Inspection on 13/02/08 for The Old Parsonage

This inspection was carried out on 13th February 2008.

CSCI found this care home to be providing an Adequate service.

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 Old Parsonage 28/01/09

The Old Parsonage 20/02/07

The Old Parsonage 22/05/06

The Old Parsonage 31/01/06

The Old Parsonage 15/07/05

The Old Parsonage 27/01/05

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOMES FOR OLDER PEOPLE Old Parsonage (The) The Street Broughton Gifford Melksham Wiltshire SN12 8PR Lead Inspector Malcolm Kippax Unannounced Inspection 13th February 2008 10:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Old Parsonage (The) DS0000061474.V359860.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. Old Parsonage (The) DS0000061474.V359860.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Parsonage (The) Address The Street Broughton Gifford Melksham Wiltshire SN12 8PR 01225 782167 01225 783245 christine.rch@googlemail.com 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) Roseville Care Homes (Melksham) Limited Mrs Christine Ann Jones Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (20) Old Parsonage (The) DS0000061474.V359860.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The staffing levels set out in the Notice of Decision dated 23 December 2004 must be met at all times Date of last inspection Brief Description of the Service: The Old Parsonage is a care home with nursing that specialises in the care of people aged 65 or over, who have dementia and other needs relating to their mental health. The Old Parsonage is situated on the outskirts of the village of Broughton Gifford. It is a 19th century listed building, which has been converted into a care home. The accommodation is on the ground and first floors, with a passenger lift available. The residents’ bedrooms are on both floors. There are 14 single rooms and 3 double rooms. The communal rooms consist of two lounges and a dining room. The outside space includes a paved courtyard and a driveway with parking areas. The Old Parsonage was purchased by Roseville Care Homes (Melksham) Ltd in December 2004. Mrs Christine Jones is registered as the home’s manager. Mrs Jones leads a team of nursing, care and ancillary staff. The fee at the time of the inspection started at £625 a week. A copy of the last inspection report is available in the home. Inspection reports are also available through the Commission’s website at: www.csci.org.uk Old Parsonage (The) DS0000061474.V359860.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We made an unannounced visit to the home on 13th February 2008. During the visit we spent time with the residents and met with Mrs C. Jones, the home’s manager. We had meetings with two care assistants and spoke to other staff members during the course of their work. One of our pharmacist inspectors looked at the arrangements being made for medication. We had a look around the home and spent time in the dining room observing the lunch. We saw how people interacted with staff and how they received support with their meals. We made a second visit to the home on 27th February 2008 in order to complete the inspection and to give feedback about the outcome. Records were looked at during both the visits. We have also taken other events into account as part of this inspection. • • We have reviewed the information that we have received about the home since the last inspection. We have received an Annual Quality Assurance Assessment (referred to as the AQAA), which was completed by Mrs Jones. The AQAA is the provider’s own assessment of how well they are performing. It also provides us with information about what has happened during the last 12 months. We sent surveys to the home and asked for them to be distributed to the residents’ relatives, staff, GPs and other healthcare professionals. We received surveys back from four relatives, three staff members, and a G.P. • The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visits. What the service does well: The home obtains good information about peoples’ individual backgrounds before they move in. This helps staff to get to know new residents and to support people with settling in. Detailed care plans are being written and kept under review, so that staff can provide people with the care that they need. Staff go about their work in a friendly and confident way. One relative described staff as ‘always efficient and cheerful’. Routines in the home are flexible. People are offered a varied menu and receive support that helps to make the mealtimes enjoyable. Old Parsonage (The) DS0000061474.V359860.R01.S.doc Version 5.2 Page 6 The home is kept clean. There is a choice of sitting areas and people are able to move freely between rooms. People are protected from harm by the home’s procedures for the safe handling of medicines. There are also procedures that help to ensure that any concerns about people’s care are properly followed up. People are protected by the way that new staff are recruited. The home has an experienced and competent manager, who puts the needs of the residents first. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Old Parsonage (The) DS0000061474.V359860.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Old Parsonage (The) DS0000061474.V359860.