Inspection on 10/08/07 for Uplands Care Home

This inspection was carried out on 10th August 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Uplands Care Home 254 Leigham Court Road London SW16 2QH Lead Inspector Mary Magee & Lynne Field Unannounced Inspection 09:00 10 , 20 &23rd August 2007 th th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Uplands Care Home DS0000068279.V342559.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. Uplands Care Home DS0000068279.V342559.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Uplands Care Home Address 254 Leigham Court Road London SW16 2QH 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) 020 8769 9944 020 8769 9955 Four Seasons (No 10) Limited Jane Anderson Care Home 65 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Uplands Care Home DS0000068279.V342559.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Date of last inspection 22nd February 2007 Brief Description of the Service: Uplands Care Centre is a purpose built nursing home for older people. It is located in a residential area of Streatham, South West London. The home offers nursing care and accommodation for 65 people. It is divided into 2 units. The upper floor is called York House and offers 32 places to older people experiencing Alzheimers and other forms of dementia. The ground floor is called Canterbury House. It accommodates 33 older people who following acute or chronic illness require nursing care. All the homes bedrooms are single occupancy with en-suite facilities. There is a passenger lift. The home has pleasantly maintained gardens surrounding the rear of the building. Car parking facilities are good. The home is conveniently located for public transport. Fees range from £559 to £900 per week Uplands Care Home DS0000068279.V342559.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection lasted over three days. Two inspectors were involved. The registered manager and deputy manager were present and facilitated the inspection process. Case tracking was used to evaluate the quality of care and the arrangements for planning and delivering care to residents. Alongside this process the inspector used the SOFIE tool (short observational framework) to evaluate the quality of life and the state of well being of the residents of York Unit. Feedback comment cards were received from ten residents, and two relatives. During the inspection the inspectors met individually with nine relatives who gave their views. Comments on the outcome of reviews were received from the care management team in one local authority. Over the three-day period twelve residents told the inspector about life at the home. A selection of records were viewed, these included the completed AQQA, personnel files for staff and residents, and records relating to complaints, incidents and the maintenance of the building. What the service does well: What has improved since the last inspection? There have been real tangible improvements to the quality of care delivered. Flexibility has been introduced into the service. Residents that choose to have late breakfast can do so and enjoy it in their own room at a time that is convenient. One resident told of enjoying being able to staying up late at night and is usually the last resident to go to bed. She said “These are the things that are important to me when I live in a nursing home” Residents that experience dementia are able to enjoy having finger food as they walk around and do not feel confined to sitting for long at a dining table. The staff team overall has improved their approach, they now show dedication and a caring and empathic approach. Uplands Care Home DS0000068279.V342559.R01.S.doc Version 5.2 Page 6 Communication has improved as a result of training and development and regular observations of working practice. Residents find that the majority of carers are jovial and good-humoured. “A smile and a kind word go a long way when you rely on someone to help you” were the words of a resident to describe how staff respond to her needs. Relatives spoke of the positive impact experienced due to management changes. The home has experienced numerous management changes over the past three years. Some relatives spoke of the impact felt from all the previous changes in the last three years. They now feel that the home has reestablished itself as a good home and have full confidence that management will continue with the improvements. Comments as follows were some of those received, “I feel that changes in the management have made a real difference here, residents are now well cared for” “ I feel confident that my husband is looked after by kind and caring staff”. Residents feel that changes in approach and practice by staff are improving and consistent. One man said that care staff are displaying a more compassionate side. The healthcare of residents is promoted. Any changes in condition that require consultation with health professionals are identified and responded to promptly with recommendations followed. Residents and relatives find that their views are listened to; any issues of concern are addressed promptly. Major refurbishment has taken place in all the communal areas. The home is attractively presented with attractive coordinating furnishings and décor. A number of bedrooms have been also decorated and had new furniture supplied. The refurbishment is continuing with many of the remaining bedrooms due to be redecorated and refurnished in the next few months. What they could do better: Despite improvements to the quality of care