Care Home: Cecil Court

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What the care home does well People are happy living at the home. There is a nicely kept garden, and some of the people living at the home have been involved with gardening.People use the local shops and go out alone if they are able to. There are good quality monitoring checks on the home. The staff are well trained and supported. The Manager is committed to improving the service. What has improved since the last inspection? The Manager and staff have worked hard to make improvements to lots of different areas. There have been improvements to care plans. There have been improvements to the way medication is managed. Some people living at the home are involved in recruiting staff. The Manager has responded appropriately to complaints and has learnt from these. There have been improvements to the environment. The staff have undertaken a range of training. There is clearer guidance for staff on their roles and they are supported to understand this. There are good systems for monitoring quality, customer satisfaction and health and safety. CARE HOMES FOR OLDER PEOPLE Cecil Court 4 Priory Road Kew Richmond Surrey TW9 3DG Lead Inspector Sandy Patrick Key Unannounced Inspection 09:00 8th July 2008 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cecil Court DS0000017354.V362789.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. Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cecil Court Address 4 Priory Road Kew Richmond Surrey TW9 3DG 020 8940 5242 020 8332 1044 miriam.kajencki@ccht.org.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Central & Cecil Housing Trust Miriam Kajencki Care Home 45 Category(ies) of Dementia - over 65 years of age (11), Old age, registration, with number not falling within any other category (34) of places Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC 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 following within any other category - Code OP (maximum number of places: 34) Dementia over 65 years of age - Code DE(E) (maximum number of places: 11) The maximum number of services who can be accommodated is: 45 2. Date of last inspection 30th November 2007 Brief Description of the Service: Cecil Court is a residential care home for up to forty-five older people. The home is managed by Central & Cecil Housing Trust. The Trust is a non-profit making organisation providing accommodation and support to vulnerable adults throughout London and the Home Counties. The house is situated in pleasant grounds in Kew, close to local shops, public transport links and local facilities. The home is also close to Kew Gardens and the River Thames. Accommodation is provided on three floors, all accessed by a passenger lift. The home is divided into four units, accommodating between 6 - 19 people. Each unit is equipped with its own facilities and communal space. All bedrooms have en suite facilities. The Registered Persons have produced a Service User Guide, which includes information on the aims and objectives of the service. A place at the home costs between £580 - £650 per week. Cecil Court DS0000017354.V362789.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. The inspection included two unannounced visits to the home on the 8th & 10th July 2008. We met with the Manager, other staff on duty, people who live at the home and their visitors. We also looked at records and the environment. We wrote to the people living at the home, their visitors and staff and asked them to complete surveys telling us about their experiences. 9 people who live at the home, 3 of their relatives and visitors and 2 members of staff returned surveys to us. We asked the Manager to complete a quality self assessment. We looked at all the information we had received about the home since the last key inspection, this included information on any accidents, concerns and allegations. We also visited the home in November 2007 to check on progress in meeting the requirements we made at the last key inspection. People we spoke to as part of the inspection were generally happy. Some of the things people said to us about Cecil Court were: ‘I am very lucky to be in such a nice home with friendly staff.’ ‘The staff at Cecil Court are all very caring, patient and helpful.’ ‘During the past two years I have been impressed with the cheerfulness of staff and the care they take to make the residents’ days fulfilled.’ ‘The home provides a secure and safe environment for the residents, good food and well trained staff.’ What the service does well: People are happy living at the home. There is a nicely kept garden, and some of the people living at the home have been involved with gardening. Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 6 People use the local shops and go out alone if they are able to. There are good quality monitoring checks on the home. The staff are well trained and supported. The Manager is committed to improving the service. What has improved since the last inspection? What they could do better: There needs to be further improvements to care plans. The Manager needs to make sure all the staff treat people with respect and meet their personal care needs. There needs to be improvements to activities to make sure individual needs are being met. The Manager needs to make sure the staff working on the dementia care unit have the skills and knowledge to meet people’s needs. There needs to be further improvements to the environment. Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 7 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. Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are given the information they need to help them make a decision about moving to the home. People’s needs are assessed so that the home knows that they can meet these needs. EVIDENCE: The Statement of Purpose and Service User Guide are displayed on notice boards throughout the home. People are given copies of these as part of the welcome pack when they move to the home. The Manager told us she is going to put a Service User guide and complaints procedure in all bedrooms. These documents are regularly updated. Most people told us that they had enough information about the home before they made a decision to move there. Some people could not remember or said that relatives made this decision for them. Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 10 People who are interested in moving to the home are invited to visit and spend a day there, getting to know other people and sharing a meal with them. During this time their needs are assessed by the Manager or senior staff. Their needs are reviewed after six weeks and people are able to say whether they wish to continue to live at the home. We saw records of assessments and review meetings. Since the last inspection a new unit has opened at the home specifically designed to care for up to 11 people who have dementia. Everybody has a contract with their terms and conditions. We saw copies of these. Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are recorded within care plans but there needs to be improvements to some of these. People are supported to stay healthy and have their medication. Most people are treated with respect and have their personal care needs met, however some of the time people’s privacy and dignity is not upheld. EVIDENCE: Everyone has a care plan and copies of these are held in each unit of the home. At the time of our visit people did not have a copy of their own care plan, although care plan summaries are kept in each bedroom. The Manager should think about ways in which information about how staff are meeting each persons needs can be recorded in a meaningful way and that people can have a copy of these so they can understand what care and support has been agreed for them. Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 12 The Manager told us that the staff had worked really hard to improve care plans since the last inspection. She said that staff had a better understanding of person centred care and were talking to relatives to get more information about individual needs, interests and personal histories. We saw that care plans had improved. Care plans in some areas of the home were very detailed. The people they were about had helped to compile them and had signed them. Most care plans gave information on basic care needs. Some care plans we saw needed to be updated because people’s needs had changed and this had not been recorded. Some care plans needed more specific detailed information. Not all care plans had a photograph of the person they were about. Not all care plans were signed and not everyone had a night care plan. Risk assessments are a series of questions and answers but do not record in detail how risks will be minimised. Most people we spoke to said that they had the support they needed to stay healthy. Everyone is registered with a local GP and see other health care professionals as needed. The GP visits the home for a regular surgery. Some people felt that they did not always get the medical support they needed. One person told us, ‘there is a reluctance to call out the doctor at weekends’. Another person said, ‘my daughter had to complain before any action was taken regarding my health problem.’ One relative told us that the staff provided escorts for people going to hospital if relatives were not able to attend appointments. We saw records that showed the staff monitored people’s health and took action to keep people healthy. There were records of accidents and incidents. There is an appropriate medication procedure. All staff responsible for administering medication are trained and assessed. We looked at a sample of medication records, storage and administration. The majority of records were clear and accurate, with good recording of personal details and prescribed medication. We saw that there were regular audits on medication practices and checks of stock. In most cases medication was clearly labelled. We saw one medication with an expiry date linked to the date of opening which needed to be labelled with the date it was opened. We saw two examples where people’s medication records did not correctly record where medication had not been administered. We saw that a small number of first aid supplies had past their best before date. The Manager told us that she wanted to encourage relatives to be more involved in assisting people with personal care if this is what they wanted. One of the bathrooms is being refurbished and the Manager told us that they Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 13 plan for this room to have attractive lighting and music to make baths in here a more enjoyable and sensory experience. She told us that there would be a seat in the room so that relatives could sit and join people during their baths if they wanted to. The Manager told us that people could have a bath or shower as often as they liked. We looked at records of baths and saw that some people did not have regular recorded baths or showers. The Manager should make sure people are offered these and that this is recorded. The hairdresser visits the home each week and people can make an appointment with her. Information on costs are included within the welcome pack. Each person has a keyworker who checks that all their needs are being met. They are also supposed to be a contact point for relatives. We spoke to some keyworkers and they showed us that they had a good knowledge of individual people. Keyworkers are supposed to spend time talking to people each week and record this. The Manager said that staff had got better at this and helped people in meeting individual needs. However, some people told us that the staff did not spend time sitting and chatting with them as they were always too busy. We looked at records of some discussions keyworkers had with people. Some of the records indicated that there had not been regular discussions and some of the things people had learnt from these discussions had not been transferred to the person’s care plan. For example where people had discussed interests and hobbies. The Manager told us that staff have changed the way in which they work and they are supposed to spend more time asking people living at the home how they are and what they think about the service. The Manager told us that staff had to record people’s feelings and experiences in daily care notes and not just about the care they had given. People told us that the staff were kind and caring and we saw examples of this. We saw some really positive interactions and staff offering people choices and listening to them. We saw some staff sharing jokes with people. We saw good examples of communication where staff members were telling people exactly what they were doing and what was happening when they were assisting them. However, we saw that in some areas of the home the staff did not really interact