Inspection on 18/06/08 for Uphill Grange

This inspection was carried out on 18th June 2008.

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

Uphill Grange 09/01/08

Uphill Grange 25/07/07

Uphill Grange 29/08/06

Uphill Grange 28/11/05

Uphill Grange 23/05/05

Uphill Grange 16/09/04

Uphill Grange 20/07/04

Uphill Grange 27/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Uphill Grange Uphill Road South Weston Super Mare North Somerset BS23 4TX Lead Inspector Andrew Pollard Key Unannounced Inspection 18th June 2008 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 DS0000020290.V364427.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. DS0000020290.V364427.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Uphill Grange Address Uphill Road South Weston Super Mare North Somerset BS23 4TX Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered deputy manager (if applicable) Type of registration No. of places registered (if applicable) 01934 635422 01934 419384 uphill.grange@fshc.co.uk Acegold Limited (a wholly owned subsidiary of Four Seasons Health Care Ltd) Deputy manager post vacant Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places DS0000020290.V364427.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. May accommodate up to 26 persons aged 50 years and over requiring nursing care May accommodate up to 18 persons aged 65 years and over requiring personal care Deputy manager must be a RN on parts 1 or 12 of the NMC register. Staffing Notice dated 03/12/2001 applies Ms Stevenson successfully completes Level 4 NVQ in Care and Management by 30th September 2006. 9th January 2008 Date of last inspection Brief Description of the Service: Uphill Grange is registered to provide personal care and or nursing care for 44 residents. The home is a converted older property in the small village of Uphill, on the outskirts of Weston Super Mare. Accommodation is provided in single and two double rooms. The majority of these have en suite facilities. Fees range from £370.62 to £625. A large dining room, with a small lounge area, is situated on the lower ground floor and a lounge and dining room on the ground floor, which overlook the large garden and surrounding countryside. Two small passenger lifts ensure level access throughout the home. Acegold limited, a wholly owned subsidiary of Four Seasons Health Care, owns Uphill Grange. DS0000020290.V364427.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means that the people who use the service experience adequate quality outcomes. Part of this visit was to concentrate on checking whether the home had met the requirements of the last report. There have been a number of improvements in quality of care in the home for residents since the last visit in January 2008. These are described in the sections below. This visit was unannounced and took two days to complete. Before the visit survey forms had been sent for staff, health professionals and residents and their relatives to complete, a small number were returned. The information gathered was used to help us form judgments about the quality of the service provided. No complaints were made and in general the outcomes were positive and are reflected in the body of the report. Information has also been gathered from the Annual Quality Assessment Audit, the last report and notifications sent from the home to the Commission. The home continues to be managed by the deputy manager who has been covering the registered managers vacancy, She was present for both days of the visit, and was joined by the regional manager. The key findings of this visit were given to the deputy manager and regional manager during the two-day visit. What the service does well: Staff we spoken with and from surveys indicated that morale in the home was good. The home was found to be clean, warm and free from unpleasant odour. Staff were cheerful and interacting with residents in a positive and caring manner. Residents were calm relaxed and looked well cared for. The recording of people’s fluid and food intake has improved reducing the risk of residents being malnourished or dehydrated. DS0000020290.V364427.R01.S.doc Version 5.2 Page 6 The home ensures that there are adequate numbers of staff to meet the residents’ needs. The home ensures that aids and equipment are provided in sufficient quantity to assist staff with meeting the needs of residents. Some positive comments on the survey forms received included: I’m very happy here and well looked after” and “I am extremely pleased with the care” and “ the food and general cleanliness is good”. What has improved since the last inspection? What they could do better: Some comments received included, “Sometimes staff can be abrupt”, “The main problem seems to be a frequent turnover of managers. Which has an unsettling effect on the staff”, “more social activities and trips”, and “Communication within the nursing home seems fragmented at times”. The registered provider needs to undertake improvements in a number of areas: Employing a suitably qualified person to manage to the home and establish stability in management of the home for the benefit of residents. Updating the Service user guide and Statement of purpose to give clear information to prospective residents. End of life planning and person-centeredness to enhance the quality of care of residents. Ensuring