Inspection on 31/07/08 for Western Rise

This inspection was carried out on 31st July 2008.

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

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

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Western Rise 27 Western Road Torquay Devon TQ1 4RJ Lead Inspector Rachel Proctor Unannounced Inspection 31 July 2008 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 Western Rise DS0000071543.V367881.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. Western Rise DS0000071543.V367881.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Western Rise Address 27 Western Road Torquay Devon TQ1 4RJ 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) 01803 312430 01803 312730 Dr Pepper`s Care Corporation Limited Samuel George Rose Care Home 37 Category(ies) of Dementia (37), Mental Disorder, excluding registration, with number learning disability or dementia - over 65 years of of places age (37) Western Rise DS0000071543.V367881.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia (Code DE) Mental disorder, excluding learning disability or dementia, aged 65 years and over on admission (Code MD(E)) The maximum number of service users who can be accommodated is 37. New Registration of an existing service. Change of ownership. 2. Date of last inspection Brief Description of the Service: Western Rise is registered to provide accommodation with personal care to older people (65 ) people with dementia (50 ) people with mental disorder (50 ) and older people with physical disability. It is able to provide service for up to 37 residents both male and female. The home offers 35 single bedrooms of which 24 have on suite facilities and 2 double bedrooms both of which are on suite. There are also communal toilets and bathrooms throughout the building. Accommodation is provided over 3 levels; lower ground, ground and first floor. The home has stair lifts connecting each floor. The home also has 3 lounges, 2 dining rooms two smoking rooms and a library. Western Rise is a large detached property set in its attractive and accessible grounds. It is located in the St. Marychurch area of Torquay and is within walking distance of local shops and amenities. Torquay town centre is a short bus ride away. The weekly cost of care at the home ranges from £350.00 to £1,451.00. The statement of purpose and the last inspection report were available in the office of the home. Western Rise DS0000071543.V367881.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was the key unannounced inspection, which took place over three days starting on the 31st of July 2008. The inspection was brought forward because of serious concerns raised about the care of one person who had been living in the home. A specialist tissue viability nurse was asked to review one persons care records. We followed the care of three people living in the home. This included seeing the rooms people occupied, speaking to them where possible and reviewing their plans of care. A tour of the home was completed with the manager. All the communal areas were visited and some peoples rooms were entered. During the tour of the home five people were spoken to in the privacy of their own rooms. Visiting professionals were spoken to regarding the care provided at the home. Documentation relating to the health and safety management of the home was viewed with the registered manager. Other records relating to the care of individuals living in the home were also seen. The records relating to the recruitment and employment of three staff working in the home were viewed. The records the manager held for training staff were discussed and reviewed with the manager. Supervision and appraisal were discussed with the manager and the template used to record supervision and appraisal was viewed. We reviewed the information received from the new providers since their registration. Comments received from healthcare professionals and people living in the home have been included in this report. What the service does well: There was a good core team of staff at Western Rise who provide care for people, which is responsive to needs. Staff appeared to have a good report with the people they were caring for. People spoken to who live at the home said the staff are friendly and help them with the things they need. Health professionals were complimentary about how staff cared for people with challenging behaviour. Health and social care professionals praised the way the manager had worked with them during a recent investigation. Western Rise DS0000071543.V367881.R01.S.doc Version 5.2 Page 6 People have a variety of communal areas provided for them. Which mean they can choose to take part in activities or sit quietly in one of the communal spaces. Meal times are a pleasant experience for people who live at Western Rise. Their personal preferences for food are taken into account when meals are provided and they can chose where they eat their meals. What has improved since the last inspection? What they could do better: Although the manager reported in the AQAA (Annual Quality Assurance Assessment) that the care plans had been improved and up dated these were still not capturing sufficient information to ensure peoples care needs were fully met. The risk assessment processes for manual handling, nutritional risk and pressure sore risk had not been up dated, as people’s needs had changed. The care plans also contained previous care plans, which were filed with the new care plan; this made them difficult to follow. The way care plans are recorded and managed puts people at risk of not having their care managed in a way that clearly identifies risk and how staff should act to manage this when people’s needs change. One person had not been referred to the district nurse team when their care needs had changed. The pressure