Inspection on 30/01/07 for West Farm House

This inspection was carried out on 30th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

West Farm House 17/04/08

West Farm House 08/10/07

West Farm House 30/01/06

West Farm House 13/06/05

West Farm House 21/03/05

West Farm House 26/08/04

West Farm House 19/11/03

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE West Farm House Collingbourne Ducis Marlborough Wiltshire SN8 3DZ Lead Inspector Malcolm Kippax Unannounced Inspection 30th January 2007 9:50 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 DS0000028653.V321546.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. DS0000028653.V321546.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service West Farm House Address Collingbourne Ducis Marlborough Wiltshire SN8 3DZ 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) 01264 850224 Mrs Helen Burnett- Price Mr Barry Price Mrs Helen Burnett- Price Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10) of places DS0000028653.V321546.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th January 2006 Brief Description of the Service: West Farm House provides personal care and accommodation to up to ten older people. The home is situated in a quiet village location. Village amenities, including a convenience store, are within walking distance of the home. West Farm House is a two storey, period property, with some adaptations that have been made to meet the needs of older people. There is a large well-kept garden with a lawn and seating areas. The communal areas of the home consist of a sitting room and a dining room, with a sun lounge extension. The service users individual accommodation is on the ground and first floors. A passenger lift is available. At the time of this inspection each service user had a single room, although shared accommodation may also be available. All rooms have an en-suite facility. The registered persons, Mrs Burnett-Price and Mr Price, are both involved in the running of the home. Mrs Burnett-Price is in the role of registered manager, with responsibility for managing the day to day arrangements and the care of the service users. During the day the service users receive support from a permanent staff team. There are no staff members present in the building during the night. Mrs Burnett-Price and Mr Price provide sleeping-in cover from their own accommodation, which is next to the home. There is a call alarm system between the two properties. The weekly fee is in the range £415.00 - £585.00 per person. DS0000028653.V321546.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit, which took place on 30 January 2007 between 9.50 am and 4.45 pm. There were nine service users at the home, two of whom were away on the day of the visit. Service users were met with in their own rooms and at lunchtime in the dining room. Mrs Burnett-Price was available during the visit and two members of staff were met with. Some of the accommodation was seen. Records were examined, including examples of the service users’ care and assessment records. Other information and feedback about the home has been received and taken into account as part of this inspection: • • Mrs Burnett-Price completed a pre-inspection questionnaire about the home. This included copies of staff rotas, menus and training records. Six ‘service user surveys’ were completed and returned to the Commission. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visit. Reference is also made to a ‘random’ inspection of the home that took place on 28 June 2006. What the service does well: West Farm House gives people the opportunity to stay in a quiet village setting. Service users like their surroundings and the home’s location. Service users often have connections in the area and know the home before moving in. Service users appreciate the assistance that they receive and feel that staff members are caring and helpful. The staff team are friendly, whilst responding to service users in a respectful manner. The home suits people who can maintain an independent lifestyle. Service users manage their own financial affairs with support from relatives. Following assessment, service users can take responsibility for their own medication. Service users are expected to be independent in their social activities; they value the contact that they have with their relatives and the company that this provides. The service users’ visitors come and go on a regular basis, which adds to the relaxed and informal atmosphere in the home. DS0000028653.V321546.R01.S.doc Version 5.2 Page 6 The meals are freshly prepared and well presented. Service users appreciate how the home is kept and the accommodation is generally clean and tidy. Service users benefit from the support that they receive from individual staff. Staff members have the opportunity to gain relevant qualifications and to attend training that develops their skills. Mrs Burnett-Price has experience over a number of years and has gained a relevant qualification. Mrs Burnett-Price is closely involved with all aspects of the home and provides good continuity in the day-to-day arrangements. What has improved since the last inspection? What they could do better: There have been occasions when the staffing arrangements at night have failed to meet the needs of each service user. These have been commented upon in previous inspection reports. The absence of staff on