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Inspection on 20/02/09 for The Squirrels Care Centre

Also see our care home review for The Squirrels Care Centre for more information

This inspection was carried out on 20th February 2009.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

No people are admitted to the care home without having their needs assessed. People who use the service are able to raise concerns and there is an effective complaints procedure in place. Visitors to the home are made to feel welcome. The quality of meals provided to people living at the care home remains good. Positive comments were noted from residents and these are recorded within the main text of the report.

What has improved since the last inspection?

The quality of records kept when medicines are received into the home, administered to residents and disposed of have improved and provide a good audit trail of medicines. This also demonstrates that residents receive the medicines prescribed for them. Records relating to the healthcare needs of individual people living at the care home have now improved. Records showed that where concerns are raised, these are promptly addressed and where appropriate, healthcare professionals are consulted for advice. Some aspects of the care planning processes have now improved. Of those care files examined, records showed these had been rewritten, reviewed and updated. Some members of staff have received care planning training. People living at the care home now receive a more varied programme of social activities. The management team of the home have been proactive in providing training for staff in both core and specialist subject areas. All staff newly employed at the care home, receive a formal induction.

What the care home could do better:

There must be procedures in place to ensure residents don`t run out of medication and so their treatment can be continued uninterrupted. Medication must, also never be left unattended and accessible by unauthorised people. Further development is required in relation to care planning/risk assessing processes. People living at the care home and/or their relatives need to be involved in the care planning processes. Appropriate staffing levels at the home must be maintained so as to make sure residents needs are met at all times. Further improvement needs to be made to ensure that robust recruitment procedures are adopted. Not all staff receive formal supervision on a regular basis.

CARE HOMES FOR OLDER PEOPLE The Squirrels Care Centre Warley Road Great Warley Brentwood Essex CM13 3HX Lead Inspector Michelle Love Unannounced Inspection 10:10 20 February 2009 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 Squirrels Care Centre DS0000018113.V373635.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 Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Squirrels Care Centre Address Warley Road Great Warley Brentwood Essex CM13 3HX 01277 224308 01277 261353 thesquirrels@schealthcare.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited 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) Roda Magwizi Care Home 58 Category(ies) of Old age, not falling within any other category registration, with number (58) of places The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Personal care to be provided to no more than fifty eight service users over 65 years. Total number of service users for whom personal care is to be provided shall not exceed 58. 18th August and 9th September 2008 Date of last inspection Brief Description of the Service: Ashbourne (Eton) Ltd., which is part of Southern Cross Ltd., owns the Squirrels Care Centre. The home provides personal care and accommodation for up to fifty-eight older people. The home is a large listed building and is situated in extensive grounds in a rural location some distance from shops and public transport. The home provides transport to both staff and visitors. There are car-parking facilities at the front of the property. The home provides single and double bedrooms and all rooms have en-suite WC facilities. There are two lounges and a large separate dining room. Passenger lifts provide access to all upper floors. As at 20th February 2009, we were advised that the fees for accommodation range from £465.00 to £750.00 per week. Extras to the fees include hairdressing, chiropody, personal toiletries, magazines and newspapers. Information about the services provided at the home is located within the homes main reception area. Inspection reports are available from the home and from the CSCI website www.csci.org.uk The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection. The visit took place over one day by one inspector and lasted a total of 8.5 hours, with all but one key standard inspected. Additionally, medication practices and procedures were examined by a pharmacist inspector. Progress against previous requirements from the last key inspection were also inspected. Prior to this inspection, the manager had submitted an Annual Quality Assurance Assessment. This is a self-assessment document detailing what the home does well, what could be done better and what needs improving. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. A partial tour of the premises was undertaken, residents and members of staff were spoken with and their comments are used throughout the main text of the report. Prior to the inspection, surveys were forwarded from us to the home for distribution. Surveys were forwarded to residents, staff and healthcare professionals. Where these have been returned to us with comments, these have been incorporated into the main text of the report. The manager, deputy manager, operations manager and members of care staff, assisted both inspectors during the site visit. Feedback on the inspection findings were summarised at the end of the inspection. The opportunity for discussion and/or clarification was given. What the service does well: No people are admitted to the care home without having their needs assessed. People who use the service are able to raise concerns and there is an effective complaints procedure in place. Visitors to the home are made to feel welcome. The quality of meals provided to people living at the care home remains good. Positive comments were noted from residents and these are recorded within the main text of the report. The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A robust assessment process ensures that people wanting to move into the home can be confident that their needs will be met. EVIDENCE: A Statement of Purpose and Service Users Guide is readily available within the care home, providing information relating to the care homes aims and objectives and details of the services and facilities available. All people living at the care home are provided with a copy of the Service Users Guide. A copy of both documents is also available on audio cassette. As part of the service’s own quality assurance, the results of 17 completed surveys recorded that all had seen a copy of the Statement of Purpose and Service Users Guide. There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff team are able to meet the prospective residents needs. In addition to the formal assessment procedure, supplementary The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 9 information is sought from the individual residents placing authority and/or hospital. The AQAA details, “prior to admission a detailed needs assessment is completed to ensure that all service user needs can be met” and “pre admission assessment information is now more in depth and reflects prospective resident’s immediate needs before admission”. As part of the inspection process, two care files for the newest people to be admitted to The Squirrels were examined. Records showed that admissions are not made to the home until a full needs assessment has been undertaken and only if the service is confident that it can meet the needs of the prospective person. Both pre admission assessments, were seen to be detailed, informative and included evidence to show that the person and/or their representative had been involved in the assessment process. Records showed that the prospective person and/or their representative are offered an opportunity to visit the care home prior to their admission. Staff surveys returned to us, recorded that staff felt they were given sufficient information about the needs of the people they provide support to. Relative’s surveys recorded mixed comments, with some people stating they were provided with sufficient information, whilst others felt that this was not always forthcoming. One survey recorded, “It is necessary to be proactive in seeking information, little is volunteered”. The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People receive care in the way that they would wish, according to their agreed and documented needs and preferences. EVIDENCE: Records show there is a formal care planning system in place to help staff identify the care needs of individual people and to specify how these needs are to be met by care staff. Additionally, formal assessments relating to dependency, pressure area care, nutrition, manual handling, falls and continence are also completed for individual people. As part of this site visit, the care files for 4 people were examined. Each person was noted to have an individual plan of care, detailing their specific care needs and providing good information for staff as to how care should be delivered in line with their care needs and personal preferences. Records showed that improvements had been made following the last key inspection. These related to care plans being more person centred, easy to understand and providing The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 11 clear guidelines for staff to follow. For example, the care plan for one person pertaining to their personal care, recorded their specific care needs e.g. what elements of personal care they were able to undertake and where they required support from staff and their personal preferences, likes and dislikes. Records also showed that following the last key inspection, the care needs of individual people have been reviewed and updated to reflect their current care needs. This refers specifically to the care file for one person, which was examined at the last key inspection. This showed at the time, deficits and shortfalls relating to their nutritional care needs. At this inspection, records showed their care plan had been rewritten/updated and where changes had occurred these were clearly recorded. A risk assessment was devised and better recording was in place detailing their nutrition/food intake on a daily basis. The AQAA details, “our care plans and pre assessments are now more detailed to ensure we can meet service user’s needs” and “case tracking of the care plans during auditing has found that all details are documented in the appropriate sections and that the quality of the information is more informative. More care plan training has been undertaken by staff this year from an in house trainer to provide them with the correct knowledge of how care plans should be written, hence the progression of more person centred documentation”. While we recognise the improvements, some further development of the care planning and risk assessment process is still required. The care file for one person recorded them as being at high risk of falls. Whilst we recognise that a plan of care was in place for the above, no manual handling