Care Home: Farringford Care Home Ltd

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What the care home does well The atmosphere at the home is warm and friendly and visitors are made to feel very welcome. The staff show respect to people living at the home and were observed being kind and courteous throughout the day. People`s health, personal and social care needs are well met by staff at the home, and each person has a detailed plan of care that the person, or someone close to them, has been involved in making. Comments from people included "The staff are very friendly and kind" and "I`m very happy here and very well cared for". Health professionals said that staff liaise well with them to ensure people receive a good level of support and made other comments such as;" The care is good". Each person is treated as an individual, they are part of their local community, and they are supported to follow personal interests and activities. Medication practices are safe and staff have received training in this area. People said that they had a choice of food and that the quality of food served is very good. People said that they felt very comfortable in going to the manager knowing that any concerns they may have would be addressed without delay. Staff feel they are well supported, they can access regular meetings and one to one sessions with their manager to discuss how well they are doing, or if they need any more training or support with their work. This better ensures that they can provide a good standard of care for the people who use the service. The manager had made sure that people living in the home would be safe with the staff employed in the home by obtaining criminal record checks and references before staff started work. Improvements had been made to the front garden; lots of colourful bedding plants, tubs, window boxes and hanging baskets have been provided which have made the front of the home very attractive. One person said "It looks glorious, I enjoy sitting out now." What has improved since the last inspection? This was the home`s first inspection under the current ownership. What the care home could do better: They must provide a plan of all the redecoration and refurbishment needed in the home to show how and when improvements to the environment will take place. New care staff working at the home must complete the Skills for Care induction programme to make sure they have been shown and understand how to look after people properly. Risk assessments should be in place to support all areas of self - medication for individuals this will make sure that people are supported properly and they are safe. CARE HOMES FOR OLDER PEOPLE Farringford Care Home Ltd 421 Grimsby Road Cleethorpes North East Lincs DN35 7LB Lead Inspector Mrs Jane Lyons Key Unannounced Inspection 19th June 2008 09:00 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 DS0000071495.V366631.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. DS0000071495.V366631.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Farringford Care Home Ltd Address 421 Grimsby Road Cleethorpes North East Lincs DN35 7LB 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) 01472 698991 01472 698991 Farringford Care Home Ltd Manager post vacant Care Home 28 Category(ies) of Dementia (28), Old age, not falling within any registration, with number other category (28) of places DS0000071495.V366631.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC; to service users of the following gender: Either; whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP and Dementia - Code DE The maximum number of service users who can be accommodated is: 28 2. Date of last inspection Brief Description of the Service: Farringford is a twenty- eight bedded care home set in the seaside resort of Cleethorpes. The position of the home is on the main road into the resort and located close to the shops, amenities and bus routes. The home caters for the needs of people with problems associated with old age and dementia. The home is a two-storey building; access to the first floor is via stairs and a passenger lift. The home has sixteen single and six double rooms, all have en suite facilities. In addition people have access to a range of communal facilities, there is a sitting room on each floor, a dining room and seating area in the inner hall. There are bathroom and WC facilities located on each floor. There is a small front paved garden and a rear courtyard area. There is a small car park to the rear of the home. The home is owned by Mr T.S Sunnar; it is managed by Mrs P Gammons. Weekly fees are: £361- £386. The home operates a system whereby the fees may include a third party contribution. Additional charges are made for the following: toiletries, newspapers/magazines, hairdressing and chiropody. Information on the service is made available to prospective and current service users via the statement of purpose, service user guide and inspection report. Documents are made available prior to and following admission, copies are always held in the reception area. DS0000071495.V366631.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection included an unannounced site visit carried out by Mrs Jane Lyons on the 19th June 2008. During the visit we spoke with some of the people who live at the home, a number of relatives, care staff, the cook, the administrator, a visiting district nurse, and the manager. We looked round the home to see if it was kept clean and tidy. Some of the records kept in the home were checked. This was to see how the people who live in the home were being cared for, that staff were safe to work in the home and that they had been trained to their job safely. We also checked records to make sure that the home and the things used in it were safe and were checked regularly. The manager at the home also completed an annual quality assurance assessment that was requested by CSCI (Commission for Social Care Inspection), which includes information about people who live at the home, the staff that work there, the service provided and any incidents or accidents that have occurred. Prior to this visit, surveys were sent out to obtain the views of people who live at the home, staff and some health and social care professionals. Fifteen surveys were returned from people who live at the home and two from the staff; the feedback was very positive. Comments from surveys have been included in the main body of this report. Due to the limited number of relatives seen during the visit, we contacted a number by phone to discuss their satisfaction with their loved ones care at the home and the feedback was very positive. We would like to take this opportunity to thank everyone who participated in the inspection process. DS0000071495.V366631.