CARE HOMES FOR OLDER PEOPLE
Urmston Cottage Greenfield Avenue Urmston Manchester M41 0HN Lead Inspector
Sylvia Brown Unannounced Inspection 8th September 2008 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 Urmston Cottage DS0000006729.V370380.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. Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Urmston Cottage Address Greenfield Avenue Urmston Manchester M41 0HN 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) 0161 747 3738 no fax Urmston Cottage (Mcr) Ltd Mrs S Burgess Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (44), Physical disability (1) of places Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Service users shall be aged over 60 years except for one named person who requires nursing care by reason of physical disability. A maximum of 25 service users who require general nursing care can be accommodated. Staffing levels as specified in the Section 13 (5) Notice dated 9 August 2005, shall be maintained. 7th April 2008 Date of last inspection Brief Description of the Service: Urmston Cottage is an extended Victorian property offering care and accommodation with nursing support to 45 service users. There are several lounges and a dining area for service users communal use. Bedroom accommodation is on two floors and is for single and double occupancy. Some bedrooms have en-suite facilities. A passenger lift supports service users to reach all parts of the home. There are gardens to the rear of the property, which are well used in fine weather and parking space is available to the side of the home. The home is near the centre of Urmston, close to a number of shops and market place. It is close to local bus routes and the Metrolink. The current fees for the home range from £353 to £726 per week which includes nursing care. Fees are dependant on care need support and individual funding arrangements. Urmston Cottage DS0000006729.V370380.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 1 star. This means the people who use this service would experience adequate quality outcomes.
The inspection report is based on information and evidence gathered by the Commission for Social Care Inspection (CSCI) since the last key inspection, which was completed on the 8th May 2008. This was a key inspection which included a site visit to the service. The site visit was unannounced, which means the registered manager and staff were not told that we would be visiting. The operations manager and manager were on the premises throughout the site visit and made themselves available. As part of the inspection process we gathered information from a number of people which included talking with and seeking the views of service users. We also sent out surveys to service users, relatives and members of staff. This gave them an opportunity to talk with us about their opinions on the services provided at Urmston Cottage. Comments received are included where appropriate and applicable within the report. We looked in depth at the care support of two people living at the home which included looking at their records in detail. We also spent time sitting with service users and observing their day-to-day routines as they received care support from care staff. This helped us get a better view about how people living at home are looked after and supported. A pharmacist inspector also completed a site visit to look at how the home was administering, recording and managing medications within the home. This included looking at records relating to medication, observing practices of administration, talking with staff and looking at training records. An audit of medication was also completed to ensure stocks balanced with records. In August 2008 the operations manager completed a self-assessment form, which is called an Annual Quality Assessment Audit (AQAA). This told us what the home had been doing since the last key inspection to meet and maintain the National Minimum Standards. It also told us what they felt they were doing well, how they had improved within the past 12 months and their plans to develop in the next 12 months. As a consequence of the last inspection outcome which was poor, we requested that the registered person provide us with an action plan on how they were going to meet the requirements made and improve the standards at the home. Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 6 This was provided to us and was used during the information gathering process about the service that was completed before the site visit. Because the last inspection identified that the home was of a poor standard we also met with the operations manager to discuss how they were going to improve conditions at the home. We found the operation manager open, honest and committed to improving standards at the home for the benefit of service users. We also gathered information through general contact with the home; through their reporting procedures which are called ‘Notifications’ and through information we received from other people, such as the general public and professional visitors. We have received two complaints about the service since the last inspection. Both complainants were advised to directly contact the registered provider and give the manager the opportunity to investigate the complaints raised. We are aware that both complaints have done this and had their complaints investigated and are satisfied with the outcomes. There have been one safeguarding issue at the home which has and continues to be dealt with through the Local Authorities safeguarding procedures. One member of staff has been referred for inclusion of the Protection Of Vulnerable Peoples Register. What the service does well: What has improved since the last inspection?
