Care Home: Birch Holt Retirement Home

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What the care home does well Birch Holt Retirement Home provides well maintained and homely accommodation for its residents. The garden at the rear of the home is pleasant and provides residents with a safe and secure open area in which to sit if they wish to. The home is free of offensive odours. The manager ensures that prospective residents have a comprehensive preadmission assessment prior to moving into the home. From this pre-admission assessment the resident`s care plan is initiated. Care plans contain detailed information relating to the personal and health care needs of the resident as well as their social and leisure interests. Each care plan has relevant risk assessments and is reviewed by the manager on a monthly basis. Residents have access as and when required to a variety of health care professionals. Residents have a wealth of home activities and village invitations which they can take part in if they wish. Some residents attend a weekly luncheon club in Herstmonceux and others go to Bexhill Community Centre. Visitors are welcome in the home at any time. There are regular resident meetings, where residents are instrumental in choosing their menus. Food in the home is good mainly using seasonal fresh food. The manager has developed a good complaint policy and procedure, and this is available in each resident`s bedroom. There have been no complaints since the last key inspection in 2007. The majority of staff have received Safeguarding Adults training, and there are good policies and procedures relating to the Safeguarding of Vulnerable Adults in the home. There have been no Safeguarding Vulnerable Adult issues since the last key inspection in 2007. Staff are employed in sufficient numbers to meet the assessed needs of the residents. Many of the staff have and NVQ level 2 or above qualification, and there are further staff working towards this qualification. All staff receive regular supervision. The manager works hard in ensuring that all documentation is kept up to date, and has a good open working relationship with both residents and staff. She has worked hard at developing a good quality assurance system. Where the manager has been asked to look after residents personal allowances this is managed in a safe and appropriate manner. The manger ensures that health and safety policies and procedures are adhered to so that residents are safe at all times. What has improved since the last inspection? The administration of PRN (as required medication administered only following an agreed protocol) is now well managed with clear guidelines for staff. The kitchen of the home is at the present time being refurbished, and on the day of this inspection was clean and tidy. The home has recently had an inspection from the environmental health officer, and there were issues raised regarding the cleanliness of the kitchen. Throughout the home there is a good standard of cleanliness, and there are no offensive odours. What the care home could do better: CARE HOMES FOR OLDER PEOPLE Birch Holt Retirement Home Marlpits Lane Ninfield Battle East Sussex TN39 5BY Lead Inspector June Davies Unannounced Inspection 09:30 4th July 2008 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 DS0000021052.V367006.R02.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. DS0000021052.V367006.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Birch Holt Retirement Home Address Marlpits Lane Ninfield Battle East Sussex TN39 5BY 01424 892352 01424 892352 Brichholt1@yahoo.co.uk 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) Mr Terence Fusco Mrs Anne Heathcote Manager post vacant Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places DS0000021052.V367006.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is twenty-six (26) Service users must be older people aged sixty-five (65) years or over on admission 28th August 2007 Date of last inspection Brief Description of the Service: Birch Holt is registered to provide care for up to twenty-six older people. The home is located on the rural outskirts of the village of Ninfield. The home is a large detached house, which provides accommodation over two floors. Twenty-two of the bedrooms are single and two bedrooms are double. There are a variety of communal areas and the home is well decorated and comfortably furnished, for the needs of residents. The garden area is wellmaintained and accessible to residents. The fees charged range from £400.00 to £427.00per week. A copy of the latest Inspection report is available from the home upon request. DS0000021052.V367006.R02.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 2 star. This means the people who use this service experience good, quality outcomes. This unannounced key inspection took place on the 4th July 2008 over a period of 7 hours. During the visit the inspector spoke with the Manager and four residents, a tour of the home and garden took place, and the inspector observed residents having the lunch as well as observing a lunch time medication round. A medication audit was carried out. The inspector looked at documentation relevant to the key standards inspected and information submitted to ‘ The Commission’ via the Annual Quality Assurance Assessment. Resident spoken to were happy with the services provided by the home. What the service does well: Birch Holt Retirement Home provides well maintained and homely accommodation for its residents. The garden at the rear of the home is pleasant and provides residents with a safe and secure open area in which to sit if they wish to. The home is free of offensive odours. The manager ensures that prospective residents