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? This was the home’s first inspection under the current ownership. DS0000071495.V366631.R01.S.doc Version 5.2 Page 7 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. DS0000071495.V366631.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 DS0000071495.V366631.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): 1, 2, 3, 4, 5 and 6 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 home provides detailed information to enable people to make an informed choice about the services they provide. People are properly assessed prior to moving into the home to ensure that their needs can be met. EVIDENCE: Information about the service is provided in a statement of purpose, service users guide, brochure and a contract/statement of terms and conditions. These are made available in the home or could be sent to prospective persons. All documents are written in plain English and could be made available in large print on request. DS0000071495.V366631.R01.S.doc Version 5.2 Page 10 Information provided by the manager prior to this visit taking place indicates that people are able to visit the home without the need for an appointment prior to them or their relative moving in. Pre-admission assessments are carried out by the manager who visits the person at their own home or in hospital which ever is applicable at the time. Community Care Assessments are obtained from the funding authority, these outline the person’s current health and personal care needs. The information collated from visiting people and that supplied by the funding authority is taken into consideration when making a decision as to whether the home is able to meet the person’s needs. The majority of recent admissions have been emergency admissions for respite care support, there was evidence in the care notes that as much information as possible is obtained from the care manager about the individual’s needs via telephone and that a full assessment is completed on admission. There is no indication that inappropriate placements have taken place and evidence suggests that the home is accepting persons under emergency placements whose needs they can manage; many individuals have continued to visit the home for regular respite care and a number have chosen to reside in the home on a permanent basis. One person wrote in their survey “I had stayed in the home three times before I moved in permanently, the staff know me and I’m settled”. The manager explained that due to peoples’ frailty it is usually relatives who visit the home to see if it meets their expectations as far as being the right type of home for their loved one. One relative spoken to said that she had chosen Farringford because of the homely atmosphere and the friendly staff, another said that the home had been recommended to her by a friend, she had been very satisfied with the care and it had been the right choice for her loved one. People are able to make a choice of staff gender when deciding whom they would like to deliver their care, as the home currently employs one male care assistant. People confirmed that they are consulted about this and felt comfortable with the arrangements in place. The home does not currently provide intermediate care dedicated to accommodate individuals with intensive rehabilitation needs, so standard six is not applicable. DS0000071495.V366631.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): 7, 8, 9, 10 and 11. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples’ care plans are detailed and outline the level of support and care each person requires in ensuring their health and welfare needs will be met. Medication systems are well managed. People’s rights to privacy and dignity are supported by caring staff. EVIDENCE: Three people’s care plans were looked at in order to obtain a picture of what their needs are and how staff support them. The care plans provide a good level of detail and enable staff to deliver the right level of care to each person. Relatives are asked to help staff complete the life history section of the care plan and this information is beneficial in terms of getting an insight into the kind of hobbies, leisure past times and significant events that make up this person’s life. Having this information helps staff to see the person as an DS0000071495.V366631.R01.S.doc Version 5.2 Page 12 individual in their own right and to engage people in things they are interested in such as a past hobby or a particular talking point. Records show that people are assisted and supported by staff to make decisions and choices about all daily living needs. Risk assessments are carried out to identify any risks to the individual. Where a risk has been identified, a care plan is produced to minimise the risk. Nutritional screening records were seen, and the manager said that this is undertaken on admission and subsequently on a periodic basis. The records confirmed this. A record is maintained of people’s weight gain or loss, and the records show what action needs to be taken depending on either a weight gain or loss. Manual handling plans used to identify the support people require with their mobility describe in detail the assistance required so staff are clear about what is expected from them. Care plans showed that people’s health was monitored and people had access to health care facilities and any relevant specialists that were necessary. One individual’s records identified how