Care Home: Cleeve Court

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What the care home does well During the two days of this visit it was evident from talking with individuals and observing interaction with staff that there is a strong commitment from all staff to provide a quality service based on respect and valuing all residents as individuals. One individual said how much she appreciated staff in that "they always help me when I need it and I feel they understand me and what help I need". Staff were observed assisting individuals in a sensitive and caring manner particularly where the individual was confused or disorientated. The home provides a high quality environment particularly in relation to individual accommodation with all having en-suite facilities. One comment received from a health professional who visits the home: "There is a real sense that the staff want to provide an excellent service To their clients and they strive to improve care all the time".And from a relative: "I can`t fault the Cleeve Court regarding the care of my relative as far as I am Concerned they do a very good job and I thank them all for this". What has improved since the last inspection? At the time of the last inspection there was no permanent manager in place and this had an impact in terms of morale and continuity for staff and residents. However a manager has now been recruited though is still to be registered with the CSCI. It was very evident in talking with staff that this has had a positive effect on the morale of staff in the home. A number commented that they now felt "listened to" and "things are much better" and certainly the new manager has been able to address some of the staffing issues particularly the arrangement where staff rotate from Kelstone Rise to Lansdown View. This in the inspector`s view was not in the best interests of individuals who live in the home or acknowledged the strengths and skills of particular staff. It is now proposed that staff work on a specific floor which will help in making sure there is greater continuity for individuals who live in the home and improved staff cohesion. An improved care plan format is being introduced resulting in improved information and a more person centred approach. A number of requirements were made at the last inspection. This inspection found they had been addressed and that improvements had been made in care planning specifically risk assessments (though continued improvement is needed), facilities in the home and meal arrangements. CARE HOMES FOR OLDER PEOPLE Cleeve Court Bath Community Resource Centre Cleeve Green Twerton Bath BA2 1RS Lead Inspector Jon Clarke Unannounced Inspection 29th May 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cleeve Court DS0000069975.V361711.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. Cleeve Court DS0000069975.V361711.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cleeve Court Address Bath Community Resource Centre Cleeve Green Twerton Bath BA2 1RS 01225 396685 01225 464364 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) Bath & N E Somerset Social Services Mr Shaun Lock (Not as yet registered with CSCI) Care Home 46 Category(ies) of Dementia (25), Old age, not falling within any registration, with number other category (21) of places Cleeve Court DS0000069975.V361711.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 either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category Code OP - maximum number of places 21 Dementia, excluding learning disability or mental disorder - Code DE - maximum number of places 25 The maximum number of service users who can be accommodated is 46. Within the overall maximum number of service users permitted to be accommodated in the home, the registered person may at any one time accommodate up to 5 service users who have been assessed as meeting the eligibility criteria to receive the services of the inreach nursing team supplied by Bath & North East Somerset Primary Care Trust. 18th June 2007 2. 3. Date of last inspection Brief Description of the Service: Cleeve Court is a Bath & North East Somerset Council Care Home for older people and people with dementia. The home is situated in part of a new purpose built Community Resource Centre based in the Twerton area of Bath. The Bath Community Resource Centre is the first to be completed of the three centres that will cover the whole of the Bath & North East Somerset area. The centre also includes the Carrswood and Hazelmeir day centres; the assessment and re-enablement home care service, supported living services, a range of meeting & activity rooms and therapeutic facilities that can be assessed by the local community. The main kitchen is situated on the ground floor and provides meals for the care home and the two day centres. The care home occupies the first and second floors of the building. The first floor (Kelston Rise) is for people with dementia and the second floor (Lansdown View) is for older people. Both floors are assessed by a lift and each floor has a separate lounge, a lounge/dining room, a kitchen and other seating areas. Every room has en-suite facilities with walk-in showers and some have ceiling hoists. Each floor also has separate toilets and assisted bathrooms. The centre has landscaped gardens and parking for visitors and staff. Cleeve Court DS0000069975.V361711.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. This was an unannounced inspection that took place over two days. As part of this inspection a number of records were looked at including care plans, staffing arrangements, recruitment and training records. The CSCI pharmacist inspector looked at the arrangements for managing and administering medication in the home. There was also an opportunity to talk with individuals who live and work in the home and discuss with them their experience of living and working in the home. A number of Have Your Say questionnaires were sent to the home before this inspection. Responses were received from 4 residents 8 relatives and 4 health professionals and 10 members of staff. As part of this inspection the manager completed an Annual Quality Assurance Assessment (AQAA) which set out the areas of practice based around the National Minimum Standards summarising what the home does well, the evidence for this, what they could do better