Care Home: College Hill

Similar services:

• Henry Nihill House
• Birchwood
• The Infirmary
• Orchard House Nursing Home
• St Josephs Rest Home
• Red Court Nursing Home
• Spinney (The)
• Queen Elizabeth House

What the care home does well The care home has a very welcoming, and warm atmosphere. The `expert by experience` reported that `the atmosphere was pleasant`, `everyone seemed alert` `to what was going on`, and that the home `is a good comfortable setting`. He confirmed that people using the service had signs of `well being`, and that `staff seemed well motivated, and put themselves out to engage with residents`. Residents spoke highly of the care home, and of being happy living in the care home, and confirmed that staff were very caring and helpful, I`m "very happy since I`ve been here" "I`m very happy and lucky". "I have a lot of friends". Observation and talking to staff indicated that staff were aware of resident`s individual needs and interacted in a respectful, and sensitive manner with people using the service. Residents spoke of staff being approachable and `nice`. The `expert by experience` reported that when staff were `going about their tasks`; `the staff were responsive to the residents; stopping to pass a remark or briefly talk with them`. Care plans are reviewed regularly and `daily` records of resident`s progress are generally comprehensively recorded. Residents` contact with relatives and others (as agreed by the residents) is fully supported and enabled by the care home. Visitors spoke highly of the staff, and of the care that their relative/friend received from staff. The home is well maintained and clean. The `expert by experience` found that `the cleanliness of the bathrooms, and the toilets were of an `excellent standard, and seemed well equipped with disability aids`. The registered manager is experienced, competent and keen to put into place, systems and practice to continue to improve and develop the quality of the service provided for residents. People using the service spoke highly of the meals provided. A person using the service commented that `the food is nice`. What has improved since the last inspection? The inspection requirements from the previous inspection were judged to have been met. A ground floor bathroom has been completely refurbished, and includes a number of aids to assist those residents who have mobility needs. The heating system within the home has been improved by replacing two boilers. Staff continue to have the opportunity to have access to a wide variety of appropriate/relevant training, and have completed several certified training courses since the previous inspection. Information in regard to protection of vulnerable adults is now included in the staff induction programme. Systems to monitor the quality of the service have been developed and improved since the previous inspection. Residents have the opportunity to participate in a regular residents meetings. What the care home could do better: The format of documents that are of particular interest of people using the service (including some policies and procedures, such as the complaints procedure) could be developed to improve the accessibility of information to residents. There could be more evidence of resident`s involvement and ownership regarding their care plans, with particular focus on the individual`s strengths and personal preferences. The number and variety of activities (including community based activities) for people using the service could be further developed, with evidence that they are linked to resident`s preferred and/or previous leisure pursuits. CARE HOMES FOR OLDER PEOPLE College Hill 64/66 College Hill Road Harrow Weald Middlesex HA3 7HE Lead Inspector Judith Brindle Key Unannounced Inspection 5th December 2007 08:40 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 College Hill DS0000017528.V338003.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. College Hill DS0000017528.V338003.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service College Hill Address 64/66 College Hill Road Harrow Weald Middlesex HA3 7HE Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8954 1235 020 8954 1668 Mrs Blasita Jeyarajah Mrs Blasita Jeyarajah Care Home 11 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (11) of places College Hill DS0000017528.V338003.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. As agreed on 10th August 2006, one named service user, with dementia, can be accommodated. The CSCI must be informed when this service user no longer resides at the home. Date of last inspection Brief Description of the Service: College Hill is a care home providing personal care and accommodation for up to 11 older people. Mrs Blasita Jeyarajah is the registered manager and owner of the care home. The registered care home is located within a short drive or several minutes walk from Harrow Weald High Road. Harrow Weald has a variety of amenities, which include shops, restaurants, banks, and bus and train services. The home consists of a large detached building. The bedrooms of the care home are located on the ground floor and the first floor of the building. The home has two shared rooms, and seven single rooms. Two of the single rooms have en-suite facilities. The home has a passenger lift. There is an enclosed maintained garden at the rear of the property, and parking for several cars at the front of the house. Information/documentation about the service is accessible from the provider. The range of fees is from £416-470 per week. Additional costs are recorded in resident’s statement of terms and conditions. College Hill DS0000017528.V338003.