risk assessment or risk assessment relating to falls and how the latter was to be minimised was devised. Records also showed the person as having two specific healthcare needs, however no risk assessment was completed for either area and it was unclear as to how their healthcare need impacted on their ability to undertake activities of daily living. As stated at previous inspections to the home, more evidence is required to show that the care planning processes are undertaken with the resident and/or their representative. During the site visit some staff on duty were observed to interact positively with residents, in a respectful and dignified manner. It was evident from discussions with staff that they have a basic understanding of individuals care needs and how they like to be supported. However it was noted that interactions by some members of staff are limited. One relative’s survey returned to us recorded, “some care staff need better language skills and also encouragement to be more interactive with residents. Interaction seems to be seen as exclusively the role of the activities organiser, rather than of all care staff and some seem to make little attempt to understand the cultural background of residents” and “people are treated as individuals”. The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 12 The majority of residents spoken with during the site visit confirmed they are provided with appropriate care and support by staff. One resident survey returned to us recorded “sometimes I am given the medical support I need” and “my diabetes needs better control”. Records showed that people have access to a range of healthcare services and professionals as and when required and these include, GP, Hospital Appointments, District Nurse Services, Social Work, Dentist, Chiropody, Optician etc. Of those healthcare records examined, these were seen to be appropriate. Practices and procedures for the safe storage, handling and recording of medication were examined by a pharmacist inspector. The home has good clear written policy and procedures for the safe use of medicines to protect residents although some aspects of this are not followed by staff. Storage for medication is adequate and the temperature satisfactory. Daily records are made of the temperatures, which were consistently below 25C. The fridge used to store medicines was not locked but the outer door to the room was locked. The home’s policy for the safe storage of medicines states that the fridge must be locked. The daily records for the fridge temperature show that it has been outside the recommended range several times during the previous week without any action taken by staff to investigate its performance or of the quality of medicines stored there. There were two items kept in the fridge which were in use and clearly labelled “when in use do not refrigerate”. Staff must be vigilant to the storage requirements for medicines as this may mean that people receive medicines that are ineffective. We expect this to be managed by the home rather than make a requirement on this occasion. Dedicated storage is provided for controlled drugs but this cupboard is not secured properly. No controlled drugs were in use at the time of this inspection but the controlled drugs cupboard also contained a medicine, which doesn’t require such strict storage requirements. This was noted on the previous inspection and remains outstanding. Again, we expect this to be managed by the home rather than make a requirement. Medication is only given to residents by trained staff. We watched some medicines being given to residents at lunchtime and at teatime. On each occasion medicines were left unattended on top of the medicines trolley within reach of residents and other staff. This is an unacceptable risk that medicines may be taken by people they are not prescribed for. Records made when medication is received into the home and when it is given to residents are reasonably good and demonstrate that people receive the medication as prescribed. There were very few discrepancies in the medication and medication records and evidence was seen that the records are checked regularly by staff. Despite this however, some deficiencies were found e.g. The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 13 when medication is given in variable doses i.e. “one or two tablets”, the record does not always indicate whether one or two were given. This could result in people receiving too much or too little medication. Medication for several people had run out sometimes for up to two weeks before a further supply was obtained and no action had been taken by staff to ensure continued supply. For two residents where medication must not be given at the same time, the record did not accurately reflect the time it was given. Although the above need to be addressed, the quality of medication records has improved over previous inspections. The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that their social care needs will be met and that they will receive a varied diet. EVIDENCE: There is an activities co-ordinator employed at the care home for 25 hours per week, Monday to Friday. A weekly timetable of events and activities is devised and this is displayed on the notice board in reception and each resident is provided with a copy. The activities programme shows there is a planned activity programme Monday to Friday and this includes, pamper sessions, bingo, arts and crafts, reminiscence, quizzes, armchair exercises, sing-a-long and a variety of games. The AQAA details under the heading of what we do well, we have a seven day robust activities programme in place offering more variety for the service users. Staff carry out activities on each shift to ensure our service