have a comprehensive preadmission assessment prior to moving into the home. From this pre-admission assessment the resident’s care plan is initiated. Care plans contain detailed information relating to the personal and health care needs of the resident as well as their social and leisure interests. Each care plan has relevant risk assessments and is reviewed by the manager on a monthly basis. Residents have access as and when required to a variety of health care professionals. Residents have a wealth of home activities and village invitations which they can take part in if they wish. Some residents attend a weekly luncheon club in Herstmonceux and others go to Bexhill Community Centre. Visitors are welcome in the home at any time. There are regular resident meetings, where residents are instrumental in choosing their menus. Food in the home is good mainly using seasonal fresh food. The manager has developed a good complaint policy and procedure, and this is available in each resident’s bedroom. There have been no complaints since the last key inspection in 2007. The majority of staff have received Safeguarding DS0000021052.V367006.R02.S.doc Version 5.2 Page 6 Adults training, and there are good policies and procedures relating to the Safeguarding of Vulnerable Adults in the home. There have been no Safeguarding Vulnerable Adult issues since the last key inspection in 2007. Staff are employed in sufficient numbers to meet the assessed needs of the residents. Many of the staff have and NVQ level 2 or above qualification, and there are further staff working towards this qualification. All staff receive regular supervision. The manager works hard in ensuring that all documentation is kept up to date, and has a good open working relationship with both residents and staff. She has worked hard at developing a good quality assurance system. Where the manager has been asked to look after residents personal allowances this is managed in a safe and appropriate manner. The manger ensures that health and safety policies and procedures are adhered to so that residents are safe at all times. What has improved since the last inspection? What they could do better: Although the home has had no new residents for a long time, the manager must ensure that where a new resident is to be funded by the local authority a care manager pre-admission assessment is obtained prior to the resident moving into the home. The manager must make arrangements for residents to be weighed on a regular basis to ensure their nutritional needs are being met. Arrangements must be made for proper storage of medication, in an appropriate medicine cupboard, with suitable locking device, and not in a kitchen cupboard. The reason for this is that the heat in the kitchen can have an effect on the stability of medications. While there are risk assessments for uncovered radiators throughout the home, and these were evidenced within residents care plans. The manager DS0000021052.V367006.R02.S.doc Version 5.2 Page 7 must be aware that as elderly people become older they also become frailer and are prone to falls, uncovered radiators could lead to severe burning. When replacing the washing machine the registered provider should purchase a washing machine with sluicing facility, to ensure the appropriate washing of foul laundry and to prevent the risk of infection. Staff must be supplied with appropriate protective clothing gloves and plastic aprons, when dealing with dirty laundry, handling spillages and cleaning human waste. Disposable gloves should be vinyl and not clear polythene. All staff should receive mandatory training within the first six months of their employment in the home, and therefore the manager must ensure that all staff receive training in – moving and handling, first aid, food hygiene, infection control, fire safety and protection of vulnerable adults as soon as possible. Staff should then update their mandatory training as and when required. Some provision is in place for further mandatory training courses this year. The manager must ensure that she re-submits her application for registered manager. The registered provider does carry out Regulation 26 visits to the home. These visits are recorded but are rather scant in information. The registered provider should record in more detail the issues that are covered in his/her regulation 26 reports, to ensure that the quality of care being offered in the home is of a high standard, this would also cover maintenance issues, that can be used for future planning. 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. DS0000021052.V367006.R02.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 DS0000021052.V367006.R02.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): Standards 1, 2, 3 and 6. People using this service experience good quality outcomes in this area. The homes statement of purpose and service user guide are good, providing the residents and prospective residents with the information they need to make a decision about moving into the home. Resident contracts need to be improved to ensure that they receive accurate information as to the number of the bedroom they will occupy and the fees they will pay, and who will pay the fees. Residents move into the home know that their needs will be met and that their independence will be maximised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: DS0000021052.V367006.R02.S.doc Version 5.2 Page 10 The statement of purpose and service user guide accurately reflects what the home is able to offer its residents, a copy of these documents are available in each resident’s bedroom. Copies of these documents are also sent to prospective residents and/or their relatives/representatives. Three