Care Home: Carham Hall

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What the care home does well What has improved since the last inspection? The home`s terms and conditions of residency have been updated in line with the new Scottish national contract. A new brochure has been produced taking account of standards included in the Scottish Borders local authority placement contract. The providers have taken action to address requirements made following the last inspection. For example: a range of preventative healthcare risk assessments have been carried out; the home`s safeguarding policy has been updated and all staff have completed safeguarding training; people who use wheelchairs have been referred to an appropriate agency for a re-assessment of their mobility needs. All wheelchairs have been serviced and checked for safety. Action has been taken to address problems experienced when trying to obtain ambulance services for the people who live at Carham Hall. The providers ensure that the Commission is notified of any concerns affecting the well being of people using their service. Carham Hall has adopted the use of a regionally recommended good practice tool to ensure that appropriate information is shared between the home and any local hospital. Improvements have been made to the home`s assessment and care planning documentation. These will help to ensure that staff receive clearer guidance about the care that must be provided to meet people`s needs. The providers have completed `End of Life` care training and have adopted best practice recording in this area. Staff have also completed certificated foot care training. Staff have completed safeguarding training and the home`s safeguarding policy has been revised following advice received from relevant professionals. A range of improvements have been made to the premises. For example, the lounge has been re-decorated and new stair lifts have been fitted providing wheelchair access throughout the building. What the care home could do better: Ensure that robust pre-employment checks are carried out before staff commence working at the home. This will help ensure that people are not cared for by unsuitable individuals who might cause them harm. Ensure that staff complete induction training that complies with the `Skills for Care` induction standards. This will help to ensure that all staff have the skillsand competencies to provide people with good quality care that meet their needs. Ensure that systems are in place which enable the quality of care provided in the home to be reviewed and monitored. This will help to ensure that the home is run in the best interests of the people using the service. Ensure that staff receive regular supervision. This will help to ensure that people working at the home are appropriately supervised and are providing care that delivers good outcomes for people using the service. CARE HOMES FOR OLDER PEOPLE Carham Hall Cornhill On Tweed Northumberland TD12 4RW Lead Inspector Glynis Gaffney Key Unannounced Inspection 8th July 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carham Hall Address Cornhill On Tweed Northumberland TD12 4RW 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) 01890 830338 01890 830338 admin@carhamhall.wanadoo.co.uk Mrs J Baxter Mr J Baxter Mrs J Baxter Care Home 22 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (12) of places Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate one identified resident - category MD for periods of respite care. 9th November 2007 Date of last inspection Brief Description of the Service: Carham Hall is a privately owned large detached stone built house standing in its own grounds overlooking the River Tweed and is under the direct personal supervision of Mr and Mrs Baxter who live on the premises. The nearest villages are about a mile away and Coldstream, where there is access to public transport, is about five miles away. The home is registered to accommodate twenty-one older people, ten of whom may have dementia. Carham Hall is well furnished and has a large number of bedrooms with ensuite facilities. Other bedrooms have exclusive use of an adjacent bathroom or toilet. A shaft lift and four stair lifts provide access to the bedroom areas on the ground and first floors of the home. Fees are from £425.00 to £600.00 per week. There may be an additional charge over and above each council’s approved rates for some rooms and this will be agreed at the time of admission. The home’s new brochure now provides people with clearer information about the fees charged. Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. How the inspection was carried out: Before the visit: We looked at: • • • • • Information we have received since the last key inspection visit on the 22 August 2007; How the service dealt with any complaints and concerns since the last visit; Any changes to how the home is run; The providers’ views of how well they care for people. We also spoke with people who use the service and staff working at the home; The views of relatives, other professionals and staff. The Visit: An unannounced visit was made on the 08 July 2008. During the inspection we: • • • • • • Talked with the providers; Looked at information about the people who use the service and how well their needs are met; Looked at other records which must be kept; Checked that staff have the knowledge, skills and training to meet the needs of the people they care for; Looked around the building to make sure it is clean, safe and comfortable; Checked what improvements have been made since the last visit. What the service