Inspection on 18/05/06 for Windmill Lodge

This inspection was carried out on 18th May 2006.

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

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

Other inspections for this house

Windmill Lodge 09/11/06

Windmill Lodge 05/11/05

Windmill Lodge 09/06/05

Windmill Lodge 13/10/04

Windmill Lodge 05/05/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Windmill Lodge 115 Lyham Road London SW2 5PY Lead Inspector Lynne Field & Mary Magee Unannounced Inspection 18th & 20th May 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000058177.V290351.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. DS0000058177.V290351.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Windmill Lodge Address 115 Lyham Road London SW2 5PY 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) 0208 674 4940 Windmill Healthcare Ltd Ms Grace Ebun Ale-Olurin Care Home 93 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0), Physical disability of places over 65 years of age (0) DS0000058177.V290351.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. There must be team leaders on every floor. Respite care must be limited to 4 beds on the ground floor and 4 beds on the first floor. Intermediate care must be restricted to the third floor only There must be a minimum of two nurses on shift on each of the first and second floors during the waking day and a minimum of one nurse on the third floor on each shift during the waking day. 5th November 2005 Date of last inspection Brief Description of the Service: Windmill Lodge Care Centre is a modern purpose built care home with nursing facilities run by Excelcare for 93 older persons in Brixton. It was first registered in January 2004. There are eight respite beds in the home, which are limited to four respite beds on the ground floor and four respite beds on the first floor. Initially there were plans for intermediate care on the third floor. After consulting with the CSCI, the home has opened this floor to provide nursing care for 13 service users. There is a general store next to the home, which is frequented by service users and staff. Brixton shopping centre with a variety of transport links is a short drive one way from the home and about the same distance in the other direction is Streatham Hill shopping centre and station. The registered person said the current range of fees is charged from £350-00 per week. Additional charges are made for things such as hairdressing and newspapers. DS0000058177.V290351.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection consisted of two visits during May 2006. The inspection was unannounced and on the first day two inspectors spent seven hours inspecting all four floors of the home. During this time comments were received from twelve service users and five relatives. The inspectors also spoke to eighteen staff, from senior managers through to domestic staff. A care manager and a specialist nurse from the hospital team visiting the home also provided feedback on the services. Documents and records the home is required to keep were also inspected. The second visit involved one inspector attending a relatives /service user meeting that was held two days later at the home. Observations were made of working practices at the home and the response to issues raised by service users and relatives attending the meeting. Some of the information in this report was gathered from other professionals and relatives before and during visits to the home. The daughter of one service user spoken to on the inspection day spoke positively of her family’s experience, she attends the home several times during the week, she said “I have never heard a cross word spoken by any member of staff in all my time visiting the home”. The CSCI pharmacy inspector went into the home on a separate visit to inspect the medication of the home. This has been incorporated into the report. What the service does well: The home’s management show a good attitude towards making necessary changes to improve the lives and experiences of service users, providing a caring and thoughtful service for service users and their relatives. Involvement of the service users and their families in care planning is good. The relative of one service user spoke well of the support given, and commented on the staff being very kind and helpful, saying that the home was improving. There are no restrictions on visiting times and relatives and friends say they are made welcome. Service users say that the food is good and there is a friendly atmosphere in the home. Staff listen to service users and their relatives concerns and complaints. DS0000058177.V290351.R01.S.doc Version 5.2 Page 6 The managers have trained most of the staff in how to best protect service users from abuse and in how to quickly report any suspicions of abuse. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000058177.V290351.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000058177.V290351.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Most service users or their representatives sign terms and conditions on admission to the home. Efforts are being made to contact the relatives where service users lack capacity to agree the contracts. Service users have their needs assessed by senior staff before they move to the home and know that the home can meet their needs before they move there. Prospective service users and their relatives can come and look around the home and meet staff before they decide to move there. An intermediate care service is not provided. EVIDENCE: Copies of the statement of purpose and service user’s guide has been revised and developed for the home. Copies of these have been sent to the CSCI and the inspectors noted that copies of these were present in service users’ rooms. DS0000058177.V290351.R01.S.doc Version 5.2 Page 9 Contracts have been developed with service users that outline the terms and conditions of their stay at the home. A number have been signed. However, where service users lack capacity staff are waiting for relatives to agree the contracts. The registered manager described the process for assessing a potential service user and how senior staff will visit the service user. The healthcare needs of service users are assessed and recorded in care plans. Relatives the inspectors spoke to confirmed that they were able to visit the home with their relative to have a look around and meet staff before they decided to move there. Service users are registered