Care Home: Fives Court

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What the care home does well The home makes comprehensive and detailed assessments with potential residents so that decisions can be made on whether their needs can be met. This information enables a comprehensive care plan to be established. The care plans direct the care. Residents are well supported in accessing local healthcare professionals. Safe arrangements are in place for the administration of medication. Staff ensure that residents are well groomed. Residents decide who they want to deliver intimate personal care. Residents are supported to follow their own routines and spend their day as they wish.Good relationships have been established with residents, staff and management. Residents are supported by well-trained and experienced staff. A good range of activities is provided both at the home and in the locality. Visitors are made welcome. Residents are provided with a range, variety and choice of meals cooked from fresh ingredients. Residents are regularly consulted on the quality of the meals and all aspects of the service. Complaints are taken seriously and fully investigated with feedback to the complainant. Staff are trained to recognise and report any abuse of residents. Referrals to the Safeguarding procedure are made when concerns are noted. What has improved since the last inspection? Mrs Hill has addressed all of the requirements and recommendations made at the last inspection of 12th May 2006. The organisation has produced a new care planning format, which includes pre-admission assessments. Much effort has been made to ensure that details of residents` care and support needs have been transferred to the new format. Residents participate in the care planning process and either they or their relative signs up to the care plan. The new format includes assessment of residents` risk of developing pressure damage and a nutritional risk assessment. Mrs Hill has developed an alerting procedure based on the outcome scores of pressure damage risk assessments. This means that staff can alert the district nurse before damage occurs and pressure relieving equipment can be put in place. The care plans of those residents deemed to be at risk gave clear instruction to staff on managing and monitoring the risks. Body maps are well documented. Staff have received interim training in prevention of pressure sores. Single use lancets are being used with each resident who needs regular blood monitoring. Clinical waste is properly stored. The storage of medication has been moved to a larger room. Protocols are in place for the administration of medication prescribed to be taken `when required`. Clear information is detailed in the care plans as to when this medication is to be given. A programme of refurbishment and upgrade of the environment is in good progress. The home is cleaned to a good standard. Staff are trained in infection control. Staffing levels have been increased. Care leaders are given time allocated to attend to administrative duties. A system of staff supervision is in place. Fire prevention training has been outsourced. All fire safety checks are carried out and recorded. What the care home could do better: The nutritional risk assessment outcome score should relate to the nutrition score in the pressure damage risk assessment. Management of shingles, medication for osteoporosis and medication delivered via an adhesive patch must be identified in those residents` care plans. CARE HOMES FOR OLDER PEOPLE Fives Court Angel Lane Mere Warminster Wiltshire BA12 6DF Lead Inspector Sally Walker Unannounced Inspection 09:30 1st April 2008 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 Fives Court DS0000028276.V343522.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. Fives Court DS0000028276.V343522.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fives Court Address Angel Lane Mere Warminster Wiltshire BA12 6DF 01747 860707 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) manager.fivescourt@osjclasitts.co.uk www.osjct.co.uk The Orders Of St John Care Trust Sarah Hill Care Home 31 Category(ies) of Dementia - over 65 years of age (11), Old age, registration, with number not falling within any other category (31) of places Fives Court DS0000028276.V343522.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No more than 31 service users with Old Age at any one time. No more than 11 service users with Dementia, over 65 years of age at any one time. 12th May 2006 Date of last inspection Brief Description of the Service: Fives Court is registered to provide personal care only for 31 older people aged 65 years and older, 11 of which may have Dementia. The home is located in the village of Mere within walking distance of the village shops and local facilities. Mere is situated on the A303 London to the west trunk road. Fives Court is a purpose built home offering comfortable single room accommodation but without en-suite facilities. The home offers various communal areas. All bedrooms and communal rooms are located on the ground floor. The home has a large patio area to the rear of the building and surrounding gardens. The staffing levels are a minimum of 3 care staff and one care leader during the day and 3 waking night staff. Fives Court DS0000028276.V343522.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 unannounced inspection took place on 1st April 2008 between 9.30am and 6.40pm. Mrs Hill was present during the inspection. Mrs Sarah Hill was registered as manager on 3rd August 2007. She has managed the home since April 2007. Since the last inspection of 12th May 2006 our Pharmacist Inspector inspected the medication arrangements in the home on 12th March 2007. Details of her report can be found under Standard 9. As part of the inspection process we sent survey forms to the home for residents, relatives, staff and healthcare professionals to tell us about the service. Comments can be found in the relevant section of this report. We asked Mrs Hill to complete an Annual Quality Assurance Assessment. This was completed in full and returned on time. