Inspection on 15/07/08 for The Regency

This inspection was carried out on 15th July 2008.

CSCI found this care home to be providing an Good 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 Regency 26/03/10

The Regency 10/07/09

The Regency 26/06/09

The Regency 15/01/08

The Regency 21/03/07

The Regency 14/03/06

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 09/11/2008.

CARE HOMES FOR OLDER PEOPLE The Regency Torrs Park Ilfracombe Devon EX34 8AZ Lead Inspector Susan Taylor Unannounced Inspection 17:30 15 & 16th July 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 The Regency DS0000065822.V365069.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 Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Regency Address Torrs Park Ilfracombe Devon EX34 8AZ 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) 01271 862369 01271 863012 nmcarehomesltd@yahoo.co.uk Norma Martin Care Homes Limited Ms Norma Elfreda Martin 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 age, not falling within any other category (20) The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Regency is registered as a care home able to provide care accommodation for up to 20 service users in the categories OP Old Age (20), DE (E) Dementia over 65 (20) and MD (E) Mental Disorder over 65 (20). 15th January 2008 Date of last inspection Brief Description of the Service: The Regency is a care home providing accommodation and personal care for up to 20 people over the age of 65 years, who may have a diagnosis of dementia or mental disorder. The home is situated in the Devon seaside town of Ilfracombe. There is a short, steep walk from the High Street and local amenities. Accommodation is provided on four floors. A ramp provides access to one floor and passenger lift to the remaining three. All the present accommodation is in single rooms. The current range of fees is from £322 to £380 per week. Additional charges are made for chiropody [£10], hairdressing [variable], newspapers, personal toiletries. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk Information about the home is made available to all prospective service users and a copy of the most recent inspection report is available in the entrance hall. The Regency DS0000065822.V365069.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 two star. This means the people who use this service experience good quality outcomes. This was a key inspection of The Regency under the ‘Inspecting for better lives’ arrangements. We were at the home with people for 9.5 hours over two days. The purpose for the inspection was to look at key standards covering: choice of home; individual needs and choices; lifestyle; personal and healthcare support; concerns, complaints and protection; environment; staffing and conduct and management of the home. We looked at records, policies and procedures in the office. A tour of the home took place. We tracked the care of three people and met some of their relatives. We also spoke to six people that live in the home about their experiences there. We sent surveys to all of the people living in the home and received 6 back. The comments of these people and our observations are in the report. We also sent surveys to all the staff and received 5 back. We have included some of their comments in the report. As at July 2008, the fees ranged between £322 and £380 per week for personal care. Extra charges are made for chiropody, hairdressing, newspapers and magazines and toiletries and these vary. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk People described living at The Regency as being “treated like royalty” and there are “wonderful staff that are lovely people and very kind”. In a survey, staff told us that they enjoy working at the home and that the managers have an “open door” and “always listen and try to improve things for people”. We also did a random inspection on 15th May 2008 to monitor whether the provider had fulfilled the legal requirements set out in the improvement plan. We found that all of the issues had been dealt with. We had to issue an immediate requirement about staffing levels at night, which was rectified the same evening. We wrote a report about our visit, which is available on request from the Commission. The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 6 What the service does well: People living at the home feel that the home has improved and that the manager puts “her heart and soul into it”. The manager listens to constructive criticism and has dealt with all the concerns the Commission raised at the last inspection. The manager ensures that an assessment is completed for all potential new people to ensure that all needs are assessed and they can plan how best to support people. Each person has a plan of care that details their preferred routines and states how staff will provide care and support to them. Plans are regularly reviewed and detailed daily records show that support is delivered. There are good links with professionals, which helps to improve peoples’ health. People who live at the home say that the staff are very kind and caring and feel they are treated as individuals day to day. The home has an open feel. People living there say that on the whole they have the freedom to do what they want to, when they want to. They feel able to voice their concerns, if they have any, and know that these are taken seriously and looked into by the manager and provider. People say that their friends and families are encouraged to visit whenever they wish to. The people living at the home get support to keep in touch with their families and friends if they need to. There is a good choice of appetising and well-balanced meals at the Regency. People say that the choice is good and meals are “very nice”. The Regency is a large converted house that is a comfortable place to live. At the same time, people who use walking aids find it easy and safe to get around the