there are areas of shortfall that need to be addressed. More consideration needs to be given to address appropriately individual needs and capacities and provide suitable stimulating activities for residents. This has been an ongoing issue as the retention of activities coordinators is poor. Care staff need to recognise the need to become more involved in providing appropriate stimulation to residents and make living at the home a more enjoyable experience. The home also needs to employ an activities coordinator so that a varied activities programme is available for residents. If the quality of care delivered is to continue to improve staff need to make sure of the importance of consistently reviewing the needs of residents. This is not just a paper exercise. Staff must make sure that all areas of need and support including risk assessment tools are considered, these to be recorded and reflected in updated care plans. Uplands Care Home DS0000068279.V342559.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. Uplands Care Home DS0000068279.V342559.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 Uplands Care Home DS0000068279.V342559.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 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The home provides important information to prospective residents, families and health professional so that they are informed on services available. No resident is admitted to the home unless they have had their needs fully assessed first and the home is confident that they can meet their needs. EVIDENCE: A copy of the revised service user’s guide and the Statement of Purpose was viewed. Relevant and essential information to inform prospective residents are detailed. Residents spoke of receiving a copy of the guide before they moved to the home. Contracts have been drawn up with new residents in response to requirements stated in a previous inspection report. Uplands Care Home DS0000068279.V342559.R01.S.doc Version 5.2 Page 10 As part of the case tracking exercise to evaluate services delivered to ten residents the inspectors examined how pre admission preparations are made. Evidence of good practice was found in assessing fully prospective residents. A qualified nurse completes pre admission assessments for all residents before they move to the home, regardless whether self-funding or not. One relative spoke of the cooperation from the organisation. Staff worked closely with family and made suitable arrangements for a prospective resident to receive a visit and have an assessment done. She lived some distance away from London. Fourseasons arranged for a representative/ nurse based near to where the individual lived to undertake the pre admission assessment. The information was then forwarded to the home. A smooth admission was experienced as told by the resident. She has settled well at the home and is near to her immediate family members. Copies of pre admission assessments are recorded and held on residents’ personnel files and form an essential part in developing appropriate care plans. The assessments contain a good description of how individuals need to be supported in the nursing home. Equality and diversity issues are considered prior to admission. Important information on nursing needs and support with dementia and challenging behaviour are recorded, also too issues with mobility, mental state and cognition, preferences for routines as well. Assessments detail weight records where possible, those with or at risk of developing pressure sores, personal safety issues. Also recorded is information on all the prescribed medication required, the support and assistance needed with taking the medication. A statement of terms and conditions is provided to residents. Contracts vary according to whether individuals are self funding or having contributions paid by local authority. Uplands Care Home DS0000068279.V342559.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 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Care planning has improved with systems in place to ensure that this improvement continues. Residents find that healthcare is promoted and that consultations are sought as necessary with professionals. Staff respond to all necessary recommendations made. Attention is needed to making better provision to meet the social care needs of residents. EVIDENCE: The inspectors viewed the written care plans in place to support ten residents, (five on York Unit, five on Canterbury Unit). The care plans had been drawn following needs assessments, evidence was present for some to indicate that individuals or representatives were involved. The plans show signs of improvements and were generally complete. Two residents spoke of being involved in contributing to their care plans. One relative spoken of her mother’s involvement, she found that her mother had been consulted and involved in developing the appropriate care plan. Care plans are evaluated monthly, but here are some inconsistencies in how these are sometimes done. Examples were seen on two of the ten files when Uplands Care Home DS0000068279.V342559.R01.S.doc Version 5.2 Page 12 all the assessment tools are not linked into evaluation of care plans. To address inconsistencies regular audits are in place where the manager or deputy audit care plans. Evidence of these audits indicated that shortfalls are identified and that plans are in place to address them. Observations were made of management drawing to the attention of nurses where this is found. The quality of care delivered at the home