Care Home: Cricklade House

What the care home does well What has improved since the last inspection? There were no requirements arising from the previous inspection and only one recommendation. The recommendation referred to the organisation of staff recruitment files, and this had been done. The manager has bought a range of specialist games and aids for the home, which are popular with service users, and also new chairs for the conservatory. The manager arranges for each service user to have their own newspaper each day. The garden has been replanted so that there is more space and service users are able to tend their own individual vegetable patch. What the care home could do better: There are no requirements or recommendations arising from this report. CARE HOMES FOR OLDER PEOPLE Cricklade House Cricklade House 57 Cricklade Avenue Streatham Hill London SW2 3HD Lead Inspector Ms Rehema Russell Unannounced Inspection 7th May 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cricklade House DS0000066465.V374854.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. Cricklade House DS0000066465.V374854.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cricklade House Address Cricklade House 57 Cricklade Avenue Streatham Hill London SW2 3HD 020 8674 9408 020 8769 2759 crickladehouse@btinternet.com 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) Mrs Mary Madden Mrs Mary Madden Care Home 4 Category(ies) of Dementia (4), Old age, not falling within any registration, with number other category (4) of places Cricklade House DS0000066465.V374854.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 (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 4 9th June 2006 Date of last inspection Brief Description of the Service: Cricklade House is a semi-detached house on two floors which was formerly a family home and which is indistinguishable from the other residential homes in the street. There is ample on-street parking and there is a large shopping centre, with full community facilities and transport links, a few minutes walk away. The ground floor has a large entrance hall, toilet with washbasin, large front bedroom, lounge, conservatory, kitchen/diner and back garden. The first floor has an office, three bedrooms and a bathroom. The downstairs bedroom and two of the three upstairs bedrooms have an en-suite toilet with shower. All rooms are decorated, fitted and furnished to a high quality. The home does not have a lift and so is not suitable for persons with mobility problems. Written information about the home is given to prospective service users and their relative/carers in the form of the Statement of Purpose and Service User Guide. A copy of most recent CSCI inspection report is available at the home if requested. The current fee set by the local authority remains at £450 per week, the same amount as set in 2006. Cricklade House DS0000066465.V374854.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was carried out by one inspector on 7th May 2007. The home was full, with 4 residents, and the manager and deputy manager were on duty. During the course of the inspection the inspector spoke with the manager, the deputy manager, three of the four service users and two visiting relatives, toured the premises and examined documents and records. The inspector returned to the home on 20th May 2008 to conduct a “probe” on safeguarding in elderly homes being carried out nationwide by the Commission, and also to speak with a care assistant because this had not been possible on the main day of inspection. The inspector also telephoned a relative on the day of writing the report to obtain further feedback. The Registered Manager had completed and returned the Annual Quality Assurance Assessment (AQAA), which is a self-assessment focussing on how well outcomes are being met for people using the services. This report is informed by information gathered at the inspection, information given in the AQAA, and any other information that has been supplied by the home or other interested parties. What the service does well: The service provides a high quality environment that is homely and welcoming. There is a happy, friendly and relaxed atmosphere at the home with the manager and staff having a sensitive and caring attitude towards service users. Staff make relatives and visitors welcome and have created an environment where service users feel that they are at home. Quotes from relatives and staff included: • “She will outlive all of us if you carry on with her” • “I am very grateful to you and the other carers for your hard work and commitment. I know in my heart that you did all you could to take care of her. Many thanks again.” • “They feel like it is their own home”. • “God smiled the day we put mum in here”. • “It is always clean and tidy no matter when you come.” • “Meals are always nice” • “All staff are very nice, gentle” • “There’s never anything to complain about”. • “Mother is happier here, she has a fondness for the carers”. • “You can approach Mary with anything, she is always responsive”. • “We can visit at anytime, with no warning, it’s always the same”. Cricklade House DS0000066465.V374854.R01.S.doc Version 5.2 Page 6 • • • • • “(Relative) said she would not be taking (service user) home as she much prefers to be here at Cricklade as she knows she will have a better time.” “I’m really happy with everything. There’s been a marked improvement in mum since she’s been here. She seems more lucid in conversation, eats properly, is socialising and using her mind more, and she no longer has hallucinations or anxiety”. “I love working here.” “It is easy to work with the manager and deputy manager, I learn lots from them”. “They are very willing to explain anything, easy to talk to” 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. Cricklade House DS0000066465.V374854.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 Cricklade House DS0000066465.V374854.