home. People living there say that they are encouraged to see it as their own home and that it is always clean and maintained. Staff feel well supported and are encouraged to do training so that they care for people properly. The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? Every person’s mental capacity has been assessed so that the team are clear about whether a person is able to make decisions about their care and life at the Regency. If they are unable to do so, the assessment clearly highlights who will be involved in the process and the issues that need to be addressed for the individual. In particular, deprivation of liberty by the use of mats linked to the call bell system and use of bedrails have been carefully considered and agreed by all stakeholders. Every person’s care plan has been reviewed and re-written. The care plans include all the information required by law. Additionally, they are person centred and are detailed providing staff with good guidance as to how to meet the individual’s needs. Medicines are stored safely in a newly purchased refrigerator. Additionally, staff follow safe practice when giving out medicines. Independent consent has been obtained for the use of bedside rails from the relatives, GP and care manager of a person needing these. Additionally, “Bumper cushions” are in place to prevent accidents and injuries. Policies and procedures have been reviewed and provide clear and consistent guidance for staff. Staff have been made aware of policies and procedures about gifts from people living in the home so that there is no possibility of abuse. Assessments have been done to establish which people are able to use these safely and are used. Staffing arrangements have been reviewed and ensure there is enough staff to care for people living in the home. Significant work has been done to the external fire escape so that it is safe for people to use in the event of fire. Fire exit doors open freely and have had alarms fitted to alert staff and ensure the safety of people that are confused and may wander out on to the fire escape. Staff have received health and safety training including basic food hygiene. The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 8 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. The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 9 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 Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 Quality in this outcome area is excellent. People are fully involved in the assessment process and information is gathered from a range of sources to ensure that individual’s needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In the AQAA the provider verified that prospective service users are given the information they need to make an informed choice prior to admission to this home - the statement of purpose and service user guide booklet. All of the people responding in a survey verified that they had received sufficent information to help them decide whether the Regency was the right place for them. Additionally, all of them verified that the home had issued them with a contract. The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 11 The manager told us that people are assessed by herself or the deputy manager who go to visit the person in their current setting to make an assessment. The pre admission form seen included information about their current abilities, medication, next of kin and equipment required. We examined five care files and tracked the needs of the individual’s concerned. A thorough assessment of needs had been completed with people and their relatives when they moved into the home. Copes of letters were seen on individual files confirming that the home would be able to meet the person’s needs. Assessments completed covered establishing any risks for an individual about their mental capacity, tissue viability, falls, and nutritional status. Additionally, information about the individual had also been obtained from social services if the care package had been commissioned by them. In addition to this, a social and economic history had been completed for individuals with the help of their family and other professionals that know them. This information provided the team with a picture of the social network a person has, hobbies and interests, and past working life. The manager told us that since the last inspection, they had developed a process for doing mental capacity assessments and had done a lot of research about this on professional websites. All of the people whose care we tracked had been assessed. We looked at the assessment of a person with dementia who was prone to wandering at night. This put them at risk of absonding from the home and therefore safety for that person was an issue. The assessment highlighted the need to use a pressure mat as a measure to reduce the risk occurring so that staff are alerted when the person leaves their bedroom during the night. It demonstrated who was involved in the decision making i.e. the manager, care manager and individuals husband. Additionally, the assessment showed that the individual was unable to make informed consent for themselves. The level of detail seen was excellent and linked directly to the care plan for the individual - this will be discussed in the next section. The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. People receive good personal and healthcare support that is person centred and is based upon the rights of dignity, equality, fairness, autonomy and respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Of the six people living in the home who returned surveys, five stated that they always received the care and support they needed. One verified that this was usually the case. Surveys we received from people living in the home and their relative’s contained positive comments like They are getting good medical care and good food. We looked at the care files