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The weekly fees for the home are between £430.00 and £510.00. What the service does well: The home makes comprehensive and detailed assessments with potential residents so that decisions can be made on whether their needs can be met. This information enables a comprehensive care plan to be established. The care plans direct the care. Residents are well supported in accessing local healthcare professionals. Safe arrangements are in place for the administration of medication. Staff ensure that residents are well groomed. Residents decide who they want to deliver intimate personal care. Residents are supported to follow their own routines and spend their day as they wish. Fives Court DS0000028276.V343522.R01.S.doc Version 5.2 Page 6 Good relationships have been established with residents, staff and management. Residents are supported by well-trained and experienced staff. A good range of activities is provided both at the home and in the locality. Visitors are made welcome. Residents are provided with a range, variety and choice of meals cooked from fresh ingredients. Residents are regularly consulted on the quality of the meals and all aspects of the service. Complaints are taken seriously and fully investigated with feedback to the complainant. Staff are trained to recognise and report any abuse of residents. Referrals to the Safeguarding procedure are made when concerns are noted. What has improved since the last inspection? Mrs Hill has addressed all of the requirements and recommendations made at the last inspection of 12th May 2006. The organisation has produced a new care planning format, which includes pre-admission assessments. Much effort has been made to ensure that details of residents’ care and support needs have been transferred to the new format. Residents participate in the care planning process and either they or their relative signs up to the care plan. The new format includes assessment of residents’ risk of developing pressure damage and a nutritional risk assessment. Mrs Hill has developed an alerting procedure based on the outcome scores of pressure damage risk assessments. This means that staff can alert the district nurse before damage occurs and pressure relieving equipment can be put in place. The care plans of those residents deemed to be at risk gave clear instruction to staff on managing and monitoring the risks. Body maps are well documented. Staff have received interim training in prevention of pressure sores. Single use lancets are being used with each resident who needs regular blood monitoring. Clinical waste is properly stored. The storage of medication has been moved to a larger room. Protocols are in place for the administration of medication prescribed to be taken ‘when required’. Clear information is detailed in the care plans as to when this medication is to be given. A programme of refurbishment and upgrade of the environment is in good progress. The home is cleaned to a good standard. Staff are trained in infection control. Staffing levels have been increased. Care leaders are given time allocated to attend to administrative duties. A system of staff supervision is in place. Fives Court DS0000028276.V343522.R01.S.doc Version 5.2 Page 7 Fire prevention training has been outsourced. All fire safety checks are carried out and recorded. 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. Fives Court DS0000028276.V343522.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 Fives Court DS0000028276.V343522.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): 3. Standard 6 is not applicable, as the home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Thorough assessments are made of potential residents’ care needs before decisions are made about whether their care needs can be met. EVIDENCE: Action had been taken to address the good practice recommendation for consideration of a more resident friendly pre-admission assessment tool. The organisation had produced a new format as part of the new care planning documentation. The home carried out detailed assessments of all prospective residents. Information was gained from the residents and all those involved in their care. Care management assessments are also taken into consideration when assessing whether care needs can be met. Social as well as medical and personal history is documented in the assessments. Fives Court DS0000028276.V343522.R01.S.doc Version 5.2 Page 10 One of the people using the respite service told us that they had enjoyed their stay but were looking forward to going home. They said they liked their bedroom and the meals provided. They said they would come again. They said that they had not been introduced to the other residents when they came. They also could not recall having been given a service users guide. Comments from a relative’s survey forms included: “We chose this home for its positive approach to looking after the elderly for the high level of care. We have not been disappointed.” Fives Court DS0000028276.V343522.