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is good overall. This judgement has been made using available evidence including a visit to this service. People’s needs are assessed before they move in, so that a decision can be made about whether the home will be suitable for them. However, not all the information that people are given about the home is accurate and up to date. EVIDENCE: When we visited the home we were shown a file, which contained a brochure, statement of purpose and service user’s guide. However some of the information in the file was not up to date. For example, it was stated in the brochure that the home was registered with Wiltshire Social Services Department. The statement of purpose had not been amended following changes to the company, and did not give all the information that is required, such as an address for Roseville Care Homes Limited. The service user’s guide had last been reviewed in January 2006. It did not contain some details that must now be included, for example about fee levels and the arrangements made for charging for additional services. The guide did Old Parsonage (The) DS0000061474.V359860.R01.S.doc Version 5.2 Page 9 not give contact details for the Commission (C.S.C.I.) although a previous address for the C.S.C.I. was included in the statement of purpose. We looked at some of the residents’ individual files. These included the care records for two people who had moved into the home since the previous inspection. Initial information had been recorded on a ‘New Client Enquiry form’. People’s needs had then been assessed and recorded on a preadmission assessment form. The home had received other information about people’s individual needs and circumstances before they moved in. This included hospital transfer letters and the outcome of review meetings. Mrs Jones said that she had written letters to the residents’ representatives confirming that the home could meet their needs. A ‘Social Information’ form was being used to record additional information about peoples’ interests and personal backgrounds. The new residents’ families had been asked to complete these forms prior to the move. This looked like a good way of obtaining the type of information that would help people to settle in. The information would also assist staff with communication and in establishing a relationship with the new resident. Old Parsonage (The) DS0000061474.V359860.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. 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. People’s health and care needs are met and they are protected from harm by the home’s procedures for the safe handling of medicines. EVIDENCE: We looked at examples of the residents’ care records. The records for three residents were looked at in full. Each of these people’s records included a series of ‘Daily Care Plans’, which were numbered from 1 – 9. The plans covered different areas of need, such as mental health, physical health, communication, eating and drinking, and personal hygiene. The desired goal to be achieved in connection with each need had also been recorded. Another section of the plans concerned the type of intervention that was needed. This provided staff with guidance about how they should be supporting people. The plans were being evaluated each month and changes recorded. People who needed more specific nursing care had fluid, food and turn charts being used appropriately by nurses and carers. We saw good examples of care plans relating to pressure care, particularly for people who would be vulnerable Old Parsonage (The) DS0000061474.V359860.R01.S.doc Version 5.2 Page 11 to such problems. Waterlow assessments were undertaken monthly to identify residents who were at risk of developing a pressure sore. We recommended that the actual date of the assessment is recorded (rather than just the month), to ensure that the details are as accurate as possible. Assessment forms were also being completed for moving and handling and other risks. In their surveys, the relatives told us that the home always provided the care that they expected. The staff members reported that they were always given up to date information about the needs of the people they cared for. One staff member commented that the care plans are regularly updated and that information is also given verbally during handover meetings. Daily statements were being written about each resident. These covered a range of matters relating to people’s health and welfare. There was information about people’s appointments. An optician and a chiropodist were visiting the home regularly. A GP came to the home during our visit on 13th February. Mrs Jones said that residents were registered with GPs from four different surgeries and that one surgery carried out a twice-yearly dementia assessment. A consultant psychiatrist was visiting one person. When asked in their survey what they felt the care home does well, the GP commented ‘seems to be a good standard of personal care’. Our Pharmacist Inspector looked at arrangements for the handling of medicines. Medicines were stored securely, however the controlled drug cupboard did not comply with current legislation and contained drugs that should have been stored elsewhere. Records were kept of all medicines received into the home and sent for disposal. A nurse was on duty at all times and they had responsibility for the medication. Clear instructions were available for all medicines, and care plans covered variable or ‘as required’ doses. Medication administration records (MAR) were printed and written additions were signed and checked by two members of staff. All administrations were recorded on the MAR except for the use of some creams and lotions. A procedure for the safe handling of medication and a homely remedy policy were in place. Mrs Jones was advised to check that the lancets currently in use for blood testing comply with the latest safety guidance. During the visits we thought that the residents looked well supported with their personal appearance and with their choice of clothing. We saw people being appropriately supported by staff. Care staff were heard talking to residents in a respectful manner, whilst also being able to have some light hearted conversations and fun with people. In their surveys, three relatives told us that they felt that the home always met people’s needs. One relative responded ‘usually’. When asked in their