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key unannounced inspection took place during a day in December 2007. I was accompanied during part of this inspection by andexpert by experience’ (a person who has particular experience of services including care homes, which may include knowing someone who has used this type of service or having experienced accessing similar services themselves). We focussed on spending a significant period of time talking with people living in the care home, and to staff, as well as observing interaction between residents and staff. Some of the people using the service have limited communication abilities, and were able to respond to questions to a limited degree, so observation was a significant tool used in this inspection. The ‘expert by experience’ also accompanied me on a tour of the care home. Following the inspection he completed a report. This information helped me to gain evidence about the care and support provided to residents in the home, and to verify any issues about the quality of the service provided to people living in the care home. Reference to the ‘expert by experience’s’ report is included within this inspection report. The ‘expert by experience’ has read this inspection report and feedback from him was positive regarding the content. I also spoke with the registered manager/owner, care staff, two visitors and a district nurse and a student nurse during the inspection. The manager was present for part of the inspection. Documentation inspected included, resident’s care plans, staff training records, and some policies and procedures. Prior to this unannounced key inspection the registered manager/owner supplied the Commission for Social Care Inspection with a completed Annual Quality Assurance Assessment (AQAA) document. This includes required information from the owner and/or registered manager about the quality of the care home and the plans to improve the service. All sections of this document were completed. Reference to some aspects of this AQAA record will be documented in this report. Assessment as to whether the requirements and recommendations from the previous key inspection (that took place in June 2006) had been met also took place during the inspection. 27 National Minimum Standards for Older Persons, including Key Standards, were inspected during this inspection. The inspector thanks all the people living in the care home, visitors, and the staff for their assistance in the inspection process. College Hill DS0000017528.V338003.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The inspection requirements from the previous inspection were judged to have been met. A ground floor bathroom has been completely refurbished, and includes a number of aids to assist those residents who have mobility needs. The heating system within the home has been improved by replacing two boilers. College Hill DS0000017528.V338003.R01.S.doc Version 5.2 Page 7 Staff continue to have the opportunity to have access to a wide variety of appropriate/relevant training, and have completed several certified training courses since the previous inspection. Information in regard to protection of vulnerable adults is now included in the staff induction programme. Systems to monitor the quality of the service have been developed and improved since the previous inspection. Residents have the opportunity to participate in a regular residents meetings. 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. College Hill DS0000017528.V338003.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 College Hill DS0000017528.V338003.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): Standards 1,2, 5 and (6 is not applicable) People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective service users have the information that they need to make an informed choice about where to live. Residents have their needs assessed prior to moving into the care home. EVIDENCE: The care home has a recently reviewed statement of purpose, and a service user guide (in leaflet form), which include comprehensive information about the service provided by the service. The manager spoke of supplying prospective residents, and their relatives/significant others with this documentation. The home has an admission procedure. The manager spoke of carrying out a comprehensive initial assessment of all prospective residents to ensure that she (and the prospective resident) is confident that the care home can meet the person’s needs. I was informed that when a Local Authority funds a College Hill DS0000017528.V338003.R01.S.doc Version 5.2 Page 10 prospective resident, a Care Manager also carries out an initial assessment. The care plans inspected all included evidence that assessment of resident’s needs had been carried out. The manager confirmed that prospective residents, and their relatives/significant others are encouraged, and supported to be fully involved in this evaluation of the person’s needs. It was evident from inspection of care plans that information from the resident, and relatives/significant others, were included in the assessment process. Each care