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Much effort has been made to implement the new care planning documentation. Care plans direct the care. Residents have good access to health care. Residents are protected with safe arrangements for the administration and control of medication. Staff ensure residents are treated with respect and dignity. EVIDENCE: Mrs Hill told us that the organisation had just produced a new care manual, which included reviewed policies and procedures. Staff had contributed to the manual. She was in the process of familiarising herself and the staff with the final published copy. Fives Court DS0000028276.V343522.R01.S.doc Version 5.2 Page 12 The organisation’s new care planning documentation had been recently implemented. Staff had made much effort to ensure that all the information from the previous format had been transferred to the new care plans. Care plans recorded residents social and medical history. Care plans had good documentation of meeting and monitoring residents’ personal care needs. Care plans also gave information about residents continence needs, emotional wellbeing, eating and drinking, health promotion, mental health, mobility, wound management and risk prevention. We saw good evidence in the daily reports that the care plans directed the care. Staff were reporting on residents progress and it was clear that needs were generally regularly monitored. We saw however that one resident’s care plan did not state that they had shingles or how the condition was being managed. Action has been taken to address the requirement we made that that residents are given the opportunity to participate in the care planning process and sign agreement to their care plan. Either the resident or their relatives were in the process of signing up to the care plans. Action had been taken to address the good practice recommendation we made that the manager should audit the care plans monthly. This applied to the previous manager. Care plans are generally regularly monitored by the care leaders and keyworkers as needs change. The home operates a ‘resident of the day’ system. This ensures that each resident’s care plan is updated monthly. It also ensures that other issues regarding the resident’s care and support are reviewed and actioned. It was clear that staff took time to ensure all residents were well groomed. One of the residents told us that they had at least one bath a week. They said it was not always the same person to support them in the bathroom. They told us that they had been asked about giving of intimate personal care by male staff. All personal care is carried out in private. Action has been taken to address the requirement we made that all residents who have pressure damage or are at risk of pressure damage have a risk assessment in place that is reviewed monthly. The new care planning format included a pressure damage risk assessment. We saw that the form did not take into consideration any history of pressure damage. We also noted that the form did not relate to the outcome number of the nutritional risk assessment. The forms did not state which score prompted the district nurse to be notified. It was however clear that staff did notify the district nurse when concerns over residents’ tissue viability were noted. As a matter of good practice Mrs Hill had produced her own alerting and intervention procedure according to the different outcome scores. This clearly stated when the district nurse must be alerted before damage occurs. The care plans of those residents who were identified as potentially at risk gave information about what staff must do. This information was identified in coloured highlighter. Body maps of any wounds were well documented. Fives Court DS0000028276.V343522.R01.S.doc Version 5.2 Page 13 Mrs Hill told us that as a result of her training needs audit, she had provided staff with interim training on prevention of pressure damage. She also ensured that all care leaders are aware of each resident’s tissue viability status. Pressure relieving equipment was in place. Residents are weighed on admission and monthly thereafter. Weights are taken into consideration in the moving and handling assessment. Any significant weight loss was notified to the relevant healthcare professional. Nutritional risk assessments were in place. Residents have good access to local GPs. Care leaders support residents with visiting their GPs. One of the residents told us that their GP made regular visits every Monday and they had no difficulties in asking to be seen. They also told us about the regular visits of the nurse to support them with managing diabetes. The district nurse was carrying out the blood glucose tests. Staff were carrying out urine glucose tests for one resident. Care plans identified how the care needs of residents with diabetes were being managed, with parameters of blood sugar levels for the residents’ wellbeing. Action has been taken to address the requirement made that the lancet devices used must comply with information in the Medical Devices Alert MDA/200/066 to prevent cross infection. Single use lancets were being used and stored in individually named boxes Our Pharmacist Inspector inspected the medication arrangements on 12th March 2007. The judgement was that residents are protected by the homes procedures for the safe handling of medicines, but improvements in protocols would safeguard residents. This related to medication prescribed to be taken ‘when required’. This had been addressed with care plans stating when this medication must be given. We noted at this inspection that medication for osteoporosis with specific prescribing instructions was not recorded in care plans. We also saw that medication administered via an adhesive patch was not in the resident’s care plan. The care plan must identify where the patches are to be put together with details of each administration, for example, right or left side of the body. The arrangements for the administration, recording and storage for controlled medication was being satisfactorily maintained. Eye drops were dated when they were opened and discarded when necessary, to avoid loss of potency of the medication. Staff only administer medication once they have received training and are deemed competent. Ongoing competence is regularly monitored. Residents can administer their own medication following a risk assessment. None of the residents we spoke to administered their own medication. Fives Court DS0000028276.V343522.R01.S.doc Version 5.2 Page 14 Action has also been taken to address the good practice recommendation we made that consideration is given to increasing the storage facilities for medication. Storage had been moved to another larger room. We spoke with one of the relatives during the inspection. They told us that the home was ‘excellent, my relative is well cared for.’ We spoke to residents during the inspection and comments included: ‘I’m looked after very well. They do help me a lot.’ Comments in GP survey forms included: “Staff at Fives Court are always helpful & courteous. The care given to residents is of a very high standard.” “I suspect they sometimes over refer to the OOH [Out of Hours] service perhaps due to inexperience.” Comments in healthcare professionals survey forms included: “The group of homes have a high ratio of out of hours admissions. I suspect that this is because their staff are less confident about managing patients out of hours and may sometimes seek help inappropriately”. Fives Court DS0000028276.V343522.R01.S.doc Version 5.2 Page 15 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. This judgement has been made using available evidence including a visit to this service. Residents generally follow their own routines. A range of activities is provided both at the home and in the locality. Visitors are made welcome. Residents enjoyed the quality and variety of the meals provided. EVIDENCE: Those residents who could choose spent their day as they wished. Other residents relied on staff for direction. One of the people using the respite service told us they followed their own routines, getting up when they wanted or having a rest in their room in the afternoons. One of the residents told us that they liked their own company and this was respected by staff. They said staff ‘let me please myself’. They said they liked to walk round the building or go out with their family. Fives Court DS0000028276.V343522.R01.S.doc Version 5.2 Page 16 On the afternoon of the inspection some of the residents and staff attended a rock and roll tea dance for all the local homes in the organisation. Transport was provided. Residents and staff dressed up in 1950s clothing. The organisation provides a good range of inter-home activities. These were advertised for the year on the notice boards. The home also has a programme of its own activities with at least 2 different activities each day. An activities co-ordinator works 20 hours a week and staff provide activities at other times. In the Annual Quality Assurance Assessment Mrs Hill told us that the appointment of a co-ordinator had resulted in a more extensive range of activities, including one to one time and more access to the locality. Care plans identified residents’ hobbies and interests and all had a separate activity care plan. During the morning of the inspection some of the residents were reading or doing jigsaw puzzles. Large print newspapers were available. Other activities included reminiscence, going to a local pub for lunch, a fish and chip supper, to a local coffee shop, games and quizzes. Photographs of the activities and trips were displayed on the notice boards. The home has a friends group which raises money to purchase items for the residents. They had purchased 2 large, wide screen, digital televisions for the sitting rooms. They had also purchased a computer system to play games on the television. The home also has an amenity fund which pays for other items for residents benefit. The gardens had raised flower beds newly installed. Mrs Hill said that plants would be purchased so residents could be involved in planting out the beds and planters around the home. There are two kitchenettes where residents and their families or visitors can make hot drinks. Mrs Hill had ordered smaller kettles so that they would be less heavy to lift when full of water. There was also a filtered water machine for residents and visitors to help themselves. Residents told us that their relatives and visitors could come at anytime and were always made welcome. There were a number of large clocks around the building so that residents could know what the time was. We also noted that clocks in residents’ bedrooms showed the correct time. The home had a grant to purchase a computer system for residents. Some residents were in touch by email with relatives who lived abroad. We spoke with one resident who was getting ready to go to the tea dance. They told us ‘its quite good here’. Fives Court DS0000028276.V343522.R01.S.doc Version 5.2 Page 17 The lunch menu was cottage pie or toad in the hole with vegetables and potatoes. A salad was also available. There was a choice of a hot and a cold dish for the evening meal. All of the meals were cooked from fresh ingredients. The residents who were going to the tea dance were having a light lunch, served before the other residents. Residents had a choice of 3 juices with the meal. We talked to residents about the meals provided. One resident told us that the meals were ‘excellent’. We asked them what they were having for lunch and they said it was ‘a mystery’. They told us that there were lots of choices at each meal. Another resident said that the meals were ‘very good. You never know what you’re going to get. There is always a choice.” The