survey what the home does well, one staff member commented that residents are ‘cared for with love and dignity’. Old Parsonage (The) DS0000061474.V359860.R01.S.doc Version 5.2 Page 12 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 overall. It is good in respect of standard 15. This judgement has been made using available evidence including a visit to this service. People are offered a varied menu and receive support that helps to make mealtimes enjoyable. Routines in the home are flexible, however people would benefit from a more individual approach to activities to ensure that their diverse needs are fully met. EVIDENCE: During the visits we saw that people were able to express themselves in different ways, for example by being able to walk freely between rooms and choosing where they wished to spend their time. People had a choice of sitting areas with different outlooks. One resident was a smoker and a room in the home had been set aside for this. Space for outside recreation was limited to a patio area at the rear of the home. Mrs Jones said that two residents went out occasionally on shopping trips. We later met with the carer who accompanied them at these times. Residents’ contact with the local community was mainly through people visiting the home. A minister and members of a local church came to the home each week. Mrs Jones said that this was a befriending service for some residents. The home Old Parsonage (The) DS0000061474.V359860.R01.S.doc Version 5.2 Page 13 recorded information about people’s family backgrounds and significant relationships. We did not see any relatives during our visits although they had signed a book, which showed when they had visited. Some residents had relatives who visited on a regular basis. Other people were dependant on staff to support them with activities and occupation throughout the day. The home obtained information at the time of admission about people’s individual interests. Information about an activities programme was displayed on a notice board in the hall. Daily activities included ball games, music, hairdresser, hymns and prayers, and ‘one to ones’. Staff told us that there was a flexible approach to activities and that it was difficult to find things that people could do. On 13th February, a staff member said that the ‘one to one’ activity in the afternoon would involve sitting and talking to residents. In their survey, one person told us that the activities listed on the notice board might not happen because there were not enough residents who were able to take part to make the activity viable. This person thought that the residents who might benefit therefore missed out on the activities and stimulation. We discussed the provision of activities with Mrs Jones, who said that guidance about suitable activities for people with dementia had not been obtained. There was no activities co-ordinator, although a staff member had been given responsibility for arranging the activities. Mrs Jones had reported in the AQAA that she would like to see more time dedicated to activities but felt that it was a very difficult client group to work with in regard to activities. A weekly menu was displayed on the notice board in the hall. This showed a choice of meals for lunch, although when we spoke to the cook we heard that a different set menu was being used. The cook said that it was more successful to adapt the set menu to suit people’s needs, and to provide an alternative if needed, rather than to offer a choice of different meals. We saw that lunch was prepared in different ways, with some people having a number of different blended items on their plates. We spent time in the dining room observing lunch. This involved us looking closely at the experiences of three people for one hour. There were three care staff and the manager present, who were also supporting other people who were not included in the observation. We saw how people interacted with staff and how they were being supported. Staff interactions with the three people were predominately good. Some interactions were observed to be neutral, but there were no poor interactions. People were given fruit juice drinks and they received support with these before their meals arrived. We had read in one person’s care records that they needed encouragement to eat and we saw that they received this with good effect during the meal. Overall, the carers were concerned that people would not eat enough of their lunch. They knew who needed individual support and provided this in a friendly and personal way. Old Parsonage (The) DS0000061474.V359860.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. People are protected by the home’s procedures and by the way that concerns are responded to and followed up. EVIDENCE: A copy of the home’s complaints procedure was included in the information pack that is given to new residents or their representatives. A ‘Comments, Complaints and Suggestions’ procedure was also displayed in the home’s office. This was discussed with Mrs Jones and we thought that a more public area, for example by the visitors’ book in the front hall, would be a more appropriate location for the procedure. We looked at a book that the home used for recording complaints and saw that no complaints had been made since July 2006. Mrs Jones confirmed that this was the case. The relatives who completed surveys stated that they knew what to do if they needed to make a complaint about the home. There was a procedure for whistle blowing. This was given to staff in a policies and procedures file that they received at the start of their employment. The two staff who we met with said that they were confident about knowing what to do if they had any concerns. One person mentioned that they had received a copy of a booklet, which explained types of abuse and how an allegation of abuse should be reported. Old