Care Home: Candle Court Care Home

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What the care home does well What has improved since the last inspection? The home has recruited an activities coordinator, who has implemented a programme of one-to-one and group activities. We observed more engagement between staff and residents in individual activities, which provides a more stimulating experience for them and improves their lifestyles. The majority of staff have attended training in moving and handling to ensure that residents are supported safely when transferring them. The recording of the administration of medicines has improved and no errors were found in this inspection. The menus for each day are now available on notice boards on both floors so that residents are more able to make choices about their meals. A specific resident`s room has been cleared of old food and drinks and the room is kept clean and tidy to prevent the risk of infection. Staff are now having formal supervision sessions to support them in their roles as carers. What the care home could do better: Steps must be taken to ensure that the temperature of the area where medication is stored does not exceed 25C so that medication does not deteriorate. The home must always inform the Commission for Social Care Inspection about any incident that adversely affects the well-being or safety of the people who live in the home and staff must be made aware of the "whistle-blowing" procedure to ensure that they know what to do if they are concerned that managers are not taking appropriate action about abuse. These measures ensure that the statutory bodies are made aware of serious incidents and can take appropriate action. The carpet in the smoking room on the first floor must be cleaned and the drain covers must be replaced in all bathrooms. Restrictors must be put on all bedroom windows to safeguard residents from injury. The proprietor should carry out an audit of staff when they leave the home to ascertain why there is such a high turnover of staff. Monies held on behalf of residents should be placed in higher interest bearing accounts for their benefit. CARE HOMES FOR OLDER PEOPLE Candle Court Care Home Bentley Drive Off Cricklewood Lane London NW2 2TD Lead Inspector Tom McKervey Key Unannounced Inspection 12th May 2008 09:00 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 Candle Court Care Home DS0000053368.V363993.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. Candle Court Care Home DS0000053368.V363993.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Candle Court Care Home Address Bentley Drive Off Cricklewood Lane London NW2 2TD 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) 020 8731 7991 020 8731 7992 Rockley Dene Homes Limited Care Home 93 Category(ies) of Dementia (14), Dementia - over 65 years of age registration, with number (0), Mental disorder, excluding learning of places disability or dementia (18), Mental Disorder, excluding learning disability or dementia - over 65 years of age (0), Old age, not falling within any other category (0) Candle Court Care Home DS0000053368.V363993.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home with Nursing - Code N to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP Dementia - Code DE (maximum number of places: 14) and Code DE(E) Mental Disorder, excluding Learning Disability or Dementia - Code MD (maximum number of places: 18) and Code MD(E) The maximum number of service users who can be accommodated is: 93. 4th June 2007 2. Date of last inspection Brief Description of the Service: Candle Court is a nursing home for people with mental health needs, including dementia. The home is owned and managed by Rockley Dene Homes Limited, a company based in Harrow, Middlesex. The company also owns three other care homes elsewhere in the U.K. The home was registered with the Commission for Social Care Inspection in April 2004. The home provides nursing care and support for 93 people of either gender over the age of 65. The residents are accommodated on two floors, each with its own staff team. Fifty-six residents live on the ground floor and thirty-seven on the first floor. Each floor is sub-divided into three named wings. The two-story building has a rectangular structure with an attractive central courtyard, which is accessible by all the residents. Each floor has its own bathrooms, toilets, lounge, dining room and small kitchen areas. There are 59 single and 17 double bedrooms. However, at the time of this inspection, four double bedrooms are being converted to singles. All bedrooms have washbasins. The basement of the premises contains a large and a small kitchen, a laundry area, staff changing facilities and a staff training room. Two passenger lifts Candle Court Care Home DS0000053368.V363993.R02.S.doc Version 5.2 Page 5 service the ground and first floors. Candle Court is situated near a busy junction between Cricklewood Lane and the A41. The home is easily accessible by public transport and there are shops and other amenities within walking distance on Cricklewood Lane. The homes stated aims are to provide long-term personal and nursing care, to 93 older people of both genders, over the age of 65 suffering from dementia, enduring mental health problems and physical disability. The fees for the service range from £630 to £650 and the cost of respite care is £850 per week. The fees do not cover hairdressing, newspapers and chiropody. Following Inspecting for Better Lives, the provider must make information about the service, including inspection reports, available to service users and other stakeholders. Copies of this report are also available on the Commission for Social Care Inspection website. Candle Court Care Home DS0000053368.V363993.