their needs had changed significantly and the current support they were receiving; the care plans had been updated following regular evaluation, the daily diary records and other communication records detailed very clearly the support the home had accessed from the G.P., dietician and district nursing staff. Those people spoken with during this visit said that staff are good at getting the doctor when you need one. We spoke to a visiting community nurse during the visit who said that she was very satisfied with the standards of care at the home and that staff were knowledgeable about the people’s needs. People looked clean, well dressed and had received a good level of personal care. Comments from people spoken to during the visit included: “The staff are wonderful, they look after me very well” and “ All the staff are really kind, they do anything for you and always have time to talk”. A sample of three people’s medication was checked during the visit this showed there to be good systems in place for the recording, administration and disposal of medications. The medication record sheets were complete and easy to follow. Controlled drugs are stored and administered properly. The manager has moved the storage of medications from the office to the clinic room which she reported works better; temperature monitoring of this area should take place to make sure it is safe. People are encouraged to administer their own medications where possible and the manager confirmed that individuals were assessed around their safety in DS0000071495.V366631.R01.S.doc Version 5.2 Page 13 managing this, this was evidenced in the care records however one individual’s file did not contain a risk assessment to support their self administration of insulin which needs to be in place. The staff training records show that staff at the home have completed appropriate training in medication. People said that staff at the home respected their privacy and dignity in a number of ways, for example, by knocking on their doors and waiting for a response before entering. Staff spoke to people in a respectful way and showed patience when providing personal care to them. We spent a lot of time during the visit observing the staff interact with people living at the home and at all times this was very positive. There are systems in place to support end of life care at the home, the manager and staff confirmed that they work closely with the community health team to make sure that appropriate care and support is provided to individuals and their families during this time. Staff said that they always make sure they have time to spend with people and their relatives, and that the manager would roster more staff if needed. Not all care plans seen had details of people’s choices around arrangements such as the type of funeral they would prefer, which although this is acknowledged to be sensitive subject should be discussed with the individual and their family. The manager is currently sourcing some courses for staff to access to support this area of practice such as bereavement and end of life care. DS0000071495.V366631.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): 12, 13, 14, and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are able to make their own choices about how they spend their time and are offered activities. They maintain contact with their families as they wish and communication between the home and relatives is good. Meals served at the home were of a good quality and offered choice to ensure people receive a balanced diet. EVIDENCE: People spoke of how they are able to make their own choices such as when they get up and go to bed, the meals they eat and generally how they spend their time. One person said that they enjoyed going out and doing their own shopping and that it was nice to sit in the front garden watching the world go by. Although some of the people choose to sit in the sitting room during the day, many individuals choose to spend time in their rooms, one person said that they liked to have their meals with everyone and have a chat with people but liked to spend time in their room watching DVD’s and looking at their stamp collection. DS0000071495.V366631.R01.S.doc Version 5.2 Page 15 The manager explained that there are various activities and entertainment on offer to people living in the home which was supported by information held within people’s individual files and the monthly activity calendar. However many individuals choose not to take part in many of the activities arranged; this was supported by surveys received as five people indicated that they “weren’t interested in joining in”. The manager has recently completed an audit and spoken to all people who use the service to try and develop a programme which will support a more individualised approach and encourage more people to participate; a number of outings for specific individuals have been arranged such as a visit to the Lincolnshire Aviation Centre and a visit to one of the local market towns. The manager confirmed that people’s individual social needs assessments and plans will be updated from the information provided from the audit and one to one discussions. Bingo sessions are held in the home each Wednesday, following the closure of a local senior citizens club in the area, the home invited the few members left to join in with these sessions in the home which the manager said is working really well and has encouraged more people to take part. People’s birthdays are celebrated in the home; the manager said that the home arranges a tea party where individuals can enjoy sharing their cake and opening their presents. One relative spoken to said how she had found some presents in her loved one’s room from the staff and was very impressed to find that they had gone to such trouble, and what a lovely touch this was. Some of the people commented on how friendly the new owners are, that they always come and talk to them when they visit the home and join in with parties and celebrations. The manager said how one of the owners regularly cooks a curry for some of the individuals, which they all