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Inspection on 23/07/08 for Welcome Care Home Ltd

Also see our care home review for Welcome Care Home Ltd for more information

This inspection was carried out on 23rd July 2008.

CSCI found this care home to be providing an Adequate service.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is small and provides a homely and friendly atmosphere for residents. Management work well with the Commission and make efforts to address requirements and recommendations made following inspections. All of the Requirements made at the last inspection were dealt with. There is a stable staff team in post who know the residents well and no agency staff are currently being used. Residents are relaxed and comfortable and in their interactions with staff, and relatives and residents say that staff are very kind and caring and they feel that they can ask the for anything they need. Residents know the manager and said they would speak to her if they had any concerns. Resident`s Religious needs are being well catered for and the manager often takes residents to church and to coffee gathering afterwards. Four residents said that they are happy at the home and that the staff are helpful.

What has improved since the last inspection?

The home now has written the fees that they charge into resident`s contracts so that they understand fully the cost of the service. The formal supervision of staff has improved and staff are being supervised by their manager at least every three months. Staff training is now being planned well and staff are paid for attending training at least three days per year.

What the care home could do better:

Residents care plans must be reviewed every month and include a review of risk assessments so that residents can be safe. Care plans must include comments about exercise and activities such as puzzles for each individual resident so that residents can be given a full opportunity for a healthy and active life with on the home. The home needs to be redecorated and repaired in many areas and attention must be given to getting rid of unwanted odours in some areas of the house so that residents can feel that they live in a comfortable environment. Staff must have current CRB checks done before they are employed, and must have a good complete record of their induction completed so that resident`s safety is fully protected. There is some training about how to best support residents care needs, which must be included in the training given to staff, so that they are skilled in helping residents. The owner of the home must carry out formal monthly monitoring inspections of the care and management provided, and of the repairs needed so that the quality of the care and the home are maintained to a good level.

CARE HOMES FOR OLDER PEOPLE Welcome Care Home Ltd 26-28 Fordel Road Catford London SE6 1XP Lead Inspector Sean Healy Unannounced Inspection 23rd July 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Welcome Care Home Ltd Address 26-28 Fordel Road Catford London SE6 1XP Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8697 5024 020 8698 8287 welcomecarehome@hotmail.co.uk Mrs Margaret Newland Mrs Margaret Newland Care Home 15 Category(ies) of Dementia (15), Old age, not falling within any registration, with number other category (15) of places Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 15 31st July 2007 Date of last inspection Brief Description of the Service: The Welcome Care Home is registered to provide personal care and accommodation to a maximum of 15 older people suffering from dementia. The overall aim of the home is to provide care and support in a homely environment with a relaxed family atmosphere. The underlying philosophy, stated in the home’s brochure, is that of a holistic approach to care. The registered provider is a company belonging to Mrs Margaret Newland, who is also the registered manager for the service. The staff team comprised of a registered manager, a deputy manager, care staff and some domestic hours. The home was opened in 1993 and consists of two semi-detached Victorian houses, which have been joined into one. There is a rear garden with a patio, a fishpond and a lawn area, which is well maintained. Thirteen of the home’s bedrooms are single with en-suite toilet facilities. There is one shared room, which has a wash hand basin only, but exclusive use of a nearby toilet. There is a passenger lift and a short stair lift to ensure access to all parts of the house. The property is situated in a residential road in the Catford area, with some local shops nearby and is close to Catford town, public transport and local amenities and shops. The provider’s email address is: welcomecare@hotmail.com Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 5 Information about the service provided is made available to current and potential residents in the homes Statement of Purpose and Service Users Guide, which are given to all service users. The recent CSCI report is kept in the office area in the home, and it is recommended that this be kept in a more accessible area and that all residents are informed. The current fees ranged from £424.50 to £450 per week and residents pay privately for items such as toiletries, newspapers and personal purchases. Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality Rating for this service is 1 Star. This means that the people who use this service experience adequate quality outcomes. The inspection was unannounced and took place as a visit to the home on 23/7/08 and ended on 18/8/08 following the organisation re-filing of important documentation relevant to the inspection. The home provided an Annual Quality Audit Assessment (AQAA), which was also used to inform the inspection. The registered care manager facilitated the visit. Four care staff had discussion with me and I interviewed two of these about their employment and understanding of their job. Six care staff responded to the CSCI inspection survey. Four staff employment files were examined to check that they had been properly recruited, trained and supervised. Two separate relatives of residents contributed their views of the home. Five residents discussed their views on the home with me and five other residents responded to inspection surveys. Four resident’s files were examined including assessments and care plans. The inspection involved a tour of the premises and examination of a range of management documentation. The home currently has one vacancy. What the service does well: The home is small and provides a homely and friendly atmosphere for residents. Management work well with the Commission and make efforts to address requirements and recommendations made following inspections. All of the Requirements made at the last inspection were dealt with. There is a stable staff team in post who know the residents well and no agency staff are currently being used. Residents are relaxed and comfortable and in their interactions with staff, and relatives and residents say that staff are very kind and caring and they feel that they can ask the for anything they need. Residents know the manager and said they would speak to her if they had any concerns. Resident’s Religious needs are being well catered for and the manager often takes residents to church and to coffee gathering afterwards. Four residents said that they are happy at the home and that the staff are helpful. Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have a Contract or Statement of Terms and Conditions, and an assessment of need completed prior to admission. Residents have received confirmation that based on assessment the service was suited to meeting their needs. Intermediate care is not provided. EVIDENCE: There was a requirement made at the last inspection for the home to ensure that local authority fees paid for the service provided be written into residents contracts or statements of terms and conditions. This requirement has now been met. All residents files examined showed that they had a contract in place, which included the fees paid for their care. All residents have full and detailed assessments of need on file. I examined for residents files and all were seen to have a detailed assessment of their health Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 10 and social care needs. The residents at the home have been placed in both three London borough local authorities, with Lewisham as the main contracting agent. Core care assessments have been provided by these local authorities and the show the primary care needs of the residents to be associated with ageing needs, with secondary care needs such as dementia and mental health support being prominent. The home does not provide intermediate care for residents and therefore a standard six does not apply to this home. Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health and personal care needs are well set out in care plans but care plans and risk assessments are not consistently reviewed each month. Health care needs are being met, and medication is well managed. Residents are treated in a respectful manner ensuring their privacy is respected. EVIDENCE: I examined four residents care assessments and care plans which included health and social care needs, and risk assessments in a range of areas. The home has a good care planning system, (The up-to-date Standex system) which includes health and social care interests and activities, relationships, medication, mobility, and a range of support guidance for staff. Care plans are consistently reviewed monthly. Staff interviewed were knowledgeable about residents needs and four residents said that staff are very good at helping the personal care, and are very sensitive, and ask questions about how they should do it. All for residents files examined showed good inclusion of a range of health care needs. Some mental health, dementia, mild physical disabilities and moving Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 12 and handling support needs featured amongst the health care needs listed. GP visits happen by request, and the residents and the manager said that the GP is quick to come out when needed. The GP normally visits fortnightly, the Chiropodist this visits three monthly, the Oral Hygienist visits monthly with the Dentist visiting at least once a year, or when a new resident comes to the home. None of the residents have tissue viability issues, as this is very well managed by the home. While seven of the homes residents are described as having dementia support needs, care plans examined do not include clear identification of what dimension means for individual residents. For example they do not describe levels of forgetfulness, or the times of day or days in the week when the resident would be most responsive to be included activities. The home must include in their care plan a clear description of how dementia effects each resident who have this diagnosis, and describe how their support needs in this are will be met. Particular consideration should be given to the provision of opportunities for exercise and mentally stimulating activities in the home. (Refer to Requirements OP7) Care plans examined did not always reflect the activities for each resident as they appeared in their care assessments. One resident’s care assessment said that the resident liked bingo, board games and photography, but