residents have access to dental services on a regular basis to maintain or improve their dental health. DS0000020290.V364427.R01.S.doc Version 5.2 Page 7 Recruiting an activity organiser to help identify resident’s expectations and preferences and to satisfy their social, cultural and recreational interests. Ensuring interview notes for new staff are more comprehensive and include standard questioning for which responses could be recorded and scored for comparative purposes. Maintain proper records of resident valuables and unclaimed property in an inventory and kept in envelopes with descriptions, signed dated and sealed. The policy for the disposal of unclaimed property and return of property needs to be clarified and applied. The requirements or recommendations relating to these areas that have been made are included at the rear of this report. 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. DS0000020290.V364427.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 DS0000020290.V364427.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): 1,2,3,5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Prospective clients and their families are given relevant information and terms and conditions in written or verbal form about the home to assist them in deciding if the home is suitable for their purpose. As a result of effective assessment of needs prospective residents can be confident that these will be met in a manner to suit the individual. DS0000020290.V364427.R01.S.doc Version 5.2 Page 10 EVIDENCE: A statement of purpose and service user guide is made available at the initial stage of enquiry to prospective residents/families. This provides useful information about the services available and includes the terms and conditions. There is a “Welcome to Uphill Grange Care Home” document giving additional information to prospective residents about how the home operates. The Statement of Purpose will need to be amended to show the change in the age ranges resulting from the changes to the registration certificate. We discussed the fact that they should include the categories of people they were able to care for in the home and the admission criteria. There should be more clarity about the level of charges made for such things as hairdressing, chiropody and aromatherapy. The surveys returned stated that people had received adequate information to help them decide if Uphill Grange was somewhere they would like to live. They also confirmed that they had received terms and conditions and a contract on admission to the home. Visits to the home are encouraged either for the day or perhaps for lunch dependent on their wishes. The home has an admission procedure and pre-admission assessments including activities of daily living, health needs and personal history. All residents have Waterlow, handling, nutritional, falls and continence assessments. The assessments were fully completed and gave useful information to staff. This information was supplemented by the social services assessment and care plan. There have been no new admissions since the last inspection (Jan 08). In the last inspection report the following findings were noted: The pre-admission assessment for someone who had moved to the home in was assessed. There was a full assessment of their needs and then a considered decision made about whether the home could meet their needs. The assessment tool used for this is quite comprehensive, and encourages staff to think about a persons every needs. All of the residents are older people and are of white UK ethnic origin. Individual assessments ensure that any specific needs i.e. spiritual/cultural are identified and included in the care support plans Some respite care admissions continue to take place. DS0000020290.V364427.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): 7,8,9,10 11 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Care plans detail residents care needs they are clearly written and give directions to staff. End of life planning and a person-centeredness approach needs further development to enhance quality of care for residents Appropriate personal and nursing care is offered to residents to maintain residents’ health, well being and dignity and residents are treated with respect and given choice in how needs are met. Proper arrangements are in place for residents to access healthcare services and for the administration of their medication to maintain or improve their quality of life. DS0000020290.V364427.R01.S.doc Version 5.2 Page 12 EVIDENCE: Several residents files were looked at, including assessments, care plans personal history profiles and risk assessments. The records showed consistency and were detailed and up to date. We discussed the value of creating a separate working document file for each person and back filing the remainder of the paperwork, this is being considered. Intermittent care plans were available when short-term needs had been identified. Regular evaluation of resident’s care plans was taking place. Where possible residents/relatives sign care plans and consents. Risk assessments were in place with detailed information to ensure safe procedures including, manual handling, and the correct use of bed rails and how to reduce the risk of falls. The care plans state that the risk must be reviewed after any fall. Nutritional assessments