Inspection on 20/11/07 for Trent House

This inspection was carried out on 20th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

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 Trent House 42 Newport Road Cowes Isle Of Wight PO31 7PW Lead Inspector Janet Ktomi Key Unannounced Inspection 20th November 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Trent House DS0000069870.V349850.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. Trent House DS0000069870.V349850.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Trent House Address 42 Newport Road Cowes Isle Of Wight PO31 7PW 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) 01983 290596 01983 281 616 McCourt Care Limited vacant post Care Home 19 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0), Physical disability (0) of places Trent House DS0000069870.V349850.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Physical disability over 65 years of age (PD) 2. Dementia (DE) The maximum number of service users to be accommodated is 19. Date of last inspection New Service Brief Description of the Service: Trent House is an extended older detached property in Cowes. The home is registered to provide accommodation and care for up to 19 people over the age of 65 years who may or may not have dementia or a physical disability. The accommodation is on three levels. The home has a passenger lift in order to access all levels. The home has appropriate communal and bathing facilities with a garden accessible via a chair lift or short flight of steps from the lounge. Most bedrooms are for single occupancy some with ensuite facilities. The home is sited close to all local amenities and on a main bus route to/from Cowes. The home is owned by McCourt Care Limited and at the time of the inspection was without a registered manager. Weekly fees correlate to social services rates and are up to £462.00 per week dependant on assessed needs. Trent House DS0000069870.V349850.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report contains information gained prior to and during an unannounced visit to the home undertaken on the 20 and 21st November 2007. As this was the first key inspection since the new owners purchased the home all core standards and a number of additional standards were assessed. The new provider is McCourt Care Limited who has a responsible individual Mr S McCourt, he was not at the home during the visit however another director was in attendance, this director is considering applying to be the homes registered manager, which is currently a vacant post. The visit to the home was undertaken by one inspector and lasted approximately nine hours commencing at 09.30 am and being completed at 2 pm on the 20th November. The inspector returned to the home on the 21st November to meet with one of the directors to complete the remaining standards and provided initial feedback to the inspection visit. The inspector was able to spend time with staff on duty and was provided with free access to all areas of the home, documentation requested and people who live at the home. Prior to the visit the provider completed an annual quality assurance questionnaire (AQQA), information from which is included in this report. Comment cards were returned from three district nurses and three GP’s. The inspector met with a visiting health professional during her visit to the home. Comment cards were sent to the home for distribution to people who live at the home and their relatives/visitors. Eight comment cards were received from people who live at the home and two relative responses were received. Four members of care staff also completed surveys. Information was also gained from the link inspector and the home’s file containing notifications of incidents in the home. During the visit to the home the inspector was able to meet with and talk to many of the people who live at the home and staff on duty. What the service does well: All comment cards, from people living at the home, their relatives and external professionals were positive about the home and service it provides to people who live there. All comments made to the inspector during her visit to the home were also positive about the service people receive. Trent House DS0000069870.V349850.R01.S.doc Version 5.2 Page 6 People stated that food provided at the home is very good with choice provided at all meals. People can choose to have a cooked breakfast if they wish. What has improved since the last inspection? What they could do better: The following requirements and recommendations were made following this inspection. The home must provide a statement of purpose and service users guide to all existing people and make this available to prospective service users. The home must ensure that contracts/terms and conditions are provided to all existing people living at the home. Contracts should be signed either by the person receiving care or by a relative/representative on their behalf. The home must ensure that everyone living at the home has a care plan that clearly identifies how that persons needs will be met. People should be fully involved in their care planning and reviews. People should be encouraged to sign their care plans and other related documents such as risk assessments and management plans. Where people are unable to sign their plans or be involved in care planning a relative or representative should be fully involved and asked to sign the care plan. The provider must ensure that polices and procedures for the administration of medication are reviewed and follow Royal Pharmaceutical Society guidelines for the administration of medication in care homes. It is also recommended that all staff who are to administer medication undertake the skills for care knowledge set for medication administration. The home must complete an audit of staff training previously undertaken and produce a training plan to meet identified training needs. The home must ensure that all information needed about staff is held in respect of everyone employed at the home. People must not commence working at the home until either a POVA first or full enhanced Criminal records bureau check has been received. Trent House DS0000069870.V349850.R01.S.doc Version 5.2 Page 7 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. Trent House DS0000069870.V349850.