Inspection on 05/06/07 for The Sharmway

This inspection was carried out on 5th June 2007.

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

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

Other inspections for this house

The Sharmway 20/12/05

The Sharmway 25/07/05

The Sharmway 04/02/05

The Sharmway 01/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE The Sharmway 113 Handsworth Wood Road Handsworth Birmingham West Midlands B20 2PH Lead Inspector Monica Heaselgrave Key Unannounced Inspection 5th & 6th June 2007 12:30 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 Sharmway DS0000017027.V337815.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 Sharmway DS0000017027.V337815.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Sharmway Address 113 Handsworth Wood Road Handsworth Birmingham West Midlands B20 2PH 0121 554 6061 F/P 0121 554 6061 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Winnie Purcell Mrs Winnie Purcell Care Home 11 Category(ies) of Old age, not falling within any other category registration, with number (11) of places The Sharmway DS0000017027.V337815.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th October 2006 Brief Description of the Service: The Sharmway is a three storey detached property located along Handsworth Wood Road. It accommodates up to 11 older adults, and is within access of public transport links to Birmingham City Centre. The home is close to local facilities including shops and places of worship. The property comprises of a double bedroom on the ground floor, with screens and wash hand basin. There is a WC with wash hand basin by the front entrance. A shower facility, laundry and kitchen are located along the hall. Adjacent to these are two lounge areas to the front and rear of the property, the front one is utilised as a dining room and seats eleven service users. The first floor is accessed via a stair lift, and has four single bedrooms and one double, a shower facility and bathroom with bath hoist chair. Two further WCs are sited on this floor. The second floor is accessed via stairs, and has two single and one double bedroom, with bathroom and WC facilities. All bedrooms are lockable and have a hand wash basin, covered radiators, window restrictors and an emergency call system. Sited around the home is ramped access to the side of the property, and parallel handrails either side of the front passageway. There is a large wellmaintained garden to the rear, and front car parking. The fees for this home are £332 pounds a week, and an additional £10 top up charge is payable. The Sharmway DS0000017027.V337815.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector spent a day and a half at the home during which a partial tour of the home was undertaken. Several records were looked at to include, the files for three of the people living in the home, and three staff. Information was gathered from speaking with people who live at the home, relatives and staff. Care, health and safety and the arrangements for medications were reviewed. Staff personnel files were checked and staff observed whilst performing their duties. Comments were also received from the questionnaires completed by people who live at the home, their relatives and visiting professionals and friends. The inspector observed both lunch and dinner, and spoke with the manager, deputy, three staff and five of the people living there. The home had a random inspection in October 2006. The reason for that visit was to follow up concerns made regarding the care and support offered to a person living there. Areas assessed during that visit were care planning, management of continence, health care and medication. Progress made following that visit is commented on in this report. Prior to this inspection information was received by the Commission regarding the conduct of a staff member. This had been managed by the home using their disciplinary procedures. This issue did not concern the wellbeing or safety of the people being cared for, and was not within the remit of the Commission to look into. This unannounced fieldwork visit was the homes key inspection for the inspection year 2007 to 2008. At the conclusion verbal feedback was given to the manager. No Immediate Requirements were made. What the service does well: The Sharmway offers a small group living experience, within which the routines are relaxed. Staff are experienced in meeting the needs of people from West Indian, Irish, Caribbean, and white European origin. Positive comments were received from people who live at the home, their relatives and visiting professionals. One said ‘the cultural consideration of Irish people was particularly important in this placement’. The Sharmway DS0000017027.V337815.R01.S.doc Version 5.2 Page 6 The pre admission assessment ensures that staff prior to admission knows the needs of the people moving into the home. Relatives felt that visiting the home prior to moving in helped them to determine their choice of home. There appeared to be a relaxed and welcoming atmosphere and staff were noted to interact well with the people they care for and their families. The needs of people living in the home are being identified which means arrangements are in place to promote their health and wellbeing. Care plans were generally well detailed which means that staff know how to respond to individual needs. Risk assessments were detailed