Inspection on 23/10/07 for The Old School House

This inspection was carried out on 23rd October 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 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 School House 21/10/08

The Old School House 05/02/07

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 The Old School House The Old School House Thame Road Longwick Princes Risborough Buckinghamshire HP27 9SF Lead Inspector Marie Carvell Unannounced Inspection 23rd October 2007 11.00 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 The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old School House Address The Old School House Thame Road Longwick Princes Risborough Buckinghamshire HP27 9SF 01844 343620 F/P 01844 343620 No e mail address 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) Mrs Nahida Arif Mrs Nahida Arif Care Home 12 Category(ies) of Dementia (3), Mental disorder, excluding registration, with number learning disability or dementia (3), Old age, not of places falling within any other category (12) The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th February 2007 Brief Description of the Service: The Old School House is a care home providing personal care for up to twelve older people with care needs associated with old age, dementia or mental disorder. The home is not registered to provide nursing care; this would require an additional registration category. The home is a converted building that was originally the village schoolhouse and is situated in Longwick. Accommodation is situated on the ground and first floors of the home. Access to the bedrooms on the first floor is via a stair lift. The home does not have a vertical passenger lift. The current scale of charges are between £ 450.00 and £ 700.00 per week. There are additional charges for chiropody, hairdressing, toiletries and newspapers. The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘key Inspection’. The inspector arrived at the service at 11am and was in the service until 3.45pm. It was a thorough look at how well the service was doing, and took into account detailed information provided by the provider/manager, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the service and other people seen during the inspection. Four service users and three relatives of service users responded to surveys that the Commission had sent out. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standards of the service. Time was spent with many of the service users, staff on duty, the deputy manager, who visited the home during the inspection and a visiting healthcare professional, a tour of the premises was carried out and a sample of records required to be kept in the home were examined, including the case tracking of three service user’s files. The inspector spoke briefly to the provider/manager by telephone during the inspection. At the last inspection undertaken two requirements and five good practice recommendations were made, these are referred to in the body of the report. Feedback was given to the senior care assistant throughout the inspection. What the service does well: Service users spoken to said that the care staff were ‘very good’ and ‘nothing was too much trouble’, this was also confirmed on surveys completed by service users that they ‘ always’ received the care and support they needed. Service users are encouraged to maintain contact with friends and family. Service users said that there was always a choice and the food as ‘very nice’, ‘tasty’ and ‘good’. Menus demonstrate that service users are provided with a The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 6 varied, nutritious and balanced diet. Service users confirmed that the cook went out of her way to meet service user requests and was described as an ‘excellent cook’ Comments made on surveys completed by relatives included ‘ we feel extremely fortunate that X has a new home at The Old school House. X is extremely happy, has made new friends. I am very impressed with the standard of care and x surroundings. They are to be congratulated’. ‘ The staff are exceptional, caring, sensitive, kind and always smiling. A very good team in every sense with an excellent team leader’, ‘ the care given is beyond our expectations. Very impressed’. What has improved since the last inspection? What they could do better: The home’s Statement of Purpose and Service User Guide must be updated to reflect the homes registration categories. A suitably qualified or trained member of staff must assess the care needs of service users before the service user is admitted to the home. Care plans must be in sufficient detail to ensure that all staff are familiar with the specific care needs of each service user, when care is to be provided and how. A review of the risk assessment process must be made and must include all staff so that there is a clear understanding of the purpose and benefits to service users. Behavioural guidelines received from healthcare professionals must be in writing, regularly reviewed and form part of the service users care plan and risk assessments, if appropriate. The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 7 Written guidelines must be in place for service users prescribed medication to be given PRN (when required), detailing in what circumstances medication is to be given. Guidelines must be agreed with the GP and form part of the service users care plan. Staff who administer medication, must complete appropriate training beforehand. This must be documented. Staffing levels must be reviewed to ensure that sufficient staff are on duty to meet the care needs of the service users in addition to catering and domestic staff. Staff recruitment processes need to be more robust to protect service users from potential harm. All staff must complete an formal induction programme which meets Skills for Care guidelines, mandatory training and appropriate, specialist training to meet the specific care needs of the service users admitted to the home with care needs associated with old age, mental health and dementia. The provider/manager must undertake the Registered Managers Award. This was a condition of registration, to be completed by January 2007. Quality assurance systems need to be developed in the home to evidence that the home is being run in the interests of the service users. All staff must receive formal one to one supervision at least six times per year, by staff that have received appropriate supervisory skills training. The provider/manager is strongly advised to remove the CCTV cameras from areas of the home other than the front entrance to the home. 