continues to improve. This was the view of the majority of residents spoken to. Relatives also confirmed that improvements under the new management have resulted in higher standards of care. They find that attitudes and the approach of staff to be good. For residents living on the ground floor unit care arrangements/plans are better organised than for those on the EMI unit. Five residents on the ground floor had the care arrangements case tracked by the inspector. Pressure care, attention to PEG feeds, mobility issues are attended to in accordance with care plans. The tissue viability nurse regularly visits to examine wound care and progress. There is evidence that individuals’ conditions are responding to the nursing/wound care delivered. Appropriate consultations take place with healthcare professionals such as speech and language, HEN team. Relatives feel that staff are competent at providing the care and know that their healthcare needs are met. On the EMI unit the inspector used the SOFIE tool on day one to evaluate the quality of life experienced by five residents. This lasted over two hours. During this exercise it was evident that the residents experienced a state of positive well being for a large period of time. A lot of engagement and interaction took place that contributed to this state of well-being. . Practices observed and records of how people are monitored demonstrated that staff are vigilant and take appropriate action to promote the healthcare of residents. Residents receive prescribed medication at the times specified. Medication audits are completed regularly to identify any shortfalls. Medication is ordered and disposed of in accordance with the policies and procedures of the home. Signatures were seen on MAR sheets to acknowledge when medication is administered. The pharmacist inspector will be completing an inspection of medication standards, for this a separate report will be available. One resident was sleeping periodically in the lounge. Her medication when examined did not indicate that dosage was contributing to this. Staff were knowledgeable on individual residents’ conditions. One carer told the inspector that the resident was not her usual self. They had taken her temperature earlier and as a result of their concern requested a GP to visit. Subsequently when checked some days later on a subsequent visit the inspector found that the GP had prescribed medication to combat an infection and the resident was much improved. Staff had followed instructions and administered the course of prescribed medication. Records viewed confirmed that medicine was administered as prescribed. Medication administration was viewed for five Uplands Care Home DS0000068279.V342559.R01.S.doc Version 5.2 Page 13 other residents. No errors were observed in recordings. Medication was administered at the times prescribed. Staff are following the advice of other health professionals. Alongside progress notes are records made in response to other recommendations made for residents, the inspectors saw completed fluid and food intake charts, weight records, blood pressure recordings, blood sugar monitoring records. During the period of direct observation the inspectors identified areas where improvements are occurring. When residents need assistance in the lounge with transfers where equipment is used then screens are used to ensure the privacy and dignity of residents are respected. Toileting regimes are done discreetly and not as regimented as identified in previous inspection. Continence care is good with necessary aids and adaptations provided to assist with this The inspector noted a calm more relaxed environment in this unit than on previous visits. Residents that experience frequent episodes of challenging behaviour appeared more settled. Some good interaction was observed between residents and staff, holding hands, listening closely and encouraging conversation. Residents that choose to walk around corridors did so and choose where they wished to be seated. Experiences spoken of by residents home demonstrate that staff at home are responding more positively to individual needs. A newly admitted resident said she was initially anxious following a long hospital stay. She feared if staff would “Know what to do”. Her experiences so far are positive and have dispelled her anxiety, she is finding that staff respond very well to her needs and know how she like to be cared for. She spoke of receiving physiotherapy and walking on the corridors and gradually becoming mobile thanks to the encouragement of staff. A relative visiting a resident spoke of the warm welcome she receives when she enters the home. “I find staff very kind and caring to my mother”. Care plans are numerous and some quite lengthy with separate plans for each area where support is needed. One area where more improvements are needed is for planning for social care needs. This is referred to in Standard 12 of the report. As well as a distinct improvements in how care is delivered there are signs of improvements in how support and care needs of residents are recorded. The care plans are evaluated every month and more frequently when needed. Audits are in place where management audit residents’ files and identify those that need attention. This process is ongoing. Staff are becoming aware of the importance of evaluating progress and updating plans to reflect changes. The evaluations/reviews can be brief. Staff should focus more on crossreferencing with risk assessment tools, progress notes and record more information. Uplands