sore risk assessment had not been up dated. This would have shown they were at risk of developing pressure sores and needed referral to the district nurses. Other people who the manager had identified as at risk of developing pressure sores had been referred to the district nurses. However their pressure sore risk assessment had not been updated. The care plans did not have the person’s preferred name recorded and the name of their GP was not easily found in the care plans. This may mean people are reliant on staff always remembering how people like to be addressed and which GP to contact if they became unwell. Western Rise DS0000071543.V367881.R01.S.doc Version 5.2 Page 7 Several baskets of personal items of clothing were awaiting ironing in one of the communal areas on the lower ground floor close to the laundry. The way staff are deployed may not give them sufficient time to complete the ironing. It also means that people may not have their personal items of clothing returned to them in a timely way. 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. Western Rise DS0000071543.V367881.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 Western Rise DS0000071543.V367881.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): 1,3,6, Quality in this outcome area is adequate. People are given sufficient information about the home to make an informed choice about whether the home can meet their needs. The assessment process adopted by the manager should provided sufficient information for people to have their care needs met. However identified assessed needs are not always followed up in the plan of care. This means that people may not have all their care needs met. The home does not provide intermediate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and Service Users Guide had been revised when the home registered new ownership. The manager advised that the Statement of Purpose and service users guide were available for people who ask. Some information about the home and its services was displayed in the reception area of the home, this included information about how to make a complaint, Western Rise DS0000071543.V367881.R01.S.doc Version 5.2 Page 10 and a notice advising that a copy of the last inspection report could be obtained from the office of the home. The three people whose care was followed had assessments completed, which identified that persons care needs. The assessment process adopted by the manager included the person’s health summary, and establishing the person’s normal routine: the type of food they liked, the time they like to get up or go to bed and what sort of activities they liked. Where a care management assessment had been completed this was included with the persons care plan. The person’s GP and their preferred name were not recorded on the assessments seen during the inspection. One person’s records showed a completed care management assessment along with their care plan. The care management assessment indicated how staff should care for the person to prevent problems with their hip following a hospital admission. However this had not been followed through into the homes care plan. This meant that the preventative advice given by health professionals on discharge was not available within the care plan that care staff refer to. This meant that the person relied on staff remembering how to provide this specific care. The home does not provide intermediate care. However the home does offer short respite stays for people who need this. Western Rise DS0000071543.V367881.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. Some people, particularly those with more complex physical health needs, had poor care plans and inadequate risk assessments. Changes in people’s needs were reliant on staff remembering what to do without reference to written details. This puts people at risk. Staff appeared to be skilled caring for people who presented with challenging behaviour. Staff were polite and respectful to the people they care for. People’s privacy and dignity was being upheld by the care practices in place. Medication practices in the home are satisfactory. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three people had their care followed as part of this inspection. This included meeting the person and viewing the room they used in the home. The care Western Rise DS0000071543.V367881.R01.S.doc Version 5.2 Page 12 plan of one person living in the home indicated in the daily evaluation that their ability had decreased over the last two weeks. However the plan of care had not been updated to reflect the changes in the persons ability to mobilise. The risk assessment for manual handling and pressure sore prevention had not been updated following the change. This meant the person was reliant on staff passing information verbally as to how they should handle them and prevent pressure sores. The manager provided information that the district nurses had been asked to review this person because their mobility had decreased. When the district nurses were spoken to they confirmed that the manager had recently referred seven people to them who he felt were at risk of developing pressure sores. However the information in three care plans did not show that the referrals had been made as a result of an up dated risk assessment for pressure sore risk or recorded increased dependency of the person. One more able person living in the home had their care plan reviewed. They were able to confirm that staff had spoken to them about the care they needed and how best to help them. There was clear information in the care plan regarding an activity that person took part in, which presented some risk. The care plan provided information for staff about how they could work with the person to help them reduce the risks identified. The person said they wanted to be able