Inspection on 06/06/06 for Well House

This inspection was carried out on 6th June 2006.

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

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

Other inspections for this house

Well House 15/06/07

Well House 14/12/05

Well House 19/01/05

Well House 10/08/04

Well House 24/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Well House Chestnut Way Brightlingsea Essex CO7 0UH Lead Inspector Kathryn Moss Key Unannounced Inspection 6th June 2006 10:00 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 Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Well House Address Chestnut Way Brightlingsea Essex CO7 0UH 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) 01206 303311 01206 306130 Southend Care Limited Ms Kerry Jane Williams Care Home 36 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (36) of places Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 36 persons) Three persons, aged 65 years and over, who require care by reason of dementia, whose names were supplied to the Commission in October 2002 The total number of service users accommodated in the home must not exceed 36 persons 14th December 2005 Date of last inspection Brief Description of the Service: Well House is a purpose built home for older people, situated in a residential area of Brightlingsea, close to the town centre. Accommodation is all on one level and the home is divided into four units, each unit consisting of seven single bedrooms and one double bedroom. Each unit has its own lounge and dining area; there is an additional large communal lounge with a small sun lounge attached, and the home has secluded garden/courtyard areas outside. The home is registered to provide personal care for 36 Older People (over the age of 65), provides 24-hour personal care and support, and has appropriate equipment (e.g. mobile hoist, hand rails, etc.) to assist residents with limited mobility. There are currently some existing service users who have diagnosed dementia living at Well House, and the home’s conditions of registration reflect the fact that the home is allowed to continue caring for these named individuals, but is not registered to admit people with dementia. The home is owned by Southend Care, and the registered manager is Kerry Williams. The current scale of charges, as notified to the CSCI in the last preinspection questionnaire (February 2006), is between £340.62 and £358.54 per week, with additional charges for personal items (toiletries, hairdresser, newspapers, chiropody, etc.). A copy of the most recent inspection report was displayed in the home, and a ‘service users’ guide’ was available to prospective residents to inform them about the home. Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place on the 6/6/06, lasting ten hours. On the day of the inspection there were 35 residents living at the home, including two short stay (respite) residents. The inspection process included: • • • • • discussions with the manager, six staff, and six residents; feedback from three relatives, two during the inspection visit and one feedback questionnaire sent to the CSCI following the inspection; viewing of communal areas and laundry; and inspection of a sample of records and policies. this report also draws on other information received by the CSCI or submitted by the provider over the previous year (e.g. feedback from healthcare professionals, notifications of deaths and incidents in the home, reports on monthly visits by the registered provider, etc.). 25 standards were inspected, and 10 requirements (3 of which were repeat requirements) and 16 recommendations have been made. Not all previous recommendations were reviewed on this inspection. What the service does well: What has improved since the last inspection? The home had recently implemented a good monthly manager monitoring form, which should promote the internal quality monitoring of various practices within the home. Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 6 The home had previously been short of senior carers but now had two new seniors: this had eased the pressure on the manager and existing seniors, and the manager hoped this would enable her to delegate some tasks and to concentrate on her management role. 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. Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had appropriate information available to prospective residents, although this needed some amendments to fully meet the regulations. The home assesses prospective residents’ needs prior to them moving into the home, to ensure that they can meet their needs. The home was meeting current residents’ needs. EVIDENCE: The home had a Statement of Purpose and Service User Guide, which met most of the requirements of Regulations 4 and 5 of the Care Homes Regulations 2001. However, the Statement of Purpose did not include some of the information required by Regulation, needing fuller information on the needs that the home aimed to meet and on the facilities provided to meet those needs. This information had been present in an earlier version seen, and the manager was written to regarding the amendments required. The service user guide was user-friendly, clearly written, and in a large print to assist people Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 9 who may be visually impaired. The provision of alternative formats of these documents was not discussed on this inspection. The most recent inspection report was clearly displayed in the hallway of the home. The file of one new