Care Home DS0000068279.V342559.R01.S.doc Version 5.2 Page 14 Risk assessments are in place recording how identified risks are to be managed. There were a few occasions when risk assessment tools such as Waterlow Scores are not used effectively and linked directly to reviews to updated care plans. Progress reports and care plans in relation to one resident recorded that a pressure sore had completely healed and that dressings were no longer required, her family are pleased with the positive response to the nursing care. Yet the evaluation sheet and Waterlow chart did not reflect this improvement. Staff must make sure that reviews are considering each aspect of individual need, also that records are kept updated to reflect all the changes. A requirement is stated in relation to reviewing care needs and recording the outcome of these reviews. There are examples of how residents prone to falls are assessed as requiring cot sides to be in place to reduce the likelihood of falls. Consent forms are in place agreeing the action needed. A resident that has been in the home for some time has experienced poor health recently despite consultations with GP and also palliative care team. Her daughter visits most days. She finds that the care is improving in the home with attitudes and approach changing. Her mother is well cared for, she said “I couldn’t ask any more, staff are kind and compassionate and care well for my mother, now her needs are greater as she becomes increasingly frail”. Uplands Care Home DS0000068279.V342559.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy living in a home where they have opportunity to exercise control over their lives. A limited range of activities within the home means that residents do not have the opportunity to participate in appropriate stimulating and motivating activities, this particularly affects those with dementia. The manager and staff recognise this area of shortfall and there is good capacity for this area to improve. EVIDENCE: “I like to read and enjoy my own company” was the comment received from a resident. She has a very pleasant room and prefers to follow her own interests. Other residents spoke of the importance of entertaining visitors in their own room without interruptions and not feeling compelled to engage in group activities. Others value the opportunity to remain as independent and take as much control as possible. Groups of residents that link up well and share similar interests were spoken to. They provided evidence that they are helped to exercise control over their lives. Relatives have regular meetings. They are given the opportunity to discuss issues and make suggestions. On one of the Uplands Care Home DS0000068279.V342559.R01.S.doc Version 5.2 Page 16 days of the inspection there was relatives meeting held, present was a representative from the Alzheimer’s Society to give a talk and provide literature on the condition. Relatives spoken to find that they are greeted warmly at the home. Relatives visiting residents on the ground floor spoke of staff being warm in their approach to residents and responding promptly to any issues where attention is required. Over the three days the lead inspector detected that practices vary, this depending on staff on duty. The great majority of staff are compassionate and caring. Good humour and kindness in the staff team were observed over the three day inspection. Residents also told of this experience. One resident said, “I can have a laugh with staff, they know my style”. Generally the service continues to improve but the greatest shortfall in the service relates to social care needs. There is a plan of activities. Some of the functions include a cheese and wine evening, afternoons of entertainment with a musical band. The home has struggled with recruiting and retaining an activities coordinator. A part time coordinator is due to commence shortly in this role. In the meanwhile care staff are expected to be involved in promoting social stimulation for residents. Their practices and commitment vary. Care staff spoken to individually recognise the importance of stimulation and the positive impact experienced as a result. Training has been delivered to staff on the value of engagement with residents. During the SOFIE observation on day one of the inspection the well-being state of residents on the EMI was very positive overall. Some examples of good practice were seen. A care worker speaking in French was communicating well with a resident and giving him encouragement to pursue his talent of singing. Staff were observed engaging with residents, making them feel valued. Some gentle touches were exchanged, one resident displays great affection for a doll. Care staff realising the importance of this made sure that the doll was with her as she relaxed in her lounge chair. For those residents that are inclined to walk for a lot of the time freely about the spacious corridors plans in place to address this. Some find sitting for mealtimes a difficult experience. This is recognised. The practice of serving of finger food that included fresh fruit pre occupied some residents for some time and provided valuable nourishment. It also gave them an opportunity for more staff engagement. Facial expressions and body language used by care staff resulted in residents receiving suitable stimulation instead of remaining withdrawn. There were areas of shortfalls observed on the second day of the inspection, some of the staff team differed to day one. This was reflected in relation to residents lack of engagement