Inspection on 29/01/08 for Yarborough House Care Home

This inspection was carried out on 29th January 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

Yarborough House Care Home 28/01/09

Yarborough House Care Home 15/02/07

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Yarborough House Care Home 34 Yarborough Road Grimsby North East Lincs DN34 4DG Lead Inspector Mrs Kate Emmerson Key Unannounced Inspection 29th January 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Yarborough House Care Home DS0000067288.V358839.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. Yarborough House Care Home DS0000067288.V358839.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Yarborough House Care Home Address 34 Yarborough Road Grimsby North East Lincs DN34 4DG 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) 01472 355791 info@jcareuk.com J Care (UK) Ltd Position Vacant Care Home 27 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (27) of places Yarborough House Care Home DS0000067288.V358839.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th February 2007 Brief Description of the Service: The home is situated close to the centre of Grimsby and motorway links and it is well served by local bus routes. The accommodation is situated over two floors with passenger lift access to the first floor. The accommodation is provided in both single and double rooms. The home is comfortable and homely with a variety of communal areas. The fees at the home at the time of the inspection were £329 per week. Additional charges were Hairdressing £3 - £10, Chiropody £9, Bingo £1 and variable charges for outings and toiletries. Yarborough House Care Home DS0000067288.V358839.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 that the people who use this service experience adequate quality outcomes. This inspection was unannounced and took place over one day in January 2008. To find out how the home was run and if the people who lived there were pleased with the care they got the inspector spent time in the home watching how the care was given and speaking with the people who lived there. Surveys were also sent out to the home and the Commission received completed surveys from two people who live in the home, one relative/visitor and four staff. The inspector spoke to the person who owned the home, the acting manager and staff working in the home at the time of the inspection. Visitors were also spoken with during the inspection. An expert by experience, Margaret Ferry, also assisted in the inspection for three hours. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. She spoke to the majority of people who lived in the home and staff who were on duty. She took lunch with people and observed the care provided and activities on offer. Paperwork kept in the home was seen to check that staff are safe to work in the home and that they had been trained to their job safely. Records of care people had received were also checked. The provider had taken over the home in June 2006 and had continued to work to improve the systems in the home and the environment and gardens. What the service does well: The people who live in the home said they were able to decide on their own daily routines. People enjoyed the food provided. They said the food was ’lovely’, ‘great’ and ‘there are two choices’. The expert by experience enjoyed lunch and said it was very, very good. The home provided a consistent staff group and staffing was arranged to meet the demands of the busiest times of day. Staff were trained to do their job Yarborough House Care Home DS0000067288.V358839.R01.S.doc Version 5.2 Page 6 safely and to give care to meet the needs of the people who live in the home. The people who lived in the home liked the staff, one said that the staff were ‘lovely, they do anything you want and are quick to answer the bell’. People were provided with clear information about the services provided and the complaints procedure. Everyone who lived in the home had care plans where their likes and dislikes were recorded. Although there were some gas in the records which need addressing. The home had good systems in place to protect people from abuse and all the staff had received training in this area. However they had received three complaints resulting in safe guarding adult’s investigation s being undertaken by the Local authority. Two were unfounded and the third was still being investigated at the time of the inspection. The home was well maintained and very clean and tidy and there had been a programme of redecoration and improvement. A sensory garden had been completed and this provided an attractive area for people. The home provided a variety of communal areas, which were very homely and enjoyed by the majority of people. The management had consulted with the people who lived in the home and people who visited the home about the quality of the care provided and had acted on the information received. The management provided staff training and safety checks of equipment to protect the health and safety of staff and people who lived in the home. They had provided detailed assessments where people required assistance with moving and handling and they had provided new equipment to assist in these tasks. A relative said ‘they try very hard to make everyone feel at home, they are very helpful and they are friendly to every one’. What has improved since the last inspection? They had provided more information for people about the terms and conditions of residency in the home and provided everyone with