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes This inspection was carried out over two days and was completed in eleven hours. The lead inspector was assisted by Daniel Lim, another inspector from the Commission for Social Care Inspection. The visit was part of the Commission’s inspection programme and to check compliance with the key standards. The manager was on leave on the first day of the inspection and the deputy manager was in charge. The lead inspector returned to the home on a second visit to meet the new manager to discuss the management of the home and the progress of the service. In September 2007, the Commission received the home’s Annual Quality Assurance Audit, (AQAA), which is a self-assessment of the service by the manager. This document is required to be completed annually to provide information about how well outcomes are being met for people who live in the home. It also gives some numerical information about the service. Reference is made to the AQAA in various sections of this report, as evidence of some of the findings. This document was discussed with the manager who updated the information with the inspector. All areas of the home were visited, including several bedrooms. Residents’ and staffs’ files, and various documents relating to the management of the home were also examined as part of the inspection process. At the time of the inspection, there were seventy-eight people living in the home and there were fifteen vacancies. Residents, relatives and staff were interviewed about their views and experiences of the service. These interviews covered all aspects of the service, but were particularly focused on how well people were being safeguarded from abuse. All interviews were carried out independently of the managers. We received seven questionnaires from relatives that we sent out prior to the inspection, all of which were very positive about the home. These are examples of their comments; “The home has improved so much and is still improving under Philomena”. It was not possible to converse with some residents because of their mental capacity. However, through observing how staff interacted with the residents and cared for them, it was possible to form conclusions about the quality of the service they received. What the service does well: Candle Court Care Home DS0000053368.V363993.R02.S.doc Version 5.2 Page 7 The new manager has the experience and competence to run the home effectively. There has been a significant reduction in the number of complaints about the home. Residents and their representatives are very complimentary about the service and have confirmed this in verbal feedback, letters and cards. In our questionnaire, a relative wrote; “ They seem always to be aiming for improvement. The staff seem well supported by management. Above all, they really care about the happiness, well being and comfort of the residents”. The standard of décor throughout the home is very good, very clean, and there are good monitoring systems in place to ensure that the home is safe for people to live in. No-one is admitted to the home until they have a thorough assessment of their needs to make sure that the home is appropriate for them. Visitors are welcome at any time. Each person who lives in the home has a care plan that identifies their needs and staff are respectful and provide personal care in a dignified and discreet manner. The people who live in the home are happy with the standard of food, and the staff support residents who need help with eating in a sensitive manner. Complaints are taken seriously by the manager who meets with the complainant and resolves issues as quickly as possible. There are enough staff on duty at all times to meet the needs of the residents and new staff are thoroughly screened before they start work at the home. There is significant investment in staff training to meet the needs of people using the service, including the protection of vulnerable people, which protects the residents’ welfare. The home meets health and safety requirements and the quality of the service is also monitored regularly by senior managers. What has improved since the last inspection? The home has recruited an activities coordinator, who has implemented a programme of one-to-one and group activities. We observed more engagement between staff and residents in individual activities, which provides a more stimulating experience for them and improves their lifestyles. The majority of staff have attended training in moving and handling to ensure that residents are supported safely when transferring them. The recording of the administration of medicines has improved and no errors were found in this inspection. The menus for each day are now available on notice boards on both floors so that residents are more able to make choices about their meals. A specific resident’s room has been cleared of old food and drinks and the room is kept clean and tidy to prevent the risk of infection. Staff are now having formal supervision sessions to support them in their roles as carers. Candle Court Care Home DS0000053368.V363993.R02.S.doc Version 5.2 Page 8 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. The summary of this inspection report can be made available in other formats on request. Candle Court Care Home DS0000053368.V363993.R02.