meals for the day were displayed on a board in the dining room. Three of the residents we spoke with in the dining room said the board was too far away for them to see. We saw that residents were shown the choice of each dish as it was served to them. In the Annual Quality Assurance Assessment Mrs Hill told us that meals were now shown to residents at the point of delivery following results of questionnaires. The meals were well presented. The mealtime was quiet and residents were not rushed to finish their meals. Some of the residents had chosen to have their meals in their bedrooms. Some of these residents need support with eating. We saw that staff gave the food at the residents pace and were chatting to the resident. One of the residents told us about how they were supported to follow a special diet. The chefs met regularly as a group to discuss the meals and menus. They also discuss the meals with residents. Comments in relatives survey forms included: [Support resident to keep in touch with you?] “No but this is not required. We visit [my relative] weekly and [my relative] doesn’t ask for us, to our knowledge. If we ask they do. [Kept up to date with important issues?] Yes very promptly. We are impressed at the level of care. [Support to live the life they choose?] This is far from easy, however they employ an activities person have frequent trips out operate a ‘friends’ support system.” Fives Court DS0000028276.V343522.R01.S.doc Version 5.2 Page 18 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. Systems are in place for residents and families to complain about the service. The home responds positively to complaints. Staff are trained to recognise and report any allegations of abuse. EVIDENCE: The home’s complaints procedure was displayed on notice boards around the home. The home’s complaints log showed good evidence that all complaints and concerns were taken seriously. There was good evidence of investigation, interview and response to complainant. One of the residents told us that they would discuss any concerns with their keyworker. A person using the respite service told us that they did not know how to make a complaint. Other residents spoken with were confident in making comments or complaints about the service. The home works to the local Safeguarding Adults procedure and refers when necessary. All staff have a copy of the local policy booklet. Staff have received training in abuse awareness. Residents have access to the local advocacy service. Fives Court DS0000028276.V343522.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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a well maintained, clean and warm environment. The home continues to be upgraded for the comfort of residents. EVIDENCE: All of the bedrooms are single accommodation. All of the residents’ accommodation is to the ground floor. Part of the grounds had been fenced so that the gardens were more secured. All of the radiators are guarded or fitted with guaranteed low surface temperature covers. Fives Court DS0000028276.V343522.R01.S.doc Version 5.2 Page 20 Mrs Hill had an ongoing programme of upgrading the building. The dining room had been refurbished with new carpet, tables and chairs. Other furniture was gradually being replaced with new. There were plans to refurbish the hairdressing room to make it into a fully fitted salon. Also the bedrooms were being upgraded with new furniture, sinks and redecoration. In the Annual Quality Assurance Assessment Mrs Hill told us that residents had been involved in choosing colour schemes. There were plans to separate the sluicing facilities from the laundry area. The laundry was well organised and clean. Clothing was separated and cleaned according to washing instructions. Residents told us that they were very satisfied with the laundry system. There is no allocated laundry person. Care staff process the laundry. Mrs Hill told us that she had requested additional hours for laundry duties so that care staff could concentrate on caring. Action has been taken to address the requirement we made that all clinical waste is stored correctly. No clinical waste was being stored in the laundry, with appropriate containers provided. Staff are trained in infection control. One member of staff has the delegated responsibility in this area. All of those residents who were visited in their bedrooms had their call bell within easy reach. The home was cleaned to a good standard and no unpleasant odours were detected at any time during the inspection. Protective clothing and disposable gloves were available to staff. Some of the residents told us that their bedrooms were cleaned every day. Fives Court DS0000028276.V343522.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Staffing levels have increased and the rota re-organised so that staffing levels meet the needs of residents at different times of the day. Staff are well trained. A robust recruitment process is in place. EVIDENCE: Action had been taken to ensure that staffing levels can fully meet all residents care needs. In the Annual Quality Assurance Assessment Mrs Hill told us that the establishment hours for care had been increased by 34 hours a week. Mrs Hill also told us that she had changed the care staffing rota, which now provides a minimum of one care leader and 3 care staff throughout the waking day. This is an increase of one carer throughout the day. At night there are 3 waking night staff. Care leaders have been given a day each week off the care rota to attend to administrative duties. Mrs Hill was in the process of establishing training needs for all staff. Relevant training would then be sought either through the organisation’s training programme or with local providers. Fives Court