plan included a questionnaire documenting prospective residents preferences, which included preferred times for getting up, and going to bed, food preferences, religious, cultural, and social needs. Care plans also included a comprehensive profile (often of a very active and interesting life) of each resident. It is evident that the manager understands the significance and importance of carrying out a comprehensive initial assessment. She gave me an example of recently assessing a prospective resident, and from that assessment information had judged that the home would be unable to meet that person’s needs, and that this person would require nursing care rather than residential care and support. Staff informed me that prospective residents visit the home if they are able, and are generally accompanied by relatives, and or a social worker. A staff member reported that if a person is admitted from hospital the prospective resident’s relatives tend to visit the home on the person’s behalf. The manager confirmed that resident’s have a six-week ‘settling in’ period. This enables residents to make up their mind if they would be happy living in the home. During the inspection I was informed that a resident had just completed six weeks stay in the home, and that she and her Care Manager had agreed her placement in the home, and that there was a planned meeting (to review the resident’s needs) with the Care Manager, registered manager, and resident. College Hill DS0000017528.V338003.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): Standards 7,8,9 and 10 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Each person using the service has a plan of care, but there could be more evidence of resident’s taking the lead and being fully involved in their individual plan of care, and support. Resident’s individual personal and healthcare needs are met. Residents are respected and their right to privacy upheld. Residents are protected by the home’s policies and procedures for dealing with medicines, but there could be development regarding the administration of a medication. EVIDENCE: All the people using the service have a plan of care. Three care plans were inspected. These include a photograph, a record of personal information, and evidence of assessment of personal, health, communication, social, religious, emotional needs, and individual level of dependency. Significant needs have been identified from this and are documented in each individual plan of care. Clear and comprehensive staff guidance for meeting these needs is recorded. There is evidence that the care plans are reviewed regularly, (at least College Hill DS0000017528.V338003.R01.S.doc Version 5.2 Page 12 monthly). The manager spoke of the importance of including the residents, and of encouraging relatives/significant others (if agreed by residents) in participating in this process of review. The care plans included assessment of risk of falls, pressures sores, mobility, moving and handling, and nutritional assessment. Information about the resident’s background including family and employment history was also documented. This contributes in giving staff an understanding of the person’s often very fulfilling and interesting life. Staff who spoke with me all had knowledge and understanding of the varied and sometimes multiple needs of each person using the service. Due to some residents’ particular communication and health needs it was difficult to ascertain if they were aware of their care plans, but these documents indicated that the needs of people using the service were being met by the home. There could be more evidence of resident’s involvement and ownership in their care plans, with particular focus on the individual’s strengths and personal preferences. This was discussed with the registered manager. I noticed that a resident’s wristwatch showed the incorrect time. I was informed by the manager/owner following the inspection that the resident was using the jewellery and wore it for sentimental reasons and not for time keeping. This should be documented in the care plan, and if needed the resident should be consulted as to whether she wishes this watch to be repaired. Daily’ and night resident’s progress records are documented. A resident spoke of choosing her own clothes and of deciding what time to go to bed. Records informed me that residents went to bed at varied times, and that their individual preferences regarding this were listened to and respected. From speaking to residents, staff and from inspection of records it was evident that people living in the home are having the support and care they need to meet their personal care needs. The manager reported that no residents have pressure sores. Staff were observed to frequently ask residents if they wanted to use bathroom/toilet facilities. Staff provided assistance and support to residents in a sensitive and respectful manner. Individual health needs of each resident are monitored and appropriate intervention taken, as and when needed. People using the service have access to care and treatment from a variety of healthcare professionals. I was informed by staff and by records that a GP visits the home at least on a monthly basis. A resident spoke having ‘seen the doctor’. Other health appointments include, optician, dentist, district nurse, chiropody care, and treatment. Records confirmed that an optician had