for 5 people to establish whether they had a care plan that had been discussed and reviewed with them and/or their advocate. The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 13 Peoples needs included individuals with diabetes, cognitive impairment, mental health issues, and physical frailty. Those that were able to told us that the manager had spoken to them about their needs and aspirations and had been totally involved in the care planning process. The content of their care plan had been discussed and agreed with them. People had signed their care plan to denote this discussion. All the care plans seen had been regularly reviewed and were person centred, which is a significant improvement since the last key inspection. We tracked the care of a person with diabetes. A nutritional assessment had been done and demonstrated that the individual needed a diabetic diet and weight monitored monthly. A comprehensive care plan had been written, which gave staff clear guidance about how this persons needs should be met. Advice had been sought from healthcare professionals such as the diabetic nurse and tissue viability nurse specialists. Daily records and observation of care of the individual verified that this plan was followed. A weight chart demonstrated that the individual had been weighed every month and that this was stable and within normal limits. Additionally, we spoke to the chef who verified that he serves the person a diabetic diet that is low in sugar and fat. We tracked the care of a person that on initial assessment prior to moving into the home had several falls, which had resulted in injury and hospitalisation. On arrival at the home, the manager had done a falls risk assessment. We looked at the daily and accident records, falls had been recorded and appropriate action taken following each incident. We spoke to the individual who told us that she was satisfied with her care. We also read a handling plan, which stated that staff always had to use equipment to help the person stand and transfer from chair to chair. We spoke to the person and they pointed out the equipment in their room that staff used to do this, which was a standaid. She told us that staff always explain what they are going to do before moving her. Since living at the home she had not fallen and felt well cared for by wonderful staff, who are lovely people and very kind. We later observed two staff moving the person. They did so, by explaining first what they were going to do and then used the equipment provided to safely help the person to stand and then transfer them into a wheelchair. We tracked the care of a person with dementia, who was being treated for an infection as detailed in their care plan. Daily records demonstrated that the GP had visited this person regularly. Antibiotics that had been prescribed by the GP was given as prescribed. Continence advice had also been sought from a specialist practitioner. Staff told us that they were working to the guidance given. In daily records, we read that the persons health was improving as a result of being on antibiotics. The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 14 We met an individual that had epilepsy. They told us they had needed hospital treatment following a fall. They told us that the staff were reassuring and quickly called out the emergency services. The manager also notified the Commission about this incident at the time. Staff that we spoke to had done First Aid training. This incident demonstrates that appropriate emergency help was sought from healthcare professionals for this person. Additionally, that the provider keeps us informed of such events that affect the well being of people. We monitored how the use of bedrails is managed as part of the the improvement plan for the home. Risk assessments showed evidence of review. Following up a matter highlighted at the last key inspection, we looked at how decisions are made with regard to the use of bed rails and whether protective “bumper” cushions were used to prevent entrapment. Bedrails were being used for one person in the home. We read the individuals care file and saw that a consent form for bedsides to be used had been discussed and agreed with the persons advocate as they were unable to consent themselves. Their mental capacity had also been assessed and highlighted who should be involved in decision making for all aspects of care for the individual as they lacked capacity themselves. Additionally, during the tour of the building we saw that bedside bumpers were in situ on the individual’s bed. We were told that staff “always knocked” before entering their rooms and treated people as individuals. We observed that people who were unable to make informed choices due to dementia were dressed individually and were wearing their own jewellery. Staff told us that they knew what people liked to wear because they had asked their relatives about this when they moved into the home. We monitored how medicines are handled as part of the improvement plan for the home. The home uses a monitored dosage system. Senior staff are responsible for stock taking. Records of ordered drugs and a register of controlled drugs were seen and tallied with those being stored. The system was easy to audit and we tracked medication given to five people. Records accurately reflected medication having been administered as prescribed by the GP. All medication was kept in a secure place. A refridgerator, that is lockable, had been purchased specifically for storing medicines since the last key inspection. We observed medication being given to people after the lunch. This was done safely and records were completed appropriately after each person had taken their medication. Other care staff that were spoke to during the inspection told us that medicines are only adminstered by people that are trained to do this. They told us that recent training had taken place in June 2008 covering the