are completed for each person and weights recorded monthly. Information about people who are having difficulty in eating or who will need a special diet is written in their care plan. We discussed the value of all the assessment/review activity being carried out and that after the initial assessments are made it is a matter of clinical judgement how often these are repeated. The assessments should be done where there is a clinical indication for doing so rather than routinely for everyone every month. It is accepted that to some extent company policy requires certain process to be followed. It is intended to introduce more specific care pathways in future, which will help to resolve this situation. It is accepted that the intention is to develop care plans with more emphasis on developing a more person centred approach in the coming year. There is a stated aim in the AQAA to better “involve family/advocates more comprehensively in the care planning process”, which will support this. The intention is that each resident has a brief biography written and a person centred assessment of their wishes, likes and dislikes which will be at the centre of the service offered to provided more focus on the holistic and social model of care. This information will supports people’s health and social needs including, psychological, emotional, and cultural needs and can demonstrate that the home takes a holistic approach to the provision of care putting resident wishes first. DS0000020290.V364427.R01.S.doc Version 5.2 Page 13 Only two residents have seen a dentist in the last six months and it is not routine to record that this is offered to or arranged for residents. It is accepted that there can be difficulties in securing NHS dentistry at times. Wound care plans were present and were accompanied by wound assessment forms, which allow an assessment of the size and condition of the wound. These gave sufficient information to gauge any improvement or deterioration in the wound. We discussed the clinical value of using photographs of pressure sores where it is not researched based practice. Formal end of life Care Plans are to be established in the home whereby residents are encouraged to think ahead about the care they would like to receive if their health deteriorates. There are documents relating to “Not for resuscitation” directions, which had been signed, by relatives and the GP but it was not clear if a Mental capacity assessment had been carried out which supported the direction. The deputy manager was to make enquiries with the GP and clarify the legal position with regard to these directives. It is worth considering the Liverpool care pathway documentation in the near future, which will further enhance this aspect of care. Each resident was referred to a GP on admission to the home and an initial first visit was then set up. The majority of residents are registered with a local surgery Policies and arrangements are in place for the storage administration, disposal and recording of drugs. There were photographs of each resident on their medication charts to help ensure that medication was dispensed to the correct person. The administration charts were up to date and in order. The storage and recording of controlled drugs was in order. One of the residents is self-medicating at the present time; appropriate procedures are in place to support this. After reading the last report there appears to have been has been a general improvement in staff treating people with respect and upholding their dignity. Residents spoken with supported this view. There was a warm cheerful atmosphere in the home. The staff/resident interactions were respectful and caring. Staff showed a positive attitude to their roles and responsibilities ensuring they provide quality of care to the residents. Residents and relative surveys agreed that staff were available when they needed them and listened and acted upon what the residents had to say. DS0000020290.V364427.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is some provision of meaningful recreation for residents but no structured approach, which may have a negative effect on resident’s quality of life. Mealtimes are sociable and pleasant time with food that residents enjoy and they are supported to eat their food if need be. EVIDENCE: It has not been possible to recruit an activity organiser to date but there are continuing efforts to do so. Surveys indicated that residents/relatives wish there was a more comprehensive activities programme that they you could take part in. DS0000020290.V364427.R01.S.doc Version 5.2 Page 15 Staff spend time with people in small groups doing activities although in an adhoc manner. There is some effort being made to offer social engagement with residents on a one to one basis if they do not enjoy group activities or at risk of being socially isolated. With no activity organiser residents are not assessed on an individual basis on admission to enable the staff to plan suitable activities relevant to their cognitive function and preferences. There are no detailed activities programmes displayed. However additional staff are on duty to try and enhance recreational and social activities in the absence of an activities organiser. Staff are making a real effort to provide some recreation. There is a record of activities that residents