with people except when completing a task. For example, they did not initiate conversation or check on people’s wellbeing or enjoyment. When they did have a conversation with someone this was ended abruptly. Some staff were very good at personal interactions and kept up a flow of conversation and made sure the people in their care were happy, felt valued, had the things they needed and were able to express themselves. We felt that some staff were set Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 14 in routines based around the tasks which they were assigned to do. We saw one example of a member of staff telling someone it was not ‘tea time’ when they asked for a cup of tea. In one unit we saw that everybody’s glasses were stored in the same container. Some of the glasses were labelled with people’s names, but some were not and the labels were not always easy to read. Wherever possible people should look after their own glasses in their rooms. If this is not possible then they should be stored individually. We saw one incident where someone was asking for assistance when they were in a toilet and the staff on duty walked past without offering assistance. In another incident we saw that a staff member was supporting someone with personal care when their bedroom door was open. The staff member was the only person in that unit on duty and they had kept the bedroom door open to make sure they were available if anyone else needed their assistance. One member of staff told us that the staff hid someone’s items of clothing to encourage them to wear a different outfit. One person’s care plan stated that they needed 2 members of staff to assist them with all personal care. Their care plan also said that they chose to go to bed at a time when only 1 member of staff was on duty in that part of the home, therefore the care plan could not be properly followed. Cecil Court DS0000017354.V362789.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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are some organised group activities but people need more support to meet individual needs. There needs to be improvements to the support people living in the dementia care unit receive. EVIDENCE: Some people told us that there were organised activities that they liked to join in with. But the majority of people we spoke to said that there were not a lot of organised things for them to do and some people said that they did not want to join in with the organised activities. There are a number of regular organised activities and special events. The week before the inspection visit there was a barbeque. A small number of trips had been organised to the sea side, Kew gardens and shopping centre and people were able to sign up for these if they wanted to go. The home has the use of a minibus but has to share this with other homes, therefore trips out are limited. If there was transport assigned solely to the home then there may be more opportunities for people to go out on short, individual trips. Regular Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 16 organised activities are advertised on notice boards around the house. These include baking, choir, film club and games. The Manager said that staff who run the activities have expressed an interest or a skill in this activity. There is a non profit making trolley shop once a week where people who cannot get out and about can make purchases of toiletries, snacks and other goods. The Manager said that she was hoping to purchase computer equipment and set up internet connection for the people living at the home to use. We saw that magazines and books were available in communal rooms for people to read. In some areas of the home, where people are more independent, they are able to help themselves to snacks, hot and cold drinks. Cupboards are labelled to help people find the things they need. There are monthly ‘diversity’ days which are designed to celebrate different cultures and special events. The Manager told us that they had celebrated St David’s Day and St George’s Day as part of this. Catholic and Church of England priests visit the home and hold services there. There is a men’s group and special interest clubs which people are able to participate in. People told us that they can request a newspaper of their choice to be delivered and they are charged for this. One person who told us that they visit the home regularly said, ‘at times such as Christmas everybody, including cleaning staff, help to create a wonderful atmosphere.’ The record of the activities people had participated in were not very good and sometimes there were no records at all. The information on people’s social interests and life before they moved to Cecil Court was varied. There was a lot of information for some people, but none for others. This is particularly important where people cannot tell the staff this themselves due to confusion, memory loss or communication. The staff need to be proactive in seeking out this information which could help them to improve the quality of care for individuals. Where people had identified interests through keyworking conversations this information was not recorded in care plans. The unit which is dedicated for people who have dementia is supposed to have its own activity programme. On the days we visited we did not see any evidence of this. On one day, staff on duty persuaded a small number of people to join in a game of throwing a ball to one another, even though all those who eventually participated said that they did not want to do this. We looked at the activity records for two people in this unit. There was no recorded activity for most days and the majority of recorded activities showed ‘ball throwing’. It is unlikely that this is an activity which the people living at the home would have chosen to do and they certainly did not want to do this Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 17 during our visit. The staff must think of more meaningful and stimulating activities which the people who live in the unit would like to take part in. Consideration should be given to more sensory activities. We observed what happened in this unit for several hours on both days of our visit. We felt that the staff lacked good understanding of the needs of people with dementia. The people on the unit were repeatedly guided into the lounge and into seats. People were prevented from entering the kitchen area. Staff did not initiate conversations