Inspection on 03/05/06 for Valentine House

This inspection was carried out on 3rd May 2006.

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 15/05/07

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 3rd May 2006 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 Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 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.V293634.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Valentine House Address Broadway Silver End Witham Essex CM8 3RF 01376 585965 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 48 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (48) of places Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 48 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 48 persons 27th October 2005 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 48 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 current registered manager is Mike Botten. Information provided by the home in February 2006 indicated that the home’s fees at that time ranged from £416 to £435 per week, with additional charges for items such as hairdressing, chiropody, toiletries, newspapers, etc. Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 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 3/5/06 and 4/5/06, lasting fourteen hours. On the days of the inspection there were 41 residents living at the home, including eleven people suffering with dementia. The inspection process included: discussions with the manager, five staff, six residents and three relatives; viewing of communal areas, laundry and three bedrooms; and inspection of a sample of records and policies. This report also draws on evidence obtained through consultation with some healthcare professionals involved in the home, and other information submitted by the provider over the previous year (e.g. notifications of deaths and incidents in the home, reports on monthly visits by the registered provider, etc.). 26 standards were inspected, and 12 requirements (three of which were repeat requirements) and 12 recommendations have been made. Not all previous recommendations were reviewed on this inspection. What the service does well: What has improved since the last inspection? Care plans showed a significant improvement since the last inspection, with those seen being up-to-date and reflecting core needs, including pressure area care. This demonstrates staff understanding of the care required by each individual. There was evidence of regular reviews, and of residents (where able) signing to show they had been consulted on their care plan. Several files Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 Page 6 viewed were also seen to include a Life History of the person, providing staff with useful information to help them understand the person and their interests. Since the last inspection a survey of residents’ views on the home had been carried out, and although the responses had not yet been evaluated or a report produced, it was good that this had taken place. It was particularly good that the home had asked an independent person (an advocate involved with one of the residents) to complete survey questionnaires with residents, as this made the process much more objective. 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. Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 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.V293634.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had information available to help service users make an informed choice about the home, but was not always providing copies of this to individuals. Assessment information was obtained by the home prior to admission to ensure staff could meet prospective residents’ needs. Residents’ needs were being satisfactorily met by the home. EVIDENCE: The manager provided the inspector with a current copy of the home’s statement of purpose and service user guide. This was a combined document, which had clearly been updated since the last time it was reviewed by the CSCI, and reflected the home’s current registration. However, it was noted that it referred to some staff roles that were not currently in post in the home, and needed minor amendment to fully meet regulatory requirements. The manager was sent feedback on this separate to this report. Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 Page 9 The file of a new resident was viewed, and contained evidence of assessments carried out prior to admission and on admission, to identify the person’s needs and ensure that the home could meet them. The relative of this resident was spoken to, and felt that the resident had been made welcome in the home and was satisfied that the home was meeting the person’s needs. The relative stated that the resident had not been given information about the home (i.e. a copy of the service user guide) on or before admission to the home. It was noted on another resident’s file that the local authority’s pre-admission assessment form indicated that the person had health needs that fell outside the home’s conditions of registration. Although feedback from the resident indicated that the home was meeting this person’s needs well, the manager was reminded that the home must adhere to its conditions of registration: if a prospective resident appears to have special needs the manager should consult with the CSCI first to see if a variation to the home’s conditions of registration is required. The home was meeting its conditions of registration with regard to the number of places for people suffering with dementia. Residents and relatives spoken to were satisfied that the home had the facilities and staff skills to meet their needs. Dementia care practices were not specifically inspected on this occasion. Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs were set out in care plans, but care plans were not in place for one resident. Health care needs were being met within the home, and practices promoted the privacy and dignity of residents. Medication procedures protected residents, but some records were not adequately maintained. EVIDENCE: A sample of five residents’ files were inspected on this visit. All contained a moving and handling risk assessment, nutrition assessment, and risk of pressure sores assessment; there was evidence that these assessments were periodically reviewed. Further assessment documentation forming part of the care plan identified the person’s likes and dislikes. Care plans were present on four of the files; there was no care plan on the fifth file, which belonged to a person who had been admitted to the home a month before. The manager was advised that care plans should be developed as soon Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 Page 11 as possible after admission. The care plans viewed were up-to-date, typed (making them easy to read), and appeared to cover a range of needs that were relevant to each individual. There were brief but clear details of the action required by staff, also indicating where the person could do things for themselves, and identifying any individual choices. There was evidence of these being reviewed regularly, and residents (or their representatives) were signing a form to indicate their consent to their care plans. Personal and health care needs appeared to be being well met in the home. Residents and relatives spoken to expressed no concerns over the care provided. Staff reported that they referred to the GP or district nurse when health care concerns arose, and that district nurses regularly visited the home. Staff reported that two people had returned from hospital with pressure sores over the last few months, but that these had now cleared up. Where residents were at risk of developing pressure areas, care plans reflected preventative care (monitoring, creaming, use of pressure relief equipment, etc.). A designated senior carer was responsible for liaising with the continence advisor over continence needs. Files contained records of contact with health care professionals; during the inspection the home was being visited by the chiropodist, and was due a visit from the optician. Two health care professionals with contact with the home provided feedback on healthcare practices in the home: both were generally satisfied with the overall care provided in the home, had not received any recent complaints about the home, and felt that the home responded appropriately to changing healthcare needs of residents. One had spoken to other healthcare colleagues who had reported that they felt standards were rising in the home. However, both felt that some carers lacked knowledge of some healthcare issues: one person felt seniors were generally better informed, but that some carers were not aware of other healthcare services available (or how such services were accessed); the other person felt that staff escorting residents to appointments were not always well informed of the presenting problem or the past medical history, and that sometimes hospital appointments were not kept, or confused residents were not escorted, which was not a good use of consultants’ time. It is therefore recommended that the home review procedures for escorting confused residents, and for providing supporting information (whether written or verbal) when accompanying residents attending appointments. At the request of a relative, the manager was monitoring the blood sugar levels for a resident who suffered with diabetes. He was advised that this should only be done with the agreement of the GP or district nurse, and should be recorded as part of the care plan, including details of who is responsible for doing the testing and how to interpret and respond to the readings. It was noted that the readings were being recorded on the GP and district nurse contact record, and it was suggested that a separate record be implemented for these readings. Several staff had attended a training session on blood sugar monitoring last year, led by the area Community Liaison Nurse. The Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 Page 12 resident in question was happy with the support the manager was providing in testing their blood sugars, and also reported that the cook provided meals that were appropriate to their dietary needs. Nutrition records have been commented on in the section on meals. One resident who suffered with dementia was exhibiting some severe challenging behaviour at times (physical and verbal). From discussion with staff, strategies for dealing with this included several staff sometimes having to assist with personal care, and the resident spending time in their bedroom when their behaviour was too disruptive in communal areas. Although staff were clear that no restraint was involved, and that the resident was able to consent to spending time in their room, the home should ensure that this is clearly recorded in care plans, and that the resident is monitored frequently. The home’s medication administration policy covered the procedures for receiving, storing, administering and recording medication on behalf of residents. The home had secure storage arrangements for drugs (including for controlled drugs, and medication requiring refrigeration), and stocks were stored in an orderly manner. The home was advised to monitor the temperature of the medication room, to ensure it remains below 25°C. Most medication administration records (MAR) were pre-printed by the pharmacist; when new medication was received by the home, the quantity was recorded on the MAR, which was signed and dated by the person checking the drugs in. In some instances (e.g. for new residents, or where medication was changed), medication details were recorded by staff on the MAR: in two records viewed, hand written details of medications had not been signed and dated by the person making the record, nor had the quantity of medication received or carried over from the previous month been recorded. Of the seven daytime senior carers, training records showed that six had received medication training from the pharmacist in 2005 (no training record was available for the seventh person). A sample senior carer’s file viewed also showed a competency assessment signed off by the previous deputy manager, showing that the senior had been observed over a number of medication rounds. One senior carer spoken to was not fully aware of the purpose of all the medications that a resident was taking, and it was recommended that the home develop a medication profile for each resident showing the purpose and any side effects of each medication. This would enable staff to easily access this information if they have a query (e.g. if a resident refuses a dose). Residents spoken to were happy with the way staff supported their personal care. Staff were observed to respect privacy and dignity in the way they related and responded to residents, and to carry out personal care in private. Care records indicated the name that each person preferred to be called by. Residents and relatives felt that laundry systems were efficient and that their won clothes were generally reliably returned to them. It was noted that post was not opened on behalf of residents (unless assistance was required). Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides opportunity for residents to meet recreational, social and religious interests, but needs to ensure that all staff actively provide this. Contact with family, friends and the local community is encouraged and facilitated by the home, and residents are helped to maintain control over their lives. The home provides a good diet in pleasant surroundings, but needs to ensure that choice of food is actively offered to residents. EVIDENCE: The home has an activities co-ordinator, and from discussion with her and with residents during the inspection it was evident that a range of activities were regularly available. Examples included: card making, Easter bonnet competition, walking in the local park, outings, bi-weekly afternoon tea at the local community centre, games and quizzes, etc. The activities co-ordinator kept records of activities offered, and of who participated; these were not viewed on this occasion. On the inspection, residents were seen sitting outside enjoying the sunshine, and on one morning the home was visited by two local school girls who were painting residents’ nails. One resident said that they felt they were doing more now than when they were at home! Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 Page 14 As the activities co-ordinator alone could not provide sufficient stimulation for 48 residents, it was discussed whether care staff also initiated activities with residents. Senior carers spoken to felt that carers did spend time with residents interacting and providing stimulation, but on the afternoon of the first day of the inspection there did not appear to be carers present in lounge areas with residents, and staff time appeared to be primarily occupied carrying out personal care (e.g. bathing and toileting residents). Residents in lounges should not be left unsupervised for periods of time, and the manager should ensure that staff have sufficient time to spend interacting with residents, especially with those who are less able/willing to engage in organised activities (including those with more severe dementia). It was recommended that care staff record any activities they initiate with residents (e.g. in daily records). It was good to see that there were ‘Life History’ records present on several of the residents’ files viewed, and also that care plans included reference to support or encouragement needed with respect to social activities. Files also recorded residents’ religion, but there was not currently anyone in the home with any specific needs arising from ethnic background or religion. One person came from different religious background to the majority of other residents, but chose not to practice this; the manager was aware of issues relating to their religion, but had discussed this with the resident and was clear that the resident was choosing not to follow this. Residents confirmed that they could receive visitors at any time, and this was observed during the inspection and from visitors’ records. They could also receive visitors in private, in their own rooms. The ‘service user guide’ (reference Standard 1) contained information on visiting arrangements and on the involvement of relatives with residents (e.g. care plan reviews). As noted on previous inspections, the home has good contact with the local community, with residents attending a local community coffee morning each week, and monthly church services held within the home. Residents were able to handle their own financial affairs where able, and some were seen to initiate conversations with the manager about accessing money held on their behalf, and about paying fees. Residents were provided with lockable storage facilities in their rooms, to enable them to keep money safe. On previous inspections it had also been noted that they could have a key to their bedroom door. An advocate was involved with one resident, and supported the person to deal with their bills. Residents spoken to felt they had control over day-to-day choices such as how and where to spend their day, when to get up and go to bed, etc.; however, one said they sometimes felt pressure to get up or go to bed earlier than they liked, and staff should monitor this. Two residents had developed a special friendship: this was discussed with the manager with respect to how staff responded to this (as there did not appear to be a consistent approach), and it was recommended Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 Page 15 that this should be discussed further within the staff team (e.g. re issues relating to choice, relationships, privacy, etc.). Lunch and teatime meals were viewed on the first day of the inspection: both meals looked appetising, and residents spoken to felt that the food was generally good. The home operated a four weekly rotating menu, with just one choice of main meal at lunchtimes, but with a range of standard alternatives available (e.g. baked potato, omelette, etc.). These options were written on a board in the dining room, together with the day’s main choice and the instruction that residents’ should request any alternative at breakfast time. Two residents spoken to were aware of this system and of the choices available. However, although there was clearly a choice available, there still did not appear to be a system in the home for ensuring that all residents were actively offered a choice each day (e.g. those who did not come to the dining room for breakfast, those who could not see/read the board, those who lacked the cognitive ability or communication skills to initiate requests for choice, etc.). This has been highlighted on previous inspections, and needs to be addressed. The cook maintained a list of special dietary needs (e.g. diabetic, soft diet) and of any specific likes or