which means risks to people living in the home, such as falling, developing pressure sores or losing weight were reduced as much as possible. Choices and standards of the meals are good and people are encouraged to have a healthy die. There is a stable staff team who have known the people they care for, for a number of years. This means the people who live in the home can enjoy continuity of care. Some of the people who live in the home have dementia and or loss of memory and were unable to voice an opinion on their care. Observation of them in the company of staff indicated they were happy and relaxed. Facilities are clean, comfortable and homely, which ensures a good degree of comfort for the people who live there. What has improved since the last inspection? The issues raised at the last inspection concerning the lack of records relating to the health care of people living in the home, have been addressed. Records now show concerns noted, access to the G.P and other health professionals, and the outcome of the consultation. This ensures any concerns are identified quickly and people have access to the treatment they need. Daily records have improved and provide better detail as to the daily activity of the person being cared for, this means it is easier to monitor if someone has eaten well, enjoyed an activity or had a visitor. It also ensures that where the usual pattern differs, changing needs can be identified an acted upon quickly. Records of bowel movements are now maintained, demonstrating that the people who live there, are well supported in this area. The Sharmway DS0000017027.V337815.R01.S.doc Version 5.2 Page 7 Regular checks on weight are maintained which means that people living in the home who have difficulties with eating or weight loss are monitored and brought to the GP’s attention. 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 Sharmway DS0000017027.V337815.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Sharmway DS0000017027.V337815.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 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pre admission assessment process ensured the staff at the home knew the needs of people being admitted and could make an informed decision as to whether the home could meet their needs. People were able to visit the home prior to admission to assess the facilities available. EVIDENCE: The files for three people recently admitted were sampled. All the files included an assessment. The assessments seen showed that all aspects of daily living are assessed and a care plan drawn up to show how these will be met. The AQAA (a pre inspection questionnaire completed prior to the visit) provided information about how the service aims to carry out assessments and care planning to meet the needs of the people who are admitted. The AQAA stated that new people are admitted on the basis of a full and comprehensive assessment that is carried out by the manager or the deputy manager, and that the assessment is undertaken with the person and or their representative. The Sharmway DS0000017027.V337815.R01.S.doc Version 5.2 Page 10 The three files reflected the process described in the AQAA; they included a pre admission assessment undertaken by the manager. Areas covered by the assessments included; *Personal details such as name date of birth, address, GP, next of kin, and social worker. *Personal care and physical wellbeing including weight, blood pressure, pulse and temperature, medication, diet and dietary preferences. *Communication needs such as sight and hearing and any communication problems, or oral health needs. *Foot care, and mobility, personal safety and risk assessments for falling. *Care needs such as washing, dressing, toileting, continence, tissue viability and mental wellbeing. *Social interests, and contact with family & friends. * Religious and cultural needs, so that staff knew the things that were important to the person, and how these were to be met. *Arrangements for death & dying to ensure everyone knew what individual preferences were to be respected. One file showed that transfer notes were obtained from the previous placement this is good practice because it enables the service to assess the needs of the person. These gave information on past history, and presenting behavioural needs. When cross-referenced with The Sharmway assessment, this did not identify any behavioural needs. The manager said that the transfer notes were received after admission, and that there had been no concerns regarding behaviour whilst at The Sharmway. In these circumstances any subsequent information or changes should be added to the care plan at the monthly review. This will ensure staff are kept informed of potential needs and how to respond to these. A social worker spoken with said that pre admission visits had been made to the home to help determine it could meet the needs of the person. These visits had been described as positive and informative, and that the cultural consideration of Irish people was particularly important in this placement. A relative spoken with confirmed that pre admission visits had been made and that this had helped to determine her choice of home, she was particularly pleased that the facilities were always clean, no odours, and that staff were friendly and welcoming. The files sampled showed assessments were signed by the resident and in one instance the son of a resident, suggesting that they had been involved with and agreed with the assessment. The Sharmway provides respite care on occasions. The Sharmway does not provide intermediate care. The Sharmway DS0000017027.V337815.