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 Trent House DS0000069870.V349850.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 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home must provide everyone living at the home with a copy of the service users guide/statement of purpose. People have not signed contracts. People are assessed prior to moving into the home to determine that their individual needs can be met. People, or their representatives, are able to visit the home prior to admission to assess the quality, facilities and suitability of the home. Standard 6 is not applicable, as the home does not provide intermediate care. EVIDENCE: The provider stated in the homes AQQA that the home did not have a statement of purpose or service users guide. This was confirmed to the Trent House DS0000069870.V349850.R01.S.doc Version 5.2 Page 10 inspector during the site visit by one of the directors. Following the site visit the same director contacted the inspector by telephone to inform her that she had found the homes statement of purpose and service users guide used by the previous owner. Also identified in the AQQA was that the current terms and conditions (contract) is in need of updating and these had not been consistently provided in the past. Comment cards received from people who live at the home all stated that they had not received a contract. The inspector was shown an example of a contract, which had not been signed by the person receiving care or a relative. The director was aware that contracts/terms and conditions must be provided to all people and these should be signed either by the person receiving a service or if they are unable to do so by a relative or representative. The inspector viewed three pre-admission assessments and discussed the admission procedure with the team leader on duty. The team leader confirmed that all people for planned admission are visited either at their home or in hospital and a pre-admission assessment is completed. These were viewed during the visit to the home. The assessments are completed on a form which, if fully completed would cover many, but not all, of the areas necessary for the home to determine if they are able to meet the persons needs. The forms viewed had not all been fully completed one containing no information about a person’s potentially inappropriate behaviour. The homes AQQA stated that ‘pre-admission documentation will be reviewed and updated where necessary’. A requirement is not made in respect of pre-admisison assessments, as the director is aware that the current procedures and forms need revising. The team leader stated that people, or their representatives, are able to visit the home prior to admission to assess the quality, facilities and suitability of the home. The home does not provide intermediate care however respite or short stays can be accommodated if a bedroom is available. The home does accept emergency admissions. Trent House DS0000069870.V349850.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans do not ensure that peoples care needs are identified or met. People’s health care needs are met. Medication is appropriately stored and records fully maintained however administration procedures are inappropriate and could result in drug errors and in people receiving the incorrect medication. People feel they are treated with respect and their right to privacy is respected. EVIDENCE: The inspector viewed care plans for new and existing people. Care plans are stored in a lockable facility. Of the four care plans viewed one person who had been living at the home for approximately three weeks did not have a plan of care identifying how her individual needs would be met. Also within this persons care plan file was an uncompleted risk assessment, uncompleted likes/dislikes and uncompleted dietary needs/wishes information sheet. The Trent House DS0000069870.V349850.R01.S.doc Version 5.2 Page 12 person had a history of falls and the falls risk assessment and management plans had not been completed. The care plan file did contain a sheet of daily recordings stating what care had been provided on most days since her admission. This persons care folder was discussed with the team leader on duty on the first day of the inspection and viewed again on the second day as the director present stated that the care plan had now been fully completed. The risk assessment, likes/dislikes and dietary needs form had been completed however the person still did not have an individual plan stating how her needs should be met. The dietary needs form should have been completed on admission and provided to the kitchen as seen in the kitchen for another person recently admitted. Other care plan files viewed contained a plan as to how a persons care needs should be met. These did not contain specific information such as, for instance, what a person could do for themselves and what they required assistance with as far as maintaining their personal care needs. There was no evidence either in discussion with people living at the home, care staff or in care plans that people had been involved in the formation of, or agreed, their care plans or reviews of care plans. Within care plans were risk assessments in relation to falls, information about nutritional needs, a hazard analysis and in one file a specific risk assessment relating to individual risk. However as previously identified not all people had completed risk assessments even for clearly identified risks such as falls. The director present informed the inspector that she had attended a care planning training session and intended to review the homes procedures for care planning. Manual handling equipment was seen during a tour of the home and care staff confirmed that they had undertaken manual handling training. The inspector was able to meet many of the people living at the home. They all stated that they felt very well cared for. Comment cards were received from two relatives, both stated that medical and care needs were always met. Comment cards were also received from eight of the people who live at the home who stating that they always/usually receive the care and support they