resident contracts were viewed and all had the number of the room they will occupy written onto the contract, but there was no evidence that fees are included on the contracts. Through discussion with the manager it was agreed that the room number is typed into the contract and that the fees will also be included into this document, stating what the fee will be, and who will be responsible for payment. The resident and or their relative/representative signed all contracts. The manager visits all prospective residents prior to them moving into the home during the visit a comprehensive pre-admission assessment is carried out. From viewing three pre-admission assessments the following information is obtained – medical history, mental health, personal care needs, communication, mobility, continence, medication, and food likes and dislikes, special requirements and diet. At the present time all residents have moved into the home as privately funded and some have since applied for funding from the local authority. Discussion took place with the unregistered manager as to the importance of obtaining care manager assessments for any new residents moving into the home or for residents receiving respite care. The home does not offer intermediate care. DS0000021052.V367006.R02.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): Standards 7, 8, 9 and 10. People using this service experience good quality outcomes in this area. The care planning system is good but some improvements need to be made, to ensure that staff are provided with sufficient information to meet residents needs. The health needs of residents are generally well met, with some improvements needing to be made in meeting nutritional needs. There is evidence of good multi disciplinary working taking place. The storage of medication and staff administration of medication needs improvement to ensure that residents are not placed at risk. Personal care is offered in a way to protect residents’ privacy and dignity and promote independence. This judgement has been made using available evidence including a visit to this service. DS0000021052.V367006.R02.S.doc Version 5.2 Page 12 EVIDENCE: At the present time there are twenty residents living in Birch Holt Retirement Home. The inspector viewed care plans for three residents. All three care plans contained information in regard to daily hygiene needs, healthcare, continence, diet and mobility. There were risk assessments in place for mobility, uncovered radiators. All care plans are reviewed each month. Records are kept of all visits from and to health care professionals. There was no evidence that residents are weighed on a regular basis. Discussion took place with the manager in regard to the checking of residents’ nutrition on a regular basis so that any concerns can be reported as soon as possible to the general practitioner. The manager stated that residents have been declining to be weighed. It is agreed that the manager will look into this issue, and try to obtain agreement with residents that they are weighed regularly. Evidence in care plans showed that personal hygiene needs of residents are met, but the plan of care was vague as to what residents were able to do for themselves and what needs they had for assistance. Daily records show that staff are observant in regard to the tissue viability of residents, and any concerns are reported directly to the district nurse. At the present time none of the residents living in the home have pressure sores. The continence nurse visits the home on request to assess for continence equipment and to reassess residents using continence aids. None of the residents at the present time require psychological health care, but the unregistered manager is aware of the importance of monitoring psychological health and reporting any needs directly to the general practitioner. Care plans showed that residents have contact with health care professionals including the general practitioner of their choice, district nurses, chiropody, opticians, dentists and audiology. The medication policy and procedure was reviewed in May 2008 this included a policy and procedure for self-medication. Both policies were detailed and provide staff with the information they would need in regard to the receipt, administration, recording and return of medicines. The home uses the Nomad system of medication. All monthly administration records were signed off when the resident had taken their medication. A lunchtime medication round was also observed by the inspector who noted that the member of staff administering the medication was handling medication with no disposable gloves and a requirement is being made in regard to this issue. Over half of the staff working in the home have received medication training. One resident is on controlled drugs and the inspector saw that this was properly managed, with monthly administration record and controlled drugs registered being signed by two members of staff when the medicine was taken by the resident, and with a running total of medication remaining being recorded in the controlled drugs register. It was noted that residents medication in use is kept in a lock kitchen cupboard, and this is an inappropriate storage area due to the DS0000021052.V367006.R02.S.doc Version 5.2 Page 13 heat in the kitchen, a requirement is being made for the registered provider to supply an appropriate drugs cupboard which is placed in an appropriate place to meet the temperature guidelines of ‘The Royal Pharmaceutical Society, Handling of Medicines in Social Care.’ During a tour of the home and observing a lunch time in the dining room the inspector observed that staff respected the residents’ privacy and dignity and spoke to residents kindly. Four residents said that they enjoyed living in the home. One resident said, ‘The staff are very kind here.’ DS0000021052.V367006.R02.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): Standards 12, 13, 14 and 15 People using this service experience good quality outcomes in this area. Both activities and links with the community are good and support and enrich the residents’ social lives. Visitors are welcome in the home at any time. The meals in the home are good offering both choice and variety and catering for special diets. This judgement has been made using available evidence including a visit to this service. EVIDENCE: While there are no scheduled activities in the home, residents are able to choose what activity they would like. Activity sessions usually take place in the afternoon and are run by the care staff, and consist of board games, extend exercise class, bingo, watching a film. Residents are often taken out on a one to one basis to visit the shops in Eastbourne, Hastings or Battle. Four DS0000021052.V367006.R02.S.doc Version 5.2 Page 15 of the residents go out each week to a luncheon club in Herstmonceux. Up to eight residents go to the St Peter’s Community Centre in Bexhill-on-Sea each month. Residents also get invited to the village carnival, garden parties, and church fetes. Every now and again residents go out to a pub. The manager also arranges for outside entertainment to be brought into the home for the residents. One resident told the inspector how she goes out for a walk in the village on most days. Another resident said, ‘There is plenty going on here and I do not get bored.’ Visitors are welcome into the home at any time. Staff always make them welcome. There is a small quiet lounge where residents can entertain their visitors if they wish. Residents are encouraged to exercise as much control as possible over their lives and from a tour the home the inspector observed that all the residents are able to bring small possessions of their own into the home with them. Residents are able to view their own care plan as and when they wish to. There is a three-week rotating menu. The inspector viewed the menus and these show that residents are offered choices. Residents’ have been instrumental via their residents meetings in choosing what should be put on the three-week rotating menu. Breakfast consists of a choice of cereals, toast, jam or marmalade, fruit drinks, tea and coffee. There is always a hot meal at lunchtime and on the day of this inspection, the lunch menu was – roast gammon, parsley sauce, potatoes, courgettes and cauliflower, the main choice of sweet was cheesecake and a choice of drink. The teatime menu is a cooked dish, sandwiches, cake, and choice of drink. Specialised diets are available as and when required. Residents are given choice at each mealtime. None of the residents require a liquidised diet, or assistance with feeding. Residents in general said that they like the food in the home. One resident said, ‘The food is very nice, I have never had to throw it back.’ DS0000021052.V367006.R02.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): Standards 16 and 18 People using this service experience good quality outcomes in this area. Residents know their complaints will be listened to and acted on. Staff have knowledge and understanding of adult protection issues, which helps to protect the residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaint’s policy and procedure is included in the service user guide that is available in each resident’s bedroom. Residents’ also have a complaints form in their bedroom, that can be used if they wish to. One resident said, ‘I would make a complaint to the manager if I needed to. The unregistered manager does have a complaints file in her office, and there have been no complaints since the last key inspection. The home has three policies and procedures to safeguard residents from abuse these include Abuse, Whistle blowing and Gifts to staff. All new staff are checked from the POVA register and via the Criminal Records Bureau prior to taking up employment in the home. There have been no adult protection issues since the last key inspection. 52 of staff have received Safeguarding DS0000021052.V367006.R02.S.doc Version 5.2 Page 17 Vulnerable Adults training and a further four staff are booked on a Safeguarding Vulnerable Adults course in September 2008. DS0000021052.V367006.R02.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): Standards 19 and 26 People using this service experience good quality outcomes in this area. The standard of the environment within the home is good providing residents with an attractive and homely place to live. Generally the standard of hygiene in the home is good, but some improvements need to be made to ensure that residents and staff are protected against infection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During this key inspection the inspector carried out a tour of the home including the kitchen and laundry area. The home was found to be clean and DS0000021052.V367006.R02.S.doc Version 5.2 Page 19 free from offensive odours. Resident’s bedrooms were bright and well decorated; furniture was of a good quality. Communal sitting areas, were well decorated and furnished, and provided comfortable places for the residents to sit and relax or be involved in activities. The communal dining room is spacious and provides a pleasant place for residents to sit and eat. Communal toilets and bathrooms were well decorated, clean and hygienic. One bathroom has been refitted and now provides an in bath hoist. It was noted however that in communal lounges and in some of the newer bedrooms that the radiators have