safe management of medication. The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. Routines and activities are flexible for people and they are listened to regarding the choice of daily activity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In a survey, we received positive responses from people living in the home about daily life and social activities. We spent time in the lounges observing how staff interacted with people. During the period of observation, activities and stimulation for people with dementia was still limited. People were seen wandering around the home unoccupied and confused on occasions. When staff did engage with people they demonstrated genuine warmth and attention, which people appeared to respond to and enjoy. We looked at records demonstrating what activities had taken place over a two-week period. There were some activities that had taken place included, a sing-along, talking about news from journals and Pet therapy. However, on other days the The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 16 records were blank. On person said that [outside entertainment] doesnt happen often. [And] It would be good for peoples minds to have more going on. Activities are group based and did not always reflect the level of ability that the person had, in particular given the stage of their dementia. To illustrate this point, some people might be more responsive to sensory activities such as painting or aromatherapy. Alternatively other people might be more responsive to cognitively based activities, such as a reminiscence quiz. We also tracked the outcomes for a person with a dementia related illness. We looked at the individual’s care file, which had background information about the person obtained from their family about their life at work, family, friends and interests. Information sent to us by the provider/manager verified that opportunities to stimulate people through leisure and recreation activities in and outside the home need to improve. This should be based on assessment of their needs in terms of occupation, interest and capabilities using evidencebased tool such as The ‘Pool Activity level instrument’. This will ensure that activities are person centred and appropriate for the individual. The home had an ‘open’ feel, with visitors coming and going to see people in the home. Relatives that we met told us that they are ‘always welcomed’ and know who to talk to if they should have any queries. We examined the kitchen, food stores, the home’s menus and spoke to the Chef. A good stock of food was seen and it was evident that there are management controls in place to ensure stock rotation. We were told that flooring in the kitchen had been replaced and there are plans to refurbish the kitchen in the future. The menus demonstrated individual choices at each main meal. Choices were recorded on a list in the kitchen and there was a record of what people had actually eaten each day. The Chef told us that he prepares food for the evening meal which care staff are responsible for heating and/or serving. There was a plentiful supply of fresh vegetables and facilities for steaming these to preserve essential nutrients. We observed a mid-day meal being taken in the home’s dining room on the lower ground floor. This comprised of Roast chicken with vegetables followed by a fruit based dessert. Most people ate this with obvious relish. Their comments were that the food was brilliant. People were offered extra helpings. During the meal, discreet assistance was offered by staff to those who required it. The Chef was aware of the particular dietary requirements of four people with diabetes and one who required a soft diet. The soft meals were being prepared so that each part of the meal was separately liquidised to provide a variety of individual tastes and colours on the plate. We were told that in terms of quality assurance plates come back clean and that there is little waste. The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 17 The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. People at The Regency are protected and able to voice their concerns, if they have any, safe in the knowledge that these will be taken seriously and dealt with promptly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 100 of people responding in a survey verified that they knew how to complain and who to speak to if they were unhappy. The procedure was outlined in the service user guide on the table in the entrance hall. Since the last inspection one complaint had been made to the Commission for Social Care Inspection regarding this home. The manager was asked to investigate the complaint and did so promptly. The majority of the complaint was unsubstantiated. 100 of people responding in a survey felt that the staff always treated them well and listened to them. The home had a written policy and procedure for dealing with suspected allegations of abuse. We spent sometime observing interactions between staff and people living there. Staff engaged with people The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 19 continuously at the right speed and demonstrated genuine warmth and attention, which people appeared to respond to and enjoy. The home holds small amounts of cash for individuals. A sample of these were checked. There were records of all transactions and the amounts counted were correct. We monitored action taken with regard to policies and procedures about the receipt of gifts as part of the improvement plan for the home. All of the staff spoken to demonstrated an awareness of the policy and clearly understood the potential risk to individuals living in the home. We saw a memo that had been sent to all the staff with a copy of the policy. Training records demonstrated that nearly all of the staff had attended a course covering the protection of vulnerable adults. Two staff that we spoke to individually during the inspection also verified this. They