Care Home: Coniston House Residential Home

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What the care home does well Prospective residents are fully assessed prior to admission to ensure that the home can meet their needs. They also have sufficient information about the home to decide if they wish to live there. The staff know the residents` needs well, and go about their work calmly, reassuring and treating residents respectfully. A relative said: "X is happy, content, and well cared for." A resident told us: "if you have to be in a home, you could not do better." The home identifies and meets the health needs of residents. It has good links with NHS services ensuring prompt attention to any medical problems. Residents said that they always received the medical support they needed. One relative said that the home was very good at keeping in touch with information about their relative. All relatives replying to our survey said that the home always kept them up to date with important issues affecting their relative. What has improved since the last inspection? The home now completes a complaints log for all complaints received from residents and relatives, with the outcome of the investigation and any action taken. The additional fire protection work completed just before the previous inspection has now been approved by the Fire Officer. What the care home could do better: The Controlled Drug cupboard must be compliant with the regulations for the safety of residents. The new care plans that have been introduced for some residents should be introduced for all residents to ensure that the most appropriate care is given. Record keeping should be improved especially for complaints, staff training, and the safety of water temperatures. With increasing numbers of residents with diagnosed dementia, the number of staff on each shift should be reviewed to ensure that staff have the time to meet the needs of residents. CARE HOMES FOR OLDER PEOPLE Coniston House Residential Home 75-79 Orwell Road Felixstowe Suffolk IP11 7PY Lead Inspector John Goodship Unannounced Inspection 24th September 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Coniston House Residential Home DS0000060116.V372574.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. Coniston House Residential Home DS0000060116.V372574.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Coniston House Residential Home Address 75-79 Orwell Road Felixstowe Suffolk IP11 7PY 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) 01394 276201 F/P 01394 276201 Enviro Medical Limited Ms SallyAnn Royal Care Home 27 Category(ies) of Dementia (27), Old age, not falling within any registration, with number other category (27) of places Coniston House Residential Home DS0000060116.V372574.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 need on admission to the service are within the following categories: Old age not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is 27. 22nd October 2007 2. Date of last inspection Brief Description of the Service: Coniston House is a registered care home for older people situated in a residential area of the coastal town of Felixstowe, close to town centre amenities and the seafront. The home was first registered in 1984 and was bought by Enviromedical Ltd in June 2004. This organisation also runs a similar home in Southend-on-Sea. The home was originally registered to provide accommodation and care for up to nineteen older people but in 1999 was extended into the property next door and is now able to accommodate up to twenty-seven service users. There is private parking to the rear of the property. The rear gardens of the property have been landscaped to provide a particularly pleasant area for service users to spent time in the more clement weather. Service user accommodation is sited on three floors all of which are serviced by 2 shaft lifts. There are twenty-three single rooms and two shared rooms. 75 of rooms have the advantage of en-suite toilet facilities. The range of fees quoted in the Service Users Guide at the time of this inspection was £355.00 to £650.00 per week dependent on the type of room occupied and its facilities. Coniston House Residential Home DS0000060116.V372574.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 was an unannounced inspection that took place on a weekday and lasted eight hours. It focused on the outcomes for residents through the assessment of key standards as listed under each outcome group. It used previous correspondence and documentation, feedback from service users and relatives, observation of staff practice, and discussion with managers, staff, service users and relatives. We toured the home, interviewed two care staff, spoke to two residents and two relatives. We also examined three care plans, two staff files, maintenance and training records. In addition, various procedures, policies, and essential records were inspected. The manager had completed an Annual Quality Assurance Assessment (AQAA) required by the Commission. This was fully completed with information about the home which was verified during the inspection. Items from the AQAA have been used in this report. A questionnaire survey was sent out by the Commission to residents, relatives and staff. Five residents responded, six relatives, and two staff members. Their answers to the questions and any additional comments they made have been included in the appropriate sections of this report. What the service does well: Prospective residents are fully assessed prior to admission to ensure that the home can meet their needs. They also have sufficient information about the home to decide if they wish to live there. The staff know the residents’ needs well, and go about their work calmly, reassuring and treating residents respectfully. A relative said: “X is happy, content, and well cared for.” A resident told us: “if you have to be in a home, you could not do better.” The home identifies and meets the health needs of residents. It has good links with NHS services ensuring prompt attention to any medical problems. Residents said that they always received the medical support they needed. One relative said that the home was very good at keeping in touch with information about their relative. All relatives replying to our survey said that the home always kept them up to date with important issues affecting their relative. Coniston House Residential Home DS0000060116.V372574.