users are stimulated. On the day of the site visit, the activities coordinator was not available, however staff on duty were observed during the day to undertake activities (skittles) with people living at the care home. The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 15 Records relating to the above, evidence peoples participation. In addition to the social care needs of individual people being recorded within their plan of care, a social profile is completed for each person and individual activity records kept. There is an open visiting policy whereby visitors to the home can visit at any reasonable time. People spoken with confirmed they are made to feel welcome by care staff. Both the lunchtime and teatime meals were observed within the main dining room on the day of the site visit. Each table was attractively laid with tablecloth, condiments, placemats, serviettes and a jug of juice. The latter is positive as it enables people to maintain their independence and promotes choice. Several residents were observed to help themselves throughout the meal to drinks and where people required support, this was provided by care staff. Menus depicting choices available on any given day, were placed on each table. Not all people spoken with were able to advise as to the choices available, however staff discussed this with each person prior to serving the meal. The food in the home is of a good quality, well presented and there are sufficient choices available. The AQAA details “service users have a choice of menu daily and our chef offers alternatives to the menu if requested”. Where support is required for individual people this was seen to be undertaken, with due respect and sensitivity. Assistance was provided at the correct pace and unhurried. Residents comments relating to the quality of meals provided were positive and included, “the food is lovely” and “I have no complaints about the meals provided”. The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be confident that their complaints will be listened to and they will be protected from abuse and neglect. EVIDENCE: A copy of the service’s corporate complaints policy and procedure was observed to be displayed within the reception area and this is supplied to everyone living at the care home. Relative’s surveys returned to us confirmed that people know how and to whom to address any issues/raise concerns. On inspection of the complaints register, this showed that a full record of complaints, including details of the specific nature of the complaint, investigation and actions taken were clearly recorded. Since the last key inspection there have been 2 complaints. Each complaint was addressed within a reasonable timeframe and included the outcome of the complaint. Residents and others know how to make a complaint. There are policies and procedures for safeguarding adults. Since the last key inspection, no safeguarding issues have been raised. Staff spoken with were able to demonstrate a basic understanding of safeguarding procedures and know how to refer an incident and to whom this should be reported to. On inspection of the staff training matrix and training statistics plan, this showed that the majority of staff have attained up to date safeguarding training. Other The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 17 training around dealing with physical and verbal aggression has also been made available to staff. The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be assured that they are provided with an environment that is comfortable, homely and safe, which meets their needs. EVIDENCE: We undertook a partial tour of the premises during the site visit. All areas of the home environment were seen to be clean, tidy and odour free. No health and safety issues were highlighted at this visit. Issues highlighted at the previous inspection pertaining to the homes boiler have been addressed and records seen confirmed this. A random sample of residents bedrooms were inspected and all were seen to be personalised and individualised. People living at the care home are encouraged to personalise their bedrooms. We were advised by the manager and operations manager that all communal areas of the home are to be The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 19 redecorated in 8-12 weeks. A schedule of works and the impact this has on the people living at the care home must be forwarded to us in writing. The AQAA details within the next 12 months, it is hoped for a sensory garden to be created for vegetables and herbs, for the dining rooms and hallways to be redecorated and to create a hairdressing salon. It is evident from information recorded within the home and from relatives’ surveys that issues relating to the home’s laundry processes and procedures need improving. One relative survey recorded, “arrangements for tidying clothes/rooms and for getting clothes to/from the laundry have not always been particularly effective”. The maintenance person is employed at the care home for 40 hours per week, Monday to Friday, however these hours are flexible to cover evenings and weekends. The staff training matrix shows that the maintenance person has up to date training relating to Fire Safety awareness, Moving and Handling, COSHH (Control of Substances Hazardous to Health), Health and Safety and Infection Control. A random sample of safety and maintenance certificates showed these were serviced/tested regularly. The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People receive care from a well trained care team but may be at risk of not having their care needs met due to low staffing levels and poor recruitment processes. EVIDENCE: We were advised by the manager that staffing levels at the home are 6 staff between 07.15 