Care Home: Clover Cottage

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What the care home does well People using the service said, "it`s a very nice and friendly place". "Staff are nice and friendly and have helped me to settle in." Relatives said, "friendly care workers make you feel welcome. There is a comfortable feeling in the home." "Mum was happy and the staff were caring. She appreciated their help". There has been a regular staff team and people are receiving support from staff that they know. The staff team receive the training that they need to provide an appropriate service for the people living there. The proprietor spends a lot of time at the service and is committed to ongoing improvements in the environment and to developing the service. What has improved since the last inspection? There have been further improvements to the environment. Bedrooms have been redecorated and have new furniture, curtains and bedding. A new industrial washing machine has been purchased to more effectively manage laundry needs. There is now a full time manager in post. The requirements from the last inspection have been met. The bath chair is now working so that people can access the bath more easily. There is now an appropriate Controlled Drugs cabinet so that this type of medication can be safely stored in line with requirements. The home now has a hoist so that when needed people can be moved as safely and comfortably as possible. Hot water temperatures are now checked weekly and are an added safeguard for the people living there. What the care home could do better: There have been a lot of improvements to the environment and the planned refurbishment of the ground floor bathroom will further improve the facilities for people living there. Although the proprietor spends a lot of time at the home it is still necessary to carry out formal unannounced monitoring visits and to write a report of the findings. It is recommended that these be carried out by someone with experience in the care of older people so that the service can be robustly monitored. Medication administration continues to improve but there are some issues that need to be discussed and resolved with the prescriber to ensure that people get their prescribed medication as safely as possible. CARE HOMES FOR OLDER PEOPLE Clover Cottage 44 Wincanton Road Noak Hill Romford Essex RM3 9DH Lead Inspector Jackie Date Key Unannounced Inspection 27th February 2009 09:45 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 Clover Cottage DS0000066722.V374211.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. Clover Cottage DS0000066722.V374211.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clover Cottage Address 44 Wincanton Road Noak Hill Romford Essex RM3 9DH 01708 342 038 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) clovercottage07@yahoo.co.uk Mrs Santosh Magon Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Clover Cottage DS0000066722.V374211.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: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 14 6th May 2008 Date of last inspection Brief Description of the Service: Clover Cottage is a care home providing care to 14 older people who do not require nursing care. The home consists of two storeys and is located in a residential area of Noak Hill within the London Borough of Havering. There are ten single bedrooms and two shared bedrooms, four of which have an en suite. All other bedrooms have a hand basin, TV point and a call system. There is a passenger lift and also a stair lift. The communal areas are situated on the ground floor and this is open plan with a small room divider making two lounge areas and a dining area. From this open plan area is a conservatory that is also used as a dining area. There is car parking and a garden to the front of the building, and a well maintained rear garden with disabled access from the conservatory. The home is situated close to local facilities in Noak Hill and is accessible by buses and by car from the M25, A127 and the A12. The charge per week for each person is between £428.00 to £ 550.00. The manager provided this information on the day of the visit. Information about the service provided is contained in the service users guide. Clover Cottage DS0000066722.V374211.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 star. This means the people who use this service experience good quality outcomes. This inspection was unannounced and started at 9.45 am. It took place over eight hours. This was a key inspection and all of the key inspection standards were tested. Staff were asked about the care that people using the service receive, and were also observed carrying out their duties. Where possible people using the service were asked to give their views on the service and their experience of living in the home. All of the shared areas and some bedrooms were seen. Staff, care and other records were checked. Social workers and healthcare professionals were contacted and asked for their opinions of the service. At the time of writing this report feedback surveys had been received from 2 relatives and 2 people living at Clover Cottage. During the visit we spoke to 7 people living at Clover Cottage. Services are now required to complete an AQAA (Annual Quality Assurance Assessment) and the completed form was received in February 2008. Information provided in this document also formed part of the overall inspection. The inspector would like to thank the people living at Clover Cottage and the staff for their input during the inspection. What the service does well: People using the service said, “it’s a very nice and friendly place”. “Staff are nice and friendly and have helped me to settle in.” Relatives said, “friendly care workers make you feel welcome. There is a comfortable feeling in the home.” “Mum was happy and the staff were caring. She appreciated their help”. There has been a regular staff team and people are receiving support from staff that they know. The staff team receive the training that they need to provide an appropriate service for the people living there. The proprietor spends a lot of time at the service and is committed to ongoing improvements in the environment and to developing the service. Clover Cottage DS0000066722.V374211.