recently visited the care home. Residents as needed, access additional specialist support and advice. A district nurse and student nurse visited a resident during the inspection. The community nurse spoke positively of the home, which included the pleasant atmosphere. She confirmed that the community nurse team were kept well informed of resident’s progress, and that the staff including the manager were very approachable. I was informed that the registered manager obtains pressure-relieving equipment from the community nurse team. I observed College Hill DS0000017528.V338003.R01.S.doc Version 5.2 Page 13 during the inspection that a resident had a pressure-relieving mattress on her bed. Records and staff confirmed that each resident’s weight is monitored closely. Records confirmed that resident’s had recently received a flu vaccination. The care home has a medication policy/procedure. The medication storage and administration systems were inspected. Medication is stored securely. Staff spoke of having recently completed a certified medication training course, which took place over a period of several weeks duration. This is commendable. I was shown some information on the content of this course. The manager reported that staff also receive training from the pharmacist, and that there was ‘in house’ medication instruction for staff, the content of which is documented. The manager should obtain an up to date Pharmaceutical medication reference book. A resident had been recently prescribed a medication to be given in response to certain behaviour. There needs to be clear guidance as to when this medication is to be administered. This guidance needs to include evidence of there being strategies in place to support the resident to manage their behaviour, prior the decision being made to administer this medication. This was discussed with the manager, who confirmed that she would draw up this guidance. Referral to a psychologist regarding the development of this guidance is recommended. Medication administration records were generally up to date but two gaps in recording were noted. Information in regard to the medication prescribed to the residents was recorded in their care plans. Records and staff confirmed that resident’s regularly have their medication reviewed by the GP. College Hill DS0000017528.V338003.R01.S.doc Version 5.2 Page 14 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): Standard 12,13 14 and 15 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents have the opportunity to participate in activities, but there could be further development in the provision of daytime activities, particularly community based activities. The visiting arrangements are flexible and meet the needs of visitors and residents, so as to ensure that residents have the opportunity to develop and maintain important relationships. Residents are supported to make choices. Meals provided are varied and nutritious. The menu could be more accessible to people using the service. EVIDENCE: Records confirmed that people living in the home had the opportunity to participate in some preferred activities. A resident spoke of taking pleasure in reading the newspaper, another spoke of enjoying some programmes on television. One resident was reading a book, the content of which she kindly spoke to me about. Other recorded activities included ball games, and exercise sessions. We were informed that a hairdresser visits the care home regularly. A resident spoke of recently having had her ‘hair done’. Another resident spoke of regularly receiving ‘holy communion’ in the care home. College Hill DS0000017528.V338003.R01.S.doc Version 5.2 Page 15 Staff spoke of resident’s birthdays being celebrated in the home. A resident had recently celebrated her 100th birthday. A person using the service spoke of there sometimes ‘not being much to do’ and of ‘sitting for much of the day’. One resident said ‘ I sing, but I haven’t sung here, I love singing’. A staff member spoke of one resident having painted pictures prior to living in the home. The ‘expert by experience’ and I saw several of this resident’s paintings displayed in their bedroom. I asked a staff member if the resident had the opportunity to paint while residing in the care home. She indicated that she was not aware that the home had any art materials. The manager reported that that there were some paints and brushes within the care home. All staff should be aware of where to access activity items. Another person using the service spoke of in the past having made her own clothes. Another person living in the home spoke of her love of dancing “ I used to go dancing three times a week”. The registered person should continue to develop the variety and number of preferred activities including resident’s having the opportunity to dance, sing, paint and/or do crafts such as sewing, as well as more 1-1 activities. Preferred activities, and action taken by the home to achieve this for each resident should be included in each individual care plan. The ‘expert by experience’ reported that ‘general motivation (of residents) seemed to be satisfactory’, and that he ‘had noticed a number of games that were easily accessed and seemed well used’. He said that he was informed that ‘entertainers came fairly regularly’. Following the inspection the manager/owner reported that a planned trip to a local school took place in