Inspection on 19/07/07 for The Hurstway

This inspection was carried out on 19th July 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Hurstway 13/07/09

The Hurstway 20/09/06

The Hurstway 16/02/06

The Hurstway 17/10/05

The Hurstway 10/02/05

The Hurstway 02/06/04

The Hurstway 04/02/04

The Hurstway 21/10/03

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

CARE HOMES FOR OLDER PEOPLE Hurstway, The 142 The Hurstway Erdington Birmingham West Midlands B23 5XN Lead Inspector Lisa Evitts Key Unannounced Inspection 19th July 2007 09:30 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 Hurstway, The DS0000024850.V341197.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. Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hurstway, The Address 142 The Hurstway Erdington Birmingham West Midlands B23 5XN 0121 350 0191 0121 386 4225 sandramurdock@heartofenglandcare.org.uk www.heartofenglandcare.org.uk Heart Of England Care 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) Ms Marie Ann Swadkins Care Home 59 Category(ies) of Dementia - over 65 years of age (59), Physical registration, with number disability over 65 years of age (59), Terminally of places ill over 65 years of age (59) Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Currently under review 1. 2. That Marie Ann Swadkins successfully obtains the registered Managers Award or equivalent by April 2005 That the home can accommodate a total of 59 people of which up to three persons are over 60 years of age but under 65 years of age in line with their categories of registration. 20th September 2006 Date of last inspection Brief Description of the Service: The Hurstway is a purpose built home located in a residential area of Birmingham, owned by The Heart of England Care charity. The home is registered to provide nursing care for up to 59 older adults and can accommodate residents who have a physical disability. At the front of the building is a car park for visitors, which includes disabled parking spaces. At the rear is a conservatory with an enclosed garden, which provides a safe area for people to frequent during clement weather, and this is accessible via a ramp, which is suitable for wheelchair users. The accommodation is laid out over 2 floors, in 4 separate units, known as Primrose, Bluebell, Lavender and Jasmine, each unit having a lounge/dining room for residents to circulate. Bedrooms are for single occupancy with shared bathroom and toilet facilities. The home has three bedrooms, which have en suite facilities consisting of toilet, sink and shower. Downstairs there is a reception area with chairs and settees, which the residents have the use of and this has recently been refurbished to include a cinema area. There is a range of aids and adaptations designed to assist residents with limited mobility, including a passenger lift between floors, a call system, grab rails and assisted bathing and toilet facilities. There are a variety of notice boards throughout the home, which provide information about the home and forthcoming events, which may be of interest to residents and visitors. Copies of previous inspection reports are available on each unit and in reception. The current scale of charges for the home range from £388 - £624.60 depending on type of room and care required. A “top up” fee of £21 is also charged. Additional charges include hairdressing, toiletries and newspapers. Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The visit to the home was undertaken by two inspectors over eight hours and was assisted throughout the day by the Registered Manager. The home did not know that we were visiting on that day. There were 57 residents living at the home on the day of the visit. Comments received from residents were all very complimentary about living at the home. One resident said “Its grand here” Information was gathered from speaking to and observing residents, although it was not possible to speak with a number of residents due to communication difficulties. Two staff and the company trainer were spoken to and staff were observed performing their duties. Five residents were “case tracked” and this involves discovering individual experiences of living at the home by meeting or observing them, discussing their care with staff, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files and health and safety records were reviewed. Prior to the inspection the Registered Manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to CSCI. This gave good information about the home, staff and residents, improvements and plans for further improvements, which was taken into consideration. Regulation 37 reports pertaining to accidents and incidents in the home were also reviewed in the planning of the visit to the home. No immediate requirements were made on the day of the fieldwork visit. What the service does well: Prospective residents are given comprehensive information to assist them to make an informed decision about whether they would like to live at the home. Residents who use the service have access to a range of Health and Social care professionals and this ensures that any healthcare needs are met. Residents undertake a range of activities and visitors to the home are made welcome. Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 6 Residents are offered a choice of meals, which meet any dietary, cultural needs or personal preferences. Aids and adaptations are provided so that the independence, choice and dignity of people using the service are promoted whilst maintaining their safety. Regular maintenance checks of this equipment ensure it is safe to use. The home maintains a core group of staff so that residents know who will be assisting them to meet their needs. Staff receive training to ensure that they have the knowledge and skills to perform competently within their roles and to meet the needs of the individual residents. Comments received included: “Its grand here” “I like the music that’s on now” “I go to the club down the road for a pint and a chat” “The food is very good and always hot” “You get fed three times a day, there are two choices of good food” “There is tea and cold drinks when you want them” “I like the breakfast of bacon and beans” “There’s nothing to complain about here”. “My bedroom is comfortable and cleaned well”. “The staff are very kind” “The nurses are all good girls, friendly and look after you well” What has improved since the last inspection? What they could do better: Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 7 The home must ensure that boxed medications are administered to residents as they are prescribed and that records are signed when it is administered. External managers must undertake Regulation 26 visits to monitor the quality of service being provided and therefore enhance the current quality assurance system. 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. Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have the information they need to make an informed choice about where to live. The home completes pre admission assessments to determine if they can meet the needs of the residents prior to them coming to live at the home. EVIDENCE: The home has produced a comprehensive statement of purpose and service user guide, which contains all the information required and ensures that prospective residents are given information about the home, which will enable them to make an informed decision about whether they would like to live there. These documents are available in large print and audiocassette to enable people who have sensory impairments to access the information. The certificates of registration and liability are on display in the reception area of the home, which enables anyone to view these when visiting. Copies of Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 10 previous inspection reports are available on each unit and in reception. In the service user guide it is clear that a copy of this report can be requested from the office and this ensures that residents or people who visit the home can access this information. Comprehensive pre admission assessments are undertaken prior to residents coming to live at the home and this ensures that the home and the residents know that their individual assessed needs can be met upon admission to the home. Prospective residents are invited to come and visit the home to see if they would like to live there. The home offer a 28-day trial period which enables residents to sample what it is like to live at the home before making a decision about whether they want to live there permanently. The staff at the home send new residents a ‘Welcome card’ which assists in making residents welcome in their new home. One resident said “Its grand here” The home does not offer intermediate care. Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s health and personal care needs are well met. Care plans provide sufficient information for staff to assist residents to meet their individual needs and preferences. The administration of boxed medication does not ensure that residents receive their medication as prescribed. EVIDENCE: Following the pre admission assessments and admission into the home, staff undertake a full nursing assessment to identify any areas of actual or potential need and each resident has a care plan written. This is an individualised plan about what the person is able to do independently and states what assistance is required from staff in order for the resident to maintain their needs. Care plans sampled were very detailed and provided staff with guidelines to follow to assist the residents to meet these needs. There were three residents in the home who had sore skin and one of these files was sampled. There was a photograph of the wound and evidence that the Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 12 Tissue Viability Nurse had been involved in the care. Wound care charts were in place and a treatment chart, which included details of pain management. The type of pressure relieving equipment was also recorded and this documentation has improved since the last visit to the home. The Tissue Viability Nurse had raised concerns about residents sitting out in chairs in the lounge with hoist slings underneath them, which may increase the likelihood of sore skin developing. This practice was not seen on the day of the visit and the manager was looking into alternative types of hoist slings to reduce any risks to the residents. One resident had a cultural and religious care plan which detailed specific skin care, headwear and types of music which was relevant to meet the needs of this resident. A care plan for a resident who was unable to see detailed how staff should offer hand guidance and allow the resident time to feel items so that she was aware of what was happening. One care plan gave good details of family involvement particularly in relation to oral care and assistance with feeding. Care plans were evaluated monthly or as changes occurred and this ensures that plans provide current information for staff to follow. The manager has introduced a letter for residents and their families explaining about care planning and invited them to meet with their named nurse to discuss and agree the care plans and this is seen as good practice as involves the relevant people in the care. Risk assessments for manual handling were very detailed and included the type of equipment to use and the size of the sling, to ensure that both residents and staff