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. Coniston House Residential Home DS0000060116.V372574.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 Coniston House Residential Home DS0000060116.V372574.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): 1,2,3. Standard 6 is not applicable to this home. Quality in this outcome area is good. New residents can be assured that they will only be admitted to the home if it can meet their needs, and they will have sufficient information to assess for themselves if the home will be suitable for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the previous inspection, the home had been registered to admit people with a diagnosis of dementia, within their total twenty-six registered places. In March 2008, we registered an additional place bringing the total to twentyseven. On the day of this inspection, all the places were filled, including thirteen people with dementia. Coniston House Residential Home DS0000060116.V372574.R01.S.doc Version 5.2 Page 9 The provider was required to update the Statement of Purpose and Service Users Guide before these variations could be approved. They included all the information that people using the service would need to know. Four out of the five people who replied to our survey said that they received enough information about the home before they moved in so that they could decide that it was the right place for them. One person said: “A friend’s relative was resident in the home for two years so it came highly recommended.” We saw evidence in the files that each resident had a statement of terms and conditions for their residence. This was confirmed by all the residents responding to the survey. The previous inspection report from the Commission was available in the hall. Information on the fees charged was included in the service users’ guide. Currently the fees ranged between £355.00 and £650.00 dependent on the type of room and the provision of en-suite facilities. We saw pre-admission assessments that had been undertaken on recent admissions. These were done by the manager or the deputy and were held in the care plans. The information gathered included health and social care needs, mobility, medication, nutrition and what activities the prospective resident enjoyed. Coniston House Residential Home DS0000060116.V372574.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is good. Residents can expect their physical and specialist needs to be identified and reviewed to ensure that these needs are met. Residents are protected by the home’s medication procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We examined three care plans. The plans included full assessment of needs under all aspects of care, together with risk assessments appropriate to each person, including moving and handling and pressure area care. If residents needed their weight to be monitored, the home only had bathroom scales for weighing, not a weighing chair, so only those who could weight bear were weighed. Coniston House Residential Home DS0000060116.V372574.R01.S.doc Version 5.2 Page 11 We saw that the physical needs of residents were well covered and recorded. Some of the care plans had been rewritten to better reflect the particular needs of those with dementia, covering their emotional and behavioural needs. Some included a life history written by the family to give staff help in understanding aspects of a person’s behaviour or reactions to events. However, none of them were fully person-centred, that is, expressing people’s needs from their perspective, and identifying their strengths and abilities before describing their weaknesses. The process had just started at the time of the previous inspection in 2007, and we were told it would be implemented for all residents, but little progress had been made towards this end. This reduced the home’s evidence of their ability to care appropriately for people. People told us that the home always or usually met the needs of their relative. However, one person told us that the home looked after people well physically but was not certain that their relative’s emotional needs were being met. The provider told us in the AQAA that more staff had started NVQ courses, and dementia care training, to enable them to provide “an excellent level of health and personal care”. One staff member was able to describe the lessons they had learnt from the training, and demonstrate that they understood that a different way of looking at residents could lead to improved care. The AQAA stated: “We liaise on a regular basis with local doctors and district nurses and have good relationships with these health professionals as well as local dentists, chiropodists, and the community psychiatric team.” We saw the records of all visits by health professionals, and all appointments for treatment. One resident received a visit from the district nurse during our inspection. The resident told us that: “I’m looked after very well.” The nurse went with the resident to his room for the check up. Residents said that they always received the medical support they needed. One relative said that the home was very good at keeping in touch with information about their relative. All relatives replying to our survey said that the home always kept them up to date with important issues affecting their relative. One person had been leaving the home when it was not safe for them to do so. They had also been entering other residents’ rooms without permission. The community mental health team had reassessed them and it had been decided their needs required different accommodation. In the meantime, their care plan advised that they should be subject to fifteen-minute checks on their whereabouts day and night. A chart was pinned on the notice board outside the main lounge with the times of each check and the location and behaviour of the person at that time. The last entry was two days before our visit. We found some further checks described in the daily record, but they were not consistent or complete. The manager told us that such frequent checks were no longer needed because the behaviour had