require. People the inspector spoke with during her visit to the home confirmed that their care needs are met and stated that staff are kind and caring. People living at the home stated that they felt well looked after and that if they were ill the home would organise for a doctor to visit them. Comment cards from people living at the home stated that they always received the medical care they required. Comment cards were received from three GP’s who stated that the home seeks advice and acts upon it to improve and manage people’s health care needs and that individuals health care needs Trent House DS0000069870.V349850.R01.S.doc Version 5.2 Page 13 are always met by the home. The GP’s also confirmed that they felt the staff had the necessary skills to meet people’s needs. Three district nurses also completed comment cards, all stating that they felt peoples health care needs are always met by the home one adding ‘I am not aware of any incidents when their (health) needs have not been met’. Also stating ‘I was particularly impresses with the care afforded to a resident in her final days who had demanding/difficult needs physically. Very respectful and dignified.’ District nurses also stated that the home contacted them when necessary and acted on their advice. The inspector spoke with a visiting health professional who was very complementary of the care provided to people living at the home. Discussions with the director and senior staff during the inspection visit indicated that they knew how to contact external professionals and when this should be done. Records seen during the inspectors visit indicated that health professionals are appropriately consulted. Care staff stated, and records confirmed that they have attended training in dementia and caring for people with challenging behaviours. The inspector undertook a tour of the home with the senior on duty on the first day of the inspection and was therefore able to meet some people who had chosen to remain in their bedrooms. Care staff stated that they felt they had enough time to meet people’s health and personal care needs. Discussions with and comment cards received from people confirmed that staff are available when required. Observations during the inspection indicated that people generally had time to meet people’s needs in a non-hurried manner. The director present stated that only senior staff who have undertaken additional training and been deemed competent administer medication in the home. All medication was seen to be appropriately stored in a secure locked facility. The medication administration records were viewed and had been fully completed. The inspector observed the lunchtime medication being administered and discussed this and how other medication rounds are conducted. The person administering the medication placed all the lunchtime medication into individual pots and then carried these pots around the home giving them to people. Other medication was left on top of the trolley in an open pot in an unlocked area along with a complete packet of medication. This was discussed with the person who stated that she was able to tell whose medication it was from the pills in each pot. The person was also seen to sign the medication record sheets before taking the medication to the person. When asked what would happen if the person refused the medication it was stated that she would then write over the signature to indicate this. This was discussed with the director who informed the inspector the day following the inspection that other staff members followed a similar procedure and used small nametags placed in the pots to indicate whose medication was on a tray of pots containing medication. The medication administration procedures were Trent House DS0000069870.V349850.R01.S.doc Version 5.2 Page 14 discussed with the director who must ensure that polices and procedures for the administration of medication are reviewed and follow Royal Pharmaceutical Society guidelines for the administration of medication in care homes. It is also recommended that all staff who are to administer medication undertake the skills for care knowledge set for medication administration. Comment cards received from people confirmed that staff listen and act on what they say. People the inspector spoke with confirmed that staff treat them with respect and that their privacy is maintained during personal care. During the inspectors visit staff were observed to treat people with respect, this was also confirmed by professional comment cards received. The GP’s confirmed that the home always respects individual’s privacy and dignity and responds to individuals’ different needs. The director confirmed that screening is provided in shared bedrooms. Trent House DS0000069870.V349850.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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The routines for daily living and activities made available are flexible and varied to suit people’s individual needs. Family and friends are able to visit. People receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. EVIDENCE: People and relatives confirmed to the inspector that they are able to choose where in the home they spend their day, many were seen to spend time in the homes lounge with others remaining in their bedrooms. People stated they could choose where they have their meals, most people choosing to eat breakfast in their bedrooms and other meals in the dining room. People confirmed to the inspector that they are given choice over their meals with options being chosen on a daily basis. This was also confirmed by the cook who showed the inspector the list of that days choices. Some people were seen to choose both main meal options having both casserole and sausages with a range of fresh vegetables at lunchtime. Bedrooms seen contained personal items brought into the home. People stated that they are able to get up and go Trent House DS0000069870.V349850.R01.S.doc Version 5.2 Page 16 to bed at times of their choosing. Comments from external professionals also indicated that people’s choices are respected one stating ‘individual preferences i.e. time of getting up, going to bed etc and choice of food appears to be tailored to individual needs’. The home