the premises at night means that the service users’ needs are not directly monitored. There should be a better means of demonstrating on a regular basis that the service users are safe during the night. A policy for the provision of additional nighttime support has been produced. However the safety and welfare of all service users would be better promoted and protected by having staff closer at hand and by having a system in place which will alert staff when support may be needed, for example if a service user was not settled at night. Service users would benefit from a more proactive approach to improvement and to promoting their safety. A lack of assessment and attention in some areas could put service users at risk, for example from uncovered radiators and from a lack of hot water temperature controls on the baths. The bathrooms are reported to be kept locked when staff are not present. Staff supervise service users when bathing and the absence of safety measures means that service users cannot act independently at this time. In contrast, there is a lack of supervision for service users at night. The home’s procedures for dealing with medication are not fully protecting service users and records need to be kept better. This is to ensure that there DS0000028653.V321546.R01.S.doc Version 5.2 Page 7 can be no misunderstanding about whether a service user has received their medication at the correct time. The lack of organised activities in the home may not be meeting the needs of each service user. Although most service users occupy themselves, one person commented that they would like some sort of activity to be provided. The home should seek to gain feedback from each person on a regular basis and use this to improve the service that they receive. The home’s system of quality assurance will need to be developed in response to the regulation about the ‘quality of service’ that a home provides, which has been amended during the last year. Some service users may appreciate having an automatic closure mechanism fitted to their bedroom door. This would enable them to safely keep the door open during the day, if that’s how they like it to be. Further action is needed to ensure that all employees, including those who only have limited contact with service users, have been subject to the appropriate checks, including a Criminal Records Bureau disclosure. This will help ensure that service users are protected from people who may have an unsuitable background. A recommendation has been brought forward from previous inspections, about making information more readily available and accessible to service users and others. For example, the service user’s guide could be more detailed and presented in a user-friendlier format. Service users and visitors may also be interested in reading the home’s inspection reports. These could, for example, be given out to each person or made available in a communal area. 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. DS0000028653.V321546.R01.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 DS0000028653.V321546.R01.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): These standards were not looked at on this occasion. Standard 3 was looked at during the random inspection on 28 June 2006. The home does not provide intermediate care (standard 6). EVIDENCE: Two new service users had moved into the home shortly before the random inspection that took place in June 2006. The admission arrangements were examined at the time and discussed with Mrs Burnett-Price. A requirement was made that: ‘New service users must receive confirmation in writing that the home is suitable for the purpose of meeting their needs in respect of health and welfare’. This requirement was followed up with Mrs Burnett-Price after that inspection. No new service users had moved into West Farm House since the inspection in June 2006. A recommendation has been brought forward from previous inspections, about making information about the home more readily available and accessible to service users and others. DS0000028653.V321546.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including the visit to the home. The format of the service users’ care plans is improving and provides a better means of recording the service users’ needs and how these are to be met. There are shortcomings in the completion of assessments, which mean that the needs of service users may not be fully reflected in their care plans. Service users’ right to take responsibility for their own medication is respected, although the home’s procedures for dealing with medication are not fully protecting service users. Service users appreciate the assistance that they receive from individual staff and feel that staff treat them in a respectful manner. EVIDENCE: Three service users’ files were looked at. Each file contained a copy of the service user’s care plans. Two service users had care plans that had originally been written in April 2005 and were being updated on a monthly basis. The third service user had moved in during the last year. It has been reported at DS0000028653.V321546.R01.S.doc Version 5.2 Page 11 previous inspections that the plans appeared to be more of a record of the service users’ needs, rather than of the action that staff need to take to ensure that these needs are met. The care planning system has previously been discussed with Mrs Burnett-Price and