with either tasks or staff. Uplands Care Home DS0000068279.V342559.R01.S.doc Version 5.2 Page 17 Not all the staff team present placed the same focus on engagement with residents. Attitudes appear to vary from those staff that recognise the importance of each individual’s need to the small minority of staff that place more emphasis on getting tasks completed. When checking through care plans for the residents there is not enough emphasis on providing for social care needs. Some have life reviews but for new residents these are not used. Dementia mapping exercise took place in 2006 with a trainer within the organisation. However the nurses that participated in the mapping exercise have not pursued this for residents. Requirements stated in previous inspection report remain, as they are yet not fully met. The manager and deputy are aware of this area of shortfall and plan to address it . The home has safe systems in place to support residents requiring support to manage their finances. For those that are subject to power of attorney with the local authority the office administrator has a system to request money from the individual fund held for each resident. Records with clear audit trails are held. A nominated person from the provider organisation also audits these regularly. The majority of residents take control of their finances with support from family or solicitor. The local authority has made provision with a local charity to provide two fully vetted volunteers to residents that have no relatives or representatives. Mealtimes are pleasant. Breakfast time is flexible. The practice of the majority of residents going to dining rooms for breakfast has ceased. Those that choose to sleep late into the morning and then have breakfast in their rooms do. Flexibility is experienced in other ways too. A resident told the inspector that she likes to remain up until late at night, she said “I enjoy being one of the last to go to bed at night”. Residents are supported well at mealtimes. The inspectors found mealtimes relaxed and residents allowed to dictate the pace. The majority of residents enjoy their meals. Comments received included the following, “food is usually very pleasant”, “I prefer my puddings, they are nice”. The chef is well known to residents on the ground floor. He frequently comes to see them in the morning to discuss meals and knows their likes and dislikes. This was evident during meals. Some choose other than what was on menu, sandwiches and fruit were brought to those requesting them. The food served appeared appetising and nourishing. There was a choice of fish pie or chicken curry on one of the days. For the majority of residents plates were empty signifying that the meals were to their liking. The chef has a list of those requiring special dietary diets, such as puree, low fat, low sugar. Menus offer a range of food that caters for dietary and cultural needs. One comment card from a relative remarked that “could do with more variety of Afro Caribbean meals”. However on checking the menus the inspectors found that the home makes good provision for this. Two residents of Caribbean origin were spoken to, both enjoy the meals and find them to be satisfactory. Uplands Care Home DS0000068279.V342559.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 17 18 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Residents are protected and safe with robust procedures in place that enable this. Residents feel they are listened to and that any complaint or issue raised is responded to appropriately. EVIDENCE: There is evidence that the home responds appropriately to any complaints raised. A copy of the complaints received since the last inspection was examined. The information recorded including the investigations and outcomes indicates that complaints are addressed appropriately. Residents spoken to are aware of the complaints procedure. They received a copy of the complaints procedure on admission. It was good to receive the views of many residents and relatives in relation to how complaints are addressed. A common reply from all those interviewed told of the way management responds. “I have only to raise an issue with the manager or deputy and it is immediately attended to”. CSCI has not received any complaints regarding the service. The inspector recognises that the home has worked hard to ensure that procedures to safeguard vulnerable adults are now robust. Staff have received training with further training planned for the team in the next month. All seven care staff spoken to demonstrate a good knowledge of the indicators of abuse or neglect and of appropriate actions to take if they have any concerns. Staff Uplands Care Home DS0000068279.V342559.R01.S.doc Version 5.2 Page 19 are vigilant and report and record any signs of unexplained bruising. Regular monitoring meetings have been taking place with the Safeguarding Adults Coordinator, the inspector and management for the past few years. In the last twelve months there were four allegations, none substantiated. Appropriate notifications were made to relevant bodies. All were investigated fully and any necessary recommendations made were followed. For one resident there was evidence of deterioration in mental frailty. A referral was made and consultation took place with the referred to the psycho geriatrician. Uplands Care Home DS0000068279.V342559.