have participated in. Activities such as soft catch ball, skittles, hoops, painting, walking around the grounds, films, card-making take place. Various entertainers visit the home including the Hula lady, the guitar man and petting zoo/pat a dog. Resident’s benefit from services run by the local church including Holy Communion each month. A resident spoken with very much enjoys the service. At present there are no residents with specific cultural needs. The menus are provided by Four Seasons and are four week rotational with seasonal variation. The menus on display did not reflect the meal choices of the day. Residents are asked for their choices the day before and there is choice for each meal. Staff were seen to be assisting some residents on a one to one basis in a dignified manner. The cook is given information about people special needs in regards to their diet. Meals can be adapted to meet the needs of the people in the home. Residents spoken with and survey outcomes stated that residents enjoyed their meals. The kitchen was cleaned to a high standard. The most recent Environmental Health report found all to be in good order. DS0000020290.V364427.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There are robust policies in place to protect residents, investigate complaints or manage allegations of abuse and good arrangements in place for staff training in these matters so residents can feel safe and their concerns dealt with. EVIDENCE: A copy of the complaints procedure is on display in the main foyer but required updating with the correct name for the Commission and the telephone number. The correct information is included in the Service User Guide provided to people on admission. The complaints policy and procedure is clear and contains the required information. No formal complaints have been received by the home since the last inspection. DS0000020290.V364427.R01.S.doc Version 5.2 Page 17 There have been no complaints received by the Commission since the last inspection. Minor concerns or grumbles have been recorded in a log including the outcomes. Resident and relative surveys indicated people knew how to complain and indicated that they knew whom to talk if they were not happy. Comments included, “I’ve never had cause to complain “. Three thank you/complimentary letters were seen. The home has written procedures for adult protection, whistle blowing and management of aggression. The Local Authority ‘No Secrets’ document was available. Abuse and adult protection information is included in the induction workbook for all staff. The Local Authority (LA) has trained all staff in the protection of vulnerable adults. The deputy manager is undergoing LA training to become a trainer in adult protection and run an in house programme. There have been no allegations of abuse. DS0000020290.V364427.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a safe and well maintained clean environment with good furnishing and décor, their needs are met by having bedrooms and communal rooms and facilities which are suitable for their purpose and meet the resident’s wishes. DS0000020290.V364427.R01.S.doc Version 5.2 Page 19 EVIDENCE: There is a new assisted bath and shower in the home. There is in addition a parker bath. Most rooms have en-suite bathrooms. The tap heads of the hot water outlets are removed unless the resident wishes to and is able to use the bath safely and then a mixing valve (to reduce the risk of scalding) is installed and the tap head replaced. Safety valves have been installed to all hot water taps in the communal baths, showers and sinks throughout the home. The maintenance man regularly tests and records hot water outlet temperatures. The residents sitting in the communal areas appeared relaxed in their homely environment. Suitable dining room seating and table facilities are provided so that residents can enjoy their meal times comfortably and in a congenial setting. The home was found clean, warm, well lit and free from unpleasant odours. There is ongoing redecoration of rooms and some carpets have been replaced. Resident’s rooms were well furnished and had been personalised. Resident areas are fitted with appropriate aids such as grab rails, suitably equipped bathrooms and there are fixed and mobile hoists and stand aids. All rooms have a nurse call system with audible alarm facility. A range of pressure relieving equipment is in use and kept in stock. Two small passenger lifts ensure level access throughout the home. Survey outcomes said the home was always clean and fresh. Verbal comments were happy with the cleanliness of the environment and its upkeep. Sluice areas included a washer disinfector. The laundry has sufficient washing machines and tumble dryers. There are infection control, policies and procedures in place. Staff have attended training on Control of Substances Hazardous to Health (COSHH). The clinical waste is correctly disposed of to prevent the spread of infections. DS0000020290.V364427.