recommendation made about how the recording forms could be amended in order to give a clearer distinction between assessments, care plans and daily reports. A new ‘care plan continuation sheet’ has been produced since the last inspection, which provides a better format for recording the service users’ needs and how these are to be met. The new form included the headings, ‘Goals or need’, ‘Desired outcome’, ‘Way of achieving it’, ‘Who is responsible’ and ‘Timescale’. These are appropriate headings with a care plan and the new format is a positive development. The continuation sheets had been written in August 2006 and added to the service users’ files. The care plans highlighted the service users’ physical care needs. Future developments should focus on ensuring that the information is as detailed as possible in all aspects of the service users’ needs. Comments had been added to the continuation sheets on a monthly basis, although there was no separate review section. Events were being regularly recorded on the service users’ ‘Daily report’ forms, in connection with their health, social needs and personal care. Contact with GPs and other healthcare professionals was being recorded. Service users said that Mrs Burnett-Price helped with making appointments. Mrs Burnett-Price said that no service users had any pressure sores, although some health matters were being followed up at the time. A continence nurse came to the home during the afternoon of the visit. Service users commented positively about whether they received the medical support that they needed. One person stated that they ‘have complete confidence in this respect’. Another person responded that this was ‘usually’ the case and commented ‘This is a residential home not a nursing home’. The service users’ files included assessment forms covering areas such as bathing, pressure sores, moving and handling, and ‘needs at night’. These included relevant guidance for staff, although they were not cross-referenced to the care plans. The completion of the assessments varied. Some forms had been recorded in full; others had not, for example they had not been dated, did not include a review date, or the section on ‘Service users’ views and contribution’ was blank. Some service users had signed their care plans and assessment forms. In their comment cards the service users responded positively about the care and support that they received from staff. The Commission’s pharmacist inspector examined the home’s medication arrangements at the last key inspection. There was a requirement at the time DS0000028653.V321546.R01.S.doc Version 5.2 Page 12 about the need to record risk assessments for service users who managed their own medication. This was followed up at the random inspection in June 2006, when it was seen that a new assessment form was being used for service users who administer or look after their medication. Mrs Burnett-Price had said that the ability of service users to administer their own medication was monitored each month, with daily observations about how well this was being managed. During this inspection, Mrs Burnett-Price said that following assessment, a small number of service users continued to take responsibility for some or all aspects of their medication. Other medication procedures and facilities within the home had not changed. Examples of the current administration of medication records were looked at. Overall these were being consistently completed, although there were gaps in one service user’s record, which meant that it was not clear whether the medication had been given at these times, or had not been given for any reason. Mrs Burnett-Price said that she thought that staff had probably attempted to give the (am) medication at different times during the morning, but had omitted to record the outcome of this, for example whether it had been received or declined by the service user. Mrs Burnett-Price said that no controlled drugs were being administered. One service user had anticoagulant medication prescribed, the dose of which was adjusted on a regular basis. Mrs Burnett-Price said that a nurse confirmed these changes over the phone and the record of administration was then amended accordingly. Mrs Burnett-Price said that she had not received the anticoagulant record book (yellow book), which is intended to be patient-held. A number of staff had completed a training course in medication. One staff member met with said that she did not administer medication, as she had not yet undertaken the necessary training. Service users said that they had good relationships with staff and were treated well. Staff were observed to be knocking on doors and heard speaking to service users in a friendly and respectful way. Service users could be private in their personal care and had space for meeting with their visitors in private. Service users had their own telephones. DS0000028653.V321546.