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5, 6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. No service user moves into the home without having their needs fully assessed by the home and being assured these will be met. Prospective service users and their relatives and carers are encouraged to make several visits to the home to assess its quality, facilities and suitability. The home does not take service users solely for intermediate care. EVIDENCE: Verbal and documentary evidence demonstrated that prospective service users are given a thorough assessment before being accepted by the home. Two care files were seen and both had multi-disciplinary care plans and nursing assessments, which the home ensures it received before it carries out its own assessment. The manager then always visits the service user in their own home or wherever they currently are in order to carry out a full assessment and observe their mobility and other needs at first hand. Relatives confirmed that they had met the manager when she came to assess their mother in Cricklade House DS0000066465.V374854.R01.S.doc Version 5.2 Page 9 hospital. The service user, accompanied by their family/carer, then visits the home at least once for 2-3 hours, but preferably for the whole day, in order for them to have lunch, be introduced to staff and the other service users, and see their room and the facilities at the home. The manager encourages the relatives and service user to visit as many times as possible, and to visit other homes, so that they are sure that this is the home they want. Relatives spoken with said that the manager had given them full information about the home. All service users have a contract and a six week trial period, with a review carried out during the six weeks. The manager has a sensitive understanding of all the different issues that can affect a service user moving to the home and expects a period of settlement, during which the service user may become aggressive or disturbed. The manager discusses potential behaviours with the service user’s general practitioner and previous placement, and if the aggression persists will have the service user re-assessed, including a reduction in medication if this is indicated. However, the home cares and manages the distress and aggression very well. For example, when one service user first came to the home, she was confused and aggressive, packing her bag and throwing it over the fence and calling for the police. This service user is now happy and settled at the home. The home does not take service users solely for intermediate care. The manager was also clear that the home would not admit service users on an emergency basis. Cricklade House DS0000066465.V374854.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 excellent. This judgement has been made using available evidence including a visit to this service. All service users have individual care plans and their health care needs are being met. Service users are protected by the home’s policies and procedures for dealing with medicines. Service users are treated with respect and their right to privacy is upheld. EVIDENCE: Two care plans were examined. They were found to be comprehensive and detailed, and written in clear and simple language that is easy to follow. It is therefore easy for staff to know what the service users’ needs are and exactly how to meet them. Care plans are reviewed monthly, signed and dated. Full daily notes, written at the end of each shift and signed, were seen on care plans and these gave a comprehensive picture of the activities, health, mood and welfare of each service user over each period of the day and night. All daily notes were signed. Once the six week trial period is complete, service users are registered with the local general practitioner and chiropody, dental and other services. The GP Cricklade House DS0000066465.V374854.R01.S.doc Version 5.2 Page 11 surgery has a community nurse attached and the manager also uses the Continence Advisory Service as appropriate. Medical appointments are recorded in care files and evidenced that the full range of healthcare services are being used to ensure that service users have optimum health, including community psychiatric nurses when appropriate. One relative spoken with said that his mother’s mental and general health had improved at the home and another relative told the manager that her 92 year old mother “will out live all of us if you carry on with her”. The manager ensures that service users keep active and interested in many small ways, such as asking them to come the few steps to the kitchen to get a drink after lunch, rather than them being served everything and thereby institutionalised. The home uses the monitored dosage system so that all medicines are in blister packs with doses pre-packed by the pharmacist. The lockable medicines cabinet has been put up in the kitchen so that there is no “institutionalised” medicines round, and service users can be given their medication individually in the kitchen as would be done in their own homes. The Registered Manager is a qualified nurse and the home has a thorough medicines policy, which has been checked by a Commission pharmacist inspector. Each service user’s medication has been reduced since coming to the home, with only two of the four service users needing mild Alzheimer’s medication. Relatives are very pleased with this, saying that “here they are not all drugged up”. All observations on the day of inspection and verbal evidence from staff, service users and relatives indicated that service users are treated with respect and their dignity and privacy safeguarded. For example, the home has provided each service user with their own laundry basket in their room/ensuite so that each service user’s linen and clothes are wished on an individual basis and returned to them. A service user with a particular interest in the garden has been put “in charge” of it, and on both visits was observed to decide at what time in the late afternoon it was no longer feasible for others to sit in the garden and clear the table and arrange the chairs accordingly. Throughout the inspection service users were observed to move around the home and go to their rooms at will, closing their doors if they wanted complete privacy. Service users are encouraged to help clear away after meals and to assist with the washing up, as they would have done formerly, so that they feel it is their own home. One service user enjoys putting the shopping away and has taken it upon herself to be the person who checks that the front door is locked. When buying games and aids for the home, the manager goes through the catalogue with service users and they choose the items that are purchased. The home ensures that all service users are well groomed and dressed and that their hair is regularly cared for. On the day of inspection