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. For the protection of resident’s, recruitment procedures and records require some improvement. Staff interview notes and evidencing Criminal Records Bureau (CRB) disclosures require improvement to make sure suitable staff are recruited to care for residents and ensure they are protected. There are sufficient numbers of staff to meet resident’s needs. Progress is being made training care staff but Registered Nurse training needs expanding for the benefit of residents care. DS0000020290.V364427.R01.S.doc Version 5.2 Page 21 EVIDENCE: At the time of the visit there were 13 people living in the home. In the morning 3 care staff and 1 Registered Nurse (RN) are on duty and an additional carer who takes responsibility for activities. In the afternoons there are 2 care staff and 1 RN and an additional carer as above. At night there is 1 carer and 1 RN, both are waking. The deputy manager stated that the dependency levels are reviewed to ensure appropriate skill mix and staff numbers although the direct correlation was not clear. The manager role is supernumerary Monday to Friday. There are satisfactory staffing arrangements for housekeeping, laundry, catering and maintenance. There staff vacancies for a registered manager registered nurse and activity organiser, all full time. Some comments in survey forms included, “ most of the staff are alright basically… some are very friendly” and “ I’m very happy here and well looked after”. Survey responses indicated that there were always or usually enough staff available. All staff surveys indicated they felt there was sufficient staff on duty to meet residents needs. The organisation has an equal opportunities policy. The recruitment records seen were generally satisfactory and met the requirements of the Care Home Regulations. Completed application forms, two written references, a statement of health and fitness to work, proof of identity and the persons qualifications are on file. However interview notes were very scant and appeared to have no standard questioning for which responses could be recorded and scored. There was evidence that the home sought confirmation from the CRB of the persons suitability to work with vulnerable people. However the full original disclosure form was not available but should be kept until signed off by a Commission inspector, then the lower part of the disclosure can be destroyed or a formal log created by the counter signatory created which records all the relevant details. DS0000020290.V364427.R01.S.doc Version 5.2 Page 22 NMC qualification confirmations are checked for all RN’s annually. The home uses a comprehensive induction booklet, which is given to new staff to work through when they start. The book contains sections on principles of care, safeguarding adults, person centred care and safe systems of working among others. An induction sheet is completed on the first day to show that staff have familiarised themselves with daily living routines, met with people living in the home and received instruction in essential health and safety matters. All staff are to undertake two day dementia awareness and person centred care training which will be helpful in practical ways as well as assisting in further developing care documentation as referred to above. We discussed the need to enhance the clinical updating for RN’s at a professional level in areas relevant to caring for older people. It was recommended that RN learning needs be fully assessed at appraisal and supervision and individual nurses equipped to have some expertise in various areas of clinical practise. It was accepted that less than 50 of care staff have achieved at least level 2 National Vocational Qualification (NVQ). The home is working towards improving the percentage of staff that have an NVQ in care. There are five care staff with level 2 and one with level 3. Two other staff have expressed interest in starting training and now that Four Seasons are an accredited provider of NVQ training there should be a rapid expansion of training across all care staff. DS0000020290.V364427.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Manager recruitment and retention has not been effective inhibiting the further improvement of services for the benefit of residents. Staff supervision is taking place, which should lead to improvements in residents quality of life and development of staff skills in care. The maintenance of services and facilities and Health and safety arrangements are in place to protect residents and staff. DS0000020290.V364427.R01.S.doc Version 5.2 Page 24 EVIDENCE: There is no registered deputy manager in post at present, recent appointments have failed for various reasons. Ms McCabe the deputy manager has taken on the acting manager role. This continuing difficulty is inhibiting progress in uplifting quality in all aspects of the service as acknowledged in the AQAA. An experienced peripatetic manager was placed in the home but was recently replaced by another to provide support to the Ms McCabe. The regional manager has been visiting the home regularly and is responsible for monitoring the home and carrying out monthly Regulation 26 visits copies of which are sent to the Commission. The deputy manager and regional manager were present for this visit. Ms McCabe is a registered nurse who was able to demonstrate an understanding of the needs of the individuals living in the home and considers she has a good team who are working to raise standards of care and quality of life for the residents. The atmosphere in the home was positive and calm. Staff were noted interacting with residents in a caring and friendly manner. Staff appraisal and supervision