with a GP that visits every week for surgery and responds promptly to any urgent calls in between. The GP attended the relatives /service users’ meeting. He explained that his surgery is held weekly at the home but that other visits are also done in response to emergency calls. He also discussed capacity to consent to treatment and the flu vaccine. One inspector spoke to two visiting professionals. A care manager undertaking a six week placement review provided positive feedback and indicated that the service user was settled and that the placement was good. She said the home was fully meeting her needs. Comments received from the specialist nurse visiting to review PEG feeds were that staff now followed recommendations she had made and that service users benefited as their conditions responded well to treatment. Service users are able to pursue hobbies that they enjoyed before moving to the home. The home provides a range of activities but these are not developed according to individual needs or preferences. The social care needs for all service users are not recorded fully. As a number of service users lack the capacity to indicate their preferences or give a full picture of what sort of activities they enjoy. Previous life histories and interests are unavailable for all service users because of this. This is detailed under standard 12. DS0000058177.V290351.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning and meeting the service users healthcare needs has improved but there are still gaps in the recording of changes of health care needs, which result in service users’ healthcare needs not being fully assessed or met. Medication handling and recording has improved, and is now of an acceptable standard, ensuring the safety and health of the service users. EVIDENCE: A total of sixteen service users’ care plans and daily records from all four floors were viewed during the inspection. Staff are in the process of updating all the care plans. The majority of care plans had been recently reviewed and evaluated to include changes to individual care and support needs. Of the files sampled during this inspection there was evidence that this area had improved but there were still some care plans that had not been signed and dated. DS0000058177.V290351.R01.S.doc Version 5.2 Page 11 The inspectors noted there were a number of improvements in the care provided. The care plan inspected contained some clear information on how individuals should be looked after and how it was to be provided. Not all individual areas of need (particularly for service users suffering from dementia) are addressed in the service user care plans in a way that describes how to meet these needs. As stated above there are some improvements in how health care needs are met but there are still some areas of shortfall found in the care delivery. An area of shortfall identified in care planning was that the information recorded on evaluation records was not always transferred to care plans. This makes it more difficult for staff to follow, as it is the guidance notes on the care plans that are read and followed and not those on evaluation sheets. Risk management strategies were in place. Information recorded on care plans included how to manage service users with challenging behaviour, how to minimise the risk of falls, supporting service users with swallowing difficulties. With records of risk assessments were written agreements on the use of cot sides for some service users. There was evidence that the use of cot sides were reviewed regularly. There were occasions that the review indicated that they were unsuitable and that their use was discontinued. On occasions when service users’ needs have changed, these were not always recorded in the care plans. One example seen by the inspector was there were incorrect details about a service user with a catheter. The requirement is repeated until all files are consistent in this area. The staff spoken to, demonstrated they were familiar with the cultural and religious needs of service users, which was recorded, such as special dietary needs relating to spiritual observations. The nutritional needs of service users are monitored. Regular weighing takes place. Those with notable changes in weights are highlighted and consultations take place with the GP. The inspector spoke to a specialist nurse from the HEN team, who was at the home reviewing the needs of service users on PEG feeds. She told the inspector she had found that improvements had taken place in the way these service users’ needs are met. The most notable improvement she had found was to the way in which the care of the PEG sites and the care recommendations that had been made on the previous visit had been responded to by staff. The fluid charts that were inspected had been maintained and kept up to date for these service users. However, these records are not easily accessible and are kept on separate files in the office. The inspector met with the family of one service user. They supported the service user to drink fluids. However, DS0000058177.V290351.R01.S.doc Version 5.2 Page 12 the records of fluid intake were not kept near the service users which could make accurate recording difficult. A recommendation is made about this. An area where further improvements in the recording on care plans is needed is in relation to the support requirements of service users with swallowing difficulties. Daily diary records seen did not indicate that service users received the soft diet specified in the care plan or that thickeners were used in drinks. Nursing staff demonstrated to the inspector an awareness of the support needs of service users with swallowing difficulties but the inspector found many of the carers required further training on the importance of supporting safely service users with this condition. The inspector noted there was equipment in the home that was being used by service users, such as pressure-relieving equipment. One service user, who was at risk of developing a pressure ulcer, was identified as not having the required equipment by the inspector. The nurse explained to the inspector that the pressure-relieving mattress that had been supplied was faulty and had been sent back to suppliers. This has resulted in the service user being without an appropriate mattress in the meanwhile. During the inspection a suitable mattress was secured by the nurse in charge and was placed on the service user’s bed. Records were seen of appointments service users had