to reduce the activity they had chosen and the staff were helping them to do this. The information in the care plans viewed contained clear information about how staff should manage a person’s mental health problem. One person who had challenging behaviour and some times refused care had this clearly recorded in their care plan. Information regarding how staff should respond to continue to support and care for the person was also included. Staff observed providing care appeared skilled at distracting the person away from something that was agitating them. Staff were seen leaving people who refused care and going back a few minutes later when the person was more receptive to having help. One of the senior staff spoken to said they had learned over time how to respond to people who may at first refuse care. Two people whose care was followed had complex physical and mental health problems. Although staff were monitoring food and drink intake a recognised nutritional assessment had not been completed. This may mean that the nutritional risks had not been assessed. The person’s likes and dislikes for food and whether they needed a soft or special diet had been recorded. The manager advised that if a person has a poor appetite they monitor the amount of food they eat and record they weight where possible. A fluid balance chart was seen in two of the individual peoples rooms entered. These had been completed over a 24-hour period by staff assisting the person to drink. A sit on scales was provided to weigh people. The district nurses had been asked for advice regarding the pressure area care for two of the people whose care was followed. Both had pressure-relieving Western Rise DS0000071543.V367881.R01.S.doc Version 5.2 Page 13 equipment and had been assessed and provided with the equipment by the district nurse team; however the pressure sore risk assessment had not been reviewed when their care need had changed. It was clear from one person’s daily records that their ability to mobilise had deteriorated over the previous month – but their manual handling and pressure sore risk assessment had not been reviewed to reflect the changes. The district nurses advised that they had not been asked to see the person until after the person had developed pressure sores. One person whose care was followed had an assessment by a community Physiotherapist during the inspection. They advised staff how best to move the person and recommended the use of a hoist for all transfers. One of the senior carers spoken to said they had been using a hoist when the person’s ability changed. Their manual handling risk assessment had not been up dated to reflect the changes. The physiotherapist reported that two staff they spoke to gave different information about how the person should be moved. One indicated the use of a hoist, the other said they manually assisted the person to stand. The person had been cared for in their own room because they had been unwell. The physiotherapist advised that they should spend time in the lounge with other people, as they were known to enjoy company. The staff at the home did this during the inspection. Three people being cared for in their own rooms did not have their call bell with in reach. The manager advised that they were unable to use the call bell and staff checked on them regularly to see they were all right. However the care plans did not include a risk assessment for the use of a call bell and what actions staff should take if they were assessed as unable to use this. The manager advised that this would be done. People being cared for in their own rooms had drinks with in easy reach. Those that needed assistance to drink had a record of the drinks they had had during the day. Medication records were checked for the people whose care was followed. These had been completed as expected. Medication was seen to be signed for by the member of staff giving the medication. A record of medication returns had been signed. A controlled drug record book was being completed in addition to the individual’s medication sheet for those who were taking controlled drugs. The manager and two senior carers confirmed that only staff who had been trained to do so administered medication. Western Rise DS0000071543.V367881.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. The activities provided are suitable for the people living at Western Rise. The planned improvements to the activities provided, following discussion with people living at the home will further enhance the opportunities people have at Western Rise There was a good choice and variety of food provided, and peoples’ individual preferences are respected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager advised that people living at the home had been asked at a resident’s meeting about the activities or entertainments they would like. One person asked said they had suggested having a minibus for the home so they could get out more. They said the activities had improved since the new owners had taken over. The garden had been made easily accessible and a patio area created. The manager advised that two outdoor games had been provided. He also advised that now the garden had been completed they were planning to have a barbecue weather permitting. Western Rise DS0000071543.V367881.R01.S.doc Version 5.2 Page 15 Since the new owners have taken over the home people are provided with a newsletter each month, which gives information about the home and the activities planned. The owner advised in his newsletter in July that a copy of the results of the entertainments questionnaire would be posted on the notice board in the home and available in the office. It also noted that two of the most popular requests were a trip to the seaside and the pub. It had advised in the newsletter that these would take place. One of the