December 2007. I was also informed by the manager that one resident regularly accompanies her shopping, and that music sessions for residents regularly take place. The manager acknowledged in the AQAA documentation in response to what the home could do better, that residents ‘ are to be encouraged to attend local centres of their choice’. Resident’s recorded activities included ‘newspaper reading’, ball games, dominoes, skittles, bagatelle, musical entertainment, and confirmed that library books are accessible to people using the service. People from a mobile library service visited the care home during the inspection to exchange some books. Staff informed me that a Christmas party was planned for residents and others. It was noted that the television was not on permanently during the inspection. It was switched off during lunch and music played instead. The visitor’s record book indicated that people regularly visited the home. Visitors who kindly spoke with me confirmed that they visited the home regularly at varying times of the day. They confirmed that they are kept informed of issues that concern their relative/friend living in the care home. Visitors reported that the manager ‘does more than she has too’, and gave examples of how well they had been supported by the care home regarding funeral arrangements following the recent death of a relative in the care home. A visitor said that his relatives ‘had landed on their feet coming here’, and that ‘I would come here if I had a need for residential care’. College Hill DS0000017528.V338003.R01.S.doc Version 5.2 Page 16 People using the service were observed to interact positively with other residents and staff, during the inspection. The home has a menu, which is displayed in the kitchen in written format. This recorded varied and wholesome meals. Improving the format of the menu to include pictures, and displaying it in the sitting/dining room was discussed with the registered manager. She confirmed that she would examine ways of developing and improving the menu format. Residents spoke of enjoying the meals, and comments during lunch included ‘It’s very nice’. Lunch served during the inspection corresponded to the meal recorded on the menu. Dining tables were attractively laid, and included napkins. Condiments were provided during the meal to residents, and lunch was unhurried, and a variety of choices were offered to people using the service. Staff were observed to encourage residents with their meal and to provide assistance when needed. Staff had knowledge and understanding of resident’s specialist dietary needs. Drinks and snacks including fresh fruit were regularly offered to residents during the inspection. Food eaten by people using the service is recorded. A variety of fresh fruit including mangoes, grapes, bananas, and apples were accessible in the communal dining area. A resident was observed to choose and help herself to a piece of fruit. College Hill DS0000017528.V338003.R01.S.doc Version 5.2 Page 17 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): Standards 16 and 18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents and others are confident that their complaints will be listened to. The format of the complaints procedure could be developed to improve its accessibility to people using the service. Residents are protected from abuse, neglect and self-harm. EVIDENCE: The care home has a complaints policy. This is in written format, displayed in the home, and recorded in the service user guide documentation. The ‘expert by experience’ reported that the complaints procedure could be more accessible, he recorded that ‘ the complaints advice notice was not easily seen’ nor easily read, and that he thought that it ‘is particularly important that friends and relatives should be made aware of the resident’s rights, and sometimes their own role, on matters that concern them’. The registered person needs to develop the complaints procedure to ensure that it is available in a variety of formats, so that it is accessible as possible to all the people using the service, including those who have difficulty in reading. A resident said that she knew how to complain and that she would make a complaint if she needed to. Visitors spoke of talking to the manager if they had a complaint. There were no recorded complaints. The registered person should seek ways of ensuring that there is recorded evidence that ‘concerns’ and complaints communicated by residents (and others) are welcomed, encouraged and College Hill DS0000017528.V338003.R01.S.doc Version 5.2 Page 18 listened to, and that appropriate action is taken to respond to and resolve them. Staff had an understanding of the importance of taking complaints seriously and of the action that they should take in response to a ‘concern’ or complaint from a person using the service or from others including visitors. The home has a protection of vulnerable adults policy. Staff who spoke with the inspector were knowledgeable of the reporting and recording procedures in regard to an allegation or suspicion of abuse. The registered person should access the up to date Local Authority Safeguarding Adults policy/procedure. Records and staff confirmed that staff training in the area of protection is regularly arranged by the care home. Information in regard to protection of vulnerable adults is now included in the staff induction programme. College Hill DS0000017528.V338003.