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is mainly adequate and good in respect of standard 15. This judgement has been made using available evidence including the visit to the home. There is a relaxed and informal atmosphere in the home. Service users generally occupy themselves socially, with the support of their relatives. The lack of organised activities may not meet the needs of each service user. Service users are expected to maintain an independent lifestyle and can exercise choice and control in their lives. The meal arrangements are of a good standard. Service users appreciate the surroundings and the manner in which food and drinks are prepared and presented. EVIDENCE: Some service users were already familiar with the home and the local area before moving in. There was a convenience store with post office counter within a few minutes walk of the home and one service user went to this during the afternoon. Another service user met with said that they continued to use their own car for local trips. DS0000028653.V321546.R01.S.doc Version 5.2 Page 14 Some service users were met with in their own rooms. They had a range of personal possessions and their own items of furniture, which gave the rooms a homely and individual appearance. One service user said that they enjoyed a sherry with others before lunch, but otherwise would generally be in their own room. During the visit, service users were mainly spending time alone in their rooms. Reading was a popular pastime and some service users had their own daily newspaper. Some service users spoke about the relatives they saw regularly and how much they enjoyed their visits and company. Family members who ‘dropped in’ during the day were welcomed into the home and appeared to have friendly relationships with those present. Some occasional social events were being arranged, although there was no weekly activities programme. In their comment cards, two service users stated that there were ‘sometimes’ activities arranged by the home that they could take part in. One person added that they were ‘not remotely interested’ in taking part in activities. Another commented that they were fortunate to have family within reasonable distance who visited frequently. Two service users stated that there were never activities arranged by the home that they could take part in. One commented that ‘we have asked for some sort of activity to be provided, e.g. armchair activities, but no action’. One service user felt that a question about activities was irrelevant and added that ‘the occupants of this care home are more interested in their comfort than in any arranged activities’. One service user said that they continued to have visits from somebody who came to the home from a befriending service. This sounded like a useful resource to have on offer, particularly for those service users who are less able to occupy themselves or who have fewer visits from relatives or friends. The kitchen was a busy area during the visit. It was used as a base for staff when not needing to be with service users and also as a throughway to other parts of the home. Service users could contribute to routines in the home, for example by helping to lay the tables. One service user had lunch in their room; the others ate together in the dining room and returned to their own rooms after the meal. There was conversation on the smaller of two dining tables, when people talked about current affairs, sport and television programmes they had watched. The meal was freshly prepared and well presented. The service users met with were generally complimentary about their meals. They did not know what was to be served during the day and there was no information about this displayed in the home. There was a set menu, which covered a four-week period. This showed a varied and interesting range of main and sweet courses for lunch and two lighter courses for the supper meal, which usually included a cooked dish. DS0000028653.V321546.R01.S.doc Version 5.2 Page 15 Service users had morning coffee and afternoon tea, with a choice of drinks available at meal times. Breakfast was served to service users in their own rooms. In their comment cards, four service users stated that they always liked the meals at the home, one service user said ‘usually’ and another that they ‘sometimes’ liked the meals. The people who always liked the meals commented that ‘the food is consistently of high quality and is satisfactorily varied’ and ‘the food is always excellent with plenty of variety’. DS0000028653.V321546.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including the visit to the home. Service users know people who they can talk to if they have any concerns. Formal complaints are not being made. Staff members receive information and guidance, which helps to protect service users from abuse. EVIDENCE: Service users have contact with relatives and other people who they can discuss their concerns with. Mrs Burnett-Price reported that no complaints had been made to the home during the last twelve months. The Commission has not received any complaints about the home during this time. Information about complaints was contained in the Service user’s guide. This included contact details for the Commission. The complaints procedure was not displayed in the home. Mrs Burnett-Price confirmed at the random inspection in June 2006 that the procedure had been given to service users. In their comment cards, service users confirmed that they know who to speak to if they are not happy. They also confirmed that they know how to make a complaint. One person commented that ‘in eight years I have never found any cause for complaint’. Written guidance about abuse was included in the home’s policies and procedures file. Mrs Burnett-Price reported that there have been no adult DS0000028653.V321546.R01.S.doc Version 5.2 Page 17 protection investigations and no ‘Protection of Vulnerable Adults’ (POVA) list referrals during the last twelve months. The staff training records showed that ‘Vulnerable Adults’ training had taken place in October 2004. A Police Officer has visited the home and held a session with staff about abuse awareness. One member of staff has started working in the home since the training in 2004. This person was met with during the visit and they said that ‘abuse awareness’ was included in the ‘Introduction to Care’ course that she was undertaking. This staff member had received guidance about abuse, including the ‘No Secrets’ procedure about reporting suspected abuse of Vulnerable Adults. DS0000028653.V321546.