contracts. They had made sure that the hot water is at the right temperature so that people are not having baths that are too cold. They had made sure that they get written references for staff they wish to employ one of which should be from the previous employer. However they must make sure that these are obtained before they employ staff. Yarborough House Care Home DS0000067288.V358839.R01.S.doc Version 5.2 Page 7 When they have reviewed the quality of the care in the home they provide a report and make this available to people. They had made sure that where people need assistance to prevent falls from bed full risk assessments were completed before bed rails were used and when they are used they are regularly safety checked. What they could do better: To make sure that people get the care they need, the care plans must be written down in more detail and up dated when needs change. They must make sure that people’s health care needs are met and timely medical assistance is sought. Staff coming on shift must be brought up to date with issues affecting people’s health and wellbeing. Records must detail the action taken in response to a person complaining of/presenting as being unwell. Procedures for calling for medical assistance must be reviewed and made clear to all staff. They must make sure that medication they record all changes to medication in detail. They must provide evidence that staff who administer medication have completed an accredited course in safe handling of medication. They make sure that where medication is prescribed to modify challenging behaviour on an as required basis there are management plans in place clearly describing in what situation this should be administered and decisions to administer are taken by a person qualified to do so. They must make sure that new staff have training to work in the home safely and provide evidence of this. They must make sure that supervision processes are further developed and that one to one discussions about progress or training needs are included and supervision processes clearly explained to staff. Please contact the provider for advice of actions taken in response to this Yarborough House Care Home DS0000067288.V358839.R01.S.doc Version 5.2 Page 8 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. Yarborough House Care Home DS0000067288.V358839.R01.S.doc Version 5.2 Page 9 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 Yarborough House Care Home DS0000067288.V358839.R01.S.doc Version 5.2 Page 10 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, 2 and 3. Standard 6 was not assessed, as the home does not provide intermediate care. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People were provided with detailed information to help them make an informed choice about where to live including information about the terms and conditions of residency. Although assessments of needs were completed prior to admission, gaps in identifying and recording needs particularly around Dementia may put people’s health and welfare at risk. EVIDENCE: Yarborough House Care Home DS0000067288.V358839.R01.S.doc Version 5.2 Page 11 The home provided detailed information for people relating to the services provided. The statement of purpose and the service users guide was well developed and provided clear information. The information was made available to people by providing a service users guide in each bedroom and the statement of purpose and inspection report in the reception area. The manager stated that the information was available in large print on request as the information was printed in the home. The home had developed a contract/statement of terms and conditions and these had now been offered to people. Where people were to be accommodated in a shared room both parties had signed a room share agreement. There was evidence that people were assessed with regard to their care needs prior to admission to the home even those admitted as an emergency. The manager stated that the first four weeks of admission were considered a trial period so people could decide if the home was suitable for them and this process was described in the service users guide. The home had a policy and procedure to support the assessment and admission to the home. The assessments used a system of numerical scoring to identify dependency levels in different areas. There was space provided in each area for comments as to how people’s medical conditions affected them and preferences for care provision. However these had not always been fully completed. Where some people had been diagnosed with dementia there was little in the way of describing how this affected people’s abilities and independence and their care requirements. This may leave people at risk due to care needs not being fully identified. A varied training plan was provided for the staff to assist them to meet the people’s needs. Yarborough House Care Home DS0000067288.V358839.