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 Candle Court Care Home DS0000053368.V363993.R02.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): 2, 3, 4 & 5. Standard 6 does not apply. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including looking at residents’ records. A thorough assessment of needs is carried out before and at the time a person is admitted to the home. Residents and their relatives can be confident about the care that is provided, and they are welcome to visit the home prior to moving in. EVIDENCE: A sample of eight residents’ case files were examined at random. The records included a full assessment of the person’s needs by health and local authority care managers and senior staff from the home. The assessment covered physical and mental health, nutrition, communication, and mobility needs. Various methods are also used to assess residents’ skin status regarding vulnerability to pressure ulcers. Two residents currently have pressure ulcers, Candle Court Care Home DS0000053368.V363993.R02.S.doc Version 5.2 Page 11 which the manager said were sustained while these people were in hospital for treatment. I was assured that the ulcers were responding well to treatment. The home was purpose-built in 1996. all areas of the home are accessible by wheelchair users, and all bedrooms have a wash basin. The home has closed circuit television and a protected entry system to ensure the safety of residents and staff, as does each floor where the residents live. The home is registered to provide care for people with mental health needs, the majority of whom have dementia, and qualified mental health nurses are on duty at all times. Many staff have been trained in dementia care. The majority of places in the home are funded by local authority block contracts. At the time of the inspection, there were seventy-eight people living in the home and there were fifteen vacancies. All new staff undergo a written induction to the home, which includes good customer care. People who live in the home and relatives who were spoken to, stated that they were very satisfied with the care provided. There is a statement in the AQAA from a social worker; “ If they have someone with challenging needs among other mental and behavioural problems, Candle Court is the last resort; there is nowhere else that will be able to meet the needs of these residents”. In a questionnaire, a relative wrote; ”I have every confidence in Candle Court. They certainly know their job, and more importantly, they care about their job”. Regarding the suitability of the home, a relative wrote; ”My husband was placed for a period of respite. However, I am very pleased with the home and hope he will be permanent there”. The relatives confirmed that they were able to visit the home to assess its suitability to meet service users’ needs. In a questionnaire that was returned from a social worker who is responsible for reviewing the placement for five residents in the home, they state; “Some good examples seen of staff treating residents with respect. A Jewish resident participates in songs for Jewish people every Friday. I am very satisfied with senior staff”. Candle Court Care Home DS0000053368.V363993.R02.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 & 10 People who use this service experience good outcomes in this area. This judgement has been made using available evidence, including observation of the residents and looking at their care plans. There is a plan of care that identifies the needs of each person who lives in the home and residents can be confident that the staff will provide personal care that respects their dignity and privacy. Residents can be confident that their medication is safely administered and recorded. EVIDENCE: Eight residents’ care plans were looked at in detail. In some cases, the plans did not include the person’s cultural and religious needs, which is necessary to ensure that there is a holistic view taken of the resident. A requirement is made for this to be included in the care plans. However, there was evidence in other records, for instance the daily progress notes and the AQAA, that these needs are addressed by the home, and ministers of all the major faiths, including Christian, Jewish and Muslim, visit the home to minister to the residents. Candle Court Care Home DS0000053368.V363993.R02.S.doc Version 5.2 Page 13 The new deputy manager has been working to simplify the care planning process and this is providing more clarity and guidance for staff in how to meet residents’ needs. The care plans reflect the person’s likes and dislikes and there is guidance for staff about how to minimise any challenging behaviours; for example taking the person for a walk or engaging with them in an activity if they become restless or distressed. A practical guideline in a care plan states; “Let her take her time, don’t rush her”. A relative commented in our questionnaire; “ Issues are always discussed from short-term matters to long-term care plans, and our views are always sought.” Each resident is assigned a key worker who is responsible for monitoring the care plan and recording any changes. There was evidence that the care plans were being reviewed monthly. Various tools are used, for example, Waterlow and Braden scales for assessing incontinence and the risk of pressure ulcers. Where appropriate, pressure relieving equipment, e.g. air mattresses and pads are used. Residents’ records indicated that they were seen regularly by the G.P and a range of other healthcare professionals, including dentists and chiropodists. Two consultant psychiatrists