stated within the AQAA that a range of entertainments and activities are organised including exercise to music (fortnightly), reminiscence work, bingo, board games and games specifically designed for older people. The director stated that the home has identified a carer with an interest in activities as having responsibility for the organisation of activities. People living at the home confirmed this to the inspector. People living at the home informed the inspector that a local vicar visits the home. Since the new providers have purchased the home a trolley shop has been introduced to enable people to purchase small items such as sweets and toiletries and the home has held a clothes party to enable people to select and purchase items of clothing. The home identified in its AQAA that it would like to provide more outings and the owner has identified a suitable minibus that can be hired. Within comment cards people stated that the home usually provided suitable activities and in discussion people were clear that they could choose to join in or not. Although there were no visitors whilst the inspector was visiting the home relatives confirmed in comment cards that they could visit and that they were kept informed about their relative. People the inspector spoke with also confirmed that they could have visitors as they wished. The home has two lounges, one being used more that the other so the quiet lounge might be available for private visits if this were required. The home has a mobile handset for the telephone that was seen being given to people to receive incoming calls. The home has a dining area at one end of the main lounge. Many people choose to have their lunchtime meal in this area. People stated that the food is always good, ‘very good’, and choice provided. A cooked breakfast is available. The inspector was present for the main lunchtime meal. The food appeared well presented and appetising. An additional comment from a visiting profession comment card stated ‘the food always smells wonderful and is reported to be very good’. Discussions with the cook indicated that wherever possible fresh vegetables are used. People confirmed that they were given choice and this was also observed when the cook was seen to be serving puddings with several choices being offered. Drinks and snacks were available throughout the day with people confirming this as well as the inspector observing people being given morning and afternoon hot drinks. People stated that they could have a hot milky drink and snack at suppertime. The cook stated that she was aware of those on a special diet and what they could be or should not be offered. Trent House DS0000069870.V349850.R01.S.doc Version 5.2 Page 17 The home has a good-sized kitchen. The home has recently been inspected by the environmental health department and awarded the maximum five stars for kitchen cleanliness. Trent House DS0000069870.V349850.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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. People are mainly protected from abuse although the homes recruitment procedures may place people at risk. EVIDENCE: Within the entrance hall is a notice providing information as to what to do if a person or visitor has any concerns or complaints. Care staff stated that they would try to resolve any issues raised by people or relatives, if they were unable to do so they would inform one of the providers. The homes AQAA stated that ‘we deal with any complaints from residents or their families as soon as possible’. The home has received one complaint since the new providers purchased the service approximately six moths prior to the inspection. The director showed the inspector the file and forms on which complaints would be recorded and action taken by the home to investigate and resolve issues. People the inspector spoke with also stated that although they had no concerns or complaints they would feel able to raise any issues with staff or one of the providers. Comment cards from people living at the home confirmed they knew how to complain. Comment cards from relatives stated that they knew how to make a complaint and the home had responded appropriately if any issues had Trent House DS0000069870.V349850.R01.S.doc Version 5.2 Page 19 been raised. GP’s and district nurses had not received any complaints concerning the service. Care staff confirmed that they have attended safeguarding adults training and were clear as to the action they should take should they suspect that a person might have been abused. The home identified in its AQAA that ‘staff have proved to be very professional in the past and are not afraid to report suspected abuse’. Care staff confirmed that they have also attended training in dementia and challenging behaviour. During the inspection the inspector was impressed with the way individual staff supported a person with demanding and potentially challenging behaviour. The home had put in additional risk assessments which detailed that two staff should always be available to support this person due to the risk of allegations however throughout the inspection one person was generally seen to be supporting this person and staff confirmed that the home did not have sufficient staff to enable two of them to always be present. The homes policies and procedures in respect of recruitment and people’s personal finances are discussed in the relevant sections of this report. Trent House DS0000069870.V349850.