dislikes. Nutrition records were being maintained as on previous inspections: although these had improved and now consistently recorded the date and the Menu Week Number (i.e. so that the records could be cross referenced to that day’s menu), the sample of records viewed still showed some gaps. Additionally, whilst nutrition records reflected some choices, these were not consistently maintained: for example, in a sample of records viewed where a resident was known not to like an item (e.g. fish) the record did not show that they had had an alternative. The manager was advised to review these records. Menus viewed generally showed a good range of balanced meals, although the cook and the manager stated that these were due to be reviewed, and it was noted that some of the range of meals might not be appropriate in hot weather. Residents spoken to were positive about the meals served to them. The cook felt that the ingredients obtained by the home were of satisfactory quality and quantity; dry food stocks were viewed, and appeared varied and sufficient for the needs of the home. The availability of evening snacks was not discussed on this visit. Jugs of cold drinks were seen in lounge areas. Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has an accessible complaints procedure, and complaints are listened to and responded to. The home had a POVA policy, but this was not readily available to staff in the home, and not all staff had received POVA training. EVIDENCE: The home has a clear complaints policy, which is displayed within the home. There is a procedure for recording any complaints received, and records viewed showed evidence of relevant concerns being recorded and investigated, and action being taken to address concerns. There were three complaints recorded since the last inspection. Relatives and residents spoken felt able to raise concerns with the manager. No complaints about the home had been received by the CSCI since the last inspection. No Protection of Vulnerable Adult (POVA) concerns had been raised over the last year. A copy of the home’s Adult Protection policy was requested from the manager at the inspection, and was subsequently provided: problems with accessing this from the home’s computer and providing the CSCI with a copy suggested that hard copies of this policy were not readily available in the home and accessible to staff. It was recommended at the last inspection that this policy be discussed with staff as part of their induction: the registered person should ensure that this policy (as with all policies) is available to staff. Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 Page 17 The Adult Protection policy contained reference to referring concerns about suspicion or evidence of abuse to the police and /or social services, but stated that concerns should only be reported to social services or the police with the service user’s consent, and that in the absence of consent the incident would be investigated internally. This was discussed with the manager at the last inspection and it was suggested that due to the potential risk to other residents, the home must refer all abuse allegations under the Essex Vulnerable Adults protection procedures, regardless of the resident’s consent. The policy did not include the need to also notify the CSCI of any allegations of abuse. There had been no change to the policy since the last inspection. A POVA workshop had been attended by five carers and two ancillary staff in February 2006. Of thirty care staff and nine ancillary staff, there was evidence that twelve carers and three ancillary staff had now attended POVA training; another six carers would also have covered POVA issues as part of their NVQ training. This still left a significant number of staff for whom there was no evidence that they had attended POVA training, and this should be addressed to ensure that all staff are aware of potential abuse issues and procedures. Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe, well-maintained environment, which on the day of the site visit was clean and hygienic. Residents have access to safe and comfortable indoor and outdoor communal facilities. Bedrooms viewed were clean and generally well-maintained, with suitable furniture and furnishings. EVIDENCE: The home continued to appear safe, clean and in a satisfactory state of decoration and repair. Records of decoration and refurbishment were not inspected on this occasion: monthly reports on the home sent into the CSCI by the registered provider over the course of the last year showed regular decoration of bedrooms taking place. The home has a maintenance person, and both he and the manager oversee the maintenance and safety of the premises. Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 Page 19 Communal lounges were homely, and it was good to see the first floor lounge now being used by residents. Some odour was noted in one ground floor lounge, and a housekeeper said that this would be cleaned. The home has a secure garden area, which was well maintained and laid out. During the course of the site visit, residents were seen to be sitting outside enjoying the sunshine, and it was good to see appropriate seating and protection from the sun being provided. Four bedrooms were viewed: these were similarly clean and tidy, with furniture and furnishings appropriate to the needs of residents, and well personalised. In two rooms it was noted that a handle on a chest of drawers was broken, and the manager was advised of this. One relative stated that a key factor in them choosing this home was the homeliness of the rooms. The home’s laundry is sited outside of the main building and away from areas where food is stored or prepared. Washing machines had the facility to carry out sluice and wash cycles suitable for infection control purposes when washing soiled linen, and the laundry person was aware of which cycles to use, and of the importance of wearing protective clothing when handling laundry. The home has separate sluice rooms on both floors of the home; these were not inspected on this occasion. Infection control policies and procedures were not reviewed on this inspection; protective clothing was seen to be available to care staff. Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home was aiming to meet agreed minimum staffing levels, but there were regular shifts when the staff team was one short. Evidence of recruitment practices were not suitably rigorous to protect residents. The home provided training in relevant topics to enable staff to be qualified and competent to do their jobs, but not all staff had completed all core training. EVIDENCE: The agreed staffing levels for the home were seven staff in the mornings, six in the afternoon/evenings, and four at night. Copies of rotas were obtained for April 2006: these showed that although the home was aiming to maintain agreed levels, over this four week period there were between three and eight daytime shifts each week where the home was a staff member short for all or part of a shift; on three occasions the rota showed only four staff on duty from 5pm. The registered person must ensure that all shifts are adequately covered. Staff spoken to stated that they felt current staffing levels met residents’ needs when fully staffed, but found it difficult when short staffed. It was also noted that senior carers were beginning to take on other responsibilities within the home (e.g. rotas, inductions, supervisions): whilst this was good to see, the registered person must ensure that they are given additional time to do these, so that they are not taken away from care duties whilst part of a shift (see also Management section). Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 Page 21 On the afternoon of the first day of the inspection, there was no visible staff presence in communal areas with residents: staff appeared to be occupied with care tasks over this time, and the registered person should therefore review whether staffing levels are adequate to provide sufficient supervision, especially with residents who suffer with dementia and may require higher levels of interaction or supervision. It was also noted that two of the six staff on duty that evening were pregnant, and therefore could not assist with heavy tasks: as over 25 of the residents required two carers to assist them with hoisting and/or personal care, to protect both staff and residents the manager should ensure a balance of staff abilities on each shift. Agency staff were regularly used within the home: evidence that the home had checked that the recruitment of these staff met regulatory requirements was not inspected on this occasion, but care staff were happy with the competence of the agency staff provided, and confirmed that the home was supplied with regular agency carers to promote continuity of care. Recruitment documentation was reviewed for three new staff. All three files contained application forms that included employment histories: in one case there was no employment recorded for the last two years, and whilst the applicant had recorded ‘career break’, the manager was advised to seek clearer information on how applicants have spent their time when there are gaps in employment histories. Application forms contained a declaration of criminal record: although all three were signed, in two cases the applicant had not completed the declaration. Two files both contained two references: in one instance the applicant had not given their most recent employer, and the manager was advised that this must be obtained where a person has been working in a care position. The third file only contained an unsigned personal reference, although the person had been in previous employment. Two files contained a CRB check, but the disclosure date was the same day that the carers started work, and therefore could not have been received by the home until after that date. The manager said that a POVAfirst check had been obtained to enable the carers to start work before the CRB was back, but there was no evidence of this check. The third file and a further file of a carer recruited last year both contained no evidence of either a CRB check or a POVAfirst check having been obtained. Further action therefore needs to be taken to address recruitment practices. There was no evidence of induction training on the four staff files inspected. However, the home had an induction workbook based on the Skills For Care induction standards, the manager was aware of the change to these standards, and a senior carer had recently taken on responsibility for carrying out inductions with new staff and confirmed that this was currently in process with the staff recruited this year and one person who started last year. The need to evidence completion of this was discussed, and the manager needs to ensure that inductions are completed within an appropriate timespan. Several staff had also attended a one day induction course: this was discussed with the Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 Page 22 manager, and it was noted that this provided useful additional input for new staff, but should not take the place of the Skills for Care Induction process within the home. The manager stated that nine staff had completed NVQ level 2 in care, and a further three staff were in the process of doing this. The home currently employs thirty carers, and this would therefore not currently meet the requirement for at least 50 of the staff team to be qualified to NVQ level 2. Six staff (including some of those who already have NVQ level 2) were due to start NVQ level 3 in June 2006, which is to be commended. The home continued to provide a good range of ongoing training for staff, with courses in the last year including: moving and handling (7 staff), food hygiene (8), fire safety (13), POVA (7), diabetes (8), safe handling of medicines (8), and understanding dementia (20). However, there was no evidence of dementia care training recorded for fourteen of the current care staff, and according to training records not all staff had attended current training in core health and safety topics (e.g. moving and handling, fire safety, food hygiene, etc.): this should be addressed. Individual training records were maintained, but the manager did not have a formal system for monitoring levels of staff training and when updates were due (e.g. a training planner or database to provide an overview of training completed); it was recommended that this be implemented. Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager has appropriate experience to manage the home, but had not yet obtained the relevant qualifications; workload pressures were preventing him from fully fulfilling his management role. Quality assurance systems were not sufficient to demonstrate that the home is run in residents’ best interests. Systems for managing residents’ monies safeguarded their interests. Supervision practices were not currently satisfactory. Health and safety practices and procedures protected staff and residents, but there was insufficient evidence of staff training in health and safety topics. EVIDENCE: The registered manager has several years experience in this role within the home. Although he had evidence of regular attendance at appropriate Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 Page 24 training, he had still not enrolled on the NVQ level 4 in care and in management. This had been highlighted on previous inspections, and a requirement has now been made to progress arrangements for the manager to achieve this. The home does not currently have a deputy manager in post and it was noted that this was creating an additional pressure on the manager’s time. The length of this inspection was partly due to the high level of interruptions caused by the manager having to respond to day-to-day issues (e.g. answering the telephone or front door, responding to queries from residents or visitors, etc.). The manager’s workload should therefore be reviewed, to ensure that he can satisfactorily fulfil management responsibilities. Some management tasks were being delegated to senior carers (e.g. rotas, staff supervisions, inductions, etc.): the manager was advised that seniors should be given additional time for these tasks, and should not carry out these tasks whilst part of a care shift. Senior staff spoken to were happy to take on the additional tasks, but wanted reassurance that someone (manager or deputy) would oversee these responsibilities. There was a lack of systems in place to monitor certain management practices within the home (e.g. recruitment documentation, overview of training, supervisions completed, etc.), and the manager needs to find time to implement systems for this and to develop other processes (e.g. quality assurance). Discussion with the registered provider subsequent to the site visit confirmed that a new deputy manager would be appointed, but the extent of their role had yet to be determined. Quality assurance processes in the home were discussed with the manager. Since the last inspection, an independent advocate had carried out a survey of residents’ views, with twelve questionnaires completed. This is commended, although it was noted that the questionnaire produced for relatives had been used with resident: although this covered appropriate issues, the wording should be changed to relate to residents. The feedback had not yet been evaluated and written up in a review of care report to submit to the CSCI and make available to residents, as required on previous inspections. Feedback had also been sought from relatives and GPs, and although the manager reported a poor response to this, it was good that their views had been sought. The manager had purchased a Quality Assurance computer package: this included a range of sample forms for standardising documentation, and also forms for monitoring practices within the home. The manager had not had time to explore the content of this, but hoped to use this to implement quality assurance processes within the home. The home still did not have an annual development plan, or formal systems for monitoring care issues (e.g. auditing accident records, or medication records, etc). However, the registered provider carries out regular visits to the home and submits reports to the CSCI as required under Regulation 26. Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 Page 25 The home does not act as agent or appointee for any residents, but will hold small amounts of money for safe keeping on their behalf. Cash was not inspected on this occasion, but the home was seen to maintain clear records of money held, with records and receipts for any expenditure. In a sample checked, records and receipts balanced. The manager confirmed that the home does not hold valuables on residents’ behalf, unless for short periods until they can be passed to a relative. Staff supervision records were viewed for a sample of eight staff who had been employed for at least six months. Although all had evidence of at least one supervision session in the last year, none met the frequency of six supervisions per year detailed in the Standards, and five of the staff had only one supervision recorded in the last year. The manager stated that three of the senior staff would be taking over staff supervision: it was noted that one senior had attended a workshop in supervisory management last year, and that a senior had already begun supervising the domestic staff. However, the supervision of care staff by the seniors had not yet begun, and the manager needs to ensure that care staff supervision is ongoing. The service had submitted a pre-inspection questionnaire within three months of this inspection, and information provided in this document indicated that the relevant servicing of equipment and facilities was kept updated within the home. Not all health and safety documentation was inspected on this visit, but examples of records checked included: regular internal checks on hot tap water temperatures, central hot water temperatures, fire alarms and electrical appliance testing; and external servicing of electrical installation, hoists, passenger lift, and fire alarms. These records indicated that the home had systems in place to promote the health and safety of staff and residents. The home had a health and safety policy statement that detailed employer and employee responsibilities, and had risk assessments on safe working practices (reviewed within the last year). Accident records were viewed and were being well maintained: it was recommended that the manager implement systems for regularly auditing and evaluating these records, as a means of reviewing the type and incidence of falls within the home. Staff training records seen showed that just over two thirds of care staff had attended moving and handling and fire safety training within the last three years; there was no recent evidence of this training for the remaining care staff, although the home does provide twice yearly fire safety training sessions; the manager attended a manual handling trainer’s course last year. From training records seen, only a few staff appeared to have attended food hygiene and first aid training; however, the manager stated that eight staff had attended food hygiene training in April 2006 (not yet evidenced on files). It was noted that some staff had attended other relevant health and safety training over the last two years (e.g. COSHH, infection control, risk assessments). The manager should review staff training records, and ensure that all staff have attended essential health and safety training. Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 3 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 2 3 3 X X X 3 X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 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 OP1 Regulation 4, schedule 1 Requirement The registered person must ensure that the statement of purpose covers all the issues required by Regulation. This relates to the ‘qualifications and experience of the registered provider and manager’. The registered person must ensure that a copy of the Service User Guide is given to each new service user. Every resident must have a written care plan, which should be developed and implemented as soon as possible after admission. The registered person must ensure that medication records are satisfactorily maintained. This is with respect to: 1. Staff signing and dating all handwritten medication administration details or changes; 2. Staff recording all medication received by the home, or carried over from a previous month. Timescale for action 30/06/06 2 OP1 5(2) 14/06/06 3 OP7 15 30/06/06 4 OP9 13 and 17 14/06/06 Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 Page 28 5 OP18 13 and 18 It is required that the registered 31/08/06 person ensure that all staff (including domestic staff) receive appropriate training in abuse awareness and in the home’s procedures for responding to suspicion of abuse. This is a repeat requirement (last timescale 31/3/06) The registered person must 14/06/06 maintain staffing levels that meet residents’ needs. In particular, the registered person must: 1. Ensure minimum agreed staffing levels are maintained, and there are arrangements in place to cover staff absences; 2. Ensure that senior staff are not required to carry out management tasks whilst part of a care shift; 3. Ensure staffing levels allow staff sufficient time to meet residents’ physical, social and mental health needs. The registered person must ensure that all information required by regulation is obtained for new staff before they start work, including: 1. A full employment history, including written explanation of any gaps; 2. A completed declaration of criminal record; 3. A CRB and POVA check (or, in exceptional circumstances, a POVAFirst check and evidence of the supervision of the person); 4. Two written references, including the last care employer. This is a repeat requirement (last timescale 30/11/05). 6 OP27 18 7 OP29 19, schedule 2 14/06/06 Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 Page 29 8 OP30 13 and 18 9 OP31 9 and 10 10 OP31 9 and 10 11 OP33 24 The registered person must ensure that all staff are appropriately trained and competent to do their jobs. This relates to evidence that staff have completed appropriate training in all core subjects (including dementia care, and health and safety training) It is required that the registered manager progress plans to achieve required qualifications without further delay. The registered provider must ensure that the registered manager has sufficient time to fulfil the required management responsibilities within the home. The registered person must establish a system for regularly reviewing the quality of care provided in the home. This should include the processes detailed in standard 33, and must include systems for seeking residents’ views. A report must be submitted to the CSCI regarding any review of the quality of care carried out in the home. 30/11/06 30/06/07 30/06/06 31/08/06 12 OP36 18 This is a repeat requirement (last timescale 31.3.06) The registered person must 30/06/06 ensure that there are appropriate supervision processes in the home, and that these are consistently maintained. Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP3 OP8 Good Practice Recommendations The registered manager should monitor pre-admission assessments to ensure that a prospective resident’s needs do not fall outside of the home’s conditions of registration. Action required by manager or staff to monitor an individual’s diabetes should be carried out under the guidance of the GP or district nurse, and be clearly detailed in the individual’s care plans. The manager should ensure that nutrition records reflect what each person has eaten, including alternative meals chosen. 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 possible side effects. It is recommended that the temperature of the medication cupboard be monitored to ensure it remains below 25°C. The home should implement practices/routines to ensure that a choice of main meal is actively offered to each resident each day. It is recommended that the home’s POVA policy be amended to reflect that all abuse concerns or allegations must be referred to social services, and that the CSCI should be notified. The registered person should keep staffing levels under ongoing review, to ensure that they satisfactorily meet the changing care needs within the home. The registered person should ensure that staff training plans include ensuring that at least 50 of care staff have completed NVQ level 2 or above. It is recommended that the registered manager implement recording systems to enable him to easily evaluate and monitor levels of staff training, and when updates are due. Systems for evidencing induction training should be implemented within the home. Staff should receive a minimum of six supervisions per year. It is recommended that the registered manager implement recording systems to monitor the frequency of staff supervisions taking place. 3 4 5 6 7 OP8 OP9 OP9 OP15 OP18 8 9 10 11 12 OP27 OP28 OP30 OP30 OP36 Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Valentine House DS0000017989.V293634.R01.S.doc Version 5.1 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!