Inspection on 15/05/07 for Valentine House

This inspection was carried out on 15th May 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Valentine House 12/08/09

Valentine House 03/10/08

Valentine House 03/05/06

Valentine House 27/10/05

Valentine House 05/05/05

Valentine House 19/10/04

Valentine House 12/05/04

Valentine House 06/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Valentine House Broadway Silver End Witham Essex CM8 3RF Lead Inspector Kathryn Moss Key Unannounced Inspection 15th May 2007 09:45 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 Valentine House DS0000017989.V340828.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. Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Valentine House Address Broadway Silver End Witham Essex CM8 3RF 01376 585965 F/P 01376 585965 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) Atlantis Healthcare Limited Mr George Michael Botten Care Home 49 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (49) of places Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 49 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 12 persons) The total number of service users accommodated must not exceed 49 persons Only the room agreed with the Commission (room number 17) can be used as a double room 3rd May 2006 Date of last inspection Brief Description of the Service: Valentine House is a large detached house, situated opposite a small parade of shops in a village location. The home has three floors that are accessed by a through floor passenger lift, and residents are accommodated in single bedrooms, all with ensuite toilets. Facilities include lounge areas on all three floors, a large dining room, a number of bathrooms (some with assisted bathing facilities), and a secure garden area with seating available. The home is registered to provide 24-hour personal care and support for up to 49 older people (i.e. over the age of 65), including up to twelve people who suffer with dementia. The home provides both permanent accommodation and also short (respite) stays. The home is owned by Atlantis Healthcare, and the registered manager is Mike Botten. Information provided by the home in April 2007 indicated that the home’s fees at that time ranged from £434 to £470 per week, with additional charges for items such as hairdressing, chiropody, toiletries, newspapers, etc. A copy of the home’s Service User Guide is available in the home. Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place on the 15th May 2007, lasting nine and a half hours. The inspection process included: • • • • • • Discussion with manager and deputy manager Inspection of communal areas Inspection of a sample of records and policies Conversations with five staff Conversations with six residents Feedback questionnaires from four relatives This report also draws on any other information relating to the home received by the CSCI since the last inspection (e.g. notifications from the home, complaints, quality of care reports, reports of visits by the responsible individual, etc.), including outcomes from a random inspection visit to the home that took place on 29.11.06. The outcomes related to 26 Standards were inspected. There were 6 requirements resulting from this inspection, and some good practice recommendations have also been made. The home provides a good level of care and support, with positive feedback from residents and relatives and with no concerns raised since the last inspection. What the service does well: Valentine House provides a pleasant, homely environment, with suitable facilities for the people who live there. It is consistently well maintained and clean, with suitable décor and furnishings. The home is in a small village location and has good contact with the local community. There are shops and a park within walking distance, residents attend a weekly coffee morning at the local community centre, and there is contact with the local church. The home has a friendly atmosphere, with a core of dedicated staff who have been there a number of years and provide good consistency of care. Comments received from relatives include: ‘The staff are always very friendly and are always there if you have a query about anything’ and ‘the carers at Valentine House always appear to show they care. As a smallish home you feel you are getting the personal touch’. Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 7 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 Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 8 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 and 4 (Standard 6 is not applicable at Valentine House) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Assessment processes ensure that residents can be confident that the home will meet their needs. Staff have the knowledge and skills to meet residents’ needs. EVIDENCE: The home’s Statement of Purpose and Service User Guide were not reviewed on this occasion. Following the last inspection, an action plan received from the manager indicated that these had been amended to reflect suggestions made at that inspection. The home continues to receive care management assessments for any people referred by social services, and also carries out it’s own assessment of any prospective residents. A pre-admission assessment was viewed for one person Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 9 who had recently come to live in the home, which covered most key areas of need and contained brief comments on relevant issues. A resident who had come to live in the home since the last inspection was spoken to: they felt that they had been made welcome in the home and was pleased that they had made friends. They had not been able to visit before moving in but confirmed that a relative had been able to visit the home to check it out and make sure it would meet their needs. In their feedback questionnaire, one relative was very positive about the response and help they had received from the home when looking for a suitable home for their parent, and said that this had helped them in making the difficult decision to place their parent in a residential home. Four relatives completed feedback surveys as part of this inspection, and all felt that the home was meeting residents’ needs. The home has appropriate premises and facilities to meet the needs of the people it aims to accommodate. On this inspection it was good to see the home making progress towards ensuring that staff have the skills to meet residents’ needs: the home is registered to care for a number of people who suffer with dementia, and a number of staff were in the process of completing a distance learning dementia care training course. Staff spoken to were enthusiastic and positive about the course, showing a good understanding of the issues and an ability to apply what they had learnt within the home. Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Care plans provide sufficient information to ensure that staff know what support residents need. Staff practices and approach promote the privacy and dignity of residents. However, medication practices were not sufficiently robust to protect residents, but the CSCI is confident that the actions being taken by the manager will address this. EVIDENCE: Residents spoken to during the inspection were positive about the care and support received from staff at Valentine House; relatives consulted felt that staff had the skills and experience to look after people properly, and gave the residents the support they expected. Staff were observed to treat residents respectfully and to be aware of issues relating to privacy and dignity. Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 11 Three residents’ care files were inspected and all contained a range of appropriate assessments and risk assessments (e.g. nutrition, dependency, moving and handling, pressure areas, general risks in activities of daily living, etc.). One file contained a ‘Mini Mental State’ assessment form. Service user plans were typed and therefore clear to read, and covered all key needs, with brief but sufficient details of the action required by staff to meet each need. It was good to see one care plan containing clear details of the action being taken to prevent pressure sores, including the equipment in use. Another plan referred to pressure area care, but was unclear whether the person still had a pressure sore and some of the action (e.g. turning) was detailed in the review notes rather than the care plan. A staff member shown this agreed that this did not accurately reflect the resident’s current needs and did not provide clear guidance on what to do. Staff need to ensure that care plans reflect current action. One person’s needs had very recently changed significantly: staff hoped this just represented a temporary period of ill-health, but it is recommended that when a person’s needs change significantly for a period of time, short-term care plan is put in place without delay. A care plan viewed for a person who suffered with dementia identified that the person had short-term memory loss, but did not describe any specific action to support this. Care plans for mental health issues would therefore benefit from further development. Senior staff spoken to showed that they were developing a good understanding of issues relating to dementia care, demonstrating that their recent training had made them think about their work and had given them ideas of changes they could make within the home. This was good to see, and staff are commended on their positive approach to this. One senior commented on the need for staff to have consistent strategies for supporting people who may be confused: this needs to be reflected in care plans. All files contained care plan evaluation forms, showing evidence of regular review. Some contained evidence that a relative had been informed of the care plan. Files contained evidence of contact with GPs, district nurses and other healthcare professionals. Staff were seen encouraging residents with their mobility, and the deputy manager was looking to implement a tool to monitor falls in the home. A healthcare professional consulted as part of the inspection felt that the staff sought appropriate medical advice and asked for help when they needed it. Records of food eaten were being maintained, and residents’ weights were monitored. The manager reported that staff had received a training session on nutrition in care homes, and that they were looking to implement a nutrition screening tool. The home’s Medication administration policy was not reviewed on this visit. Medication was stored securely and in an orderly manner, with separate storage facilities for controlled drugs and medication requiring refrigeration. The record of controlled drugs was well maintained. Medications details were printed on the Medication Administration Records (MAR) form by the Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 12 pharmacist; staff had signed and dated these records to confirm medication received by the home. Any hand written details were clearly written, and changes to instructions were signed and dated. Medication administration records seen were generally well completed. However, one prescribed medication had not been signed as administered for the previous four days, although the medication was available. The senior in charge of the shift did not know why this had not been signed for: they were not aware of any instruction not to give the particular drug, and would have expected it to have been given. They were advised to look into this, and the manager needs to ensure that systems are in place to ensure such discrepancies are identified promptly. The senior was not familiar with the purpose of this medication (therefore did not know the implications of it not being given): it is therefore recommended that the home implement clear medication profiles for each resident, showing the medication they are on and the function of each medication. The manager stated that the home had recently implemented a medication audit form, and the first audit carried out identified a number of discrepancies. As a result of this they had requested a full medication audit from their pharmacist, and are commended on taking action to address this. Information provided by the home prior to the inspection identified that twelve staff are responsible for medication administration in the home. Training records submitted following the inspection showed that nine of these staff had received training in medication administration, but there were no training dates for three night seniors and some training dates were over two years ago: it is therefore recommended that the home review medication training. A senior carer spoken to during the inspection showed good understanding of the process of administering medication, demonstrating that they were aware of the risks and responsibilities. Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home provides flexible routines, and opportunities to meet a variety of social, recreational and religious interests and needs. However, at present there is an insufficient level of activities to provide a stimulating lifestyle for all residents. The home provides a varied and balanced diet. EVIDENCE: Routines within the home appeared flexible, with residents being able to spend time where they want (lounge, bedroom, etc.). On both this inspection and the random inspection in November 2006 it was good to see residents having late breakfasts, showing that there was no pressure to get up at any particular time, and also being able to have breakfast in their room. Files contained forms on which to record people’s interests, social contacts, and religious and cultural needs, and some files seen contained life history information. Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 14 The home has a part-time activities co-ordinator who organises a good range of activities, both in the home and in the local community. However, the activities co-ordinator does not have time to provide high levels of regular engagement with all residents, and some activities are more suited to more able residents. It was good to hear that the home had recently acquired some new activities (an indoor basket ball game, and some musical instruments) that had been positively received by residents, and it was also noted that the home had two new volunteers, one who takes an exercise class once a week, and the other offers support with activities on a couple of days. A monthly service is held in the home, and a priest regularly visits. However, several residents spoken to felt that not much happened when the activities co-ordinator was not around: they said that staff did not have time to spend with them, and some complained that ‘the TV is always on’. Over several inspections it has been noted that there does not appear to be much staff presence in the lounges in the afternoons to provide interaction and activities. Although the manager stated that staff were expected to spend time with residents, daily records showed very few activities taking place. Staff spoken to reported that afternoons are generally quite busy, with two staff bathing residents, two putting laundry away in rooms, and one organising the afternoon drinks and clearing away afterwards, then setting tables for tea. With only five staff on duty this does not provide much time in the afternoons to spend with residents. No care staff are specifically allocated for activities; one carer stated that if they start an activity they usually get called away to deal with a care issue. Several senior staff spoken to confirmed that care staff do not organise many activities with residents at present, but felt that their dementia care training had made them more aware of the need to spend time engaging with residents, and felt this needed addressing in the home. When the home was registered for dementia care it was expected that staffing would be reviewed to ensure that residents’ needs, including social and recreational needs, are met. The home therefore needs to review care staff levels, roles and routines in order to ensure a sufficient level of interaction with residents, particularly with those who suffer with dementia and are less able to occupy themselves. The home’s Visitors book showed regular visitors to the home, and relatives who provided feedback for this inspection felt that the home helped residents to keep in touch with them, and that the home kept them up-to-date on any important issues. The home has good links with the local community, and some residents regularly attend a coffee morning at the local church hall. Residents can bring their own possessions into the home with them, and can have their own phone. Residents are able to handle their own financial affairs as long as they are able, and are encouraged be involved with their money. Residents spoken to were generally positive about the meals served to them, and one person confirmed that they were always given an alternative when the Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 15 main meal was something they did not like. Menus seen showed a good range of meals provided, with choices available at each mealtime: at lunchtime one main cooked meal was provided, with a range of set alternatives available (e.g. baked potatoes, omelette, chicken nuggets, salads); cooked items were available at both breakfast and teatime. The chef reported that menus were due to be reviewed, and was able to describe how they were encouraging one resident to try a wider range of choices, in order to improve their nutritional input. A new fridge was delivered on the day of the inspection, and the chef stated that this was to enable them to order more fresh meat instead of frozen, and to increase the variety of food items available at tea-times. Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Practices in the home generate few complaints, and residents are confidant any concerns will be listened to. The home does not demonstrate a sufficient level of staff training in the Protection of Vulnerable Adults to ensure that staff are aware of abuse issues and of the home’s procedures for responding to concerns. However, the CSCI has been advised that this training is in process. EVIDENCE: At previous inspections the home’s complaints policy had been noted to be included in the home’s Service User Guide. All four relatives providing feedback as part of this inspection stated that they knew how to make a complaint, with two stating that the home usually responded appropriately if they voiced any concerns about the resident’s care, and the other two reporting that they had not had cause to raise any concerns. Residents spoken during the inspection said that to felt able to speak to manager and deputy manager about any concerns. No complaints have been received by the CSCI since the last inspection. The home’s complaints log was viewed, and contained records of two complaints received by the home, both of which appeared to have been appropriately resolved. Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 17 The home’s Protection of Vulnerable Adults (POVA) policy was not reviewed on this visit. No concerns or allegations of abuse have been raised in the home since the last inspection. Details of staff training provided as part of this inspection showed that of a list of 31 care staff (including deputy manager and activities co-ordinator) and 8 ancillary staff, only 18 care staff and 1 ancillary staff member had completed POVA training. The file of one new carer had evidence that they had received a booklet on adult abuse at their induction, and they were undergoing an induction process that covered POVA issues. However, another new carer had not had POVA issues discussed with them: they were not aware of the home’s policy and procedures relating to this, and had not yet started a formal induction process. This is not an adequate level of POVA training amongst existing and new staff, and needs urgent action as training in POVA has also been a requirement at the last two inspections. However, following this inspection the manager confirmed that he and the deputy manager were planning to carry out POVA training as soon as possible, using a DVD training pack the home had purchased. Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, and 26 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home provides a safe, well-maintained and clean environment, which meets residents’ needs. EVIDENCE: Valentine House provides appropriate facilities for the people who live there, including a range of different communal space. All residents are currently accommodated in single rooms with ensuite bathrooms: the few bedrooms viewed were in a good state of repair, with some rooms were well personalised. Not all areas of the home were inspected on this visit, but ground floor communal areas were viewed and were all clean and tidy, homely and warm. There were no unpleasant odours noticed in the areas inspected. When asked what they felt the home did well, one relative said that it provides Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 19 ‘a clean, well-maintained environment for residents’. It was noted that the home did not have a maintenance person at the time of this inspection, and the manager was therefore monitoring maintenance issues. However, the home continued to appear well maintained. Decoration and maintenance records were not specifically discussed on this occasion, but Regulation 26 reports received from the provider over the last year showed decoration taking place, plans were in progress to improve the kitchen, and staff reported that a new hoist had recently been obtained. As a result of recent dementia care training, it was good to hear both staff and manager suggesting ways in which the environment could be improved upon for residents suffering with dementia (e.g. having plain colour carpets and curtains). The home is encouraged to put these ideas into practice. When invited to suggest ways in which the home could improve, one relative suggested that they thought the gardens and frontage could be improved upon, and that they felt the ramp to the garden was quite steep for wheelchairs and people with limited mobility. Another relative felt that it would be helpful if the home provided audio amplification equipment (e.g. a loop system) in the lounges, to help the hard of hearing. The manager should review these suggestions to see if any action is needed. The laundry was not inspected on this occasion, as there had been no change to facilities since the last inspection, when they had met infection control requirements. The manager reported that twelve staff had completed a 12week distance learning course in infection control last year. Training records showed that in total 17 care staff had completed infection control training, but no auxiliary staff. It is recommended that the home treat this as core training and ensure that all staff complete training in this subject. Disposable protective gloves and aprons were seen to be available to be available for staff to use, and new staff were aware of the need to use these for personal care. Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Staffing levels meet residents’ personal can health care needs, but do not satisfactorily meet their social and recreational needs. Levels of staff training generally ensure that residents are in safe hands. The home has appropriate recruitment procedures, but practices are not sufficiently rigorous to fully protect residents. EVIDENCE: At the time of this inspection, the manager confirmed that staffing levels were seven staff on a morning shift, six on an afternoon shift, and four at night. Rotas for the two weeks preceding the inspection showed that these staffing levels were being consistently maintained, and staff spoken to reported that occasions when they were short staffed on a shift were now relatively rare, showing an improvement from the last key inspection. Staff felt that they could generally manage residents’ care on this level of staffing, apart from occasions when they were short staffed for any reason (e.g. last minute sickness or if a client needed an escort to attend a hospital appointment). Staff confirmed that they were able to arrange agency staff if required. There were appropriate levels of ancillary staff (domestic, laundry and kitchen). Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 21 However, as noted in the section on Daily Life and Activities, although care staff had sufficient time to satisfactorily meet care needs, they do not currently have time to initiate sufficient activities with residents. It was noted that care staff were carrying out tasks in the afternoon that additional ancillary staff could perform (e.g. preparing and serving cups of tea, setting tables, putting away laundry, etc.). The registered person therefore needs to review staffing levels and roles, to ensure that care staff have sufficient time available to spend with residents’ and to meet their social and healthcare needs. Recruitment records were checked on both the random inspection carried out in November 2006 and on this inspection. On the random inspection it was noted that the file of a new carer did not contain any written references received, only a brief record of a verbal reference that was not signed or dated. A ‘POVAfirst’ check had been obtained, but there was no evidence of supervision arrangements pending receipt of the full Criminal Records Bureau (CRB) check. On this inspection the files of three new