was reviewed. Most staff had received supervision on a one to one basis. There was discussion about delegating some of the supervisions to other RN’s, however they may require training to feel confident in delivering the process before it can be properly established. It was discussed that due to the small number of residents in the home at present there could be a combination of supervision and appraisal for nursing and care staff four times a year rather than six. A Process is in place to conduct annual appraisals for all staff. The procedure for safekeeping of resident’s money was examined. Each person has a ledger sheet, which accounts for all transactions and receipts for purchases are kept, however money is pooled in a float rather than each person having their own cash available. Several items including a ring and watches were found loose in the safe and other items belonging to residents who either were no longer alive or had moved to another home. The deputy manager was unsure of the system for managing and recording residents monies in the absence of the administrator, the regional manager undertook to teach her the process. The record keeping for valuables and unclaimed items need to be improved by recording all items deposited in a formal inventory. Items in envelopes should have the content described, be signed and dated by the two staff sealing the envelope. The policy for the disposal of unclaimed property and return of property needs to be clarified and applied. DS0000020290.V364427.R01.S.doc Version 5.2 Page 25 The fire alarm system is checked weekly and the maintenance checks of the fire fighting equipment and alarms are done regularly. Staff are updated with fire safety training, the night staff having three monthly and the day staff six monthly updates. The deputy manager has completed train the trainers moving and handling course and is able to sign off handling assessments; review equipment needs and train staff. The home has appropriate moving and handling and pressure relieving equipment and that staff have attended updates on handling residents. The home employs a maintenance man who works full time. Records showed that relevant inspections and maintenance has been carried out at the required intervals for the fire alarms and equipment, gas and electrical services, water, wheelchairs, hoists and lifts. Communal baths and showers have thermostatic mixer valves and the en-suite baths as required. The monitoring of hot water outlet temperatures takes place to ensure comfortably hot but safe water. Accidents were properly recorded and reviewed as required. A new form is being put into use to record follow up comments or concluding statement about each incident. A discussion took place about accidents and the need to inform the Commission through the Reg 37’s forms in that the manager has freedom to use judgement about what was serious enough to warrant notifications. All residents have risk assessments including tools for assessing falls and falls prevention. DS0000020290.V364427.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 X 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 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 3 X 2 3 X 3 DS0000020290.V364427.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4&5 Requirement The registered provider must update the statement of purpose and service user guide to include the categories of people the home is able to care for and the admission criteria. There should be more clarity about the level of charges made for such things as hairdressing, chiropody and aromatherapy. The registered provider must employ a suitably qualified person to manage to the home and establish stability in management of the home. Timescale for action 01/08/08 2. OP31 9 15/08/08 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. Refer to Standard OP8 Good Practice Recommendations The registered provider should ensure residents have access to dental services on a regular basis. DS0000020290.V364427.R01.S.doc Version 5.2 Page 28 2. OP7 The registered provider should ensure that end of life planning and person-centeredness is further developed. The registered provider should recruit an activity organiser to help identify resident’s expectations and preferences and to satisfy their social, cultural and recreational interests. The registered provider should ensure that RN learning needs are fully assessed at appraisal/supervision and individual nurses equipped to attain some expertise in various areas of clinical practise relevant to older peoples nursing care. The registered provider should ensure that staff interview notes be more comprehensive and include standard questioning for which responses could be recorded and scored and compared with other candidates. The registered provider should seek to achieve a minimum of 50 of care staff have NVQ level 2 or above. The registered provider should make sure that all resident valuables and unclaimed property are recorded in an inventory and kept in envelopes with descriptions, which are signed dated and sealed. The policy for the disposal of unclaimed property and return of property needs to be clarified and applied. 3. OP12 4. OP30 5. OP29 6. 7. OP28 OP35 DS0000020290.V364427.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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