Inspection on 10/01/08 for The Paddocks

This inspection was carried out on 10th January 2008.

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

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 Paddocks 08/01/09

The Paddocks 26/04/06

The Paddocks 22/09/05

The Paddocks 13/04/05

The Paddocks 20/09/04

The Paddocks 16/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

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

CARE HOMES FOR OLDER PEOPLE Paddocks (The) Hilperton Road Trowbridge Wiltshire BA14 7JQ Lead Inspector Alison Duffy Unannounced Inspection 9:15 10 January 2008 th 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 Paddocks (The) DS0000028296.V352101.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. Paddocks (The) DS0000028296.V352101.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Paddocks (The) Address Hilperton Road Trowbridge Wiltshire BA14 7JQ 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) 01225 752018 manager.thepaddocks@osjctwilts.co.uk www.osjct.co.uk The Orders Of St John Care Trust Mrs Anna Lovesey Care Home 30 Category(ies) of Dementia - over 65 years of age (14), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (3), Old age, not falling within any other category (30) Paddocks (The) DS0000028296.V352101.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users who may be accommodated in the home at any one time is 30. No more than 14 service users with dementia may be accommodated at any one time. No more than 3 service users with a mental disorder may be accommodated at any one time. 26th April 2006 Date of last inspection Brief Description of the Service: The Paddocks was built in the 1970s as a home for people with a visual impairment. All residents’ bedrooms and communal areas are therefore on the ground floor. The home is divided into three units. All lead off from a central area of a dining room and adjoining lounge. Each of the units has its own small lounge, bathroom and toilets. Originally managed by Wiltshire County Council, the home is now registered to the Orders of St John Care Trust. Ms Anna Lovesey is the manager although Ms Lovesey is not as yet registered with us. The Paddocks is situated on the outskirts of Trowbridge within a mile from the town centre. The home offers one room for respite care and an integral day service. Residents are able to join in with the activities and events organised by the day service. Staffing levels are maintained at one care leader and three carers in the morning and one care leader and two carers in the evening. At night there are three waking night staff. There are also housekeepers, catering staff, a day care activities organiser, a maintenance person and an administrator. If the resident is self-funding, the fees for living at the home range between £410.00 and £485.00 a week. If a placing authority arranges the placement, the fees range between £386.61 and £455.16. The range of fees is dependent on the level of the resident’s individual need and the size of the room that is occupied. Paddocks (The) DS0000028296.V352101.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. This key inspection took place initially on the 10th January 2008 between the hours of 9.15am and 5.10pm. The inspection was concluded on the 17th January 2007 between 9.00am and 3.10pm. Ms Lovesey was available for the majority of the inspection. Ms Lovesey and Ms Stenning, a lead manager within the organisation, received feedback. We met with a number of residents in the privacy of their bedrooms. We spoke to staff members on duty. We examined the medication systems and the management of residents’ personal monies. We observed the serving of lunch. We looked at care-planning information, training records and recruitment documentation. As part of the inspection process, we sent surveys to the home for residents to complete, if they wanted to. We also sent surveys, to be distributed by the home to residents’ relatives, their GPs and other health care professionals. The feedback received, is reported upon within this report. We sent Ms Lovesey an Annual Quality Assurance Assessment (AQAA) to complete. To date this has not been returned. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. What the service does well: Residents are encouraged to follow their preferred routines and give their views regarding service provision. Medication is orderly managed, which minimises the risk of error. Residents have regular access to health care professionals and are seen by the GP and District Nurse, as required on a regular basis. Residents are able to personalise their own rooms and receive visitors at any time. Paddocks (The) DS0000028296.V352101.R01.S.doc Version 5.2 Page 6 Residents are offered a good level of external activities and are able to be an integral part of the community. Residents and their relatives are clear about the ways in which they can raise their concerns. Training is encouraged and various subjects are arranged as part of the organisation’s training programme. Robust recruitment procedures are in place and a high level of health and safety material is available for staff reference. What has improved since the last inspection? What they could do better: Care plans must be more detailed and evidence how residents’ needs are to be met. Unclear global statements must be replaced with specific information to ensure clarity. Key aspects such identifying the