Inspection on 24/07/06 for Valerie`s Rest Home

This inspection was carried out on 24th July 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Valerie`s Rest Home 14/08/08

Valerie`s Rest Home 27/09/05

Valerie`s Rest Home 20/04/05

Valerie`s Rest Home 07/10/04

Similar services:

St Vincents

Hamilton House

The Cotswold Home

Newbeech House

Winton House

Little Haven Nursing & Residential Home

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

CARE HOMES FOR OLDER PEOPLE Valerie`s Rest Home 20 Ravenswood Avenue Crowthorne Berkshire RG11 6AY Lead Inspector Stephen Webb Unannounced Inspection 24th July 2006 10:45 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 DS0000060562.V294899.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. DS0000060562.V294899.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Valerie`s Rest Home Address 20 Ravenswood Avenue Crowthorne Berkshire RG11 6AY 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) 01344 761701 S E S Care Homes Ltd Mrs Annette Chuter Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places DS0000060562.V294899.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th September 2005 Brief Description of the Service: Valerie’s Care Home is a large detached Victorian house set within a private residential road within the village of Crowthorne, and is within 5 minutes walk from local shops, post office, railway station and bus stop. The home has thirteen single bedrooms (five have en-suite) and two double bedrooms. The rooms are arranged over two floors, and a passenger lift is available. The building is not suitable for service users who are wheelchair dependant due to some premises restriction. There is a large Victorian-style conservatory that leads from the main dining area and is used as a lounge. The home has an attractive rear garden with plenty of natural shade afforded by mature trees, and seating is provided. At the time of this inspection the fees were between £451-£500 per week. DS0000060562.V294899.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced site visit from 10.45am until 7.45pm on 24th of July 2006. The inspection also included reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversations with service users, relatives, management and staff at the unit, and from eleven returned service user questionnaires, some of which were completed by residents with the support of a social work student on placement at the home. The inspector also toured the premises and had lunch with service users. What the service does well: The service provides appropriate information to prospective residents and their families to enable them to decide whether it offers what they are seeking, and has an appropriate assessment process. The emotional health assessment is a particularly useful element of the system. The care plans are detailed and include evidence of the choices and preferences of residents. Healthcare needs are met effectively and the home has an effective medication management system, for which staff have received training. The home has sought appropriate specialist support in caring for residents with impaired hearing and sight. The home effectively promotes the privacy and dignity of residents for the most part. Residents are enabled to make choices in their day-to-day lives. The home provides an appropriate schedule of activities and seasonal events, which residents can opt to take part in. Complaints are addressed effectively and residents are made aware of the procedure for making known any concerns they have. Systems are in place to protect the residents from abuse and all staff receive training in the prevention of abuse. Recruitment checks are carried out rigorously. The home provides an attractive, secure and well-maintained garden, which is afforded areas of natural shade by mature trees. Seating and sun umbrellas are also available to encourage use by residents. DS0000060562.V294899.R01.S.doc Version 5.1 Page 6 The resident’s bedrooms are personalised and meet the needs of the current fairly able resident group effectively, for the most part. The laundry facilities are appropriate and residents report that laundry is managed effectively. The home employs a handyman who carries out day-to-day repairs and redecoration as well as maintaining the garden. The dining room is attractively decorated and homely and the tables are dressed with cloths and provided with cruets etc. providing a pleasant environment for mealtimes. The staffing levels are sufficient to meet the needs of the current, relatively able group of residents, and feedback from residents was complimentary about the care provided. The manager has sourced training and NVQ support from a range of external sources and staff receive a good range of training. The manager attends some training alongside her staff, in order to remain up-to-date in key areas. The unit is effectively managed and there are clear procedures and systems in place to ensure its smooth operation. The manager has begun to develop effective quality assurance systems to consult with residents. The manager introduced a degree of independence by utilising a student on placement at the home, to support service user in completing the CSCI resident questionnaires for the inspection, rather than staff or management taking this role. What has improved since the last inspection? The quality of the meals provided to residents has improved with the appointment of a new chef, and her provision of new menus in consultation with the residents. Choice is now available at each meal. The chef has improved food hygiene, storage