attended with other healthcare professionals. These included the chiropodist, the optician and the dentist. The inspector viewed copies of referrals made to physiotherapy and occupational departments. For one service user an excessively long period has lapsed. Relatives spoken to have found this distressing and would like to see such lengthy delays followed up by staff. At the relatives meeting the GP explained that for some facilities available from the NHS such as physiotherapy and occupational therapy have long waiting lists and that response to referrals are slow. A recommendation is made about this. There are policies and procedures in the home aimed towards protecting and respecting service users’ privacy and dignity. There are no shared rooms and all rooms have en-suite facilities. Service users and their relatives talked about how the staff team within the home were caring and worked very hard. Staff were seen to knock on service users bedroom doors before they entered. Staff addressed service users by their preferred names and talked to them respectfully. The CSCI pharmacist inspected the medication standard. Medication handling has improved since the last inspection by the CSCI Pharmacist. There were no out of stock medicines, the GP and supplying Pharmacy are providing a reliable service, all Medication Administration Record (MAR) charts were inspected, and were accurate, residents have had medication reviews, storage facilities are acceptable, medication procedures are in place and are being followed, and the home is conducting regular audits on each unit to pick up and address issues DS0000058177.V290351.R01.S.doc Version 5.2 Page 13 with medication handling and recording. A system to ensure medicines refusals are notified to the GP in time was implemented in February 2006 which is good practise. Areas to be improved on: -Only one service user is self-administering. Although this is low for such a large home, the home is now going to assume that service users will selfadminister their medication unless they have been risk-assessed as not being able to. -At least six service users were on medication for Urinary Tract Infections, four on one floor. Some of these service users have catheters. The home must ensure that fluid intake is adequate and that infection control procedures are being used effectively. There is new guidance available of the Department of Health website, Essential Steps to Safe, Clean Care. -Certain blood glucose monitoring and lancing devices are for single-patient use only. There have been several MHRA alerts in the last 2 years on the use on these devices, and the possibility of cross-infection if the wrong device is used. The home must check that both the monitoring device and the lancing device are suitable for multiple patient use. More information is available on the MHRA website. -Homely Remedies (over the counter medicines for minor ailments) are occasionally given to staff. This is not good practise; Homely Remedies should only be used for service users’. DS0000058177.V290351.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The activities organiser has worked very hard. However, despite these efforts there are not sufficient suitable activities for service users in the home, leading to under stimulation. There is a need to record service users interests and life styles in care plans so that relevant activities can be provided. Meals are nutritious and well balanced. Service users are consulted about menus. EVIDENCE: There was evidence of some service users leading lifestyles that were fulfilling and that gave them great pleasure. An exhibition of miniature furniture made by a service user was displayed in the reception area. The service user told the inspector how much he enjoyed life at the home. He likes living at the home and finds that it has given him a new lease of life. He likes the fact that there is always company and that staff find time to chat with him. DS0000058177.V290351.R01.S.doc Version 5.2 Page 15 Another service user spoken to likes to have time to herself and prefers her own company. She said that staff are kind and caring but that she experiences some difficulties with communicating with a small number of staff. She is hearing impaired but family members present said that she does not like using a hearing aid. The registered manager said that staff, whose first language is not English, attend language classes. Relatives attending the relatives meeting agreed that staff were kind and were hopeful that following these classes that communication would improve. A three month activities planner seen by the inspector, showed that a variety of activities are planned. These range from daytime tours outside to barbeques at the home. Generally, more development is needed so that service users lead fulfilling lifestyles. One service user has an orientation board in her room. This was supplied by family and is used by staff as well as a means of communication. This form of orientation would also benefit other service users. Not all the life reviews have been completed for service users. There is a lack of essential information available on care plans about individuals’ interests and backgrounds. Some of this is due to the fact that some service users that lack the capacity to put forward their views and that there is very little involvement from family and friends. As a result there is insufficient information available on to develop appropriate activities to reflect their preferences. A requirement has been given for this. The inspector met the new activities area manager, who was appointed in December 2005. She told the inspector she planned to meet the homes activities coordinator and managers to discuss the activities programme. She plans to have the activities coordinators assess each service user and record the assessment as part of the development of the activities programme. The activities area manager said part of the staff development was to assess staff training needs and develop those. The inspector was invited to join service users for their midday meal. The service users told the inspector they could choose food and told the inspector they were happy with the food. Several service users need a diet of soft food and the inspector observed this was nutritious and appetising. One inspector observed that for a service user who had a swallowing problem, the daily diary record did not record that a soft diet was to be provided. The inspector was told that the home had adopted protected meal times and they are using the “Essence of Care” benchmarking process to look at improving food and nutrition. DS0000058177.V290351.