DS0000028276.V343522.R01.S.doc Version 5.2 Page 22 As a result of the review of training needs, Mrs Hill had provided staff with updated training in abuse and neglect and preventing pressure damage. The organisation makes an e-learning package available to all staff. This covered amongst other subjects: principles of care, health and safety, abuse and neglect. Mrs Hill told us that currently the housekeepers and new relief staff were undertaking some of this training. All staff receive regular updated training in mandatory subjects, for example, first aid, moving and handling, fire prevention and infection control. Staff have also been trained in equality and diversity and dementia care. In the Annual Quality Assurance Assessment Mrs Hill told us that over 50 of care staff have Level NVQ 2. All the care leaders have NVQ level 3. One of the care leader was undertaking training in supervisory management. Staff had been involved in special projects on dementia and this year were undertaking a project on nutrition. A robust recruitment process was in place with no staffing commencing duties until checks had been made on their suitability to work with vulnerable people. All the documents and information required by regulation were on file. One of the residents told us that the staff were ‘good company’. They went on to describe one of the male staff as a ‘great guy’. They said that they had been given the choice as to whether male staff were involved in their intimate personal care. It was clear from observation that good relationships were established with residents and management. Comments in relatives survey forms included: “My experience is that the carers cope very well, especially when there is a clash of personalities. [Staff have right skills & experience?] I believe so. Certainly I have been impressed by their positive approach to difficult situations. [Meet diversity & equality needs?] To be honest this does not require a great test of their skills at this particular home.” Fives Court DS0000028276.V343522.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Mrs Hill is qualified and has much experience of management. The home is run in the best interests of the residents. Staff are appropriately supervised. Systems are in place to ensure the health and safety of residents and staff. EVIDENCE: Mrs Hill has managed the home since April 2007. She was registered as manager on 3rd August 2007. Mrs Hill has NVQ Level 4 and the Registered Managers Award. She previously managed another home in the organisation and has many years experience of providing care to older people. Fives Court DS0000028276.V343522.R01.S.doc Version 5.2 Page 24 Mrs Hill had recently undertaken management training provided by the organisation. She told us that she was looking at further training to support her role as manager. Mrs Hill is clear about her plans to develop the home. We saw that Mrs Hill had good relationships with the residents. Clearly she is well known to all the residents. Action had been taken to ensure that all staff receive appropriate and regular supervision. Mrs Hill has set up a system to ensure that this takes place. Supervision records were kept but not inspected. The different staff groups also have their own meetings with management. As part of the home’s quality assurance audit, Mrs Hill asks residents for their views on the service in questionnaires. The organisation had recently carried out a quality audit of the service. Mrs Hill was carrying out recommendations in her action plan. Residents’ views are also sought at the regular residents meetings with minutes kept. Views are taken into consideration and any changes made. Action had been taken to ensure that emergency lighting is tested monthly. Action had also been taken to ensure that a person qualified to teach fire training is provided. All fire safety training has been out sourced to a fire training provider. The home’s handyman carried out and recorded the regular fire safety checks. Any accidents were well recorded. Mrs Hill monitors the accident records each month. The environmental risk assessments are regularly reviewed and revised as necessary. Staff are trained in health and safety and moving and handling. Comments in relatives survey forms included: “The management work hard to contact either my sister or myself when there is a need to discuss [my relative’s] health or welfare. [Does well?] Provide adequate care in very positive agreeable surroundings. [Could improve?] I note they are continually changing small things. Thus I believe that there is a programme of updates ongoing being discussed.” Fives Court DS0000028276.V343522.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 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 X 3 X 3 Fives Court DS0000028276.V343522.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The person registered must ensure that all aspects of residents care and support needs are identified in their care plan. This should, for example, include management of shingles, medication for osteoporosis with specific prescribing instructions and guidance for administration of medication delivered via an adhesive patch. Timescale for action 01/04/08 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 OP8 Good Practice Recommendations The outcome number of the nutritional risk assessment should relate to the nutrition score in the pressure damage risk assessment. Fives Court DS0000028276.V343522.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Regional Office 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Fives Court DS0000028276.V343522.R01.S.doc Version 5.2 Page 28 - 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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