of the date and time of the last meeting held two months previously was still being displayed. This was misleading and could even be disorientating for those residents with limited understanding. However these meetings give residents the opportunity to be involved in the day-to-day running of the home. Residents spoken with also said that they were able to make choices about when they got up and went to bed and interaction observed between staff and residents supported that they are able to make choices in their daily lives. Bedrooms viewed showed that they were able to bring in personal possessions with photos, pictures, ornaments and plants on display. Two visitors spoken with said that they were made welcome and that visiting was at any reasonable time. The small lounge was available for visitors and one resident spent the time with her visitor in the sitting area of the reception hall. Meals are served in the attractively decorated dining room and in two sittings. On the day of the visit it was apparent that residents who were able to make the decision were choosing which sitting they preferred. A choice of meals was available and offered at the time of each meal. A menu displayed on the notice board and in the dining room referred to the current week but those on display in the lounges were for a previous week and could therefore be confusing for the residents. Menus offered varied and nutritious meals. The cook interacted with residents to ensure that their likes and dislikes were considered. The lunchtime meal was served from a trolley that was taken to the dining room and residents were able to decide what was served to them. There was adequate supervision and assistance was offered sensitively as required. Residents were not rushed during the meal. Hot or cold drinks are available throughout the day with a chilled water dispenser and cordials also available in the dining room. At teatime several residents chose to eat in the lounges and the trolley was taken to them to choose what they wanted. A large variety and choice of food
DS0000004519.V340296.R01.S.doc Version 5.2 Page 19 was available for tea, including egg, chips and beans, fried egg or chip sandwiches made by staff at the trolley or cold sandwiches of meat or cheese pre-made in the kitchen. Some of these meals were served on disposable plates, which staff said was because they were more manageable, by the residents sitting in the lounges. Staff did not always use food tongs when serving the finger food creating the risk of cross infection/contamination. Care also needs to be taken to ensure that food remains at required temperatures during this serving time in order to maintain food hygiene and to ensure that it is edible. The AQAA advised that residents who lost weight have “snack boxes into which we put 24 hours of high calorie/high protein snacks”. This was not inspected on this occasion. All residents asked about the food at The Grove said that they enjoyed their meals. The kitchen was visited and apart from the back door being open and without fly screens, was in good order. Appropriate temperature recordings were seen and safe food storage methods had been followed. DS0000004519.V340296.R01.S.doc Version 5.2 Page 20 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. The home has appropriate policies and procedures to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One complaint had been made to us regarding the communication between the home and the family of a resident who needed to be transferred to a nursing home. This was addressed appropriately by the home. Records are kept of any complaints received, action taken and response to the complainant. This shows that the home takes complaints seriously A complaint procedure was on display in the reception area for residents and visitors to see and a copy was included in the Service User Guide. The home has a Vulnerable Adult and Whistle Blowing policy that was accessible to staff. Staff spoken with showed that they had the appropriate training, knowledge, skills and awareness required to identify and safeguard residents from abuse. The home has a policy stating that no member of staff can assist or benefit from a service user’s will, further safeguarding their financial interests.
DS0000004519.V340296.R01.S.doc Version 5.2 Page 21 There have been no Protection of Vulnerable Adults referrals since the last inspection. DS0000004519.V340296.R01.S.doc Version 5.2 Page 22 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): 19,20,26 Quality in this outcome area is good. The home offers the people living there comfortable, attractive and generally well maintained surroundings, but with some minor shortfalls. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were two large lounges and a further small lounge on the ground floor and a sitting area in the reception. The lounges, that had large windows opening onto the garden and many original features, had been recently redecorated and refurbished, one of them since the last inspection, and were attractive and comfortable for the people living at the home. The rooms were furnished in a domestic manner and the floors of communal areas have an attractive non-slip wood-like vinyl covering with the appearance of wooden flooring. Residents spoken with said that they enjoyed the new look of the lounges.
DS0000004519.V340296.R01.S.doc Version 5.2 Page 23 The dining room had recently been decorated and refurbished and offered an attractive place for residents to take their meals. The corridor leading to the laundry was in need of decoration and the deputy manager advised that government funding had been acquired in order to do this, a bathroom and to install an air conditioning unit and hearing loops in the lounges. A passenger lift, a stairlift and ramps to the front and back of the building offer residents access to all parts of the home. The home was generally well maintained with just a small number of minor concerns. These were - the laminate trim on the hairdressing vanity unit needed repairing; a small area of wallpaper needed replacing around the alarm unit in the reception area; the hearth tiles on one of the lounge fireplaces needed refixing; bedroom 17 was in need of redecoration; the large screen television in one of the lounges had very poor colour that needed attention. A plan as to when the external structural fabric concerns identified will be replaced or repaired had been forwarded to us, as was requested at the last inspection. The deputy managers advised that as was required at the last inspection hot water outlets where residents have access had been fitted and were checked at regular intervals. These will maintain hot water temperatures at around 43°C and protect residents from accidental scalding. The valve fittings were not looked at during this visit. The home was seen to have good infection control practices thereby reducing the risk of cross infection. The home has been provided with a disinfector for cleaning commodes. Suitable protective clothing was readily available for when staff were dealing with personal hygiene needs or when serving food, preventing contamination. Appropriate hand washing facilities were available throughout the home to maintain good hand hygiene. Apart from one bedroom viewed the home was free of offensive odours. The laundry area was secured by a digilock to protect residents with limited understanding. Washing machines had appropriate washing cycles and there were suitable systems in place to prevent cross infection. Hand washing facilities were also available for staff to maintain good hand hygiene. DS0000004519.V340296.R01.S.doc Version 5.2 Page 24 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. There are sufficient care staff available to meet the needs of the residents. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Rotas, discussion and observations showed that there were sufficient care staff provided to meet the needs of the residents with five members of care staff on duty in the day, four in the evening and two during the night. Ancillary staff including laundry, domestic and catering staff were also provided in sufficient numbers to meet the standards for food, infection control and cleanliness. The home had a duty rota detailing what staff were on duty, the job that they undertook and whether the hours had been worked. These rotas looked complicated and relied on the use of codes, for which a key was provided. The registered manager was not included in the copies made available. More than 50 of care staff have achieved National Vocational Qualification (NVQ) Level 2 or 3. Ancillary staff have also had the opportunity to achieve NVQ, with catering staff having NVQ Level 2 and 3. This indicates that staff have been assessed as competent to fulfil their role.