staff were inspected: evidence of CRB checks had greatly improved and most pre-recruitment checks and information were present. However, none of the files contained a photo of the person, in two instances the declaration of criminal record had not been completed, and on one file there was only one reference, which had not been received back before the carer started work (although the manager recalled receiving a second reference, this could not be found). In two files the employment history had either some unclear dates or a small gap. Whilst recruitment practice had improved in regard to CRB checks, the manager still needs to be more rigorous in obtaining and checking information before new staff start work. The home has information on the Skills for Care ‘Common Induction Standards’, and one of the senior staff had taken on responsibility of working through these with new staff. The senior showed an interest and commitment to developing this induction, and there was evidence that this was in progress with one new carer, and evidence that they had received induction information (POVA information, General Social Care Council code of conduct, staff handbook, etc.). Another carer who had been in post just over a week stated that they had completed moving and handling training with the home before they started, and had shadowed other staff initially and felt well-supported. However, no formal initial induction appeared to have taken place: they had not been informed of key policies and procedures (e.g. fire procedures, POVA, etc.) and there was no evidence to show that they had been given information. Training information submitted following the inspection showed that out of over 30 care staff only 12 currently have NVQ level 2. There were no plans in progress for other staff to do this training, and there had been no progress in obtaining funding for senior staff to do NVQ level 3, as hoped at the last inspection. The home needs to progress plans to ensure that more staff complete NVQ training. Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 22 Training information viewed on the random inspection in November 2006 showed a good range of training provided to staff during 2006, including: POVA, Health and Safety at Work, infection control, COSHH, fire training, moving and handling and first aid. At that time the manager stated that the Community Liaison Nurse was hoping to arrange some training sessions (e.g. skin care, catheter care, falls, diabetes, etc.), and that food hygiene training was to be delivered in-house using a video training package. On this inspection it was noted that eighteen staff were in the process of completing a distance learning dementia care training course, and that some training sessions on nutrition had been arranged. This shows a good level of training provided to staff in the home. However, a summary of staff training provided as part of this inspection showed that not all staff had received all core training; action required in relation to specific training has been highlighted elsewhere in this report (e.g. medication, POVA, infection control, and NVQ). Not all staff had received (or were currently doing) dementia care training, and this needs to be addressed. However, it was very encouraging to hear staff being enthusiastic about what they were learning on the current training course; the manager should ensure that staff have opportunity to implement this learning within the home. Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35, 36 and 38 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Management structures ensure that residents benefit from consistent management of the home. The home is run in the best interests of service users, although formal quality assurance processes are not yet sufficiently developed to demonstrate this. Practices in the home protect residents, and promote a safe environment. EVIDENCE: Due to the timescales for his future retirement, the current registered manager will not be completing a required management qualification. However, the deputy manager of the home has now enrolled on the Registered Manager’s Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 24 Award (NVQ level 4), and the registered provider is progressing plans for the deputy manager to take on the role of registered manager when the current manager retires. The manager and deputy manager work closely together in running the home, and are supported by the company operations manager, who visits the home regularly. Staff spoken to were positive about working at Valentine House, stating that they found the manager and deputy manager approachable and supportive. A new carer was enjoying working at the home, saying that they found it a friendly place and that nothing seemed too much for the staff, who were always willing to help and advise. The deputy manager confirmed that staff supervisions are now being regularly carried out and that most staff had received a supervision in the last two months. Where possible two senior staff were on duty each shift, and seniors were positive about the extra support this gave them in their role. A lack of formal quality assurance systems in the home has been highlighted at several previous inspections. A quality assurance computer package obtained by the manager at the time of the last inspection had not proved useful, but the manager reported that the home was due to obtain a new computer system that should enable the monitoring of certain functions within the home (e.g. staff training, supervision, etc.). The home currently has limited internal auditing processes in place, but there was evidence that the manager had recently implemented a tool for monitoring medication practices, food safety audit forms had been implemented in the kitchen, a bedroom cleaning checklist had been implemented for domestic staff, and the deputy manager was developing a form for auditing falls. The home also had a health and safety check form (not been completed for a few weeks due to the maintenance person leaving), and the manager audited residents’ monies. This showed an improvement in monitoring practices since the last inspection. The home has a survey form to seek the views of residents and relatives on the home. The manager reported that this had been sent out this year, and an independent person had supported some residents to complete these, although only a few responses