were safe while moving. Nutritional and skin sore risk assessments were undertaken and action was taken to address any concerns. Residents are weighed monthly so that staff can monitor weight loss or gain. Individual assessments were undertaken for specific identified risks in order to minimise the potential of harm. Life history books had been introduced and the manager was aiming for all residents in the home to have these completed. One of these was reviewed and it gave information about the residents past history, family life and likes and dislikes and this gives staff topics of interest to talk to the resident about while getting to know them properly. Residents can keep their own GP (If the GP is in agreement) or the home can arrange for the resident to be transferred to a local surgery. A GP from this surgery visits the home once a week. There was evidence that external professionals see residents as required and included GP, chiropodist, optician, physiotherapist and dietician. The home has recently implemented the Gold Standard Framework programme which is an evidenced based approach to optimising the care of residents Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 13 nearing the end of their life and reducing hospital admissions. This was not reviewed on this occasion. Residents were well presented and were supported to wear clothing, which reflected their personal choices. Hair was neat and fingernails were clean. The management of medication was reviewed and residents had identity photographs to minimise the risk of a drug error. Photocopies of prescriptions are kept and this enables staff to check that the correct drug has been received into the home as prescribed. Medication is signed into the home upon receipt however it is recommended that this is done by two nurses to ensure that the drugs received are correct. Eye drops were labelled with the date that they were opened and this ensures that they are discarded at the appropriate time in order to minimise the risk of cross infection. The Controlled Drug medication was appropriately stored and balances were correct. The Manager undertakes monthly audits of medication and qualified nurses have recently completed a BTEC in medicine management. Seven residents medications were reviewed and discrepancies were found in four balances of boxed medications. There were a number of gaps on the Medication Administration Records (MAR) and these were consistent to one particular day. A variable dose medication was unable to be audited, as it was not clear if one or two tablets had been administered. Each floor had a medication fridge and the temperatures were recorded each day. The fridge on the upstairs floor had temperatures outside of acceptable ranges and this was brought to the attention of the manager as does not ensure that medication is being stored within its product licence and it is required that this is reviewed. Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 14 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 are able to exercise choice and control over their lives, which promotes their individuality and independence. Residents are offered a choice of meals, which meet any special dietary, cultural needs or preferences. EVIDENCE: The home has a dedicated activities coordinator, who was on annual leave on the day of the visit. Residents had built up a good rapport with the coordinator and one resident was asking when she would be returning because he was missing her, and it was clear that he enjoyed the activities. On each unit there is an activity programme displayed so that residents can choose if they want to participate. Activities included fun with music and singalongs, cooking, reminiscence, aroma mornings, crafts, bingo, quizzes, games, and flower arranging. Activities are organised on different units and residents have the choice of attending these on units other than the one they live in. External entertainers visit the home and include progressive mobility, which is exercise to music. On the afternoon of the visit to the home an entertainer was provided and residents were seen to be joining in with the singing. Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 15 One resident said, “I like the music that’s on now” Since the last inspection the home has created a cinema area, named ‘Hurstway Picture House’ and this consists of comfortable settees, a projector screen and a surround system. Each week a matinee show is provided for residents who choose to take part. The home has a salon and the hairdresser visits each week to attend to residents hair needs, clergy visit the home. No trips outside of the home have been planned at present due to the minibus being vandalised. Some residents have their own newspapers delivered and two residents have talking books through a mail service every fortnight. There are a number of residents who have dementia in the home, although this is secondary to their nursing and medical needs. The activity coordinator has attended a training course to expand her knowledge of activities for residents with dementia. Following this the home are in the process of setting up sensory boards and tables, which may be of interest to the residents. The home has an open visiting policy, which means that residents can receive their visitors at anytime. Residents can go out of the home as they choose with their family and friends; the only requirement is that staff are aware the resident is out of the home for safety reasons. Some residents attend their own church, which enables them to continue to practice their chosen religion, and one resident attends a lunch club and committee meetings, as she previously did when living in her own home. One resident said “I go to the