Inspection on 03/05/07 for The Worthies

This inspection was carried out on 3rd May 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Worthies 01/04/09

The Worthies 02/04/08

The Worthies 27/06/06

The Worthies 25/11/05

The Worthies 04/05/05

The Worthies 11/01/05

The Worthies 28/06/04

The Worthies 11/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Worthies 79 Park Road Stapleton Bristol BS16 1DT Lead Inspector Sandra Gibson Key Unannounced Inspection 3rd May 2007 09:45 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 DS0000026524.V334851.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. DS0000026524.V334851.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Worthies Address 79 Park Road Stapleton Bristol BS16 1DT 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) 0117 9390088 0117 9655881 shenbutt@hotmail.com The Worthies Residential Care Home Ltd Ms Sehnaz Bi Butt Care Home 24 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (19) of places DS0000026524.V334851.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 24 persons aged 65 years or over Date of last inspection 27th June 2006 Brief Description of the Service: The Worthies is a care home registered with the Commission for Social Care inspection to accommodate 19 people in the older persons category and 5 older people with dementia. The home is located in Stapleton village situated on a bus route, within quarter of a mile to shops, libraries and health centres. The accommodation is arranged over three floors, with shared space on the ground floor and bedrooms on all floors, accessible to all floors by a passenger lift. There is a courtyard at the rear of the house. However, this area is not enclosed With two exceptions, bedrooms are single. The double bedrooms are en-suite offering privacy with personal care. The fees range from £348.00 - £415.00 per week and extra charges are made for chiropody, hairdressing, etc. Currently this information is initially only provided verbally prior on admission. DS0000026524.V334851.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the key or main inspection carried out over one day (unannounced). The visit was to follow up requirements and recommendations made at both the last key inspection held on the 27thand 14th June 2006 and at the random unannounced inspection 20th March 2007. The random inspection was carried out to focus on a complaint made about a visitor falling on 24th February 2007. Prior to the visit to the home a survey had been sent to all residents and their relatives by the Commission for Social Care Inspection. Comments from the responses to the surveys are included in the report. Information was also gathered from: examining previous correspondence with the home, inspection reports, information from pre inspection questionnaire (received after site visit to home). A range of records was looked at during the visit, which included: a sample of care records, staff records, policies and procedures. A number of people who live in the home and staff employed at the home were spoken with during this visit. The manager and deputy manager were also present. What the service does well: People accommodated at The Worthies are treated with dignity and respect and their health care needs are met . The complaints procedure in place in the home is satisfactory . The arrangements in place ensure that residents and their represenatives are fully aware of how to make a complaint and know they will be listened to. Arrangements are in place to support with their legal rights as far as possible. Systems in place to ensure that residents are protected from risk of harm are satisfactory Staffing levels at night and during the day are satisfactory with a result that residents’ needs are met at all times Residents and staff continue to benefit from an experienced manager who has begun to encourage an open style management approach. Support to care staff is satisfactory which ensures that residents benefit from staffs that are appropriately supervised. DS0000026524.V334851.R01.S.doc Version 5.2 Page 6 Health and safety checks are satisfactory which ensures that the health, safety and welfare of residents and staff is promoted and protected at all times. Residents accommodated at the home and their relatives were positive in their comments about life at the home. One resident said, ”The whole environment that I live in is safe, peaceful and everyone is helpful. I love to be here and appreciate all the service given to me”. One relative said I have never witnessed any discord in 5 years of regular visiting. They seem to be caring My sister in law seems content and that is all that matters”. What has improved since the last inspection? What they could do better: Information about the home is not provided to all prospective and current residents but is available for everyone to see. However, the information may be misleading as it does not provide sufficient detail for residents and their relatives to be clear about the services the home provides to meet their individual needs. The assessment and record keeping in the four-week trial period is not wholly satisfactory. It needs further attention so that the home can fully monitor whether they can meet an individuals needs and the placement is suitable for them There have been great improvements in the care planing system since the last inspections. However, it is still not wholly satisfactory as the information held in care plans needs