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 good. This judgement has been made using available evidence including a visit to this service. The needs of people living in the home are being identified and arrangements are put in place to promote their health and wellbeing. However the care plan lacks the written detail as to how continence and behaviour is managed, this is needed to ensure staff have the information to support the needs of the person. Staff practices in respect of safe administration of medications need to be improved to ensure that medications are administered safely. EVIDENCE: The Sharmway DS0000017027.V337815.R01.S.doc Version 5.2 Page 12 The care files of three people living in the home were sampled. These people had been admitted to the home in the last twelve months, one very recently. The care plans were well detailed and included comments in relation to personal care, dressing, oral hygiene, skin care, mobility, cultural, social needs, tissue viability and diet. Each care plan had instructions to staff as to how to carry out a task and this was then in turn linked to their training. Care plans are broken down into subject headings such as, ‘Creating a safe environment’. This then identifies what needs to be done to keep the person safe. An example of this for a person with impaired vision was, ’keep obstacle free’, ‘warn of fire alarm’, and ‘show fire exits’. The care plan identified care instructions such as ‘likes the radio in her room’, and ‘likes to stay in her bedroom. The care plan included a risk assessment for falling, and this was linked to the persons’ impaired vision and the added risk of hallucinations. This said ‘needs guidance around the home.’ Some people living in the home had specific needs in relation to their hair and skin care due to their ethnicity and these were clearly detailed, for example, ‘ ‘skin care coconut butter oil’. Issues with continence were identified in the initial assessment for one person but the care plan lacked written detail as to the sizes of the aids to be used, frequency of change and what care at night was needed. This is important to ensure all staff are aware of the aids to be used, and that care is person centred. Staff were able to describe these elements, ensuring that the outcome for the person being cared for was good. One care plan needed to be updated. There was information on file that indicated behaviour needs and this was not referred to in the care plan. The manager said that the assessment information had come to light after admission and that there had been no behavioural concerns shown by the person. The daily records were looked at some entries were made by staff such as ‘getting angry all the time, bad language, didn’t want to change clothes’. There is a monthly review of care plans, which means that changing needs can be identified and care plans updated to show how these are to be met. The review notes did not indicate that this had been done in this instance. Discussion with staff indicated that they had a good understanding of this persons’ needs and how to encourage and support the person, this needs to be written into the care plan so that all staff know how to respond to these needs. The manager was able to tell the inspectors how staff managed this but it needed to be recorded. Discussion with the Social worker identified that general wellbeing had improved, as had hygiene needs and a reduction in medication had taken place. Overall the outcome was positive, the needs of this person were being met. All the people living in the home had had tissue viability and nutritional screenings. Where a risk had been identified this information had been included on the care plan. For example one of the individuals being case tracked was at risk of developing pressure sores and the details of how staff were to try and avoid this happening was detailed on her plan. Reminding staff to check her skin, apply cream and report any changes. All the people being case tracked had manual handling risk assessments. This ensures that staff supports people appropriately and safely around the home. There was ample evidence that the personal and health care needs of the people living in the home were being met. Daily records evidenced the monitoring of ongoing health concerns. There has been a big improvement in ensuring a clear audit trail in the daily records. The new format of the daily records enables the staff to specify the concern, what was done for example the G.P. was called, and the outcome of that visit. One person told the inspector about a health concern, this was checked against the daily records and it was apparent the G.P. had been called and the outcome of the consultation was recorded, this means where people have concerns they have access to healthcare professionals, without delay. People in the home are referred to and maintain links with specialist health care professionals as necessary for example, Psychiatrist, mental health team, as well as having regular visits from G.Ps, district nurses, opticians and so on. The inspector received a number of completed questionnaires from visiting professionals who commented on the good standard