resident was viewed during the site visit to the home. This person had been admitted as an emergency, but there was clear evidence that an assessment had been carried out by the service provider prior to the resident coming to stay at the home. The home had a standard pre-printed assessment form containing set tick box statements to describe a person’s abilities or need: whilst this format can limit the content and detail of the information recorded, it was good to see some additional information about the person being recorded on the example seen. This person was spoken to, and was positive about their experience of living at Well House so far, feeling that they had been made welcome. Information on the person’s needs, taken from care plans and from discussion with the manager, demonstrated that the home had appropriately assessed that staff could meet this person’s needs, and that the home could provide suitable services and facilities. Other residents spoken to also reported that they felt the home was meeting their needs, and feedback from two relatives confirmed that they were happy with the care being provided. The home provides appropriate facilities (premises, equipment, etc.) for the needs that it aims to meet, and staff spoken to felt that current staffing levels were sufficient for meeting the needs in the home at the time of this inspection. Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health and personal care needs were being met by staff, but the action required by staff was not satisfactorily set out in individual care plans. The home’s medication administration policies and procedures protected residents, but some aspects of recording required further action. Residents’ privacy and dignity were being upheld. EVIDENCE: Residents observed during the site visit appeared well cared for, with clean clothing and personal hygiene needs met. Residents spoken to were positive about the staff team, and felt that staff assisted them appropriately with their personal care. Two relatives also provided positive feedback, with no concerns about the care provided. Staff were seen to offer assistance with personal needs, but to also respect someone’s wish to manage alone. It was noted that residents could choose when they wanted their bath (e.g. one person preferred their bath mid evening). Staff were observed to treat residents respectfully, and to promote privacy when they carried out care (e.g. discussing needs Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 11 discretely, shutting bedroom door when assisting, etc.), and a double room was noted to have a privacy curtain between the beds. It was noted that residents were able to have a phones installed in their rooms if they wished. Four residents’ care records were inspected as part of the site visit, for people with varying needs and abilities. The home used its pre-admission assessment form as a general ongoing assessment form on admission: this was present on three of the four files, and in each case had been completed again after admission. However, there were no dates to show when it had been completed, and (as noted in the previous section) assessment forms containing set statements to describe levels of need/ability can limit the range and accuracy of the information recorded. There were a range of other assessment forms also present on the files, covering issues such as nutrition, handling, risk of pressure areas, risk of falls, risks for service users with poor mobility, use of bed safety rails, etc. These were generally well completed, although in a few cases the assessments had not been signed or dated. Care plans were present on all four files. The home used a pre-printed range of care plan forms to address a wide variety of needs: these forms contained a series of standard ‘action’ statements with a box for staff to tick if this applied to the individual. In general there were care plan forms on each file that were appropriate to the person’s needs. Some care plans contained some good additional comments relating to meeting the person’s needs, but many of the care plans viewed lacked any detailed action about how staff should meet that person’s needs (e.g. for washing/bathing and for inability to self-toilet, several just indicated that assistance was required, but did not describe what assistance was needed, or what the person could do for themselves). This was also highlighted for further action at the last inspection. There was also no evidence that care plans were being reviewed at least monthly, which has been a requirement at the last two inspections. In one case a person’s needs had very recently changed significantly, but care plans had not yet been updated to show the changed needs and the different care required by staff: although it was noted that in this instance the needs had only recently changed, the manager was advised that care plans should be updated as soon as possible after a person’s needs change. Two of the care plans viewed were for people who were at risk of developing pressure areas; both had slight pressure areas at the time of this inspection. The home had taken prompt and appropriate action in regard to these, referring to the district nurse, ensuring that pressure relief equipment was in place, providing periods of bed rest throughout the day where required, encouraging fluid intake, etc. One person’s care records included a care plan for the prevention of pressure areas: this had been updated to note that the person had a pressure area, although did not fully describe the action being taken (e.g. did not record a routine in place for periods of bed rest). There was no care plan for pressure area care/preventative care for the other person. Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 12 Files viewed contained records of contact with GPs, from which it appeared that staff promptly referred any healthcare concerns to healthcare professionals. Staff reported that the home had good contact with community nurses, who regularly visit the home. Care records contained nutrition records, and daily notes also contained comments on whether the person had eaten well or poorly. Soft diets were provided where required, and staff were observed providing appropriate assistance with feeding. Some staff from the home were due to attend training in pressure area care, falls prevention and diabetes awareness. Continence care practices in the home were not specifically discussed on this inspection. The home had appropriate policies and procedures in relation to medication administration, covering receipt and storage of medicines, controlled drugs, administration, recording, and disposal. There was also a good policy on selfmedication, which emphasised the importance of promoting choice and of assessing a resident’s ability to self-medicate. Southend Care had an in-house training programme on the home’s procedure for administering medication, which included an assessment of competence; additional training was provided by a pharmacist (e.g. on the use of a Monitored Dosage System for dispensing medication). Evidence of staff training in this subject was not viewed as part of this inspection. Medication was stored on each unit in the home. Practices were inspected on just one unit on this occasion, where medication was safely stored in an orderly manner. The home also had a separate controlled drugs cabinet that was not inspected on this occasion, but a senior carer confirmed that any controlled drugs would be stored in this, and recorded in a separate register. Medication administration records (MAR) were pre-printed by the pharmacist with medication details, and staff entered the quantity of medication received by the home. It was noted that where details of a medication (or changes to details) had been entered by hand by a staff member, these entries were not always signed and dated by the person entering them. Some medication administration details did not reflect actual practice (e.g. one record stated ‘as directed’ but there were no specific directions with the medication; one record stated ‘4 times daily’ but the medication was being given ‘as required’). The manager was advised to request the GP to amend prescriptions to accurately reflect current administration instructions. Records of medication administered were well maintained on the unit inspected. Records of medication returned to the pharmacist were not inspected on this occasion. Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provided activities and daily routines to meet residents’ social and recreational interests and wishes, and enables residents to exercise choice over their lives. The home promotes contact with relatives and with the local community. The home provides an appropriate diet in pleasing surroundings. EVIDENCE: From discussion with residents and staff, plus observations on the site visit, it was clear that residents had choice over daily routines in the home. They could decide when to get up and when to go to bed, and were able to chose how and where to spend their day (some spending time in the unit lounges or communal lounge, others choosing to remain in their rooms); some were observed wandering around the home. A few were able to attend the day centre held on the premises, subject to daily availability of places. Activities were available in the home, and residents chose whether to participate. Residents also had choice of where to take their meals (some were observed taking these in their room), and had a choice of food available for each meal. Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 14 The home had a weekly activities programme, and it was good to see this displayed in a large format in all the hallways. This showed a range of suggested daily activities, although staff stated that this was subject to residents’ wishes on the actual day. Activities included reminiscence, games, bingo, sherry morning, hairdresser visit, etc., and some residents had recently been involved in planting up some flowerpots for the front of the home. The home also had an annual activities plan, and aimed to provide at least two ‘events’ each month, including parties, outings, visits by entertainers, etc. The Salvation Army had visited the home at the weekend, there were photos of a party held the previous Friday, and arrangements were being made to take residents to watch a forthcoming local carnival. The wide age range in the home (from age 70 to 100) was discussed with the manager in relation to meeting different interests: the manager felt that this was addressed through trying to treat everyone individually. The home only had three male residents: two of them were football fans and it was good to see that arrangements were being made to enable them to enjoy the World Cup (with plans to decorate the communal lounge in World Cup theme, and to provide some beers for a resident who wanted to stay up to watch late matches!). One resident spoken to was clearly looking forward to this. A visitor reported that there had been a trip out to the theatre earlier in the year, and was positive about the interaction their