Inspection on 24/01/07 for The Noel

This inspection was carried out on 24th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Noel 04/06/09

The Noel 28/04/09

The Noel 30/01/09

The Noel 17/03/08

The Noel 01/02/06

The Noel 27/07/05

The Noel 07/10/04

The Noel 07/04/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Noel, The St Boniface Road Ventnor Isle Of Wight PO38 1PN Lead Inspector Neil Kingman Unannounced Inspection 24 January 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Noel, The DS0000012516.V318922.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. Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Noel, The Address St Boniface Road Ventnor Isle Of Wight PO38 1PN 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) 01983 852292 Miss Sandra Vivienne Phillips Miss Sandra Vivienne Phillips Care Home 12 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (12), of places Physical disability over 65 years of age (4) Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1 February 2006 Brief Description of the Service: The Noel is a residential care home providing care and accommodation for up to 12 older people, with some capacity for older people with a physical disability, or illness associated with dementia. The home is owned, and managed on a day-to-day basis by Miss Sandra Phillips. The home is a period three-storey (including basement) detached house in Ventnor, near to the town centre, with its shops and amenities. Accommodation is arranged over the ground and first floors and a stair lift assists with access to rooms on the first floor. Rooms at the front enjoy fine sea views and those at the rear face St Boniface Down. While the home is registered to accommodate 12 older people, the manager prefers to provide single room accommodation and therefore limits the occupancy to 8. Double rooms are used only if residents choose to share. There is off road parking to the front of the building. A stair lift is available to assist those with mobility difficulties to negotiate the steps up to the front door. The managers philosophy is to provide tailor made care that is relaxed and flexible to suit the individual needs of frail older residents. The home provides 24 hours staffing. Weekly fees range from £361.97 to £443.52. The manager states that a copy of the statement of purpose and terms and conditions of residency are provided to all prospective residents, or their representatives where applicable Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report details the results of an evaluation of the quality of the service provided by The Noel and brings together accumulated evidence of activity in the home since the last key inspection on 1 February2006. Part of the process has been to consult with people who use the service; including telephone discussions with two social services care managers and three representatives of residents, who visit the home. Included in the inspection was an unannounced site visit to The Noel by an inspector on 24 January 2007. During the visit the inspector spoke with the manager, staff on duty and most of the residents in the privacy of their rooms. The inspector toured the building with the manager Miss Phillips and looked at a selection of records. At the last two inspections there were concerns about the upkeep of the building. At this inspection the inspector looked closely at this issue, with particular attention to the outcomes for residents. The responses from the consultations were very positive. What the service does well: The results of this inspection should be looked at in the context of a home that would certainly not suit all tastes but does suit the current resident group. Residents value the fact that they can spend much of each day in the privacy of their room with the manager and staff on hand to respond to their every need. Residents described the manager, staff and service variously as: “Marvellous, very kind and helpful.” “Very good, you can have whatever you like.” “It’s absolutely lovely, nothing is too much trouble.” “It’s a home from home – such a lovely atmosphere – a first rate service.” The home’s approach to health and personal care is good. One of the social services care managers said that the manager copes very well with some complex cases, has a good understanding of their needs and fights for residents’ rights. Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The Noel is a relatively small service with never more than eight residents accommodated in recent times. With the age and layout of the building the managing proprietor has found difficulty with the upkeep of the environment. Consequently, this will be the third consecutive inspection where requirements have been made. While residents seem very happy with the home, they do spend much of their time in their rooms. Areas of the building now fall well short of what is acceptable as a minimum standard, and must be addressed. The Care Homes Regulations clearly state what information should be given to residents before they decide to move into the home. The information currently available is not sufficient. Other areas for improvement reflect the fact that the home has not kept abreast of changes in legislation and best practice. They include: • • • • • An outdated practice of administering medicines. Medicines must only be administered by designated and appropriately trained staff. Recruitment procedures must be thorough and meet regulatory requirements. Several health and safety issues need to be addressed. Mandatory staff training must be scheduled (and refreshed at appropriate intervals). Miss Phillips has owned and managed the home for many years and comments from all those consulted suggest that she is well respected for the service provided at The Noel. However, the above areas for improvement show that she needs to demonstrate she has undertaken periodic training to update her knowledge, skills and competence in managing the home. At the time of producing this report the manager has confirmed that a programme of statutory training for staff has been arranged, with dates set for manual handling and first aid training. Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 7 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. Noel, The DS0000012516.V318922.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 Noel, The DS0000012516.V318922.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 and 6 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The information available for prospective residents is not complete and does not fully meet the standard. This could limit their ability to make an informed choice about whether to move in. The manager ensures that the care needs of the people who live at The Noel will be met by undertaking an assessment of their needs at the time, or prior to them moving into the home. The home does not provide dedicated accommodation for short-term intermediate care or specialised facilities for rehabilitation. Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 10 EVIDENCE: Information In order for prospective residents to make an informed choice about moving into the home they should be given a copy of a service user’s guide. In discussions with the manager about the circumstances in which prospective residents typically enter The Noel it was clear that recent admissions in particular, have been emergency situations, referred through social services care management. In such cases written information about the home has not been the priority for service users or their representatives. The home has produced a document titled ‘Statement of Principal Aims and Objectives’. It provides information about the home, but does not cover, as it should, all the information referred to as the ‘Statement of Purpose’ and listed in Schedule 1 to the Care Homes Regulations. When compiled a copy of the statement of purpose must be supplied to the Commission and made available for inspection by every resident and/or their representatives. Additionally, a service user’s guide must be produced and a copy supplied to the Commission, and each resident and/or their representative. Regulations 4 and 5 of the Care Homes Regulations (amended in September 2006) give clear information about what is required. Pre-admission assessment The inspector looked at how the home managed the admission of the newest resident, who moved into The Noel in May 2006, left after several months, and was admitted in emergency circumstances in December 2006. The previous admission was also an emergency situation. These, according to the manager are typical scenarios, as social services know the home would be able to meet certain individual’s needs. This was confirmed in discussions with two care managers. The manager explained that before people move in she obtains as much information as possible over the telephone and is helped in the process by having a good liaison with the Community Nurse. The manager is very clear about the level of care that the home can offer, given the particular layout of the house, staffing, and the needs of the existing residents. She is very clear that no person is admitted to the home whose individual care needs cannot be met. Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 11 Intermediate care Residents at The Noel tend to be long term. The home does not provide dedicated accommodation for short-term intermediate care or specialised facilities for rehabilitation. However, respite care is provided if there is a room available. . Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 12 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 and 10 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a system of care planning with an individual plan for each resident. They provide a basic demonstration that residents’ health and social care needs are identified and met. The home promotes and maintains residents’ healthcare and ensures that access to healthcare services is available at all times. While medication is securely held and appropriate records maintained, the system used is outdated, and considered by the Royal Pharmaceutical Society of Great Britain to be unsafe practice. The home ensures that staff respect residents’ privacy and dignity at all times, especially with regard to the arrangements for health and personal care. Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 13 EVIDENCE: Care planning – The home has a system of care planning with an individual personal plan for each resident. The inspector looked at a sample of two plans. The intention was to look at the outcomes for residents in general by assessing all areas of care for those sampled. The sample included the newest admission to the home, and a resident who spent a good deal of time in their own room by choice. The inspector noted the structure and content of the sampled plans to be very basic, covering: • History. • Family/background information. • Dietary habits, likes and dislikes. • Day and night behaviour patterns. • Plan of care for problems and needs. • Manual handling risk assessments. • Daily recording of information and night log. . The manager and staff confirmed in discussions that given the small size of the home and the effectiveness of verbal communication they were very familiar with the needs and wishes of each resident, and what was needed to meet those needs and wishes. There were positive comments from social services care managers who felt that while recording of information was not one of the home’s strong points, the level of personal care certainly was. There was a mixed reaction from residents when the inspector asked them about their individual care plans. Most seemed confused about the existence of a care plan but one said she was aware of her care plan, and confirmed that staff wrote things in the plan while talking to her in her room. Health and access to care services Miss Phillips confirmed, and daily records evidenced the regular contact the home has with GPs, community nurse and other healthcare professionals. One resident spoken with said that the home takes care of all her healthcare needs. Another, describing the management of pressure areas said that nothing was too much trouble for the staff. One care manager said Miss Phillips goes out of her way to get everything the residents need, copes very well with complex cases and fights for their rights. Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 14 In discussions with the manager it was clear that a minority of residents were vulnerable to pressure sores. However, there was ample evidence in the form of equipment, routines and liaison with the community nurse to show that pressure areas were well managed. The three visiting relatives confirmed that the manager keeps them informed about important matters affecting the resident and consults them about their care. Medication During the site visit the inspector looked at the arrangements in place for storage, recording and administration of medicines. Medication for the residents is stored and records kept in the lower ground floor where only staff have access. Medication is supplied to the home in individual containers as prescribed to the resident. The manager transfers the medication on a daily basis, from the original container, into another container for later administration by a member of the care staff. The manager explained that in her experience this practice, known as ‘secondary dispensing’ enables her to be in total control of the process. However, secondary dispensing is regarded as an outdated and unsafe practice and is not in line with best practice as described in The Administration and Control of Medicines in Care Homes and Children’s Services document, produced by The Royal Pharmaceutical Society of Great Britain. While there is no suggestion that any errors have been made the practice of secondary dispensing was described as frequently associated with medication errors in a report by the Department of Health, Building a Safer NHS for Patients. Records showed that only one member of the care staff had a formal qualification from an external source in the safe administration of medicines. For the home to fully meet this standard: • • The practice of secondary dispensing must cease. Medicines must be administered by designated and appropriately trained staff. The training should provide the care worker with knowledge and practical skills to safely select, prepare and give different types of medicines, a process that is referred to as ‘medicine administration’. Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 15 • If medication training is to be provided ‘in house’ it must be supported with a body of up to date knowledge in the subject of medicines. While controlled drugs are held under secure conditions it is recommended that the present cabinet be replaced by an appropriate metal controlled drug cabinet. Privacy, dignity and respect In discussions with residents, relatives and care managers it was very clear that treating residents with dignity and respect is what the home does well. One commented that the manager is passionate about it. The manager said that the subject is a high priority in the home, and is covered in the induction training for new staff. On the day of the site visit the inspector had an opportunity to spend time with residents in the privacy of their rooms, and to observe the staff at work. Staff were at all times respectful and kind towards residents, calling them by their preferred names and knocking on doors before entering rooms. One resident said the manager does everything she wants and needs. Residents can use the facility of three portable phones provided by the home to make and receives calls. Two residents have their own installations in their rooms. The manager said that she makes no charge for either telephone calls or newspapers. Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 16 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 and 15 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Noel offers a service where choices and preferences are encouraged and supported. Activities are limited but do suit the needs of the residents. Friends and family are made to feel welcome and can visit at any time. Residents are encouraged and supported to manage their own financial affairs for as long as they wish and are able. However, the current resident group have family members or a solicitor to assist. The promotion of choice extends to all aspects of daily living including personalisation of rooms, and meals. Residents’ nutritional needs are satisfied with a varied and balanced diet of good quality food. EVIDENCE: Routines and activities – It was evident from the discussions with residents, relatives and care managers that Miss Phillips is committed to ensuring that daily life in the home is organised around the choices and preferences of the residents. They can get up and go to bed when they want, take meals when they want and Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 17 generally do what they want during the day. The home does not have a formal programme of leisure and social activities. However, as at previous inspections residents said that they prefer to spend their day as they choose and had no wish to take part in organised activities. If residents want to go and visit their own home, staff will go with them. A minority of the residents enjoy trips out with family or friends. The manager makes a point of organising birthday celebrations and likes to arrange a special tea and invite relatives and friends. Likewise with Christmas festivities, there is always a communal event with special food. Visiting arrangements – Visitors are welcome at any time. Details of visiting arrangements are included in the information given to the residents/representatives on admission. Residents can receive visitors in their own rooms or the communal sitting room. Both care managers and the visiting relatives confirmed that they were always made welcome by staff and were able to meet with residents in private in their rooms. Personal autonomy and choice – Residents were spoken with individually in the privacy of their rooms. Due to some cognitive impairment it was not possible to obtain informed views from two of them. However, the consensus from the others was that they were given choices regarding routines in the home, e.g., times of rising, going to bed, activities, meals, personal care etc. Residents are encouraged to bring with them pictures, ornaments and personal items for their room. During discussions with the residents the inspector noted many personal items that gave their rooms an individual touch, reflecting the residents’ individual tastes and preferences. The management of residents’ finances is covered later in the report but in a general sense families or a solicitor took that responsibility for all but one of the residents. It was confirmed the manager is appointee for one resident. This long-standing arrangement is considered by the individual’s social services care manager to be appropriate. Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 18 Meals and mealtimes – As at previous inspections the high standard of food provided for the residents is maintained. There are no menus in the home because residents are served whatever they want to eat. The cook maintains records of what residents have actually eaten. They demonstrated food is varied, appetising and nutritious. There was unanimous praise from residents for the standard of food provided. Resident’s typically eat their meals in their rooms, or in the communal lounge. In discussions with residents it was clear that they were happy with the arrangement. Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 19 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 and 18 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home treats residents’ complaints seriously and responds appropriately. The home’s policies, procedures and practices ensure that residents are safeguarded from abuse. EVIDENCE: Complaints The home has a very clear complaints policy and procedure in place. Additionally, the process is summarised on the home’s Statement of Principal Aims and Objectives document. However, the document needs to reflect the change of regulatory body to the Commission for Social Care Inspection (CSCI). This should be addressed when the home produces a new statement of purpose and service user’s guide. Since the last inspection a concern raised about a lack of infection control procedures in the home was found not to be upheld. A further concern about some specific healthcare procedures was unresolved. However, requirements arising out of the concerns have been met. Residents and visiting relatives felt confident about taking any concerns they may have to the manager. Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 20 Adult protection The home holds a copy of the Isle of Wight Social Services Adult Protection Policy Guidance and has its own comprehensive policy and procedure, which follows local authority guidance. Staff spoken with were very clear about the importance of reporting issues of concern without delay. They confirmed that training was provided by the manager. Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 21 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 and 26 – Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Noel is not purpose built but has been adapted over the years to provide a reasonably comfortable environment for the older people who live there. However, the building is old, very dated and in need of some investment and improvement. This makes the decoration and upkeep of the premises more difficult. All areas of the home are kept reasonably clean, hygienic and there are no unpleasant odours. EVIDENCE: Environment The inspector toured the building with the manager, to check for cleanliness and the state of the decoration. Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 22 The Noel is a similar property to others in St Boniface Road with steps up from street level. There is an outside stair lift from the car park to the front door. Inside, although the home does not have a passenger lift, there is a stair lift from the ground floor to the first floor and residents use this with assistance from staff. Residents do not have access to the basement that houses the kitchen, laundry, office and staff accommodation. There is one communal sitting room on the ground floor. Although there is no separate dining room this does not appear to disadvantage the residents; most are happy to spend time in their rooms and the sitting room is not widely used. In fact on the day of the site visit only one resident frequented the sitting room throughout the whole day. There is an assisted bathroom on the ground floor and one on the first floor. There is a garden area at the back of the house, but residents cannot easily access this independently. In terms of outcomes for the residents the overwhelming view was that in spite of the shortfalls, i.e., lack of dining room and difficult access to the first floor and the garden they are very happy to be in the home. Residents enjoy the fine views that the home offers and most of the bedrooms are of sufficient size to offer a ‘bed-sitting room’. Residents can have their own furniture and possessions with them, if they choose. At the last two inspections there have been requirements for the registered manager to provide written evidence that there is a planned programme of refurbishment and maintenance to address the environmental issues identified. To date no written evidence has been received. The manager explained that it is difficult to arrange decoration of the home without affecting the residents and usually rooms are decorated and refurbished as they become vacant. During this tour of the building the inspector noted areas that must be addressed: • • • The hallway and up the stairs looks dull and gloomy. Walls have become stained over time through smoking. The standard of decoration and fittings in the first floor bathroom is unacceptable. The room looks old fashioned, tired and depressing. Outside the windowsills have been painted since the last inspection. However, the frames have badly peeling paintwork and evidence of some rotting wood. Handrails on the front steps are beginning to show rust through the paintwork. The manager said that she plans to replace existing windows with replacement plastic