of healthcare provided, some of the comments received were: ‘They are well looked after by Winnie and her staff team who show an ethical caring attitude’. ‘I do not have any concerns about the care they provide’. ‘Physically her appearance has changed for the better, hair cut, clothes clean and has gained weight, general wellbeing, is much better’. The arrangements for the ordering receipt, and storage of medications was assessed and found to be appropriate. The medication round was observed and a number of concerns were noted; the staff member handled medication when popping it from the blister pack, as apposed to popping it directly into the medicine tot without touching it. This is not hygienic and can contaminate tablets. Medication was not checked against the MAR chart before being given to ensure the correct medication is drawn up, and this could lead to errors. One person threw their tablet on the floor the staff member picked it up and offered it again. Three people refused their medication this was not entered on the MAR charts until after the medication round, at the same time as signing for those who had taken their medication. This needs to be avoided to ensure that the correct medication and amounts are being administered to people and signed for at that time to avoid any errors. These concerns potentially put people who live in the home at risk. The AQAA completed by the manager prior to the visit stated that staff administering all medications, including controlled drugs have undertaken formal training and also undertake on going training in the home to ensure safety and adequate knowledge of medications. The staff record showed that the member of staff had not received formal training in the Safe Handling Of medicines. The records for the second staff member present during the medication round showed formal training had been completed. Staff administering medication must receive accredited training to ensure their practice is safe and they are competent to undertake this task. These concerns were discussed with the manager. The staff member will cease administering medication until formal training has been completed. No issues were raised in relation to the privacy and dignity of the people living in the home during the course of the inspection or on the completed questionnaires that were returned to the Commission. Staff addressed the people living in the home appropriately and by the name of their choice. The G.P. confirmed that consultations are held in the privacy of peoples’ own rooms. A random inspection took place in October 2006 to follow up on concerns made regarding the care and support offered to a person living in the home. At this visit the inspector found that the majority of requirements made at that time had been met. These included: The daily records have improved so that care staff can elaborate on the outcome of any concerns. Records of bowel movements are maintained, and it was possible to establish from the records that the home was supporting people who live there, well in this area. Daily notes available at the home now show when people have seen the GP, Chiropodist and Dentist, and the outcome of these consultations is recorded. It was evident that people living in the home had been weighed at regular intervals, and those difficulties with eating or weight loss are monitored and brought to the GP’s attention. Concern had been raised that the food offered at The Sharmway was not nutritious. The food store at the time of that and this inspection showed a wide range of fresh vegetables, and a selection of meat products. It was requested advice from Environmental Health on the best way to cool, chill, and reheat meals was sought. This was not assessed on this occasion and remains outstanding. As a result of this inspection, the manager must ensure that staff that administer medication have undertaken formal training to do so. The way in which incontinence is to be managed must be planned for in the service users care plan. This should include any advice from the continence nurse on appropriate products to use with each service user, arrange a supply of such items, the sizes of the aids to be used, frequency of change and what care at night is needed. The way in which aggression is to be managed must be planned for in the service users care plan to ensure that aggression is managed safely. 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. There were no rigid rules or routines in the home and there were activities available for those people wishing to take part. There were no restrictions on visitors to the home and they were made welcome by staff. The meals in the home met the needs of the people living there. EVIDENCE: People living in the home were sat either in the rear lounge looking out onto the garden, or in the front dining room listening to Irish music, or watching T.V. Two people sitting in the lounge were spoken with at the start of the inspection and told the inspector they were comfortable and happy in the home. Comments received from the people living in the home included: ‘I enjoy living here and am happy here’ ‘I am happy at the home’ ‘I like it here the staff are nice’ There were no rigid rules or routines in the home and the people living there were able to choose to join in a ‘keep fit’ session, the staff member was observed to be friendly and light hearted to enhance peoples enjoyment. The