Care Home: Fletcher House

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What the care home does well Clear information is provided to people who are looking for a care home and their relatives. This is available in different formats, so that it is accessible for people with different needs. The manager or her deputy completes a full assessment before a person is admitted to make sure the home can meet their needs.People who live in Fletcher house have access to a good range of professionals from other agencies to help with their care, for example GPs, District Nurses and other advisors. People are supported to self medicate when they are able and this helps maintain independence and choice. The staff attend to people in a kindly way. The staff were also praised by relatives for their patience and understanding. People felt safe in their hands. There are good links with the local community and visitors are welcomed, so that the home remains part of the community. The environment is well maintained, clean and warm. People can choose to personalise their rooms with their own belongings and can choose where to spend their time. Staff have access to a good range of training to help them care for people skilfully. Residents are asked for their views and, within the limitations of community living, their suggestions are acted upon. Health and safety is managed effectively, for the safety of all. What has improved since the last inspection? The environment has changed since the last inspection and this has provided new communal areas, including a new dining room and kitchen. There are new bedrooms and these all have ensuite facilities. Other areas have been upgraded and refurbished. All areas seen were well decorated and furnished. The breakfast period has been extended to give a more flexible approach to this mealtime. More equipment has been purchased since the increase in the size of the home. What the care home could do better: There were instances where the care plan was not accurate. These inaccuracies could be misleading for care staff and could mean that the person does not receive the care they need. Similarly the Manual Handling document was not clear or accurate in two care plans and could cause confusion. The opportunities for meaningful occupation have not been well organised recently, mainly due to staff vacancies.It was not confirmed that current arrangements for meals and mealtimes are adequate for all residents to meet the standards. However, it is acknowledged that Mrs Mohide has recognised that this is an area needing improvement and she plans to examine in more detail what are the problem areas and review how changes can be made. The two sluices have not yet been upgraded. The paint was seen to be peeling from the walls and this means that the walls cannot be cleaned sufficiently. This may compromise infection control. The manager has identified that staffing numbers may not be adequate, especially at mealtimes. The inspection confirmed this, so that people may not have their needs met at all times. CARE HOMES FOR OLDER PEOPLE Fletcher House Glastonbury Road Wells Somerset BA5 1TN Lead Inspector Cathy Butterworth Unannounced Inspection 12 March 2008 9.15 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 Fletcher House DS0000016001.V359629.R02.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. Fletcher House DS0000016001.V359629.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fletcher House Address Glastonbury Road Wells Somerset BA5 1TN 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) 01749 678068 01749 675927 Carol.Mohide@somersetcare.co.uk Somerset Care Limited Mrs Carol Ann Mohide Care Home 58 Category(ies) of Old age, not falling within any other category registration, with number (58) of places Fletcher House DS0000016001.V359629.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is 58. 27 February 2007 Date of last inspection Brief Description of the Service: Fletcher House is a 58 bedded social care home, situated in the beautiful and historic city of Wells. The home is on the main Glastonbury road into Wells and is entered through secure gates into a large drive with ample car parking spaces. The home is just one mile from the city centre and its varied shops and leisure amenities. Fletcher House offers an attractive and comfortable homely style environment. All of the bedrooms are furnished to a high standard. The accommodation is in single rooms. Rooms in the new build have ensuite facilities. There are several communal rooms for relaxing and two dining areas in the home. To the rear are extensive well maintained and wheelchair friendly gardens accessed from the home. Fletcher House provides personal care services only to people over sixty five years old. The care is provided by experienced and trained. District nurses attend to any nursing care needed by service users. People who live in Fletcher House receive services from the local GP’s and other health care professionals as required. People enjoy a range of social activities in and outside of the home. The current fees are from £400 to £490 per week. Fletcher House DS0000016001.V359629.R02.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 stars. This means the people who use this service experience good quality outcomes. The inspection was unannounced and started on the morning of 12 March. The inspector spent the whole day in the home and then a further morning in the home. An ‘Expert by Experience’ also helped with the inspection and was in the home from 10am to 2.30pm. An ‘Expert by Experience’ is a person who has experience of care homes, either as a resident or because of close contact they have had with care homes. The Expert helped in the inspection by talking to residents in their rooms and in lounges, observed what happened during the day and joined residents for lunch. Her findings are incorporated into the report in the relevant sections. The inspector also talked to residents during both days. Staff and visitors were also available for discussion. The manager helped with the inspection on both days by providing information and records. Phone calls were made to two relatives who had requested contact with the inspector. Pre-inspection information was received before the inspection in the form of the Annual Quality Assurance Assessment (AQAA). This is now required to be completed every year and sent to CSCI. It was completed in enough detail and gave a good overview of the home’s activities, including what it has done well, what has hampered improvements and what is planned for the future. Surveys were sent out, and the total received were as follows:- 11 surveys were completed by people who live in Fletcher House - 6 surveys were