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 23 25 26 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Residents enjoy living in a safe attractive well maintained environment. An ongoing refurbishment programme is in operation to maintain the premises to a high standard. EVIDENCE: Residents are please with the refurbishment programme that has taken place. All the communal areas are now attractively decorated and furnished. Colour schemes are well coordinated. The coordination of colours has improved the overall ambience of the home. Attractive additions such as fireplaces, pictures and mirrors compliment the interior of the premises. The EMI unit has on display a range of pictures relative to earlier periods that residents identify. They are set out to cover sport, news, music and history. These appear to have the desired affect as some residents spoke of certain Uplands Care Home DS0000068279.V342559.R01.S.doc Version 5.2 Page 21 sport stars in the photos. To many of the residents this is a valuable reminisce exercise. The provision of new carpets appears to have a calming effect overall. This was particularly noticeable during the inspection. Staff and relatives have also noticed this change in residents since the change in floor covering. The incidents of falls also appear to have reduced since the carpet was fitted. Light fittings have changed and now ensure that areas are brighter. A number of bedrooms have been refurbished. Others are planned to be refurbished as they become vacant. It is important that bedrooms are prioritised for redecorating and that others even though not vacant are redecorated. A recommendation is made. The home has purchased a number of profiling beds, more are on order. A selection of hoist were seen, both mobile and standing hoisting. Service records confirm recent servicing of equipment. The inspectors found that a bathroom was used one day to store a supply of food supplements that were delivered. This was rectified and dealt with immediately when brought to the attention of the manager. The manager should ensure that staff do not use bathrooms as storage facilities. Uplands Care Home DS0000068279.V342559.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Staff recruitment procedures are robust and ensure the safety of residents. The staff team have a training and development programme in place that responds appropriately to training needs and equips them for the role. EVIDENCE: The inspectors found that staffing levels are maintained at appropriate levels to meet the needs of residents. On the York Unit five carers plus two qualified nurses are on duty in the morning, the afternoon period has one less carer. The ground floor has six carers plus two nurses on duty in the morning, with one les carer in the afternoon. Management recognise and respond to additional areas of need and reflect this in staffing levels. The call bell on the ground floor was not operating due to a fault as the new air conditioning was fitted. Additional staff are engaged to complete regular half hourly checks of residents until this problem is rectified. The inspection involved the examination of nine staff files. All of them had satisfactory information available in relation to previous employment, proof of identity and immigration status; also records of CRB Enhanced disclosures were in place. It was evident that no member of staff commences employment until all this information is satisfactory. The staff files are well ordered and facilitate easy access to information. Uplands Care Home DS0000068279.V342559.R01.S.doc Version 5.2 Page 23 Over 50 of care staff have acquired NVQ level 2. There some carers with lengthy experience in care work. New members of staff (four) have been enrolled to begin the next NVQ programme in the Autumn. A training matrix was provided of all training received since the beginning of 2007. Some of the training records from the past have been mislaid during the time of previous management, and records of these are being sought through the supervision process. Staff receive an abundance of training both from the organisation and from CHST. The organisation’s training department also provides mandatory training. All new staff complete the induction programme that meets Skills For Care Standards. Evidence of this is held on staff files. The majority of staff spoken to value the training they receive and like having the opportunity to develop. This is also reflected in improved practices that both residents and relatives speak of. A training session on infection control was in progress during one of the days when the inspector was present. Qualified nursing staff also attend professional development. There are some gaps in the training matrix due to previous training records not been held securely. The plans of future training arranged should ensure that these gaps are responded to. A recommendation is made that identified gaps in training be addressed. Uplands Care Home DS0000068279.V342559.