risk of developing a pressure sore and the management of any vulnerable area must be identified. Care interventions associated with the frailty of particular residents must be clearly evidenced to ensure individual needs are met. This includes mouth care, maintaining continence and nutritional intake. Food and fluid charts should be fully completed, totalled and evaluated at the end of the day to ensure effective monitoring. Written entries made on body maps need to be sufficiently detailed to evidence the healing process. Paddocks (The) DS0000028296.V352101.R01.S.doc Version 5.2 Page 7 Staffing levels need on going review to ensure residents have sufficient time with staff to meet their needs. The review should give consideration to care staff relinquishing some of their housekeeping tasks, such as the laundry. Consideration should also be given to ensuring a consistent amount of housekeeping cover during a weekend and at times of annual leave and sickness. Ms Lovesey has been undertaking the role of manager for approximately a year although is not as yet registered with us. There has been some confusion with the application process but this must be finally resolved to ensure successful registration. 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. Paddocks (The) DS0000028296.V352101.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 Paddocks (The) DS0000028296.V352101.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): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential residents are encouraged to visit the home and are assessed before admission, which enables an appropriate placement. EVIDENCE: On the first day of the inspection, two people were looking around the home in view of a possible placement for their family member. We heard Miss Lovesey explaining the philosophy of the service, emphasising the element of enabling resident’s choice within their daily routines. Miss Lovesey confirmed that all potential residents are encouraged to visit the service before making their decision to move in. In addition, Miss Lovesey completes an assessment in the prospective resident’s own environment. Documentation demonstrated a clear assessment. Information from a placing authority if applicable, also forms part of the assessment process. Paddocks (The) DS0000028296.V352101.R01.S.doc Version 5.2 Page 10 Two residents told us of their situation before moving in. One said they had been familiar with the home, so knew about its general principles. Another said they had left the decision to their family. They told us their family had visited many care homes, but thought The Paddocks was the best. Both residents were happy with the decisions they had made. Within a survey, one resident told us ‘I was asked to come and see the Paddocks a couple of times and on XX I moved in. I enjoy it because its all on one floor.’ At the last inspection, a requirement was made to consider the ongoing provision of a service to people with mental disorder. In response to this, a successful application was made to us, to reduce the numbers of residents with a mental disorder. Ms Lovesey told us that consideration is now being given to totally withdrawing this category. Ms Lovesey was informed of the need to inform us, once an outcome has been established. A requirement to clearly identify the information in the Statement of Purpose, regarding the service given to residents with mental health needs, was also made at the last inspection. This requirement has been addressed. The Paddocks does not provide intermediate care and therefore Standard 6 is not relevant to this service. Paddocks (The) DS0000028296.V352101.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While the residents’ general experience of care practice is good, care plans do not always reflect the support residents require. Residents’ benefit from regular access to health care personnel yet daily health care provision is not fully evidenced. Residents are protected by the home’s procedures for the safe handling of medicines. Residents’ rights to privacy and dignity are maintained. Paddocks (The) DS0000028296.V352101.R01.S.doc Version 5.2 Page 12 EVIDENCE: All residents told us they were satisfied with the care they received. Within surveys, three relatives said the care home always meets the needs of their relative. Two said the home usually did. Ms Lovesey told us that a new care planning format was in the process of being implemented. Staff are currently transferring information to the new documentation. We looked at a sample of care plans. Some areas explained the support required. For example daily routines, the assistance required to eat and triggers for anxiety were identified. Other aspects of good practice including offering a wheelchair for long distances and encouraging a resident to change their clothes were stated. However some key aspects in some plans, lacked detail. One care plan did not evidence the frailty of the resident and the complexity of their need. The information was also not up to date. There was no information for example, on how to support the resident with fluid and nutritional intake, how to maintain continence, mouth care or dying wishes. While staff were completing fluid charts, the amounts stated had not been totalled. Monitoring was therefore not taking place. This was despite a request from the District Nurse. A formal tissue viability assessment had not been undertaken although staff had identified the resident was at risk of developing a pressure sore. There was no specific care plan addressing tissue viability. Staff had recorded the need to apply creams to any red/sore areas and to give moisture. Highly susceptible areas, which staff needed to give special attention to, were not identified. Staff were recording when they supported the resident to change their position. However, there was conflicting information regarding when this needed to be undertaken. Within daily records we noted evidence of a sore. This information was not identified within the resident’s care plan. Within another plan, terminology was not clear. For example, it was recorded ‘ensure XX gets a lot of help with personal care’ and ‘needs support due to eyesight.’ The plan also stated ‘diagnosed as having Alzheimer’s – staff to encourage XX to participate in daily activities.’ Ms Lovesey was advised to ensure that staff detail the actual support the resident requires. There was good detail regarding the use of particular topical creams. Some aspects within the care plan were reviewed in October 2007. There was no evidence of more regular reviewing. Within daily records there were a number of entries identifying sore areas. Further follow up action or the management of the areas, were not evidenced. Within body maps, these areas had been identified as ‘red mark’ or ‘red sore.’ We advised Ms Lovesey to ensure staff give clarity to their recording to enable effective monitoring. This had been identified as a requirement at the last inspection but has not therefore been addressed. Paddocks (The) DS0000028296.V352101.R01.S.doc Version 5.2 Page 13 Within the old care plan format there were no formal tissue viability, nutritional or falls assessments in place. These had been developed however in the new care planning format. Each care plan contains a record of all health care appointments. This may include the GP, the district nurse or chiropodist. Within surveys, two health care professionals confirmed satisfaction with the service. However, one told us ‘I sometimes feel that the care needs stretch the staff too far and there is a reluctance to assess re nursing placement. But overall I think they provide excellent care.’ A resident within their survey said ‘that’s one good thing about the medical wants at The Paddocks. It’s brilliant.’ One resident said ‘if you need a doctor at any time, you just need to ask the staff and they will get someone to come out.’ A care leader told us that residents are able to administer their own medication following an assessment stating they are safe to do so. The majority of residents however, rely on staff to support them with their medication. A monitored dosage system is used. The system is stored securely within a locked cupboard and trolley. Staff only have access to and administer medication, if they have passed competency checks and have had medication training. The care leader told us they were responsible for assessing staffs’ competence. At the last inspection, we identified that residents were not speedily receiving medication, which a GP prescribed to them, on their visit. A requirement was made to address this. The care leader told us that all prescriptions are now faxed to the surgery and are delivered to the home when ready. The medication administration records demonstrated receipt of medication. The care leader told us that before admission, the resident’s GP is contacted to verify all medication. Two staff check and receipt the medication when it arrives into the home. The medication administration record was satisfactorily maintained. This gives evidence that residents have been receiving their medication appropriately. The majority of all handwritten medication instructions on the record had been countersigned. Medications with a short shelf life had been dated, when opened. We saw staff knocking on residents’ bedroom doors and waiting to be asked in before entering. There were times, when talking to residents in their bedrooms, that some staff knocked to come in and then apologised for the interruption. Residents told us that staff respected their privacy. One resident said ‘I spend most of my time down here. They don’t disturb me but bring me drinks and check that I am ok.’ We saw staff delivering mail to residents unopened. One care plan stated the resident’s preference of receiving their intimate personal care, from a female member of staff. However, residents’ preferences were not always stated on all care plans. Paddocks (The) DS0000028296.V352101.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A programme of activity provision is offered yet developing the profile of activities would further enhance opportunities to residents. Residents are able to follow their preferred routines and receive visitors as they wish. Residents’ expressed enjoyment from a menu, which contained a varied selection of traditional meals. EVIDENCE: There is a day care/activities coordinator who works 35 hours a week. They told us that they are responsible primarily, for organising activities for the day care clients. However, as there is no designated day care centre, residents are encouraged to join in with all activities. Miss Lovesey told us the post of day care/activities coordinator is shared. They are therefore responsible for activity provision for both residents and day care members. The day