had a clear understanding of the concepts of whistle blowing and adult protection issues. We saw a letter demonstrating that additional training had been arranged about safeguarding for two people that had missed the session. Since the last inspection the provider responded promptly to allegations and made a safeguarding referral, which the Commission is involved with. The manager immediately followed the disciplinary procedure for the home to ensure that people living there were protected. The police are in the process of investigating this matter and have reported that the home correctly followed procedures and had detailed records. People described the team as wonderful staff, who are lovely and very kind. The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 20 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 & 26 Quality in this outcome area is adequate. People living at The Regency are provided with an adequately clean and comfortable living environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Regency is a large and complex building situated in the Torrs Park area of Ilfracombe. A short, steep walk provides access to the high street and local amenities. The property has a large sloping garden at the rear to which access was being constructed at the time of our visit. There is on-street parking for visitors. All parts of the premises were inspected. The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 21 An improvement plan was produced to deal with shortfalls in the home’s environment and we monitored progress with this at the random inspection on 15th May 2008 and during this inspection. Building improvements and refurbishment were evident and are commented upon in this and the management sections of the report. For example, alarm devices had been fitted to external doors to alert staff if a person has opened it. This is a particularly important improvement that will safeguard people who are prone to wandering by preventing them from injury on the external fire escape. New carpet had been fitted up to the second floor landing. We looked at the maintenance file, which was well kept and demonstrated that external contractors had been used throughout the year to check compliance of equipment such as the lift, hoists, gas and electrical appliances. Some bedrooms had been redecorated and recarpetted and the home had been rewired. Unfortunately, rewiring of the call bell system had occurred after redecoration which meant that the décor was once again disturbed. The manager told us that this would be addressed over the coming months. Furnishings in individual rooms and communal areas were generally comfortable and homely. This was particularly evident in the large main lounge which is a light, airy and comfortable room overlooking the garden. Whilst some parts of the premises were comfortable and well-decorated, others required considerable decorative attention. For example, the external fire door on the 2nd floor was in a poor state of repair although it did open freely and provided protection from the elements. Additionally, the area near the ramp on the lower ground floor showed signs of penetrating damp. Wallpaper had been stripped off a large area exposing a damp wall with mould growth. We were shown letters from the insurance company that demonstrated this issue was in the process of being dealt with. The provider/manager told us that the home needs considerable refurbishment and that they aim to do this over the course of a few years. They did not have a five year refurbishment plan to demonstrate how this would be done. We recommended that it would help them organise and prioritise work to be done throughout the home. The home was generally clean and odour free. A toilet frame in the toilet on the second floor that had previously found to be dirty and corroded had been replaced. Staff told us that the provider/manager had worked so hard, cleaning and trying to improve the environment. People living in the home also said the same and one person commented XXX has put her heart and soul into the place to improve it. The carpet edge at the top of the ramp in the lower ground floor had been secured and no longer presented a trip hazard. The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 22 People we met during the tour of the building told us there was a maintenance person who is really good. One person said I told him about the door slamming and hes trying to sort it out. Individual rooms all have hand washing facilities. These were supplied with liquid soap and paper towels. Some rooms were provided with facilities according to individual need such as pressure relieving mattresses. Bed rails were fitted in one room and protective “bumper” cushions were in place, which reduced the risk of injury to the person residing there. Radiators in individual rooms were covered. A sample of hand basins and baths we inspected were fitted with hot water regulators. Most bedrooms were fitted with mortice type locks. Many of these continue not to work. We read risk assessments that had been done since the last key inspection. The majority of people that had capacity told us they did not wish to lock their doors. However, one person chose to and used the lock to their room. A ground floor toilet doors did not have a privacy lock that worked. We made the provider/manager aware of this. Infection control measures such as hand washing had been discussed with people living in the home and staff. People we spoke to told us that they are “reminded to wash” their “hands” after using the toilet and before meals. Staff told us that gloves and aprons are always available and that they are encouraged to use them when delivering personal care. Information sent to us by the manager verified that all staff have done infection control training. Additionally, the department of health ‘Essential Steps’ had been used to audit infection control management and an action plan