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Clover Cottage DS0000066722.V374211.R01.S.doc Version 5.2 Page 7 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 Clover Cottage DS0000066722.V374211.R01.S.doc Version 5.2 Page 8 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, 4 & 5. Standard 6 does not apply to this home. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Information is obtained to enable the staff team to decide whether or not the home can meet a persons needs. People thinking of moving into the home and their relatives can spend time in the home to find out what it would be like to live there and to enable the person to make a choice about living in the home, within their capacity to do so, and to be confident that the home meets their needs. The home does not offer intermediate care. EVIDENCE: Referrals are usually received from Social Services department and they provide initial assessment information. This may be from information that they have gathered or from assessments made by hospital staff. The manager then carries out assessments before an individual moves into the home. At this time people are provided with information about the home and encouraged to Clover Cottage DS0000066722.V374211.R01.S.doc Version 5.2 Page 9 visit. The assessments cover all of the required areas and include health, mobility, nutrition, continence and religious and cultural needs. Examples of this were seen in files. From this assessment information an initial basic care plan is drawn up to enable staff to provide appropriate care for an individual when they move into the home. Individual records are kept for each person and three files were examined. These included pre-admission assessments. In the case of one person that did not live near enough for the manager to visit information had been obtained from the health authority and a community care assessment. The manager had also had telephone discussions with the persons care manager. From the paperwork and discussions with the manager we were satisfied that appropriate assessments are carried out and that the necessary information gathered before a decision is made as to whether the service could support an individual. People considering moving into Clover Cottage and/or their relatives are provided with information about the home and encouraged to visit before making a decision about living in to the home. The home does not provide intermediate care. Clover Cottage DS0000066722.V374211.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. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. People’s needs are identified and staff have information about how to meet these. They receive personal and healthcare care that meets their individual needs and preferences. The principles of respect, dignity and privacy are put into practice. People receive their prescribed medication appropriately. EVIDENCE: The home has recently purchased a computerised care recording system. This covers all of the relevant areas including pre assessment, care plans, medical appointment and daily records. As staff are still familiarising themselves with this and information is being put onto the system paper copies of care plans are still in use. However most staff make daily records on the computer. Each person has a care plan, which give details of their needs and how to maintain their independence as far as possible. This includes health and Clover Cottage DS0000066722.V374211.R01.S.doc Version 5.2 Page 11 personal care. The care plans developed on the new system will have aims and plans of action for each person. There are night care plans tailored to each individual. For example, they give details as to when a person usually likes to go to bed, how many pillows they have and if they like the light on. Where possible people have signed their own care plan. This is a small home and people living there are supported by a regular staff team that know them and their preferences. There are risk assessments in place. These identify risks for people and indicate ways in which the risks can be reduced to enable their needs to be met as safely as possible. These were relevant to each person and included moving and handling and when necessary prevention of pressure sores for people identified as at risk of this. These had been reviewed and were up to date. Some people living at the home require help with personal care but others spoken to said that they can manage most of this on their own. They said that they were allowed time to do this and were not rushed. All of the people living at Clover Cottage are registered with a local doctor and specialist help is received when needed. Records are kept of medical appointments and these show that people have checks from the optician, dentist and when needed the chiropodist. District nurses provide nursing support when needed. The new computer package has a reminder system for appointments and checks. For example one person needed to have a urine test the following week and this was on the computer diary. A member of staff said that people were well looked after and that when people return from hospital with pressure sores they are able to provide the necessary support for these to heal. Staff were observed to be polite and respectful to the people using the service and were observed to knock on doors before entering peoples’ rooms or bathrooms. People spoken to confirmed that staff respected their privacy and dignity. With the exception of Controlled Drugs