ones, one at a time as rooms become vacant. It is felt that the Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 23 bathroom is a priority, to be addressed without delay. A written plan with timescales must be forwarded to the Commission as evidence of a commitment to improve the standard of the home’s environment. Residents’ rooms were noted to be reasonably decorated, warm and homely. Those spoken with said they liked their rooms and most, by choice, spent a good deal of time in them. Cleanliness During the tour of the building it was noted all areas were generally kept reasonably clean, tidy and free from unpleasant odours. Bathrooms have hand-washing facilities to ensure good standards of hygiene and infection control. The laundry area is located at the rear of the building with access via the kitchen and from a side door, round and into the rear; this being, according to the manager, the route taken by staff with soiled articles in the approved, sealed plastic bags. The home uses domestic style washing and drying machines. However, the home sends the bulk of the home’s laundry to a commercial contractor. Noel, The DS0000012516.V318922.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 and 30 - Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels are adequate to meet residents’ needs. However, there are shortfalls in the skill mix. The home’s system of recruitment is not robust. It lacks the safeguards to offer protection to people living in the home. While the home has been successful in developing NVQ trained staff, induction and statutory training require attention. EVIDENCE: Staffing levelsThe home employs six care staff, with the manager and a cook. Staff rosters showed and Miss Phillips confirmed that two care staff and the manager are deployed during the morning. In the afternoon and evening the manager works on the floor with one care assistant. There is one waking overnight with the manager sleeping in on call. On the day of the site visit there were seven service users resident in the home with two care staff, the manager and the cook on duty in the morning, reducing to the manager and a care assistant in the afternoon. The cook works flexibly so as to be in the home at times necessary to prepare and cook Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 25 the meals. These staffing levels are considered sufficient for the current needs and numbers of residents in the home. The visiting relatives and the care managers consulted felt there were always sufficient numbers of staff on duty and no concerns were raised about staffing levels by anyone. NVQ training – The manager confirmed and staff qualification certificates showed that currently three of the six care staff have achieved the NVQ at level 2. The manager said that until recently when some experienced staff left the home the ratio of NVQ trained staff was higher. Recruitment Staff recruitment is an area that must be improved. The manager said that three staff had been recruited since the last inspection. Schedule 2 to the Care Homes Regulations sets out the information and documents required to be kept in respect of people working at the home. The inspector noted shortfalls in the information available for the three most recently recruited staff: • • • No proof of identification with photographs No written references All three staff had commenced working in the home before satisfactory Protection of Vulnerable Adults (POVA) checks had been received In mitigation the manager said that when some experienced staff had left she recruited three people she knew personally and satisfactory criminal record (CRB) checks have now been received for two of them. The inspector clarified the position that no new care staff must commence working in the home without a minimum of two written references and satisfactory POVA checks having been received. Staff Training – The manager said that she had a core group of experienced staff that had worked in the home for many years and knew well the wants and needs of the residents. Care managers, visiting relatives and the residents themselves said the standard of care was very good. It was clear during the site visit however, that the good standard of care was not supported by evidence of ongoing training and development. Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 26 The manager was not able to readily find evidence of staff training that had been completed. This was partly due to the home’s filing system being disorganised, making the retrieval of documents difficult. An effective individual training and development assessment and profile would show at a glance the qualifications achieved, training needs identified and training scheduled. Records that were available showed the only up to date mandatory training to be infection control. Other mandatory training was ad hoc and out of date. The home must arrange for all staff to receive mandatory training in Moving and handling Basic food hygiene First aid Health and safety Fire safety Infection control Adult protection The home provides an induction/foundation training programme for new staff, which follows the TOPSS England guidance. TOPSS England became ‘Skills for Care’ in April 2005 and produced a new set of Common Induction Standards (CIS) designed to be met within a twelve-week period. The home is advised to introduce the new standards for all newly appointed care staff. At the time of producing this report the manager has confirmed that manual handling and first aid training have now been arranged. Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a home, which is run by an experienced registered manager, who, while considered fit to be in charge, needs to demonstrate she updates her skills and knowledge with periodic training. To ensure the home is run in the best interests of the residents the manager regularly seeks feedback from residents. However, attention to the requirements raised in this report would make quality assurance more effective. Residents’ financial interests are safeguarded by the arrangements currently in place in the home. The home’s system of keeping records is disorganised. This means important documents are not readily accessible for staff or other persons authorised, and residents’ rights are compromised. Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 28 Shortfalls identified in the home’s approach to health and safety have the potential to affect the safety and welfare of the residents. EVIDENCE: Management – The registered manager Miss Sandra Phillips has owned and managed The Noel since 1984. While she is very knowledgeable and familiar with the conditions and diseases associated with old age she has no management or other formal qualifications and has no plans to achieve them. Staff felt well led and supported by the manager, and the residents, relatives and care managers consulted mentioned the manager as someone they had complete trust in. However, she needs to achieve some qualifications that are relevant to her role. Quality assurance – There is no annual development plan or formal quality assurance systems at The Noel. However, with the size of the home and type of service the home provides the manager is in very close touch with the residents on a day-to – day basis, providing them with what they want and what they need. This was strongly supported by the residents and relatives spoken with. What is also clear from the evidence is that the manager does need to look closely at all the elements of this standard as they are closely linked to the shortfalls identified in other outcome groups: • • • A development plan would address the environmental issues. Regularly reviewing policies and procedures would help to keep up to date with new legislation and best practice, e.g., medication practices. Ensuring staff training is scheduled and updated would demonstrate a commitment to lifelong learning and development. Residents’ monies – The home is not directly involved with the management or administration of residents’ finances. However, the manager acts as appointee for one resident. This situation is considered by the individual’s care manager to be appropriate in the circumstances. Records It was apparent during the site visit that the manager experienced difficulty locating the records that are required by regulation for the protection of the Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 29 residents and effective and efficient running of the business. A good example being health and safety risk assessments. The manager felt that there were some, but could not locate them. This in turn raises a question about how the home treats policies and procedures, which should be working documents to inform staff about safe practices in the home. The manager needs to develop a much more organised system of keeping records to ensure that those called for are readily available, up to date and in good order. Health and safety – The home’s pre-inspection information signed by Miss Phillips confirmed that policies and procedures were in place to ensure safe working practices in the home. The inspector was shown a complete set of policies and procedures, produced by a professional organisation. However, there were gaps in the information about maintenance and associated records. The inspector noted the following issues needed to be addressed: • • • • Assessments of the health and safety risks to employees in the home were not available for inspection. COSHH risk assessments need to be carried out on hazardous chemicals and substances in the home. The residents’ accident record needs to be replaced with one that complies with the Data Protection Act 1998. An electrical wiring inspection needs to be carried out by a NICEIC qualified contractor. Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x 2 2 Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4&5 (Sch’ 1) Requirement Timescale for action 31/03/07 2 OP9 13(2) 3 4 OP9 OP19 13(2) 23 To produce a statement of purpose and service user’s guide for the home, which contains the information set out in Regulations 4 & 5 (Schedule 1) Care Homes Regulations 2001 as amended. In the interests of safe 28/02/07 medication handling all medication must be administered directly from the original labeled container to the resident, and not placed into any secondary container for later administration by another person. Medicines must be administered 31/03/07 by designated and appropriately trained staff. To forward to the Commission a 28/02/07 plan, with timescales, giving details of a programme of work to address the environmental issues set out in standard 19 of the report. (Elements of this requirement remain outstanding from the last two inspections). DS0000012516.V318922.R01.S.doc Version 5.2 Noel, The Page 32 5 OP29 19 (Sch’ 2) 18 Recruitment procedures must be thorough and meet regulatory requirements. To ensure that all mandatory staff training is scheduled (and refreshed at appropriate intervals). The registered manager must demonstrate she has undertaken periodic training to update her knowledge, skills and competence, whilst managing the home. To ensure the following health and safety measures are carried out: • To make arrangements for an electrical inspection by an NICEIC qualified electrician. • To undertake health and safety at work risk assessments in the home. • To undertake COSHH assessments of hazardous chemicals and substances in the home. • To ensure the method of recording accidents/incidents in the home complies with the Data Protection Act 1998. 16/02/07 6 OP30 28/02/07 7 OP31 9 28/02/07 8 OP38 13, 23 31/03/07 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 Refer to Standard OP9 Good Practice Recommendations To store controlled drugs in an appropriate metal controlled drug cabinet. DS0000012516.V318922.R01.S.doc Version 5.2 Page 33 Noel, The 2 3 OP30 OP30 To introduce the new Common Induction Standards for all newly appointed care staff. To produce a staff training and development plan/matrix and individual staff training profiles. Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Noel, The DS0000012516.V318922.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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