hobbies and preferred leisure pursuits were detailed on individual care plans. The daily records have been improved since the last inspection visit and now give better information as to the activities people take part in. Those sampled had the following entries: reading, T.V, music, joined in Communion service, read the Metro paper, watched a video, looked at magazines, had a visitor from the church services. Discussion with staff identified that a varied amount of other activity has taken place to include, parties at Christmas, birthdays, shopping trips, and choir visits to the home. The AQAA gave some indication that the service is looking at other types of activities that would suit people who live in the home, and ways of encouraging them to participate. Some activities were said to have taken place but were not recorded in the daily records this included: nail polishing; make up sessions, and hair care. It’s important to include the detail of what activity people engage in so that this is tailored to meet their individual needs, and demonstrates that people have a variety of stimulating activities programmed for them to choose from. Four questionnaires were received from the people who live in the home. These asked people to comment on whether activities they can take part in are arranged. Two responded ‘sometimes’ and one ‘usually.’ A fourth had no comment to make. The AQAA said that in house audits of activities have taken place, and indicated that the home does very well in this area. It also stated their intention to look at other types of activities that would suit the people who live there. The outcome of these should be useful for identifying a good variety is on offer. One visitor who visits the home regularly commented on their questionnaire: ‘ I feel that the people looking after my friend do everything that is possible, whenever I go I am always made welcome and offered tea and biscuits.’ One person spoke to the inspector about waiting for her friend from the church to visit. The inspector also received questionnaires from regular visitors to the home to include a Reverend at the local church, a Pastoral visitor, and a Social Worker. The service maintains links with their local community enabling the people who live in the home, to continue to enjoy these. Visitors were seen to come and go throughout the course of the inspection and all appeared to be made very welcome by staff. The people living in the home were encouraged to exercise choice and control over their lives. Likes and dislikes were documented and known by staff. They were able to get up and go to bed when they chose and spend their time as they wished. There were regular meetings with the people living in the home where their views on a variety of topics were discussed. All the bedrooms seen were personalised to the occupants choosing. A random inspection in October 2006 to follow up concerns, found the food stock at that and this inspection had a wide range of fresh vegetables, and a selection of meat products. It was requested at that time that advice from Environmental Health on the best way to cool, chill, and reheat meals was sought. Birmingham City Council provided training as to the safe standards of food and hygiene, which incorporated cooling, chilling and reheating foods. The menus were not sampled on this visit. The inspector observed lunchtime and teatime over the two days and spoke to some of the people having their meals. They were satisfied with the food in the home, which was wholesome and plentiful, and were clearly enjoying this. Appropriate assistance was being given to those who needed help. The likes and dislikes of the people living in the home were detailed in their care plan and followed up in their daily records for example, one person does not eat at regular intervals and prefers to eat in the bedroom. The daily records showed what food was offered, if it was refused, and whether an alternative was offered. In discussion with the family they said they had concerns about the lack of eating and didn’t‘ know if sandwiches were offered. The daily records showed a good audit trail of what was offered and eaten, for example ‘sandwich offered, toast eaten, and tea and cake eaten.’ It was positive to note that nutritional screening is undertaken, and a record of weights of people maintained. A comparison of these showed a weight gain for people living in the home. A social worker commented in a recent review held at the home that the person had gained weight. The previous inspection to the home showed that the cultural needs of people in relation to meals was being well met. These people still reside at the home and it was evident that appropriate meals were provided. The people at the home enjoy curry and rice, mango and a variety of ‘take away’ meals. 