residents asked said they hoped the weather would improve enough for them to be able to spend more time in the garden. People were using all the communal areas during the inspection. Some were sitting in one of the two conservatory areas having a smoke. Others were sitting in one of the two communal lounges either watching television or chatting to each other. Visitors were coming in going throughout the inspection. They were seeing people in the privacy of their own rooms or in one of the communal areas available. When health professionals visited individuals they were seen in the privacy of their own rooms. The manager advised that some of the people living in the home like to smoke. An example of a risk assessment completed for people who were able to do this safely was seen. The manager advised that where the persons access to cigarettes had been reduced and monitored by staff this was recorded in a plan of care and agreed with the person. An example of this was seen. The home has two designated smoking areas for people who wish to smoke. This means that people who dont smoke have access to a smoke-free environment. A choice of meals were being offered, people who were able to respond said they liked the meals. The cook who had worked at the home for several years said the menu was put together with the senior staff after discussion with the people living at the home. They said they had found that people usually preferred traditional English food, although occasionally they did have other options available such as curry. Fresh vegetables were being used on the day of the inspection. The cook advised meals are cooked fresh each day and alternatives are offered if the person doesnt like whats on offer. Food was being pureed separately for people who needed this. This allows people to experience different tastes of foods. Individual care plans used included peoples personal likes and dislikes for food and if they needed any specialist diet. Staff were seen to be assisting people to eat their meals discreetly. The manager advised that a designated staff member gave people who needed it help to eat their meals. The five people asked said they enjoyed the meals provided. Western Rise DS0000071543.V367881.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): 16,18 Quality in this outcome area is adequate. People can have confidence that any concerns they have will be listened to, taken seriously and acted on promptly. The home has an appropriate adult protection policy and staff are trained in its use, however, staff do not always align this with ensuring a proactive approach, so that peoples needs are properly predicted and met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who are able said they knew who to speak to have had any concerns. People living in the home were coming to the office to see the manager about any issues they had. The manager or senior staff on duty dealt these with sensitively and promptly during the inspection. The (AQAA) Annual Quality Assurance Assessment indicated that their had been three complaints since the last inspection. Records of complaints received including staff disciplinary records were seen during the inspection. The record of complaints received and the actions taken to address the complaint were provided for inspection. This showed that the concerns people have are taken seriously and action taken to address the concern raised. A copy of the complaints procedure was displayed in the reception area of the home. The manager advised that this had been up dated recently. Western Rise DS0000071543.V367881.R01.S.doc Version 5.2 Page 17 The Commission has received one safeguarding adults alert since the change of ownership. The manager has cooperated fully with those caring out the investigation. However the records of care being kept for this person did not support that staff ensured they received all the health care they needed. District nurse advice had not been sought when the person’s care needs changed. The person developed pressure sores before being referred to the district nurse. The pressure sore risk assessment and manual handling risk assessment had not been up dated when the person’s care needs changed. Had these been completed in a timely way it would have alerted staff that the person needed referral to the district nurse team. This meant that the management of their care did not fully protect this person. The home has an appropriate adult protection policy and procedure in place. Training has been provided for carers; three carers spoken to were clear on the procedure and what action should be taken if abuse was ever discovered. Western Rise DS0000071543.V367881.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): 19,26 Quality in this outcome area is adequate. The quality of the furniture and furnishings at Western Rise was dependent on where the individuals room was in the home. This means that people living in Western Rise dont all have the same standard of décor and furniture available. The home was being kept fresh and clean for the people who live at Western Rise. However the way their personal clothing laundry was managed may mean that their clothes are not returned to them quickly after they had been washed. Staff have an infection control policy to guide them. Protective gloves and aprons are provided. This should mean people are protected from cross infection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Western Rise DS0000071543.V367881.R01.S.doc Version 5.2 Page 19 A tour of the home was completed with the manager. The room’s people were occupying and some empty rooms were seen during the inspection. The majority of the lower ground floor rooms had lino flooring. Two of the rooms entered had a slight odour. A further three rooms on this floor had furniture that either had broken drawer fronts or damaged