Inspection on 15/10/07 for Townsend House

This inspection was carried out on 15th October 2007.

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

The inspector 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

Townsend House 19/09/06

Townsend House 20/01/06

Townsend House 30/08/05

Townsend House 28/09/04

Townsend House 25/05/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Townsend House Bayswater Road Headington Oxfordshire OX3 9NX Lead Inspector Steve Webb Unannounced Inspection 15th October 2007 10:00 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 Townsend House DS0000013161.V344728.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. Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Townsend House Address Bayswater Road Headington Oxfordshire OX3 9NX 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) 01865 762232 01865 744681 manager.townsendhouse@osjctoxon.co.uk www.oxfordshire.gov.uk The Orders Of St John Care Trust Care Home 45 Category(ies) of Past or present alcohol dependence over 65 registration, with number years of age (3), Dementia - over 65 years of of places age (17), Learning disability over 65 years of age (3), Old age, not falling within any other category (45), Physical disability over 65 years of age (20) Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of persons that may be accommodated at any one time must not exceed 45. 19th September 2006 Date of last inspection Brief Description of the Service: Townsend House is a purpose-built residential care home, dating from the 1960’s, situated in Headington, on the outskirts of the city of Oxford. It can provide care for 45 older people managed by The Orders of St John Care Trust, a charitable organisation. The home is a two-storey building with a passenger lift provided, and each room is linked to a call system to summon staff assistance when required. The care home provides 45 single bedrooms with several lounge areas, one of which is designated for smoking. There is a communal dining room, an attractive conservatory room and pleasant accessible grounds with seating. The fees for this service range from £570 to £725 per week. Items not covered by the fees include hairdressing, podiatry, newspapers, magazines, toiletries and contributions to some outings and activities. Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced site visit from 10.00am until 7.30pm on 15th of October 2007. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversations with staff members on duty, and discussions with the manager. The inspector spoke to a number of the residents during the inspection, and some time was also spent observing the interactions between residents and staff at various points during the inspection and over lunch with the residents. The inspector also inspected the communal facilities of the home and proportion of the residents’ bedrooms. What the service does well: An appropriate preadmission assessment is undertaken on a prospective resident in order to establish whether their needs can be met. Prospective residents or their relatives are provided with a detailed Residents’ Handbook and other information to enable them to make an informed decision about coming to Townsend House. The home has an appropriate system in place to manage the medication on behalf of those residents who are either unable, or prefer not to do this. If a resident wishes to manage elements of their own medication, this is supported, subject to appropriate risk assessment. Residents feel that the staff treat them with respect and uphold their privacy in the way care support is provided. They are provided with a range of group and individual activities and outings to ensure they have a fulfilling lifestyle. Residents are supported to remain in contact with relatives and friends and visitors are made welcome. Residents can also access events and facilities in the community, and a number are supported to attend local places of worship to provide for their spiritual needs. The residents are supported to make choices in their daily lives and to have an input into the running of the home, through residents meeting and consultations thorough quality assurance questionnaires. Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 6 They are provided with a varied diet, within pleasant dining environment to maintain wellbeing and try to ensure that their mealtimes are a positive experience. The home has an appropriate complaints system in place, which is made available to residents and others. The home has systems in place to protect residents from abuse, and works to the local written protocol for safeguarding vulnerable adults. The home provides a well-maintained and homely environment for residents, which maximises their mobility and independence, and appropriate specialist equipment is provided to support residents where necessary. The home is clean and standards of hygiene were observed to be good. Appropriate laundry facilities are provided. The diverse staff team have the skills to meet the needs of residents, and some progress has been made on NVQ attainment. The home’s thorough staff recruitment and selection procedures help to protect residents. The home provides staff with a standard induction and core-training to ensure they are trained to support the residents. An experienced and appropriately qualified manager runs the home. She now has an established team of seniors to share management responsibilities. The manager has applied for registration. Where the home has a role in managing residents’ personal allowance, appropriate systems are in place to safeguard these funds. The health safety and welfare of residents are promoted within the home. What has improved since the last inspection? Though the existing care plans contain satisfactory information on residents’ needs, and these are broadly met; the new care plan format which is being introduced should lead to a greater focus on the individual wishes and preferences of each resident, in terms of how their needs are met by the staff. The recent appointment of a full-time activities coordinator should enable greater focus on individual residents’ needs, once she takes up her position. Standards of hygiene have been improved since the last inspection. The recent active involvement of residents in the interview process for new staff is a positive development. Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 7 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. Townsend House DS0000013161.V344728.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 Townsend House DS0000013161.V344728.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): Standards 1, 2, 3 and 6: Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective residents and/or their next of kin are provided with the information they need, and invited to visit the home, to enable them to make an informed decision about its suitability, and also receive a copy of the relevant contract. The home undertakes an appropriate preadmission assessment on a prospective resident in order to establish whether their needs can be met. The home does not provide an intermediate care service, so Standard 6 is not applicable. EVIDENCE: The completed pre-inspection information indicated that a pre-admission assessment is undertaken on all residents, involving a visit to the resident where they are living at the time. The prospective resident and/or their next of Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 10 kin are invited to visit Townsend House prior to making a decision, and are provided with a copy of the home’s Residents’ Guide. This was confirmed in discussion with the manager, who indicated that she undertakes the majority of assessments herself. Examination of a sample of four resident’s case records confirmed that a completed preadmission assessment was present in each case. In addition to the assessment format, an information sheet is now also completed regarding the resident’s food likes and dislikes and any dietary needs or food allergies, to ensure their dietary needs are met. The home does not admit residents where it does not feel their needs can be met effectively. The Residents’ Guide provides comprehensive information about the facilities in the home, its staff and about key procedures, and had been revised in February 2007. The guide also contains a summary of the home’s Statement of Purpose and a copy of the contract. It is also stated that the guide can be made available in audiotape, Braille or other language formats on request. In the case of one recent admission, appropriate arrangements were made via the resident’s family to translate the Resident’s guide and complaints procedure to ensure the resident understood these. The guide also identifies the resident’s key carer once they are admitted. The home does not provide an intermediate care service, though it does offer respite care. Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Though the existing care plans do detail residents’ social, emotional and healthcare needs, and these are broadly met; the new care plan format being introduced should lead to a greater focus on the individual wishes and preferences of each resident, in terms of how their needs are met by the staff. The home has an appropriate system in place to manage the medication on behalf of those residents who are either unable, or prefer not to do this. Where residents wish to manage elements of their own medication, this is supported, subject to appropriate risk assessment. Residents feel that the staff treat them with respect and uphold their privacy in the way care support is provided, and aspects of the physical environment also support this. Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 12 EVIDENCE: Each resident has a care plan within a proprietary format, but the manager is in the process of introducing an improved care plan format that will enable a greater focus on the individual’s wishes and preferences, and improve the accessibility of this information to care staff. The existing care plans for each resident are supported by a second file, which contains other paperwork relating to the individual. Some elements such as the individual’s preferred funeral arrangements are to be incorporated within the new care plan format, so the information is readily available. These files also include consent forms, self-medication assessments where applicable, and a dependency assessment tool. At the time of inspection work had begun on only a small number of care plans, but the new format should be more person-centred. They will include sections on detailed life history, individual observational records on various aspects of care where necessary, and a range of risk assessments, as well as healthcare records. As noted there is also a record of the individual’s dietary preferences and any specific dietary needs or allergies. Care plans are reviewed on a monthly basis, and the review dates recorded. Since the last inspection, systems for nutritional and pressure area risk assessments have been established for all residents, which are being informally reviewed monthly. The manager reported that none of the residents had any pressure areas at the time of inspection. The home obtains any required pressure relief equipment via the relevant local GP practice, with whom they reportedly have positive relationships. The manager also described a supportive link with the local Falls Prevention Unit, which enables them improved access other health-related resources. The home can also call upon the support of the Macmillan service for palliative care, and some care staff have also received some palliative care training. Daily records are also maintained on each resident’s wellbeing, and some references to the specific care given are also included here though not in a consistent way. Some aspects of care are also still recorded in records, such as a collective bath record book. In order to provide a more consistent record of daily care, that can also be monitored by management and provide accountability, it is recommended that some form of individual personal care monitoring sheet be included in the new care plan format. Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 13 The current care plans contain a record of healthcare appointments with details of relevant outcomes, and a similar system is included within the new care plan format. The home managed a recent viral outbreak, appropriately to try to protect residents, and reported the matter to appropriate external agencies. There was evidence of periodic formal review on three of the case records examined. The other resident’s review was not yet due. The home has an appropriate system to manage the medication on behalf of the majority of residents who are either unable, or opt not to do this for themselves. However, where a resident wishes to manage all or part of their own medication, this is supported, subject to a risk assessment and possibly with the consent of their GP. Three residents were managing some aspects of their own medication at the time of inspection. The current medication records were sampled and included details of the quantities of medication received and any returns, as well as details of that administered to residents. The required audit trail was thus in place. A laminated photograph of the resident is at the front of their medication administration records. The home also has an appropriate system and a separate designated controlled drugs log for ‘controlled’ medication. The privacy and dignity of residents is addressed by the provision of individual bedrooms for each resident. Bedroom doors are lockable, from inside via a fixed toggle and externally via a key. All residents are offered the key to their room, though some decline to have one. Each bedroom also has a lockable drawer to which the resident has the key, where they can secure valuables. Bathrooms and toilets are fitted with appropriate locks to enable those who are able to maintain their independence and privacy. Staff have access to a pass key to enable them to gain access to a locked bedroom in an emergency. GPs and district nurses always consult with and treat residents in the privacy of their own bedroom, and support with personal care is provided behind closed doors. Bathrooms and showers are equipped appropriately to meet the needs of residents who require support to bathe, with dignity and safety. The residents’ guide informs residents about having their clothing labelled, and the home offers to obtain suitable labels at a competitive cost. Supplies of these name labels were seen in the laundry for a number of residents and on items of clothing, helping to ensure that individuals own clothing is always returned to them. Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 14 The improvements in the care planning system should also lead to improvements in residents’ dignity in terms of improvements in consultation on their preferences and wishes with regard to how they are supported. In conversation with the inspector, several residents indicated that the staff treated them with respect and supported their privacy in the way they worked. Townsend House DS0000013161.V344728.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): Standards 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. Residents are provided with a range of group and individual activities and outings to ensure they have a fulfilling lifestyle. The appointment of a full-time activities coordinator should enable greater focus on individual residents’ needs. Existing contacts are supported and encouraged by the home to maintain residents’ relationships with their family and friends wherever possible, and residents are also supported to maintain contacts within the community such as with local churches to address their spiritual needs. The residents are supported to make choices in their daily lives and to have an input into the running of the home, through residents meeting and consultations thorough quality assurance questionnaires. They are provided with a varied diet, within pleasant dining environment to maintain wellbeing and try to ensure that their mealtimes are a positive experience. Individual nutritional risk assessments are undertaken to highlight any concerns so these can be addressed. Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 16 EVIDENCE: At the time of inspection, the home did not have an activities coordinator, though it was reported the post had now been filled. The post is to be for 37 hours per week for a trial period to see if this enables greater opportunities to engage on a one-to-one basis with those residents who do not take part in the general group activities, in order to provide also for their needs, as well as providing the broad range of planned group activities throughout the week. Three of the residents go with staff to the local shop to get their newspapers and some walk to the nearby dentist for their appointments, to maximise mobility and exercise. Residents who are interested have opportunities to follow sport on one of the home’s communal TV’s or in their bedroom, where many also have a TV. One of the residents commented that staff were always willing to take residents out in their own cars, and that the home uses a local authority minibus for larger group outings. Recent outings had included two canal boat trips, a visit to an ice cream farm and a visit to Bournemouth, as well a swimming trip, and there have been various events in the home. Photomontages of a variety of these outings and events were posted on notice boards about the home. Unfortunately these were becoming damaged in some cases and it is suggested, in future that framing or lamination of the pictures is considered, as they are an attractive memory of the social aspect of life in Townsend House. There is a “wish tree” in the entrance hall, where residents can express a desire for a specific outing or event for example, and the home will try to provide for this in some way, Example were given of where outings had resulted from these ‘wishes’, including a visit to an ice cream farm and a swimming trip. This is a creative idea, and the photographic evidence of wishes being met will hopefully further encourage participation. Ten of the residents attend services at a local church every week. Two Roman Catholic residents attend church weekly with their family. One of the staff, who is a Roman Catholic nun, also offers some spiritual support. The local priest visits the home as do church ‘official visitors’. One resident is from the former Yugoslavia, and contact with a representative from their religion has also been explored via the Internet, in order to try to provide for their spiritual needs. Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 17 The majority of the other current residents are of white UK origin, with two being of Irish origin. Appropriate music is available to meet the needs of these residents and relevant cultural festivals are celebrated. The home tries to meet the individual ‘cultural’ preferences of residents with regard to their dress, including aspects such as their preference for the wearing of ties, nail varnish, makeup and jewellery, as well as the individual residents’ preferred style of clothing. The funeral preferences of residents are also identified to ensure that these are respected in the event of a resident’s death. The home has a culturally diverse staff team who receive training on cultural awareness and discrimination as well as in understanding dementia, in order to support their care practice. The available evidence suggests that the home is able to address a range of cultural and diversity needs, and accesses support to do so from within the local community. The manager indicated that all but two of the residents had some ongoing family contact, and in one case the manager enables this via email. The local vicar visits one of the residents who has no family contact. Some of the residents confirmed that they received regular visits or other contact from family, and visitors are encouraged by the home. The majority of residents were felt able to make their preferences known to enable them to make choices in their daily lives, and staff were observed to offer individuals a variety of choices, including refreshments, and meal options, and where they wished to sit. Regular residents meetings are held, (minutes are taken by one of the residents), and several individuals confirmed they attended these, together with the manager. Residents’ views are also sought via quality assurance questionnaires. A number of changes had been made in the home, in response to residents‘ meeting requests and quality assurance feedback. In response to a request from some residents the home’s bar is going to be opened more often for a trial period. As already noted, residents have the choice whether they wish to hold a key to their bedroom, and they can secure the door from inside, without one. The manager is aware of the new Mental Capacity Act and is seeking training on its implications for the home. Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 18 The menus provide a varied diet and residents have a choice of two options at each meal. Residents’ confirmed that they enjoyed the food and that choices were always available. Nutritional risk assessments are now undertaken for all residents in order to identify any particular dietary concerns so they can be addressed. The lunch provided on the day of inspection was tasty and well presented. The manager indicated that where residents need their meals to be liquidised, this was done with separate items to preserve the variety of texture and colour. The dining environment is relaxed and comfortable and residents enjoyed their lunch at their own pace. Staff were attentive and available where necessary to offer encouragement to residents. The handyman arrived at lunchtime to undertake some work on a resident’s walking frame at her request, and clearly had a friendly and familiar relationship with the residents, exchanging conversation and banter with them. It was explained that the chef was leaving in the near future, but the post had been advertised to find a suitable replacement. Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 19 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): Standards 16 and 18: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an appropriate complaints system in place, which is made available to residents and others. This, together with the manager making herself increasingly accessible to residents and others, makes residents feel they can approach her with any concerns they may have. Evidence from the complaints log indicates that complaints are recorded and appropriately addressed, though it would be beneficial for staff to receive some training on responding to and passing on complaints, to ensure the system is always accessible. The home has systems in place to protect residents from abuse, and works to the local written protocol for safeguarding vulnerable adults. EVIDENCE: The home has an appropriate complaints procedure in place, which is outlined in the Residents’ Guide. Examination of the complaints log indicated six complaints since the last inspection, which had been addressed appropriately. The manager indicated a positive attitude to complaints, and said that wherever possible, lessons were learned from them to avoid a recurrence. Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 20 However, staff do not receive formal training on responding to complaints, though the subject is discussed in team meetings. It is suggested that some training is provided to staff on how to respond to complaints and appropriate reporting procedures, as there may sometimes be links to safeguarding issues. The complaints are regularly monitored by the Trust, who may undertake further investigation in some cases. In discussion with the inspector, several residents were aware of the complaints procedure or were clear that if they had any issues they would raise them with the home manager. The manager is planning to relocate her office to a much more accessible room in the main part of the home, from its current location, where it is rather isolated from the day-to-day events. This will further improve her accessibility should residents, relatives or others wish to raise any concerns. Despite the current issue with regard to the location of the manager’s office, residents felt she was accessible and one said she is always going round the home and checking how people are. The Commission has received no complaints requiring referral to the provider for investigation, since the last inspection. The manager indicated that the staff team (all bar the two most recent appointees), have received accredited training on safeguarding vulnerable adults. An update on this training was reportedly provided recently and is also part of the standard induction for new staff. The home also has videos and an e-learning package to back up the formal training. The training records confirmed that the vast majority had received this training. A copy of the local Oxfordshire Protection of Vulnerable Adults Protocol (POVA) was available in the home. No issues related to the safeguarding of vulnerable adults have been notified to the Commission since the last inspection. The home has systems in place to protect residents’ finances where they look after these on behalf of them. Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 21 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): Standards 19 and 26: Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides a well-maintained and homely environment for residents, which maximises their mobility and independence, and appropriate specialist equipment is provided to support residents where necessary. The home is clean and standards of hygiene were observed to be good. Appropriate laundry facilities are provided. EVIDENCE: The home was attractively decorated and furnished in a homely fashion. The building has a light and airy atmosphere, for the most part with plenty of natural light in the communal areas. A variety of lounge and dining areas are available as well as some additional seating areas about the home. One of these was seen to be very popular with residents as it overlooks the main entrance and the attractive enclosed Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 22 courtyard garden. The railings here were due to raised slightly to comply with health and safety guidance. The home has a small bar area, which was popular with some of the residents, though they were looking forward to its increased opening times. One corridor was reported to be due for redecoration, and the others were to be done on a rolling programme, thereafter. As well as the courtyard garden, the home has another large area of garden, which is currently under-used, though work has begun to make this area more attractive to residents. A planted border had already been provided alongside the pathway, and the manager expressed a desire to continue to develop this area to increase residents’ use. The home provides all single bedrooms, which are of varying sizes, and fees vary accordingly. As already noted, bedroom doors have an appropriate locking device to enable residents to lock the door from inside, as well as them having the option to have a key. Staff have access to a pass key in the event of an emergency. The home has four adapted bathing facilities in the form of two specialist height-adjustable baths with integral hoists and two wheelchair accessible showers. There are currently eleven toilets in the home, four of which are within the bathrooms. The bathroom/toilets have double-acting hinges and catches fitted which allow the door to open inwards in normal use while enabling outward opening in an emergency. Corridor and communal room doors are held open via appropriate electromagnetic holdbacks, which are integrated with the fire alarm, during the daytime, to maximise residents’ independent mobility about the building, but are closed at night. Should the fire alarm be triggered, these doors are released and close automatically on their self-closers. Small ramps are present where necessary to ensure full accessibility, and the home has a passenger lift. A radio alarm system operates throughout the home providing bleeper alerts to staff when an emergency call bell is activated. Since the last inspection, some missing window restraints had been installed on upstairs windows. Previously noted odour problems associated with the home’s cat had been addressed through thorough carpet cleaning and the rehoming of the cat. Standards of hygiene were observed to be good, with no residual odour present. The home has an appropriately equipped laundry, with sluice-cycle washing machines to reduce the risk of cross-infection. Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team are able to meet the current needs of the resident group, though remaining vacancies need to be filled to provide increased flexibility and consolidate the activities programme. The home has made progress on NVQ attainment but there remains some way to go to provide a sufficiently trained team in terms of NVQ to fully meet the needs of residents. The provider needs to address the disparity between the information on NVQ attainment, provided in the Residents’ Guide and the training record. The home’s thorough staff recruitment and selection procedures support and protect residents, and the recent active involvement of residents in the process, is a positive development. The provider has an appropriate written induction and core-training package in place to try to ensure that staff are trained and competent to support the residents. However, the training records indicate a number of gaps in core training, which will need to be addressed. Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 24 EVIDENCE: The home has a culturally diverse team of staff with a wide range of care experience, but there is a core of experienced staff. The home has had care staff vacancies, which has in the past, necessitated the use of agency staff at times to provide essential cover, when existing staff could not cover shortfalls, though the manager had worked to reduce the use of agency, and tried to use only known agency staff more recently. During the recent viral outbreak, agency staff use increased as a number of the staff were also affected. The outbreak reportedly took a lot out of the team and their energy levels were just beginning to recover. The “standard” staffing was said to be five carers throughout the morning shift, and from 5pm until 9pm, with four staff between 2pm and 5pm. At nights there are two waking night staff plus an additional person sleeping in who is on call if required. In addition to this, the activities coordinator will provide activities input five days per week, once the person commences in post. The manager indicated that one further carer and a kitchen assistant had just been recruited, leaving only one full time carer post vacant, though the post of chef was also being advertised, now that the chef was leaving. The vacant activities coordinator post had recently been appointed to. Feedback from the