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 and 26 Quality in this outcome area is mainly adequate. This judgement has been made using available evidence including the visit to the home. Service users appreciate the location of the home and like their surroundings. The home is generally kept clean and tidy. Service users could be at risk from uncovered radiators and from a lack of hot water temperature controls on the baths. EVIDENCE: West Farm House is located in a quiet location that is close to a number of village amenities. The position and layout of the home were in keeping with its stated purpose. There was a car parking area directly outside the front door and a large garden at the side of the property. The communal areas consisted of a sitting room and a dining room, which had been extended to create a sun lounge with access to the garden. The decoration and furnishing of the accommodation was in keeping with the character of the building. DS0000028653.V321546.R01.S.doc Version 5.2 Page 19 The service users’ rooms varied in size and outlook. They could use a passenger lift or a staircase to the first floor. Service users commented positively about different aspects of the home. One service user said that they liked the view of the garden from their first floor room. Another service user had bed-sitting room type accommodation on the ground floor with its own separate entrance. Service users liked having their own en-suite facilities. Mrs Burnett-Price has said that all the windows at first floor level have restricted openings. There were two bathrooms, both of which were on the first floor. One of the baths had a hydraulic chair. There was no portable hoist available in the home. This has been the subject of recommendations at previous inspections; the need for a hoist should be kept under review. The controlling of hot water temperatures has been discussed with Mrs Burnett-Price prior to this inspection. Mrs Burnett-Price has reported that thermostatic controls to control the temperature of the hot water supply have been fitted to the wash hand basins in the service users’ rooms, but not to the baths. These are normally seen as being a high-risk area. Mrs Burnett-Price has said that the bathrooms were kept locked to ensure that service users did not have unsupervised access to these areas. The service users’ assessments referred to the need for service users to be supervised when having a bath. A requirement has previously been made about the need to fit individual thermostatic controls to the baths. Mrs Burnett-Price has said that these would be fitted, but a plumber had advised that there was a problem in fitting controls because of the type of water system that is involved. Following the random inspection in June 2006, Mrs Burnett-Price was asked to confirm any technical difficulties that may prevent the fitting of thermostatic controls. It was also recommended that advice is sought from the environmental health officer about ways in which the temperature of the hot water can be regulated to a safe level. Rooms were centrally heated. Radiator covers have been fitted in a number of locations, but not in all the service users’ rooms. Radiator surfaces were included on the service users’ risk assessment forms, but it was not clear whether the assessments also included the radiators in the bedroom en-suite areas. In their comment card, one service user mentioned that there was a lack of double glazing which they felt affected the warmth of the rooms. The service users met with during the visit were satisfied with their rooms and did not raise this as a concern. The rooms felt warm and some service users had kept their windows open for ventilation. Since the last inspection Mrs Burnett-Price has contacted the Commission in connection with the use of portable heaters in order that service users could have additional heating if required. DS0000028653.V321546.R01.S.doc Version 5.2 Page 20 In their comment cards, five service users confirmed that the home was always fresh and clean. One service user stated that this was ‘usually’ the case and commented that the toilets were not always fresh and that the cleaning of individual rooms could be improved. The en-suite areas seen during the visit had been carpeted; there was a small amount of staining but no odour at the time. There were no unpleasant odours in other areas. An environmental health officer had last visited the home in June 2006 and Mrs Burnett-Price has reported that there are no outstanding requirements or recommendations. The laundry area was located outside the home. This area has improved in recent years although it is without a hand washing facility, which has been recommended at previous inspections. Staff members use the facilities in a utility room, which is next to the kitchen. DS0000028653.V321546.R01.