and management practice and uses mainly fresh ingredients. Appropriate records are maintained. Work to improve the environment has been ongoing, since the new proprietor took over, and significant improvements have taken place. There is a rolling programme under way for the replacement of carpets in bedrooms. The manager has successfully recruited permanent staff, and only one vacant post remains. There are plans to recruit a deputy manager to complete the management team. Skills To Care have undertaken a training-needs analysis and produced individual staff development plans, which are a positive tool for planning future training needs in the unit. The manager is ensuring that core training needs DS0000060562.V294899.R01.S.doc Version 5.1 Page 7 will be met form all staff. Key training is being sourced from appropriately qualified external accredited trainers. The manager has introduced more frequent residents meetings to maintain regular consultation with them. Residents have been provided with lockable boxes within bedrooms in which they may secure personal items. What they could do better: A care plan should also be in place for the service user who is largely selfcaring, to identify her preferences around staff input and any areas where this may become necessary. The identified medication recording errors should be addressed and a monitoring system instigated to ensure any omissions are promptly addressed. Consideration should be given to phasing out the potential shared use of the two double bedrooms as this conflicts with the proper provision of privacy and dignity, and one of these in particular, is significantly undersized. Two of the single bedrooms are also significantly undersized, and consideration should be given to their combination, to provide one good-sized single with en suite facilities. A number of the remaining bedroom carpets are worn and may be contributing to unpleasant odours in some areas. These will need to be appropriately prioritised for replacement within the rolling programme. Some of the carpets in communal areas are also worn and would benefit from replacement as part of the rolling programme of improvements, and the first floor hallways would also benefit from redecoration. The current lounge/conservatory is extremely hot on sunny days and the proprietor must make arrangements to maintain an appropriate and safe temperature here, to enable its continual safe use by residents. The kitchen requires refurbishment and the defective cooker must be repaired as a priority. The decommissioned appliances should be removed from the storeroom to enable effective cleaning of the area. There is room for further development of the quality assurance system to include wider consultation with other relevant parties, and the proprietor must ensure that copies of Regulation 26 monitoring visit reports are provided to the manager for filing in the unit. The manager or proprietor should produce an annual development plan for the unit. The manager must ensure that identified health and safety related service certification is available to evidence that appropriate service and maintenance regimes are in place. DS0000060562.V294899.R01.S.doc Version 5.1 Page 8 The manager must establish a collective accident record in addition to the individualised records on resident’s files. 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. DS0000060562.V294899.R01.S.doc Version 5.1 Page 9 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 DS0000060562.V294899.R01.S.doc Version 5.1 Page 10 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, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides sufficient information to prospective residents to enable them to make an informed choice. Detailed assessment information is obtained prior to admission in order to ensure the needs of the individual can be met. The home is not specifically set up to provide an intermediate care service. EVIDENCE: According to feedback from residents, the home provides satisfactory information prior to admission, and encourages visits by prospective residents or their next of kin. All of the eleven respondents to the resident’s questionnaire confirmed they had received relevant information and a contract, and several specifically confirmed that they or their relatives had visited. A copy of the previous inspection report was available on the table next to the visitor’s book, which is good practice. DS0000060562.V294899.R01.S.doc Version 5.1 Page 11 The home has an appropriate assessment format for prospective residents, which is used in addition to whatever hospital or social work assessments are provided. The tool comprises various formats including intellectual ability, selfcare, physical health, medication, biographical details and lifestyle choices and preferences. The format includes an assessment tool for emotional wellbeing, which is a good document to identify a risk of depression or other emotional concerns. There is also an individual personal profile, which identifies spiritual needs, dietary needs and preferences, preferred activities, social network and other relevant issues. In one of the case tracked files examined, the majority of the assessment papers were absent, possibly being worked on by the keyworker, but these papers were present in the other files examined. The manager was clear that the home cannot admit residents with a diagnosis of dementia related conditions, though it has a good record of continuing care for individuals who subsequently develop various conditions or become increasingly frail. Although the home