had been put in place. We observed that staff followed safe procedures with regard to separating bed linen and clothing to maintain good infection control. The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate Recruitment practices at the Regency are not robust and therefore fail to protect residents, however training and staff development ensure that competent and knowledgeable staff care for people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the random inspection on 15th May 2008 we found that on 14th; 15th; 16th and 17th May 2008 there was only one person on duty at night in the building. A report of this has been written and is available on request. We issued an immediate requirement that was addressed the same evening by the manager who covered the night shift. They also reviewed staffing levels and have sent us duty rosters since that date to demonstrate that there are sufficient staff on duty. People we met and were able to do so told us that they get help promptly if they need it. We spoke to staff and they verified that there is always two staff on duty at night in the building. We observed that staff were not rushed during the two days we were at the home. The size and layout of the building does present some challenges with regard to how staff are managed and the needs of people living in the home are met. However, it is The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 24 our view that these were generally well met and staffing levels had increased since the random inspection. However, we discussed this issue with the provider/manager and advised them that staffing levels will need to be kept under constant review as the dependency of people living in the home changes and should be increased to meet this. We spoke to the provider/manager about recruitment and they told us that they had appointed four new staff in 2008. We examined the files for these individuals to establish whether the recruitment procedure was robust and had been followed. CRB and POVA checks had been obtained for all 4 new staff. However, other pre-employment checks had been carried out properly for only 2 out of 4 [50 ] new staff. The first file did not have two written references. An undated record demonstrated that a verbal reference had been obtained and a decision made to employ that person. In the second file, a reference had been obtained for the individual after the start date of employment. We looked at duty rosters for weeks commencing 21/4/08 and 28/4/08 and established that the individual had worked on 28/4/08. This was also verified by the provider/manager. A second reference for that person was dated 4/5/08. Therefore recruitment procedures have not been followed and people have not been protected because of this. We discussed our findings with the provider/manager and deputy manager who were reminded about the Commission’s publication ‘Safe and sound? Checking the Suitability of new care staff in regulated social care services’ [available at http:/www.csci.org.uk/pdf/safe_sound_tagged.pdf]. We also clarified best practice in relation to recruitment procedures. New staff had completed equal opportunities and health monitoring forms prior to employment. Information sent to us by the provider/manager tells us that 70 or 7 out of 10 staff hold NVQ level 2 in care and a further 20 or 2 are in the process of doing it. Additionally, staff responding in surveys have verified that they are encouraged to do training. In the 4 files examined, we saw that induction records follow the Skills for Care standards. The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 25 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, 33,35,36 &38 Quality in this outcome area is good. Management monitoring systems are in place that ensure people live in a home that is well run. Excellent initiatives have been put in place that safeguard people unfamiliar with the layout of the home in terms of fire procedures or who are confused. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 26 The Registered Manager (who is also the registered provider) is a registered nurse and is currently studying for the NVQ level 4 in management. She told us that she uses the internet extensively, in particular the Commission’s professional website, to keep up to date thus ensuring that the care delivered is best practice. She had recently downloaded and shared with staff the Commissions publication See me, not just my dementia. Throughout the inspection we found her to have a clear understanding of their role in meeting the stated aims and objectives of the home. Similarly, she provided the Commission with a lot of information in a document entitled AQAA (Annual Quality Assurance Assessment). In it she outlined what the home could do better to improve the quality of life of people living there and how it would be done, in addition to explaining what had been improved. In particular, this highlighted that the adherence to the building and maintenance programme was important to ensure continual improvement to the interior and exterior of the building and better stimulation for people through leisure and recreational activities. This was also borne out in our findings. Our main concern at the inspection has been that the recruitment procedure was not consistently followed. However, we are confident that this will be addressed and audited in the future to ensure that this does not happen again. We observed that there are clear lines of accountability within the home. People told us that the registered provider is also “very much hands” on and asks people for “feedback all the time”. We spoke to four staff and observed practice throughout the day and saw that there is an open door policy that also allows people living there, visitors and staff to speak with the Registered Manager should they wish to do so. People told us that the home was “well run” and that XXX had put her heart and soul into the