and how they have improved in the last 12 months. The information from the AQAA and questionnaires has been used to help make a judgement about the quality of care provided in the home. What the service does well: During the two days of this visit it was evident from talking with individuals and observing interaction with staff that there is a strong commitment from all staff to provide a quality service based on respect and valuing all residents as individuals. One individual said how much she appreciated staff in that “they always help me when I need it and I feel they understand me and what help I need”. Staff were observed assisting individuals in a sensitive and caring manner particularly where the individual was confused or disorientated. The home provides a high quality environment particularly in relation to individual accommodation with all having en-suite facilities. One comment received from a health professional who visits the home: “There is a real sense that the staff want to provide an excellent service To their clients and they strive to improve care all the time”. Cleeve Court DS0000069975.V361711.R01.S.doc Version 5.2 Page 6 And from a relative: “I can’t fault the Cleeve Court regarding the care of my relative as far as I am Concerned they do a very good job and I thank them all for this”. What has improved since the last inspection? What they could do better: A number of areas were identified from this inspection which need to be addressed. Recognising the improvements taking place in care planning there remains an issue around completing and reviewing risk assessments. Records are not always updated and current and this must be addressed. This inspection also identified some concerns as to the staffing levels in the home and a requirement has been made for the manager to look at staffing in the home. It is acknowledged that improvements are being made which will improve continuity. The use of agency staff has at times been high and again this should be closely monitored and wherever possible be avoided. The arrangements for mealtimes have improved however further changes would improve the experience for individuals and also assist in maximising the independence of individuals who live in the home. Cleeve Court DS0000069975.V361711.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. Cleeve Court DS0000069975.V361711.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 Cleeve Court DS0000069975.V361711.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home undertakes full and comprehensive assessment of prospective residents so that they are able to make an informed decision about the capacity of the home to meet health and social care needs. EVIDENCE: Pre-admission assessments were looked at. They provided good information about the health and social care needs of the individuals with comments from the individuals and carers. No admissions take place without a formal assessment and information from specialists such as mental health team for the dementia unit. Cleeve Court DS0000069975.V361711.R01.S.doc Version 5.2 Page 10 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. Care Planning and arrangements for meeting health care have improved with new format however efforts are still required to make sure they are at the required standard so that staff are provided with the necessary information to ensure the health and social care needs of residents are met. The practice of staff and policies of the home help to make sure that residents are treated with respect and their dignity is upheld. Some improvements are needed in the handling of medication to make sure that it is always looked after safely and residents health is protected. EVIDENCE: A number of care plans were looked at and a limited number of the new format had been completed at the time of this visit. The new format offers information through a daily programme which provides person centred information about Cleeve Court DS0000069975.V361711.R01.S.doc Version 5.2 Page 11 the needs of individuals. Included are assessed need, risk, goals and intervention. There were a number of care plans where risk assessments had been completed though not reviewed i.e. in one instance last review 03/06/07 another 12/12/07. One individual who was a wheelchair user (unable to weight bear or mobilise independently) had no risk assessment regarding risk of developing pressure sores though there was history of pressure sores and equipment was in place such as ‘spenco’ mattress. There was no guidance or tasks outlined in their care plans around maintaining skin integrity. For another individual who was diabetic there was no detail in risk assessment as to indicators of low blood sugar level. It is not enough to indicate individual at risk. Staff must be given information to inform them of how to identify and respond to risks. In two individuals care plan there was no personal information as to any specific dietary needs, allergies. Information as to individual wishes on death was not available and it is noted that the manager has identified that this is an area for improvement (AQAA). There are good arrangements for access to health services including dental, optician and chiropody. The In-Reach Nursing service also provides a service to the home to support those individuals who require daily nursing support. One health professional said that what the home does well is “respond quickly to changing health needs” In talking with individuals who live in the home they all spoke positively of the approach of staff “always speak to me as I would like” “they treat you as individuals”. One relative in their survey commented that their relative had been distressed when being given personal care by male member of staff. This was discussed with the manager; all care plans must state the wishes of individuals with regard to receiving personal care from carer of opposite sex. This is of particular importance where an individual has a level of dementia and potentially because of this could cause real distress. In the inspectors view there is no reason why male carers should assist individuals where they do not wish this to happen and, if unable to ascertain the individual’s wishes, full regard to the individuals dignity should be upheld. In observing staff there was always a sensitivity and respect shown to