a.m. and 14.15 p.m. (including shift leader), 5 staff between 14.15 p.m. and 21.15 p.m. (including shift leader) and 4 waking night staff between 21.15 p.m. and 07.15 a.m. (including shift leader) each day. In addition to the above, there is an administrator (Monday to Friday), maintenance person (Monday to Friday), chef/weekend chef each day and domestics/housekeepers. The manager’s hours are supernumerary to the above and the deputy manager receives 2 supernumerary shifts per week. The AQAA details that the use of agency staff is minimal so as to provide continuity of care. The manager advised that at the time of the site visit there were 29 people living at The Squirrels Care Centre. As a result of this figure staffing levels, were reduced during the day by one person. On inspection of 4 weeks staff rosters, records showed that staffing levels as detailed above were not always being maintained. We have not received any The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 21 Regulation 37 notifications advising us of the staffing shortfall and measures undertaken to deploy staff to the home. The staff rosters were well maintained and clearly evidence staff on duty on any given shift, however it was noted that a small number of staff are regularly working between 56 and 70 hours per week. The rosters also evidence on one occasion that 2 members of staff completed a late shift followed by a waking night shift (total of 17 hours on duty). We were advised that this happened as a result of bad weather when it snowed heavily in January 2009 and there were problems getting staff to and from the home. Following the inspection we received information that identified one member of staff as working at The Squirrels Care Centre (minimum of 39 hours per week) and also working at another local care home for between 4050 hours per week. This is not good practice and potentially places staff and residents at risk. It is unclear from the number of hours that are being completed each week by this member of staff, that they remain competent to undertake their role. Staff surveys returned to us recorded, “staffing was an issue, but things seem to be getting better”. As stated at previous inspections to the home, several members of staff have been employed at the care home for a significant period of time, providing both consistency and stability to people living at The Squirrels Care Centre. A random sample of 3 staff files were examined for those people newly employed since the last key inspection. Staff files were well organised and presented, with the majority of records as required by regulation available. Gaps were noted in relation to employment histories not fully explored for 2 people, written references for one person not from their most recent employer and a Criminal Record Bureau (CRB) check for one person relating to their previous employer. Each person was noted to have undertaken an induction. On inspection of the training matrix, this shows that since the previous key inspection, staff have received training relating to fire safety, food hygiene, moving and handling, COSHH, health and safety, safeguarding, infection control, nutrition, pressure area care, customer care, care planning, dealing with challenging behaviour, dementia awareness and bed rail safety. Staff surveys returned to us, confirmed that staff are provided with regular opportunities for training. One survey recorded, “I have been training on a regular basis. I always enjoy training” and “training is being done on a regular basis”. The AQAA details, “all staff are given adequate training that enable them to carry out their duties” and “training statistics have improved and staff are encouraged to further develop themselves”. At the time of this site visit we were made aware that 5 members of staff have attained NVQ Level 2, 6 members of staff have achieved NVQ Level 3, 8 members of staff are registered/undertaking NVQ Level 2 and 3 members of staff are registered/undertaking NVQ Level 3. The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 22 The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst management arrangements within some aspects of the service are either good or adequate, shortfalls in some areas, could potentially affect positive outcomes for people living at the care home. EVIDENCE: The manager has several years experience in providing care and support for older people and has been managing The Squirrels Care Centre since September 2008. The manager attained the Registered Manager’s Award in December 2007 and completed a variety of additional training e.g. person centred care planning, managing and leading staff effectively, coaching skills for managers etc. The manager is currently in the process of completing a The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 24 Leadership and Management course and this is due to finish in December 2009. The management team of the home operate an open door approach, with the aim that residents, their relatives/representatives, staff and others can meet with the management team as and when required. The manager advised that it has taken time for the staff team to adjust to her managerial style and newly implemented systems and “ways of working”, however this is now proving successful and staff morale within the home is much improved. On the day of the site visit, the atmosphere within the home was observed to be calmer and staff, were observed to have defined roles/duties. Throughout the inspection the manager demonstrated good people skills with staff, residents, relatives and professionals, and the importance of ensuring positive outcomes for the people living at The Squirrels Care Centre. The manager advised that the ethos of the service is to “provide person centred care to the people living in the home and to ensure, their care needs are understood and met by care staff”. It is evident from this inspection that the management team of the home have endeavoured to meet previous identified shortfalls and deficits. 