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): Standard 19, 21, 23, 24, and 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment of the home is safe, homely, clean and comfortable. The premises are suitable for the care home’s stated purpose. Residents bedrooms are individually personalised, meet their individual needs. EVIDENCE: The environment of the care home provides for the individual requirements of the people using the service. The living environment is very clean, homely and generally well maintained. The décor of some areas of the home could be repainted to make them appear ‘brighter’ and more attractive. AQAA information informed me that the manager plans to replace the carpets in the corridors, and redecorate communal areas of the care home. She informed me that the heating system within the home has been improved by replacing two boilers. Thermometers located within the home monitor the temperature of College Hill DS0000017528.V338003.R01.S.doc Version 5.2 Page 20 the environment. Festive seasonal decorations were displayed. Residents, who kindly spoke to me, confirmed that the environment is agreeable, and meets their needs. The forecourt of the home has parking for several cars. The ‘expert by experience’ communicated that though the communal sitting and dining areas were small, ‘the home only caters for eleven (residents) and therefore did not feel crowded’, and that the shape of the sitting/dining room ‘enabled two groups (of residents) to sit separately’. Also he confirmed that ‘the atmosphere was pleasant’, and that ‘everyone (the residents) seemed alert’ ‘to what was going on’. Information regarding the date and month was displayed in the sitting/dining room. The garden is enclosed and generally well maintained. A resident spent sometime with a staff member in the garden during the inspection. Bedrooms are generally personalised. The bedroom doors have numbers to identify them. The manager/owner could explore ways (with consultation with residents) of identifying the individual bedrooms, such as having personal pictures on the door and possibly painting the bedroom doors in another colour to aid orientation and to improve the attractiveness of the environment. Pictures, photographs and ornaments were among the items located in resident’s rooms. The manager spoke of residents being able to bring to the care home items of their own furniture. The bedrooms each have a call bell, I tested one, which was found to be in working order. The ‘expert by experience’ reported that the resident’s bedrooms were ‘clean and pleasant, with a comfortable air about them’, and that ‘with one exception the rooms were bright with good daylight from windows’, also ‘the pictures and photographs gave a personalised feel to the occupants’. He noted ‘a minor criticism’; which was the absence of a pull switch to turn lights on and off from the bed. This was discussed with the owner/manager who agreed that this was an issue in one room and that she would resolve this issue. The home is clean and odour free. The ‘expert by experience’ was positive about the standard of cleanliness of the bathrooms and toilets, and noted that they ‘seemed well equipped with disability aids’. Soap and hand towels are located in the bathrooms/toilets inspected. The ground floor bathroom had recently been completed refurbished to a high standard, and includes a new bath with a built in hydraulic hoist. The laundry facility is located away from food storage and food preparation areas. The home has an infection control policy/procedure. Staff were observed to wear protective clothing including disposable gloves and aprons as and when needed. Staff receive infection control training. College Hill DS0000017528.V338003.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): Standard 27,28 29 and 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff receive appropriate and comprehensive training to ensure that they are competent and skilled in regard to carrying out their roles and responsibilities in meeting the care and support needs of residents. Sufficient numbers and skill mix of staff are employed to ensure that the needs and changing needs of people using the service are met. People using the service are supported and protected by the care home’s recruitment policy and procedure. EVIDENCE: People living in the care home spoke highly of the staff, and reported that they know them well. Staff were observed to communicate with people living in the home in an effective and sensitive manner. Comments from people using the service, about the staff included staff ‘do things for me’, and ‘they are nice here’. The ‘expert by experience’ said that when staff were ‘going about their tasks’, ‘the staff were responsive to the residents; stopping to pass a remark or briefly talk with them’, and that ‘staff seemed well motivated, and put themselves out to engage with residents’. A resident spoke of being ‘happy’ in the home and of not wanting to be ‘anywhere else’. Staff spoke of their key worker role, which included updating care plans with individual residents. College Hill DS0000017528.V338003.R01.S.doc Version 5.2 Page 22 Visitors spoke of how they had ‘peace of mind’ that their relative was ‘safe and secure’ in the care home. They spoke of knowing all the staff by their names and reported that during their