Parsonage (The) DS0000061474.V359860.R01.S.doc Version 5.2 Page 15 It was reported in the AQAA that there had been no safeguarding referrals or investigations during the last year. However, as the home’s manager, Mrs Jones has had previous experience of initiating the safeguarding adults procedure and of being involved in the process of investigation. The staff training records showed that training for the staff team in abuse awareness had last taken place in 2004. Some staff had not attended a course since then, although the subject was covered within their induction. See ‘Staffing’ section. Old Parsonage (The) DS0000061474.V359860.R01.S.doc Version 5.2 Page 16 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 overall. This judgement has been made using available evidence including a visit to this service. People live in a home environment that is generally suitable and meets their needs. However, some areas are in need of further attention to ensure that good facilities and standards are maintained throughout the home. EVIDENCE: Some areas of the home have been refurbished and redecorated in recent years, which have given the accommodation a more homely feel. It was reported at the last inspection that new flooring had been laid throughout the home. This was of a vinyl type and Mrs Jones said that this had produced a lot of benefits in terms of cleanliness. One relative who completed a survey commented that there were no unpleasant odours. We also found this to be the case during our visits to the home. Cleanliness was generally good, although the condition of some parts of the home made it difficult to achieve a clean appearance. There was some Old Parsonage (The) DS0000061474.V359860.R01.S.doc Version 5.2 Page 17 variation between those areas of the home that had been redecorated and refurbished and those that had not. The paintwork on the first floor landings was damaged in a number of places through wear and tear. In the AQAA, Mrs Jones reported that she would like to see a maintenance programme in place, in order to maintain a good standard of decoration. In the AQAA, Mrs Jones provided information about new equipment that had been provided in the home during the last year. This included four new nursing beds, as well as new electronic hoists and wheelchairs. It was also reported that all the laundry equipment was relatively new. There was a new dishwasher in the kitchen. An environmental health officer had inspected the kitchen shortly before our visits. Mrs Jones said that the full report had not yet been received although there was work that needed to be done as a result of their inspection. We were told about a problem with the supply of hot water to some parts of the home. This meant that the hot water was very slow to reach some outlets. We found this to be the case when we tried some taps during the visits. Mrs Jones said that the problem was being investigated, but the nature of the problem needed to be confirmed before work could be carried out to improve the situation. Mrs Jones said that contractors were due to visit the home again on 24th February 2008 in connection with this. There was a policy for preventing infection and managing infection control. Mrs Jones reported in the AQAA that the Department of Health guide ‘Essential Steps’ had been used to assess the way that infection control was managed in the home. We spoke to a domestic member of staff who described their role in infection control and in ensuring that soiled laundry is safely moved using a bag system. Old Parsonage (The) DS0000061474.V359860.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. People’s main needs are being met. However the lack of consistent deployment and of a planned approach to training and development affects the quality of support that people receive. People are protected by the way that staff are recruited. EVIDENCE: We saw staff going about their work in a friendly and confident way. When we spent time in the dining room, the staff appeared to be knowledgeable about the residents’ needs and the support that they required. In their survey, one relative commented ‘the staff are always efficient and cheerful’. All the relatives felt that staff had the right skills and experience to look after people. Staffing at the time of the visits was in line with the agreed minimum level for the home. This meant that a qualified nurse was on duty with carers at all times. Domestic staff, a maintenance person and a cook, were deployed to undertake non-care work. At the last inspection it was reported that an additional (fourth) carer had been deployed during the morning shift to provide the extra support that people needed at that time. It was reported that this had also meant that administrative tasks were more manageable for Mrs Jones, who was usually working in the role of nurse when in the home. However, a recommendation Old Parsonage (The) DS0000061474.V359860.R01.S.doc Version 5.2 Page 19 had been made about employing an administration person who could provide support with the financial business of the home. This recommendation had not been acted on. Other requirements and recommendations have been made as a result of this inspection that will have an impact on the manager’s time. When we visited on 13th February, there were three carers working during the morning. Mrs Jones said that the fourth carer had phoned in sick. Agency carers were being used regularly, but could not always provide cover at short notice and sometimes the home reverted to the minimum of three carers. The carers were encouraged to achieve a National Vocational Qualification (NVQ) and at the time of the inspection the percentage of care staff with an NVQ was just below 50 . Mrs Jones reported in the AQAA that the overall training of staff needed to improve and that she would like to have a yearly programme in place. Training