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. This judgement has been made using available evidence including a visit to this service. People who live at the home and their family are confident that their views will be listened to and complaints dealt with effectively. The arrangements in respect of adult protection protect people from risks of harm. EVIDENCE: The complaints procedure is simple and clear to follow. It is available in the Service User Guide, in each bedroom and on the notice board. Details of how to complain are also stated in the service users contract. These documents are in large print and bold type, which makes them easier for people to see and access. The AQAA stated that the complaints procedures are up for review, these were not looked at during this visit. There is a niggles and comments book where comments can be made if someone does not wish to make a formal complaint there were no entries in this. The manager said there had been no formal complaints lodged with the home since the last inspection. It was positive to see that where people who live in the home raise concerns, these are listened to. One resident had recently told the manager she was left waiting for a member of staff to assist her. The manager said she had spoken with the staff member. The manager was advised to record the issue in a complaints book specifying what action had been taken to resolve this. A complaints book was not available but on the second day of the visit, this had been implemented. This will ensure that the home can demonstrate that they respond to concerns raised. Questionnaires received by the inspector indicated that people who live in the home and or their relative know how to raise their concerns and are confident they will be listened to. The Commission had received information from the manager that disciplinary action had been taken resulting in a staff member being dismissed. This was discussed with the manager who confirmed this was in relation to issues, which are not within the remit of the Commission to look into, and not issues that concerned the safety and welfare of the people who live in the home. From the discussion it would appear that the manager had followed their own disciplinary procedures, but the record of this, which was said to be in the formal supervision notes, was not available. (The manager provided the inspector with an explanation for this.) The manager is aware that adult protection issues must be referred to Social Care and Health and they will decide how to proceed with any investigation. The AQAA confirmed that the service is aware of the procedures for suspicion or evidence of abuse or neglect, and stated that training in POVA (Protection Of Vulnerable Adults) procedures is incorporated into the training program and formal supervision for all staff. This will ensure that staff takes appropriate steps in the event they have any suspicion of abuse. The files for two staff included basic training in relation to Adult Protection and Whistle Blowing. People who live in the home are protected by the recruitment practices; two staff files were sampled and showed that all the necessary checks had been carried out before being employed to work with vulnerable adults. It was positive to see that the requirements made at the random inspection in October 2006 have been met. There were good examples in the daily records that showed discussions with relatives are recorded. This is particularly important where they may be a difference of opinion. This ensures an accurate record is available of events that may affect the people who live in the home. 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 good. This judgement has been made using available evidence including a visit to this service. The home provides a warm, comfortable and well-maintained environment. There are sufficient facilities and equipment to assist people who have restricted mobility. Infection control and hygiene practices prevent people from developing infections. EVIDENCE: A tour of the home was carried out during the course of the inspection and some bedrooms were sampled. There had been no changes to the layout of the home since the last inspection. The exterior of the home remains well maintained with a garden to the front with flowers and shrubs. Ramped access to the side of the property, and parallel handrails either side of the front passageway, allow for people to have easy access to the property. The lounge and dining area are spacious and well laid out enabling people to move around safely, these are comfortably furnished and decorated. The rear lounge has a large patio door to the garden, this offers a nice view for the people but on a bright sunny day the sun is very bright and the room quite hot. Some protective covering is needed to shade the people in the lounge. The rear garden is spacious, well maintained, and relatively level. Some people were seen to enjoy sitting out or walking around. There are an adequate numbers of bathrooms, shower rooms and toilets throughout the home. These facilities allowed for assistance from staff, and are within reach of communal areas so that people who live in the home can access them without too much difficulty. The manager was advised that floor mats seen in the bathroom and toilet are potentially a trip hazard and should be removed to ensure no one has a fall. There were some aids and adaptations throughout the home including a stair lift, emergency call system, and grab rails, which enabled some people to move around more independently. Bedrooms were personalised to the occupants’ choosing with personal effects. Decoration was satisfactory, and bedding and flooring in good repair. Rooms were clean and tidy and well ventilated, one window restrictor was faulty and requires replacement/repair to ensure the safety of the occupant. The home was clean and odour free. The main kitchen was not inspected during this visit. The laundry room has a sluice that is able to cater for soiled items .An industrial sluice washing machine with specific programmes to meet disinfection standards is used. The AQAA stated that a clinical waste contract is in place to ensure collection of clinical waste to comply with infection control procedures. All staff is trained in accordance with infection control and its prevention. 