care/activities organiser demonstrated a clear interest in providing meaningful activity and enabling residents to be an integral part of the community. They told us however that the whole staff team does not necessarily share this view. They also told us that many residents would prefer to go out, than join in with activities in the home. Photographs displayed around the home, demonstrated activities such as ice-skating. Meeting the needs of all residents and day care Paddocks (The) DS0000028296.V352101.R01.S.doc Version 5.2 Page 15 clients is therefore a challenge. These views were shared with Miss Lovesey and Ms Stenning. Ms Lovesey told us that consideration would be given as to how the activities coordinator could be given more support. Ms Lovesey told us ‘XX [the day care organiser] does a wonderful job. She has lots of ideas and lots of energy so we need to look at how best to use her. ’ Ms Stenning told us that day care is being reduced, which in turn would give the day care organiser more time to spend with residents. A number of residents told us about the day care organiser. They also told us that they were happy following their own solitary interests. One resident said ‘they do do things but I like my room and my own company, so I don’t go down.’ They told us they liked reading, watching television and watching the birds in the trees outside of their window. Another resident told us that they liked sitting with their friend and having a chat. Within surveys, relatives spoke positively about activities. One relative told us ‘they organise many activities both on site and on trips out e.g. the races, the pub, the zoo, the seaside.’ In response to the question, ‘what do you feel the care home does well’ one relative said ‘Supplying entertainment. Offering choice for outings. Teaching crafts for occupational therapy.’ Another relative said ‘treats the residents as individuals. Has lots of activities and now has guinea pigs. Christmas and the 3 weeks leading up to it are a mass of activities. All residents get Easter eggs and birthday and Christmas presents.’ As a means to improve the service, one relative suggested ‘to play the radio ‘BBC2’ all day Sundays, it is perfect for older people, instead of television, which few take notice of when all together in the main collection area.’ During the morning of the inspection, music was playing in the lounge. In the afternoon, a film was on the television. One resident told us that they did not like the music. They said ‘its always on and it’s so loud.’ We told Ms Lovesey about this and she said she would discuss it with staff. An activity programme was displayed on the notice board. This highlighted arts and crafts; sing along, games and one to one sessions. During the inspection, one resident repeatedly walked around the home. Staff said that it was difficult to find activities the resident wanted be involved with. Ms Lovesey told us that consideration would be given to how the residents’ social needs could be met more fully. All residents told us that they could have visitors at any time. One said ‘my XX means the world to me. S/he sometimes comes in the afternoon but usually comes late in the evening, when s/he finishes work.’ Within surveys, four relatives told us that staff always keep them informed of events. One relative said ‘I’m regularly informed if my XX has seen the doctor, the result of any tests and also how s/he is generally e.g. if s/he’s tired because s/he’s been up most of the night.’ Residents told us they were able to follow their preferred routines such as getting up and going to bed. All said they could eat where they wanted to and Paddocks (The) DS0000028296.V352101.R01.S.doc Version 5.2 Page 16 spend time, independently in their room. We saw some meals being delivered to residents in their own rooms. One resident told us ‘I just ask when I want a bath and they help me.’ Another said ‘it’s very relaxed here. You can do as you please. You just need to ring your bell if you want anything and then they will do it.’ Within a survey, one relative told us ‘They treat him/her as an individual and try to accommodate all his/her wants.’ Residents told us that the food is generally very good and there is a good selection across the week. They told us there is always a choice of two items at each mealtime. One resident said ‘they know what I don’t like, so they always give me something else.’ Another resident said ‘I can’t complain, I have all I need.’ Within surveys, one resident told us they usually liked the meals. They said ‘the food is good, you have a variety, if you don’t like one thing you have something else.’ Another resident told us, they ‘sometimes’ liked the meals. The cook told us that there is a rolling menu, which can be changed at any time according to seasonal produce. They told us that all meals are generally ‘cooked from scratch’ with very little pre-prepared items. We saw homemade cake in the kitchen, which had been made earlier in the day. The menus demonstrated traditional cooking such as braised steak, cauliflower cheese, chicken casserole and toad in the hole. The lunchtime meal of roast chicken or an omelette looked appetising and was served in quantities, according to residents’ individual wishes. Paddocks (The) DS0000028296.V352101.