to be more detailed and regulary reviewed to ensure that residents’ individual needs are fully met. There have been improvements in the medication administtration system since the last inspection . However , further attention is required to ensure residents’ safey when taking risks needs to be improved. The opportunities at The Worthies for residents to experience a more stimulating and varied life style are not satisfactory. This area needs urgent attention to ensure that arrangements are in place to ensure that all residents’ social, religious, cultural and recreational needs can be satisfied. DS0000026524.V334851.R01.S.doc Version 5.2 Page 7 Visitors are made welcome and meals are on the whole well managed and provide daily variation, and good nutrition for people. However, further attention must be given to residents choice about where they prefer to eat their meals. On the whole residents benefit from living in a safe, comfortable, and homely environment. However, improving the outside space could make it more comfortable for residents. The procedures for the recruitment of staff have improved since the last inspection. However, further improvement is required to ensure that residents are fully protected from risk of harm. The staff training programme is on the whole satisfactory. However, there are some gaps in specialist training with the result that residents’ mental health needs may not always be fully met. The system in place to ensure that residents’ financial interests and valuables are safeguarded by the homes record keeping, policies and procedures is on the whole satisfactory. However it needs some minor attention to ensure that safeguards are operating at all times. 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. DS0000026524.V334851.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 DS0000026524.V334851.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): 1,2,3,4,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information about the home is not provided to all prospective and current residents but is available for everyone to see. However, the information may be misleading as it does not provide sufficient detail for residents and their relatives to be clear about the services the home provides to meet their individual needs. The assessment and record keeping in the four-week trial period is not wholly satisfactory. It needs further attention so that the home can fully monitor whether they can meet an individuals needs and the placement is suitable for them DS0000026524.V334851.R01.S.doc Version 5.2 Page 10 EVIDENCE: The statement of purpose is available on request. It describes the admission process, which includes the criteria for admission to the home including the arrangements for introductory visits and trial periods. A copy of the service users guide can now be found on the notice board at the entrance of the home. The manager said that this information is not provided for each individual resident but attention to this information is brought to all prospective residents, current residents and their representatives. There was no evidence to confirm this information .The service users guide is available in small typed print. There are currently no other formats such as large print or audio. The statement of purpose together with the service users guide gives a reasonable amount of information about the home. However, it has not been up dated recently and there are gaps in the information available. The statement of purpose says that care can be provided to older people with mental health needs as well as residents with dementia. However, this home is not currently registered to provide care to people with mental health needs. The manager demonstrated that she and the deputy manager have experience in this area, but there was no evidence of them having recent training to up date their skills or any evidence of the care staff doing any training to work with residents with mental health needs. There was evidence of staff training to work with people with dementia. Other misleading information included the type of activities provided. The Statement of purpose said that residents go for walks, drives and shopping outings. There was no evidence to confirm that these outings had taken place in the last six months. It also indicates that there is a large range of activities including an art and craft. Evidence confirmed during the inspection that there were a small number of activities that took place in the home, which did not include an art and crafts group. We did a survey of people who live at The Worthies just before this inspection. People were asked if they had received a contract but most could not remember as they had been in the home a long time. They were also asked about information they were given when they came to the home. The majority seemed happy with the information they had been given at the time but none of the residents or the relatives were aware of the service users guide. There is DS0000026524.V334851.R01.S.doc Version 5.2 Page 11 also no information on fees charged and what extra facilities residents are expected to pay for. Majority of comments received about the home were positive. However, some residents said activities not happening often enough and this was confirmed by relatives who said, “ Could arrange more outings to have a different surroundings and break up day and have more in house activities” Further gaps in information included