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 mainly adequate, but poor in respect of the arrangements at night. This judgement has been made using available evidence including the visit to the home. Service users benefit from the support that they receive from individual staff. The staffing arrangements at night have failed to ensure the safety of each service user. Sufficient action has not yet been taken to improve this and service users may be at risk from a lack of monitoring of their needs during the night. Staff members have the opportunity to gain relevant qualifications and they receive training that develops their skills. Further action is needed to ensure that all staff have been the subject of appropriate checks and that service users are protected as a result. EVIDENCE: There was a staff team of eight care staff and one ancillary staff member. Some carers were undertaking cooking and domestic duties as part of their role. There was a low turnover of staff and no new staff had been recruited during the last year. Mrs Burnett-Price said that the deployment of staff had not changed since the last inspection. One staff member had increased their hours to make up for a part-time member of staff who had retired during the last year. DS0000028653.V321546.R01.S.doc Version 5.2 Page 22 Service users confirmed that staff listened and acted on what they said. One service user commented that ‘staff will do anything they can to help in any way’. Most service users felt that staff were always available when they were needed (one person stated that this was ‘usually’ the case). Five care staff, or 63 of the staff team, had gained a National Vocational Qualification (NVQ) at level 2 or above. This included one staff member who had achieved NVQ at level 4. The staff rotas showed at least two people working between 8.00am and 9.00pm. There were three people working at certain times during the week. Mrs Burnett-Price and Mr Price were covering many of the shifts, usually working alongside one the staff team. After 9.00 pm, cover was provided by Mrs Burnett-Price and Mr Price until 8.00 am the following day, when one of the staff came on duty. The rotas did not show when Mrs Burnett-Price and Mr Price started their ‘sleeping-in’ cover. Service users who needed assistance during the night were expected to summon assistance by using the call alarm system or to telephone Mrs Burnett-Price and Mr Price in their own accommodation. The service users have confirmed that that they are aware of this arrangement. Following incidents and discussions that have been reported on at previous inspections, the Commission has required the registered persons to provide additional night time support and supervision to ensure that service users are safe and their needs are met. The home has produced a policy for the provision of additional nighttime support and facilities. This detailed the support that would be available for individual service users whose needs could not be met through the usual arrangement at night, for example if a service user was ill and needed attention during the night. ‘Needs at night’ assessments have been introduced to identify service users who may need additional support. As a permanent arrangement, the Commission has advised Mrs Burnett-Price and Mr Price that the preferred option is for a staff member to be present in the building at night. Mrs Burnett-Price and Mr Price have acknowledged previous failings in the systems at night and confirmed that measures would be taken which would provide a means of alerting them, for example, if a service user was in need of support or was unsettled and possibly at risk. The Commission would consider any proposal on its merits. To date, Mrs BurnettPrice and Mr Price have said that different systems have been considered but they have not yet responded with a firm proposal and confirmation of when it would be implemented. This requirement remains outstanding and needs to be addressed within the timescale identified in this report. ‘Needs at night’ assessments were being completed. It was reported in the assessments seen that the service users did not have any needs at night and DS0000028653.V321546.R01.S.doc Version 5.2 Page 23 this was reflected in the daily reports that were written by Mrs Burnett-Price. It is important that good information is available about the service users’ movements during the night in order that their ‘Needs at night ’ assessments are as accurate as possible. It has previously been recommended that regular monitoring of service users’ activities and routines during the night should be part of the assessment process. This recommendation has not been followed up, although Mrs Burnett-Price has said that she talks to service users on a regular basis. Given the service users’ different levels of need and the likelihood of accidents arising, there needs to be a good system in place for identifying service users who are at risk and may need additional support at little or no notice. A matrix had been completed which gave an overview of the training undertaken by each staff member. Mrs Burnett-Price also provided information about training prior to the visit. Each care staff member held a current first aid certificate. Staff had attended a ‘General principles