changed. There was no updated risk assessment in the care plan. The checklist on the notice board on public Coniston House Residential Home DS0000060116.V372574.R01.S.doc Version 5.2 Page 12 display was an intrusion into that resident’s privacy. It was taken down when we raised the matter. The staff were keeping a diary of the behavioural incidents for one resident at the request of the hospital memory clinic, which the person was attending. They went there on the day of our visit, accompanied by their relatives. The relatives told us that they were so pleased with the care the person received in the home, particularly in view of their difficult behaviours. We examined the record of falls and saw that four residents had fallen twenty four times between June and September 2008. The majority of these falls had occurred after the resident had gone to bed at night. The community physiotherapist had recommended using a pressure mat for one resident to alert staff that they had got out of bed. This had been put in place. The manager told us that she was reviewing the training and routine of night staff to ensure better surveillance of residents. We noted that the morning medication round was still in progress at 10:30am. The senior person who was administering the medication was also answering the phone. The length of the round made it difficult to ensure residents received their medication close to the prescribed time. Interruptions increased the difficulty of maintaining the security of the medications as the trolley had to be locked up each time the person was called away. However no medication errors had been reported to us since the previous inspection and the Medicine Administration Records (MAR) were fully completed. We noted that the record was not signed until the medication had been seen to be taken. There were photos of each resident on their MAR sheet to ensure that there were no identification mistakes. We checked the controlled drugs (CD) record for one resident. The stock remaining was correct against the balance shown in the CD record. The CD cupboard was not compliant with the Misuse of Drugs Regulations. Coniston House Residential Home DS0000060116.V372574.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. Residents can be assured that the home will provide opportunities and activities suited their wishes and abilities. They can expect to be able to choose nutritious and varied menus. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA told us: “Through holding Service User meetings we were able to establish that some of our Service Users would like to have a certain activity more than once a week, whilst other Service Users came up with ideas for different types of activities which was agreed we could try.” The manager told us that Bingo was now the favourite activity, together with skittles and hangman. Activities also included beanbag throwing, scrabble, dominoes, cards, film, and sing-alongs. An Activities organiser came in for three hours twice a week. The manager also told us that they had put on a cream tea for all comers. Visitor included the district nurses and the GPs. They had held an Old Time Music Hall. The home had organised an outing to the community hut on the sea front. A social worker told us in their survey form that the Coniston House Residential Home DS0000060116.V372574.R01.S.doc Version 5.2 Page 14 entertainment provided was of a good quality and activities were varied and stimulating. All the relatives who replied to our survey said that the home always or usually met the needs of their family member. One said: “There should be more activities for people with dementia eg music/art therapy. My relative loved classical music and pottery and this could be a way in to motivate and stimulate them.” All the residents who replied to our survey, completed with the help of a relative, said that there were always or usually activities arranged by the home that they could take part in. Daily activity charts were in care plan files, which should have been completed daily by staff, recording when residents had taken part in activities within or outside the home. However some of the ones we examined had very few entries and were not up-to-date. In the afternoon there were thirteen residents in the main lounge with the TV on loud. It appeared to be controlled by one resident. Some others were asleep. Picture quality was very bad because of the effect of the dock cranes nearby. The sound volume was not conducive to a calm atmosphere in that room, and the fuzzy picture was difficult for any person to look at. The menu for the week was pinned to a notice board in a corridor. Unfortunately it was for the wrong week. The cook changed it as soon as we pointed this out. None of the residents we spoke to knew or could remember what was to be the main dish for lunch. It was braised lamb, or jacket potato with different fillings and salad, followed by summer puddings. Everyone we saw was having the lamb. All the residents who replied to our survey said that they always or usually liked the meals provided. One person was using special cutlery to enable them to eat their food by themselves. One pudding was put down next to a resident while they were still eating their main course. We felt this was hurrying the person. All but two residents were eating in the two dining rooms. The cook was making cakes for afternoon tea. Supper was chicken nuggets and baked beans, or prawn sandwiches. The environmental health officer of the local authority had visited the home earlier in 2008. The only requirement made was that a metal cupboard be provided for the storage of boxes of cereals in the outside dry store. Coniston House Residential Home DS0000060116.V372574.