10 out of 15 statutory requirements highlighted at the last key inspection have been addressed. Evidence from this inspection show that further development is required in relation to some aspects of the care planning and risk assessing processes, some elements of medication practices and procedures, ensuring that robust recruitment procedures are in place and that staff working at the care home receive regular supervision. The management team of the home must continue to demonstrate progress and sustainability, so as to ensure residents continued safety, wellbeing and positive outcomes. All sections of the Annual Quality Assurance Assessment were completed. The AQAA was returned to us when requested and information recorded within the document, lets us know about changes that have been made and where they still need to make improvements. The evidence to support the comments made were satisfactory. On inspection of the staff supervision planner for 2008-2009 and from a random sample of individual staff files, records showed that some staff are not receiving formal supervision in line with National Minimum Standards recommendations. Staff surveys completed as part of the home’s quality assurance confirmed this and comments recorded included, “twice since started working since January 2008” and “I can’t remember the last one I had”. There is a quality assurance system in place at the home to seek the views of residents, relatives, staff and other interested parties about the quality of the The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 25 service provided at The Squirrels. This was completed in October 2008 and February 2009. In general terms, surveys from residents/relatives were complimentary about the care provided. However comments from staff were not so positive and require addressing by the management team of the home and/or the registered provider. At the time of the site visit, there was no evidence to show that comments made by staff were being addressed. We must be assured that issues are taken seriously and will be looked into. Comments included, “handovers not done with care staff”, “I have complained to the assistant home manager several times that carers refuse to help or assist when called upon to work as a team. It makes the job difficult”, “the admin on occasions will take a message regarding a resident but will forget to tell us” and “the level of care provided depends on the staff on shift and if you are fully staffed. Some of the residents are left to sit whilst the more active receive more”. Additionally staff did not feel there was sufficient communication. Appropriate policies and procedures relating to health and safety are readily available within the care home. Staff spoken with confirmed that have access to these as and when required. The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 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 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X X 1 X 3 The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13(4) Requirement Risk assessments must be devised for all areas of assessed risk so that risks to residents can be minimised. Records must be explicit, detailing the specific risk, how this impacts on the person and steps taken to reduce the risk. Previous timescale of 1/10/08 and 2/12/08 not fully met. Medication must not be left unattended and accessible to unauthorised people. This is an unacceptable risk that medicines may be taken by people they are not prescribed for. Previous timescale of 18/8/08 not met. There must be adequate supplies of medicines for the continued treatment of residents. This will ensure people are not put at risk of not receiving their medicines as prescribed. Records made when medicines are given to people must be DS0000018113.V373635.R01.S.doc Timescale for action 01/05/09 2. OP9 13(2) 03/04/09 3. OP9 12(1) 13(2) 06/04/09 4. OP9 13(2) 17(1)(a) 03/04/09 The Squirrels Care Centre Version 5.2 Page 28 5. OP27 18(1)(a) accurate and complete, especially where medication is prescribed in variable doses. This is to demonstrate that people receive the medicines as prescribed and do not receive too much or too little medication. Ensure there are sufficient staff, 03/04/09 on duty at all times, so as to meet the needs of residents and to ensure their safety and wellbeing. Previous timescale of 18/8/08 not fully met. Ensure that robust recruitment procedures are adopted at all times for the safety and wellbeing of residents and that all records as required by regulation are sought. Not inspected on this occasion. Previous timescale of 18/8/08 and 2/12/08 not fully met. Ensure that staff, receive regular supervision so that they feel supported and residents know that staff are appropriately managed. Previous timescale of 18/8/08 and 2/12/08 not met. 6. OP29 19 03/04/09 7. OP36 18(2) 01/05/09 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 OP7 Good Practice Recommendations Provide evidence to show that residents and their representatives are involved in the care planning processes. DS0000018113.V373635.R01.S.doc Version 5.2 Page 29 The Squirrels Care Centre 2. OP26 Review the laundry arrangements in the home so as to ensure that individual resident’s laundry is managed to a satisfactory standard. The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Squirrels Care Centre DS0000018113.V373635.R01.S.doc Version 5.2 Page 31 - 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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