is not specifically set up to provide an intermediate care service they have one resident who is hoping to move on to warden supported living in the near future, following support from the home to regain her strength following a prolonged illness. DS0000060562.V294899.R01.S.doc Version 5.1 Page 12 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, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of residents are recorded within individual care plans, which have been constructed in consultation with residents and, where necessary, next of kin. One largely self-caring resident also needs a suitable care plan. The home meets the current health needs of service users effectively, and has good links with relevant local medical agencies. Medication systems are appropriate and the staff receive a detailed training on medication management. However, the identified recording errors should be addressed with the individuals concerned, and it is suggested that a system of monitoring is introduced to ensure any omissions are picked up promptly. The privacy and dignity of service users is managed effectively for most service users. Where there are shared rooms, curtaining is provided to enable some degree of privacy. In the longer term consideration should be given to phasing out shared bedrooms except where individuals specifically request to share. (Recommendation made under Standard 23). DS0000060562.V294899.R01.S.doc Version 5.1 Page 13 EVIDENCE: The home’s assessment documents lead to a care plan focused on areas of identified need for support. Records also include pressure area and other risk assessments. In one case where the resident is largely self-caring, no care plan format had been completed. This should be done identifying where any support is needed, and covering other issues supporting the aims of the placement, entering “not applicable” where necessary, as a care plan must be in place for every resident. There is good evidence of choice and individual preferences within care planning and profile documents. None of the current residents have any particularly complex needs at present, and all are able to verbalise their needs and wishes to staff. One resident confirmed they had been consulted about their care plan and individual likes and dislikes. Reviews of the care plan were evident on some of the files, and in one case a copy was due to be received from the funding Authority. Although there are formats for healthcare records, within the files, the manager reported that generally the current residents had few healthcare needs at present, and routine healthcare appointments were recorded within the individual clinical notes, within the daily contact sheets file. None of the current residents requires a special diet though the manager reported that dietician advice had been sought in the past when necessary. In the case of one resident who is experiencing hearing loss, staff are signing things to her on her hand in order to anticipate her future needs for alternative means of communication. The RNIB were consulted in the case of two residents with failing sight, and assisted with care planning. Should residents’ healthcare needs become more complex, consideration should be given to the use of individualised healthcare records for each external healthcare professional, to enable ready access to track how health and welfare needs are met. The home uses local optician, chiropodist, dentist etc. though a few retain their own previous dentist where able. Visits are regular. The home has a positive relationship with a local GP practice and district nurses and obtains specialist pressure relief equipment as required via the district nurses. DS0000060562.V294899.R01.S.doc Version 5.1 Page 14 Details of medical appointments are passed on to staff via the handover book. Individual notes are maintained on residents via the contact sheets Medication is administered by trained staff only. Most staff have completed a ten-week modular course on safe handling of medication run by a local college, and the last two staff were undertaking this course at the point of inspection. Inspection of the medication administration sheets indicated that an effective audit trail was in place with medication counted in and recorded on the MAR sheets. There are separate returns records. Records for controlled drugs were also in place. However there were a few gaps in administration records and staff need to be reminded of the importance of accurate medication records. It is suggested that a system of monitoring be introduced to ensure that any medication errors are addressed promptly. The support and care provided by staff respects the privacy and dignity of residents and is carried out behind closed doors. Where possible residents are supported to manage their own personal care. For example a resident might be assisted into a bath and allowed to bathe in private, subject to risk assessment, with a staff member available outside the bathroom. Of the eleven respondents to the resident’s questionnaire, nine felt they always received the care and support they needed, and two felt this was usually the case. The staff were observed to knock on bedroom doors before entering, where they though the resident might be within. There remain two double bedrooms in the home, one of which is beneath the size given within the National Minimum Standards for a shared bedroom, though only one is currently being shared. Curtaining is provided to maximise privacy and dignity in these rooms. In the long term, consideration should be given to phasing out sharing unless specifically requested by two individuals, in order to optimise the privacy and dignity of residents. Each of the bedrooms is provided with a lockable box for the safe-keeping of small items. DS0000060562.V294899.