in dementia was identified as one area in need of attention. Each staff member had a training file, which included details of courses attended and copies of certificates. We also saw induction booklets which new staff worked through when they started in the home. Mrs Jones adapted the induction programme, according to a new staff member’s knowledge and previous experience. In their surveys, two staff members said that their induction had covered everything very well; one person responded ‘mostly’. In between our two visits to the home, Mrs Jones had produced a matrix, which gave an overview of the training that staff had undertaken. A range of different training events had been attended however there was no consistent approach and some staff were due to attend refresher courses. The comments made to us by staff also reflected a need for more training to be provided. Mrs Jones said that there was no written policy on training. We recommended this as a starting point to show the company’s aims and intentions. We talked to Mrs Jones about the future arrangements that would be made for training. After our visit on 27th February, Mrs Jones sent us a copy of the staff training requirements assessment that she had produced. This showed timescales and the priorities for training, with suggestions about the how it could be provided. The three staff who completed surveys told us that their employer had carried out checks, such as Criminal Records Bureau (CRB) and references, before they started work. We looked at the recruitment files for two staff members who had been appointed since the last inspection. The recruitment procedure included CRB and protection of vulnerable adults list (POVA) checks. References and proof of the applicant’s identity were being obtained. We talked to Mrs Jones about the records that she kept of the nurses’ registration with the Nursing and Midwifery Council (NMC). Copies of the nurses’ NMC PIN cards had been obtained and were kept on file. However there was no system for maintaining an up to date record of the nurses’ current registrations with the NMC. Old Parsonage (The) DS0000061474.V359860.R01.S.doc Version 5.2 Page 20 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live a home that has an experienced and competent manager. However a lack of resources and monitoring means that people cannot be confident that the home will be run in their best interests. EVIDENCE: Mrs Jones is a registered nurse and has managed the home since 2001. Mrs Jones gained the Registered Managers Award in 2004. A deputy manager was providing management support. Mrs Jones has a good track record of managing the home. It has been found at previous inspections that Mrs Jones has good leadership skills, manages the home well and puts the needs of residents first. Old Parsonage (The) DS0000061474.V359860.R01.S.doc Version 5.2 Page 21 We found at this inspection that Mrs Jones had an open and positive approach and was keen to develop the service in the residents’ best interests. Mrs Jones had completed a comprehensive AQAA, which provided a very clear selfassessment of what the home does well and what could be done better. Future improvements were identified, although Mrs Jones stated that these would be dependant upon the necessary resources being available. Mrs Jones also referred to matters within the company, which had affected the running of the home and had made it difficult to plan for the future. Staff told us that they felt the manager was supportive. However, there was no formal programme of staff supervision. Mrs Jones acknowledged in the AQAA that this was something that needed to be addressed. We also talked to Mrs Jones about the need to establish a system of quality assurance, to include gaining feedback regularly from the people who use the service, and their representatives. This will ensure that their views are taken into account when an annual development or improvement plan for the home is produced. Reports of monthly visits to the home by the provider had not been produced consistently during the last year. There were reports in the home for January and February 2008, although these did not cover all the required areas and provided very limited information about what had been looked at and done during the visits. There was a new ‘Responsible Individual’ for the company, which has given the opportunity for a better system of management support and overview to be started. Mrs Jones had responsibility for managing the majority of residents’ personal money. The financial procedures included the recording of money received and spent, with receipts kept of the money spent. It was reported at the last inspection that there was one matter that needed to be addressed concerning the financial arrangements of one resident. Mrs Jones had been advised to contact this person’s care manager. We discussed this again with Mrs Jones and she confirmed that this matter had now been resolved with the appointment of a new appointee. We received information in the AQAA about the arrangements being made for health and safety in the home. We were told that there had been improvements in the equipment available for moving and handling and that risk assessments were in place. We saw examples of the completed risk assessment forms during the visits and discussed these with Mrs Jones. The assessments covered a variety of matters, such as behaviour, the use of bedrails, and hazards in the workplace, including fire. We checked some of the servicing and maintenance records. We saw evidence for the servicing of the lift, hoists, and the fire precaution systems. There was a certificate for an inspection of the electrical installation in January 2008. However there was no evidence of portable electrical appliance testing. Mrs Jones could not confirm the arrangements being made and said that she would get