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 good. This judgement has been made using available evidence including a visit to this service. The people living in the home receive care and support from a stable staff team with appropriate staffing levels to meet their needs. Staff is competent in meeting the needs of the people they care for and recruitment practices ensure people are safe and protected. EVIDENCE: The staffing rota viewed showed that staffing levels were at the required level, and the people on duty on the day of the visit matched those on the rota. Staff rotas do not tend to change from week to week; staff has the same shifts permanently unless they are on holiday. The staff team has been retained for many years and knows the people who live in the home, well. This provides a degree of continuity for the people who live there. Staff members have various levels of experience in caring for older people, and all are in training for NVQ National Vocational Qualification, at various levels. The AQAA completed by the manager states that 77 of staff have achieved NVQ Level 2 or above. Five staff has NVQ Level 2, and two staff is currently working towards it. This will help to ensure that the skill mix of staff on duty will support meeting the needs of the people who live there. The manager who is also the proprietor, works in the home on a daily basis and this ensures she is available for the people who live there, relatives and staff to approach should they need to. A number of people and their relatives were positive in their comments regarding the staff; ‘They are good, I feel I can talk to them.’ ‘I think they are well looked after, although my (relative) can’t tell me anything, but has retained a reasonable weight and staff say (relative) has eaten well’. ‘ I visit regularly, and always find it clean, no odours and I think the staff are good.’ On the day of the visit the interaction between staff and people who live in the home was positive, people seemed relaxed in the company of staff, some engaged in a keep fit session and appeared to be enjoying this. At peak periods in the day such as dinnertime, the routine was relaxed and unhurried. The recruitment procedures ensure that staff is employed following appropriate checks being carried out prior to being employed. This ensures a greater degree of safety for the people who live in the home. Since the last visit to the home one new member of staff has been recruited. This file was not looked at during this visit. Two staff personnel files were checked and gave information about the homes recruitment arrangements. They indicated that all of the required checks are carried out and two written references are obtained before a post is offered. This suggests that the safety of people who live in the home is paramount. The Information provided on the AQAA states that there are procedures in place to ensure staff are safe to work in the home with the use of preemployment checks to include CRB (Criminal Records Bureau check, and a POVA 1st check). Upon employment all staff undertake the homes’ Induction training. The training matrix for the most recent staff member showed that First Aid, Manual Handling, Health and Safety, Fire Awareness, Food Hygiene, Medication, and COSHH was covered on Induction. However the accredited Safe Handling Of Medicines was not, and this staff member was seen administering medication and shortfalls in practice were noted. The manager said that the staff member had been nominated to attend the Safe Handling Of Medicines training. The AQAA stated that new would staff undertake TOPSS training. Skills for Care Induction training documentation should be available for use with any new staff employed. The staff file did state that the staff member was awaiting this Induction. This will ensure that staff is equipped with the specific skills necessary for meeting specialist needs of older people. Discussion with a staff member showed a good understanding of the principles of care and what standards are expected from them, ensuring that the care delivered to people in the home is of a good standard. The AQAA stated that all staff had received training in the Prevention Of Infection And Management Of Infection Control. A 100 of catering staff and 50 of care staff had Safe Handling Of Food training, and this is important to ensure food safety standards are known by care staff who at times prepare and cook the meals. Staff meetings are undertaken but the manager said that it is difficult to get staff in for these meetings and so staff supervision and appraisals are utilised to ensure communication and promote teamwork. Three staff files showed that regular supervision and staff appraisal take place, and that within this, shortfalls in essential training had been identified and staff had been nominated to attend the relevant courses. 