details of when meals are provided. According to the statement of purpose and service users guide there are only three meals a day. The last one being the evening meal is served between 45pm. However, the manager said residents received supper between 6pm and 7pm and a selection of hot and cold drinks and snacks are served after 9pm. This was not confirmed by residents but there was no evidence to say that they were hungry or thirsty at night. One resident said “Oh yes the meals are lovely, I have not had one complaint” and a relative said “they keep clients clean and tidy and fed well.” Social work assessments were seen for the majority of persons whose records were looked at. These assessments gave clear information about peoples needs and what actions would need to be taken to meet those needs. However, a full assessment had not been completed for one new resident. Evidence confirmed that residents are reviewed within a four-week period of entering the home to ensure that the home can meet that persons needs. DS0000026524.V334851.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is (adequate). This judgement has been made using available evidence including a visit to this service. There have been great improvements in the care planing system since the last inspections. However, it is still not wholly satisfactory as the information held in care plans needs to be more detailed and regulary reviewed to ensure that residents’ individual needs are fully met. There have been improvements in the medication administartion system since the last inspection . However , further attention is required to ensure residents’ safey when taking risks needs to be improved. People accommodated at The Worthies are treated with dignity and respect and their health care needs are met . DS0000026524.V334851.R01.S.doc Version 5.2 Page 13 EVIDENCE: A sample of care plans was seen including those of two new residents. Evidence of updating information and changing actions appears on care plans. Following a requirement made at the last inspection the manager has started to develop an action plan to guide staff to meet residents needs, residents likes and dislikes, preferred routines and abilities are beginning to be included in the plan and signatures of residents involvement in developing the plan were seen. This is an improvement since the last inspection. However there was evidence to confirm that details of residents communication and safety needs were not always included and some risk assessments had not been dated or reviewed. Residents have access to health care services that meet their assessed needs both within the home and in the local community There was evidence of residents having access to dentists, opticians and other community services. One resident spoke about regular visits from a chiropodist and district nurse. Another about the support he/she had received from the mental health team and his/her social worker. There was evidence that residents’ health is monitored and appropriate action taken. The home seeks professional advice on health care issues, acts upon it and is generally able to provide the aids and equipment recommended. There is evidence in the care plans of health care treatment and a record of health care information. However there are gaps in the detail for example two residents enjoy Caribbean food, but this was not found in the care plan. Staff were able to give a verbal update and evidence of residents receiving this food were found in the cook’s diary. The home has a medication policy and procedure in place, which now includes information on medication to be given when required. This is an improvement following a requirement made at the last inspection. This information is accessible to staff. A sample of medication records were checked for residents seen during the inspection. Evidence confirmed that medication records are generally up to date for each resident and medicines received, administered and disposed of are recorded. There is evidence of some residents administering their own medication. However no risk assessment was seen for one resident. The home has a medication administration training plan in place which involves the local pharmacy. The home has policies and procedures, which inform staff how they should handle dying and death. DS0000026524.V334851.R01.S.doc Version 5.2 Page 14 The majority of staff are aware of the need to treat residents with respect and to consider dignity when delivering personal care. Evidence confirmed that residents are happy with the way most staff deliver care and respect their dignity. However, some concerns were raised by visiting health professionals about the skills and attitude of some of the staff and the general lack of stimulation provided to residents by staff. This will be discussed later in the section on Daily life and Social Activities” One resident said “I am quite happy and feel safe”. Another said “I am happy with all my services because I am treated with care and respect and also by the other residents in the home. I like it here.” Another resident said “They look after me here”. One relative said “the staff understand…. need’s very fully resulting in her general contentment of the home. I am please with the care in so far as my sister is allowed to lead her own life as she wishes”. Another relative said “As we visit at different times each week… we are happy that the support and care laid on is not especially laid on for our benefit, and as far as is known mother is always kept warm, clean and tidy”. A third relative said “Mum has fallen out of bed a couple of times at night and the response has been immediate. They notice if there is a change ie visit the toilet more frequently or look paler than normal. The staff are generally kind and caring”. DS0000026524.V334851.