medication is stored in an appropriate metal trolley that is attached by a chain to the wall in the dining/conservatory area. Where possible medication is administered via a monitored dosage system. Medication is administered by staff that have received appropriate training and there is a list of staff that can administer medication along with their initials. When administering medication staff wear a tabard indicating what they are doing and asking not to be disturbed during this. One member of staff said that she was doing medication training the next week and had therefore not yet administered medication. She did say that she had observed medication being administered. Clover Cottage DS0000066722.V374211.R01.S.doc Version 5.2 Page 12 The medication file contained profiles of each person and in most cases a photograph. This is good practice. Since the last inspection an appropriate CD (Controlled Drugs) cabinet has been fitted in the office. An appropriate CD register is in use, two people sign entries and the CD’s are counted and checked. This is good practice. We counted the CD’s and the amount held agreed with the register. The district nurse visits to administer insulin to those people that require this. Examination of the MAR (Medication Administration Record) found that there were a couple of occasions when staff had not signed to say that they had administered medication. However the medication had been taken from the monitored dosage system. The person administering the medication must complete medication records at the time of administration. This is for accountability, to provide an accurate record of medication and to lessen the possibility of error. On occasions the code “O” was used and the reason for the omission was recorded to give feedback on the treatment as required by the previous inspection. For some people the directions for giving a medicine allow a choice of dosage, for example 1 or 2 tablets, and the previous inspection required that the MAR chart must accurately reflect the dosage and frequency of the medication that a person is prescribed. Staff have been instructed to record the number of tablets that they give but the variable amounts are still on the charts without clear guidelines and this needs to be addressed with the prescriber and/or the dispensing pharmacist. This is important to ensure that people get their prescribed medication appropriately and as safely as possible. We observed some of the lunchtime medication being administered and this was done appropriately. The member of staff removed the necessary medication from the monitored dosage system and took it in a dispensing cup to the individual concerned. The trolley was locked whenever the member of staff left it. On returning to the trolley the MAR was signed. Overall the administration of medication continues to improve and by addressing the issues identified this will help to make this process as robust as possible and to minimise the risk of error. Clover Cottage DS0000066722.V374211.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. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. People living at the home have the opportunity to join in some activities and providing regular activities will help to keep people as active and alert as possible. Visiting times are flexible and visitors are welcomed in the home People living in the home are given meals that they enjoy and that meet their needs. As far as possible, people are helped to exercise choice and control over their lives and to make choices about what they do and how they spend their time. EVIDENCE: We were able to talk with several people during the inspection, and all said that they were very happy at the home. One of the people that moved in recently said that it was nice and friendly and then went on to tell us that he had won some prizes when he had played bingo and that he had enjoyed this. Two students from the local college are on a one day a week placement at Clover Cottage DS0000066722.V374211.R01.S.doc Version 5.2 Page 14 present and on the day of the visit had organised bingo and also a television quiz. We noted that quite few people joined in and seemed to be really enjoying this. In the afternoon the ‘music man’ visited to entertain people. It was the first time that he had visited and he had music and musical instruments and staff, students and most of the people using the service joined in. One lady said that she did not like that sort of thing or the games and she chose to sit separately. A relative said, “being a small home I think they do well to keep the patients as active as possible but there could possibly be more activities”. There is also a ‘little shop’ once a week where people can buy small items. A hairdresser visits the home weekly and people look forward to this as they like having their hair set and view this as a social occasion. It is evident that some activities are being introduced and that most people enjoy these but it is an area for ongoing development and it is important that there is sufficient time for staff do organise regular activities to keep people as active and alert as possible. People’s nutritional needs are recorded and the menu is discussed with the people using the service. Fresh vegetables, fruit and meat are obtained from local suppliers and are delivered to the home. Staff said that people get choices of meals with several options and the manager said that they were offering a hot choice at tea time. People are asked to choose their main meal the evening before so that the cook can prepare it. However if people do change their minds this is not a problem. There were ample supplies of food in fridges, freezers and the store cupboards and the cook keeps the necessary records. The cooks are in the process of completing NVQ in catering. People using the service said that the food was good and you can always have