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have the opportunity to access an appropriate range of activities, within and outside the unit, though some decline to take part. Contact with family and other visitors is encouraged and they are made welcome. Residents are able to make choices in their day-to-day lives and have opportunities to air their views through residents meetings. The quality of food provided to residents has improved and they have more choice than was previously available. Residents are now being consulted about the menus. EVIDENCE: There is a schedule of activities provided by care staff daily in the afternoons, including bingo, quizzes, puzzles, nail care and hand massage, painting /craft and keep fit. The home has a series of seasonal events through the year to which relatives are also invited. It was felt that there had been a reduction in available options DS0000060562.V294899.R01.S.doc Version 5.1 Page 16 for outings more recently, but the manager reported that a schedule of trips is made available via “Keep Mobile”, but are usually declined. It may be that the available outings should be discussed at the next residents meeting to ensure everyone is clear what is available and can comment on the options provided. A few residents had gone out to parks, the supermarket and garden centres, but these did not appear to be regular events. Three of the residents attend a local day centre The residents spoken with were all positive about the activities provided, whilst acknowledging that they did not always wish to take part. One resident who remains very able, walks around the gardens several times a day to keep herself fit and mobile. The activities provided are recorded within the daily diary. Of the eleven respondents to the residents’ questionnaire, three said there were always activities they could take part in and seven that this was usually the case. Some residents receive regular visits from family, and the relatives spoken to during the inspection were positive about the care and service in general. The existing residents are all currently able to voice their wishes and make day-to-day choices verbally. They can do so to care staff, the manager or during the residents meetings, which are being increased in frequency. Residents now have improved opportunities for choice at mealtimes. Residents were aware of the recent improvements in the menus, and the increase in home cooked meals and cakes. The chef is also using mostly fresh ingredients, and has also made improvements to teas and suppers to make them more substantial. The chef has improved the temperature records for fridges and freezers and takes regular temperatures of meals. Records are maintained of the meals provided and a new four weekly menu has been devised in consultation with residents, including choices where the main meal is not wanted. Ten of the eleven respondents to the residents’ questionnaire stated that they either always (7), or usually (3) liked the meals. One felt this was the case only sometimes. The dining room is a very pleasant and homely environment and the mealtime was relaxed, with some conversation between residents. DS0000060562.V294899.R01.S.doc Version 5.1 Page 17 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, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are aware of the procedure for raising complaints, and the evidence indicates that complaints are addressed appropriately. Residents are protected from abuse by the home’s recruitment procedures and all staff receive training in the protection of vulnerable adults. EVIDENCE: The home has an appropriate complaints procedure. There was a fairly new comments and complaints log, which indicated five complaints and four positive comments about the service. The log indicated that all of the complaints had been addressed appropriately. A copy of the complaints procedure is posted on the notice board in large print. The service users spoken to were happy with the care they received, and had no complaints. The responses to the resident’s questionnaire indicated that residents knew who to complain to and how to do so, if they were not happy. The manager confirmed that no POVA (Protection Of Vulnerable Adults), issues had arisen since the last inspection. DS0000060562.V294899.R01.S.doc Version 5.1 Page 18 Staff confirmed they had received POVA training, and the manager said they receive this as part of their induction and also attend the POVA course run by the local authority. The home’s recruitment practice is appropriately rigorous to help protect residents from harm. DS0000060562.V294899.R01.S.doc Version 5.1 Page 19 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, 23, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment provided for service users is improving but remains unsatisfactory in a number of areas as identified below. Ongoing refurbishment will be required in the areas identified to bring them up to standard and address the issues detailed below, some of which relate to health and safety. The garden is an asset to the home, providing a secure area with natural shade and a variety of facilities to enable service users to utilise the space. The bedrooms are personalised and for the most part suit the needs of the current, relatively able resident group. However the re-designation of at least one of the shared rooms as a