home and had made huge improvements. We toured the premises and saw that the certificate of registration was displayed in a prominent position where people living in the home and visitors could see it. In a survey staff comments included I like this one the best, everything is done by the book” and they wanted to praise the hard work thats been achieved. Evidence was seen of systems to monitor the quality of the service provided. This included questionnaires and audits of health and safety measures, medication, first aid equipment, care files and night shifts. At the time of our visit an analysis was being undertaken of accidents in the home. A record of the outcomes of these audits showed what action was taken following the audit. For people that are unable to look after their own money, the Regency holds a small float of money for people whose relatives are unable to do this for them. The money is kept in secure facilities. People we spoke to verified this and The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 27 told us that either they managed their own money or relatives did this for them. We saw records that the home kept and checked balances – which were correct – for 3 people living in the home. Appraisal records for 2008 were seen in the staff files we looked at. Staff told us that the manager and provider were always approachable. No other records were seen, which would have demonstrated that staff had supervision sessions other than appraisals. We spoke to the provider/manager and deputy manager about this and they verified that this was an area that needed to be addressed so that they can be sure that staff have the right skills and understand the care needs of older people. We followed up action taken to rectify serious concerns that are in the improvement plan for the home. We were sent copies of letters, which demonstrated that a professional engineer had been consulted about the fire escape. A refurbishment plan had been recommended and letters verified that this had been agreed and work had commenced. This is a long process and will take several months. However we are satisfied that the provider/manager has followed the consultants recommendations and the external fire escape stairs have been made safe. Further work will be part of the ongoing maintenance of the stairs. The stairs had been cleared of debris. Escape routes were also clear. Comprehensive Health & Safety policies and procedures were seen, including a poster displayed in the kitchen stating who was responsible for implementing and reviewing these. In information sent to the Commission, the manager verified that risk assessments are carried out. We saw various examples of this with regard to audits done, which included medicines, fire safety and first aid equipment. As we toured the building we observed cleaning materials were stored securely and used with by staff wearing gloves. Data sheets were in place and staff spoken to understand the risks and strategies to minimise those risks from chemicals used in the building mainly for cleaning and infection control purposes. Records of accidents were kept and showed that appropriate action had been taken. The fire log was examined and demonstrated that fire drills, had taken place regularly. Similarly, the fire alarm had also been regularly checked. People living in the home, and staff told us that the alarm was regularly and “were checked yesterday”. Certificated evidence verified that an engineer had checked the fire equipment. First aid equipment was clearly labelled. Excellent practice was seen with regard to maintaining safety for people in the home. Individual risk assessments had been done that demonstrated that the persons mental capacity and physical capabilities had been considered in the event of fire in the home. Individual fire plans had been produced as a result of these assessments. Nearly all of the staff on duty held a current first aid qualification. Risk assessments for the environment had been reviewed since the last inspection. Maintenance certificates were seen for the heating, electrical and fire alarm systems. The manager had verified in information sent to the Commission that portable electrical appliance checks had been The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 28 done and we were told by people living there that an electrician had looked at their appliances. The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 4 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 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 2 x 3 The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 30 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 OP29 Regulation 19(4)b(i) Requirement The registered provider must ensure that people living at the home are safeguarded by ensuring that thorough preemployment checks have been carried out on all new employees prior to their commencement of duties at the home. Timescale for action 14/09/08 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 OP12 Good Practice Recommendations The recreational needs of people, particularly those with dementia or communication difficulties, should be assessed using a tool such as the ‘Pool Activity level instrument’. Activities would then be person centred and pitched at a level that is suitable for the individual. A five year refurbishment plan for the premises should be developed to demonstrate where priorities lie with the aim of improving the quality of accommodation for people DS0000065822.V365069.R01.S.doc Version 5.2 Page 31 2. OP19 The Regency 3 OP36 living in the home. Staff should receive 1:1 supervision six times a year and a record be kept of it. This will ensure that staff follow best practice and are supported when caring for people living in the home. The Regency DS0000065822.V365069.R01.S.doc Version 5.2 Page 32 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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