enjoy. Visitors are welcome at the home at any reasonable time and the manager explained that relatives/friends are able to have a meal with their loved ones if they choose to. The visitors’ book gives a good indication that the home receives a number of visitors on a daily basis. Many of the individuals regularly go on trips and outings with their family and visitors, one person said how much he enjoys his regular lunch outings with his friends. In the reception area and hall there is information regarding planned activities and how to make a complaint. Leaflets about local advocacy services and other information is also available. The meals observed were good quality and offered a choice. There are cooked options available at all meal times, some of the comments received were: “The food is lovely just like I had at home” and “All the meals are really good, there is always a choice”. DS0000071495.V366631.R01.S.doc Version 5.2 Page 16 An observation made at mealtime showed that meals are presented in an attractive manner and that people living at the home were enjoying their food, and being supported appropriately. Staff were seen to interact with people in positive ways, enjoying pleasant conversation and offering people drinks whilst talking about their day. Discussions with the cook identified that she is given information about people’s specific nutritional needs and dietary preferences; the home is currently providing fortified diets and diabetic diets for a number of individuals. There is good evidence that the cook regularly consults with people about the menu and they are reviewed regularly to include new choices. DS0000071495.V366631.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): 16, 17 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has systems in place to protect people from abuse. People can be confident that their complaints will be listened to and acted upon. EVIDENCE: People and their representatives had been provided with a copy of the home’s complaints procedure, which is also on display in the entrance hall. This contains details of who to speak to at the home and who to contact outside of the home to make a complaint should they wish to do so. People who completed surveys responded ‘yes’ when asked if they knew how to make a complaint. Those people spoken with during the day said that they felt very comfortable in going to the manager knowing that any concerns they may have would be addressed. No complaints have been received by the home or the commission, the manager has systems in place to support the investigation and management of complaints. Information about advocacy services is displayed in the reception area. The administrator completes the registration documentation enabling people who live in the home to vote. DS0000071495.V366631.R01.S.doc Version 5.2 Page 18 There are policies and procedures in place to reduce the risk of abuse. All staff commencing employment have a CRB (Criminal Records Bureau) and a POVA (Protection of Vulnerable Adults) check before starting work in the home. All staff have received safeguarding (adult protection) training which provides information on how to protect people from abuse. After talking with staff at the home, it was clear that they understand the procedures for safeguarding adults. DS0000071495.V366631.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): 19, 20, 21, 22, 23, 24, 25 and 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Farringford provides very comfortable, homely and safe surroundings. Although some of the décor and furnishings are now looking tired and worn which impact on the overall quality of the environment, people recognise the improvements that have been made to date following new ownership. EVIDENCE: The home provides accommodation over two floors there are six double rooms and sixteen single rooms all having en-suite facilities. There is lift and stair access to the first floor. There is a sitting room on each floor and a large dining room, seating is also provided in the inner hall area. There are three assisted bathrooms and a new shower facility. People said they are comfortable at the home. The home has a variety of chairs and furniture and touches such as ornaments and pictures that give DS0000071495.V366631.R01.S.doc Version 5.2 Page 20 rooms a homely feel. A number of sofas have recently been provided which clearly contribute to this homely feel however they are low in style which may restrict the use for many of the individuals or cause difficulty for staff with moving and handling practices for individuals with more dependent mobility needs. Generally the décor and some furnishings in the home are worn, tired and in need of refurbishment. The manager said that the new owners of the home are committed to further improving the facilities and have the intention of carrying out a major refurbishment programme however this has been delayed due to the unexpected and significant work carried out to upgrade the electrical and heating systems. This said, work has taken place to alter part of the upstairs lounge area and provide two single rooms with en- suite facilities in order to reduce the overall number of shared rooms and a new shower facility has been installed. The manager confirmed that flooring to the bathroom was scheduled for replacement and other redecoration and refurbishment was planned. Because of this no individual requirements concerning the environment have been made instead the owner of the home must provide a maintenance and renewal plan of the fabric and redecoration of the premises for the home to show how and when further essential redecoration and refurbishment work will be completed. The manager has made efforts to reorganise and rearrange aspects of the homes storage, as previously detailed the medications are now stored in the clinic room. Further work in this area would be beneficial such as the cupboards in the hall area, wheelchair storage and the tidying of the activities area in the upstairs sitting room. Improvements have been made to the call system and all exits now have a key code entry system in