single, and the possible combination of two undersized single rooms into one good-sized single, would improve the space provision to residents in these areas, and should be considered in the future. Bedroom carpets are being replaced on a rolling programme, which may help to address the odour evident in some bedrooms. DS0000060562.V294899.R01.S.doc Version 5.1 Page 20 The home was found to be clean and the laundry facilities were appropriate and reported to be well managed by residents. EVIDENCE: The home was taken over by a new provider last year and work has begun to bring the physical environment more in line with the national minimum standards. The exterior of the building is attractive and well maintained. Some areas have been redecorated and some carpets replaced, but there remain areas in need of work. The hallways, particularly on the first floor would benefit from redecoration. As already noted, two of the bedrooms are currently double rooms, though only one of these was shared at the time of inspection. One of these two bedrooms is significantly undersized. Conversion of this room to single occupancy would improve privacy and dignity and the level of space available. Both of these double rooms are equipped with dividing curtaining to provide some privacy and dignity. Two of the single bedrooms are also significantly undersized and their combination into one good-sized single, perhaps with an en suite, would further improve the physical facilities in the home. Five of the fourteen single bedrooms had en suite toilets provided. Six of the bedrooms had been re-carpeted since the previous inspection and others were due to be done on a rolling programme. All of the rooms are provided with a lockable box in which residents can secure medication or personal items. The bedrooms were personalised with some of the occupants’ personal items and furniture. Works required by a previous fire safety deficiency notice from the fire officer, had since been fully addressed. Some of the hallway and communal area carpets were in a worn condition and should be considered, along with remaining bedroom carpets, for early replacement as part of the home’s rolling maintenance programme. The home employs a handyman who carries out much of the routine day-today maintenance as well as attending to minor repairs requested by residents, and he was observed engaging in conversation with residents, and responding to their wishes with regard to opening the ventilation in the conservatory. DS0000060562.V294899.R01.S.doc Version 5.1 Page 21 The home’s lounge comprises a conservatory extension, which was very hot on the day of inspection, despite the presence of roof vents and ceiling fans, and having the external door open. The residents confirmed that the manager had been asking them not to remain in there during the afternoons during the heat-wave. Some went to shaded areas of the garden while others went to the dining room or their rooms. The staff were observed offering frequent cold drinks to residents throughout the day, to mitigate the effects of the heat. The provider must make appropriate arrangements to maintain a suitable temperature in the conservatory/lounge, so that this facility is safe and comfortable to use throughout the day. As already noted, the dining room is a very pleasant and homely facility, which is satisfactorily furnished and attractively decorated. The kitchen requires additional refurbishment to bring it up to a satisfactory standard. The worktops had been replaced recently, however the cupboards are beginning to deteriorate and will also need replacement in the near future, as the doors and carcases are beginning to swell which will make it impossible to maintain appropriate standards of hygiene. The cooker was defective in not having a heat guard above the oven. This causes the controls to become hot, and they had become scorched as a result, rendering them unreadable. One of the cooker legs was also not upright and the oven door seal was ill fitting and causing the oven door not to shut fully. This is a health and safety issue, which must be addressed as a priority. It is also suggested that a new dishwasher is provided to free up staff to spend time on their primary tasks with residents, rather than on washing up. The kitchen sink mixer tap was leaking and wobbly, and appeared to be beyond repair. The manager reported that a replacement was on order and would be fitted by the handyman. The new cook had taken some of the older, rusty fridges and freezers out of commission and was monitoring the temperatures of the remaining appliances as required. The decommissioned appliances should be removed from the storeroom to enable more efficient cleaning of the area. Although there is level access throughout the ground floor, the home is unsuitable for residents who need to use a wheelchair owing to the layout of corridors and raised thresholds in some areas, though these have been smoothed with ramps in some cases. DS0000060562.V294899.R01.S.doc Version 5.1 Page 22 There are ramps down to the garden, one of which appeared rather steep, although a handrail was provided. The proprietor subsequently clarified that the ramp complies with building regulations. The home provides an attractive enclosed garden, which was mostly laid to lawn, with some patio and paved areas and borders. The garden is well maintained by the handyman. One resident said that she enjoyed walking around the garden for her daily exercise. The garden affords a lot of natural shade provided by the surrounding mature trees, and garden furniture, swing seats and