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s needs were set out in an individual care plans although gaps in assessment, care planning and daily records meant that people’s health needs may not always be met in a timely manner. The home had detailed procedures in place for the safe handling of medication but some of the administration practise could increase the risk of error. People felt they were treated with respect and their privacy was upheld. EVIDENCE: Yarborough House Care Home DS0000067288.V358839.R01.S.doc Version 5.2 Page 13 A selection of four care plans was examined. Overall these had continued to improve and some were very detailed. There was also some improvement in regards to consistency of application of the formats used. There were detailed moving and handling assessments and care plans, which also included photos of staff in the hoist slings showing how the hoist slings should be positioned. Staff had been provided with information booklets re pressure area care and these were held in each care plan where there was a risk of pressure damage. The providers had purchased a variety of equipment to assist in appropriate moving and handling including a portable overhead hoist, profile beds and a sheepskin sling to protect people with fragile skin. There were some gaps in care planning due in part to gaps in assessment. This was particularly evident for those who were diagnosed with dementia and had specific problems relating to their condition. In these care plans there was a lack of specific care instructions for staff to enable them to meet people’s needs in a consistent manner. Evaluations of the care plans were completed regularly but care plans had not always been updated where needs had changed. Daily diary records were maintained. However the records did not always indicate if any action had been when people complained of feeling unwell and there was little evidence of follow up between one shift and the next. For example staff may note in records that someone is unwell but there is no further comments as to whether the person has improved of deteriorated or whether medical assistance had been sought. This may be further exacerbated due to the processes of handover between shifts where staff coming on shift should be brought up to date. Staff stated that shift handovers are done one to one between senior staff ‘so it makes it hard for other members of staff on shift to know always know what is going on’. A compliant made to the Local Authority indicated that health needs had not been recognised and referred in a timely manner, this was under investigation at the time of the inspection. This means that people may not be having health needs monitored and met in a timely manner. The home had a detailed policy and procedure for the safe handling of medication. Records of receipt, administration and disposal of medication including controlled drugs were maintained. Staff had received training from Boots and had received a half-day training session in drug awareness but there was no evidence that either were an accredited course. An accredited course in safe handling of medication had been booked for February 2008. Yarborough House Care Home DS0000067288.V358839.R01.S.doc Version 5.2 Page 14 Changes to the prescription and hand transcribed records were not always dated and signed by the person making the change. There was a lack of recording where discussions regarding medication had taken place with GP’s or the hospital. Where medication had been prescribed on an as required basis to modify challenging behaviour there was no management plan to describe to staff the circumstances in which this should be given and daily diary records did not support decisions to administer the medication. The staff in this home are not trained to make decisions to administering this type of medication on an as required basis. The manager was advised to contact the GP in the first instance to discuss any alternative options. People felt they were well cared for and their privacy and dignity was maintained. Likes and dislikes were recorded, as was peoples preferred term of address. Observation of staff interaction with people showed them to be polite, respectful and considerate. Yarborough House Care Home DS0000067288.V358839.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People confirmed that they were able to exercise choice and control in the home. People were provided with a varied nutritious diet and they enjoyed the food they received. EVIDENCE: The expert by experience assisted the inspector when looking at how the home met these standards. There was evidence from observation and discussion with people that the home was conducted to maximise autonomy and choice. Information with regard to advocacy services, data protection and access to records was displayed in the home. Yarborough House Care Home DS0000067288.V358839.R01.S.doc Version 5.2 Page 16 People confirmed that they were able to exercise choice in their daily routines and always had choices at meal times. The staffing was arranged to ensure that individual’s needs with regard to rising and retiring could be met. One person said that ‘I am able to get up when I choose, you can choose your own time’. The home employed an activities coordinator six hours per day Monday to Friday. She had attended training related to the provision of activities with people with dementia. People had had their needs assessed in this area and records of individuals participation in events was recorded. The expert by experience was very impressed with the activities on offer in the home. There was emphasis on meeting peoples individual needs as well as group activities. One of the people living in the home was going ice-skating the day after the inspection and another was having a fishing trip arranged for them. Group outings were also arranged. Church services were held fortnightly and Communion was provided in the home. The home had raised over £5,000 for a sensory garden through a range of activities, which people had enjoyed. The sensory garden had been completed and detailed records had been maintained to show how the money had been