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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a clean, safe, environment, with the provider being aware of areas in the home that require attention and upgrading. EVIDENCE: The team leader showed the inspector round the home (as she had not previously visited Trent House) and the inspector was then able to move independently around the home. Overall the home is clean and free from any offensive odours with comment cards from people who live at the home confirmed this was always the case. The home is an adapted/extended older building with all floors being accessible via a passenger lift capable of carrying two people at a time. The home identified in the AQAA that areas of the home are in need of redecorating and modernisation. The inspector was shown plans to alter two small WC’s adjacent to the main lounge/dining room to provide Trent House DS0000069870.V349850.R01.S.doc Version 5.2 Page 21 one larger WC which people who require support or manual handling equipment could access. The director also identified that most areas of the home are in need of redecoration and stated that one bedroom has been completed and that they are trying to recruit a maintenance person to undertake routine jobs and redecoration work as part of an ongoing programme. The director also identified in the homes AQAA that furniture, fixtures and fittings are also looking dated in both communal rooms and within bedrooms. Requirements in respect of redecoration and updating are not made as the proprietor is fully aware of issues that require attention. Most bedrooms are for single occupancy with two being for twin occupancy. Some bedrooms have ensuite facilities. Bedrooms seen contained various items of personal furniture and possessions brought into the home by the rooms’ occupant and are lockable. The home has a dining/lounge room, which overlooks the gardens at the rear of the home. The home has an additional quiet lounge. The gardens are accessible via a short flight of steps or by a chair lift. People stated they were happy with their bedrooms and communal facilities. Assisted bathing facilities are available and WC’s are located close by the lounge/dining room. Moving and handling equipment was seen during the inspection visit with care staff confirming that they had the necessary equipment to meet people’s needs. The comment cards from people living at the home confirmed that the home is always fresh and clean. The home employs housekeepers who stated that they have sufficient time to complete their daily and weekly cleaning schedules. The home has a laundry facility that is appropriate for the size of the home. Care staff confirmed that they have free access to supplies of disposable gloves/aprons etc for infection control purposes, supplies of which were seen conveniently and discreetly located around the home. Trent House DS0000069870.V349850.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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home employs appropriate numbers of care and ancillary staff that ensure that peoples needs are met. Over fifty per cent of care staff have NVQ in Care of at least level 2 however the home must complete an audit of training undertaken and produce a training plan. The home must ensure that robust pre-employment checks are undertaken on all staff prior to their commencing employment at the home to protect people living at the home. EVIDENCE: All comment cards, from people who live at the home, relatives and professionals were positive about care staff. One professional stating ‘the carers always seem very kind and caring, helpful and responsive’, another adding ‘staff generally friendly and informed about patients’. A relative stated ‘have always found the staff very friendly and seem to have the necessary skills to carry out the everyday care of the residents’. Discussions with people during the visit to the home confirmed the above opinions. Duty rotas were seen during the visit to the home. People stated in comment cards and to the inspector that there are sufficient staff on duty. During the inspectors visit staff on duty corresponded to those on the duty rota. Care staff stated that they generally have sufficient time to meet people’s needs and Trent House DS0000069870.V349850.R01.S.doc Version 5.2 Page 23 throughout the inspection care staff appeared to have time to meet people’s needs. The director confirmed that on call support is provided. The director provided training and qualification information during the inspection and in the homes AQAA. The home has at least fifty per cent of care staff with an NVQ of at least level 2 with some having a level three qualification. Additional care staff are to undertake NVQ training. Discussions with care staff confirmed that they had NVQ qualifications in care including level 3. The home identified in the AQAA that ‘staff could be given more opportunities to choose from a wider range of training to improve on their qualifications’. The inspector saw a list of dates for Mental Capacity Act training being provided at the hospital and a note for staff to indicate when they would be attending. The inspector viewed training certificates in staff files and discussed training with staff on duty. Staff confirmed that they had undertaken mandatory and other relevant training and felt that they had the necessary skills to meet people’s needs. The director has not yet completed a full review of staff training undertaken and identified that which is now overdue or required by staff. The recruitment records for the two staff recruited since the new owners purchased the home were viewed. These did not contain all the required information as specified in Schedule two or evidence of a POVA checks or full enhanced Criminal Records Bureau check having been completed prior to the person commencing employment at the home. The director had obtained the contact details for Skills for Care and stated that she is aiming to introduce the skills for care induction process. The home has used some agency staff with the director stating that she is in the process of recruiting more permanent staff. The home is in the process of introducing new contracts and shift patterns for care staff to ensure a better skills mix on shifts and provide more staff at busy times. Trent House DS0000069870.V349850.