individuals and a number of individuals confirmed this “they always treat me with respect” and “you can’t fault the staff”. The pharmacist inspector looked at the handling of medication in the home: At the time of this inspection none of the people living in the home looks after their own medicines, staff look after and give all the medicines. The pharmacy supplies medicines using a monthly blister pack monitored dosage system. The home has been designed so that each person’s room has a medicine cupboard to store their own medicines instead of them being stored centrally. Staff said that in practice this had made it difficult for them to give medicines because most people are not in their rooms for much of the day. The home is Cleeve Court DS0000069975.V361711.R01.S.doc Version 5.2 Page 12 moving towards keeping medicines centrally but giving individuals the choice of keeping their own medicines in their room if they would prefer to do this. Further action is planned to make sure that secure central storage for medication is available. A medicine fridge is available for storing medicines that need to be kept between 2 and 8 degrees Centigrade. A thermometer is needed so that staff can record the temperature every day to make sure it is in the safe range for storing medicines. A lock is needed on the fridge to make sure these medicines are kept securely. Additional secure storage is available for a group of medicines called Controlled Drugs, but this does not meet the Misuse of Drugs Act (Safe Custody) Regulations 1973. Action is needed to make sure that Controlled Drugs cupboards do meet these regulations. A stock of Paracetamol is kept as a homely remedy. Some additional records of the receipt of this and a running stock balance should be kept to make sure that this is used correctly. We saw staff giving the lunchtime medicines. One person signs the medicines administration record sheet and another member of staff checks that the medicines have been given correctly and signs a checking sheet. Staff said that this was to reduce the risk of mistakes being made. Residents we spoke to said they were happy with how their medicines were given to them. The pharmacy provides printed medicines administration record sheets each month for staff to complete. Staff had handwritten two new medicines administration record sheets. Handwritten additions should be signed and dated and checked by a second member of staff to reduce the risk of mistakes being made, which could result in medicines being given incorrectly. There were occasional gaps in the administration records particularly on Kelston Rise. Staff must sign the administration record for all medicines that they give. If a regular medicine is not given a reason must be recorded on the medicines administration record sheet. A requirement has been made concerning this. We checked two care plans for people who were prescribed medicines to be used When required and found that clear information about when these medicines should be given was not provided for staff. This could mean that someone was given medicine for the wrong reason. Action should be taken to make sure information about the use of medicines prescribed, When required is available for staff. Cleeve Court DS0000069975.V361711.R01.S.doc Version 5.2 Page 13 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. The arrangements for meeting the social and recreational needs of residents could be improved however there are opportunities for residents to maintain links with family, friends and the local community. The home’s practice and routines are flexible and enable residents to exercise choice and have control over their lives. The home provides meals, which are balanced and meet the dietary needs of individuals in the home. EVIDENCE: In talking with individuals who live in the home about the activities available there was a mixed response with some saying there was not enough to others feeling there was sufficient. One individual commented that they “would like to participate in activities depending on what was available but concerned over lack of staff” and another “there’s not enough going on” “not as much going Cleeve Court DS0000069975.V361711.R01.S.doc Version 5.2 Page 14 on”. A health professional who visits the home commented on the “dearth of activities” and another “there are generally not enough staff to offer enough time to sit with residents” and a staff member said they would like to see “more staff for activities” and “residents would benefit from outings no ‘en masse’ but regular small trips just to the park or shops but no staff time”. The manager has recognised this is an area for improvement and there are plans to recruit an activities organiser. Activities that currently take place include bingo, music therapy, keep fit sessions. An occupational therapist is currently offering support to the home. In talking with individuals who live in the home they spoke of staff being “friendly and welcome my visitors”. A relative who responded to the Have Your Say questionnaire stated “we always feel that staff are caring and let us know if there are any changes in how our relative is”. The menu was seen and offered a varied diet and individuals all spoke positively of the food provided in the home: “it’s always good” “always a choice”. On the days of this visit the meal was well presented and staff were available to assist individuals, this was always done in a sensitive and supportive manner. A health professional commented, “the area in which some improvement could be sought is that of residents with special dietary needs”. There is a need to consult a dietitician who could advise the kitchen staff on varying foods and providing balanced meals for those on restricted diets and ‘ethnic’ meals. It was noted that for one individual who is on special diets their likes and dislikes and what they could eat was available to staff. The manager advised that they are looking at getting the support of a dietitician to look at this area. However in the inspector’s view the mealtime experience could be improved particularly for the dementia floor. Individuals were being seated at the dining tables but there were no visual clues as to why they were seated and on more then one occasion an individual got up and walked away to be re-directed back to the dining area. There