wardrobe doors. The lower ground floor also had the older style call bell system. The manager confirmed that the display boards in the home picked up when a call bell was used wherever you were in the home. The lounge, dining room and conservatory area on the lower ground floor had worn furniture and carpeting. The rooms on the ground and first floor appeared lighter and some had been redecorated. People were using the communal lounge and dining room on the ground floor during the inspection. These areas looked brighter and fresher than the communal space on the lower ground floor. One room entered on the upper floor had had the window restrictions removed from the window in the room and in the en suite bathroom. There was a significant drop from the window. The manager advised that the window restrictors would be replaced that day. By not ensuring the window above ground floor was restricted opening to the recommended 4 inches puts people at risk. Several hoists and pressure relieving mattresses, which had been provided by the health teams were available for people who needed them. Two people whose care was followed had airflow pressure relieving mattresses in place, which had been provided by the district nurse team. Disabled access bath and showers are provided on each floor for people who need them. One bathroom on the lower ground floor had grout missing around the bath and the bath enamel was damaged. The manager confirmed that some of the bathrooms were due to be refurbished to provide better access for people. The home was fresh and clean in most of the areas entered during the inspection. A cleaner was working in the home during the inspection. They advise that they clean the rooms and communal areas as required. A room adjacent to the lower ground floor lounge. Which had been used as a reading room for people living in the home had five baskets of laundry waiting to be ironed. The manager advised that the night staff do the ironing if they are able. One of the senior carer said that each shift each carer has responsibility for a set number of people in the home. They further commented that they had responsibility for making sure the person had the clothes they needed and would iron clothing for them if necessary. The senior carer also confirmed that as part of their duties carers put peoples clothes in the washing machine and dryer during the shift. Although the senior carer said the system was working. The amount of laundry waiting to be ironed may mean that people dont get their clothes returned to them in a timely manner. Western Rise DS0000071543.V367881.R01.S.doc Version 5.2 Page 20 The laundry area was on the lower ground floor, the manager advised of planed improvements and extension to the laundry, which were due to take place. He confirmed that this would enable space for peoples clothes to be sorted and hung up while awaiting ironing. One of the newsletters provided during the inspection indicated that the laundry upgraded had been approved and they were waiting for this to be completed. Gloves and aprons were available for staff to use when providing personal care for individuals. A yellow bag system was in place for disposal of clinical waste. A policy relating to infection control was in place and available for staff. The manager advised that training for infection control had been provided for staff. Western Rise DS0000071543.V367881.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): 27,28,29,30. Quality in this outcome area is adequate. The way work was organised and staff deployed in the home means that some of the care staff time was taken up with domestic tasks. This may limit the time staff have to spend with individuals living in the home. The home’s management team were committed to ensure staff have access to (NVQ) National Vocational Qualification training that will improve their knowledge and skills. Recruitment practise are adequate to protect people from unsuitable staff. Although staff appeared to be managing peoples challenging behaviour well, staff had not routinely received training for managing challenging behaviour. This may mean staff do not have a clear theoretical understanding of how to manage people who have challenging behaviours. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager provided a duty rota for a four-week period, which showed the number of staff on duty each shift in what capacity they were employed. This showed that more staff were on duty in the morning. They were 26 people living at home at the time of this inspection. The duty rota showed the two staff were on duty at night. Western Rise DS0000071543.V367881.R01.S.doc Version 5.2 Page 22 In addition to the care staff a Cook, domestic and maintenance personnel are employed. However the duty rota showed that domestic staff were not routinely employed on a Sunday. The manager and two of the senior carers confirmed that the care staff on duty during Sunday carry out cleaning tasks, as they are needed. One of the senior carers employed had also covered as the cook for two days in July. The cook on duty during the inspection advise that they prepare the lunchtime meal and prepared food for the evening meal for staff to give people. This can be sandwiches or food that needs heating such as a quiche. One of the daily worksheets provided by the managers showed that named carer’s were allocated to complete the laundry on the upper and lower floors both for the morning and afternoon shift. The afternoon duty shift also included setting up the tea trolley for afternoon tea and tidying and cleaning the kitchen. The duty rota showed that the domestic works 8 a.m. until 2 p.m. six days a week. And the cook works morning shifts between 8 a.m. and 3 p.m. The manager confirmed that one of the senior carers works as the cook when the cook isnt available. This ensures that