something different. We joined people at lunch time and meals were well presented and the dining tables nicely laid. People were offered cold drinks with their meal and tea or coffee afterwards. At a residents meeting people had requested a ‘drink’ with their meals on occasions and those that wanted had sherry with their meal. People spoken to said that they enjoyed this. Two people have diabetes and appropriate food is prepared for them. Another person needed support from staff to eat and we observed that a member of staff sat with her, encouraging her to eat and drink. She was given plenty of time to do this and was not rushed or hurried. At present none of the people using the service have any specific dietary requirements in relation to their cultural or religious needs. Drinks are available throughout the day and people have jugs of water or juice beside them so that they can have these whenever they want to. A relative said, “the food is good”. Relatives can visit at any time, as there are no restrictions placed on visiting times. A relative said, “the friendly care workers make you feel welcome”. People can spend time with their visitors in the lounge, conservatory, and garden or in their own rooms. Some people said that they had relatives that visited regularly and that they were made welcome and offered refreshments. Clover Cottage DS0000066722.V374211.R01.S.doc Version 5.2 Page 15 Relatives are invited to any celebrations. People living at the home said that they always celebrate birthdays and have a birthday cake. People using the service also confirmed that they are asked what they want or what they would like and that they can then make a choice about this. This included food, what they did and when they got up and went to bed. Clover Cottage DS0000066722.V374211.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. People living at Clover Cottage are safeguarded by the working practices and support of the staff team. EVIDENCE: The home does have a complaints procedure that is used in the event of a complaint being made. There have not been any complaints since the last inspection. From talking to the people living at the home it was evident that they are asked ‘if everything is okay’ and that they can talk to the manager or proprietor. One person who recently moved to Clover Cottage said, “the owner said if I want anything to ring the bell and he has asked me if I am okay”. The Commission has received a series of anonymous complaints since the last inspection. The proprietor has investigated some of these and some have been investigated by the local authority but none have been substantiated. The home has policies and procedures for safeguarding people from abuse. Staff have received training in the detection and reporting of abuse and this has been updated recently. Staff spoken to said that people were well cared for and that if they ever had any concerns they could and would discuss these with the manager. The section on staffing later in this report gives information that confirms that there is an appropriate recruitment procedure and this also helps to safeguard people living in the home. Clover Cottage DS0000066722.V374211.R01.S.doc Version 5.2 Page 17 The home does not deal with peoples’ overall finances, but some people have small cash amounts held in safekeeping and only the manager and proprietor has access to this. The section on management and administration gives more details on this and confirms that systems in place safeguard people from financial abuse. Clover Cottage DS0000066722.V374211.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. People live in a clean and comfortable home and benefit from the proprietors ongoing commitment to improve the facilities and the environment. EVIDENCE: The home has two storeys and is located in a residential area of Noak Hill within the London Borough of Havering. There are ten single bedrooms and two shared bedrooms. Four of the bedrooms have an en suite and the remainder have a hand basin, TV point and a call system. There is a passenger lift and also a stair lift. The communal areas are situated on the ground floor and this is open plan with a small room divider making two lounge areas and a dining area. From this open plan area is a conservatory that is also used as a dining area. There is car parking and a garden to the front of the building, and a well maintained rear garden with disabled access from the Clover Cottage DS0000066722.V374211.R01.S.doc Version 5.2 Page 19 conservatory. The home is situated close to local facilities in Noak Hill and is accessible by buses and by car from the M25, A127 and the A12. A tour of the care home indicated that the premises are clean, hygienic and well maintained, with no offensive odours. All areas were appropriately furnished and had a homely appearance. All bedrooms were individually decorated and lots of personal possessions were on display making the rooms look homely. Since the last inspection more of the bedrooms have had new furniture, curtains and duvets. The week after the inspection the lounge and conservatory were due to be decorated and to have new curtains and light fittings. The garden areas were neat with seating areas and it was apparent that these are regularly maintained. A handyman is employed and any repairs and maintenance are therefore dealt with in a timely fashion. There were sufficient bathrooms/shower and toilets for the number of people living at the home and those toilets viewed were equipped with hand washing facilities, soap and towels. The bathroom on the ground floor contains a corner bath that is not suitable for use by people living in the home. It is also in poor condition. This bathroom needs to be refurbished and to have suitable facilities fitted. The proprietor has plans and quotes for the improvements and these are linked with other possible changes on the ground floor to include better office facilities. There is also a bathroom upstairs with a bath chair that is now in working order. Therefore people living at Clover Cottage do have a choice between a bath and a shower but the planned improved bathing facilities will mean that the toilet and bathing facilities will be more accessible and of a better standard. The home has some moving and handling aids and since the last inspection a new hoist has been purchased. However this is not currently needed but will ensure that suitable moving and handling aids are available to assist in safely moving people using the service when the need arises. There are appropriate laundry facilities available. There is a sluice sink and since the last inspection a new industrial washing machine has been fitted. Therefore peoples’ clothing, bedding etc can be washed appropriately. Clover Cottage DS0000066722.V374211.