of moving and handling’ course in November 2006. A training provider for the care sector was being used. Other training undertaken has included continence awareness, infection control, dementia and ageing, safe handling of medication and food hygiene. Requirements have been made at previous inspections concerning the need for Criminal Record Bureau (CRB) disclosures to be undertaken on staff. This has received attention over time. At the random inspection in June 2006, Mrs Burnett-Price said that she would follow up the gardener’s CRB disclosure, who had the forms to complete, but had not yet applied for a disclosure. During this inspection, Mrs Burnett-Price said that the gardener worked on a casual basis and she questioned the need for them to have a disclosure. Guidance had previously been sent to Mrs Burnett-Price about who needs to have a CRB disclosure and at what level. DS0000028653.V321546.R01.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 and 38 Quality in this outcome area is mainly adequate, but poor in respect of how some matters are being responded to. This judgement has been made using available evidence including the visit to the home. The management approach provides good continuity in the day-to-day running of the home, but service users would benefit from a more proactive approach to improvements and promoting their safety and welfare. Service users manage their own financial affairs with the support of their relatives. EVIDENCE: Mrs Burnett-Price was originally registered with Wiltshire County Council, when she was considered to meet the standards in respect of supervisory experience, qualifications and competence. DS0000028653.V321546.R01.S.doc Version 5.2 Page 25 Mrs Burnett-Price has undertaken training in conjunction with the staff team and has completed the registered managers award. Mrs Burnett-Price is closely involved with all aspects of the home. In her role as manager, Mrs Burnett-Price has regular contact with the service users and is usually available to deal with any issues directly. There was a requirement at the last key inspection that a report is produced of a review of the quality of care (Regulation 24 of the Care Homes Regulations 2001). This was followed up during the random inspection in June 2006. Mrs Burnett-Price had written a Quality Assurance report for 2006. The report described a ‘dialogue with each service user in an informal manner to establish needs and preferences’. The report stressed the importance of staff continuing to learn and gave details about current training. It also mentioned the ongoing decoration of the premises and how security has been addressed during the last year. To fully meet this requirement, the report needed to reflect more on the outcomes for service users and the feedback that has been gained. There had been discussion with Mrs Burnett-Price about how quality assurance could be developed, for example by looking at how well the home is responding to external inspection. The regulation concerning ‘quality of care’ has been amended since the inspection in June 2006 and information about this has been sent to Mrs Burnett-Price. A new requirement has been made in the light of the amended regulation, which requires registered persons to evaluate the quality of services provided at the home, including the extent to which requirements and recommendations identified by the Commission have been responded to. Recent inspections have highlighted shortcomings that have not been appropriately recognised and followed up through the home’s own systems. Requirements and recommendations continue to be identified in inspection reports, which show that the regulations and standards are not being addressed in a timely manner. Mrs Burnett-Price has reported that the home has no involvement with the service users’ financial affairs, as these are handled personally by the service users or by their families. Mrs Burnett-Price provided information about the arrangements for the servicing and maintenance of facilities in the home. Checks and tests of the fire precaution systems were reported to be up to date. The home’s fire risk assessment was looked at. Mrs Burnett-Price was in the process of completing a new assessment, using forms provided by a business services company. DS0000028653.V321546.R01.S.doc Version 5.2 Page 26 It has been recommended at previous inspections that automatic mechanisms are fitted to the bedroom doors, which will enable the doors to be safely kept in an open position. At a previous inspection Mrs Burnett-Price had said that she was looking at the options that are available. This was discussed further and Mrs Burnet-Price said that she was now telling service users that their doors needed to be kept shut. The home’s lift was inspected by an engineer in June 2006. The most recent date for the checking/ servicing of the bath hoist was given as 18 May 2005. A check should be made to ensure that the manufacturer’s recommended timescales for servicing and maintenance are followed. Risk assessments had been undertaken in relation to some environmental hazards, including hot water, and the risk they present to individual service users. As reported under standard 24, further action needs to be taken in connection with some environmental hazards. A risk assessment form was being completed with each service user. This listed a number of areas that could present a risk to service users. The risk of service users smoking in their own rooms was being assessed. The assessments covered a limited range of hazards and, as previously reported, the risk assessment forms have not always been completed in full. Accident reports, and on occasions R.I.D.D.O.R. forms, are being completed. The use of the R.I.D.D.O.R. forms was discussed with Mrs Burnett-Price. It is recommended that advice is sought about the occasions when these need to be completed and to whom they should be sent. DS0000028653.V321546.