these activities were not included in this residents care plan. Two residents said that they had no seen activities such as games puzzles and exercise happening in the home in quite a while. The homes management commented that these activities may have dropped off the agenda a bit due to lack of take up by residents. The home must ensure that these activities are identified individually in residents care plans and that appropriate in house activities as described are offered to residents a number of times a week. (Refer to Requirements OP7) Care plans include risk assessments that are relevant to the needs of each resident as described in their care assessment. These risk assessments are then included in a practical way in support plans such as personal care. However two residents who had falls, and epilepsy included in their risk assessments, did not have enough detail about the support needed in their personal care plans. For example the personal care plan for these residents just said “needs support in bathing and showering”. More detailed written guidance for staff is needed in order to better protect residents and staff. (Refer to Requirement OP7) Two of the four care plans I saw had not been reviewed consistently every month. The home must ensure that all care plans and risk assessments are reviewed every month and a record made of the review and any changes needed (Refer to Requirement OP7) Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 13 Medication is well managed by the home and none of the current residents manage their own medication. The home carries out an assessment of the resident’s wishes and abilities to self-medication as part of the referral and moving in process. All residents spoken to said they are very happy for the home to look after their medication. All of the resident’s bedrooms are now single rooms, providing a private meeting place should they need it. Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are satisfied with their lifestyle but more stimulating in house activities and exercise opportunities are needed. They are supported to maintain contact with family and friends. Residents are involved with making decisions about their life and are given a choice of good and wholesome food. EVIDENCE: Resident’s care plans include a list of activities offered a daily basis, which are recorded on a daily activities chart. This chart was examined and was consistently completed by staff. Activities included are: a visiting musician, cinema, hairdressing, manicure, quiz evenings, reminiscence sessions, story reading, dancing, shopping, café, and visits to the Kingdom Hall for one resident’s religious support needs. Other residents said that they are supported to go to church by the manager. Care plans examined did not always reflect the activities for each resident as they appeared in their care assessments. One resident’s care assessment said that the resident liked bingo, board games and photography, but these activities were not included in this residents care plan. Two residents said that they had not seen activities such as games puzzles and exercise happening in the home in quite a while. Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 15 (Refer to Requirement OP7) All the residents I spoke to said they had family who visit and also who take them out on a regular basis. They are able to entertain visitors in their room but mainly prefer to use the front room with their visitors. Two family members I spoke with said that they always receive a welcome when they visit the home, and they feel that they can visit at any time. Residents financial support needs are assessed on admission and support to manage finances is offered when necessary. The support needed is included in their care plans. The home provides a wholesome and nutritious diet for residents and offers a choice of food on a daily basis. Five residents whom I spoke with said that the food is good and they are offered a choice every day. At the last inspection the home had changed the menus to reflect residents preferred meals, and that the residents now have what they want on each day. Residents are asked the day before about the food that they want to eat the next day, and residents said that on each day they could change their minds and get something else if they really wanted. The kitchen was clean and tidy. I looked at records of food provided and sampled a meal and found that the food was wholesome and well presented. There were bowls of fruit available for the residents. Good records of food eaten are maintained as part of the home’s system for monitoring healthy diets. A record is kept in each resident’s own individual file. Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory systems are in place to manage complaints and the protection of vulnerable adults. EVIDENCE: The homes complaints policy was last reviewed in March 2007. This policy adequately shows how complaints are to be managed, and residents have been given a copy. Two residents confirmed this. The owner of the home and registered manager is at the home on a daily basis and residents commented that they are available to speak with them whenever they need to. There have been no complaints made since last inspection. The Statement of Purpose includes a summary of complaints policy and all of staff had received training in how to deal with complaints. There have been no allegations of abuse or POVA referrals made since the last inspection. The home has a written policy and procedure in relation to Adult Protection. The procedure should state clearly that all suspicions or allegations of abuse must be referred to the local authority for investigation under their procedures. A copy of the local authority’s Adult Protection procedures is available to staff in the home in addition to the home’s own policy. The Adult Protection policy was last reviewed in March 2007 and shows clearly how to report suspicion of allegations of abuse. There is a flow chart showing clearly how to make reports quickly and efficiently. Two staff interviewed had a good Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 17 awareness of adult protection and how to manage an allegation or suspicion of abuse. Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is safe but is not well maintained and needs considerable redecoration and replacement of flooring and curtains in upstairs hallways and residents bedrooms. There are sufficient toilets and washing facilities, and toilets are now adequately maintained, but some areas have unwanted odours. Resident’s bedrooms need redecoration to be made comfortable. EVIDENCE: The home was opened in 1993 and consists of two semi-detached Victorian houses, which have been joined into one. There is a rear garden with a patio, a fishpond and a lawn area, which is well maintained. There are plans in place to further develop the garden area. Thirteen of the home’s bedrooms are single with en-suite toilet facilities. There is one shared room, which has a wash hand basin only, but exclusive use of a nearby toilet. There are an Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 19 adequate number of toilets and bathrooms in the home to meet the resident’s needs. There is a passenger lift and a short stair lift to ensure access to all parts of the house. The property is situated in a residential road in the Catford area, with some local shops nearby and is close to Catford town, public transport and local amenities and shops. I walked around the home with the manager and inspected living room and dining room areas, hallways, and four residents bedrooms. The living room and dining room areas are in a good state of repair. Hallways and stairways in the upper floors particularly, and some residents bedrooms have generally become tired with need for replacement of curtains and repainting in some bedrooms. A good deal of redecoration and refurbishment is needed to bring the home up to a good standard. Currently there are no plans in place for the level of refurbishment that is required. The owner said that though some work is in progress, there is no written plan or schedule in place outlining the work to be done. The following are a sample of the repairs and refurbishment identified, but this is not an exhaustive list. The home must compile a full list of repairs and refurbishment needed and include these in a written schedule of maintenance for the home. (Refer to Requirement OP19) Bedroom 7: • The wallpaper trim is coming away and needs to be reaffixed to the wall • The board covering electric wiring needs to be secured as it is coming away from the wall • Carpet needs replacing as there are some paint stains • The window frame needs repair and repainting Bedroom 9: • The carpet join for short of the wall and does not join under the sink • Tiles under the sink need cleaning • Skirting board needs painting Bedroom 10: • Curtains are poorly hung and need replacing as the material is very thin and does not have any backing • Wallpaper is torn in places needs replacing • Flooring in the toilet area is loose and sticking up • The sliding door to the toilet area is badly railed causing the door to swivel and swing • The paint on walls and ceiling is old and discoloured and needs repainting • There is a strong unwanted smell in the room • The lamp shade is very dusty Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 20 Although some residents I spoke to said that they were happy with their bedrooms, two residents said that they felt their rooms needed to be redecorated, and my inspection of four bedrooms reveal that all of these needed work to be done to bring them up to standard where they could be said to be comfortable and homely. (Refer to Requirement OP19) The stairway between the first and second floor needs repainting. The home is generally clean in the main living areas such as dining room lounge and ground floor hallways. However there is a strong unwanted smell in one bedroom already mentioned, and there is dust evident in two bedrooms, which I inspected. The home must be ensure that resident’s bedrooms are regularly and adequately cleaned and dusted (Refer to Requirements OP26) Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of the staff meets resident’s needs, and they are in safe hands at all times. Residents are not fully protected by the homes recruitment and induction practices. Staff are trained and competent to do their jobs but training in some important areas of residents care is not routinely planned. EVIDENCE: The staff team is made up of a registered manager who is an experienced manager and qualified nurse, a deputy manager, 14 care staff on various part time and full time contracts, and contract cleaners who come to the home six days a week. A written staff roster was kept to show which staff were on duty at any time. There are 3 staff on duty between 8am and 2pm and 2 staff on duty from 2pm to 9pm, with additional support provided by the manager. At night one waking and one sleeping member of staff are on duty. No agency staff or others who do not know residents are used which is a good achievement and helps maintain a consistent service. The homes staff are made up of one male, 10 female staff and a number of other bank staff who are mainly female. They provide support for 9 female and five male residents. The cultural backgrounds of residents are 10 White English