parasols are available to enable safe use by residents throughout the day. The home was clean and hygienic in most areas, but there was some evidence of unpleasant odours during the mid morning in some bedrooms, which may relate to the need for the additional carpet replacements noted above. The laundry facilities were satisfactory and the laundry service was commended by some of the service users. DS0000060562.V294899.R01.S.doc Version 5.1 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ current needs are met effectively the staff team, who all undertake regular training in aspects of their role. Residents are protected by the rigorous recruitment procedure operated by the manager. EVIDENCE: Service users were complimentary about the care provided by the staff. One commented that “you can’t fault them” and a relative said the staff were caring and aware of the residents as individuals and monitored their wellbeing. The observed relationship between staff and residents was one of warmth and familiarity, and there were examples of humour from staff and residents. The care staff were observed to prioritise the needs of residents appropriately and though they were busy, most made time to chat to individuals in the course of their work. All of the respondents said that the staff were, either always or usually available when they needed them, listened to them and met their care needs. The usual staffing for the unit is two care staff plus the manager on the morning and afternoon/evening shifts, and two staff overnight, one of whom is on waking duty, the other sleeping in. This appears to meet the needs of the DS0000060562.V294899.R01.S.doc Version 5.1 Page 24 current service user group, but will need to be kept under review as their needs change. The manager plans to recruit a deputy to complete the senior team, with herself and the three senior carers, and will then be able to delegate some responsibilities to the members of the management team. There is currently only one care staff vacancy, which is due to be advertised. Skills To Care have undertaken individual training needs analyses and produced personal development plans for each staff member. The staff team have received a broad range of training in the last two years, and some subsidised local authority training has also been accessed. Most of the staff have received dementia training and the remaining ones are due to do so. All of the team are going to receive the one-day first aid training in August. Staff have also received training in pressure area care, and all staff receive POVA training as part of induction and attend the local authority POVA training in addition. Staff confirmed that they had access to regular training. The manager attends key training alongside staff to ensure she remains up to date in her knowledge. Staff are encouraged to attend English courses (provided by Skills To Care), if English is not their first language, to ensure they can communicate effectively with residents. The unit accesses NVQ training through PACT and the manager reported that around 75 of staff had completed their NVQ level 2 or 3. One staff member was due to commence on level 3, and one experienced staff member is going to do the new ten week NVQ for experienced staff. Remaining staff will commence their NVQ as soon as practicable. The manager operates an appropriately rigorous recruitment procedure, including open local advertising and undertakes consistent interviews against a written job specification and prepared questions, and keeps records of interviews via an interview checklist, which is good practice. Applicants complete an application form, which includes the required employment history and declaration regarding criminal convictions. Two written references are taken up, including one from the previous employer, and these are telephone verified by the manager. She also retains copies of ID evidence, documents relating to work permits and of the CRB, for inspection. Staff do not start unaccompanied work with residents until their CRB is returned satisfactory. Their TOPSS(Skills For Care)-based induction is now recorded and signed off within a written record. All staff receive a contract. DS0000060562.V294899.R01.S.doc Version 5.1 Page 25 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, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed effectively by the manager to meet the needs of the resident group. Residents have been consulted about their views on the care provided, and there is evidence of changes having been made in response to their views. There is room for further development of quality assurance systems and Regulation 26 monitoring visit reports must be provided to the manager. It is the manager’s policy not to have any direct management responsibility for residents’ funds, but lockable boxes are provided in residents’ bedrooms. The health, safety and welfare of residents are promoted by the home, though one or two aspects of health and safety related servicing and certification, need to be addressed. A collective accident record is also required. DS0000060562.V294899.R01.S.doc Version 5.1 Page 26 EVIDENCE: The manager is experienced and qualified to run the home. She has completed her Registered Manager’s Award, and the assessor units, and almost completed Level 4 in management. She undertakes key training alongside her staff to maintain knowledge of current practice. In conversation the manager demonstrates a clear understanding of her role and responsibilities. The manager has carried out a quality assurance survey in September 2005, and is