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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 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 X X X X X 2 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 2 X 3 X X 2 DS0000028653.V321546.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 OP9 Regulation 13(2) Requirement The registered manager must ensure that the administration of medication records are appropriately completed to make sure that there can be no misunderstandings about what medication has been given, which could result in service users being put at risk. Timescale for action 31/01/07 2. OP9 13(2) The registered manager must 31/01/07 ensure that an appropriate record is kept of the adjustments that are made in the dose of anticoagulant medication. (Further advice about the recording of this medication is available from the Commission’s pharmacist inspector). That the provision of activities in the home is reviewed following consultation with each service user to ensure that their individual needs and preferences are met. The registered manager must ensure that the radiators in the DS0000028653.V321546.R01.S.doc 3. OP12 16(2)(n) 31/03/07 4. OP25 13(4) 31/03/07 Version 5.2 Page 29 service users’ en-suite areas are included in the risk assessments of radiators and hot surfaces. Safety measures will need to be put in place, where indicated by the assessments. 5. OP25 13(4) (Previous requirement not met: ‘Individual thermostatic controls must be fitted to the baths’) Individual thermostatic controls must be fitted to the baths (The Commission must be informed if this is not reasonably practicable for technical reasons and of the alternative arrangements to be made for ensuring that the temperature of the hot water supply to the baths is maintained at a safe level). 6. OP27 18(1)(a) (Previous requirement not met: ‘Additional night time support and supervision must be provided to ensure that service users are safe and their needs are met’) The Commission must be informed of the long term arrangements to be made and of a date for completion / implementation. 7. OP29 19(1) Criminal Record Bureau disclosures must be undertaken in accordance with the Commission’s policy and guidance. (Requirement outstanding from previous inspection). That a report is produced which is based upon a system for evaluating the quality of services provided at the home, as required under Regulation 24 of DS0000028653.V321546.R01.S.doc 31/03/07 28/02/07 28/02/07 8. OP33 24 30/06/07 Version 5.2 Page 30 the Care Homes Regulations 2001. The Commission must be supplied with a copy of the report. 9. OP38 13(4) That checks are undertaken, for example of accident reports and of the aids and facilities in the service users’ rooms, in order to identify hazards that need to be assessed to ensure that service users are not at risk of harm. 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations That information about the home is more readily available and accessible to service users and others. (Carried over from previous inspection). That the system of care planning and recording is developed further to: • • • Include greater detail and information about all aspects of the service users’ needs and how these are to be met. Produce a clear means of recording reviews of the care plans and the service users’ progress with meeting their individual goals and needs. Identify in the care plans, e.g. by a system of crossreferencing, where risk assessments have been undertaken in connection with individual service users. 2. OP7 3. OP7 That each of the service users’ assessment forms is completed in full, including for example the section on ‘Service users’ views and contribution’. That service users are asked if they would like to receive a befriending service. That service users are offered the opportunity to have an DS0000028653.V321546.R01.S.doc Version 5.2 Page 31 4. 5. OP14 OP24 automatic mechanism fitted to their doors, which will enable the doors to be safely kept in an open position. (Carried over from previous inspection). 6. 7. OP26 OP26 That a hand-washing facility is provided in the laundry. (Carried over from previous inspection). That a check is made of the bedroom en-suite areas and action taken where necessary to ensure that these are in a hygienic condition and that service users are satisfied with the type of floor covering. That regular monitoring of service users’ activities and routines during the night is part of the assessment process (Carried over from previous inspection). That advice is sought about the occasions when R.I.D.D.O.R. forms need to be completed and who they should be sent to. 8. OP27 9. OP38 DS0000028653.V321546.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 DS0000028653.V321546.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. 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