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is (adequate). This judgement has been made using available evidence including a visit to this service. The opportunities at The Worthies for residents to experience a more stimulating and varied life style are not satisfactory. This area needs urgent attention to ensure that arrangements are in place to ensure that all residents’ social, religious, cultural and recreational needs can be satisfied. Visitors are made welcome and meals are on the whole well managed and provide daily variation, and good nutrition for people. However further attention must be given to residents choice about where they prefer to eat their meals. EVIDENCE: DS0000026524.V334851.R01.S.doc Version 5.2 Page 16 Staff are aware of the need to plan the routines and activities of the home in a way which meets the choice and wishes of residents. However evidence confirmed that this does not always happen. There was no information included in the care plans about recreational activities despite a requirement being made at the last inspection that this information must be included and reviewed. Residents living at The Worthies are given limited opportunities to take part in a small number of activities in the home which do not please everyone. Despite discussion at residents meetings about activities/ outings to take place in the community, evidence also confirmed that no outings have been arranged for the last three – four months. The last trip organised was January 2007 when a few residents were taken for a drive in Bristol but did not get out of the minibus as there was only one member of staff escorting the driver. Comments received from visiting health professionals included:”The deputy manager has the right skills and experience to support residents. The rest of the staff vary in their skills and attitude towards patients and visitors. Standards are higher than a year ago, but greater stimulation in terms of activities and constructive conversation is needed”. Another visiting health professional said, “Whilst I appreciate the home has a difficult client group. I feel the atmosphere at this home is extremely depressing. The surroundings are drab and dark and there never appears to be any attempt to engage the residents in activities. A large number spend most of their time sitting in the dining room all day or in their rooms.” Relatives surveyed said, “ They could arrange more outings to have a different surroundings and break up day. They could have more in house activities”. Another relative said, “ They could improve with a bit more interaction “. The manager told the inspector that outings are to start again in June 2007. The home shares a minibus with another home owned by the manager/owner. Staff told the inspector that residents have the opportunity to join in with skittles, bingo, listening to music in one of the lounges and playing catch ball. On the day of the inspection the majority of residents were watching TV in two of the lounges, and some residents joined in with a game of bingo in the afternoon. During the inspection comments received from residents included: “There is not a lot happening here“. Another resident said, “I do not get bored”. “I listen to the radio”. “I do not bother with other residents”. “I leave the door open and can hear people talking during the day”. “I never go out”. “I am not aware of outings, but I do not want to go out”. “I go to Church with my family on a Sunday”. A third resident said, “I enjoy watching TV”. “I am asked to sing a long with the others and we have fun among us”. DS0000026524.V334851.R01.S.doc Version 5.2 Page 17 “I do not want to join in with activities”. A fourth resident said “no complaints here , but it is a bit boring”. Evidence confirmed that the home has open visiting arrangements and residents know they can entertain their family and friends in their own room. If they prefer they can use one of the three communal lounges to talk to visitors. Two visitors were seen during the inspection talking with their relatives and later with staff about their relatives special care needs. Evidence confirmed that the food in the home is of good quality, well presented and meets the dietary needs of residents. The menu records were examined .The cook is experienced and there is evidence she talks to residents and tries to meet the preferences and suggested dishes when preparing the menu. An example of this was that she had discussed Caribbean food with two residents and their relatives. She told me how she regularly buys special food these residents enjoy. This information was recorded in the cooks diary. One meal time was observed during the inspection. Evidence confirmed that staff are trained to help those who need help when eating and are sensitive in their approach. The manager told the inspector that residents are able to choose to eat in their room if they wish. However there was no evidence to confirm this information. One resident said, “the food is lovely” and spoke about the tea time meals “We can have hot dogs, cauliflower cheese, cheese on toast or macaroni cheese, cheese pies