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 &30. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. People are supported and protected by the recruitment practices of the service. Staff receive the necessary training and support to meet peoples current needs and to provide an appropriate service for them. EVIDENCE: On the day of the inspection there were 10 people being supported by the service. Two other people were in hospital. The usual staffing compliment is now 2 staff on each shift. One of these staff is normally a senior carer. At night there are 2 waking staff on duty. In addition there is a cook on duty from 8 am until 2pm and a part time housekeeper. Staff on duty said that the staffing levels are currently sufficient to meet the needs of the people using the service but that this would need to be increased if the home was full or if there was anyone with higher support needs. From checking the rota, talking to staff and observations during the visit the current staffing arrangements were sufficient to meet the needs of the people that were in the home on the day of the visit. Staffing levels do need to be reviewed regularly and will need to be increased if the home is full or if the needs of people returning from hospital have increased. Feedback from people living at the home was that the staff were nice. One of the people that had recently moved into Clover Clover Cottage DS0000066722.V374211.R01.S.doc Version 5.2 Page 21 Cottage said, “the staff are very nice and friendly and have helped me to settle in”. Another said, “it is a very nice and friendly place.” The manager said that staff came in 15 minutes before the start of their shift for a handover and that they were paid for this. However this is not shown on the rota. The last inspection recommended that the rota be changed to show the exact times that staff are working and that this includes any handover period. This good practice recommendation still applies and would give a clear record of when people are working and provide confirmation that handovers are built in to allow for sharing of information. From discussions with the manager and staff and from checking staff records it was evident that staff have experience of caring for older people and that they have been receiving the training that they need to carry out their duties. This included medication, moving and handling, Protection of Vulnerable Adults, infection control, first aid, fire safety and the Mental Capacity Act. The manager has continued to arrange training and the service has now contracted with a company to provide training and this includes NVQ. One of the staff on duty had achieved NVQ level 3 and the other was due to complete NVQ level 2 in June. The cooks are doing NVQ in catering and the housekeeper NVQ 2 in housekeeping. Staff records are kept at the home. We were informed that there had not been any new care staff employed since the last inspection and at that time a selection of staff files were examined and this included the file of a new employee. Files seen then contained a copy of the application form, references, confirmation of identity, CRB (Criminal Records Bureau) check and other required details. There have been some ancillary staff employed more recently and a sample of these files were inspected and confirmed that the necessary checks had been carried out. Due to the length of time for CRB (Criminal Records Bureau) checks to be obtained it had been necessary for people to commence work after a POVA (Protection of Vulnerable Adults) check but they did not work unsupervised. Therefore an appropriate recruitment process is in operation. Observations at the time of the inspections was that staff were patient and kind to people living in Clover Cottage and there was a calm relaxed atmosphere. Clover Cottage DS0000066722.V374211.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 & 38. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. The home is being appropriately managed by an experienced manager and a safe environment is being maintained. The manager is implementing changes for the benefit of people using the service. EVIDENCE: At the time of the last inspection the new manager had been in post for almost 3 months. The manager then took up a post elsewhere but continued to be employed on a part time basis to support and advise the next manager and to carry out some of the monitoring visits. Unfortunately neither of the two new managers employed since the last inspection remained in post for very long. Therefore although the staff team have been consistent the management arrangements have not and the result of this is that the development of the Clover Cottage DS0000066722.V374211.R01.S.doc Version 5.2 Page 23 service has been slower than anticipated. However the person who managed the service at the time of the last inspection has now returned to the home on a full time basis. This manager has a lot of experience of managing services for older people and has previously been a registered