relative had with other residents and with staff. Feedback received from another relative indicated that they felt the home provided appropriate day-to-day activities. This indicated that a good level of activity was available in the home. Staff were seen to be present on each unit, and felt that they did have time to spend with residents. The manager felt that levels of staff interaction with residents had improved within the home, and reported that monthly residents’ meetings were held to seek residents’ views and ideas. Residents’ care plans contained forms to record ‘family/social history’, and care plan forms for ‘lack of leisure/recreational activities’. However, files viewed contained very little information on people’s life histories, and care plans indicated the person’s likes and dislikes (e.g. with regard to TV programmes and music), but did not describe the action required by staff to encourage or enable the person to join in activities or receive social stimulation. Where residents were able to participate in activities, their care records contained a clear record of the activities they had joined in with; however, for those who were unable to actively join in with formal activities, activities records did not reflect the ways that staff spent time with them (mainly containing comments such as ‘bed rest’, ‘watched TV’, ‘had visitors’, etc.). Care plans and records relating to social/recreational needs therefore needed further development. From observations and discussions on the site visit, friends and relatives were free to visit at any time, and were made welcome by the manager and staff. They were also invited to join in with events in the home, which was particularly appreciated by one person spoken to. The home is located in a Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 15 residential area and promotes contact with the local community through attending local events (e.g. pantomime and carnival), local groups visiting the home (e.g. Salvation Army), and through the day centre held within the home, which some of the residents were able to attend. Residents were able to bring their own possessions into the home with them, and could have their own telephone installed (to promote their independence and autonomy). The service user guide advised residents of their right to access their records. Access to advocacy services was not discussed on this inspection. Over the last two years there had been some concerns raised on inspections about aspects of the food served at Well House, particularly relating to the variety of food served at tea times; the CSCI had also received a recent anonymous complaint about food issues, which the home had been advised of. On this visit it was noted that the manager had looked into these concerns, and had carried out a survey of residents’ views on the food provided. Meal records showed that there was a greater variety of food being offered at tea times, although a two week sample of menus submitted to the CSCI still showed some repetition of food at tea-times over a two week period, which should be monitored (e.g. ravioli on two nights, quiche on two nights, sausage and tomatoes on two nights, scrambled egg on two nights). Most residents and relatives consulted appeared to be quite happy with the meals served. Sample menus submitted showed a good range and choice of main meals being served, and the lunch served on the day of the inspection was well cooked, included fresh and frozen vegetables and a choice of main dish, and was positively received by residents spoken to. The daily menu was clearly displayed on a white board in each unit. Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a procedure for responding to complaints, and residents felt able to raise concerns. Procedures were in place to protect residents from abuse. EVIDENCE: The home had a clear complaints procedure for service users, advising them how and who to contact, and including contact details for the CSCI. It did not include the timescales for the registered provider to respond to any complaints, and this should be included to ensure that the procedure reflects the regulatory requirements. Only one complaint had been received by the CSCI since the last inspection, and this had been appropriately investigated and addressed by the home. The home maintained a record of complaints received, and the complaint received by the CSCI and a concern about care practice (see below) were the only complaints recorded since the last visit. Residents spoken to were clear that they felt able to speak to the manager about any concerns, and it was noted that the manager was regularly around the home and interacting with residents during the day of the site visit, providing them with opportunity to speak to them. The home has an appropriate policy and procedure on the Protection of Vulnerable Adults (POVA), which includes guidance on types of abuse, and the home’s procedure for responding to any concerns (both carer and manager roles), including referral to the police or social services, as appropriate. Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 17 Records of training in POVA issues were not viewed on this inspection. Three of the staff spoken to during the inspection stated that they had not yet attended POVA training with the home: however, they were clear about responding to concerns about poor practice and reporting this to the manager, and several mentioned having received a booklet about adult abuse awareness. The manager stated that further POVA training had been arranged for later this year, which she hoped all staff would attend. Since the last inspection, a resident had raised a concern with staff about an incident in the home, and the staff and manager had responded to this appropriately under local multi-agency POVA procedures. This incident had subsequently been investigated internally by the home and dealt with under their disciplinary procedures. This showed good practice within the home for reporting and responding to suspicion or allegations of abuse. Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe and satisfactorily maintained environment for service users, including access to appropriate communal areas. The home was generally clean and hygienic. EVIDENCE: The home’s layout and location suits its purpose and meets the needs of residents. Premises issues were not inspected in detail on this visit, nor were records of decoration and refurbishment; however, the manager reported that décor had been touched up as and when required, and that the home’s annual development plan incorporated a number of premises issues, including obtaining some new chairs for lounge areas. The home is currently in the process of having an extension built, to provide some additional rooms and facilities on the first floor; the manager had completed a risk assessment on the building work in progress. Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 19 There was a range of communal space available to residents (with unit lounges, a communal lounge, and a day centre), including outside areas that were accessible to residents and had seating provided. These were well maintained, and residents had been involved in planting up containers to put outside the home. Communal areas viewed were clean and tidy, and in a satisfactory state of repair. The home generally had a homely atmosphere, facilitated by a unitised layout that provided accommodation for small groups of residents, each with its own bathrooms, lounge, dining and kitchenette areas. Some unpleasant odour was noted in one hallway area, caused by one resident’s reluctance to accept assistance with personal hygiene. This was discussed with the manager, and it appeared that the staff were making every effort to persuade the person to accept help with this. Feedback from one relative confirmed that they felt the premises were generally clean, warm and well maintained when they visited the home. The home’s laundry was clean and tidy, located away from areas where food was prepared or served, and was equipped with three washing machines and three drying machines. Washing machines had wash cycles capable of a 60° or 95°C wash: the laundry person was aware that for infection control purposes items soiled with body fluids needed to be washed at over 65°C, and confirmed that she therefore used the 95°C wash. The home had a sluice room adjacent to the laundry area, with a porcelain flushable sluice sink. It was reported that when laundry was delivered to the laundry area, items soiled with body fluids were not always clearly separated from other laundry, raising concerns of cross contamination. This was discussed with the manager, who was advised to remind care staff to ensure soiled laundry is kept separate from other items. Infection control policies and procedures were not inspected on this occasion, but it was noted that infection control training was booked, and care staff were seen to use protective gloves when carrying out personal care. Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ needs were met by the number and skill mix of staff, but some staff were working an excessive number of long shifts each week. Evidence of recruitment practices did not fully meet regulatory requirements. The home provides an appropriate range of training to ensure that staff are trained and competent to do their jobs. EVIDENCE: Staff confirmed that staffing levels were generally maintained at seven staff throughout the day and three at night, and felt that when fully staffed the current staffing levels enabled them to meet residents’ needs. Rotas seen for the two weeks preceding the inspection showed that there were a few shifts where the home was one staff member short: as the home was almost at full occupancy and over 25 of residents required the assistance of two staff due to being non-weight-bearing, the registered provider must ensure that staffing is consistently maintained at an accepted level that safely meets residents’ needs. Rotas submitted to the CSCI earlier in the year had shown that, through volunteering to cover extra shifts, one person had worked fourteen days between their days off on one occasion earlier in the year; this was discussed with the manager who stated that this is now usually closely monitored. Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 21 However, rotas provided for the two weeks preceding this inspection still showed that five staff had worked between five and eight long days (of approximately 7am to 9pm) over the two week period, including (in four instances) three or four consecutive long days, and in some cases amounting to over 130 hours worked during the two weeks. Staff reported that the home was currently short staffed and that they volunteered to cover extra shifts: whilst it is noted that this was staff choice, these are unacceptably long hours and could potentially impact on staff abilities and put staff and service users at risk. The files of three new staff were inspected, and all three contained completed application forms that included: a full employment history, names of two referees, a health declaration, and a completed declaration of criminal record. Two references, including a last employer reference, had been obtained before each person started work: however, in one instance one reference appeared to be a testimonial as it was dated over a year prior to the application and not addressed to the home. All three files contained evidence of identification, a photo, and evidence of work permit (where applicable). Two files contained a completed CRB check, but in none of the three files had a CRB been obtained before the person started work. Two files contained evidence of a POVAfirst check, but in one instance this had not been received until the day after the person started work; the manager confirmed that a POVAfirst check had also been obtained for the third person, but could not locate this at the time of the inspection. The manager was reminded that carers should only be started without a CRB check and on the basis of a POVAfirst check in ‘exceptional circumstances’ (DH Guidance), and that in these circumstances the home must be able to evidence the supervision arrangements put in place until the CRB check is received (reference DH POVA Guidance). Although the home had an induction workbook based on the Skills for Care induction units, the completion of this was not being evidenced in the home. There was evidence of a checklist of issues covered with new staff during their induction period (orientation, fire procedures, employment issues, etc.), and also checklist of care tasks covered; a carer confirmed that they had had an induction period when they were supervised by a senior carer. The manager submitted an overview of training completed by staff following the inspection: however, this only covered core Health and Safety issues (moving and handling, emergency aid, fire training, and food hygiene), and did not provide evidence of training in other care issues, POVA, medication, etc. Evidence of general training cannot therefore be commented on in this report, and will be inspected at the next inspection. It is recommended that the home maintain a clear central record of all training completed by staff, to enable the manager to easily identify which staff require training or updates in various topics. From discussion during the inspection it was good to see that eight staff had started a distance learning course in dementia care, and that training was planned in POVA, basic first aid, infection control, pressure area care, falls Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 22 prevention and diabetes awareness. It therefore appeared that an appropriate range of training was regularly provided to give staff the knowledge and skills to do their job. At the time of this site visit the home employed 24 carers, and information provided by the manager indicated that nine care staff had achieved NVQ level 2 or above. A further six staff had been recruited from overseas and the provider has advised the CSCI that they have qualifications from their own country that are equivalent to NVQ level 2 or above: the provider therefore needs to demonstrate for each individual how their qualification meets the National Minimum Standard for care staff qualifications. The staff team is occasionally supported by four staff from the day centre, all of whom have NVQ level 2 or above. Two staff had recently started their NVQ level 3, and a new carer was keen to start NVQ level 2. Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered manager had appropriate experience to manage the home, but had not yet started work to achieve the necessary qualification. The home had processes in place to monitor the quality of service, and systems for managing residents’ monies safeguarded their interests. Staff supervision practices were not satisfactory. Practices in the home generally promoted the health and safety of staff and service users, but evidence of staff training in health and safety topics was not satisfactory. EVIDENCE: The manager’s registration has been completed since the last inspection, and she has now been in post for over a year. Although she has applied for NVQ level 4 in management and in care, she has not yet started this training, and Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 24 this needs to be progressed as soon as possible. Feedback about the manager from staff and residents was positive, with people reporting that she was supportive, approachable, and easily accessible within the home. It was noted that the manager assisted on care shifts when required, and regularly spent time around the home. Residents appeared comfortable and relaxed with her. The manager stated that a survey of residents’ views had taken place in March 2006, and the questionnaires were being evaluated by someone outside of the home; the manager confirmed that a report would be produced, and was asked to ensure that a copy of this be submitted to the CSCI. The views of other stakeholders had not been sought as part of this survey. The home had an annual development plan for the home for 2006 containing a range of aims, predominantly relating to premises issues. Although there were also aims relating to staff training and care plans, these aims were very general (e.g. care plans ‘ongoing’) and did not have any defined timescales for achieving them in, or how this was going to be measured/monitored. It was therefore recommended that aims and objectives in annual development plans be specific and have clear timescales, so that the home can monitor whether these are being achieved. It was recommended