visits, staff always interacted sensitively and frequently with people using the service. Staff spoke positively about their role and reported that they enjoyed working in the care home, supporting and caring for the residents. A staff rota was available for inspection. This indicated that there was flexibility of staff numbers on duty in accordance with meeting the needs and changing needs of people using the service. The manager reported that the home was presently fully staffed, and that there were no staff vacancies. The home has a recruitment and selection policy/procedure. Three staff personnel files were inspected. This documentation included evidence that required and appropriate recruitment procedures had been carried out. The manager and other staff informed me that the staff ‘turnover’ rate is low, and that staff generally work in the care home for several years. AQAA information confirmed that there were appropriate policies and procedures in place to support all aspects of equality and diversity, and that equal opportunities monitoring of staff is promoted during the recruitment and selection of staff. The registered manager spoke of the staff induction programme that staff receive when commencing employment in the home. A staff member confirmed that she had received satisfactory and comprehensive induction training. Staff and records confirmed that residents cultural and diversity needs were understood and supported within the home. The ‘expert by experience’ spoke with staff and was informed that staff ‘training sessions took place in the home’. The home has a staff training plan. Records and staff confirmed that staff training including specialised training appropriate to the roles and responsibilities. This training included, staff having the opportunity to complete NVQ (National Vocational Qualification) level 2 and 3 in care courses. The manager informed me that the NVQ training includes gaining and understanding of equality and diversity needs of residents. The manager informed me that only three new staff have not yet completed an NVQ care training course, but that this was planned following their induction programme. Staff have completed dementia care training, and a variety of other appropriate training including food and hygiene training, medication training, First aid, manual handling, health and safety infection control, and other training. The home has a consistent record of facilitating staff members to undertake external and internal development training beyond basic requirements. The manager/owner is proactive in seeking out varied staff training courses for staff to complete. This ensures that the staff team has a balance of skills and knowledge, and experience to meet the needs of people who use the service. College Hill DS0000017528.V338003.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): Standard 31,33,35, 36, and 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The registered manager/provider is qualified, competent and experienced to run the care home. Effective quality assurance and quality-monitoring systems are in place to monitor and improve the quality of the service provision by the care home. So far as reasonably practicable the health, safety and welfare of residents and staff is promoted and protected. EVIDENCE: The registered manager/owner is a registered nurse, and has several other relevant qualifications including being an National Vocational Qualification(NVQ) Assessor. She completed an NVQ 4 in management in College Hill DS0000017528.V338003.R01.S.doc Version 5.2 Page 24 2005, and has managed the care home for several years. The manager spoke of a National Health Service ‘Essential steps to clean care’ training course that she was presently in the process of completing. It is evident that she has a good understanding of the needs of older persons, and is highly competent to run the care home and meet its stated aims and objectives. She is particularly caring and sensitive in understanding and meeting resident’s needs, and has a very much ‘hands on’ approach. She works most days, completing a variety of shifts. Visitors and residents spoke positively of her and it was evident from observation that they knew her well. Records, staff and visitors confirmed that there are clear lines of accountability within the home, and that the manager communicates a clear sense of direction. The manager ensures that inspection requirements are completed within the required timescales. Records confirmed that there were some systems in place to monitor the quality of the service. This includes reviewing care plans and other documentation including some policies and procedures. Records confirmed that questionnaires about views of the service had been supplied to relatives/significant others, and that these views were very positive. An annual development plan of the service for 2007 was available for inspection. It is evident that the manager works hard to continuously improve and develop the service provided to residents. Residents meetings take place. I was informed that an open meeting (regarding views of the service), with relatives and visitors had taken place. Relatives/significant others generally manage residents financial affairs. Small amounts of cash are managed by the home. The home has efficient systems to ensure effective safeguarding and management of individual’s money including