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints within the home are generally handled properly and service users feel confident that their concerns will be listened to. Service users legal rights are adequately protected. Adult protection awareness training for staff has now been provided. EVIDENCE: There is a register of complaints showing that nine complaints had been reported and investigated since January 2006. The inspector noted that the response to complaints has improved. The registered manager showed the inspector the register of complaints, which records the date, type of the complaint and action taken. The registered manager has investigated these following the homes complaint policy and procedures. All the complaints were taken seriously and appropriate action taken to ensure service user needs were addressed. The inspector was told that staff are encouraged to report any complaints immediately so they are dealt with before they become bigger issues. There is a separate Adult Protection policy and Whistle Blowing policy, which is made available to service users and their representatives, at admission. DS0000058177.V290351.R01.S.doc Version 5.2 Page 17 The Lambeth Council adult protection coordinator told the inspector he had been running a number of adult protection training sessions for the home’s staff and all the staff had attended these. DS0000058177.V290351.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment is good and service users live in an attractive and comfortable home. The standard of cleanliness and hygiene is also good. EVIDENCE: The home is purpose built, is well maintained, suitable for its purpose and safe. There are a number of communal rooms in the building. Each floor has a large living room and dining room and in addition there are small seating areas in the corridor, a prayer room and smoking areas. There is a pleasant enclosed courtyard garden. On the day of the inspection the home was clean throughout and service users and relatives commented that this was always the case. All service users have single rooms with en-suite facilities, which are well furnished. Bedrooms are personalised and reflect the taste and interests of the service user. Service users spoken to said they are happy with their bedrooms. DS0000058177.V290351.R01.S.doc Version 5.2 Page 19 There were a number of adaptations and aids in the home. There were at least one hoist on each of the three nursing floors and on the second floor five hoists available. Two service users have their own hoists as well. All bedrooms have showers and the inspector was told that each service user has their own shower chair if they need one. The home meets health and safety requirements. The windows have restrainers to stop them being opened too far, the radiators and pipe work are guarded and there are temperature control valves to allow service users to control the heat in their rooms. Weekly checks are kept on water temperatures. The homes maintenance team follows the health and safety guidelines to prevent the risk of legionella. On the day of this inspection the standard of cleanliness within the home was high. The inspector toured the building and it was clean and free from offensive odours. The laundry facilities are satisfactory. They have impermeable flooring and walls. There is a washing machine that rinses and washes at a high temperature for foul linen. DS0000058177.V290351.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels were appropriate to service users’ needs. Staff need training in the following areas: swallowing difficulties; communicating with service users who may hearing impairments; and, palliative care. EVIDENCE: Twelve staff files were inspected, these included four new staff. Records show that staff are more closely vetted than they had been previously. An enhanced CRB disclosure was available on each file viewed as well as two written references. Work permits were also present. The home has recruited some staff members from overseas. References were available for these in their native language and these had been translated into English as well. The home has a training and induction programme. However, it was not up to Sector Skills workforce training targets. The inspector was told by the registered manager that all staff are going through the homes induction training again as part of the homes commitment to improve the care the service users receive and developing staff interpersonal skills. The registered manager showed the inspector a copy of the new programme that is being rolled out for all staff. Staff the inspectors spoke to said they were all going through the induction training programme again. This included the basic personal care for service users. DS0000058177.V290351.R01.S.doc Version 5.2 Page 21 There is a copy of a staff training matrix covering future planned training displayed in the office. The inspectors observed that some of the conditions experienced by service users were not linked to training needs of staff. Examples of these absent from the programme include care of people with swallowing difficulties, communicating with service users who may have hearing impairments and palliative care. Staffing levels were appropriate to service users’ needs on the day of inspection. On the second floor for example there were two qualified nurses and five carers on duty for the am shift, in the afternoon there were two nurses and four carers. The home staff team are making good progress in attaining the required percentage of NVQ qualified staff. A list of staff that had completed NVQ’s was shown to the inspector and certificates were stored in staff files. DS0000058177.V290351.