manager at other services. He has an NVQ in care and has also completed the RMA (Registered Managers Award). The service has not had a registered manager in post for some time and the proprietor was recently advised that this must be addressed. As a result of this he has contacted the registration team for the Commission to start this process. The quality of the service is monitored by the manager and by the proprietor. People living in the service were given a quality assurance questionnaire in April last year to get their feedback about the service provided. The issues raised were then discussed at a residents meeting. The proprietor visits the home most days and takes an active interest in what is happening and the development of the service. The records showed that since the last inspection the proprietor has only carried out three of the required monthly unannounced monitoring visits and these are a requirement even if the proprietor visits regularly and must take place. The proprietor does not have a background in care and the previous inspection recommended that the monitoring visits be made by a person with experience of care and of good practice in services for older people. This good practice recommendation still applies and will help to ensure that the service is robustly monitored. Staff spoken to said that they had been receiving supervision and that staff meetings were being held. This gives staff the opportunity both collectively and individually to discuss work practice, any concerns and the development of the service. However, the manager does not receive any professional supervision and is important that this does happen to support the manager in his own development and the development of the service. The previous inspection recommended that the proprietors make arrangements for the professional supervision of the manager and this good practice recommendation still applies. The manager does not deal with peoples’ overall finances, but for some people cash amounts in safekeeping. This cash is used on their behalf for purchases or services from the chiropodist and hairdresser. The cash held for two people was checked and amounts recorded tallied with cash held. All entries were recorded and receipts were kept to evidence any expenditure. Each person’s cash is kept separately with an individual record. Only the manager and the proprietor have access to the cash held. Therefore peoples’ finances are appropriately dealt with and safeguarded. With the exception of confidential information all of the records are in the office in the main part of the home and are therefore available for inspection at any time and are also more easily accessible for staff. Clover Cottage DS0000066722.V374211.R01.S.doc Version 5.2 Page 24 The staff team carries all of the necessary health and safety checks out regularly. For example fire call points are tested weekly to ensure that they are working correctly. Hot water temperatures are tested weekly now instead of monthly as recommended by the previous inspection in line with best practice to offer more robust safeguards for people living at home. Fridge and freezer temperatures are tested daily and appropriate servicing is carried out on the fire system and fire equipment. There was a current gas safety certificate and portable appliance had been tested. However there was not any confirmation that the electrical intake had been checked and this must be done to ensure that this is safe. However overall, a safe environment is maintained. Clover Cottage DS0000066722.V374211.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 3 2 Clover Cottage DS0000066722.V374211.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 Requirement The prescriber must be asked to clarify or amend variable doses of medication to ensure that people receive the correct amount of medication as safely as possible. Timescale for action 30/06/09 2. OP9 13 The person administering the 30/04/09 medication must complete medication records at the time of administration. This is for accountability, to provide an accurate record of medication and to lessen the possibility of error. The planned ground floor bathroom refurbishment must be carried out and include facilities suitable for the needs of people living at the home. This will ensure that they are able to easily and safely use the facilities. The registered provider must visit the home unannounced at least once a month to monitor the service provided. They must DS0000066722.V374211.R01.S.doc 3. OP21 23 31/12/09 4. OP33 26 30/06/09 Clover Cottage Version 5.2 Page 27 then prepare a written report on the conduct of the care home. This is so that the service is robustly monitored. 5. OP38 13 A satisfactory electrical intake certificate must be obtained to ensure that the electrical services in the home are safe. 30/06/09 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 OP27 Good Practice Recommendations It is recommended that the rota be changed to show the exact times that staff are working and this includes any handover period. This will give a clear record of when people are working and provide confirmation that handovers are built in to allow for sharing of information. It is recommended that the monthly monitoring visits be made by a person with experience of care and of good practice in services for older people. This will ensure that the service is more robustly monitored and that any area that did not meet minimum requirements is identified. It is recommended that the proprietor makes arrangements for the professional supervision of the manager. This will ensure that the manager has the opportunity to discuss their own development and the development of the service. 2. OP33 3. OP36 Clover Cottage DS0000066722.V374211.R01.S.doc Version 5.2 Page 28 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. 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