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is good. Residents can feel confident that they can complain and raise concerns. They can be assured that the home has robust procedures for protecting them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaints procedure was prominently displayed in the hall. It included the name, address, and telephone number of the Commission. All the residents except one said in the survey that they knew how to make a complaint and raise any concern. All but one of the relatives who replied to our survey said that they knew how to make a complaint. The complaints log listed two complaints. One was about a relative’s concern about bathing frequencies and the application of eye drops. The other concerned a report of a member of staff talking sharply to a resident. In both cases the home investigated and gave the complainant a full explanation within the timescale in the policy. Both complaints were resolved satisfactorily. In one case a member of staff was moved to a day shift for further supervision. However the log did not record two complaints which were reported directly to the Customer First office of Social Services. One was querying the differing Coniston House Residential Home DS0000060116.V372574.R01.S.doc Version 5.2 Page 16 reasons given by staff about the fall of a resident. The other was concern about unexplained bruising on a resident. The home was asked to investigate the first issue. Two people from the victim care team investigated the latter complaint. Nothing untoward was found and no further action was taken. The home was asked to ensure that accident reports were completed for all such incidents. These two matters should have been logged in the home’s complaints record. Similar shortfalls in recording had been noted in the previous inspection report. Staff received training on the protection of vulnerable adults (POVA) at their induction course, and in their NVQ, if they did one. We were not shown evidence of any regular refresher training in this topic. However staff whom we interviewed were able to describe to us what could constitute abuse and what action they would take. We examined the home’s POVA policy. It had not been reviewed since October 2004, and did not reflect the current County adult protection policy and procedure. There was no statement in the policy about staff training. However the management had experience of dealing with referrals about safeguarding in the appropriate way. No residents’ monies were held in the home. Residents or their representatives were invoiced quarterly for any additional items they needed, such as toiletries, hairdressing and chiropody. This was explained in the service users guide. Coniston House Residential Home DS0000060116.V372574.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26. Quality in this outcome area is good. Residents can be assured that they live in a safe and secure environment, in comfortable communal rooms, and with rooms containing their own possessions. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Coniston House had a permanent handyman who worked four days a week to undertake any work that needed doing. They had their own work book which allowed staff to communicate any repairs to be done. There was a tidy and pleasant garden which provided seating areas, also a summer house for residents to enjoy during the summer months. Coniston House Residential Home DS0000060116.V372574.R01.S.doc Version 5.2 Page 18 A vacant room on the top floor was being refurbished to incorporate the bathroom next door to increase the number of en-suite rooms. We had registered an additional bedroom in July 2008. One of the small ground floor lounges had been used for this conversion. It was occupied already and had been personalised with family photographs. There was sufficient communal space still available to meet the needs of the residents. A new fire door had been installed on the first floor corridor. The door and the wall around it had not yet been painted. It also had a strong return spring which some residents could find difficult to push open. A key pad entry and exit system had been installed on the front door for the safety and security of residents. All residents’ rooms that were viewed showed evidence that they were personalised with pictures, knick-knacks, mementos, flowers, books and some own pieces of furniture. All the residents who replied to our survey said that the home was always or usually fresh and clean. A relative said their family member’s room was always clean. The manager told us that the policy was to deep clean one room per day. Since the previous inspection, the home had changed its policy on hot water checks. The company which the home used to carry out six-monthly water quality tests had wrongly advised the home that the company’s checks were sufficient. This was not the case, and the tap temperatures used by the company were not in line with the temperatures recommended for older people by the Department of Health. When we discussed this with the manager, they said they would revert to the previous system of regular checks to protect residents from scalding. A routine water test in March 2008 had identified the presence of Legionella. The correct action was taken by the home, who also informed us of the situation and the temporary measures in place during treatment of the water system by the company. Coniston House Residential Home DS0000060116.V372574.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good. Residents can be assured that their needs will be met by the trained and competent staff, and that they will be protected by the home’s recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information from the AQAA and from the rota confirmed that the staffing levels remained at three carers plus a senior on in the morning, two plus a senior in the afternoon/evening, and two waking staff at night. During the weekdays, the manager was usually on site as well, and was always on call at night and weekends. Residents told us there were usually staff available when they needed them. Two relatives said that the home was often short staffed at weekends. We did not find evidence of this in the rotas we examined. Of the two staff who replied to our survey, one said that there was usually enough staff on duty. The other person said there was only sometimes enough. We observed that call bells were answered within a reasonable time during the day. Carers were also seen supporting a resident who they found walking down the corridor and guiding them back into the lounge. Staff were seen to help residents to the toilet from Coniston House Residential Home DS0000060116.V372574.R01.S.doc Version 5.2 Page 20 the lounge, and one sat next to a resident for about five minutes to reassure them about a concern they had. There would