does well: Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 6 Relatives who returned surveys said: • • • • Staff always seem to be helpful and friendly; The home has lovely rooms, is very clean and has friendly staff; Staff appear attentive and always ready to help. My friend has no complaints and is happy with the care; The staff are always around in the home but not in an intrusive way. The residents always look contented. The home is spotlessly clean. The residents are always clean, well dressed and well cared for. The home has no smell at all; Everything at the home is to a very high standard. • Staff who returned surveys said: • • I would like to think that if I have any questions that the service would give me training and answer my questions; My managers were very supportive when I started and still are. Appropriate training opportunities relating to the care of residents are offered to staff on a regular basis and personal development is encouraged. A welcome pack and brochure are given to people who are interested in using the service. These tell people what they may expect once they move into the home. The Northumberland ‘FISHNETS’ falls project has provided staff with certified training in falls prevention and management. People at risk of falling have been provided with a pendant that alerts staff when someone has fallen. This helps to keep people safe. Bedrooms are always redecorated before a new occupant takes up residence. Most people have access to en-suite facilities, which enables them to receive care and support in a more private setting. The premises are well maintained and kept in a clean and hygienic condition. Furnishings and fittings are of a good standard. The providers have taken action to comply with the recent no smoking legislation. The premises are smoke free. This will help to keep people fit and healthy. 83 of the care team have obtained a nationally recognised qualification in care. This helps to ensure that people receive good quality care delivered by professionally trained staff. What has improved since the last inspection? Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 7 The home’s terms and conditions of residency have been updated in line with the new Scottish national contract. A new brochure has been produced taking account of standards included in the Scottish Borders local authority placement contract. The providers have taken action to address requirements made following the last inspection. For example: a range of preventative healthcare risk assessments have been carried out; the home’s safeguarding policy has been updated and all staff have completed safeguarding training; people who use wheelchairs have been referred to an appropriate agency for a re-assessment of their mobility needs. All wheelchairs have been serviced and checked for safety. Action has been taken to address problems experienced when trying to obtain ambulance services for the people who live at Carham Hall. The providers ensure that the Commission is notified of any concerns affecting the well being of people using their service. Carham Hall has adopted the use of a regionally recommended good practice tool to ensure that appropriate information is shared between the home and any local hospital. Improvements have been made to the home’s assessment and care planning documentation. These will help to ensure that staff receive clearer guidance about the care that must be provided to meet people’s needs. The providers have completed ‘End of Life’ care training and have adopted best practice recording in this area. Staff have also completed certificated foot care training. Staff have completed safeguarding training and the home’s safeguarding policy has been revised following advice received from relevant professionals. A range of improvements have been made to the premises. For example, the lounge has been re-decorated and new stair lifts have been fitted providing wheelchair access throughout the building. What they could do better: Ensure that robust pre-employment checks are carried out before staff commence working at the home. This will help ensure that people are not cared for by unsuitable individuals who might cause them harm. Ensure that staff complete induction training that complies with the ‘Skills for Care’ induction standards. This will help to ensure that all staff have the skills Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 8 and competencies to provide people with good quality care that meet their needs. Ensure that systems are in place which enable the quality of care provided in the home to be reviewed and monitored. This will help to ensure that the home is run in the best interests of the people using the service. Ensure that staff receive regular supervision. This will help to ensure that people working at the home are appropriately supervised and are providing care that delivers good outcomes for people using the service. 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. Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are suitable arrangements for making sure that people’s needs are assessed before they are admitted into the home. This means that people can feel confident that staff will be able to meet their needs. EVIDENCE: Admissions do not take place until a full needs assessment has been carried out. For people who are self-funding, and without a social services assessment, the home undertakes its own assessment. The recently improved documentation covers the good practice areas referred to in the National Minimum Standards. Wherever possible, the home consults with the person wishing to use the service and their family. Where the assessment has been undertaken through care management arrangements the home obtains a copy Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 11 of the social services assessment and care plan. On admission into the home, each person is allocated a key worker. This member of staff is responsible for maintaining good relationships with people’s families and for ensuring that their emotional and social care needs are attended to. Although Carham Hall now provides intermediate care, the home was not inspected against the relevant standard. Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. People’s health and personal care needs are being met. However, people’s care plans do not adequately identify their needs and how to meet them. This means that staff do not have sufficiently clear written guidelines on how to meet people’s needs. EVIDENCE: The providers have recently revised their assessment and care planning documentation to take account of best practice guidance. The documentation is being completed for all new people admitted into the home and will eventually be put in place for people already accommodated at Carham Hall. A written record of the assessment of people’s needs following their discharge from hospital into Carham Hall is kept. People’s care records contain important information including: Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 13 • • • A personal profile that tells staff about important events in a person’s life. Details of people’s preferred routines, likes and dislikes are also included helping to provide staff with a better understanding of each person and what is important to them; An assessment of each person’s needs covering such areas as personal hygiene, continence care and personal safety. These assessments provide information about what people can do for themselves as well as recording where a person might need help; A care plan summary that informs staff about how they should meet people’s assessed needs. Staff said that they are given up to date information about the needs of the people they support. However, although it is clear that the providers have taken steps to improve the quality of people’s care records, the inspectors identified that: • People’s care plan summaries do not contain information about desired outcomes. Including such information in care plans should help make sure that people’s care plans reflect what they, or their relatives want, from the care team at Carham Hall; People’s needs are not always clearly identified in the care plan summaries; Tasks to be carried out by staff to meet people’s needs have not been described in sufficient detail. • • Annual placement reviews are held in conjunction with the relevant local placing authority. This helps to ensure that people’s needs are being met and that the placement continues to offer good value for money. Discussions held with people who use the service, as well as a review of the health care records completed by staff, show that the home takes action to meet people’s health care needs. For example, one person had fallen in their bedroom. The log notes kept by staff showed that consideration had been given to the need to observe the person’s condition and seek medical intervention if any concerns were identified. There was evidence that another person had received dental, optical and chiropody care and their weight had been regularly monitored. Required pressure relieving equipment is obtained before a person is admitted into the home. Recognised risk assessment tools are used to record people’s susceptibility to falling, developing pressure sores and suffering from poor nutrition. People’s wishes about whom they would like present during healthcare consultations has been obtained and recorded in their care records. The Continence Advisory Service has visited the home and provided staff with training and support. A water dispenser has been purchased and sited nearby to the lounge areas. Easier access to water may help encourage people to increase their water consumption and lead healthier lifestyles. Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 14 The majority of staff have completed a recognised qualification in care. This means that they will have received training in how to meet people’s physical needs, including the monitoring of any health care needs they might have. The staff whose training records were examined had not completed tissue viability training. Such training would help staff to be more aware of how to prevent pressure sores developing. The inspectors observed staff treating people with respect and dignity. For example: people needing support and encouragement to eat were given individual care in a sensitive manner; following the lunch time meal staff offered people the opportunity to receive support to change their clothing where necessary; staff spoke to people in a respectful manner. People said that staff: • • • • Listen to what they say and act upon it; Make themselves available when they need them; Make sure that they receive the medical support they require to keep healthy; Ensure that they receive the help and support they require. Arrangements are in place to ensure that people receive the medication they need to keep them healthy. A recent inspection carried out by a Commission pharmacist found the home’s medication policy and day-to-day practices satisfactory. Requirements and recommendations arising out of this report have been complied with. The medication records checked were generally well completed. However, it was identified that handwritten medication records had not been double signed for one person. People’s medication is kept secure at all times. Staff were observed administering medication in a safe and competent manner. All staff administering medication have completed accredited training. However, staff records did not contain a written assessment of their competency to handle, administer and record medication. For people who are able to self medicate, the home provides safe facilities for keeping their medication. The home confirmed in its Annual Quality Assurance Assessment that there had been no The serious incidents involving the mis-administration of controlled drugs. providers have adopted an additional audit tool to ensure that controlled drugs continue to be safely managed within the home. Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff encourage people to make choices about how they live their lives and support them to maintain contact with their families and friends. This helps people to live a lifestyle that matches their expectations and preferences and makes them feel valued and respected. EVIDENCE: Regular religious services are held at the home and people are invited to attend. People’s religious beliefs are ascertained as part of the home’s preadmission assessment. Wherever appropriate, the home encourages ministers of all faiths to visit Carham Hall and provide religious services to people from their congregations. One person told the inspectors ‘you are free to follow your own faith here. Nothing is imposed on you. I choose not to practise my faith and this is my choice. That is okay too.’ People are able to access group social activities at least once a day and the activities on offer range from general knowledge quizzes to art and crafts Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 16 sessions. People said that they are happy with the social activities provided and can choose whether or not to participate. On the day of the inspection, a member of staff led a quiz that was well attended and enjoyed by all. The home has a large 12-seater wheelchair adapted mini-bus, which is used to take people out on shopping trips to the Metro Centre or to events such as the Edinburgh Tattoo. Regular musical concerts are held at the home. A member of staff has recently been given the responsibility of being the home’s activities co-ordinator. The providers hope that this will enable a more structured activities programme to be delivered. Important anniversaries such as Christmas, Easter and birthdays are all celebrated. The home develops contacts with local organisations that may be able to provide interesting activities or events at Carham Hall. For example, the providers are exploring the possibility of the Northumberland Wildlife Trust delivering garden based activities. Information about people’s social needs is obtained during their pre-admission assessment, or shortly after their admission into the home. A social care assessment is carried out for each person providing staff with information about their social interests and preferences. Although social needs care plan are devised, people’s needs in this area are not always clearly recorded. The home is registered to provide dementia care. However, activity plans have not been devised for people with dementia. People are supported to maintain relationships with their families. People said that their visitors are made to feel welcome and are offered refreshments when they arrive. People can see their visitors in private or in any of the communal lounges. Care plans to support and promote people’s contact with their families have not been devised. People using the service told the inspectors that they were able to choose how they lived their lives. They also said that they made decisions about where they spent their time and what they ate. People’s care records do not contain an assessment of their capacity to make informed choices and decisions. The providers have recently completed Mental Capacity Act training and are now in a position to assess people’s needs. The inspector attended a lunchtime meal. The tables were pleasantly set and the meal looked appetising and was nicely presented. The mealtime was relaxed and staff were attentive to people’s need for support. People said that the meals served are always of a good standard and they receive sufficient to eat and drink. They also said that choices are available at main meal times and alternatives to the main menu are offered if required. Kitchen staff work to a set of prepared menus. A record is kept of any changes made to the printed menu. The menus provide a good variety of food Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 17 choices. However, some people using the service said that more fresh fruit and vegetables would be welcome. A relative also suggested that more fresh fruit and vegetables would be beneficial to people’s health. The menus do not always specify what vegetables would be served and neither do they make any mention of the range of beverages that are available throughout the day. Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are safeguarding arrangements for protecting people from harm or abuse. EVIDENCE: Details of the home’s complaints procedure are included in its welcome pack. Information about the procedure is also posted around the home. People using the service said that they have been made aware of the homes complaints procedure and would be happy to raise matters of concern with any member of staff. 