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager and the care manager are experienced, qualified and skilled. Between them, they have the necessary skills and awareness that ensures the home is well run. They have clear expectations of staff and the ethos and approach the staff at the home should take. There are systems in place to regularly gather the views of service users and their relatives. Action is taken in response to these views to make sure that the home improves in ways that will benefit service users. Improvements are needed to staff supervision arrangements to ensure staff are regularly provided with supervision sessions. EVIDENCE: DS0000058177.V290351.R01.S.doc Version 5.2 Page 23 The management team has been strengthened by the additional presence of an experienced care manager. He spends a great amount of his time working on the floors directly supervising and observing care practices. As a result the senior management team has become more proactive in managing and supervising staff in the workplace. The inspector observed that the care manager addresses issues as they arise. A member of staff whose care practice was not acceptable was spoken to by the manager and informed directly about how he should behave. The improvements the inspectors found indicate that there is more focus on placing service users at the centre of the service. Relatives have found that improvements have taken place recently in how service users are cared for. The majority of those service users and relatives spoken to find that staff attitude is good, they are kind and demonstrate a commitment in their role. The inspectors noted the home was making progress in gaining the views of service users/relatives and stakeholders by having regular relatives meetings where relatives are encouraged to voice their views. One inspector attended the service user /relatives meeting. Fourteen relatives were present. It was planned in advance with a prepared agenda. This was the second such meeting held since January 2006. The inspector was pleased to note the service users GP also attended the meeting. The registered manager encouraged the service users family and friends to speak about any issues or complaints they wished to discuss. Relatives spoke openly about issues that affected them and service users and that can easily be put right. The registered manager and care manager responded positively to questions raised and agreed to take on board their views. Relatives were told they could speak to the management or the inspector in private after the meeting about any confidential issue they wished to discuss. The GP also outline areas in which cooperation may assist service users. He gave the relatives his mobile phone number and encouraged them to contact him directly if they had any concerns about service users. Record keeping in the home has improved but there are still some areas in the service users files that need to be addressed. See Standard 7. The records the inspectors checked indicated one to one supervision is provided but that it needs to be more regular. One member of staff told the inspector they had supervision in the past with their line manager and this was recorded but they had not had this regularly. Staff meetings are being held monthly and the inspector saw copies of the minutes. Topics for discussion were staff attitudes and how to treat service users with dignity and respect. One item was about rough handling of service user and the staff were told that this was unacceptable and was a disciplinary offence. The inspectors were told there were night staff meetings. DS0000058177.V290351.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 2 3 DS0000058177.V290351.R01.S.doc Version 5.2 Page 25 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 OP7 OP37 Regulation 15(1) (2) Requirement Timescale for action 30/08/06 2 OP7 15(1) 3 OP7 OP30 12(1)a b 13 (6) 4 OP9 13 (2) The registered person must ensure that care and health needs are reflected accurately in care plans and are kept up-todate. Professional guidance must be incorporated into care plans and followed. Previous timescale of 31/01/06 not met. The registered person must 30/08/06 ensure that care plans include the assessment of service users’ social and emotional needs as well as their physical wellbeing. The care plan to be drawn up with the involvement of the service user, where possible. Previous timescale of 31/01/06 not met. 30/08/06 The registered person must ensure that proper provision is made for the health and welfare of service users. Staff to receive training in supporting service users with swallowing difficulties, communicating with service users who have a hearing impairment and palliative care. The registered person must 01/09/06 DS0000058177.V290351.R01.S.doc Version 5.2 Page 26 5 OP9 13 (2) 6 OP9 13 (2) 7 OP12 12(1)(b)( 16)(2)(m) 8 OP36 18(2) ensure that all residents are given the opportunity and support to self-administer their medication unless they have been risk assessed as not being able to. The registered person must ensure that the incidence of urinary tract infections is investigated, that fluid intake is adequate and that infection control procedures are being followed. The registered person must ensure that both the monitoring device and the lancing device currently being used for blood glucose monitoring are suitable for multiple patient use. The registered person must ensure that where possible individuals’ interests and previous lifestyles are recorded on the care plan and that appropriate stimulating activities are devised to respond to these needs. The registered person must ensure that one to one supervision is provided to all staff at least six times a year. 01/09/06 01/09/06 30/08/06 30/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP8 Good Practice Recommendations The registered person should ensure that fluid charts are kept with the service user or in the service users rooms to prompt and enable easy access by staff and relatives to fill them in after they have assisted the service user to take any fluids. DS0000058177.V290351.R01.S.doc Version 5.2 Page 27 2 OP8 3 4 5 OP8 OP12 OP9 6 OP12 The registered person must ensure that records of important and essential information relating to individuals’ conditions sent with service user when they attend hospitals. The registered person should ensure that when referrals are made to healthcare professionals that delays in response to these referrals are followed up. The registered person should ensure that staff develop the language skills to effectively communicate with service users and their families. The registered person should ensure that homely remedies are used for residents only and alternative arrangements are made if the home wishes to provide treatment for minor ailments to staff. The registered person should ensure that appropriate facilities and formats such as orientation boards for communication are provided to enable communication and stimulation. DS0000058177.V290351.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000058177.V290351.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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