are responsible for all the residents and they visit regularly to monitor care and review the medication. We observed residents being taken to the bathroom/toilet frequently during the day and personal care was given in private with the door closed. Accidents were appropriately recorded in the accident book, as were the action taken, for example referring the resident to the G.P or A&E department as necessary. There are ample hoists and special equipment to assist staff in supporting residents with mobility problems. Staff were observed using these aids appropriately and records showed that the majority of staff had been trained in moving and handling techniques. Relatives who were spoken to during the inspection, said they were very satisfied with the care and that the staff were always very respectful to the residents. Staff were observed knocking on bedroom doors before entering. The residents appeared well cared for and were clean and dressed appropriately. The gentlemen were clean-shaven. None of the residents are able to self-medicate. We found that the medication records were properly filled in and there was a good system in place for recording the medication that was received and returned to the pharmacy. Noone was having controlled drugs at the time of the inspection, but there is an appropriate locked cupboard for storing these. Liquid medication was dated on the day it was opened to ensure that it did not exceed its used-by date. The records of the temperature of the medication storage area on the first floor showed that it often exceeded 25Centrigrade. A requirement is made to ensure that the temperature is not exceeded so that medication does not deteriorate. Candle Court Care Home DS0000053368.V363993.R02.S.doc Version 5.2 Page 14 Candle Court Care Home DS0000053368.V363993.R02.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): All these standards were assessed. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including observing how staff interacted with residents and looking at daily records. Residents can be confident that there are stimulating individual and group activities provided and there is good interaction between staff and residents who have dementia. The visiting arrangements are good and religious and sexual preferences are respected. Residents who have the ability to make choices are supported in doing so by the staff, and people who live in the home say they are satisfied with the quality of the food. EVIDENCE: People’s likes and dislikes, interests and hobbies, are documented when they are admitted. An activities organiser who works twenty hours per week has been in post in the home for the past few months. This is a welcome addition to the service. He has arranged a programme of activities that are aimed at groups of resident; for example, bingo and sing-a-longs, but other activities are on a one-to-one basis, for example, taking people out for walks and visits Candle Court Care Home DS0000053368.V363993.R02.S.doc Version 5.2 Page 16 to shops. Residents who were spoken to, said that they enjoyed activities like art and crafts and musical movement. An outside entertainer also visits and this is enjoyed by the majority of the residents, and a trainer comes and does yoga. At the time of the inspection, several residents were sitting out in the central courtyard, enjoying the sun and listening to music. The activities coordinator told me he has an adequate budget for purchasing games and equipment. He had attended a seminar about dementia and when reminiscing with residents, he is careful about broaching issues that may be distressing to them. Some residents said that the staff respected their wishes to spend time in their rooms watching television, listening to the radio and reading. There were records of some residents going out to church and of regular visits to the home by ministers of religion. We saw complimentary letters from relatives. One for example, expressed gratitude about a resident being taken out to the RAF museum, Golders Hill park and several “favourite childhood haunts”. These are examples of comments from other relatives; “In addition to the variety of activities by outside entertainers, all staff do their utmost to ensure residents are provided with stimulation, conversation and company”. “Good to know he’s being looked after so well”. “ My heart was in pain because I did not know what she was going to find in her new home; of course unaware that God had closed a window and opened a double size door for her. In other words, a blessing. Many thanks to you and your team for the enjoyable evening and the exquisite touch of the chef”. Another person said; “You could not have been kinder or treated her with more dignity. Every time I visited, I thought how lucky she was to be in such good hands in the last months of her life”. Staff were observed interacting with individual residents who have dementia, on a one-to-one basis. There are frequent visitors to the home at various times during the day and evening, which are recorded in a visitors’ book in the entrance. The visitors who were spoken to, said they were always warmly welcomed by the staff. There is comfortable seating in the reception area for visitors and they can also visit residents in their rooms or any other area in the home. Provision has been made in the past for a couple who were gay to share a room. One of these people has sadly passed away earlier this year. Both floors have dining areas that are pleasantly decorated and attractively furnished. The menus were prominently displayed on notice boards on both floors, which showed that there was a good variety of nutritious food provided, including fresh fruit. Residents stated that they could have alternatives to the menu if they preferred something else. Some residents had finely chopped food because of swallowing difficulties. Staff were observed supporting some residents who were unable to feed themselves. This was done in an unhurried manner and with dignity. Candle Court Care Home DS0000053368.V363993.R02.S.doc Version 5.2 Page 17 A new chef has been appointed since the last inspection. He is appropriately qualified and said that the food budget was sufficient to ensure that residents had plenty of good quality food. A relative wrote; “ Meals are varied and plentiful” Candle Court Care Home DS0000053368.V363993.R02.