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, 33, 35, 36, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home must have a registered manager with the necessary skills and experience to ensure that the home is appropriately managed and run in the best interests of the people who live there. People’s financial interests are safeguarded. Records must be fully maintained. The health, safety and welfare of people and staff are promoted however the home is recommended to undertake more regular checks of fire detection equipment. EVIDENCE: The previous registered manager resigned in September 2007. Initially the homes deputy manager undertook the role of the manager however shortly Trent House DS0000069870.V349850.R01.S.doc Version 5.2 Page 25 before the inspection she decided that she did not wish to continue as acting manager. One of the homes directors informed the inspector that she had now decided to apply to the commission for registration. The director has a management qualification and experience in running care homes and as an inspector of care homes. The director stated that she is generally at the home three days per week with her husband (co-director) being present on one or two days per week. The director stated that whilst the manager was present and then the acting manager she had not been fully involved in the organisation and general running of the home and would now be focusing more on the management aspects of the home. Discussions with the director indicated that whilst she was aware of many areas of the home that required attention she was less aware of some issues. The director stated that she has developed links with other homeowners on the island and joined the care homes association. Discussions with the director and information in the homes AQAA indicated that she is aware of quality assurance issues however the home has yet to undertake any formal quality assurance since the service was purchased. This standard will be fully assessed during the next inspection of the service. The home does not act as appointee for anyone. Some of the people living at the home continue to manage their own personal money and the home holds small amounts of personal money for other people. The storage arrangements and records of personal money held on behalf of people were viewed. It is recommended that the directors introduce a regular audit of the records and money held on behalf of people. Care fees are invoiced to the person responsible for paying the persons fees on a monthly basis. The director informed the inspector that supervision is organised on a cascade system with her supervising senior staff who in turn supervise a number of care staff. A list of who is to supervise whom was seen on the office wall. The director stated that training is being organised for senior staff and the inspector was shown planned supervision paperwork that included supervision contracts and record forms for supervision. As the supervision system is still in the process of being fully implemented this standard will be re-assessed at the next inspection. Various records were viewed throughout the inspection visit to the home. These have been detailed in the relevant sections of this report. Some records were well maintained others were not. Medication administration records must only be completed once a person has taken medication and not before. Everyone must have a care plan and this should be signed by the person whose plan it is or if they are unable to do so by a relative/representative. The home must ensure that information as specified in schedule two of the care homes regulations 2001 are held in respect of all people employed at the home. Trent House DS0000069870.V349850.R01.S.doc Version 5.2 Page 26 Whilst viewing records in the home the inspector requested the records of the checks of fire detection equipment (fire alarms). The records showed that the previous manager had undertaken these checks on a weekly basis until she resigned and ceased employment at the home in September 2007. Since that time the weekly checks had not been undertaken. Receipts and records form an external company showed that they have undertaken a check of equipment every three months. The director telephoned the local fire officer the day following the inspection visit and clarified the requirements re checking of fire detection equipment. The director contacted the inspector following this and stated that they although the fire office had not specified weekly checks these would be re-commenced. Trent House DS0000069870.V349850.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 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 2 2 Trent House DS0000069870.V349850.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? New service 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 4 and 5 Requirement The provider must provide a copy of the statement of purpose and service users guide to all existing people and made available to prospective service users. The provider must ensure that contracts/terms and conditions are provided to all existing people living at the home. Contracts should be signed either by the person receiving care or by a relative or representative on their behalf. The provider must ensure that everyone has a plan of care clearly stating how his or her care needs will be met. People must be involved in the planning and reviewing of their care and be encouraged to sign their care plans. The provider must ensure that polices and procedures for the administration of medication are reviewed and follow Royal Pharmaceutical Society DS0000069870.V349850.R01.S.doc Timescale for action 01/02/08 2. OP2 5B 01/02/08 3. OP7 15 (1) and (2) 01/01/08 4. OP9 13 (2) 01/01/08 Trent House Version 5.2 Page 29 5. OP29 19 6. OP29 Schedule 2 7. OP30 18 (1)(c) guidelines for the administration of medication in care homes. People must not commence working at the home until a POVA First or full enhanced CRB has been received. The provider must ensure that all information as specified in Schedule 2 of the care Homes regulations 2001 (updated) is held in respect of everyone employed at the home. The provider must undertake a review of training previously undertaken by care staff and produce a training plan to meet future training needs and identified skills gaps. 01/01/08 01/02/08 01/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP35 Good Practice Recommendations It is recommended that all staff who are to administer medication undertake the General Social Care skills for care knowledge set for medication administration. It is recommended that the directors introduce a regular audit of the records and money held on behalf of people. Trent House DS0000069870.V349850.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Trent House DS0000069870.V349850.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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