advice about what needed to be done. Old Parsonage (The) DS0000061474.V359860.R01.S.doc Version 5.2 Page 22 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 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Old Parsonage (The) DS0000061474.V359860.R01.S.doc Version 5.2 Page 23 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 OP1 Regulation 4(1)(c) Requirement The statement of purpose must include all the information that is listed under Schedule 1, Regulation 4(1)(c). This includes the address of the registered provider. Timescale for action 31/05/08 2. OP1 5 The service user’s guide must 31/05/08 contain all the information that is required to be kept under Regulation 5. This includes the details of fees and additional charges, and the address and telephone number of the Commission. The statement of purpose and the service user’s guide must be kept under review and revised to ensure that the details are accurate and up to date. All controlled drugs must be stored in a cupboard that meets the current storage regulations (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007. 31/05/08 3. OP1 6 4. OP9 13(2) 31/05/08 Old Parsonage (The) DS0000061474.V359860.R01.S.doc Version 5.2 Page 24 5. OP19 23(2) Work must be undertaken which will ensure that hot water is readily available at all outlets in the home. Staff must receive training that is appropriate to the work that they are to perform. In order to show compliance with this regulation, a programme of training will need to be provided in accordance with the training requirements assessment that has been produced. A record must be kept of the nurses’ current registrations with the Nursing and Midwifery Council. 28/02/08 6. OP30 18(1) 31/03/08 7. OP30 19(5) 31/03/08 8. OP33 24 A system must be established for 31/08/08 evaluating the quality of the services provided at the care home. The system must include consultation with people who use the service, and with their representatives. An appropriate person must, on behalf of the company, visit the home unannounced at least once a month and prepare a written report on the conduct of the home. The person carrying out the visit must: • Interview, with their consent and in private, such of the residents and their representatives, and persons working at the home as appears necessary in order to form an opinion of the standard of care provided in the home. • Inspect the premises, the record of events and records of any complaints. 31/03/08 9. OP33 26 Old Parsonage (The) DS0000061474.V359860.R01.S.doc Version 5.2 Page 25 10. OP36 18(2) Staff working at the home must be appropriately supervised. In order to show compliance with this regulation a programme of formal supervision will need to be arranged and implemented. Guidance must be obtained from an appropriate source about the arrangements that need to be made for the testing of portable electrical appliances. This is to ensure that the electrical equipment in the home is maintained in good working order. 31/03/08 11. OP38 23(2) 31/03/08 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 OP1 Good Practice Recommendations That the contents and format of the home’s information file is reviewed. This is so that the information given to people is clearly set out and provides consistent details about the home. That the Waterlow assessment forms are dated to show the day on which the assessments were undertaken. This is to ensure that the details recorded about people’s pressure care are as accurate as possible. The registered manager should be satisfied that the arrangements for blood testing meet the current safety guidelines issued by the MHRA. The use of all creams and lotions should be recorded in a format that is easy to refer to. That advice is obtained from a specialist source about activities that are suitable for people with dementia. This DS0000061474.V359860.R01.S.doc Version 5.2 Page 26 2. OP7 3. OP9 4. 5. OP9 OP12 Old Parsonage (The) is so that the home can provide a more varied range of activities that will meet the residents’ needs. 6. OP12 That the activities programme includes more ‘one to one’ activities that reflect the residents’ individual interests and personal routines. The social care part of the residents’ individual care plans should show which activities are to be undertaken with each person and when these are to take place. That a programme of maintenance is produced as a way of ensuring that refurbishment and maintenance work is completed in a planned and timely manner. Bathrooms and WCs should be easily identifiable by door labelling or other means. (Recommendation outstanding from the last inspection). Consideration should be given to employing an administration person who can support the manager and deal with the financial business of the home. (Recommendation outstanding from the last inspection). That the arrangements being made for undertaking management and administrative tasks are reviewed. This is so that a decision can be made about the best means of providing the additional support that the manager needs when she is the only registered nurse on duty. That a policy is produced which sets out the company’s aims and intentions in respect of staff training. This is so that residents will benefit from a well trained team of care staff. That a policy is produced which sets out the company’s aims and intentions in respect of quality assurance. This is so that residents can feel confident that there is a good system in place for improving the home and for taking their views into account. That the recording of risk assessments is changed in order to give clearer information about the outcome of the assessments. 7. OP19 8. OP21 9. OP27 10. OP27 11. OP30 12. OP33 13. OP38 Old Parsonage (The) DS0000061474.V359860.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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