was no cutlery, condiments available. Whilst choice is offered this is on the previous day and for individuals who are confused or have memory difficulties how real is this choice? There was no offering at the time of the meal of choice and this could be achieved. Visual aids could be available through menu cards and menu board and the manager did advise that this is being put in place. Cleeve Court DS0000069975.V361711.R01.S.doc Version 5.2 Page 15 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. The home has clear procedures in place and this enables individuals to make a complaint and voice their views about the service they receive and to know that they will be listened to and actions taken where necessary. The home makes sure that as far as possible residents are protected from harm by having policy and procedure about the Protection of Vulnerable Adults and providing training to all staff in this area. EVIDENCE: The home has received 4 complaints since the last inspection. These were looked at and it was noted that all had been investigated in an appropriate way within the set timescales and actions taken where necessary in response to the complaint. In one instance the relative commented, “the complaint was dealt with professionally”. In talking with individuals they all said that they were aware that they could make a complaint if they wished. One individual said they would “always say something if I was unhappy” and believed “something would be done about it”. The home has A Safeguarding Adult policy and procedure and all staff undertaken Adult Protection training. I spoke with staff about their Cleeve Court DS0000069975.V361711.R01.S.doc Version 5.2 Page 16 understanding of adult abuse. They were able to give good and clear responses to what is considered abuse and how they would respond particularly if they witnessed abuse in the home. Cleeve Court DS0000069975.V361711.R01.S.doc Version 5.2 Page 17 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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe and hygienic environment for the residents and staff. People who live and work in the home benefit from a warm, welcoming and well-maintained environment. EVIDENCE: In walking around the home it was evident that there is a good standard of cleanliness and maintenance and individuals confirmed this saying that the “home is always very clean”. The facilities offered in the home are of a high standard particularly individual accommodation. The lounges are spacious and well furnished however the access to the garden for individuals who live on the second floor is not easy having to use the lift. One individual said they found using the lift difficult specifically the use of door-code and felt “locked in”. The manager advised that Cleeve Court DS0000069975.V361711.R01.S.doc Version 5.2 Page 18 there are plans to build a balcony and this will be of benefit in providing direct outdoor space. Seating areas, which are placed at the ends of corridors, could be made more inviting in terms of providing armchairs and small tables where this is possible. This would then give a stronger message that these are seating areas particularly for those individuals who walk around the building on a regular basis. Cleeve Court DS0000069975.V361711.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. Staffing arrangements in the home are satisfactory so that the needs of residents can be met with care being provided by skilled and competent staff. However, there is real concern around the level of care demands on staff and measures should be put in place to make sure as far as possible there are sufficient staff on duty at all times. The recruitment and selection of staff is undertaken to make sure that as far as possible the health and welfare of residents is protected. EVIDENCE: Staffing arrangements for a period of 3 weeks were looked t (30/3-19/4). They showed that on the Dementia floor there are generally 5 staff on duty on the am and pm shifts. Use of agency is, at times, high. For one-week 210hrs, another 106 though in one week this reduced to 25hrs. Currently there are two posts vacant total of 48hrs. One individual I spoke with said that staff were all “helpful but not enough staff” and another “need more staff”. A number of comments were received from relatives and professionals about the staffing in the home; “I feel there is not enough staff on duty most times of the day. There are also so many different staff as well. Difficult to get continuity” “Agency staff used do not know needs of residents” (relatives). “For a superior service more staff needed or less residents on floor one” and “a lot of shifts are Cleeve Court DS0000069975.V361711.R01.S.doc Version 5.2 Page 20 short staffed and this home sometime uses a lot of agency staff which is not good, with some of the clients they need consistency which they don’t get very often and the staffing levels can be quite bad which is not good for staff morale” One relative did state that “staffing levels appear to have improved now”. Staff who responded to the ‘Have Your Say’ questionnaire when asked Are there enough staff to meet the individual needs of all the people who use the service? Said “Usually” 4 “Sometimes” 2 “Never” 4 none replied “Always”. It was noted on the days of this inspection that staff were continually busy and not always related to needs of residents. At one point two staff were spending time taking laundry around the home for a considerable time not in the inspectors view the most efficient used of skilled care staff. At lunchtime it was particularly busy, almost chaotic, and could in the inspector’s view be better organised (staff focusing on giving residents at tables meals perhaps allocating individual staff to tables and waiting until end of mealtime to assist those that need feeding of which there were a number, one care staff being taken away to give medication could this not be done by senior staff member on their own?) Certainly in the morning but also afternoon, from observation on both days, there was little evidence of staffing just sitting with residents though it is acknowledged that on one day an activity was organised. A comment from a health professional reflects this “there is too much work for staff on duty and no time left for interaction”. Staff spoke of the high dependency