all service users were happy and relaxed, welcoming to visitors and interested in their surroundings. Cricklade House DS0000066465.V374854.R01.S.doc Version 5.2 Page 12 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 excellent. This judgement has been made using available evidence including a visit to this service. Service users’ social, cultural, religious and recreational interests are provided for and the home encourages and promotes contact with family and friends and the local community. Service users are encouraged and supported to exercise choice and control over their lives. They are given a wholesome and balanced diet in pleasant surroundings. EVIDENCE: The home makes every effort to keep service users stimulated and interested, not only in their immediate surroundings but also what is happening outside of the home environment. For example, the manager arranges for the “Metro” newspaper to be collected every day, and for service users to each have their own copy with their name on it. After breakfast, staff and service users read the papers together and discuss items of interest. When the inspector arrived one service user was still reading her newspaper, another was playing indoor netball with the deputy manager, one service user was in the middle of a table game with the manager and the fourth service user was having a family conference in her bedroom. The manager has recently purchased new Cricklade House DS0000066465.V374854.R01.S.doc Version 5.2 Page 13 dementia games for the home, chosen by service users from a specialist catalogue, which each help service users to maintain specific skills such as eye & hand co-ordination or help them to think about and express their feelings. There is also a giant wipe-off crossword and new large-numbered clocks, and one of the service users told the inspector the time. Except for immediately after lunch, service users were occupied throughout the day. At various times service users were observed to be reading magazines, giving each other a manicure, watching a specific programme on television, having a cigarette in the garden and playing dominoes together. Staff either joined in these activities or supervised them, and were continually communicating with service users, just as would be found in a happy family home. One relative spoken with said that his mother had made a “marked improvement” since coming to the home, he felt this was because it is such a good environment and with so much service user interaction with staff. The home helps service users to access the community as much as they are able to. For example, one service user is accompanied to the high street so that she can buy her cigarettes herself. Once admitted to a residential home the local authority considers that the service user’s leisure and social interests are met, and therefore does not facilitate access to day centres. Nevertheless the manager has found a local Alzheimer’s society outreach facility in the community and takes all service users there once a week, where they dance, play bingo and quiz games, and she also takes them to a local drop-in centre once a fortnight. Service users are also taken to the park and would be taken out as a group more often if the home had a minibus. The home does all it can to encourage and support relatives and friends to visit service users. Visitors may come to the home at any time and are always made welcome. They can choose where to visit with their relative, in the main lounge, more privately in the conservatory or garden, or in complete privacy in the service user’s bedroom. Relatives spoken with said; “the home is always clean and tidy, no matter when we come”; “the atmosphere is always happy”; “we can visit at any time – we never give a warning and it’s always the same”; and “the manager or staff always say “who’s this coming?”to our mother when we arrive”. The four current service users do not have any cultural needs but two are taken regularly to a church services that accord with their religious beliefs. A previous service user of the home used to attend the temple of a specific religion before entering the home so while she was at the home the manager had arranged for representatives of this religion to visit her and to take her to the temple weekly. The home gives service users every opportunity to exercise choice and autonomy. Routines are flexible, with service users encouraged to choose when to rise and when to go to bed, and how to spend their time during the Cricklade House DS0000066465.V374854.R01.S.doc Version 5.2 Page 14 day. For example, after lunch one service user went to her room, one dozed in the lounge, one watched television and another just relaxed in the lounge. All service users are offered early morning tea in bed and then can get up and have breakfast as they choose, usually between 7-9 am. The inspector was told that one service user started to get up very late but then said she missed the other service users at breakfast and so she chose to return to getting up earlier. Similarly, service users choose freely when to go to bed, one choosing to go up between 9.30-10 pm each night, another usually watching films till 11 pm, one getting tired very early and going to bed at 8pm and the fourth person choosing any time between 9pm – midnight each evening to go to bed. The manager prefers service users’ relatives to handle all aspects of service users’ monies and this is the case for three of the four service users. However, the only family member of the fourth service user is abroad and refuses to become involved in her affairs, and the local authority is retaining the service user’s personal allowance. The Registered Manager is therefore personally paying for all of the service user’s personal expenses as she does not want her to be deprived or to have less choice than the other service users. The manager sends copies of all such expenditure to the service user’s social worker so that there is a record. Relatives spoken with confirmed that they are given “full receipts for everything” purchased or spent on behalf of their mothers. Menus were seen and were found to be healthy and varied. Service users have a choice of cereals, toast and egg for breakfast, a full lunch, snacks at midmorning and afternoon, supper at 6pm and a choice of milky night drink later in the evening. All meals are adapted to the individual tastes of the service users. For example, lunch on the day of inspection was beef with mashed potato and mixed vegetables but two service users prefer rice to potato and so chose and were given this. The inspector tasted the food and it was delicious. Another example is that all service users have traditional fish on Fridays but one service user said that she only likes a certain type of fish and so she is given a dish with jumbo prawns. Relatives said that “the meals are always nice”, and the manager said that staff invite visitors to join in the meal if they wish to. Menus showed that supper is a lighter meal but also cooked, for example omelette or tuna with salad. The manager is very aware of nutritional needs and so provides fresh fruit for snacks instead of biscuits. Cricklade House DS0000066465.V374854.