place, which makes the home a safer environment. Staff said that the provision of equipment in the home is good; there are a variety of portable hoists and other equipment to assist with the moving and handling of individuals. Bedrooms checked were comfortable, homely and reflected people’s personal tastes. People said their beds were comfortable and bed linen checked was clean and in a good condition. Laundry facilities are sited in an adjacent building. Policies and procedures are in place for control of infection; this is covered in the induction-training programme for new staff and staff confirmed that they had good supplies of protective clothing. All areas of the home were seen to be generally clean and tidy; there were no odour problems. One individual’s relatives told us that they had noticed in recent weeks that the standard of cleaning had fallen; this issue was discussed with the manager who confirmed that there had been a DS0000071495.V366631.R01.S.doc Version 5.2 Page 21 shortage of domestic staff however recruitment was taking place and although the care staff had been providing additional support in this area the home would shortly have the full complement of domestic staff in place. The home now employs a gardener who has made very significant improvements to the front paved area of the home. Lots of colourful bedding plants, tubs, window boxes and hanging baskets have been provided which have made the front of the home very attractive. Seating has also been provided and although the paved area is adjacent to a busy road, a number of the relatives and individuals said how pleasant the area now is and how they enjoying sitting out. DS0000071495.V366631.R01.S.doc Version 5.2 Page 22 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): Standards 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People have safe and appropriate support as there are enough competent staff on duty. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support. EVIDENCE: People spoke highly of the staff team and said staff always listened and acted on what they said. People had responded in surveys that staff were “always” or “usually” available when needed. Observation during the day also confirmed this with people receiving support in a calm, paced manner and staff having time to spend with people. Staff and the manager confirmed that staffing levels were adequate although there had been shortages over the previous few months including domestic staff. Rotas showed the hours had been covered satisfactorily although the care staff had provided more domestic support at times. The manager confirmed that staffing numbers would be boosted further as new staff have just been recruited to work at Farringford. DS0000071495.V366631.R01.S.doc Version 5.2 Page 23 Following the change of ownership and subsequent change in registration the manager now needs to use the Residential Forum Guidance to calculate staffing hours, this is a staffing tool which identifies the dependency of individuals and informs the hours needed for care support. All people spoken to during the day and comments on surveys were extremely complimentary about the staff at the home. Many people said how lovely and kind the staff were. One relative said “All the staff are wonderful, I have the utmost respect for them, they are always kind, caring and cheerful”. The manager explained the recruitment procedure, which was found to be satisfactory. She said that two written references are obtained before appointing a member of staff, and any gaps in employment records are explored. Checks on three new staff members’ records confirmed this and show that new staff are confirmed in post only following completion of a satisfactory police check, and satisfactory check of the Protection of Vulnerable Adults register. These checks are necessary to help protect people from potentially unsuitable staff. The home remains committed to providing National Vocational Qualification training for staff. Information received prior to the visit indicated that 50 of the care staff have achieved NVQ level 2 and five further staff have enrolled on the course. New staff receive 3 days in house induction training where they go through policies and procedures and work alongside a senior staff member. Records evidenced that all aspects of the programme had been completed and signed off. The home has the Skills for Care booklets for staff to complete induction training to National Training Organisation standards; however the manager confirmed that recently recruited staff had not completed this induction training as they had commenced the NVQ programmes. The formal induction to NTO standard must be completed for all new care staff employed at the home. The manager keeps an overview of the staff training programme to assist her in the planning of training in the home. The home provides a good staff training programme with staff accessing annual updates in statutory courses and a variety of general and service specific courses. Records evidenced that staff are up to date with mandatory courses in fire safety, moving/ handling, first aid and food hygiene. All staff have completed safeguarding courses and updates in health / safety and infection control. Senior care staff have all completed the safe handling of medications course and the manager is currently arranging for further staff to enrol. Staff have also accessed courses on dementia and age related changes; a course on Diabetes has been arranged for July. One staff member said “The training DS0000071495.V366631.R01.S.doc Version 5.2 Page 24 programme is very good, more than just the mandatory courses and undertaken regularly”. Feedback from people who completed our surveys and from discussions indicated that they believed that the staff were well trained. DS0000071495.V366631.R01.S.doc Version 5.2 Page 25 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): Standards 31, 32, 33, 34, 35, 36, 37 and 38. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence a visit to this service. People have confidence in the care home because it is led and managed appropriately. The environment is safe for people and staff because appropriate health and safety practices are carried out. EVIDENCE: Mrs Pamela Gammons is the manager for the home. She has many years experience in working with older people, she has completed her Registered Managers Award and is currently applying for registration with the commission. She is committed to ensuring that people staying in the home are consistently well cared for, safe and happy. People, staff and relatives said they were all DS0000071495.V366631.R01.S.doc Version 5.2 Page 26 happy to approach the manager at any time for advice, guidance or to look at any issues. They all said that they are confident that she would respond to them appropriately and swiftly. There is clear evidence from discussions with the manager and staff at the home that staff moral has improved. Many people commented on the change in atmosphere in the home and how their working environment is more positive. One staff member said “The manager listens to us and we feel able to make suggestions” and another staff member said “ There is a good team at the home, the atmosphere is lovely, a much more pleasant environment to work in.” The manager has made some improvements and updated the quality assurance system. There is evidence of internal auditing of the homes environment, services and records. Surveys have been issued to individuals around specific aspects of the service such as meals and activities. There is evidence that the manager analyses the results of the audits and surveys and where deficiencies have been identified, action plans have been drawn up. Staff meetings are held and minutes of these meetings were seen. The responsible individual visits the home on a regular basis; a report needs to be made following the visits. The manager is aware that she needs to develop an annual development plan to reflect the new ownership, the direction the service is going and the improvements the home is planning to make over the next twelve months. People who use the service meet with the management of the home. These quality assurance systems will help to ensure that the service is operating in the best interest of the people who live there. The home has good policies and procedures in place, and the manager explained that they review and update these as and when required. The records confirmed this. The homes business and financial plan and insurance arrangements are in place and were submitted to support the home’s registration earlier in the year. Some people have small amounts of personal money that is held safely at the home by staff. Records are available to show when money is deposited on behalf of people. The records show the individual cash balance for each person and how their money is used on their behalf, including receipts for goods and items purchased. A formal staff supervision programme is in place and records showed that staff had received regular sessions with the manager or deputy manager. Staff spoken to said that supervision usually involves talking about the care people need, how the home should operate and their own training needs. The DS0000071495.V366631.R01.S.doc Version 5.2 Page 27 manager confirmed that the annual appraisal programme had started and so far seven staff have completed this. The home has systems in place to manage health and safety in the home and appropriate records are maintained. Risk assessments are undertaken for all safe working practices; an external audit has taken place for all the health and safety measures/ practices within the home. Safe working practices are also maintained by the provision of training to staff in the form of moving and handling, basic food hygiene, first aid at work, infection control and fire safety. The checks of equipment have been completed and certificates are available. The homes fire risk assessment has been updated and checked by the local fire safety officer. Audits of accidents are completed and action taken to minimise risk in this area are recorded. New risk assessment documentation has been put in place to support the use of bed rails in the home. DS0000071495.V366631.R01.S.doc Version 5.2 Page 28 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 3 3 3 3 3 DS0000071495.V366631.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? N/A 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 OP19 Regulation 13,23 Requirement The registered person must produce a maintenance and renewal of the fabric and redecoration of the premises plan for the home to show how and when essential redecoration and refurbishment work will be completed. This will ensure that people are living in a pleasant and comfortable environment. Timescale for action 18/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations The registered person should ensure that regular temperature monitoring of the clinic room takes place to ensure that the storage of medications is safe. The registered person should ensure that risk assessments DS0000071495.V366631.R01.S.doc Version 5.2 Page 30 2. OP9 3. OP9 4. 5. 6. 7. OP27 OP30 OP37 OP38 are in place to support all aspects of an individual’s decision and the homes assessment to self medicate. The registered person should ensure that discussions around an individual’s end of life support include the details of their choice in funeral arrangements and this is recorded. The registered person should now utilise The Residential Staffing Forum to identify the staffing hours needed in line with the home’s dependency. The registered person should ensure that all new staff are provided with induction training to NTO standard prior to commencing NVQ courses. The registered person should ensure that reports to support visits to the home to comply with Regulation 26 are completed and held in the home. The registered person should assess the suitability of the new style seating i.e. sofas, to ensure they are safe and comfortable for use. DS0000071495.V366631.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 DS0000071495.V366631.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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