40 of the staff returned surveys. They said that they knew what to do if a relative or person using the service raised concerns. Staff interviewed were also very clear clear about the action they would take on receipt of a complaint. The home’s adult protection policy has been revised and updated. The policy has been shared with local safeguarding teams to ensure that it is in line with their safeguarding protocols. The providers have also obtained copies of local authority safeguarding policies and procedures. This will help to ensure that the providers and staff are familiar with the measures that these local authorities will expect them to take to keep people safe. The Commission has been notified of one safeguarding concern since the last key inspection. This matter is currently being investigated under the relevant local authority’s Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 19 safeguarding procedures. Staff said that they have received training in how to keep people safe from harm or abuse. The providers have also completed safeguarding training provided by the local authorities placing people in their home. Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People live in a home that has good facilities, is well maintained and clean, and has been adapted to meet the general needs of older people. EVIDENCE: Carham Hall provides a safe, attractive and comfortable place for people to live. The premises have been adapted to meet the needs of the people who live there. Specialist aids and equipment have been provided to meet people’s individual needs. For example, there is a shaft lift providing access to the first floor and four stair lifts have been installed providing disabled access to all bedroom accommodation. Staff have access to hoisting equipment enabling them to safely assist people to mobilise and transfer. Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 21 Since the last inspection a range of improvements to the fabric of the building have been made. For example, the emergency exit gate in the coachhouse has been replaced and all heated towel rails have been covered to prevent people suffering harm. The turning circle in the car park has also been resurfaced to provide people with a better and safer surface on which to walk. Carham Hall provides a variety of communal areas enabling small clusters of people to socialise and spend time together. For example, people have access to two large lounge areas and a smaller area where they can congregate and mix with others using the service. People can also spend time with visitors in the privacy of their own rooms. The home is maintained in a clean and hygienic condition with odour control being given a high priority. Anti-bacterial hand wash has been placed in toilet areas and at the entrance to the home. This helps to minimise the risk of infection and keep people safe. The home has a well equipped laundry, which is kept clean, tidy and hygienic. All laundry equipment is in good working order. The kitchen is clean and well equipped. There are good food stock levels and food that had been opened was appropriately labelled. People have been encouraged to personalise their bedrooms. Bedrooms visited contained items of people’s own furniture as well as ornaments and furnishings brought with them from home. Bathrooms and toilets are kept clean and are fitted with appropriate aids and adaptations to meet the needs of the people who use the service. For example, grab rails have been fitted to help people use the toilet more independently. The home has a Parker bath and a disability friendly shower to help people bathe more easily. Since the last key inspection of the service, the home’s conditions of registration have changed to enable it to provide more dementia care beds. Although the providers and staff are experienced in meeting the needs of people with dementia, the environment would benefit from being further developed to meet the specific needs of people with dementia. Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff, and the training they have received, help to make sure that people’s needs are met and that they are in safe hands. EVIDENCE: There is a rota that shows, which staff are on duty and at what times. Four care staff are scheduled to be on duty between 8am and 2pm each day and there are three care staff between 2pm and 8pm. In addition, Mrs Baxter works between 8am to 6pm each weekday or as required, and Mr Baxter also works at the home. Mr and Mrs Baxter live on the premises and are available at any time. The manager provides ‘out of hours’ cover seven nights a week. Mrs Baxter said that she is rarely called out to the support the waking night carer. Agency staff are not used. Staff turnover is low. Three staff have left their employment at home during the previous 12 months. The rotas show that there can be up to three domestic staff rostered on duty between 8am and 2pm. This is a good level of cover ensuring that the home is kept clean, tidy and hygienic. A good level of maintenance cover is also provided and this helps to maintain the home in a good condition. A cook is employed and usually works between 8am and 2pm. Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 23 An audit of a sample of the home’s rotas shows that: • There are occasions when a shift senior member of staff is not rostered on duty between 6pm and 8pm to cover the shift. However, Mr and Mrs Baxter live on the premises and are available to be consulted at any time; There is a rota that shows, which staff are on duty and at what times. Four care staff are scheduled to be on duty between 8am and 2pm each day and there are three care staff between 2pm and 8pm. In addition, Mrs Baxter works between 8am to 6pm each weekday or as required, and Mr Baxter also works at the home. The manager provides ‘out of hours’ cover seven nights a week. Mrs Baxter said that she is rarely called out to the support the waking night carer. Agency staff are not used. Staff turnover is low. Three staff have left their employment at home during the previous 12 months. The rotas show that there can be up to three domestic staff rostered on duty between 8am and 2pm. This is a good level of cover ensuring that the home is kept clean, tidy and hygienic. A good level of maintenance cover is also provided and this helps to maintain the home in a good condition. A cook is employed and usually works between 8am and 2pm; Only one waking member of staff covers the nighttime period from 8pm to 8am. This level of staffing may need to be adapted as and when people’s needs change or where greater numbers of people with dementia are cared for. Mrs Baxter said that extra staff hours would be provided where a need to do so was identified. • • Staff reported that there are ‘always’ or ‘usually’ enough qualified and experienced staff on duty to meet people’s health and welfare needs. The inspectors did not see any evidence that suggested that people’s needs are not met. Pre-employment checks are carried out before staff can commence working at the home. For example, in two of the staff files checked there was evidence that each person had completed an application form and provided employment history details. However, two issues of concern were also identified. These concerned Criminal Records Bureau disclosure and POVAFirst checks not being carried out before staff started work at the home. These matters were brought to the attention of the providers who immediately took appropriate action to address the concerns. In addition, there was no evidence that staff had confirmed in writing that they were physically and mentally fit to do the job for which they were being employed. New staff are provided with an in-house induction, which they said covered everything that they needed to know to do their job. However, there was no written record of this and newly appointed staff do not complete training that Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 24 complies with the ‘Skills for Care’ induction standards. The providers said that this would be addressed immediately following the inspection. Eight of the home’s 11 care staff have obtained a nationally recognised qualification in care. Two other staff are in the process of doing so. The level of qualified staff within the home shows that the providers place a high level of importance on supporting staff to achieve a care based qualification. This will also help to ensure that people receive good quality care. The providers said that staff have the opportunity to complete statutory training in areas such as moving and handling and fire safety. However, whilst staff confirmed this, documentary evidence of qualifications obtained is not always in place. The home also offers staff opportunities to complete training that is more relevant to the needs of older people, as well as those people with dementia. For example, one staff member had completed training in podiatry and dementia awareness. The providers said that all staff would receive dementia care training over the next 12 months. This is important as the home now has a flexible registration that enables them to provide care for people with dementia. Staff who completed surveys said: • • • • The providers carried out pre-employment checks before they started working at the home; The training they receive is relevant to their job, covers equality and diversity issues and keeps them up to date with new ways of working; They meet with their manager on a ‘regular’ basis; They feel they have the right support, experience and knowledge to meet the different needs of the people they care for. Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from living in a home where their health and safety is promoted and protected. EVIDENCE: The home’s manager is a trained district nurse with 20 years experience of working with older people, and has completed the Registered Manager’s Award. Mrs Baxter has managed the home since 1988. Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 26 The providers are clear about the improvements that they wish to make to the service and were able to describe the way in which the service will be developed over the next 12 months. For example: the first floor bathroom is to be extended and an assisted bath is to be fitted; arrangements have been put in place to ensure that staff receive formal supervision every two months. In addition, the providers are in the process of developing a quality assurance system, which will enable them to carry out regular checks of the home’s performance against the National Minimum Standards and the Care Homes Regulations. The providers have started carrying out audits of the home’s performance in such areas as continence and dementia care management and they gave assurances that further developments are planned. These developments are however at an early stage and more work is required. Annual satisfaction questionnaires are issued to people using the service and their families. This helps the providers to judge where improvements in the service are required. Arrangements have been put in place to keep staff and people using the service safe from potential harm. For example: • • • • • All hoisting equipment had been serviced in February 2008; Electrical