residents and three Caribbean residents, supported by a staff team Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 22 who are predominately either Afro-Caribbean or Black British. The manager has in place management of diversity training to try to ensure that the resident’s cultural needs are understood and are being met by staff. The home provides work experience for care students who are completing NVQ training. When on duty the students are supervised by the person in charge of the shift. Volunteers are sometimes used to provide additional support but not as part of the minimum staffing levels. The manager checks that all students and volunteers had up to date CRB and POVA checks before working in the home. Residents and relatives said that they felt there were adequate numbers of staff on duty and that all were quick to provide help when needed. The manager and deputy manager were both qualified nurses and eight of the twelve permanent care staff had achieved NVQ level 2, which is over 50 of care staff. The deputy manager is undergoing an NVQ level 4 course in care and management. Recruitment policies and procedures are in place. Four employee personnel files were viewed. These were generally well kept and included all of the information required by regulation. However one staff member had been employed on the basis of a CRB check that was more than 6 months old, without the owner having requested a new CRB. This is unacceptable and the home must get an up to date CRB for this member of staff and ensure that all staff are employed only after receipt of a current satisfactory CRB check. (Refer to Requirement OP29) There is an induction schedule in place for new staff, which is largely in line with the Skills for Care requirements. However there are a number of important areas not listed in this induction schedule. These areas are: management of complaints, safeguarding and use of wheelchairs. Although staff interviewed said that they had been informed about these areas it is important that they are formally included to ensure that they are consistently addressed as part of the initial induction of care staff. I also found that the induction schedule was not consistently signed and dated by the staff member. The home must address these points and ensure that staff are inducted in accordance with Skills for Care specification. (Refer to Requirements OP30) The home has a training schedule, which includes; equal opportunities, diversity, health and safety, fire safety, moving and handling, infection control, medication and food hygiene. However some important features of the care needs of residents are not fully reflected in the homes training plan for care staff. These are: Dementia, complaints and mental health. The home must include these areas in the training plans for staff in order to meet the assessed and changing needs of residents. Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 23 (Refer to Requirement OP30) Recommendations were made at the last inspection for the home to keep clearer records on staff training and to ensure that staff attend three days paid training per year. These recommendations were met. Staff training records showed that all staff attended in excess of three days training and the owner and two staff confirmed that they are now paid for attending training. Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has an experienced manager but accountability for resident’s reviews, staff recruitment and induction and training of staff needs to be improved. The home cannot fully show that it is run in the best interests of residents. Resident’s financial interests are safeguarded and staff are supervised appropriately. The health, safety and welfare of staff and residents are promoted and protected. EVIDENCE: The home’s manager was registered with the Commission and had the experience and qualifications needed to manage the service. The manager was a registered nurse, had achieved NVQ 4 qualification in care and management and was supported by a deputy manager who was also a Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 25 registered nurse and who has worked in the home over a number of years. Residents spoken with said they were happy with how the home was run. Two visitors commented that they were very happy with the homes management and that their relative was very happy living there. They said they were fully consulted about the move to the home, and are confident that they can speak with the manager when they need to. Six residents responded to the inspection surveys and these also showed confidence in the homes management. However a range of important management activities in the home were not being consistently implemented. These included: Monthly review of residents care plans, carrying out appropriate CRB checks on staff, and planning and recording of staff induction and training. The registered manager must ensure that ensure that these tasks are accounted for by anyone to whom these tasks have been delegated. To this end the owner and registered manager of the home must carry out formal monthly monitoring inspections of the care provided, including care plan reviews, the management of staff, and of the repairs renewals and refurbishments needed so that the quality of the care and the home are maintained to a good level. (Refer to Requirement OP31) There was a recommendation made at the last inspection for the home to make further developments in the homes quality assurance systems, to include a greater range of checking of systems used in care planning, implementation and intervention such as care planning, complaints and adult protection and staff management. This was not done and as