club down the road for a pint and a chat” and this was confirmed as a weekly activity by the staff. The home has a variety of caged birds inside the home and outside in an aviary. This may be of particular interest to residents who have owned birds or other animals in their past. There is a four-week rotating menu and alternatives are also offered. Diabetic, soft and pureed diets are catered for and the menu has recently been changed after a ‘food party’. Dining tables were set with placemats; condiments, menus and cold drinks were available. Residents who require assistance with eating are given their meals before other residents so that staff have time to assist them. Staff were seen to assist residents appropriately and were sitting down to help residents eat their meals. One member of staff was heard to refer to these residents as “the feeders” and this was brought to the attention of the manager, as it does not promote the dignity of the residents. The inspectors joined a resident for lunch and sampled the meal of haddock, mashed potato and vegetables, followed by trifle. Savoury mince was the alternative offered on that day. The music in the lounge was loud and it was difficult to hear the resident and staff must be aware of this. One resident did not want what he had ordered and was brought an alternative, he also requested a beer which was brought to him, although it was observed that one Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 16 member of staff was more helpful than another and this was brought to the managers attention. Comments from residents included: “The food is very good and always hot” “You get fed three times a day, there are two choices of good food” “There is tea and cold drinks when you want them” “I like the breakfast of bacon and beans” One resident commented that he would like more curry on the menu, this was discussed with the manager who advised that it has been offered but the resident often refuses. Hurstway, The DS0000024850.V341197.R01.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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is comprehensive and is accessible to residents and their representatives should they wish to make a complaint. The home has policies, procedures and staff training, which should safeguard residents from harm. EVIDENCE: The home has a comprehensive complaints procedure for residents and their representatives to use if they need to make a complaint. This is on display in each of the units and is included in the service users guide. There were a number of thank you cards and letters on display throughout the home, which suggests satisfaction with the service provided. Since the last key visit to the home in September 2006, CSCI had not received any complaints pertaining to the home. Shortly after the visit to the home and before this report was written CSCI received an anonymous complaint pertaining to an odour in one unit and staff practice and this has been referred back to the provider to investigate using the homes own complaints procedure. The home had received two complaints since the last visit and these were documented clearly with details of the nature of the complaint, who had dealt with it, the date resolved and the outcomes and action taken. Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 18 The manager had implemented a compliments/complaints/suggestions box, on each unit, which gives residents or their visitors the opportunity to inform the manager of any concerns. One resident spoken to said, “There’s nothing to complain about here”. The home had an adult protection policy in place however this requires amending to ensure that all incidents are reported to Social Care & Health as the lead agency. This will ensure that staff have guidelines to follow in the event of any situation occurring. There were leaflets on display in the main reception area of the home that gave information about elder abuse and a helpline number and this ensures that information is available to people about what to do if abuse is suspected. Two staff spoken to were able to state the correct actions to take should an allegation of abuse be made and this should ensure that residents are safeguarded from harm. There have been no incidents of adult protection concerns since the last key visit to the home. The home has a whistle blowing policy, which should ensure that staff act appropriately in the event of an allegation, without fear of reprisal. The majority of staff have received training in abuse and the Protection Of Vulnerable Adults (POVA) and this should ensure that staff have the knowledge to safeguard residents from harm if an allegation should arise. Each month the company trainer meets with the Registered Manager and identifies who needs training or updating and this should ensure that all staff receive training in this area. POVA training was taking place at Head Office on the day of the visit to the home. Hurstway, The DS0000024850.V341197.R01.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): 19,20,21,22,24,25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a homely, comfortable and clean living environment in which their privacy and safety is maintained. EVIDENCE: The home has ramped access suitable for wheelchair users and entrance to the home is via a bell. This ensures that staff know who is entering the building and assists in maintaining the safety of the residents who live at the home. Since the last visit a number of improvements have been made to the environment to make it larger and more homely for the residents who live there. A partial tour of the home and garden area was undertaken. On the day of the visit the home was clean and odour free. Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 20 Each unit has a lounge and dining room for residents to use and since the last visit to the home Primrose and Bluebell unit have had conservatories built increasing the space available. Jasmine and Lavender units have also been extended. The whole building has had new windows and doors fitted. There is a large conservatory, however residents were not using this on the day of the visit, as it was too warm in there. There is a reception area with chairs and settees, which the residents have the use of and this has recently been refurbished to include a cinema area. New carpets and flooring have been fitted to the reception area, lounge, dining rooms and stairs. An occupational therapist reviewed the home in 2004 to ensure that it was fit for purpose. There is a range of aids and adaptations designed to assist residents with limited mobility, including a passenger lift between floors, a call system and grab rails. The home also has a four hoists and pressure relieving equipment for use with residents who are at risk of sore skin. There are a number of assisted bath and shower facilities to meet the needs of the residents living at the home. One bath was broken and this was to be replaced; however other bathrooms could be used as an alternative. A toilet on the ground floor had been refurbished and this had been made larger to accommodate wheelchair users or hoists. It is planned that the toilet area on the first floor will be refurbished in the same way. Some of the decor in the corridors was becoming worn and needs redecorating and the home has a rolling programme of maintenance in place to address this. Bedrooms are for single occupancy and rooms seen were personalised to reflect individual choices and preferences. The home has three bedrooms, which have en suite facilities consisting of toilet, sink and shower. Residents can have a key to their room if they choose. One resident said, “My bedroom is comfortable and cleaned well”. The garden area is enclosed and has various furniture for residents to use. There is a small open summerhouse, which has sensory mobiles and a bird aviary. The Environmental Health Officer had visited the home in December 2006 and made a number of requirements. The manager had devised a very detailed action plan to address these and a follow up visit in January 2007 found that all the requirements had been met. There is a payphone available in the reception area should residents wish to make telephone calls. Hurstway, The DS0000024850.V341197.R01.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. The home maintains adequate staffing levels to meet the needs of the residents living at the home. Recruitment procedures ensure that residents are safeguarded form harm. Staff undertake training to ensure that they have the knowledge to perform competently within their roles. EVIDENCE: The home has nine care staff and two nurses on duty throughout the daytime and two nurses and six carers throughout the night. The home currently has one part time domestic and one registered nurse vacancy but generally maintains a core group of staff, which ensures that the residents know who will be assisting them to meet their needs. Staff rotas were reviewed and confirmed the staffing levels. Agency and bank staff are used to cover any shortfalls and the home attempts to use the same agency staff where possible to ensure consistency for the residents. The manager and deputy manager are on call out of hours and this is clearly identified on the rota should the staff require advice. In addition to the nursing and care staff the home also have domestic, laundry, administration, kitchen and maintenance staff to ensure that all the needs of the residents are met. Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 22 The Registered Manager confirmed that 76 of the staff had completed National Vocational Qualification (NVQ) Level 2 and the remaining 24 of staff are working towards this qualification. This should ensure that skilled and knowledgeable staff support the residents to meet their identified needs both collectively and individually. Comments from residents included: “The staff are very kind” “The nurses are all good girls, friendly and look after you well” A questionnaire completed by a relative for the home stated, “Staff are very nice” It was observed that there was only one male member of staff employed at the home and this was discussed with the manager. Residents are not asked about their preferences of carer but it has not raised any concerns. The manager responded well to this discussion and will be aware of this in the future. Three staff files were reviewed and these contained all the required information, including three written references, and a Criminal Records Bureau (CRB) check to ensure that residents are safeguarded from harm. Induction records were seen for new staff at the home and this ensures that they are given basic information about the home in order to be competent in their roles. The organisation employs a dedicated trainer and a discussion was held during which time records were examined. These records were very comprehensive. Staff receive mandatory training such as fire and manual handling but also undertake other training to enhance their knowledge and therefore the care afforded to residents. All trained nurses and some other designated staff had just completed first aid training and trained staff had completed a BTEC qualification in medicine management. Copies of training certificates are kept in the training file. Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36, & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in the best interests of the resident’s. There are systems in place to monitor the quality of the service on offer. There is a robust system in place for the management of resident’s personal finances. Maintenance checks of equipment used ensure that the safety of residents is protected. EVIDENCE: The Registered Manager is a Registered Nurse and has worked at the home for a number of years. Both the Registered Manager and the deputy manager have recently completed the Registered Managers Award (RMA). This shows that the manager is keen to learn and update her knowledge in order to lead the staff team whilst ensuring that the home is run by a team who have the Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 24 knowledge and skills to act in the best interests of the residents living at the home. Prior to the inspection the Registered Manager had completed the Annual Quality Assurance Assessment (AQAA) and this gave CSCI good detail about the service provided, how it had improved and how the home wanted to improve further over the next year. This shows that the manager has a proactive approach to the running of the home rather than a reactive approach. Staff meetings are held and minutes of these were available for review. The home does not currently hold any residents meetings however the manager had identified this as being an area where the home could improve and planned to re establish resident meetings, and this is recommended. These meetings would enable residents and their representatives to have the opportunity to discuss and share any ideas or concerns in an open and inclusive atmosphere, while also providing an opportunity to socialise. In addition to this the manager has an ‘open door policy’ and residents and relatives are welcome to discuss concerns at anytime. The home has a formal quality assurance programme operating to monitor the quality of service being provided. The audit is matched to the National Minimum Standards and when the audit is completed an action plan, with timescales, is devised to address any shortfalls. The home sends out satisfaction questionnaires and a number of positive comments had been received from relatives including “I think the home is excellent”. Regulation 26 visits had only been undertaken three times this year and prior to this only one report for the last year could be provided. The Registered Manager confirmed this as being accurate. It is required that an external person visits the home once a month and reviews the home and writes a report under Regulation 26, these reports must be available for review. There is a robust procedure for the handling of resident’s personal money, which ensures that it is held safely by the home. Balances checked were correct and receipts were available for any items purchased. The Heart of England financial officer also audits the home and no errors had been found recently. Some staff had received formal supervision, which is an opportunity to discuss training requirements, or any concerns with performance. Some of these had been documented and were seen on staff files, but the process needs to be developed to ensure that all staff receive at least six sessions per year. The manager had identified this as an area that needed improvement and it is recommended that this is now reviewed as was identified at the last visit to the home. Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 25 Robust Health and safety and maintenance checks had been undertaken in the home to ensure that the equipment was in safe and full working order. Staff had received fire training and took part in fire drills to ensure that they had the knowledge to act appropriately to safeguard residents in the event of a fire. Both day and night staff had received training in the use of the Evac chair and the home has an emergency evacuation plan. Accident records were reviewed and the home informs CSCI of any incidents as per Regulation 37. A monthly audit log is in place and this enables the manager or deputy to identify any trends or reoccurrences. If any concerns are found these are investigated and outcomes recorded. Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 2 X 3 Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13(2) Requirement The Registered Manager must ensure that all staff who administer medicines sign the chart as they are given (Previous timescale of 27/09/06 not met) Variable dose medication must state how much has been administered to provide an audit trail. Staff must ensure that residents receive boxed medications as prescribed. Fridge temperatures must be within the range of 2-8 degrees to ensure that medicines are stored within their product licence. The adult protection policy must be reviewed. Monthly visits to the home must be undertaken and a report written to monitor the quality of the service provided. Timescale for action 30/08/07 2. OP9 13(2) 30/08/07 3. 4. OP18 OP33 13(6) 26 24/08/07 01/09/07 Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 28 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. 4. 5. Refer to Standard OP9 OP15 OP15 OP32 OP36 Good Practice Recommendations It is recommended that two nurses sign medication into the home. It is recommended that the volume of music is reviewed during mealtimes. It is recommended that the term “feeders” is not used as does not promote the dignity of the residents. It is recommended that residents meetings are introduced. It is recommended that staff receive supervision at least six times per year. Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Birmingham Local Office 1st Floor, Ladywood House 45-46 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 © 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 Hurstway, The DS0000024850.V341197.R01.S.doc Version 5.2 Page 30 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!