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. The Old School House DS0000068368.V353467.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 The Old School House DS0000068368.V353467.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): Standard 1 and 3. Standard 6 does not apply, as the home does not provide intermediate care. Standard 3 was subject to a good practice recommendation at the last inspection. Quality in this outcome area is adequate. The home’s Statement of Purpose and Service User Guide need to be updated and developed. Pre admission assessments need to be undertaken by a person trained to carry out assessments for service users with needs associated with old age, mental health or dementia. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s Statement of Purpose and Service User Guide are out of date and need to be reviewed to reflect the home’s registration categories. Once completed a copy of each document should be sent to the Commission. All The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 10 surveys completed by service users confirmed that they had received enough information about the home before moving in. A sample of service user’s files were examined and although an assessment was undertaken prior to admission, these were varied in quality of information recorded. At the last inspection a good practice recommendation was made that consideration be given to employing an experienced member of staff who is trained to carry out assessments of care needs and who could take the lead in the care provision in the home. This has not been actioned. The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10. Standard 8 was subject to a good practice recommendation at the last inspection and standard 9 was subject to a requirement at the last inspection. Quality in this outcome area is adequate. Care plans need to contain sufficient information to demonstrate that the needs of the service users are being met. Staff must receive appropriate medication training before administering medication to service users. The use of CCTV cameras in the home detracts from the service users right to privacy and is intrusive in their daily life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three service user files were case tracked. Since the last inspection the provider/manager has changed the care planning documentation and now uses a commercially produced document system. Information recorded in care plans The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 12 was brief. None of the care plans seen were signed or dated. It was not evident that service users are involved in their care planning, no evidence was seen that care plans are updated or contained sufficient detail to ensure that all care staff are familiar with the specific care needs of each service user, when care is to be provided or how. The inspector overheard a new member of staff being told how to bathe a service user. In discussion with staff on duty it was confirmed that of the current eight service users care needs were associated with old age, mental health issues and dementia. Care plans made no reference to psychological health, nutritional screening or end of life care. Daily records did not validate information recorded on care plans. Following the inspection the provider/manager sent the inspector documentation regarding care plans; these were dated July 2007 and were not seen during the inspection. Service users spoken to said that the care staff were ‘very good’ and ‘nothing was too much trouble’, this was also confirmed on surveys completed by service users that they ‘ always’ received the care and support they needed. At the last inspection a good practice recommendation was made that a review of the risk assessment processes used in the home should be made and should include all the staff so that there is a clear understanding of the purpose and benefits to the service users. This has not been actioned. Not all the service user files examined included assessments of identified risks, such as safe bathing, risk of falls, nutrition, use of the stair lift or moving and handling. One service user’s file contained a risk assessment, for falls at night. this was undated. Healthcare needs are provided by a local GP practice and records seen evidenced the healthcare professionals are involved as necessary. All surveys completed by service users confirmed that they ‘always’ received the medical support needed. There are behavioural guidelines in place for one specific service user and these were explained to the inspector. It was confirmed that the guidelines had been given verbally by a healthcare professional and are not recorded on care plans. None of the staff team have received training in mental health or dementia care. At the last inspection a requirement was made that all medication must be recorded on the service users medication administration records and if this is a controlled drug must also be recorded in the controlled drug book. This has been complied with. Some service users are prescribed medication to be given PRN (when required) no guidelines are in place to advice staff in what circumstances the medication should be given. Medication administration records were seen to be up to date with no obvious gaps in recording. Not all staff who administer medication have received any medication training. Trainee care assistants, in post for less than three weeks are on occasions, administering medication to service users. The staff signature list for staff who The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 13 administer medication needs to be updated as the majority of signatures are of staff are no longer in post. Service users were seen to be well groomed and appropriately dressed. Staff were observed to interact with service users in a respectful manner, not all care staff have a good command of English and this can cause problems with verbal communication with some service users. The home’s Aims and Objectives refer to the right of the resident to be left alone and undisturbed whenever they wish, the understanding of a resident’s needs and enabling them to maintain their dignity and allowing a resident to take calculated risks, to make their own decisions and