record keeping. Appropriate recording and monitoring of monies held by residents takes place. Staff supervision records were available for inspection. A staff member spoke of receiving regular 1-1 staff supervision, when staff practice and performance is discussed. The manager reported that staff appraisals are carried out, and that she aims to ensure that all staff receive a staff appraisal annually. There were no obvious health and safety issues apparent during the inspection. Working practices during the inspection were safe. Records and staff confirmed that the manager/owner ensures that staff are trained in health and safety matters. Up to date certificates of gas and electrical checks, and of moving and handling equipment, were available for inspection. The passenger lift is regularly serviced. There was evidence that required equipment checks are carried out. Required fire checks of are carried out. Fridge/freezer temperatures are monitored. Radiators are covered. College Hill DS0000017528.V338003.R01.S.doc Version 5.2 Page 25 During the tour of the premises it was noted that there was a bolted door located near a resident’s bedroom, near the second front door. The manager informed me that this was not generally bolted. This issue needed to be reviewed regarding emergency access, the fire risk assessment, and in regard to a possible issue of restraint. Following the inspection the manager/owner reported that this bolt had been removed. Accidents and incidents are recorded as require, and action is taken by the manager to prevent recurrence of any accidents. An up to date employers liability insurance certificate was displayed. College Hill DS0000017528.V338003.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 X X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 2 17 X 18 3 3 X 3 X 3 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 3 X 3 College Hill DS0000017528.V338003.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 12,13(2) (4) Requirement Timescale for action 01/03/08 2 OP16 22(2)(6) There needs to be clear guidance as to when a medication (prescribed when needed in response to a resident’s behaviour needs) is to be administered. This guidance needs to include a record of strategies in place (and agreed by the resident) to support and assist the resident to manage their behaviour, before the decision be made to administer this medication. The registered person needs to 01/04/08 develop the format of the complaints procedure to ensure that it is accessible as possible to all the people using the service, including those who might have difficulty in reading. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. College Hill DS0000017528.V338003.R01.S.doc Version 5.2 Page 28 No. 1 2 Refer to Standard OP7 OP9 Good Practice Recommendations There could be more evidence of resident’s taking the lead, and being more involved in their individual plan of care, and support. The manager should obtain an up to date Pharmaceutical medication reference book. Referral to a psychologist regarding the development of strategies and guidance to support a resident manage their behaviour is recommended. Staff should ensure that they always sign the resident’s administration record sheets following the administration of medication. It should e documented in the care plan that a resident wishes to wear a wristwatch (showing the incorrect time) as jewellery and if needed the resident should be consulted as to whether she wishes her wristwatch repaired. Preferred activities, and action taken by the home to achieve this need should be more evident in each individual care plan. The registered person should continue to develop the variety and number of preferred activities for people using the service, including having the opportunity to dance, sing, paint and/or carry out crafts such as sewing, as well as more 1-1 activities. All staff should be aware of where to access all activity items. Developing the format of the menu to include pictures, and displaying it in the sitting/dining room to improve its accessibility to people using the service is recommended. The registered person should seek ways of ensuring that there is recorded evidence that ‘concerns’ and complaints communicated by residents (and others) are welcomed, encouraged and listened to, and that appropriate action taken to respond to and resolve them. The registered person should access the up to date Local Authority Safeguarding Adults policy/procedure. The manager/owner could explore ways (with consultation with residents) of identifying the individual bedrooms, such as having personal pictures on the door and possibly painting the bedroom doors in another colour to aid orientation and to improve the attractiveness of the environment. DS0000017528.V338003.R01.S.doc Version 5.2 Page 29 3 OP10 4 OP12 5 6 OP15 OP16 7 8 OP18 OP24 College Hill The owner/manager should ensure that the bedroom, which is presently without a pull switch to turn on a light, has one fitted, so that the resident using that bedroom can turn on a light without having to get out of bed. College Hill DS0000017528.V338003.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Harrow Area Office 4th Floor, Aspect Gate 166 College Road Harrow London HA1 1BH 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 College Hill DS0000017528.V338003.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!