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 & 18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including looking in particular at the issue of how the home safeguards vulnerable people. Residents and their representatives can be confident that people who live in the home are well treated. However, more diligence is required in the reporting of serious incidents affecting residents, so that there is transparency about how these are dealt with when they do occur. EVIDENCE: Over the past few years, this home received several complaints from relatives about the care of residents. However, since the last inspection, there has been a significant reduction in complaints, and at the time of this inspection, none were outstanding. One relative who had made frequent complaints in the past, told the inspector that there has been a significant improvement in the quality of the care in the home and they were very satisfied with the service. Four other relatives who were spoken to during the inspection, also said they were very happy with the care the residents received and said the staff were excellent. All people interviewed, said they were aware of the home’s complaints procedure and were confident that the manager would take any concerns seriously and address them immediately. Candle Court Care Home DS0000053368.V363993.R02.S.doc Version 5.2 Page 19 There was a particular focus at this inspection on looking at how people are safeguarded from abuse. The home has its own and the local authority’s procedures about dealing with incidents of abuse. One incident of concern that occurred in February this year was recorded in the complaints/incident log. This related to a member of staff who was found to be negligent when attending to a resident, which resulted in the resident falling out of bed. The manager took appropriate action by suspending the staff from duty while an investigation was held. The manager informed the relatives about the incident, and although they were concerned, they were satisfied that she had dealt with this matter in a satisfactory manner. The staff member subsequently left the home. The National Minimum Standards require such incidents to be reported to the Commission. However, this did not happen in this incident, which the manager said was an oversight. A requirement is made to ensure that the Commission is always notified about alleged abuse and negligence so that there is transparency for residents and their representatives about how the home deals with and reports, serious incidents to the statutory bodies. However, the manager confirmed that the local authority social services had been informed and they were satisfied that she had dealt with the incident appropriately. The staff training records showed that the majority of staff had attended seminars on the protection of vulnerable adults. Most staff who were spoken to, were able to describe various types of abuse that could occur, and they all stated that they would immediately inform the manager if they were concerned that abuse was taking place. However, some staff were unsure about the “whistle-blowing” procedure, which details how to contact Social Services and the Commission for Social Care Inspection if they are concerned that managers do not take appropriate action. A requirement is made to ensure that staff are familiarised with this procedure. The staff records showed that all new staff have pre-employment checks with the Criminal Records Bureau before they start working at the home, and references are taken up to ensure their fitness to care for vulnerable people. All residents and relatives who were spoken to, said they were well treated and were satisfied with the care provided. Candle Court Care Home DS0000053368.V363993.R02.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, 22, 24 & 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including looking at all areas of the home. Residents can be confident that they live in a home that is generally safe and clean, well-maintained and is appropriate for their specific needs. There are good procedures for the prevention and control of infection. EVIDENCE: At the time of the inspection, extensive building work was taking place. Four double bedrooms are being converted to single rooms and with additional work on four other single bedrooms, twelve new single rooms will be provided. This will improve the overall accommodation, since double rooms are not generally required by placing authorities and often remain empty for long periods. The work is being done with great care so that there is no disruption to the service and residents are not inconvenienced or at risk from hazards. Candle Court Care Home DS0000053368.V363993.R02.S.doc Version 5.2 Page 21 All areas of the home