with people and did not sustain conversations others started. They turned the TV on and then off and did the same with various radio stations without any consultation or telling people what they were doing. The unit is arranged so that the chairs are placed around the edges of a small lounge and people do not have the space to walk about or participate in individual activities. The staff told us how some people liked music and some people liked it quiet. With only one small communal area for this unit it is impossible for the staff to meet everyone’s needs. We felt that the senior member of staff responsible for running this specialised unit had a good understanding of people’s needs. However, other staff need to improve their skills and knowledge. The organisation needs to continuously review staffing levels in this unit because some people have high needs and these change on a regular basis. Relatives and visitors told us that they were made welcome when they came to the home. They said that they could visit when they wanted, that staff kept them informed of important events and that they could continue to care for their relative at the home. Some visitors told us that regular relatives meetings were very helpful and that they could share ideas at these. People who live at the home have started to be involved in recruiting and selecting staff. Some people have volunteered to be on an interview panel. They have thought up their own questions based on the things people living at the home said that they wanted from staff. They each ask a question and then give feedback to the Manager about what they thought about the candidate. Potential staff also join other people for a meal and their interactions are observed. This assessment forms part of the selection criteria. There is a choice of two main meals every lunchtime and regular alternatives for people who do not want one of these choices. Copies of the menu are placed on each dining table and the choices are recorded on large notice boards in the dining rooms. We saw that tables at mealtimes were laid with condiments and vegetable dishes for people to help themselves. Some people told us that they really liked the food at the home while others said that they did not always get the variety they wanted. One person said, ‘there is sometimes too much on my plate’. Another person told us, ‘the food is always good here’. And another person said, ‘there is some good food, some very good food’. Cecil Court DS0000017354.V362789.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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are appropriate procedures designed to help keep people safe and to enable them to make complaints. EVIDENCE: The complaints procedure is displayed on notice boards throughout the home. Copies of this are given to people in the home’s welcome pack. Most people told us that they knew who to speak to if they were unhappy about something. But some people told us that they did not know the official complaints procedure. We looked at records of complaints. These were clear and showed how complaints had been investigated and the outcome of these. There are copies of the London Borough of Richmond and Central and Cecil protection of vulnerable adults procedures at the home. All staff have had training in this area. The staff we spoke to had a good understanding of the procedures and their responsibilities in helping keep people safe. Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 19 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, 22 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a generally well maintained and clean environment. The building meets most people’s needs however some people are restricted by the layout of the area they live in. EVIDENCE: People told us that they liked the environment particularly the garden. Some people said that they liked the fact they could personalise their bedroom and bring their own furniture. One person said, ‘it is nice that residents take a pleasure in planning and planting the garden and are allocated their own space if requested.’ Since we last visited there have been improvements to the environment. Areas have been repainted. The garden has been landscaped. The Manager Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 20 told us that the whole house was due to be repainted (internally) shortly after our visit. New laundry equipment and new kitchen equipment had been purchased. Some new furniture had been purchased. Some areas of the home had been rearranged, including a lounge on the ground floor, and this has benefited the people living there. A bathroom was due to be refurbished to make this easier and more pleasant for people with dementia to use. An area of the first floor is designated as a special dementia care unit. Following research into best practice, the unit has been decorated to help people orientate themselves. The communal area in this unit is small and we saw that there was not enough space for people to express themselves and move around comfortably without other people getting agitated. The Manager said that she hopes the lounge could be extended onto a flat roof area so that there could be an additional communal room. The organisation should strongly consider this because the lack of communal space means that it is difficult for staff to meet people’s individual needs. One person told us that they had forgotten how to use the emergency call bell system. The Manager should make sure everyone is assessed for their ability to use this and people are reminded how to use it if necessary. The Manager told us that people have been assessed and have been offered alternative equipment such as sensor pads and pendant alarms. The Manager must make sure everyone who needs this equipment has access to it. Most people thought that the home was kept clean and fresh. However one person said, ‘dusting could be done more regularly’ and another person told us, ‘my room is often not clean enough and the carpet is very dirty’. The Manager showed us that she has created a checklist for domestic staff to make sure the house is thoroughly cleaned in all areas. We saw that there were specific guidelines for cleaning staff and that the Manager made regular checks on cleanliness of all rooms. On the days we visited the home was clean and fresh in most areas. One area of the home had an unpleasant odour. The Manager said that the flooring in this area needed to be replaced so that the smell could be eradicated and prevented from reoccurring. Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 21 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are cared for by well trained and supported staff. EVIDENCE: People living at the home told us that the staff were friendly, kind and helpful. Some people felt that the staff did not have enough time for them and were sometimes too busy. People told us that most of the staff listened to them and acted upon what they said. The staff we spoke to said that they were happy and well supported. They said that they had a good range of training and information, regular meetings and supervision. The organisation has introduced new specific role profiles for staff which replace their old job descriptions. These outline the competencies and skills each staff member needs for their role in the home. All the staff have been given copies of these in detailed documents. Managers and staff discuss these during individual supervision meetings and appraisals. There are clear instructions for staff on how to support people living at the home and how to carry out each task they are responsible for. Copies of these instructions are given to new staff and are available in the office. Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 22 There is a full complement of senior staff who each have responsibility for managing a unit. The senior staff are undertaking ‘Leadership’ training from the organisation to help improve their management skills and knowledge. All senior staff have or are undertaking NVQ Level 3. The Deputy Manager is taking her NVQ Level 4. The majority of care staff have achieved NVQ level 2 or above. The Manager told us that many of the staff were undertaking training provided by the local authority, such as protection of vulnerable adults, infection control, communication and diabetes. The organisation also provides a range of training. There are records to show training the staff have undertaken. All staff have had training in manual handling which is updated each year. Since the last key inspection all the staff have had basic training in dementia care and the senior staff, including the Manager, have had in depth training in dementia care. Some of the senior staff told us that they did not think the training in dementia that the care staff had undertaken was thorough enough for them to have the skills they needed to care for people with dementia. All new staff complete an induction booklet and a number of training courses. They shadow experienced staff before they work on their own. Senior staff assess their skills before the completion of their induction. The organisations should consider supporting some senior staff to become qualified trainers so that they can provide in house training for other staff. The staff we spoke to told us that thorough checks, including criminal record checks, were done on them before they started work at the home. Staff recruitment records are kept at the home and these show that all staff have had a formal interview and that a number of checks are carried out. People living at the home have started to be involved in recruiting staff. There are regular team meetings for all members of staff and these are minuted. Staff told us that they were able to chair these and to contribute their ideas and opinions if they wanted. Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and there are checks to monitor quality, health and safety and customer satisfaction. The Manager is working towards continuous improvement. EVIDENCE: The Manager has NVQ Level 4 and the Registered Managers Award. She has worked at the home for two years and is an experienced homes manager. Since the last key inspection there have been a lot of improvements to the service. Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 24 The staff told us that the Manager was supportive. One member of staff told us, ‘I think the home has good management and good staff, the residents and relatives are happy.’ The Manager and staff have worked hard to make improvements and to meet the requirements and recommendations we made at the last inspection. At the end of this inspection we discussed some of the areas which we felt needed to be improved. The Manager showed us that she was committed to addressing these issues and told us about some of the ways in which she would do that. Staff are allocated specific duties each day and this is recorded. The systems for allocating tasks and checking people have done these are very organised. All the staff know where to find this information and are given clear instructions. There is a handover of information about the home and each person every time there is a changeover of staff. We observed one such handover. All the staff were able to contribute and everyone listened and recorded key information. The staff use a notice board, diary and communication books to make sure information is passed on appropriately. Senior staff are always on duty and the either the Manager or Deputy Manager are on duty most days. There are good systems for monitoring quality and checking that people living at the home are happy with the services that they are receiving. We saw recorded checks on medication administration, care plans, food, activities, money, cleanliness, health and safety and communication. The Manager and Deputy Manager conduct checks through looking at records, observation and talking to people. They record their findings and discuss ways to improve the service. We saw evidence that the Manager made regular recorded checks on the environment, including cleanliness. The Manager makes unannounced spot checks on staff during the day and night to make sure people’s needs are being met. Everyone living at the home has representatives outside of the home who help them to manage their financial affairs. They can leave small amounts of cash with the Manager for everyday purchases such as the hairdresser and papers. There are good systems for keeping this money safe, including regular checks on the balances and clear records. Only designated senior staff have access to this money. We saw that records were accurate and that there was a clear audit trail for all transactions. Senior staff learn about the organisation’s policies and procedures through Leadership training. They also learn skills to help them manage staff and situations. The Manager has organised team building sessions for the senior staff. They told us that these sessions had been useful. The senior staff have been trained so that they can give the staff annual appraisals of their work. All members of staff were having appraisals around the time of the inspection. Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 25 Records at the home are organised and up to date. There are good records of quality checks and monitoring. Information is clear and easily accessible. The organisation has a range of policies and procedures and these are regularly updated. Staff have access to these and staff who we spoke to said that they knew where to find them. There are regular recorded checks on health and safety, including fire safety, electricity, gas and water. We saw records of these and they were up to date. The Fire Officer visited the home in 2007. All recommendations from their report had been met. There are recorded fire drills and checks on safety equipment. The Deputy Manager told us that she plans to hold more fire safety training and scenarios for the staff. The Deputy Manager has started to make full risk assessments of all rooms in the home and is recording areas where work is needed to minimise risks. Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 2 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 4 X 3 3 3 3 Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement The Registered make sure: Person Timescale for action must 15/08/08 1. Medication with an expiry date linked to the date of opening is labelled with the date of opening. 2. There are accurate records to show when and why medication has not been administered. 3. First aid supplies are within date and there are regular recorded checks on these. 2 OP10 12 The Registered Person must 15/08/08 make sure the staff support people with their personal care needs respecting their dignity and privacy at all times, assisting them as required and following their care plans. The staff must not put restrictions on people or restrict people’s access to their personal belongings. The Registered Person must 31/08/08 Version 5.2 Page 28 3 OP10 12 Cecil Court DS0000017354.V362789.R01.S.doc 19 make sure there are enough staff on duty to meet everyone’s assessed needs, without compromising anyone’s privacy, rights or care plan. The Registered Person needs to 31/10/08 make sure people’s individual interests and social needs are recorded and they are supported to meet these needs. The Registered Person must 31/08/08 make sure people living in the dementia care unit are supported to participate in a range of stimulating, varied and appropriate activities which they enjoy and are interested in. The Registered Person must 15/08/08 make sure the staff allow people to express themselves and do not try to contain them. The Registered Person must 31/10/08 make sure the staff have the skills and knowledge to support people living in the dementia care unit. 4 OP12 12 16 5 OP12 12 16 6 OP14 12 7 OP14 18 8 OP4 18 The Registered Person must 31/08/08 regularly review individual needs for people living in the dementia care unit and make sure there are enough staff to meet these needs. The Registered Person must 31/08/08 make sure unpleasant odours are eradicated and should DS0000017354.V362789.R01.S.doc Version 5.2 Page 29 9 OP26 23 Cecil Court consider the replacement of flooring in certain areas to prevent the problem from reoccurring. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Care plans should be recorded in a format which is meaningful to each individual and they should be given a copy of these. The Manager must make sure care plans are updated when a person’s needs change. Care plans must give sufficiently detailed information on each specific need. The Manager should make sure each person has a night care plan. People living at the home or their representative should sign a copy of their care plan to show that they have agreed to this. There should be a recent photograph of each person on their care plan. The Registered Person must make sure risk assessments record how risks are minimised and the support people need. 2 OP7 3 OP7 4 OP7 5 OP7 6 OP7 7 OP7 Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 30 8 OP8 The Manager should make sure everyone is getting the medical support they need whenever they need it. The Manager should make sure people are offered regular baths and that this is recorded. The Manager should make sure the staff have the time to talk to people and find out about them. The staff should make sure information they have about people’s interests and personal needs are recorded in care plans so that all the staff can give them support to meet these needs. The staff should have a more person centred not task focused approach to their work. The staff must understand that people can have a hot drink whenever they request this and not just at set times. Wherever possible people should look after their own glasses in their rooms. If this is not possible then they should be stored individually. There should be transport available for the home to use at any time to support people to go out more. The Registered Person needs to make sure people’s individual interests and social needs are recorded and they are supported to meet these needs. The Registered Person must make sure the staff allow people to express themselves and do not try to contain them. The Registered Person should strongly consider extending the physical environment of the dementia care unit as the current environment restricts people’s movement and DS0000017354.V362789.R01.S.doc Version 5.2 Page 31 9 OP10 10 OP10 11 OP12 12 OP10 13 OP10 14 OP10 15 OP12 16 OP12 17 OP14 18 OP19 Cecil Court makes it hard for staff to meet their needs. 19 OP22 The Manager should make sure everyone is assessed for their ability to use the call alarm bell and people are reminded how to use it if necessary. Alternative equipment or plans must be in place for people who cannot operate the alarm system. The staff should work with people and their families to create detailed information on their lives before they moved to Cecil Court. The organisation should organise for some senior staff to be manual handling trainers. 20 OP12 21 OP30 Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 32 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 Cecil Court DS0000017354.V362789.R01.S.doc Version 5.2 Page 33 - 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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