preparing to repeat this exercise. The last cycle included questionnaires to residents and relatives, and the summary report was made available to participants, and was very positive. For the next quality assurance cycle, the questionnaires should be provided to social workers and relevant external professionals, as well as residents and their relatives, in line with Standard 33, to ensure a cross section of views of the home are obtained from a range of sources. The CSCI residents‘ questionnaires for this inspection were completed by residents, with the support of a social work student on placement at the home, which is good practice, as it maintains an element of independence. The manager is increasing the frequency of residents meetings to every two or three months to ensure they have an ongoing voice. These meetings are minuted. The minutes of the April and July meetings were examined, and included discussion of meals activities, outings and the heat-wave. Residents confirmed in conversation, that they were asked their views during these meetings. It was evident that changes had been made in response to resident feedback. The provider undertakes monthly Regulation 26 visits on a regular basis, but not all reports were available in the home as required. The provider must ensure that copies of all Regulation 26 visit reports are provided to the manager and filed in the unit available for inspection. There was a previous business plan for the service for the period 2004-5, but there is a need to produce an annual development plan for the unit, addressing relevant areas for priority attention over the next year, with reference to any priorities identified herein and from quality assurance surveys and other sources such as Regulation 26 reports and complaints records. The home takes no part in the management of residents’ monies, beyond providing lockable boxes within each room for residents to use if they wish. DS0000060562.V294899.R01.S.doc Version 5.1 Page 27 A sample of health and safety related service certification was examined and most were up to date. However, the annual PAT testing of the portable electrical appliances was overdue and must be arranged as a priority. The annual gas safety certificate could not be located, though the manager thought this service had taken place. The manager must confirm the details of when this safety check was carried out. Accidents were few, with the current residents being a relatively able group, and records were in place on individual case files, where they had occurred, but there was no collective accident record for monitoring by management and inspectors. The manager must establish a collective record for accident monitoring, which can be done by copying completed accident forms and filing one copy within a collective file, in addition to the copy for the resident’s individual file. DS0000060562.V294899.R01.S.doc Version 5.1 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X 2 X X 2 STAFFING Standard No Score 27 3 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 DS0000060562.V294899.R01.S.doc Version 5.1 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement The manager must ensure that residents’ medication is always given in accordance with the prescription. The provider must make appropriate arrangements to maintain a suitable temperature in the conservatory/lounge, so that this facility is safe and comfortable for residents to use throughout the day. The provider must ensure that the kitchen storage cupboards are in a suitable condition to enable appropriate hygiene standards to be maintained. The provider must ensure that the cooker is maintained in a safe and functional condition. The manager must arrange for removal of the decommissioned fridges and freezers to facilitate effective cleaning of the storeroom area. The provider must ensure that copies of all Regulation 26 monitoring visit reports are provided to the manager for filing in the unit. DS0000060562.V294899.R01.S.doc Timescale for action 24/08/06 2 OP19 23(2)(a), (e) & (g) 24/09/06 3 OP19 23(2)(b) 24/10/06 4 5 OP19 OP19 23(2)(c) 23(2)(d) 24/08/06 24/08/06 6 OP33 26 & 17(2) Sched. 4.5 24/08/06 Version 5.1 Page 30 7 OP38 13(4) 8 OP38 17(2) & Sched. 4.12(a) The manager must ensure that the home conforms to relevant safety-related legislation, with respect to electrical appliance testing and gas appliance servicing. The manager must establish a collective record of accidents in addition to the individual records present on residents’ files. 24/08/06 24/08/06 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 3 Refer to Standard OP9 OP19 OP19 Good Practice Recommendations The manager should consider introducing a monitoring system to ensure that any medication errors are promptly identified and addressed. The Provider should consider redecorating the identified corridor areas in the near future. The provider should ensure that the programme of physical maintenance and renewal for the home prioritises the replacement of the identified carpets in communal areas. The manager should consider including questionnaires to social workers and relevant external professionals as part of the next quality assurance cycle. The manager or provider should produce an annual development plan identifying the priorities for the home over the ensuing year. 4 5 OP33 OP33 DS0000060562.V294899.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA 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 DS0000060562.V294899.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. 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