were visited, including the majority of the bedrooms. The home is secluded from the busy surrounding roads by a long driveway, which reduces the traffic noise considerably. The front aspect of the building is pleasant, with well-maintained shrubs and hanging baskets. There is an attractive, spacious inner courtyard with raised flower beds. This area is paved so that all residents, including wheelchair users, are able to sit outside when the weather is suitable. The company employs a full-time maintenance person, who is also responsible for the company’s other homes. The building is generally well maintained and there are good records of repairs and health and safety checks. The standard of décor throughout the home is very good and I was satisfied that the repair/maintenance issues identified at the last inspection, had been addressed satisfactorily. The maintenance person who works at the home twice weekly, was present during this inspection and was attending to repairs requested by staff in the home maintenance book. In the AQAA, the manager states that all the bedroom linen has been replaced and new curtains purchased for bedrooms. A number of bedrooms have also been redecorated this year. A new hoist and some new wheelchairs have been provided. The majority of bedrooms had personal photographs of the residents on the doors, which helps to orientate those who are confused, and there was evidence of personal possessions and mementoes that residents had brought with them to personalise their rooms. There are sufficient bathing and toilet facilities in the home, including mechanical baths and hoists to assist in transferring residents with poor mobility. There are records to show that this equipment is serviced regularly to ensure safety. Staff are trained in the safe use of mechanical aids and moving and handling techniques. There is a team of cleaners, and at the time of the inspection, the home was very clean and tidy and there were no offensive odours. There is a control of infection policy in place and staff were seen wearing disposable gloves and aprons as necessary. There are notices above washbasins about the necessity for careful hand-washing. Three maintenance issues were identified; the carpet in the smoking room upstairs was badly stained and should be cleaned. Window restrictors were missing in some bedrooms, and in several bathrooms, the drain covers were missing. Requirements are made to attend to these issues. Candle Court Care Home DS0000053368.V363993.R02.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 these standards were assessed. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including speaking to staff and examining their records. The residents can be confident that there are always enough staff on duty to meet their needs. Staff are well trained and competent and there are good recruitment practices to ensure that residents’ welfare is safeguarded. EVIDENCE: The staff rota showed that there was always a qualified nurse on duty on both floors at all times. In addition to the care staff, there are teams of catering, laundry and cleaning staff. There is also a maintenance person and a part-time activities coordinator. The staff who were spoken to, stated that there are sufficient numbers of staff on duty at peak times, when many residents require personal care and help with meals. At the time of the inspection, there were no staff vacancies. The home does not use agency staff and vacancies are usually covered by the existing staff who work on a bank system, which enables continuity of care. The manager has implemented a rotation system so that all staff experience day and night duty, which enables staff to obtain a wider view of residents’ needs and aids the staffs’ development. Candle Court Care Home DS0000053368.V363993.R02.S.doc Version 5.2 Page 23 The manager stated in the AQAA that nine staff had National Vocational Qualifications at level 2. Staff records showed that there is an ongoing programme for all care staff to obtain NVQs. (In response to the draft report, the provider stated that twelve staff had attained this qualification and thirteen others were currently on this course.) The National Minimum Standards state that at least 50 of care staff should have this qualification, but the manager explained that some staff leave after qualifying, which makes it difficult to catch up. A recommendation is made for the proprietor to investigate why there is a high turnover of staff in the home. As stated elsewhere in this report, this inspection was focused particularly on safeguarding issues. A major component of which, is ensuring that there are proper staff recruitment procedures. The records of all staff who were recruited since the last inspection were examined in detail. The records showed that they had formally applied in writing for posts and had been interviewed. Appropriate screening had been done by the Criminal Records Bureau and references were obtained. All staff have contracts of employment and up to date job descriptions. All new staff have an induction to the home, which is aligned to the Skills for Care Council’s induction programme. Each staff also has an extensive training and development programme which includes mandatory subjects relating to health and safety, tissue viability, wound care and dementia care. Staff were appreciative of the amount of training they received. In our questionnaire, a relative wrote; “In addition to having the right skills and experience, every single member of staff has the right attitude and commitment, not only ensuring excellent care, but maximum quality of life under the circumstances”. Candle Court Care Home DS0000053368.V363993.R02.