spent. People stated that their visitors were made to feel to welcome and the visitors/relatives commented in surveys that they were made to feel to welcome, were able to see their relative in private and were kept informed about important matters. They generally thought that the standard of care was good in the home and had improved. One person said that they have been involved in activities in the home and was invited to meetings. The expert by experience observed that visitors were offered refreshments and privacy to speak to their relative. The home has a three-week rotating menu. There were always at least two choices available at meal times including a hot snack at teatime. The expert by experience ate a meal with people who lived in the home. She enjoyed the meal and said it was very, very good, tasty and served well. She stated that there was a nice choice and that there were good portions. She said that there was a good atmosphere in the dining room and other communal areas, with lots of interaction between staff and people who lived in the home. However she did think the music in the dining room was too loud. Staff were seen to assist people sensitively and discreetly. Aids were provided to encourage independence. Soft diets had improved by not mixing the whole meal together. For example serving the individual elements of the meal, such as the meat and vegetables, separately so people can be offered different textures and flavours throughout a meal. Yarborough House Care Home DS0000067288.V358839.R01.S.doc Version 5.2 Page 17 People spoken with enjoyed the food and stated that the food was ‘’lovely’, ‘great’ and ‘there are two choices’. A relative said that ‘some meals like roast beef are a bit tough as their relative wears false teeth, but they are offered a choice of meals’. Staff said they ‘cater for diets, give choices and try to meet individual choices of food at all times. A variety of foods are available in kitchen twenty-four hours a day for snacks’ and ‘food is always lovely’. The kitchen was clean and tidy and appropriate records were maintained. Yarborough House Care Home DS0000067288.V358839.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Complaints were taken seriously and acted upon in appropriate manner. The policies and procedures and staff training should protect people from abuse but a lack of intervention may mean that people are risk of neglect in respect of health needs. EVIDENCE: The home had a detailed policy and procedure for the management of complaints and a copy of the procedure was provided in each bedroom in the service users guide. A copy of the procedure was also displayed on the notice board in the reception area. At the last inspection complaints investigations were detailed and included written staff statements where required. However these could not be checked at this inspection as records had been taken off site for the provider to audit as part of the quality monitoring processes. He was requested to provide to the Commission a summary of all complaints received since the last inspection. People who lived in the home and visitors stated that they knew how to make a compliant but were happy with the services and care at the home. Yarborough House Care Home DS0000067288.V358839.R01.S.doc Version 5.2 Page 19 To protect people living in the home from abuse the home had safe guarding policies and procedures in place and staff had received external training in safeguarding. Following issues raised in a safe guarding investigation the management are providing refresher training to all staff. Three referrals had been made to the Local Authority Safe Guarding team, one of which was being investigated at the time of the inspection. The other two were unfounded but practise issues were raised and the Local authority had made recommendations to address the issues. The provider and management were found to be cooperative and helpful through out the investigations and were working to address the issues raised. There were some issues in relation to assessment care planning and daily diary records that indicates that there may be a lack of monititoring and timely intervention with regard to health needs which may put people at risk of neglect. This was also the basis of the most recent compliant and referral to the Safeguarding team which was being investigated at the time of the inspection. Yarborough House Care Home DS0000067288.V358839.R01.S.doc Version 5.2 Page 20 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, 20, 21, 22, 25 and 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provided a clean, tidy and homely environment, which was suited to the needs of people living there. EVIDENCE: The home is well situated, close to the centre of Grimsby and is on local bus routes. The home and gardens were accessible to people who lived in the home. The home has a sensory garden with raised beds and seating. The home had taken advice to improve the environment for people with dementia. Yarborough House Care Home DS0000067288.V358839.R01.S.doc Version 5.2 Page 21 Internally the home was undergoing a programme of redecoration and improvement. The home was very clean and tidy and free from offensive odours. The home had a selection of bathing options over the two floors, which were appropriate to peoples needs. There were a number of communal rooms, which were well decorated and domestic in character. One room was designated as a quiet area and another was used for activities. The dining room was spacious and well furnished. The bedrooms had been