that the annual development plan could also include specific development aims individual to the home and reflecting clear outcomes for residents (e.g. review of meals, development of activities, specific training for staff, etc.). In relation to ongoing quality monitoring and audit processes within the home, the organisation had recently implemented a Monthly Management Report, consisting of a comprehensive checklist covering a wide range of practices within the home: this was a good self-audit tool, and was a commendable initiative. There was also evidence of a form used to audit medication practices in the home. The manager confirmed that the organisation carries out regular monthly monitoring visits to the home (as required by Regulation 26 of the Care Homes Regulations 2001): the manager was advised that copies of reports on these visits had not been regularly submitted to the CSCI over the last year, and it was noted that there was very little evidence of these reports held at the home. The responsible individual needs to ensure that the manager has copies of these monthly reports at the home. The home has secure facilities for the safekeeping of any money looked after on behalf of residents. Clear individual records were maintained for any money held, and in those viewed two people had signed each transaction, and the records had been periodically audited. In a sample record checked, the cash held, receipts and transaction record all balanced. The home also has a non-interest bank account for the sole use of residents, into which they can deposit larger sums of money for safekeeping, if required. Only a few residents had money in this account, mainly those for whom the home acted as appointee and where their benefits were paid direct into this account. Each person had a clear ‘account record’, and a sample record viewed balanced with Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 25 the cash held transaction record, showing deposits and withdrawals from the ‘account’. The manager is currently appointee for five residents. Individual staff supervision records were not viewed on this occasion. However, the manager was maintaining a chart to evidence when supervision sessions had taken place: this showed that although four staff had received two supervisions so far this year, most had only had one supervision, and some had not yet received a formal supervision session. The manager was aware that the frequency of supervisions had not been maintained, and stated that this would be addressed. All staff had received an appraisal, in the form of a self-appraisal form that staff completed themselves, and which had an additional section that the manager completed. The manager stated that she had been round and spoken to staff about this, but this did not appear to have been completed as part of a formal supervision/appraisal session. Not all aspects of Health and Safety practices in the home were inspected as part of this inspection. On an inspection in January 2005 it had been noted that the home had a health and safety policy file containing a variety of policies and guidance on health and safety issues, but that this did not appear to contain an overall policy statement describing the organisational arrangements for managing health and safety within the home (i.e. employer and employee responsibilities, and who is responsible in the home). The manager was asked to submit a copy of the home’s health and safety policy following this information, and the information received indicated that the same policies and guidance were in place in the home. Evidence of staff training submitted to the CSCI following the inspection showed that, apart from four new staff, all staff had completed moving and handling training (including ancillary staff). However, the records showed that a number of staff had not completed fire safety or food hygiene training, and only eight staff had completed emergency aid training. The training record submitted did not include details of any staff training in COSHH or in infection control. The manager needs to ensure that all staff have received training in all core areas of health and safety, and that records reflect this. The home maintained good written risk assessments on a range of safe working practices within the home: these had been reviewed annually, and included a risk assessment relating to the use and storage of chemicals in the home. There was still no risk assessment relating to the hot tap water temperatures in the kitchen areas of each unit: the manager confirmed that warning signs were in place, but it was recommended that a risk assessment on any potential risks to residents is carried out, as tap temperature records showed that the water was very hot. Accident records were not inspected on this occasion. The home had submitted a pre-inspection questionnaire earlier in the year (February 2006), which indicated that regular servicing checks were carried Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 26 out on equipment and utilities in the home. A sample of records viewed on this inspection confirmed that equipment was appropriately maintained (e.g. evidence seen that portable electrical equipment had been tested this year, and of the recent servicing of call alarms, fire alarms, emergency lighting and hoists). A fire drill had recently taken place, and internal checks were carried out on fire alarms and emergency lighting, and on hot tap water temperatures: some recent records of these checks could not be located at the time of the inspection, but the manager subsequently submitted evidence to show that these checks had been carried out and recorded. Well House DS0000017993.V299201.R01.