or sandwiches”. “We have our meals in the dinning room. “They do not like serving meals in our rooms only when you are not well”. Another resident told the inspector that she preferred to have supper in her room as she was tired at the end of the day. However the resident said that some staff were not happy with this request. This situation was discussed with the manager who agreed to look into the matter. Regular drinks and snacks are available through out the day. This was observed during the inspection and as discussed previously in the section on choice of home the manager explained that residents received supper between 6pm and 7pm and a selection of hot and cold drinks and snacks are served after 9pm. Other comments received from residents confirmed the above information: “ Oh yes the meals are lovely”. Another resident said:” Sometimes special meals are made for me when I request it (rice and peas)”. Relatives surveyed also commented:” We requested that some meals were liquidised for easier consumption. This was put into effect immediately”. DS0000026524.V334851.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Quality in this outcome area is (adequate). This judgement has been made using available evidence including a visit to this service. The complaints procedure in place in the home is satisfactory . The arrangements in place ensure that residents and their represenatives are fully aware of how to make a complaint and know they will be listened to. Arrangements are in place to support with their legal rights as far as possible. Systems in place to ensure that residents are protected from risk of harm are satisfactory EVIDENCE: The Complaints procedure on display in bedrooms is in large print to ensure the residents can read it. Residents spoken with during the inspection confirmed that they knew the procedure for making complaints and would approach the manager / owner or deputy manager with any concern or complaint. Comments received from residents included: “I know who to speak to and I can make myself heard”. Another resident said I have not had one complaint”. One relative said “As a family we visit several times a week and the management and senior staff are always on hand if we need to talk” DS0000026524.V334851.R01.S.doc Version 5.2 Page 19 There was one complaint received at the home by The Commission for Social Care inspection resident since the last inspection. The complaint was from a visitor who had fallen at the home. A random visit took place on 20th March 2007. The owner/manager was required to complete a specific risk assessment for the area leading to the upstairs toilet. This requirement was followed up during this inspection and a risk assessment was found to have been completed about this risk and was available for resident’s relatives, visitors and staff to see. Residents meetings take place in this home on a regular basis. There was evidence in place to confirm that a member of staff had applied for a postal vote for those residents who wished to vote in the local elections. Unfortunately, this postal vote had not been processed in time for the residents to be able to vote on this occasion. However, the member of staff who organised this application said she planned to pursue the postal votes for residents when the next election was to take place. The home’s Abuse policy has been updated to instruct staff on the actions to be taken for alleged abuse, which follow The Local Authority ‘No Secrets in Bristol guidelines’. Evidence confirmed that the management team and other members of staff have attended Safe guarding adults training. DS0000026524.V334851.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is (adequate). This judgement has been made using available evidence including a visit to this service. On the whole residents benefit from living in a safe, comfortable, and homely environment. However, improving the outside space could make it more comfortable for residents. EVIDENCE: During the course of the inspection the inspector completed a tour of the communal areas, viewed a sample of residents bedrooms and sat with a DS0000026524.V334851.R01.S.doc Version 5.2 Page 21 resident in the courtyard space at the rear of the home. The inspector was informed that the driveway has recently been resurfaced. The courtyard at the rear of the property is only accessible to a few residents. It is situated close to the homes car park. This area is not suitable for residents with dementia as it is not secure. It was observed that this area and the area at the front of the house are also in need of some attention to make them more homely and attractive for example plant pots were full of weeds. The communal areas were found to be clean, smelt fresh and were well maintained. Records confirmed that arrangements for cleaning the home on a regular basis are good. The member of staff who is responsible for the maintenance was on leave on the day of the inspection. However, the manager formally requests major work and records are maintained of the programme of work including refurbishment, decoration and safety checks. On the day of the inspection a couple of bedrooms were having new carpet laid and new furniture installed. The manager informed the inspector that two of the communal lounges had new carpets in place and the kitchen floor had been retiled. Records confirmed that arrangements were in place for residents to have access to the equipment and adaptations they were