of some individuals and of the high needs of individuals on the dementia unit. It was noted that in one instance an individual had been waiting to move to a nursing home since February this is not acceptable in that clearly this individual no longer should have been in this setting despite the level of care provided and support of the In-Reach service with respect to this individual. There should be a more pro-active response from the Adult Community Care Service in making sure this particular individual had been moved by this time and this was discussed with the manager at the time of this visit. Recruitment and training records were looked at and show that the required procedure had been followed with two references being obtained and staff having a Criminal Record Bureau check. Staff had undertaken a range of training including Best Practice in Dementia Care, Mental health Awareness as well as the mandatory training; Moving & Handling, Adult Protection, Fire Awareness. Staff had also received medication training this is required for all staff who assist or have some responsibility with regard to medication administering. One staff member stated, “the choice of training is very up to date and there is a wide variety to do”. Over 50 of staff have undertaken NVQ professional qualification. Cleeve Court DS0000069975.V361711.R01.S.doc Version 5.2 Page 21 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): 31,33,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The practices of the home help to make sure that the health, safety and welfare of individuals who live and work in the home are as far as possible protected. There is a failure to provide adequate and appropriate supervision to staff so that management can formally review and monitor their practice, look at performance and give staff the opportunity to express any concerns and discuss their professional development. EVIDENCE: As previously noted in this report the manager has yet to be registered with the CSCI it is understood his application has been made and being processed. Staff were clearly, by the comments made, feeling that his appointment had Cleeve Court DS0000069975.V361711.R01.S.doc Version 5.2 Page 22 improved morale and as one staff member stated “we now feel more valued”. A number of staff commented that his approach was that of someone who was prepared to listen and “take action in changing things for the better” “already put things in place to enhance work performance” “new manager much more approachable”. This is certainly a positive move for Cleeve Court and it is hoped will lead to further improvements in the quality of care provided in the home. The inspector found his approach welcoming and co-operative and very willing to discuss the shortfalls identified by this inspection and highly motivated to achieve the necessary change. An area of improvement has been that of staff meetings and these are now taking place on a more regular basis with good attendance from staff one of whom said “its worth going now things are discussed”. Supervision records were looked at for 4 members of staff. There was no record of supervision taking place during 2008 in one instance the individual had not received supervision since Feb 07, another May 07. Regular residents meeting are planned to take place. A Visitors quality assurance questionnaire showed that 89 respondents (19) felt the quality of care was excellent or good, 84 felt friendliness of staff was excellent or good. The previous inspection noted that the required risk assessments including fire risk assessments had been completed. Fire Alarm systems are regularly tested and serviced as required as is moving and handling equipment. Cleeve Court DS0000069975.V361711.R01.S.doc Version 5.2 Page 23 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 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 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X 2 X 3 Cleeve Court DS0000069975.V361711.R01.S.doc Version 5.2 Page 24 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 Cupboards used to store Controlled Drugs must meet the requirements of the Misuse of Drugs Act (Safe Custody) regulations 1973. By 01/09/08 Staff must sign the administration record for all medicines that they give. If a regular medicine is not given a reason must be recorded on the medicines administration record sheet. By 30/05/08 A thermometer must be used to record the daily temperature of the medicine fridge to make sure that medicines are stored within the safe range of 2 to 8 degrees C The manager to ensure all elements of individual’s care plans are completed and reviewed. (This refers to risk assessments) The manager to ensure that care plans contain all the required information as to the health and DS0000069975.V361711.R01.S.doc Timescale for action 01/09/08 2 OP9 13.2 30/05/08 3 OP9 13.2 30/05/08 4 OP7 15(2) 30/06/08 5 OP7 15 (1) 30/06/08 Cleeve Court Version 5.2 Page 25 6 OP27 18 (1) (a) 7 OP36 18 (2) welfare of the individual. The manager to ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. (This refers to staffing levels in the home it is advised that dependency scale is used as measure for establishing the level of staffing that are required and that Department of Health guidance is used as part of this measurement of staffing need.) The manager to make sure that staff are appropriately supervised. (This refers to staff receiving formal supervision the National Minimum Standard being at least 6 times a year.) 30/07/08 30/09/08 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 OP9 Good Practice Recommendations Action should be taken to make sure information about the use of medicines prescribed, When required is available for staff. This is to make sure these medicines are given for the correct reason. Handwritten additions should be signed, dated and checked by a second member of staff to reduce the risk of mistakes being made, which could result in medicines being given incorrectly. Improve the arrangements for mealtimes which provides a more relaxed and enabling experience. 2 OP9 3 OP15 Cleeve Court DS0000069975.V361711.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Cleeve Court DS0000069975.V361711.R01.S.doc Version 5.2 Page 27 - 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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