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 38 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a home that is well run by a capable and effective management team. The home has the capacity and an effective quality assurance system in place to identify and drive further improvements in the service. EVIDENCE: The tangible improvements found in the home are due to the effective management now in place. The registered manager has taken the home forward in a number of ways in the past eleven months. She has strong leadership skills and communicates clearly the codes of conduct and the standards expected. She has experienced some opposition from staff that previously under performed or that had an inappropriate Uplands Care Home DS0000068279.V342559.R01.S.doc Version 5.2 Page 25 attitude in their role. An able and hard working deputy manager who takes a clinical role lead supports her. The regular auditing of residents files, observing the quality of care, arranging staff and residents meetings, drives improvements. The manager and deputy undertake unannounced night checks. Reports of these show signs of continued improvement. Supervision has become more regular and consistent. The majority of staff are delivering well and are committed in the role. Observations made identify the passion that some staff have for caring. The inspector found from talking to residents and relatives and making observations that more work has to be done. There is a very small core of staff that are under performing and that have not the appropriate attitude. Management are aware of these staff and are addressing and challenging the issues by one to one supervision and performance management, rotating staff. A recommendation is made. The registered person should consider more frequent one to one supervision for staff that are not delivering in accordance with their contract. Staff realise that they are accountable for their actions. The disciplinary procedures are used to effectively deal with staff that are not delivering in accordance with codes or that are under performing. Both residents and relatives value the contribution that management have made in improving life for residents. Comments received from both groups include the following “The manager has turned this home around”, “ This is much better now than when my relative moved in here some years ago” Comments received from a care management team suggest that the outcome of recent reviews for a resident to be positive. Effective quality assurance systems are in place that constantly monitor and evaluate the quality of services provided. Weekly and monthly audits are completed that record residents care needs and conditions and progress, these also highlight those at risk from particular conditions such as infection, low body weights. All of these are used towards the quality assurance process that seeks to drive improvement. Residents’ finances are protected. Those with the capacity to be supported to mange their own money. There are a small number of residents where the local authority has power of attorney. There are systems in place to request the personal allowance from the local authority when required. Receipts and records are then held of all transactions. A member of staff from Fourseasons audits these regularly. The home retains copies of records made of visits made in accordance with regulation 26. The home employs a maintenance person. His responsibilities are ensuring that the entire environment is safe and hazard free, that equipment is safe. He undertakes regular fire drills and tests fire fighting equipment. Records show that essential equipment is regularly serviced and maintained. Both induction and mandatory training given to staff include practices that promote the health and safety of residents and staff. Risk assessments are in place that identify and record the practices to adopt for safe moving and handling of residents, the operation of cot sides. Uplands Care Home DS0000068279.V342559.R01.S.doc Version 5.2 Page 26 Uplands Care Home DS0000068279.V342559.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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X 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 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Uplands Care Home DS0000068279.V342559.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(2) b Requirement The registered person must ensure that the outcome of reviews is recorded and accurately reflects if and how care plans are responding to individual resident’s needs, or if any changes are needed to these plans. The assessment tools in place must be used more effectively and in conjunction with care plans to inform the planning of care. The registered person must ensure that an activities coordinator is employed to take on the role of developing an activities programme that is varied and appropriate to the needs of residents. The registered person must ensure that the home makes proper provision for the social care needs of all residents. For those that are mentally frail they must receive appropriate and suitable stimulation. (Previous timescale of 30/04/07) not met) Timescale for action 30/09/07 2 OP12 12 (1) a 30/09/07 2. OP12 12(1) a, b16 (2) m 30/09/07 Uplands Care Home DS0000068279.V342559.R01.S.doc Version 5.2 Page 29 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 OP21 OP21 Good Practice Recommendations The registered person should ensure that bathrooms are not used to store any items The registered person should consider fitting taps that are more appropriate to the needs of residents with dementia. The registered person should ensure that occupied bedrooms are prioritised for redecorating and not left until they become vacant The registered person should ensure that training gaps identified in training matrix and in supervision are addressed by the end of 2007. The registered person should ensure that more frequent one to one supervision is used by management to address performance and attitude issues. 3 4 5 OP24 OP30 OP36 Uplands Care Home DS0000068279.V342559.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Uplands Care Home DS0000068279.V342559.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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!