be times on the late shift when the senior would be administering medication, leaving only two carers on the floor for twenty seven residents, half of whom had dementia. This cover should be reviewed. Although the AQAA said that staff turnover was low, it also listed twelve care staff, out of seventeen, who had left in the last year. The manager was able to tell us the reasons for seven of these. The others had resigned without giving reasons. The AQAA told us that four shifts had been covered by agency staff in the three months April to June 2008. A relative said: “The permanent staff are very caring and friendly. They always make you feel welcome when you visit.” Another told us: “The staff are always cheerful and welcoming.” We examined the staff files for two recent appointments. They both contained all the identification checks and safety checks required. These protected the residents from the danger of abuse. We interviewed two members of staff about their work and training. They were able to talk about residents for whom they were the key worker and showed sensitive understanding of their needs and abilities. They described the training they had attended from induction through NVQ to dementia training. One of them said that there were more residents now who needed two staff to transfer them. Although the AQAA told us there were only two residents needing two staff for personal care, staff felt there were more. One of them said that one person was not following best practice when moving and handling residents. The manager told us that this person was being retrained in moving and handling. Both staff said that if they had a problem they would go to the manager. Another said: “I find our manager very easy to approach and easy to talk to. She is very supportive with training and has offered her help and support where needed.” We examined the staff training records. Each person had their own record but the ones we saw were not up to date. The manager had organised training in Food Hygiene and Fire safety in the near future. We did not see a record of training to date. We did see the record of those staff doing dementia training. This was a sixteen-week distance-learning module through a local college. Six staff including the manager had completed the course. Four staff were in the process of doing the course. The manager pointed out to us that no night staff had yet been trained in dementia care. Both staff replying to our survey said that they received appropriate training. All staff we spoke to said that they met with the manager regularly to discuss how they were working. Coniston House Residential Home DS0000060116.V372574.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38. Quality in this outcome area is good. Residents and relatives can expect the home to be well run, by competent staff. Their safety is assured by the home’s health and safety practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager was a registered nurse. She was experienced in the care of older people and had undertaken training in the care of people with dementia. In the last six months, the deputy manager and the senior co-ordinator had left. The deputy post was to be left vacant. An appointment had been made two weeks prior to our visit to the post of senior coordinator. Coniston House Residential Home DS0000060116.V372574.R01.S.doc Version 5.2 Page 22 We saw the supervision schedule for each member of staff. We were shown the record of the last session for one person. This helped to ensure that staff skills were maintained. The Certificate of Registration was displayed near the entrance and was the latest version. The home was properly covered by insurance covering its legal liabilities to employees, residents and third parties. The certificates were displayed and were up-to-date. The provider was complying with regulations by undertaking monthly inspection visits, and by informing us of serious incidents and the deaths of residents. The monthly visit acted as a quality control check. Other checks included the auditing of care plans by the senior co-ordinator, and resident meetings. Staff confirmed that staff meetings were held regularly. They were split between day staff and night staff. The next meetings were due to be held in October. No residents’ monies were held in the home. Residents or their representatives were invoiced quarterly for any additional items they needed, such as toiletries, hairdressing and chiropody. This was explained in the service users guide. As has been noted earlier, the home had contracts for the surveillance of water quality. Fire equipment was also inspected regularly. The next inspection was due in November 2008 together with a review of the fire risk assessment. The fire log listed in-house checks by the maintenance man, covering alarm tests and emergency lighting. The last recorded test of the lighting was 21st July 2008. Following a visit from the Fire Officer in December 2007, he confirmed that the home complied with fire safety legislation. Coniston House Residential Home DS0000060116.V372574.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 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 X 3 X 3 3 X 3 Coniston House Residential Home DS0000060116.V372574.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 Requirement The controlled drugs cupboard must comply with the Misuse of Drugs (Safe Custody) Regulations amended 2007. Timescale for action 01/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP7 OP10 OP16 OP18 OP27 Good Practice Recommendations Care plans appropriate for the care of the residents should be implemented as soon as possible. Staff should be trained to consider the privacy and dignity of residents. Complaints and allegations, from all sources, should be recorded in the complaints record with the outcome. The home’s policy on the protection of vulnerable adults should be up to date and include the policy for staff training. The provider should keep staffing levels under review as residents’ needs change to ensure that appropriate care can be given. Coniston House Residential Home DS0000060116.V372574.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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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