had been received. No report had been produced to summarise the responses, as required at previous inspections. The manager was able to describe action taken to address some of the issues raised (e.g. consultation with residents about meals, and action being taken to revise menus). The home still did not have an annual development plan. The home’s financial records were not reviewed as part of this inspection, but profit and loss information seen for the company showed that the company makes sufficient income to support the needs of the home. Evidence on the inspection suggested that the home was well-maintained, with regular investment in the facilities (e.g. new fridge and new hoist obtained), and with sufficient supplies (e.g. food, cleaning items, etc.) for the running of the home. Staff highlighted that they had been waiting some time for new uniforms, and some new staff were wearing second-hand overalls that did not fit them properly. This should be addressed as soon as possible. Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 25 Money looked after on behalf of residents was stored securely, and clear individual records were maintained, with receipts obtained for purchases. One person’s money and records were checked and seen to balance. There was evidence that the manager regularly checked these. Health and Safety policies and risk assessments were not reviewed on this occasion. Training information showed a good level of training in moving and handling, fire safety and first aid, but not all staff had completed food hygiene and infection control training. The manager reported that food hygiene training was due to be delivered. Information provided by the manager prior to the inspection showed that service checks on utilities and facilities were regularly carried out and up-to-date. Records seen on the inspection showed that regular internal checks were carried out on fire alarms and fire equipment: these had lapsed in the last month due to the maintenance person leaving, and the manager needs to make alternative arrangements for these checks to be carried out. The home has a fire risk assessment and training is provided to all staff each year. The manager stated that fire drills are carried out as part of this training, and that staff on duty when fire alarms are tested each Monday are expected to respond as if it were a drill: as some drills should take place unannounced, it is recommended that the days/times of alarm testing are varied each week, and that night staff also receive these drills. Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 X 18 2 3 3 X X X 3 X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 3 3 3 X 3 Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 27 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 OP9 Regulation 13(2) Requirement To promote and protect residents’ health, the home must ensure all prescribed medication is correctly administered. If a GP has instructed otherwise, this must be clearly recorded to ensure senior staff are aware. All staff responsible for administering medication must receive suitable training (including an assessment of competence), which should be regularly updated to ensure they have the knowledge and skills to safely carry out this task. The home must ensure that all residents have sufficient and suitable opportunity for social and recreational activities that meet their needs and preferences, in order to promote their health and welfare. To ensure the protection of residents, all staff (care and ancillary) must receive appropriate training in abuse awareness the home’s procedures for responding to suspicion of abuse. DS0000017989.V340828.R01.S.doc Timescale for action 15/06/07 2 OP12 12(1) 30/06/07 3 OP18 13(6) 30/09/07 Valentine House Version 5.2 Page 28 4 OP27 18 This is a repeat requirement for the second time (last timescale 31/08/06). Daily staffing levels and roles 30/06/07 must ensure that suitably skilled staff have sufficient time to spend with residents to meet their personal, health care, social and emotional needs. This is a repeat requirement (last timescale 14/06/06). For the protection of residents, appropriate checks must be carried out on all new staff before they start work. This particularly relates to obtaining: 1. a full employment history, including written explanation of any gaps; 2. a completed declaration of criminal record; 3. two written references, including the last care employer. This is a repeat requirement for the third time with respect to references (last timescale 31/12/06). 5 OP29 19, schedule 2 15/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations It is recommended that the home continue to develop care plans that show the action required by staff to meet needs relating from dementia. Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 29 2 OP9 3 OP12 4 5 OP26 OP28 6 OP30 It is recommended that the home develop medication profiles for each resident, to ensure staff are aware of the purpose of each medication, and any side effects. This is a repeat recommendation. It is recommended that activities initiated by care staff are recorded, so that the manager and seniors can monitor whether there are sufficient levels of stimulation in the home, and the impact of activities on residents. It is recommended that the manager ensure that all staff receive training in infection control. The registered person should ensure that plans are progressed to ensure that at least 50 of care staff are qualified to NVQ level 2 or above. This is a repeat recommendation. The registered manager should ensure that all staff have received, and are regularly updated, in all core training. New staff should be given guidance on core policies and procedures at the start of their employment in the home. The home’s quality assurance systems should incorporate: 1. clear processes for auditing key practices in the home 2. surveys of residents’ and other stakeholders’ views, and a clear evaluation of responses received and any action to be taken 3. an annual development plan reflecting aims and outcomes for service users. Where residents lack the cognitive capacity to express their views on the home, the home should explore other ways of evaluating their experience of the home. 7 OP33 Valentine House DS0000017989.V340828.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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