a result of inconsistency in the operation of these important management systems a separate requirement has now been made under standard 31 of this report. The home has a system for carrying out resident’s surveys and has begun a system for carrying out annual quality audits. There is also a current development plan in place. These systems will be checked for progress at the next inspection. There was a requirement made at the last inspection for the home to ensure that there is written agreement for the home to manage the bank accounts and finances for two residents. The home does not now manage these responsibilities and the requirement is withdrawn. Residents financial support needs are assessed on admission and support to manage finances is offered when necessary. All of the residents or their family are responsible for their bank accounts and DSS benefits. The home only manages small amounts of cash deposited with them for personal spending such as hairdressing, or small shopping. In these cases receipts and records are being maintained. All for staff files examined showed supervision to the generally happening well with good notes being kept. At the last inspection the regularity of three monthly supervision was not always adhered to and a requirement was made to rectify this. This requirement is now met. Staff interviewed confirmed that they receive regular supervision and that the content address care of residents, and their own employment and training and development issues. Four staff files examined also showed good records of these supervisions are Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 26 being kept. These files also showed that an annual appraisal system is in operation for all care staff. There was a requirement made at the last inspection for the home to ensure that a five year electrical certificate be available for inspection. This is now met and the last electrical inspection was carried out on the 15th September 2007. All health and safety and fire safety documentation was checked and found to be up to date and in order. Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 X 2 2 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 3 Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 28 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 OP7 Regulation 12. (1) a Requirement Timescale for action 31/12/08 2 OP7 12 (1) a 3 OP7 13 (4) b&c The registered provider and manager must ensure that all relevant residents have their dementia care needs described in their care plans, especially regarding diet, exercise and mentally stimulating activities. This is to ensure that their physical and mental health is maintained The registered provider and 30/11/08 manager must ensure that all residents have the opportunity to participate in physical exercise and mentally stimulating games within the home, a number of times a week, to ensure they are given the opportunity to maintain their health 31/12/08 The registered provider and manager must ensure that risk assessments for residents who have high personal care support needs are accompanied by written guidance for staff, describing how they are to keep the resident safe, while also maintaining individual levels of independence. This is to allow residents to maintain as much DS0000025650.V372610.R02.S.doc Version 5.2 Welcome Care Home Ltd Page 29 4 OP7 15 (2) 5 OP19 23 (2) b 6 OP26 23 (2) d 7 OP29 19 (4) b 8 OP30 26 independence as possible while remaining safe The registered provider and manager must ensure that all resident’s care plans are reviewed on a monthly basis, and a record is kept of these reviews. This is to ensure that the care provided meets the residents current care needs The registered provider and manager must ensure that a programme of routine maintenance and renewal of the fabric and decoration of the premises be produced and implemented. This must include all areas of the home discussed in this report under Standard 19. This is to ensure that the home is safe and well maintained The registered provider and manager must ensure that all areas of the home are kept clean, hygienic and free from offensive odours, paying particular attention to resident’s rooms as discussed in this report Standard 26. This is to ensure that residents live in a clean and pleasant environment. The registered provider and manager must ensure that all new staff have an enhanced CRB check carried out by the home and received by them prior to commencement of employment. This is to protect residents. The registered provider and manager must ensure that the homes induction schedule for new staff meets the requirements of Skills For Care, and is fully implemented and recorded. The registered provider and manager must ensure that the DS0000025650.V372610.R02.S.doc 31/10/08 30/11/08 30/11/08 31/10/08 30/11/08 9 OP30 18 (1) c 31/12/08 Page 30 Welcome Care Home Ltd Version 5.2 10 OP31 26 home’s training programme for care staff meets the assessed needs of the residents, especially in relation to dementia and mental health care needs, and the management of complaints. This is to ensure that staff are adequately able to support resident’s care needs The registered provider and 30/11/08 manager must ensure that adequate monthly management monitoring checks are carried out and recorded, ensuring that all areas of residents care and staff management are properly checked. This is to ensure that any issues arising are quickly dealt with by the registered manager RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Welcome Care Home Ltd DS0000025650.V372610.R02.S.doc Version 5.2 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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