not been covered, there is a risk assessment in each residents care plan, but this does not prevent residents falling against a radiator and sustaining a burn, a recommendation is being made that radiators and exposed pipe work should be covered to minimise the risk of burning. The kitchen was in the process of being revamped and the manager explained that a new vinyl floor was waiting to be fitted, once the pipe work for the new dishwasher has been attended to. Cupboards were clean and tidy. Most of the food in the fridge had been covered and dated, with exception of two jellies that had just been made. The home has had a recent inspection from the Environmental Health Officer, and there are no issues outstanding from this visit. The back garden has a ramp from the back door down to a well-tended lawn and garden area, and there is a small patio where residents can sit if they wish to. The manager explained that a part of a handrail running alongside the ramp is about to be replaced. This outdoor area provides a safe and secure area for the residents to enjoy. The laundry room is situated in the basement of the home. The inspector noted that the industrial washing machine does not offer a sluicing or disinfecting programme, but there is a large stone sink that is used as a sluicing facility when required. The manager stated that at the present time there is no need for a sluicing facility in the home, but the inspector has suggested that when the washing machine needs replacing an industrial machine with a sluicing programme is purchased. It was noted that staff were managing laundry without plastic aprons and were wearing see through polythene gloves. These gloves do not offer any protection against infection and the inspector is making a requirement that protective vinyl gloves and plastic aprons are purchased for staff to wear. DS0000021052.V367006.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 People using this service experience good quality outcomes in this area. Staff are employed in sufficient numbers to meet the needs of the residents. The standard of vetting and recruitment practices within the home are good ensuring that residents are not placed at risk. The qualification level of staff is high but further work still needs to be done to ensure that all staff have completed their mandatory training, and have the knowledge and skills to meet the residents assessed needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are sufficient care staff employed on each shift to ensure that the needs of the residents are met. Sufficient ancillary staff are employed for cooking, cleaning, handyman duties and gardening duties. On the day of the inspection staff were relaxed and unrushed and observed spending time with the residents. DS0000021052.V367006.R02.S.doc Version 5.2 Page 21 54 of staff have achieved their NVQ level 2 or above qualification, a further 2 staff are in process of working towards this qualification, ensuring that the number of staff with NVQ qualifications are above the required 50 . The inspector look at 3 staff personnel files and found that not all application forms contained a full employment history, for one staff member this was due to her being employed in the home for a number of years. Discussion took place with the unregistered manager regarding the importance of ensuring that a full employment history is sort and that any gaps in employment are explained in writing. All three staff files contained evidence of POVA first checks and Criminal Records Bureau checks. Each file had two forms of identification, and two written references. All files had evidence of staff appraisal and supervision as well as staff training. The inspector viewed the staff training matrix this showed the following staff had completed mandatory training – Moving and Handling 57 ; Fire Safety 71 ; Food Hygiene 42 ; First Aid 81 ; Infection control 47 ; Protection of Vulnerable Adults 52 ; Medication 52 and Health and Safety 71 , further courses for mandatory training have been booked throughout the year, the inspector is making a recommendation that mandatory training continues until all staff have completed. There was evidence in staff files that some of the staff have completed work related training such as End of Life Care, Reminiscence, Life Review, Continence and Nutrition. All staff have received Induction, and newer staff now complete ‘Skills for Care’ induction, with completed workbooks available in staff personnel files. DS0000021052.V367006.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): DS0000021052.V367006.R02.S.doc Version 5.2 Page 23 Standards 31, 33, 35, 36 and 38 People using this service experience good quality outcomes in this area. The manager has the skills and experience to manage the home, and is aware of areas in the home that need to be improved upon. The quality assurance system is well developed with some further work required to ensure that residents receive the best quality of care. Where residents personal monies are kept for safekeeping these are well managed and kept securely and safely in the home. All staff receive regular supervision to ensure that they have the skills and knowledge to meet the residents assessed needs. Health and safety in the home is well managed ensure that resident and staff live and work in a safe environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has her NVQ level 4 in care and is in the process of applying for Registered Manager’s Award. There was evidence in her personnel file that she regularly attends further training to ensure that she has the knowledge and skills appropriate to her job. She has many years experience of working in Birch Holt firstly as a carer, then