There are many areas which have been improved since the last inspection and there are clear indicators that service users lives have improved as a consequence. Extensive improvements have been made in all aspects of the service which means service users now live in a home which places them first and which is making sure routines, practices and support is service user led rather than designed to meet the needs of management and staff. A substantial amount of finance has been invested which has enabled the commencement of a total refurbishment and upgrading programme to take place. All parts of the home are to be upgraded and areas already completed indicate that fixtures and fittings are of a high standard. Already service users communal areas offer more comfort and safety, there are plenty places to sit which has encouraged service users to move around the home and mix with each other. Every service user has received a new bed and most have received complete new bedding sets which include quilts, pillows and covers
Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 7 etc. New carpets have been fitted in five bedrooms along with new furniture and room decoration. There is a new manager in position and management systems are planned for and structured. A number of new staff have been employed as a consequence of other staff leaving and increased staffing levels. The management team have ensured new staff have received appropriate instruction, support and guidance which has made sure they treat service users in a respectful and dignified manner at all times. We observed better interaction between service users and staff and the general atmosphere within the home was relaxed and cheery. All levels of staff have attended staff meetings with the new manager and from records observed we can see that routines within the home are now service user led and that poor and inappropriate care practices will not be tolerated. The manager appears to have a clear understanding of her role and responsibilities and a strong management style which we think is required to ensure that improvements made are sustained for the benefit of service users. Record keeping has improved in many areas and plans were underway at the time of the site visit to introduce new care planning procedures and records which we are told will be person centered. This means that service users will be fully involved in all aspects of their care planning and will be able to say how they would like their needs to be met. This will make sure staff have all the information they need to support service users in a consistent manner. From what we have observed directly, seen through inspection of records and through talking with service users and families we think that the home has turned itself around and now has systems and routines in place to suit service users rather than staff. Staff no longer have set routines, rather they apply a flexible approach to daily routines. A full time activities co-ordinator has been employed and after consultation with service users, a daily activities programme has been developed which appears to be varied and stimulating. In addition service users have also been given the opportunity of going out on trips and places of interest. Meals and mealtime routines have also significantly changed. The dining room has totally been refurbished and new fixtures and fittings provide service users with a pleasing safe environment. A new menu has been put in place which offers a wide variety of foods. We shared two mealtimes with service users and observed that they interacted more with each other, were more involved in making their meal choice and clearly enjoyed the food served. They told us its lovely you can ask for anything and they will try and get it you. One service user even encouraged the inspector to order off the menu to see what happens. Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 8 Since the last inspection some work has been done to help make medicines handling safer. Some staff administering medicines had had training to help them do so safely and extra nurses had been put on some shifts What they could do better:
Whilst we recognise that the management team of Urmston Cottage have commenced developing all aspects of the service, we are aware that previously standards kept changing which meant that service users could not rely on receiving a good dependable care service. As a consequence we are now looking to see how the current management team are going to make sure that the good standards noted during this inspection process are maintained over a period of time. Urmston Cottage is still developing in many areas still for instance, care plans. Many care plans are in the old format but we could see that staff had been deployed to transfer old information onto new formats prior to a full review of each service user and the new consultation process taking place to gather more accurate and detailed information. Because of this we are not making any recommendations and are giving the home time to implement new systems. The operations manager has agreed to inform us when the process has been completed. We do not think the care of service users is or will be detrimentally affected during this process as staff are much more informed about service users and their practice is now appropriately monitored. Staff indicated that communication between them is not always affective and sometimes they do not feel listen to. We were able to look at records which identified that the manager has met with all levels of staff and is improving how information is gathered and passed onto to the correct people in a timely manner. This is enabling staff to know about changes in service users condition and support them appropriately as required. Some parts of Urmston Cottage still require upgrading and finishing touches are required in many areas, however this process cannot be completed quickly therefore we are extending some flexibility because of the good progress made so far. We are making a recommendation for the registered person to provide us with a planned refurbishment programme and confirmation when the upgrading has been completed. At that time we will make a decision if to conduct a random inspection to monitor conditions at the home. During the inspection we saw that medicines were usually stored safely but sometimes nurses left the medication room open when they were not there. Medication records showed that medicines which were supplied regularly for service users were well accounted for and were given properly, however not all the records had enough information on them to track all medicines or to show they have been given properly. Some medicines could not be accounted for at all. When medicines cannot be accounted for service users could be at risk
Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 9 We also saw medicines which were not part of the regular medication cycle often ran out at the beginning of the new month’s supplies. Furthermore some medicine delivered to the home for a resident had not been given to them for a number of days. We found that when service users are discharged from hospital they are not always given their new medicines properly. If service users are not given medicines as prescribed their health could be put at risk. Because of this we have told the registered person that they must take action to make sure practice is improved by the 9th September 2008. 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. Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 10 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 Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 11 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): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are provided with information about the home and have their needs assessed. This enables both the service user and the manager to know whether Urmston Cottage is suitable to meet the service user’s individual needs. EVIDENCE: The history of this service is that they have good pre assessment and admission systems in place. The AQAA indicates that there have been no changes to previous practice and records confirmed that service users continue to have their needs assessed prior to moving into the home. Pre assessment outcomes were recorded and staff are informed of service users needs through supervision and meetings. Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 12 Standard 6 is not applicable to this service as no service user is admitted for intermediate care support services. Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 13 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 adequate. This judgement has been made using available evidence, including a visit to this service. Service users have their health care needs recorded and met. Some medication systems increased the risk of service users not receiving their medication as prescribed. This means their health condition may be compromised. EVIDENCE: Since the previous inspection the operations director and manager have reviewed how the home record and maintain records relating to service users. They have recognised that improvement need to be made and have commenced developing new care planning procedures and records. The new procedures are in depth and detailed, if completed thoroughly the records should reflect good personal information about the service user, their needs and preferences for care support. At the time of the inspection information was being transferred from the old system to the new. We found that notes
Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 14 were made where information was absent and plans underway to follow through the tracking of information. We looked at a number of care plans and specifically two were looked at in depth. We found that generally care plans identified most of the service users individual needs and we could identify that service users received appropriate medical support. Doctors, district nurse visits and hospital appointments were recorded. During the inspection the pharmacist inspector looked at how well medicines were handled to make sure that service users were being given their medicines properly. Since the last inspection some work has been done to help make medicines handling safer. Some staff administering medicines had had training to help them do so safely and extra nurses had been put on some shifts. During the inspection we saw that medicines were usually stored safely but sometimes nurses left the medication room open when they were not there. Medicines must be safely locked away at all times so that people in the home are not put at risk. The records showed that medicines which were supplied regularly for service users were well accounted for and were given properly. However not all the records had enough information on them to track all medicines or to show they have been given properly. Some medicines could not be accounted for at all. When medicines cannot be accounted for people could be at risk of not receiving their medication when prescribed. We saw medicines which were not part of the regular medication cycle, often ran out at the beginning of the new month’s supplies. We also found some medicine that had been delivered to the home for a service user had not been given to them for a number of days. Furthermore when service users are discharged from hospital they are not always given their new medicines properly. If service users are not given medicines as prescribed their health could be put at risk. Throughout the site visit staff were attentive, pleasant and respectful to service users. We could identify significant improvements in the way staff conducted themselves. We found that staff did not leave service users alone for long periods of time as previously observed. Staff deployment has improved which has meant that staff are allocated a certain number of service users and section of the home. We observed that staff knew the service users whereabouts and managed their ‘unit’ effectively. Staff and service users interacted more and the general atmosphere within the home had improved. Staff were courteous and polite enabling service users to
Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 15 take their time when making decisions and or when moving around the home. Service users mobility was promoted and appropriate support was provided. We had the opportunity of talking with a number of service users, each one appeared happy and contented. When asked how they were supported one service user said by lovely girls, another said everything is done just right. Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 16 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. Each service user is treated as an individual and are supported to follow interests and activities. This means they are living as they desire and expect. EVIDENCE: The AQAA stated We have a wide variety of activities that take place on and off the premises and we have monthly activity meetings where residents can request activities they would like to do or outings they would like to go on. During the site visit we found these statements to be true. Since the last inspection a full review of the homes activities programme has been undertaken, in addition a new fulltime activities coordinator has been employed with the specific purpose of consulting with service users and developing activities on both and individual and group basis to suit their need and requests. From the records looked at we could tell that service users had been involved in the planning process of the new programme sand that they now had daily opportunities to joining in activities within the home.
Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 17 During the inspection we observed service users sitting with the co-ordinator reading the daily news papers, and whilst this has been observed on other inspections, this time service users were engaged in the process and discussed interesting articles. Relatives and service users have planned meetings where they can discuss with the manager any issues and contribute to the development of daily activities and outings. Care and attention had been paid to small details we observed that female service users now had leg coverings, carried handbags and wore more jewellery. Ladies also had nice nails which had been varnished and some were now wearing make up. We arrived at the home as service users were preparing for breakfast. The homes routines have completely changed since the last inspection with significant improvements evident. As service users joined each other for breakfast, conversation indicated that they had been looking forward to meeting each other and receiving their meal. Service users were more interactive with each other and staff were much more attentive. One member of staff is now designated to remain in the dining room when mealtimes are in progress, this makes sure service users are not left unattended and that they receive the support they require in a timely manner. New menus has been introduced with service users being offered hot food items at breakfast and more variety and choices at each mealtime including supper. We spoke with a number of service users as we shared a mealtime with them. They confirmed the food was fantastic with one service user encouraging the inspector to ask for something off the menu so you can see what they do Service users told us that nothing is to much trouble and that they can ask for what they want. Whilst vast improvements have been made there are still areas that need further developing. We were told that staff had been trained in how to lay tables and make sure service users independence was promoted, however staff continue with the practice of serving cereals and hot drinks ready prepared. Staff used one service users own marmalade for another service users toast and milk and sugar was not readily available for independent use on tables. The meals served were of a good quality and appetising. Service users all commented positively about the improvements. Because of the improvements made both at mealtimes, with the provision of daily activities and increased opportunities to go out and because staff practice in supporting service users
Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 18 has improved we think service users now have a better quality of daily living at Urmston Cottage which promotes them to develop individual routines which suit them. Relatives who visit frequently told us each resident is given every care and attention to their needs and I am fully satisfied with the care and attention given. Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 19 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. If service users have concerns or feel unsafe they or people close to them know how to complain. They are aware of safeguarding procedures in place which are there to protect them EVIDENCE: The last inspection identified that this area of care was of a poor standard. Since them the new manager has implemented more stringent routines for the recording of complaints. We looked at records which identified that she has met with all service users and relatives and they have been informed of how to raise matters of concern. The manager has informed them of an Open Door policy and on ways she can be contacted if complaints are of a serious nature and identified out of hours. Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 20 Complaints are now fully recorded and we were able to see the actions taken to investigate and resolve all matters of concern. Because of new improved staff practice and actions taken to develop the management team there has been a reduction in the number of complaints about the home. Relatives told us that times have been difficult but they have confidence in the new manager and staff team. Within the last twelve months there have been a number of concerns regarding adult protection. As a consequence safeguarding procedures have been completed in accordance with local authority procedures. At the time of writing the report there are no outstanding matters of concerns about the protection of service users at Urmston Cottage. When spoken with, staff appeared more aware of standards to be maintained and of how they should support and protect service users. The AQAA told us that as part of the managers development for staff, all staff are to have adult protection training repeated, which ensures they fully understand their duty of care responsibilities. Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 21 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users live in a home that is being upgraded to a high standard. This means service users have comfortable, pleasant and safe surroundings. EVIDENCE: An extensive upgrading and refurbishment programme was in place at the time of the inspection. Areas that had been completed had been done to a good standard offering service users comfort and security in addition to pleasant surroundings. Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 22 We looked at records which confirmed that the manager has met with ancillary staff and has introduced new ways of working which should ensure that the home is clean and hygienic at all times. Additional staff are to be recruited to support ancillary duties and ensure that standards are maintained. It was clear from the records that service users daily routines are now prioritised and that cleaning routines are flexible and work around service users. We observed that the home was clean and free from odours during the site visit even though extensive building work was continuing. One relative told us that although it has been difficult the way the building has been managed during the upgrading has been good. Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 23 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Service users have safe and appropriate support as there are enough competent staff on duty at all times. They are protected because recruitment checks are made to make sure staff are suitable to care for them. EVIDENCE: Since the last inspection there has been some significant changes in the staff team. The AQAA identifies that ten staff leaving within the last twelve months, as a consequence a recruitment drive has taken place. Previousley recruitment and selection procedures were not followed correctly which placed service users at risk of receiving care and support from people who may have done them harm. Inspection of staffing records identified that recruitment procedures have improved. Full checks are made on staff and they are not able to work alone until a full CRB check has been issued which confirms the person is safe to work with vulnerable people. A mentoring system has also been introduced which means that new staff now work along side designated experienced staff who have been identified as maintaining good standards. Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 24 We can confirm that systems have been introduced to ensure new staff complete appropriate induction programmes which includes the formal Skills for Care Common Induction Training. The new staff team is not without its problems and staff have told us that communication could improve and more training provided, particularly for the less experienced staff. When speaking with the manager we were informed that she was aware of these issues and that she had taken action to ensure staff development and team building is being put into place. Staff confirmed this they also told us all mandatory training is being completed and the new manager is finding ways to improve the communication between staff members This service is working well now because of the changes that are happening, more carers are aware that they should be doing what is right for the service uses and not themselves. We have carers that genuinely do care about the well-being of our service users, and put it into practice. We looked at staff meeting records and noted that the manager has been direct in the improvements she wishes to make whilst at the same time being supportive to staff. The AQQA stated that staffing levels had improved which we can confirm after looking at the staffing rotas for all levels of staff. Staff also told us new staff levels are better, we can provide more time to the client as an individual as well as provide better care. Staffing levels have been much better since the new manager has started and this is reflected in the general atmosphere of the home. It feels like a much nicer place to work in. There are a number of staff working at the home who have various minority ethnic backgrounds and cultural differences. They informed us they receive the support they required with one staff saying, I work in a very ethnically divers environment and new management discusses these issues in meetings we have. As previously mentioned all staff are to have training provided. When completing a training audit the operations manager and manager told us they were not able to find out fully which staff have received what training, as a consequence a new training programme has been planned for. Staff meetings have commenced and staff have received information about individual training and development plans which are to be introduced. From our observations we feel service users are benefiting from a stronger management team, staff appeared to know what is expected of them and how they should work for the benefit of service users. Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 25 Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 26 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. Service users and staff have confidence in the care home because it is managed appropriately. They are protected because financial and health and safety procedures are in place. And because staff providing care receive support and guidance from their manager. EVIDENCE: Since the last inspection the home has recruited a new manager. She has yet to complete a management qualification and Nation Vocational Qualification (NVQ) at Level 4. We were told that she is in the process of completing her
Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 27 management training and once finished she will be continuing to achieve an NVQ at level 4. Although the process has commenced, the manager had not at the time of writing the report completed the registration process with us. From our observations and from feed back from the operations manager, service users and staff, we are able to tell that the new manager has made a strong and positive start in developing the home. Staff told us the manager was very supportive and is always fair and since Urmston Cottage appointed a new manager, I have already noticed improvements for example staff meetings and issues being discussed. The manager now is very approachable, fair and always ready to listen. We looked at a number of records that showed us how the new manager has gained control of Urmston Cottage and is ensuring it is run for the benefit of service users rather than staff. Service users, relatives and all levels of staff have had the opportunity to meet with the manger. We can see from the records that service users are being encouraged to live their lives as they wish and that relatives are being actively invited to become involved with various aspects of Urmston Cottage and its future development. Monies held on behalf of service users are kept to a minimum amounts. Records are audited by a director of the company and were made available for inspection. Health and safety records continue to be in place and up to date. Fire safety practices have increased and there is an indication that staff have received unannounced practical fire drill training. A homes risk assessment has been completed which indicates the hazards and risks whilst the building is being upgraded. Although staff have not received supervision at the required frequency, it is evident that the manager has recognised that staff need instruction, guidance and support. Because this takes time group staff meetings have been held. We can confirm that individual supervisions are planned for and that it is the intention of the manager to individually supervise all staff until she is assured that standards are known and maintained. Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 28 Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 29 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 3 3 X X X X X X 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 X X 3 Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 30 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 OP9 Regulation 13(2) Requirement Timescale for action 09/09/08 2 OP9 13(2) Put in place effective arrangements to ensure that all records regarding medicines are clear and accurate in order to show that medicines are given properly and can be accounted for. Put in place effective 09/09/08 arrangements in the home to ensure that medications are administered in exact accordance with the prescribers’ directions in order that residents’ health is not placed at risk. 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 OP8 Refer to Standard Good Practice Recommendations We should be informed when the new care planning procedure has been implemented and full care centered practices have been developed.
DS0000006729.V370380.R01.S.doc Version 5.2 Page 31 Urmston Cottage 2 3 OP15 OP18 3 OP19 Service users independence should be promoted at meals times. Where appropriate and safe they should have the opportunity to serve themselves hot drinks. To make sure service users are supported by staff who have received adult protection training, we should be informed when training is complete and all levels of staff are trained. We should be provided with a detailed upgrading programmes which includes times scales for completion. Urmston Cottage DS0000006729.V370380.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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
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