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, 36 & 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including speaking to the manager and looking at relevant records. People who live in the home can be confident that the manager is experienced and competent to run the home in their best interests. Residents and their representatives are consulted about the service. There are good systems in place to safeguard the health and safety of the residents, staff and visitors to the home. Candle Court Care Home DS0000053368.V363993.R02.S.doc Version 5.2 Page 25 EVIDENCE: Candle Court Care Home DS0000053368.V363993.R02.S.doc Version 5.2 Page 26 The manager is a registered nurse, and previously held the post of deputy manager. She became the manager in July 2007 and a new deputy who is a registered mental health nurse, has also been appointed to support her. There are two senior nurses on the ground and first floors respectively. The manager has applied to the Commission for her registration and she has been studying for the Registered Managers Award, which she expects to complete in June 08. The manager demonstrated a commitment to continuous improvement of the service, which is detailed in the home’s AQAA document. Comments from relatives, including letters and cards, and feedback from staff, indicated that they hold the manager in high regard and they are confident about her ability to manage the home well. The manager has started to hold meetings with groups of relatives since taking up post and a regular newsletter is published to inform them about residents’ issues and plans for the development of the service. The manager states in the AQAA; “ We have updated the service users quality questionnaire in order to gain a more advanced understanding of how the service is meeting the needs of our service users”. The manager said that a survey of residents and their representatives was carried out in December 07 and the issues raised were currently being considered by the organisation’s senior managers. The results of the survey will be published soon. Barnet college, which provides most of the training courses for this home, awarded Candle Court its “Learner of the Year” award for “outstanding enthusiasm and determination”. Staff meetings are held each month and we noted that staff are invited to add items to the agenda for discussion. The minutes of these meetings were seen. Relatives manage the financial affairs of the majority of the residents, but the home manages some residents’ personal finances. Proper records were being kept for purchases made on their behalf, for example toiletries and hairdressing. A recommendation is made for residents’ personal finances to be held in high interest bearing accounts to protect their interests. (In response to the draft report, the provider stated that they have already acted on this recommendation.) Each month, a senior person from the organisation visits the home to monitor the service. Reports of these visits are made available for inspection. There were records to show that regular formal supervision of staffs’ performance takes place. This was confirmed by staff who were spoken to. There were good records of health and safety checks for all gas, fire electrical and water installations. Hoists and lifts were regularly serviced, and fire alarms were tested and drills carried out. A fire risk assessment of the home is in place and there is an emergency plan in the event of a serious incident requiring evacuation of the building. Candle Court Care Home DS0000053368.V363993.R02.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 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 2 2 3 X 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 X 3 Candle Court Care Home DS0000053368.V363993.R02.S.doc Version 5.2 Page 28 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 OP7 Regulation 15(1) Requirement Residents’ care plans must include the person’s cultural and religious needs, so that all their needs are addressed. Steps must be taken to ensure that the temperature of the area where medication is stored does not exceed 25C so that medication does not deteriorate. Staff must be made aware of the “whistle-blowing” procedure to ensure that they know what to do if there are concerns that managers do not take appropriate action about abuse. The Commission for Social Care Inspection must be informed about any incident that adversely affects the well-being or safety of service users. The carpet in the smoking room on the first floor must be cleaned and the drain covers must be replaced in all bathrooms. Restrictors must be put on all bedroom windows to safeguard residents from injury. Timescale for action 30/06/08 2. OP9 13(2) 30/06/08 3. OP18 13(6) 30/06/08 4. OP18 37(1)(e) 30/06/08 5. OP19 23(2) 30/06/08 6. OP19 13(4)(c) 31/07/08 Candle Court Care Home DS0000053368.V363993.R02.S.doc Version 5.2 Page 29 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 OP28 OP35 Good Practice Recommendations The proprietor should investigate why there is a high turnover of staff in the home. Monies held on behalf of residents should be place in higher interest bearing accounts. Candle Court Care Home DS0000053368.V363993.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Candle Court Care Home DS0000053368.V363993.R02.S.doc Version 5.2 Page 31 - 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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