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives are clear about the ways in which they can raise concerns. Residents are assured greater protection through well-managed adult protection systems and the appropriate use of the Safeguarding Adult Unit. Paddocks (The) DS0000028296.V352101.R01.S.doc Version 5.2 Page 18 EVIDENCE: Residents told us they would tell a member of staff or their family if they were unhappy. The home has a detailed complaint’s procedure, which is displayed in the hallway. Within surveys, three relatives told us that they were aware of how to make a complaint. They said that they felt the home deals with complaints appropriately. Ms Lovesey told us that she aims to resolve any issues quickly through good communication. One member of staff told us they would try to sort any issue of concern out immediately, if they could. If not, they would pass the matter to a care leader. A record of formal complaints is maintained. Ms Stenning told us that the complaint log is checked during monthly operational visits. During the inspection, we asked a member of staff, a hypothetical question about abuse. They said they would immediately inform a care leader who would then inform the manager. In the manager’s absence, they said they would contact Ms Stenning. Ms Lovesey told us that she would assess the need to make a Safeguarding Adults referral. Ms Lovesey told us that all staff have a copy of the local Safeguarding Adults policy entitled ‘No Secrets in Swindon and Wiltshire. This was confirmed within recruitment documentation. There was evidence that the procedure had been used appropriately. The majority of staff have had recent adult protection training. Paddocks (The) DS0000028296.V352101.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from an environment that is clean, comfortable and well maintained. EVIDENCE: Residents have a single bedroom on the ground floor. Many of these overlook the home’s gardens. The rooms we saw were personalised with residents’ own belongings. Some rooms however are small which restricts the amount of personal furniture that can be accommodated. All had a call bell that was readily accessible. One resident said s/he had their own key and could lock their room, as they wished. All residents spoken with said they were happy with their room. Within a survey one resident told us ‘my room is lovely and I do a lot myself. My XX gives me polish and a duster and I can see all the comings and goings. I love my room.’ Paddocks (The) DS0000028296.V352101.R01.S.doc Version 5.2 Page 20 On the first day of the inspection, the carpet in the corridor and small lounge in one area of the home was being replaced. This significantly improved the area. Ms Lovesey said that since the last inspection a number of bedrooms had been redecorated. A rolling programme of redecoration to further bedrooms was planned. There are toilets and bathrooms in close proximity to bedrooms and communal areas. One bathroom was not used, as the bath was not assisted. Ms Lovesey told us that plans are in place to provide a specialised bath in this area. This bath and one other contained a large amount of lime-scale type stain. Ms Lovesey told us that due to their age, the baths were difficult to keep clean. Ms Lovesey said she would discuss this further with senior management. The home was cleaned to a good standard although there were two areas, which presented an unpleasant odour. Ms Lovesey was aware of this and told us the carpets were being replaced to resolve the issues. All hand washbasins contained pump action soap dispensers and paper towels to minimise the risk of infection. Staff had access to protective clothing as required. A member of staff told us the laundry systems continued to meet residents’ needs. However, specific laundry staff are not deployed. Care staff are responsible for all laundry tasks. We discussed this with Ms Lovesey, who said a care support worker post had been developed. It was possible that this role might cover the laundry service. Two residents told us they were happy with the laundry arrangements. One said ‘It’s very good. All my things come back quickly.’ Paddocks (The) DS0000028296.V352101.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels, although maintained in line with the previous registration authority, are insufficient to meet residents’ individual needs and assure satisfaction from residents and their relatives. Residents are protected through a clear, well-managed recruitment procedure. Residents benefit from a staff team who have regular access to training. EVIDENCE: There are generally three carers and a care leader on duty, during the waking day. At night there are three waking night staff. In addition to the care staff team, there are housekeeping and catering staff, an administrator, a day care/activities coordinator and a maintenance person. Staff told us, that during the early morning handover, they are allocated a particular corridor to work in. Staff told us however, that this practice is currently not working. They said there are now at least six residents who need the assistance of two staff members, to complete their personal care routine. They said this places strain on the workload and leaves some areas of the home without staff presence. Ms Lovesey told us after the inspection, that she had spoken to staff about the number of residents needing personal care support. She confirmed there were three residents who needed the support of two members of staff. Paddocks (The) DS0000028296.V352101.R01.S.doc Version 5.2 