as a deputy manager and now at management level. At the present time she is not registered with the Commission for Social Care Inspection, due to her application being lost. She has now completed a second application form and will be applying for registration in the near future. The manager of the home is always available to residents and staff throughout her working day. The quality assurance system in the home is well developed, with questionnaires for residents and visitors, and a further questionnaire being developed for visiting professionals. Systems used in the home are monitored on a regular basis such as care plans, medication, cleaning, and cleaning systems, laundry and kitchen hygiene and food. The manager carries out a monthly health and safety check of all rooms in the home. It was noted that while the registered provider carries out the required Regulation 26 visits, these reports are rather vague, and similar for each month, it would be more DS0000021052.V367006.R02.S.doc Version 5.2 Page 24 helpful if the report was written in more detail, in regard to what issues were discussed with the residents and staff, what further developments need to take place in the home and where areas of the home need further attention to maintenance issues. The manager is also in the process of developing a summary of the quality assurance system that will be made available to the residents, The Commission and other interested parties. Two residents living in the home have their personal allowances looked after by the manager. Each of these residents has their own finance book, which reflects incoming monies and expenditure. Where money is spent on the resident’s behalf receipts are retained and numbered, the numbers then crossreferenced with expenditure entries in the finance books. The manager checks money on a regular basis to ensure it is correct. From evidence when the inspector viewed the staff personnel files all staff receive regular recorded formal supervision at least six times per year. As mentioned under staffing not all staff have received their mandatory training in health and safety issues, such as moving and handling, fire safety, food hygiene and infection control, while this training is on going it is important both for the health and safety of residents and staff, that mandatory training is completed as soon as possible. During a tour of the home the inspector noted that the Control of Substances Hazardous to Health cupboard is kept locked. Hot water outlets are fitted with temperature control valves. All equipment used in the home has an up to date maintenance certificate. Fire point checks are carried out weekly and recorded, as are hot water outlets where the temperature of the water is recorded. The home has an up to date health and safety policy and procedure. Accidents to residents are recorded in a Health and Safety Executive Accident Book. There have been three falls in the home since January 2008. During the review of the care plans each month the manager also looks at the number of falls that have occurred, where there are continuous falls for a resident, these are reported immediately to the residents general practitioner. DS0000021052.V367006.R02.S.doc Version 5.2 Page 25 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 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 X 2 X 3 3 X 3 DS0000021052.V367006.R02.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement The registered provider must ensure that medicines are stored appropriately in the home, and at the correct temperature, so that medication is not spoilt. Therefore a proper medication cupboard must be provided to ensure that medication is stored appropriately at all times. Timescale for action 29/08/08 2. OP26 13(3) 3. OP33 26 The registered provider must 29/08/08 ensure that all staff have appropriate protective clothing – vinyl gloves and plastic aprons to reduce the risk of cross infection when dealing with laundry and working with spillages. The registered provider must 29/08/08 ensure that Regulation 26 reports are clearly and fully written, regarding the issues he/she has looked at in the home, the names of residents and staff spoken to and their replies. This Regulation 26 forms part of the quality assurance system, and therefore must highlight areas where there is good practice and those areas DS0000021052.V367006.R02.S.doc Version 5.2 Page 27 that need improving on. 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 OP8 OP25 Good Practice Recommendations The manager needs to ensure that resident’s are weighed on a regular basis, to check on nutrition and ensure that residents’ nutritional needs are being met. While the manager has risk assessed uncovered radiators, she needs to bear in mind that residents residing in Birch Holt are becoming older and frailer, and are at risk of falling and receiving severe burns from an uncovered radiator, therefore provision should be made in future planning for the uncovered radiators to be covered, to reduce the risk further. At the present time there is no double incontinence in the home. When the present washing machine needs replacing a washing machine with sluicing facility should be purchased. The manager should ensure that application forms provide a full employment history and that any gaps in employment are explored and reasons recorded. The manager must ensure that ALL staff have received mandatory training and that this is updated as required. 3. OP26 4. 5. OP29 OP30 DS0000021052.V367006.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 DS0000021052.V367006.R02.S.doc Version 5.2 Page 29 - 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. 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