residents was positive about the approach of staff who were described as “very good” and said to be kind in responding to their needs. One resident said they often took individuals out to church or to the shops. None of the residents indicated any undue delays in staff responding to their needs. Observation of the interactions between staff and residents during the inspection, were positive. The staff were seen to be attentive, and friendly, and there were examples of humorous exchanges and banter, which were evidently enjoyed by the residents. Staff were seen to offer residents’ choices and to treat them with respect and dignity. One staff member was seen kneeling down next to a resident so she could make sure the resident could hear what she was saying, rather than simply shouting to make herself heard. The handyman was attending to various minor maintenance tasks on residents’ wheelchairs and noting individuals’ requests for other matters to be addressed, and still found time to chat and joke with the residents. The home has made some progress on NVQ attainment, with the head of care and two of the three senior carers having NVQ level 3 and one who is Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 25 undertaking this. The head of care is currently undertaking level 4. Of the carers, five have attained NVQ level 2 and a further three are undertaking this, according to the training spreadsheet. Two night staff have attained level 2, a further two are working towards this and one is working towards level 3. Once the indicated staff complete their NVQ, the home will exceed the required level of 50 of care staff having their NVQ. The provider should consider working towards another group of care staff commencing NVQ as soon as possible, to plan for maintaining/increasing the percentage in the future. These figures for NVQ attainment from the training spreadsheet do not match with the information given in the Residents’ Guide, which suggests that all of the seniors have NVQ level 3, and suggests that all of the carers are already working towards NVQ level 2. The difference between these two records must be reconciled in order to portray the true position. Examination of recruitment records indicated systematic, indexed staff files, which included all of the required evidence or recruitment and selection procedures. The CRB confirmation letter included the required information, and there was also a copy of the interview record. Files included a copy of the Skills Council induction, providing a signed and dated record of the process. Two written references were present even in the case of staff from overseas, and translations had been obtained where necessary. Residents had been successfully involved in the recent recruitment of the new activities coordinator, and this approach was to be developed further. The provider has a detailed induction and core-training package, which is provided from a mix of in-house and external sources. Training on moving and handling is sourced from accredited trainers from the local authority. Key food handlers undertake certificated food hygiene training, other staff, who are not primary food handlers, receive an in house training on the basics. A new computer system was being introduced where collective training records were to be held. Though these were not available on the day of inspection, they were forwarded subsequently to the commission. It was said that the new system would help to flag up where training updates become due. All staff receive the General Social Care Council’s Code of Conduct, which is gone through as a part of induction. Some staff have received training in equality and diversity issues and a distance-learning package on palliative care has also been introduced. The training spreadsheet indicates some shortfalls in core training, which will need to be addressed, but the majority of staff have received the expected training. Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 26 Indicated shortfalls include gaps in health and safety and COSHH training for some care leaders, and gaps in core training on COSHH, hoist use, and “safeguarding” for some carers. Significant numbers of carers are still to receive bereavement training, though around half of the team attended this in August 2007. Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 27 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): Standards 31, 33, 35 and 38: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An experienced and appropriately qualified manager runs the home. She now has an established team of seniors to share management responsibilities. The manager has applied for registration. The home is run in the interests of residents and their views are sought on aspects of its operation. A quality assurance system is in place to seek the views of residents, in addition to regular residents meetings and other surveys, though the views of other interested parties should also be sought. Appropriate systems are in place for the management of residents’ funds where the home takes some responsibilities in this regard, which safeguard residents’ financial interests. The health safety and welfare of residents are promoted within the home. Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 28 EVIDENCE: The manager had been in post for about eighteen months at the time of this inspection and has addressed a number of issues previously noted. She is seeking to relocate her office to a more central location to enable more effective monitoring of the home, and improved access by residents and relatives who may wish to see her. The manager has NVQ level 4 and the Registered Manager’s Award as well as a Diploma in Management Studies and other relevant qualifications. She has been a home manager for about fourteen years and has applied to become registered manager of this home. One resident said that the manager always made herself available to the residents, and was very helpful. Feedback from staff indicated a positive relationship with the manager. The home has a quality assurance system in place, and also uses other customer feedback forms such as meal satisfaction surveys, and regular residents’ meetings, attended by the manager. Residents had also been involved