DS0000004519.V340296.R01.S.doc Version 5.2 Page 25 Three staff files were looked at and showed that the home has a robust recruitment procedure and that employment history and references are validated. This protects residents from the appointment of unsuitable employees. Records also showed that equal opportunities for employees was practised and monitored. Training records showed that new staff had undertaken appropriate induction training and this was further confirmed by staff spoken with. Staff had undertaken a substantial amount of training in a variety of subjects including all health, safety and welfare areas and specialist needs. This training gave the staff the knowledge and skills they needed to meet the needs of the residents and to ensure a safe living and working environment. The AQAA advised that staff undertake Equal Opportunities training and that there are plans to increase staff awareness in this area. DS0000004519.V340296.R01.S.doc Version 5.2 Page 26 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is good. A person with the appropriate qualifications and management experience manages the home. There is a Quality Assurance programme to ensure that all services operate in the best interests of the residents. residents financial interests are safeguarded and the health, safety and welfare of residents and staff are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In the absence of the registered manager who was on leave, the deputy manager was present throughout the inspection visit. She presented as professional and efficient and was fully aware of the needs of the residents and the running of the home. Other senior staff, who like her and the registered manager had been at the home for some years, supported her.
DS0000004519.V340296.R01.S.doc Version 5.2 Page 27 The registered manager is a registered nurse and has National Vocational Qualification level 4 and the Registered Managers Award which are appropriate qualifications for this post. Staff spoken to said that they felt supported by the management and that they felt the home was well run. The home has a board of governors, the chairman of which is the Responsible Individual. A Regulation 26 (of the Care Home Regulations 2001) unannounced inspection visit is carried out monthly and a report is forwarded to us and the manager. Staff spoken to referred to surveys that had been completed by residents for feedback on the care that was provided. A suggestion box was also in place for this purpose. These things demonstrate that the service is being monitored to ensure that standards are being met. The AQAA informed us that the home had a Quality Assurance programme but records were not viewed on this occasion. Some money is held on behalf of residents and a random audit was made. The money is stored in a locked location. Individual transactions are maintained and money is stored individually maintaining residents’ autonomy and safeguarding their financial interests. All monies and transactions looked at were correct. There was evidence of advocacy with one resident receiving this support from a friend. All staff files looked at and discussion with the deputy manager and other staff confirmed that regular staff supervision had been undertaken. This gives staff the opportunity to discuss care and training issues, their own development and to be able to affect the service offered at the home. The deputy manager showed an understanding of health and safety matters. Regulation 37 (Care Home Regulations 2001) notifications had been forwarded to us to notify us of relevant incidents. Staff had undertaken training in the past year in Moving and Handling, First Aid, COSHH (Control of Substances Hazardous to Health), Food Handling and Fire Awareness. This showed that staff had the knowledge and skills to maintain a safe working and living environment. The AQAA advised that several staff had undertaken further fire awareness training and acted as fire marshals in the home. A random check was made on health and safety, and all checks and servicing had been maintained. This was further evidenced in the completed AQAA returned to us. All fire service recommendations had been carried out. The deputy manager also advised that the home’s fire risk assessment had also been approved by the fire service. The home therefore further safeguarded residents in the event of a fire.
DS0000004519.V340296.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 2 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 4 x x x 3 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 3 DS0000004519.V340296.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement All residents must have an up to date, detailed care plan that where practicable are signed by the resident and/or their representative. This will ensure that their needs are met in a person centred manner. All handwritten medication administration recordings have two staff signatures. This will safeguard residents’ welfare. (the previous timescale of 28/02/07 was not met) The home remedies policy must have evidence that it has been approved by the GP. This will ensure that minor ailments can be treated safely. The minimum, maximum and current temperatures of the medication fridge must be taken and recorded daily. This will ensure that medication remains stable. Any member of staff drawing up and administering insulin must have been trained and have
DS0000004519.V340296.R01.S.doc Timescale for action 30/09/07 2. OP9 13 30/08/07 3. OP9 13 15/09/07 4. OP9 13 15/09/07 5. OP9 13 30/08/07 Version 5.2 Page 30 6. OP19 23 evidence from the district nurse that they are competent to do so. This will safeguard the welfare of the residents. All maintenance concerns must be addressed. This will ensure the comfort and safety of the people living at the home is maintained. 30/09/07 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. 2. 3. Refer to Standard OP3 OP7 OP15 Good Practice Recommendations All assessments should be signed and dated. All care plans should be signed and dated. The temperature of food served in the lounges should be monitored to ensure safe ranges are maintained. DS0000004519.V340296.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham LO 1st Floor, Ladywood House Stephenson Street Birmingham West Midlands B2 4UZ 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
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