someone to cook the food was available seven days a week. The staff spoken to during the inspection confirmed that they had been encouraged to complete a National Vocational Qualification (NVQ) in care. Two of the senior carers spoken to said they had completed an NVQ level 3 and had found this really helpful. One new member of staff spoken to said they had been encouraged to complete training and had starting their NVQ training. They also said they felt supported to learn and do their work. The manager advised that 8 staff had achieved an NVQ level 2 or above and a further 3 staff were working towards an NVQ qualification. This information was also provided in the (AQAA) Annual Quality Assessment Audit. The manager advised that some of the staff had worked at the home for several years and there had been a low staff turn over. The staff spoken to said they enjoyed working at the home and felt able to make suggestions about care issues. Three staff files were seen during the inspection. Two from long standing staff and one form a member of staff appointed since the last inspection. Two staff who had worked at the home for some time only had one reference on file. The new member of staff had two “To whom it may concern”, references with no record that these had been followed up by the manager. It was unclear in the files seen whether the previous employer had been asked for a reference for one staff member. Police checks had been completed for the staff whose files were seen. The manager advised that he obtains a POVA first check before staff start work in the home supervised until the police check’s returned. One new member of staff confirmed that they started work at the home after their police check had been returned. Western Rise DS0000071543.V367881.R01.S.doc Version 5.2 Page 23 All the staff spoken to during the inspection said they had access to training that improved their knowledge and skills. Two saying that their access to training had improved since the change of ownership. The new member of staff spoken to had completed induction training. The manager confirmed that the skills for care induction programme would be used for all new staff joining the home. Examples of this were seen; this was also stated in the returned AQAA. The manager was asked about the reference material available for staff. Very little reference material information was provided for staff. The staff asked said they would speak to the manager or other senior staff if they wanted more information. The training records were discussed with the manager. Training for problems specific to some of the people being cared for in the home had not been completed. The five staff spoken to said they had not received training for managing challenging behaviour. They said that they had learned how to manage challenging behaviour by experience and working with staff that understood this. The home cares for several people who have challenging behaviour. This means that the way staff manage this has depended on their experience of working with people not training. The manager confirmed that key staff had received Mental Capacity Act training locally. This should ensure that staff are aware of recent changes in legislation for people who lack capacity. Training for management of pressure areas had also not been provided. The care plans seen had not had the pressure sore risk assessments up dated when the person’s ability had changed. The manager advised that a registered nurse trainer organised by the provider was due to provide training for managing challenging behaviour and pressure area care training in August. There were clear records that staff had received mandatory training for fire, health and safety and manual handling. The manager confirmed that only staff who had received training managed peoples medication. The staff spoken to during the inspection backed this up. Western Rise DS0000071543.V367881.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): 31,33,35,36,37, 38. Quality in this outcome area is adequate. The manager tries to run Western Rise in the best interests of the people who live there. People are encouraged to attend meetings where they can express their views and influence the way the home’s run. The management of the home was generally satisfactory. However there were some areas that could be improved. These related to records of risk management for individuals being up dated as needs change. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has several years experience in care and has achieved an NVQ level 4 in management. They have acted responsible to address any concerns raised by the inspection process. The manager confirmed that he has continued to keep up to date with changes, advising he had recently completed Western Rise DS0000071543.V367881.R01.S.doc Version 5.2 Page 25 Mental Capacity Act training. There were clear lines of accountability in the home. Three deputy managers who have been given extended duties have been appointed since the change of ownership to support the manager. He advised that the duty rota shift system was being changed to ensure a senior member of staff was on duty for each shift. Two people living in the home said they had been able to make suggestions about the activities provide and meals at residents meeting. The newsletters provided showed that some suggestions people had made had already been implemented. The home manager returned the AQAA Annual Quality Assurance Assessment when it was asked for. This provided information about how they plan to improve and what has been achieved since the last inspection. One person spoken to said that things had improved since the home had changed ownership and they were looking forward to the new activities planned. One relative spoken to said they looked after their relative very well and always kept them