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their relatives are confident that any complaints would be listened to and acted upon. Service users are protected from abuse. EVIDENCE: The home’s complaints and abuse policies meet all of the requirements of legislation. The home has received no complaints since it opened. The manager ensures there is an atmosphere at the home that encourages and empowers service users and relatives to comment or complain about anything they are not happy with, and that they get an immediate response. Relatives spoken with said that they know how to make a complaint but that “there is never anything to complain about”. Staff spoken with were aware of and fully understood the abuse policy and safeguarding issues. They are given a copy of the policy during induction and then have training on abuse and whistleblowing, which is tested in writing and consolidated verbally. The manager said she makes every effort to make staff feel that they will be supported to report abuse and not intimidated for doing so. Staff confirmed that they would have no hesitation in doing this. Cricklade House DS0000066465.V374854.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users live in a safe, well-maintained environment, with access to safe and comfortable indoor and outdoor communal facilities. There are sufficient and suitable lavatories, washing facilities and aids to facilitate independence. Service users’ bedrooms suit their needs and are safe and comfortable. The home is clean, pleasant and hygienic throughout. EVIDENCE: The location and layout of the home is suitable for its stated purpose, and it is accessible, safe and well maintained. It is a few minutes walk from a large shopping centre with full community and transport facilities but as it is located in a wide residential street it is also safe and accessible. Conversion works to build a conservatory, widen the kitchen/diner area and add en-suite bathrooms to three of the bedrooms have been completed to a very high standard and the whole home has been newly redecorated and fitted. It is bright, welcoming and comfortable throughout. Cricklade House DS0000066465.V374854.R01.S.doc Version 5.2 Page 17 There is an attractive garden leading out from the conservatory that has garden furniture, plants and an area where service users have their own vegetable patch. There are four communal areas, the lounge, the conservatory, the kitchen/diner and the garden, and each area is spacious and well laid out. The indoor areas have good quality decorations, fittings and furnishings and are homely and comfortable. There is a large table in the conservatory that can be used for leisure facilities or for eating at as an alternative choice to the dining area. The home has obtained a number of interesting and varied games and aids that are designed especially for people with Alzheimer’s. Service users were observed to be enjoying these games and using the aids (such as large numbered clocks) throughout the day. There is a large notice board in the lounge that has information in large letters such as the date, date, month, year, names of staff on duty and a photo of each service user with their name. This helps service users to orientate themselves to the present and is a very good memory aid. The manager has also purchased a large screen television, which service users were very happy with. All four single bedrooms meet minimum space requirements, with three of the bedrooms being much larger than minimum size and also having an en-suite shower, washbasin and toilet. Bedroom fittings, furniture and furnishings are attractive, comfortable and of good quality and service users are encourage to bring their own possessions, including items of furniture if they wish. All bedrooms were seen and found to be personalised according to the individual tastes and wishes of the service user. A relative told the inspector that her mother was very happy with her room and had brought her own television, table and chest of drawers with her. Social services did not facilitate one service user obtaining her personal possessions when she moved into the home and so she does not have framed photos of her family like other service users. The manager has made sure that framed pictures of this service user’s interests have been obtained and put up in her room so that her bedroom is also personalised and homely like everyone else’s. In addition to the en-suites, there is a toilet with washbasin downstairs and easily accessible from the lounge, and a bathroom with toilet upstairs. All service users are mobile and able to use their en-suites without aids, and the manager had ensured that there are grab rails in all toilets. Laundry facilities are located in the conservatory, completely away from the kitchen, and are housed in a low wooden cupboard structure which makes them non-visible. The kitchen is well organised, menus are displayed and the dining table is attractively laid out. The home is well lit and ventilated throughout and there is a window in the conservatory roof that can be opened to give greater airflow and coolness in the conservatory. On the day of inspection the home was found to be meticulously clean and hygienic throughout. Cricklade House DS0000066465.V374854.