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, & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is experienced and possesses the skills to oversee the day- today running of the home. There are quality assurance arrangements in place with a view to improving the service on offer. Some improvements have been made for the benefit of those who live at the home. Arrangements are generally sufficient to ensure the health and safety of people who live in the home although some areas required improvement to ensure the risk of accident is minimised. EVIDENCE: There have been no changes to the management arrangements since the previous inspection. The manager who is also the proprietor had commenced her NVQ Level 4 in Care and Management in 2005. The training was interrupted for health reasons and remains outstanding. The manager was present throughout the course of the inspection. She had a good knowledge of the needs of the people living in the home. The deputy is a qualified RGN and has worked in the community as an Advanced Nurse practitioner with older adults. She is the daughter of the manager, and works part time. Both have a wide range of experience, in meeting the needs of older persons. Quality assurance documentation is being produced. Questionnaires have been developed and sent out to people who live in the home, and visitors. The AQAA completed by the manager suggested this is still a developing area. More selfassessment is proposed to make changes for the people who live there. The development of records that show the outcome of these surveys, for instance how the views and wishes of people who live in the home have been acted upon still needs some development. The manager discussed some audits that take place, for example Fire Safety, Food, Health and Safety practices, Manual Handling, Infection Control, Falls risk assessments, and Control Of Substances Hazardous To Health. (COSHH). These are undertaken three monthly, and ensure that the wellbeing of the people who live in, work in and visit the home is promoted. Their relatives manage the financial affairs of people, who live at the home. Where people require personal items there is a system in place to bill relatives, this includes retaining the receipts for expenditure undertaken on their behalf. The health and safety of the people living in the home and the staff was generally well managed. The in house checks on the fire system were up to date and fire drills were being undertaken regularly. There was evidence on site that the equipment was being serviced as required including gas appliances, fire extinguishers, fire alarms, hoist, stair lift and the emergency call system. The AQAA also provided information that equipment had been serviced this year. A window restrictor was faulty and needs to be repaired to ensure the occupant of the room is safe. The floor mats in bathrooms need to be removed as these are a trip hazard. The outcome of the fire risk assessment must state the control measures that are in place to protect people from the risk of fire. 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 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 OP8 Regulation 12(1)(a) Requirement The continence needs of people who live in the home must be included in the plan of care. The care plan should detail all their needs in relation to continence and how they are to be met by staff. This will ensure that the people living in the home receive person centred care, and that staff have the information they need to meet these needs. Any intervention plan for aggression must be included in the plan of care. The care plan should detail all the needs in relation to aggression and how they are to be met by staff. This will ensure that the people living in the home receive person centred care, and that staff have the information they need to meet these needs. Timescale for action 31/07/07 2. OP8 12(1)(a) 31/07/07 3. OP9 13(2) 4. OP31 10(1)(3) 5. OP38 13(4)(A) Staff who administers medication 20/08/07 must have up to date accredited training in the Safe Handling Of Medicines. This will ensure the people living in the home receive their medication safely. Suitable arrangements must be 31/07/07 made for the manager, and made known to the Commission for the Registered Manager to complete NVQ level 4 training in care and management. This will ensure she has the necessary qualifications to run the home. This is an outstanding requirement Floor mats in the bathroom and 31/07/07 toilet are potentially a trip hazard and should be removed This will ensure the people living in the home are protected from accidents. One faulty window restrictor requires replacement/repair to ensure the safety of the occupant. The outcome of the fire risk assessment must state the control measures that are in place. This will ensure people who live and work in the home are protected from the risk of fire. 6. OP38 23(4)(A) 31/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations When assessment information is received after the admission of a person the care plan needs to be revised, to ensure the needs of the people being admitted to the home are known by staff. This will ensure that the records support and advise the staff in how to meet needs Records that show the outcome of quality assurance surveys, for instance how the views and wishes of people who live in the home have been acted upon still needs some development. 2 OP33 Commission for Social Care Inspection Birmingham Record Management Unit 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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