assessed as needing by health professionals. All residents’ rooms seen during this inspection were found to be safe comfortable and homely and residents confirmed that they could bring items of their own furniture if they chose to. Comments about the home from residents included: “The home is clean all of the time”. Another resident said, “Yes the home is always well kept. I am quite happy and feel safe”. And a third said “the surroundings are always clean”. A fourth resident said, “I like living here. I like my room. It is near the toilet on the ground floor. It was decorated a couple of years ago and it also had a new carpet then”. A relative commented that, ”The place is always clean bright and fragrant”. DS0000026524.V334851.R01.S.doc Version 5.2 Page 22 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. Staffing levels at night and during the day are satisfactory with a result that residents’ needs are met at all times The procedures for the recruitment of staff have improved since the last inspection. However further improvement is required to ensure that residents are fully protected from risk of harm. The staff training programme is on the whole satisfactory. However, there are some gaps in specialist training with the result that residents’ mental health needs may not always be fully met. EVIDENCE: Evidence confirmed that three staff are on duty throughout the day with ancillary staff for cooking and cleaning. At night there are two staff undertaking waking duties at the home. The Owner /manager is in day-today control of the home with the deputy and nine senior care assistants. DS0000026524.V334851.R01.S.doc Version 5.2 Page 23 The owner /manager explained that she is currently in the process of recruiting a new manager who could support her in her role. There is an expectation that members of staff undertake vocational qualification and twelve out of seventeen staff have an NVQ level 2. Four of these staff members have recently registered to do NVQ3. There is evidence of a training programme in place, which includes specialist training such as dementia care and sexuality in the elderly. As discussed in the section of choice of home there is no evidence care staff doing mental health training. Although training on depression is planned for the future and there is evidence of the mental health in reach team providing training for staff when working with residents who have dementia during the last year. The Worthies have a staff recruitment procedure in place which is on the whole adequate and generally meets the national minimum standards. Improvement has taken place since the last inspection which required that the owner / manager obtained references from current/ most recent employers and carried out a check to see they were genuine However, it was noted that one current staff who was appointed when the Criminal Records bureau checks were in the process of being set up was appointed with a check that had been conducted by a previous home and one of the references that had been accepted had been provided by the member of staff relative. This is not acceptable practice. There have been no new staff appointment since the last key inspection and there are no agency staff currently used in this home. However bank staff are used and it was observed by the inspector that some of the conditions of staff work permits may not be checked fully. Consequently the manager is advised to contact the Home office for advise on the matter. DS0000026524.V334851.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37,38 Quality in this outcome area is (adequate) This judgement has been made using available evidence including a visit to this service. Residents and staff continue to benefit from an experienced manager who has begun to encourage an open style management approach. Support to care staff is satisfactory which ensures that residents benefit from staffs that are appropriately supervised. The system in place to ensure that residents’ financial interests and valuables are safeguarded by the homes record keeping, policies and procedures is on the whole satisfactory. However it needs some minor attention to ensure that safeguards are operating at all times. Health and safety checks are satisfactory which ensures that the health, safety and welfare of residents and staff is promoted and protected at all times. DS0000026524.V334851.R01.S.doc Version 5.2 Page 25 EVIDENCE: The owner/manager has completed the NVQ level 4 and will be undertaking the assessor’s course, as well as continuing with the degree course in Care of the older person. She is also a qualified nurse with nine years experience of working in the field of mental health. She is the owner of another care home in another local authority. She is the registered responsible individual for this home and therefore has the responsibility to oversee the management of this home as well as The Worthies. As discussed in the section on staffing. A part-time manager is in the process of being recruited to assist with the day-to-day running of The Worthies. The owner / manager spoke about supporting staff and what support systems she has put in place. Evidence of supervision and staff meetings was seen. The manager also said that she provides support to night staff by working until 12am on some occasions. How ever there was no record of these late shifts and discussions held with night staff. A recommendation was made to record these meetings. There are also plans in place for the management team to do team building training which the owner / manager feels the staff team would benefit from team building due to improve staff communication This is good practice. Comments from relatives included:” The Owner / manager is a kind and understanding person and her influence makes for a warm and tranquil environment.”