Page 22 During the first day of the inspection, a day care client left the building unattended. This was attributed to the carpet fitters having a lounge door open. However, with staff busy in specific areas, this may also have attributed to the incident. Staff told us that generally the whole morning shift is taken up with personal care routines. Staff told us they are responsible for all laundry procedures. This includes the laundering of all items and returning them to residents’ rooms. The night staff do the ironing. Staff said they are not able to spend quality time with residents or undertake any form of social activity. One resident was repeatedly walking around the home. Having carpet fitted to one corridor, may have attributed to this anxiety. However, staff explained this as usual practice. They told us they did not have the time to enable one-to-one support to the resident. Staff told us that residents often ring their bell during the day, which makes the home busy at all times. The day care organiser told us that staff often do not have the time to assist with activities. Some staff come in on their day off to help with external events. Within surveys, there were four comments about staffing levels. These were ‘they could endeavour to keep more staff. There has been an increase in the use of agency staff recently’ and ‘very happy but the girls are sometimes stretched to their limit.’ Also, ‘to ensure staff are always in communal areas. Often staff in office completing paperwork.’ As a means to improve the service, one relative said ‘employ more staff.’ We discussed staffing levels with Ms Lovesey and Ms Stenning. Ms Stenning told us, in response to a requirement to review staffing levels, made at the last inspection, additional care hours were allocated. Within this year’s budget, a further 13 care hours and 20 hours care support had been allocated. However, to give more consistent staff cover, Ms Stenning told us that she would review the staffing situation with Ms Lovesey. Ms Stenning also commented that time management of staff might need to be looked at. There are generally three or four housekeepers on duty. The housekeepers help maintain the standard of cleanliness within residents’ rooms and also wash up in the kitchen. At weekends, there is one housekeeper and one kitchen assistant. During the first day of the inspection, there were two housekeepers on duty due to sickness and annual leave. One staff member was in the kitchen while the other was completing priority tasks such as cleaning toilets and hand washbasins. The housekeeper told us that they were planning to vacuum, if they had time. Ms Stenning told us, the deployment of housekeeping time would be considered. Residents told us positive things about the staff. These included ‘staff are very good,’ ‘they are helpful and friendly’ and ‘some of them are lovely. They will do Paddocks (The) DS0000028296.V352101.R01.S.doc Version 5.2 Page 23 anything for you.’ One resident told us they rarely rang their call bell unless they had to. They felt the staff were very busy. They said ‘they’ve got enough to do. They don’t need me worrying them.’ Staff told us that they had recently completed a dementia care course with the Alzheimer’s Society. They also said they had done a course in infection control and fire training. Ms Lovesey told us that all staff are up to date with their mandatory training such as first aid and food hygiene. There are two manual handler trainers in the home so training sessions are provided regularly, as required. All night staff have completed a fire marshal course. Ms Lovesey had a large file of certificates waiting to be filed. These demonstrated training in relation to tissue viability, continence, adult abuse and neglect, visual awareness and medication. At the last inspection, a requirement was made to ensure all staff had on going training in mental health care. Ms Lovesey told us that this training continued to be difficult to access. However there are now no longer any residents under the mental health category of the home with a diagnosis. Ms Lovesey said, if training were not forthcoming, residents with mental health care needs would not be admitted to the home. Ms Lovesey told us 12 members of staff have NVQ level 2 and 3 are working towards the award. Three staff have NVQ level 3. This ensures the home exceeds the required 50 ratio of staff with NVQ. All new staff are expected to register for NVQ training. We talked about recruitment with one member of staff. They told us they had filled in an application form and were called for an interview. They said they did not start straight away, as they had to wait for their references and a Criminal Records Disclosure. We looked at the recruitment documentation of three most recently employed members of staff. All files contained the required information although the checklist on the front of the file had not been completed. All prospective staff had been checked against the Protection of Vulnerable Adults register before commencing employment. Documentation confirmed that staff had been given a copy of the ‘No Secrets’ pamphlet and the General Social Care Code of Conduct, when they commenced employment. Paddocks (The) DS0000028296.V352101.R01.S.doc Version 5.2 Page 24 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 good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a manager who is resident focused