think and act for themselves. The Commission was advised in June 2007, that the provider/manager had installed CCTV cameras in the communal lounge, kitchen, front entrance to the home, corridors and top of the staircase. In discussion with service users and staff, their understanding was that the CCTV cameras were installed on the advice of the Commission. This is incorrect and is considered by the Commission to be intrusive to the daily lives of service users and should not be used as a means of monitoring service user’s movements. The provider/manager has stated that the CCTV cameras are not operational. From discussion with staff on duty, the inspector considers that the home may be able to provide a service to meet the needs of individual service users of various religious, racial or cultural needs. The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15. Quality in this outcome area is good. Activities provided to service users are dependent on staff time and are limited. Service users who require minimal staff assistance are able to make choices about routines of daily living. Choices and preferences are not recorded. Service users were complementary about the meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One service user confirmed that the home meets his/her expectations and preferences well. Service users are encouraged to maintain contact with friends and family. There were no activities taking place at the home on the day of inspection. There was no activity plan for the home and no activity schedule in the service user files seen. The television was on in the lounge throughout the inspection, including the midday meal. There appears to be an The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 15 over reliance on this form of entertainment. One service user said that service users rarely watched the television and usually slept in their chairs. One surveys completed by a service users commented ‘there doesn’t seem to be many activities in the home at present’; other service user surveys commented that there are sometimes activities arranged by the home. The home does not employ an activities organiser, staff spend time with service users, usually in the afternoon, time permitting. Comments made on surveys completed by relatives included ‘ always very keen to gently encourage any activities the residents wish to continue with, visiting local friends etc and very welcoming to visitors. It is a pleasure to visit’, ‘ more activities needed for the residents’ The inspector joined four service users for the midday meal. The meal was tasty and served attractively. Service users said that there was always a choice and the food as ‘very nice’, ‘tasty’ and ‘good’. Menus demonstrate that service users are provided with a varied, nutritious and balanced diet. Service users confirmed that the cook went out of her way to meet service user requests and was described as an ‘excellent cook’. In discussion with the cook, it was clear that she was familiar with the food preferences of all the service users. Three surveys completed by service users stated that they ‘always’ liked the meals at the home and one service user stated ‘ sometimes’ they liked the meals at the home. One survey completed by a relative commented ‘ the early evening meal, whilst perfectly adequate could be made to look a little more appetising’. The cook is employed for six days per week from 8am until 3pm. When the cook is off duty or on leave then food is cooked by care staff including the evening meal. No evidence was seen that care staff who are involved in food preparation have received training in food legislation. The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 16 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): Standards 16 and 18. Standard 16 was subject to a good practice recommendation at the last inspection. Quality in this outcome area is adequate. Service users and relatives are confident that complaints made will be taken seriously and addressed. All staff need to undertake training in the protection of vulnerable adults from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last inspection a good practice recommendation was made that the home’s complaints procedure needed to be amended to reflect that people can approach the Commission at any time. This has been actioned. Surveys completed by service users and relatives confirmed that they were aware of the home’s complaints procedure. The home’s complaints book has no complaints recorded. Since the last inspection the Commission has received four complaints regarding the installation of CCTV cameras in the home. The use of CCTV cameras in a care home is referred to in the body of this report. The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 17 Seven members of staff have been booked to attend Protection of Vulnerable Adults training in November 2007. The provider/manager is advised to obtain a copy of the Buckinghamshire Multi-Agency Protection of Vulnerable Adults code of practice. Staff when asked were aware of the home’s whistle blowing policy. No adult protection investigations have been undertaken since the last inspection and no referrals have been made for inclusion on the POVA (Protection of Vulnerable Adults) list. The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 18 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): Standards 19,21,22,23,24,25 and 26. Standard 19 was subject to a good practice recommendation at the last inspection. Standard 26 was subject to a good practice recommendation and a requirement at the last inspection. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection there has been a major refurbishment of the home, this has included five en-suite added with level access showers, communal bathrooms and toilets replaced and appropriate aids to assist with independence now in place. All furniture, soft furnishings and floor coverings have been replaced. The kitchen is due to be refurbished in the next few The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 19 months. At the last inspection a good practice recommendation was made that work surfaces and floor covering should be made good until such time as the refurbishment is undertaken. This has been actioned. At the last inspection a good practice recommendation was made that the fire authority should be contacted to seek the most appropriate door closures to be fitted. This has been addressed. Bedrooms seen were comfortable, personalised and reflected the interests of the service user. Service users are able to bring in items of their own furniture if they wish. The communal lounge and dining room are comfortable and now furnished to a high standard. Service users expressed their satisfaction of the furnishings. The home was found to be clean, hygienic with no unpleasant odours. At the last inspection a requirement was made that waste bins used for soiled incontinence pads must have a lid at all times. This has been complied with. Laundry facilities in the home are adequate. CCTV cameras have been installed in the home. Comments made on surveys completed by relatives included ‘ I find the home is very clean, comfortable and happy for my X’, ‘ a conservatory is planned at some point, this would be icing on the cake’, ‘ the facilities are superb’. The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 20 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): Standards 27,28,29 and 30. Quality in this outcome area is adequate. Staffing levels appear to be inadequate at times to meet the needs of the service users. Recruitment procedures need to be more robust. Induction, training and supervision of staff need to be documented. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The provider/manager considers that the home has good staffing levels. There is a staff team of six care staff and a deputy manager in post who are contracted to work 274 hours per week, in addition there is a full time cook who works 8am until 3pm for six days per week. The home does not employ laundry or domestic staff, these tasks are undertaken by staff on duty. Since the last inspection the provider/manager has reduced the night staffing level from two care assistants to one. In the last twelve months four full time and five part time staff have left their employment at the home. From observation, examination of duty rosters and discussion with staff, staffing levels are at times inadequate to meet the needs of the service users. At the time of this inspection, the duty roster showed that the night care The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 21 assistant had gone off duty at 8am that morning. The senior care assistant was working from 8am until 8pm, assisted by a trainee care assistant, in post for two weeks, working 7am until 2pm. At 2pm another trainee care assistant, in post for two weeks, was rostered to work until 9.30pm. The duty rosters do not include a handover period between staff coming on duty and staff going off duty. The two staff on each shift, in addition to meeting the care needs of service users, are required to undertake domestic duties, laundry and prepare the evening meal for service users. The deputy manager and senior care assistant are in the absence of the provider/manager required to carry out management and administrative tasks. From 8pm until 8am a night care assistant was rostered to work, with the provider/manager, deputy manager or senior care assistant providing on call cover from their own homes. This is an informal agreement and the night care assistant would not necessarily know who to contact. It was not evidenced that the provider/manager has carried out a lone working risk assessment. The provider/manager should give serious consideration to providing a senior member of staff who is present in the home during the night to provide assistance as necessary. The home currently has a vacancy for a full time care assistant. The inspector was advised that a domestic assistant and more care staff may be recruited when the home has full occupancy. The deputy manager, senior care assistant and two care staff have completed NVQ level II. One care assistant has completed NVQ level III. The two trainee care assistants are on a one year contract from China for work experience and to improve their English, it is understood that both are studying to be nurses. The home has a new staff team and other than the newly appointed deputy manager, who has worked in the home since September 2006 and a care assistant in post since 2004, all have been recruited since March 2007. A sample of three staff personnel files were examined. All files contained a completed application form, two written references and enhanced police checks. Application forms need to request full employment history and evidence that any gaps are explored during the interview process. One application form only gave employment history for two years. It was not evidenced that staff are formally interviewed. No evidence was available that staff receive a formal induction programme, which meets Skills for Care guidelines. The induction of the two most recently employed trainees, consisted of working on three shifts as an observer. The inspector was advised that staff training records are not up to date. The home does not have a training and development programme in place. There is a need to develop training profiles for each member of staff. The The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 22 provider/manager advised the inspector that some training has been arranged for staff. There is a need for all staff to receive training in moving and handling, fire safety, basic food hygiene, health and safety, infection control, first aid, medication administration and protection of vulnerable adults from abuse. In addition to mandatory training, staff should receive appropriate, specialist training to meet the specific care needs of the service users admitted to the home with care needs associated with old age, mental health and dementia. Staff were observed to be courteous, patient and cheerful in their approach to service users, colleagues and visitors. Comments made on surveys completed by relatives included ‘ we feel extremely fortunate that X has a new home at The Old school House. X is extremely happy, has made new friends. I am very impressed with the standard of care and x surroundings. They are to be congratulated’. ‘ The staff are exceptional, caring, sensitive, kind and always smiling. A very good team in every sense with an excellent team leader’, ‘ the care given is beyond our expectations. Very impressed’. The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35, 36 and 38. Quality in this outcome area is adequate. The provider/manager is committed to improving the quality of care to service users, however this is not underpinned by knowledge of care provision. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The provider/manager has previous management experience, but limited experience in a care setting. At the time of the provider being registered with the Commission in September 2006, a condition of registration was that the manager must complete the Registered Managers Award by January 2007. This The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 24 has not been complied with. The provider/manager has advised the Commission that she is to start sourcing appropriate training to complete NVQ level IV in Care and the RMA. From examination of duty rosters, due to staff shortages the provider/manager is covering some night duty shifts and has very few hours free to undertake her management responsibilities for the home. Consideration should be given to delegating some management tasks to the deputy manager. At the last inspection the inspector was advised that the provider/manager had bought a proprietary quality assurance system that would cover all areas of managing the home once it was implemented. Quality assurance processes are not evidenced as to how the views of service users, relatives and other stakeholders are sought on a regular basis. None of the service users are able to manage their own finances. The service users relatives or representatives undertake this task. None of the staff receive planned formal supervision. The provider/manager has recently completed a one day seminar on staff supervision. Staff confirmed that formal one to one supervision does not take place. It is not clear how often staff meetings are held. The staff meetings file contained minutes of a staff meeting held in November 2006 only. A sample of records relating to fire, health, safety and welfare were examined. These were seen to be maintained to an acceptable standard. It was noted that fridge and freezer temperatures had not been recorded since the 16th October 2007, the senior care assistant agreed to address this immediately. The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 25 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 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 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 2 3 x 3 2 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 2 x 3 The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 26 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 and 5 Requirement The home’s Statement of Purpose and Service User Guide must be updated to reflect the homes registration categories. Copies of the completed documents should be sent to the Commission. A suitably qualified or trained member of staff must assess the care needs of service users before the service user is admitted to the home. Care plans must be in sufficient detail to ensure that all staff are familiar with the specific care needs of each service user, when care is to be provided and how. A review of the risk assessment process must be made and must include all staff so that there is a clear understanding of the purpose and benefits to service users. Behavioural guidelines received from healthcare professionals must be in writing, regularly reviewed and form part of the service users care plan and risk assessments, if appropriate. DS0000068368.V353467.R01.S.doc Timescale for action 23/12/07 2 OP3 14 23/12/07 3 OP7 15 23/12/07 4 OP8 13 23/12/07 5 OP8 13 07/12/07 The Old School House Version 5.2 Page 27 6 OP9 13 7 OP9 13 8 OP27 18 9 OP29 18 10 OP30 18 11 OP31 9 Written guidelines must be in place for service users prescribed medication to be given PRN (when required), detailing in what circumstances medication is to be given. Guidelines must be agreed with the GP and form part of the service users care plan. Staff who administer medication, must complete appropriate training beforehand. This must be documented. The staff signature list for medication administration must be updated. Staffing levels must be reviewed to ensure that sufficient staff are on duty to meet the care needs of the service users in addition to catering and domestic staff. Staff recruitment processes need to be more robust to protect service users from potential harm. This must include a full employment history and evidence that a formal interview was conducted. A staff training and development programme must be completed and include individual staff training, a development assessment and profile for each member of staff. In addition all staff must complete an formal induction programme which meets Skills for Care guidelines, mandatory training and appropriate, specialist training to meet the specific care needs of the service users admitted to the home with care needs associated with old age, mental health and dementia. The provider/manager must undertake the Registered Managers Award. This was a condition of registration, to be completed by January DS0000068368.V353467.R01.S.doc 07/12/07 07/12/07 23/12/07 23/12/07 23/01/08 04/03/08 The Old School House Version 5.2 Page 28 12 OP33 24 13 OP36 18 2007. Quality assurance systems need 23/12/07 to be developed in the home to evidence that the home is being run in the interests of the service users and how the views of service users, relatives and other stakeholders are sought on a regular basis. All staff must receive formal one 23/12/07 to one supervision at least six times per year, by staff that have received appropriate supervisory skills training. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP12 OP19 OP27 Good Practice Recommendations Leisure and social activities are planned on a regular basis to meet the needs of the service user group. This should form part of the service users care plan. The provider/manager is strongly advised to remove the CCTV cameras from areas of the home other than the front entrance to the home. That the duty roster includes an overlap of staff shifts to enable staff to handover to the staff coming on duty. The provide/manager is to give serious consideration to providing a senior member of staff to sleep in on the premises, to assist the care assistant as necessary. Consideration should be given to the delegation of some management tasks to the deputy manager. 4 OP31 The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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 The Old School House DS0000068368.V353467.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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