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ needs are met by the numbers and skills of staff and service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. EVIDENCE: The home has a full complement of staff, comprising a manager, deputy manager, and 4 care assistants. Two of the care assistants are part time but all other staff are full time. All service users are self-caring in regard to physical care, although a member of staff always supervises showers for safety. Rotas showed that there are always 2 members of staff on the early shift, and that there is one member of staff on the afternoon shift with a second member of staff in the evening as necessary. As this is a very small home, the manager works hands-on as part of the care team. Night staffing is waking. All staff at the home have attained NVQ Level 2, and some are studying for Level 3, so the home exceeds the recommended training target for care workers. The manager and experienced staff members all have a minimum of 4 years experience with the client group, with the manager and deputy manager having many years more experience than this. Cricklade House DS0000066465.V374854.R01.S.doc Version 5.2 Page 19 Four staff recruitment files were checked and all contained all documentation necessary to meet regulation standards, including enhanced Criminal Record Bureau checks. Each file also had two written references, and in addition the manager takes a verbal reference whenever possible, for example from a course tutor. Files also contained evidence of application forms, face to face interviews, medical health checks, previous experience and qualification certificates, proof of identity and visa permits if applicable. All staff are inducted using the Malvern Partnership induction system, which is a very comprehensive induction tool. Staff have all mandatory training during induction, such as fire safety, food hygiene, moving & handling, infection control and health & safety, and in addition have are given training in medication administration, dementia and protection of vulnerable adults. As stated above, all staff have attained NVQ Level 2, and some are being supported to the home to attain NVQ Level 3. Cricklade House DS0000066465.V374854.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. 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 her responsibilities fully. Service user benefit from the ethos, leadership and management approach of the home, and staff are appropriately supervised. Service users financial interests are safeguarded and their health, safety and welfare is promoted and protected. EVIDENCE: The Registered Manager, who is also the Registered Provider, is a very experienced practitioner who is a registered nurse and who ran a residential care home for older people for 15 years. The previous care home was registered for elderly people and up to five people with dementia and so she is Cricklade House DS0000066465.V374854.R01.S.doc Version 5.2 Page 21 amply experienced and competent to run a four bedded home for older people with dementia. Throughout the inspection she demonstrated a thorough knowledge and understanding of the conditions associated with old age and dementia, a loving and caring attitude towards service users and a commitment to providing a high quality service tailored to their individual needs. She is currently completing the NVQ Level 4 in management and care and Registered Manager’s Award. There was an open, friendly and very happy atmosphere at the home on the day of inspection and staff spoken with said that they found the manager’s style to be open, approachable, encouraging and supportive. Staff said that they could speak to the manager and deputy about anything and that they were “very willing to explain anything”. They said that both managers were “easy to work with” and that they “learn lots from them”. The manager is at the home throughout the week and often at weekends, and as she is always “hands on” staff are able to benefit and learn from her attitude and experience. Relatives said they could approach the manager “with anything, she is always responsive”. The manager devised as sent out a Customer Satisfaction Survey for relatives, residents and friends towards the end of last year, and responses were very positive. As the manager is at the home on a near-daily basis, and works full shifts, there is no need for monthly Regulation 26 reports. Residents/service user meetings are held annually and the home has almost daily visitors as two service users have relatives that visit several times each week. Feedback about the home is therefore given and received informally on a daily basis. As stated under Standard 14 above, the manager prefers service users’ relatives to handle all aspects of service users’ monies and this is currently the case for three of the four service users. However, the only family member of the fourth service user refused to become involved in her affairs, but as the local authority is retaining her personal allowance and monies, the home does not handle any monies on her behalf. The manager keeps receipts of individual service user’s expenditures and presents these by invoice to relatives for payment. Relatives spoken with confirmed that they are given “full receipts for everything” purchased or spent on behalf of their mothers. Staff meetings are held every 3 months and staff confirmed that they are also given formal supervision. The National Minimum Standards recommends that staff receive formal supervision at least 6 times per year, but as the manager works alongside all staff on a daily basis and gives feedback, advice and support on a constant basis, the current system of formal supervision approximately once every 4-5 months is appropriate. A range of health & safety documentation and certificates was seen and found to be in good order. This included: fire drills, call points, boiler, fire alarm system, fire safety inspection, fire risk assessment, insurance, electricity, gas Cricklade House DS0000066465.V374854.R01.S.doc Version 5.2 Page 22 and food hygiene inspection. The food hygiene inspector had left some minor recommendations, all of which had been implemented. Cricklade House DS0000066465.V374854.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 4 X 4 N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 4 3 4 4 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 X 3 3 X 3 Cricklade House DS0000066465.V374854.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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cricklade House DS0000066465.V374854.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cricklade House DS0000066465.V374854.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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