and committed to enabling wellbeing. Systems are in place to regularly audit and improve the service given to residents. The safe keeping of residents’ personal monies is well managed therefore minimising the risk of financial abuse. Residents’ well being is promoted through clear health and safety systems. EVIDENCE: There has been a change in manager since the last inspection. Miss Lovesey has been in post for approximately a year and has recently completed NVQ level 4. Ms Lovesey told us that an application to register with us has been submitted. However the Central Registration Team have not received it. Ms Lovesey must therefore clarify the situation to ensure her registration. Ms Lovesey has a strong value base and passionately believes in promoting Paddocks (The) DS0000028296.V352101.R01.S.doc Version 5.2 Page 25 residents’ rights and wellbeing. Ms Lovesey has recently undertaken training in supervisory management and is aiming to complete her Registered Managers Award before the end of the summer 2008. Ms Lovesey has experience of being a registered manager within other care homes within the organisation. The home has a quality assurance system that is used within all of the homes within the organisation. The system consists of various audits and questionnaires. An audit was undertaken in March 2007 whereby a small number of non-compliances were identified. These have been addressed. Within the summer period, all residents were asked to complete a questionnaire. The feedback was coordinated and shortfalls were identified. Many issues were addressed immediately. Others such as the redecoration of rooms are being programmed. Residents are able to give their views within regular residents meetings. There is also a suggestion box in the small lounge. A number of residents have placed small amounts of their personal monies, for the home to hold safely. We looked at the systems for managing this. Only the manager and administrator have access to the system. The administrator said that she knows which residents often go out and therefore need immediate access to their money. The administrator therefore asks these residents, if they need any money before she goes off duty. Cash amounts corresponded with the balance sheets. The resident or another member of staff countersigns the record. Receipts were in place to demonstrate expenditures. The records are regularly audited within the home. There are also external audits. Ms Lovesey told us regular health and safety audits take place. Ms Stenning confirmed that audits form part off her remit during her monthly visits. Systems are in place to monitor issues such as hot water temperatures. Radiators have been covered to reduce the risk of scalding. There is a range of environmental risk assessments. Some individual risk assessments are located on residents’ care plans. Equipment such as manual hoists and the fire alarm systems are serviced regularly, as part of a contract. The organisation has specific contractors, which the home must use. Paddocks (The) DS0000028296.V352101.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 3 X 2 X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Paddocks (The) DS0000028296.V352101.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement The person registered must ensure that care plans fully identify residents’ individual needs and how these are to be met. The person registered must review the allocation of staffing hours to ensure that care needs are met. Management and administrative duties must be clarified. This was identified at the last inspection. Additional care hours were allocated in response to the requirement yet there was evidence that staffing levels need further review. The person registered must ensure that a full and detailed record is kept of any marks, redness or wounds. This must include size, exact location and quality. This was identified at the last inspection. Body maps are in place yet specific detail of the wound is not evident. Paddocks (The) DS0000028296.V352101.R01.S.doc Version 5.2 Page 28 Timescale for action 31/03/08 2 OP27 18(1)(a) 31/03/08 3 OP37 17 17/01/08 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 OP8 Good Practice Recommendations The person registered should ensure that fluid and food intake charts include whether meals and drinks were offered or refused rather than leave blank spaces. This was identified at the last inspection but has not been addressed. The person registered should ensure that all fluid charts are totalled and evaluated at the end of each day. The person registered should give consideration as to how the social needs of residents can be more readily met. The person registered should provide an assisted bath in the identified bathroom and replace the other stained bath. The person registered should review the tasks of all staff to enable care staff to spend more time with residents. The person registered should ensure that the checklist demonstrating the recruitment process is fully completed. 2 3 4 5 6 OP8 OP12 OP21 OP27 YA29 Paddocks (The) DS0000028296.V352101.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Regional Office 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. Extracts may not be used or reproduced without the express permission of CSCI Paddocks (The) DS0000028296.V352101.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. 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