informed about the important things. The records of expenditure for individuals were being kept on a computer database. This provided a balance of money left after expenditures had been taken out. The manager confirmed that each person record was up dated when money was handed in or a purchase made. Supervision and appraisal records were being completed. The manager confirmed that these had improved and staff would receive at least six supervision sessions a year. He also advised that training and development plans would be up dated at staff annual appraisals. An example of this was seen. The five staff spoken to said they were supported to do their work and had access to training. The AQAA Annual Quality Assurance Assessment provided information about the policies in place. The manager confirmed that these were being up dated to ensure they reflected current practice and were up to date. The fire logbook had been completed and showed that staff receive training. A fire hazard assessment had been completed in July 2008. This was available during the inspection. The manager confirmed that 12 staff had recently completed a first aid course and this enabled him to have a first aider on duty each shift. The staff were congratulated in one of the newsletters provided for the inspection. The manager has a risk assessment tools for manual handling, falls risk and pressure sore risk. However these had not routinely been up dated when peoples needs change or at the monthly care plan review. This may mean that Western Rise DS0000071543.V367881.R01.S.doc Version 5.2 Page 26 the risks people have are not fully recognised and people will rely on staff who understand them and know their needs have changed caring for them. A record of accidents was being kept. These recorded what actions were taken by staff at the time. The manager advised that he reviews these on a regular basis. Western Rise DS0000071543.V367881.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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 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 1 2 X X X X X X 2 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 3 X 3 X 3 3 2 2 Western Rise DS0000071543.V367881.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 OP3 Regulation 14(2) Requirement Timescale for action 01/12/08 2 OP8 13(b) The registered person shall ensure that the assessment of the service user needs is. (a) Kept under review; and (b) Revised at any time when it is necessary to do so having regard to any changes of circumstances. This relates to ensuring assessed needs are followed up with a care plan and risk assessments for manual handling, prevention of pressure sores and falls risks are up dated as the persons needs change. The registered person shall make 01/12/08 arrangements for service users(c) To receive where necessary, treatment, advise and other services from any health care professionals This relates to district nurses advice not being sought when a persons dependency and ability to mobilise changes. Risk assessments for prevention of pressure sores must be updated DS0000071543.V367881.R01.S.doc Version 5.2 Western Rise Page 29 3 OP18 13(1)(b) 4 OP19 23(2)(d)( m) 16(2) (c) as a persons needs change. This should prompt staff to refer to district nurses in a timely manner The registered person shall make 01/10/08 arrangements for service users(d) To receive where necessary, treatment, advise and other services from any health care professionals This relates to district nurses advice not being sought when peoples dependency and ability to mobilise changes. Risk assessments for prevention of pressure sores must be up dated as peoples needs change. This should prompt staff to refer to district nurses in a timely manner. 01/01/09 The registered person shall having regard to the number and needs of the service users ensure that – 23 (e) all parts of the home are kept clean and reasonable decorated. (m) Suitable storage facilities are provided for the service users. 16(c) provide in rooms occupied by service users adequate furniture, bedding and other furnishings, including curtains and floor coverings, and equipment suitable to the needs of service users. This relates to the standard of accommodation provided for people on the lower ground floor - furniture, which includes chest of draws and wardrobes being damaged with missing drawer Western Rise DS0000071543.V367881.R01.S.doc Version 5.2 Page 30 4 OP26 16(2)(e) fronts and damaged wardrobe doors. The registered person shall having regard to the size of the care home and the number and needs of the service users(f) Arrange for the regular laundering of linen and clothing This relates to peoples individual clothing being laundered, ironed and returned to them in a timely way. Several baskets of peoples clothing were being stored in a communal area awaiting ironing. 01/12/08 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 4 5 Refer to Standard OP7 OP27 OP29 OP37 OP38 Good Practice Recommendations The service users plan should include a plan of care for all the care needs identified in their assessment of need. The manager should consider the way staff are deployed in the home, to ensure that individual peoples clothing is not left in communal areas awaiting ironing. The manager should ensure that recruitment of new staff includes obtaining two written references one of which includes the last employer. Records relating to care planning should be kept up to date and easy to follow. The manager should ensure that risk assessments for individuals, which include manual handling, nutritional risks and pressure sore risk are up dated monthly or when peoples needs change. Western Rise DS0000071543.V367881.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Western Rise DS0000071543.V367881.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!