. Another relative said, “The home is very transparent in their dealings with relatives, keeping us informed at all times”. A third relative said, “Given the financial constraints impose on services of this nature I believe that the Worthies provides excellent service in all categories”. Facilities for the safekeeping of cash and valuable exist at the home and a sample of the cash held in the home was checked. The records contain a brief description of the transaction and cash balances were consistent with the balances held. Many of the residents are subject to power of attorney or their family deal with financial arrangements. On checking the records for a couple of new residents it was found that one of the residents valuables had DS0000026524.V334851.R01.S.doc Version 5.2 Page 26 been listed on an envelope. This is not an adequate record and a requirement is made for improved recording to take place Service certificates for the lift, portable equipment, with heating and boiler documentation of checks conducted by contractors, indicates that residents and staff’s safety are promoted. The records that relate to fire safety procedures, checks and practices were examined and indicated that checks and practices are carried out at the recommended times. DS0000026524.V334851.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 1 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 2 3 3 3 DS0000026524.V334851.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 6 The registered provider must keep under review and where appropriate revise the statement of purpose (To ensure that all gaps in information are included as outlined in Older Persons NMS 1) 2. OP1 15 A full needs assessment must 02/07/07 be conducted on all residents prior to admission to the home ( A needs assessment must be part of the admission process) The Registered provider must keep under review and where appropriate revise the service users guide ( all information must be included as out lined in Older Persons NMS2) The registered person shall (b) keep the service users plan under review DS0000026524.V334851.R01.S.doc Requirement Timescale for action 02/07/07 3. OP2 6 02/07/07 4. OP7 15(2) 02/08/07 Version 5.2 Page 29 c) where appropriate and unless it is impracticable to carry out such consultation , after consultation with the service user or a representative of his revise the service users guide plan (The service users plan must be more detailed ) The registered person shall ensure that any activities in which a service users participate are so as reasonably practicable free from avoidable risk . 5. OP9 13(4)( c ) 02/07/07 6. OP12 16(2)(m) (Risk assessment must be completed for all activities that residents may put themselves or others at risk including self-medication. Risk assessments must be reviewed on a regular basis) The Registered person shall 02/08/07 having regard to the size of the care home and the number and needs of service users: Consult service users about their social interests and make arrangements to enable them to engage in local, social and community activities and to visit or maintain contact or communication with their families and friends (This information must be recorded in individual residents care plans) The registered person shall not employ a person to work at the care home unless he has obtained in respect of the person the information and documents specified in DS0000026524.V334851.R01.S.doc 7 OP29 Schedule 2.1 Regulation 19 02/08/07 Version 5.2 Page 30 paragraph 1-9 of Schedule 2 (Each member of staff must have a Criminal record bureau check completed through the home. This includes older staff members Reference letters must not be accepted from past or present relatives All work permit conditions must be checked with The Home Office. Failure to do so may result in prosecution if a offence has been committed 8 OP30 18(1)(c ) (I) Sch 2.5 The registered person shall having regard to the size of the care home, the statement of purpose and the number and needs of service users , ensure that the person employed to work at the care home receive training appropriate to the work they are to perform (All staff must have training in working with older persons with mental health needs) A record of all money or other valuables deposited by a service user for safe keeping or received on the service users behalf which (a) shall state the date on which the money or valuables were deposited or received ( Clear accurate records and receipts must be kept of possessions handed over for safekeeping) . 02/10/07 9 OP35 Schedule 4 regulation 17 (2) 02/07/07 DS0000026524.V334851.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP15 OP19 Good Practice Recommendations Residents should be given the choice of where they wish to eat meals Grounds should be kept tidy, safe, attractive and accessible to service users and allow access to sunlight DS0000026524.V334851.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 DS0000026524.V334851.R01.S.doc Version 5.2 Page 33 - 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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