successfully in the recent interviews for a new activities coordinator. The most recent quality assurance cycle took place in June 2007, and a summary report of the findings was presented to the residents meeting. The annual Action Plan and business plan for 2006 were seen, though the action plan for 2007 was still to be published. At present the quality assurance system only takes the views of residents, (of whom, some are supported by family members to complete the forms). In order to obtain a 360-degree review of the home it is recommended that surveys be broadened to include relatives, care managers and external healthcare professionals as each has their own experience of the home, which can highlight new issues or provide confirmation of the views of others. It is also beneficial to survey the staff working in the home for their views. The provider also undertakes periodic financial, and other audits, and is required to undertake monthly Regulation 26 monitoring visits. The majority of recent visits had taken place and copies of the reports were available as required, but for the last quarter of 2006 and January 2007 the reports (produced by a previous line manager who was no longer employed by the provider), could not be located. However, the majority of the required reports since February 2007 were present. Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 29 The provider must ensure that Regulation 26 visits are undertaken monthly and a copy of the resulting report is provided to the manager for filing in the unit. The home has also attained ISO 2000 status and has an Investors In people award. Oxfordshire County Council, as the home’s largest stakeholder, also undertakes annual monitoring visits, which include interviews with staff. Two residents confirmed to the inspector that they had been asked to fill in a quality assurance questionnaire, and other surveys, and also added that their views were sought within the residents meetings as well. The home has systems in place to safeguard residents’ monies where it takes some role in their management, though the home/provider are not appointee for any of the residents. There is a residents’ bank account, with numbered and named sub-accounts for each resident. The home holds a limited amount of cash for each individual, which can be available directly to the resident or when requested by the keyworker on their behalf. Three residents currently receive their full personal allowance in cash each week. Whether the resident or a staff member on their behalf, withdraws cash, they signs for this to provide a proper audit trail and receipts are filed for any expenditure on a residents’ behalf. A collective balance sheet is maintained on paper, which is reconciled with individual balance sheets held on computer. Receipts are attached. Where collective receipts are provided, such as by the hairdresser, they identify the individuals who received the service to enable proper billing. The home has an overall fire risk assessment, and a written overall evacuation plan. Training on fire evacuation risk assessments was due, after which the manager said, individual fire evacuation risk assessments would be compiled for each resident. The last fire drill took place in September 2007. A fire roll call list is maintained which includes details of any mobility impairment, to assist the fire brigade in the event of a fire. In house fire alarm checks are regular and the alarm is serviced on a quarterly contract. Examination of a sample of other health and safety-related service certification indicated that required servicing takes place regularly. The home has a collective month-by-month record of all accidents for monitoring purposes, which is copied to head office, and the individual accident forms are filed by resident, in a collective file for the current year. Older forms are filed within the residents’ case record file. Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 30 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 4 3 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 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 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 4 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 31 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 OP28 Regulation 6 Requirement The provider must address the disparity between the given information on NVQ attainment, provided in the Residents’ Guide and the training record in order to ensure that current position is accurately reflected. The manager must take steps to address the identified gaps in core training to ensure that staff receive the necessary training to enable them to meet the needs of residents. The provider must ensure that Regulation 26 visits take place monthly, and that copies of resulting reports are provided to the manager to be filed in the home; in order to ensure that the operation of the home is appropriately monitored. Timescale for action 15/12/07 2. OP30 18 15/01/08 3. OP33 26 15/11/07 Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 32 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 OP7 OP7 Good Practice Recommendations The roll-out of the new care plan system should be completed to enhance the individualisation of the care provided to residents. Consideration should be given to the introduction of a system of individual personal care recording which addresses individual privacy and provides the opportunity for accountability and management audit. Consider the provision of training to staff on responding to and reporting complaints, in order to ensure than any relevant issues are appropriately recorded and reported. The provider should consider additional care staff commencing NVQ level 2 at the first opportunity to maintain/improve the ratio of qualified staff in the home. The provider should consider broadening the quality assurance system to seek feedback from relatives, care managers and external healthcare professionals in order to obtain a comprehensive view of the operation of the home. 3. 4. 5. OP16 OP28 OP33 Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 Townsend House DS0000013161.V344728.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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