equipment, including the nurse call alarm and the central heating system, had been tested during the previous 12 months; A record of accidents occurring within the home is kept and is regularly monitored to identify any patterns or health and safety issues; Regular fire checks are carried out. Following a visit from the local fire service, the providers installed a new fire system to comply with British safety standards; A small group of staff have attended ‘competent person’ fire safety training. However, it was not clear from the home’s records that all staff have had fire training at appropriate intervals and this is to be addressed. An inspection of the premises revealed no obvious hazards or health and safety concerns. The home has completed a written risk assessment to ensure that hazardous substances are safely handled and stored. The home has devised an infection control policy and has completed the Department of Health guide ‘Essential Steps’ to ensure that steps are taken to minimise the spread of infection. The providers confirmed that all staff have completed infection control training. Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X 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 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 2 X 3 Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP6 Regulation 4 and 5 Timescale for action Ensure that the home’s 01/03/09 Statement of Purpose and Service User Guide are revised to include details of how intermediate care is provided at Carham Hall. This will help to ensure that people assessed and referred solely for intermediate care are helped to maximise their independence and return home. 2. OP29 19(9)(10( 11) Schedule 2 Paragraph s 1 to 9 Ensure that: • Where staff commence work before a full Criminal Records Bureau Disclosure check has been received, a POVAFirst is obtained; Where staff commence working at the home with only a POVAFirst, they are appropriately supervised at all times and have received a full induction. 01/08/08 Requirement • This will help ensure that people are not cared for by unsuitable individuals who might cause Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 29 3. OP30 18(1)(c)(i ) them harm. Ensure that: • New staff complete an induction that complies with the ‘Skills for Care’ induction standards; There is documentary evidence confirming that staff’s statutory training is up to date. 01/01/09 • 4. OP33 24 This will help to ensure that all staff have the skills and competencies to provide people with good quality care that meet their needs. Establish and maintain a system 01/02/09 for reviewing and improving the quality of care provided at the home. This will help to ensure that the home is run in the best interests of the people using the service. Ensure that staff receive: 01/04/09 • • Supervision at least times a year; An annual appraisal. six 5. OP36 18 This will help to ensure that people working at the home are appropriately supervised and are providing care that delivers good outcomes for people using the service. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Carham Hall Refer to Good Practice Recommendations DS0000000511.V370288.R01.S.doc Version 5.2 Page 30 1. Standard OP6 As the home now provides intermediate care, ensure that arrangements are in place to comply with Standard 6 of the National Minimum Standards. Ensure that people’s care plans contain: • • • Information about desired outcomes; Clear descriptions of their assessed needs; Detailed descriptions of the tasks that staff are expected to carry out to meet people’s needs. 2. OP7 3. OP9 Ensure that all staff complete tissue viability training. Ensure that: • • Handwritten medication records are doubled signed; A written assessment of staff’s competency to administer medication is carried out regularly. 4. OP12 Ensure that: People’s social care needs are clearly defined and staff are provided with clear guidance about how to meet them; • Undertake a review of the provision of activities within the home. Develop person centred activity plans for people with dementia. Devise care plans which provide staff with clear guidance on how to promote people’s contact with their families and friends. Ensure that the home’s menus specify the range of beverages available throughout the day. The types of vegetables provided with each meal should also be specified. Carry out a review to determine how the general environment can be made more ‘dementia care friendly.’ Ensure that a senior member of staff is available on the floor at all times. Ensure that: A written record of each staff member’s in-house induction is kept in their training file; • Each staff member’s training file contains documentary evidence that they have successfully completed induction training to the ‘Skills for Care’ induction standards; The home’s training policy is updated to reflect changes to • • 5. 6. OP13 OP15 7. 8. 9. OP19 OP27 OP30 Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 31 10. OP33 its practices in this area. Devise an annual development plan that takes account of: • • • • Requirements and recommendations made in Commission inspection reports; Feedback from surveys completed by people using the service, their families, staff and those professionals who have contact with the home; The planned improvements referred to in the home’s Annual Quality Assurance Assessment; Any issues identified through the home’s internal quality monitoring systems. Carham Hall DS0000000511.V370288.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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