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 2 X 3 3 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 2 Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4, Sched 1, and 5 Requirement The registered person must ensure that the home’s statement of purpose and service user guide meet the requirements of the relevant regulations. Care plans require further development to ensure that they contain sufficient details of the action required by staff to meet each need. Timescale for action 31/08/06 2. OP7 15 31/07/06 3. OP7 15 This is a repeat requirement (last timescales 31/1/06). Care plans must be reviewed 31/07/06 regularly (the National Minimum Standard suggests at least monthly), and updated whenever needs significantly change. This is a repeat requirement for the second time (last timescale 31/1/01). The incidence and intervention (action required by staff) in relation to pressure areas must be clearly recorded in care plans. 4. OP8 12 and 15 30/06/06 Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 29 5. OP9 13 and 17 6. OP27 18(a) and 12(a) It is required that hand written details and changes to details on the Medication Administration Record are signed and dated by person making the entry. The registered person must make arrangements to ensure that sufficient numbers of staff are working at the care home as are appropriate for the health and welfare of service users. 30/06/06 30/06/06 7. OP29 19 This is in relation to staff working excessive hours in the home. The registered person must 30/06/06 ensure that CRB and POVA checks are obtained before new staff start work. In exceptional circumstances where a person needs to start work prior to a full CRB check being obtained, there must be evidence that a POVAfirst check has been obtained before the person started work, and documented evidence of the supervision arrangements in place pending receipt of the CRB. The registered provider must 30/09/06 progress arrangements to enable the registered manager to achieve appropriate qualifications as soon as possible. The registered person must 30/08/06 ensure that persons working at the home are appropriately supervised (reference also recommendation 12). 30/09/06 The registered person must ensure that all staff have received training in relevant health and safety issues (including moving and handling and fire safety). This is a repeat requirement (last timescale 31/3/06). DS0000017993.V299201.R01.S.doc Version 5.2 Page 30 8. OP31 9(2)(b)(i) 9. OP36 18(2) 10. OP38 13 and 18 Well House 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 OP12 OP12 Good Practice Recommendations It is recommended that the registered person requests that GP update prescription details, to ensure that administration instructions are accurate. It is recommended that staff record much fuller life history information on each resident, including past interests and hobbies. It is recommended that care plans for social and recreational needs clearly show the action required by staff to help service users occupy their time and engage in activities or social interaction. It is recommended that the manager continue to seek regular feedback from residents about the tea-time meals provided, and monitors the range of meals provided. The home’s complaints’ procedure should include details of the timespan in which the provider will respond to complaints (reference Regulation 22.4). It is recommended that the registered person ensure that all staff have received appropriate training in POVA issues. It is recommended that the registered person ensures that all staff abide by appropriate infection control practices with regard to identifying and handling soiled laundry. It is recommended that the registered person review and monitor arrangements for minimising the impact of odour from specific bedrooms on adjacent communal areas. The registered person needs to ensure that carers’ files contain evidence of any alternative qualifications deemed equivalent to NVQ level 2, and how this was assessed. Testimonials supplied by applicants should not be accepted as references, but the provider should apply to the referee for a reference on behalf of the home. The registered person should ensure that the home can demonstrate that each new carer has completed an induction process that meets the specification of the National Training Organisation (i.e. Skills for Care). DS0000017993.V299201.R01.S.doc Version 5.2 Page 31 4. OP15 5. 6. 7. 8. 9. 10. 11. OP16 OP18 OP26 OP26 OP28 OP29 OP30 Well House 12. OP33 13. 14. 15. 16. OP36 OP38 OP38 OP38 It is recommended that annual development plans contain objectives that reflect aims and outcomes for residents, and are specific, measurable and time limited (i.e. SMART). Care staff should receive formal supervision at least six times per year. It is recommended that there is at least one person on each shift who is trained in emergency first aid. The home should have a clear written statement of the policy, organisation and arrangements for maintaining safe working practices in the home. It is recommended that the home’s risk assessments on safe working practices cover any risk to residents from the hot tap water in kitchenette areas. Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Well House DS0000017993.V299201.R01.S.doc Version 5.2 Page 33 - 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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