personalised and some had been redecorated and had new carpets fitted since the last inspection. Lockable storage was provided in bedrooms. The home provided specialist equipment to assist people with poor mobility such as an overhead hoist and profile beds. A new wet room had been developed to enable people to have an assisted shower if they wished. This had been very well designed. The conservatory was still being used to store items, which made this area look untidy and not particularly inviting. This is a pity as the conservatory has the best views of the sensory garden and should be used to its full advantage. A loose floorboard near the entrance to the dining room was a potential trip hazard. The expert by experience found there to be a homely atmosphere. She observed that the home was clean, tidy and warm and there were no offensive odours. Yarborough House Care Home DS0000067288.V358839.R01.S.doc Version 5.2 Page 22 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): All the above standards People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People were protected and their needs met by the numbers of staff provided. Checks for safe recruitment had mostly been completed prior to employment. Staff were trained for their role. EVIDENCE: The home’s staffing levels had been assessed under the Department of Health guidance from the Residential Forum and staffing implemented to meet the guidance and the needs of people accommodated. One person commented that ‘the carers are lovely, they do anything you want and are quick to answer the bell’ and another said ‘all the girls are good to us’. A relative said the staff were ‘very caring and cheerful’ and another said they are ‘very friendly’. There had been a very low turnover of staff and only four staff had left the home in the twelve months prior to the inspection. Three staff files were checked; two written references were in place. In one case one reference hadn’t been obtained prior to employment. Employment had commenced prior to receipt of the full CRB (Criminal Records Bureau) check but following receipt of a POVA first check (Protection of Vulnerable Adults). Records had been maintained to evidence that staff had been working under supervision until the CRB had been obtained. Whilst this adequate, staff must not be routinely Yarborough House Care Home DS0000067288.V358839.R01.S.doc Version 5.2 Page 23 employed prior to the receipt of a full CRB. Proof of identity had been obtained and photos were held in all but one file. The manager stated that induction training was provided to skills for care standards and completed the skills for care workbooks. The manager stated the staff kept the workbooks and there was evidence that completion of workbooks was monitored and discussed in supervision. There were also certificates to indicate that new staff had completed training in areas such as moving and handling and fire safety and safeguarding. There was a training plan in place and records of training provided were maintained. Staff had received mandatory and service specific training including moving and handling, food hygiene, fire safety, first aid, diabetes, bereavement and protection of vulnerable adults. Refresher training had also been provided in areas requiring annual updates. The manager stated she was looking to improve training in areas such as dementia, pressure area care and incontinence. Training in safe handling of medication was booked for February 2008 and training in dementia and challenging behaviour was booked for April 2008. Information provided to the Commission prior to the inspection stated that twelve of the twenty-one care staff had achieved NVQ 2 and five were working towards the qualification. The manager had achieved NVQ 4 and the deputy manager had achieved NVQ 3. Yarborough House Care Home DS0000067288.V358839.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, 32, 33, 35, 36, 37 and 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. An experienced but unregistered manager ran the home. The home was run in the best interests of the people living in the home and the management was generally proactive in ensuring that people’s health, safety and welfare were protected. Staff did not fully understand supervision processes. EVIDENCE: Yarborough House Care Home DS0000067288.V358839.R01.S.doc Version 5.2 Page 25 The manager, Marion Bourne, had commenced work as acting manager at the home on 20 February 2006. Marion is experienced in the care field and has previously been a Registered Manager of a care home. She stated she has achieved NVQ 4. Marion stated that she has submitted her application to the Commission to be considered as the Registered Manager of the home. The atmosphere in the home was open and friendly and the manager had an open door policy. The staff and people who lived in the home found the management approachable and helpful. However some staff members thought confidentiality was an issue and one said ‘you can speak to the management and everything is discussed around other members of staff’ and another said ‘management are too friendly with staff’. This should be addressed if staff confidence in management is to be maintained and improved. One of the issues raised in the Local Authority investigation was the amount of time the manager spends on the floor rather than on management duties. Whilst it is useful for the manager to continue to have a hands on presence on the floor she should make sure that this does not weaken her management position with the staff group. The provider was keen to improve the home and the service provided and had purchased a quality-monitoring tool. People who lived in the home, staff and visitors had been surveyed about the quality of the care in the home and results were being collated. They had published the results of the surveys completed in October 2006. The home had policies and procedures to support most areas of practise and the provider was proactive at improving these reviewing and updating as required. Some people were assisted with their finances. Clear records were maintained and receipts were held for purchases on behalf of people.. There was evidence that supervision that had been provided on a regular basis. However the supervision consisted mostly of observation of practise and there was little evidence that one to one discussions about progress or training needs were included as part of this. Staff confirmed that they received supervision although most thought that this was additional training rather than supervision. This process should be further developed and explained to staff to make sure that supervision can be more effective. Records were generally well maintained. include the time and cause of death. The records of peoples death must The management was proactive in ensuring the health and safety of people by making sure that all the equipment was serviced and maintained at appropriate intervals. The staff had received mandatory training including moving and handling and fire safety. Detailed fire and environmental risk Yarborough House Care Home DS0000067288.V358839.R01.S.doc Version 5.2 Page 26 assessments had been completed. Individual moving and handling assessments had been completed and equipment such as an overhead hoist had been purchased to assist in these tasks. Records of accidents were maintained and these were audited regularly. Fire records were maintained and showed that checks had been completed at appropriate intervals. Yarborough House Care Home DS0000067288.V358839.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 3 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 3 3 X X 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X 3 2 2 3 Yarborough House Care Home DS0000067288.V358839.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 OP7 Regulation 15 Requirement The registered person must ensure care plans reflect all identified needs, are specific in the action required to meet needs and are updated as needs change. (The previous timescale of 01/06/07 was not met) The registered person must make sure that people’s health care needs are met and timely medical assistance is sought. Staff coming on shift must be brought up to date with issues affecting people’s health and wellbeing. Records must detail the action taken in response to a person complaining of/presenting as being unwell. Procedures for calling for medical assistance must be reviewed and made clear to all staff. The registered person must 29/01/08 ensure that clear records of the circumstances of any changes to medication are completed and administration records are DS0000067288.V358839.R01.S.doc Version 5.2 Page 29 Timescale for action 01/04/08 2 OP8 OP18 12(1)(a) 13(6) 01/04/08 3 OP9 17(1) Yarborough House Care Home 4 OP9 13(2) 5 OP9 13(2), (6) and (7) 12(1) 6 OP16 22(8) 7 OP19 23(2) 8 OP19 23(2) 9 OP29 19 10 OP36 18(2) 11. OP37 17(1) signed by the person making changes and witnessed. (The previous timescale of 15/02/07 was not met) The registered person must provide evidence that staff that administer medication have completed an accredited course in safe handling of medication. The registered person must make sure that where medication is prescribed to modify challenging behaviour on an as required basis there are management plans in place clearly describing in what situation this should be administered and decisions to administer are taken by a person qualified to do so. The registered person must provide to the Commission a summary of all complaints received and actions since the last inspection. The registered person must clear the conservatory of stored items. (The previous timescale of 01/05/07 was not met) The registered person must make sure that the loose floor board near the dining room door is fixed so as not to be a potential trip hazard. The registered person must ensure that written references are obtained in all cases prior to employment. The registered person must make sure that supervision processes are further developed and that one to one discussions about progress or training needs are included and supervision processes clearly explained to staff. The registered person must make sure that the time and DS0000067288.V358839.R01.S.doc 01/04/08 29/01/08 01/04/08 01/04/08 01/04/08 29/01/08 01/05/08 29/01/08 Page 30 Yarborough House Care Home Version 5.2 cause of a person’s death is recorded. (The previous timescale of 15/02/07 was not met) 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 Refer to Standard OP32 OP32 Good Practice Recommendations The registered person should review how much time the manager works on the floor and develop strategies to strengthen the management position. The registered person should review procedures to make sure that staff confidence in the management’s ability to maintain confidentiality is improved. Yarborough House Care Home DS0000067288.V358839.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Yarborough House Care Home DS0000067288.V358839.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. 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