completed by people who work in the home - 12 surveys were completed by relatives, carers and advocates There has been a considerable change in the environment since the last inspection. A new extension has been built which has increased the number of people who can live at Fletcher house and has provided new communal areas. Existing areas have also been refurbished to enhance the overall environment. What the service does well: Clear information is provided to people who are looking for a care home and their relatives. This is available in different formats, so that it is accessible for people with different needs. The manager or her deputy completes a full assessment before a person is admitted to make sure the home can meet their needs. Fletcher House DS0000016001.V359629.R02.S.doc Version 5.2 Page 6 People who live in Fletcher house have access to a good range of professionals from other agencies to help with their care, for example GPs, District Nurses and other advisors. People are supported to self medicate when they are able and this helps maintain independence and choice. The staff attend to people in a kindly way. The staff were also praised by relatives for their patience and understanding. People felt safe in their hands. There are good links with the local community and visitors are welcomed, so that the home remains part of the community. The environment is well maintained, clean and warm. People can choose to personalise their rooms with their own belongings and can choose where to spend their time. Staff have access to a good range of training to help them care for people skilfully. Residents are asked for their views and, within the limitations of community living, their suggestions are acted upon. Health and safety is managed effectively, for the safety of all. What has improved since the last inspection? What they could do better: There were instances where the care plan was not accurate. These inaccuracies could be misleading for care staff and could mean that the person does not receive the care they need. Similarly the Manual Handling document was not clear or accurate in two care plans and could cause confusion. The opportunities for meaningful occupation have not been well organised recently, mainly due to staff vacancies. Fletcher House DS0000016001.V359629.R02.S.doc Version 5.2 Page 7 It was not confirmed that current arrangements for meals and mealtimes are adequate for all residents to meet the standards. However, it is acknowledged that Mrs Mohide has recognised that this is an area needing improvement and she plans to examine in more detail what are the problem areas and review how changes can be made. The two sluices have not yet been upgraded. The paint was seen to be peeling from the walls and this means that the walls cannot be cleaned sufficiently. This may compromise infection control. The manager has identified that staffing numbers may not be adequate, especially at mealtimes. The inspection confirmed this, so that people may not have their needs met at all times. 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. Fletcher House DS0000016001.V359629.R02.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 Fletcher House DS0000016001.V359629.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3, 4, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who are considering living in Fletcher House and those close to them are provided with enough information about the home in a variety of ways. All people moving to Fletcher House have their individual care needs assessed before admission to the home is agreed. EVIDENCE: The registered provider has produced a statement of purpose and service user guide along with other brochure type leaflets that give prospective service users and relatives information on the home and service. A copy of the statement of purpose was available in the reception area of the home. Mrs Mohide said in the AQAA that a copy of the service user guide is given to all service users as it is part of the terms and conditions. She stated that the guide is available in Braille, written and CD formats. In the surveys of people Fletcher House DS0000016001.V359629.R02.S.doc Version 5.2 Page 10 who live in the home 81 said they received enough information about the home before they decided if it was the right place for them. Admissions to the home are not made until a full needs assessment is made. The registered manager receives the social worker assessment and then carries out her own needs based assessment. A sample of these was seen in the care plans. They were detailed enough for a decision to be made about whether the home can meet the person’s needs. For one person it was not clear how her consent had been sought for admission to the home, since the pre-admission assessment showed she did not want to move into the home. Mrs Mohide said that this person had changed their mind after the assessment and before admission to the home. In order to meet the requirements of the Mental Capacity Act 2005, it is advised that a record is kept of discussions, so that a person’s wishes are seen to be respected. The home can meet the needs of the people who live there in terms of the skills and experience of staff. In the surveys from people who live in the home 50 said they ‘always’ receive the care and support they need and 50 said they ‘usually’ or ‘sometimes’ do. Similarly for relatives, carers and advocates, 50 said the home ‘always’ meets their needs and 50 said they ‘usually’ or ‘sometimes’ do. Comments were received from staff, residents and relatives about the high level of needs of people living in Fletcher House. Some people asked whether the home was now taking people who needed ‘nursing’ care. Please see Standard 27 for staffing numbers. Mrs Mohide said in the AQAA that people can spend a trial period in the home if they are unsure if they are making the right decision. There are two ‘Step-down beds’ for people who are staying temporarily in Fletcher House and who need some additional support to return to their own homes. This care is not defined as ‘Intermediate Care’. Fletcher House DS0000016001.V359629.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Although there are some areas where improvements are needed, the health and personal care needs of people who live in the home are met. People are supported in a kindly way. Medication is well managed apart from drugs needing refrigeration. EVIDENCE: A sample of four care plans (service user plans) was inspected. The care plans are devised on computer and then a copy of the main pages is printed and kept in a file. These are accessible to staff and the person living in the home. All but one had been signed by the person, showing their involvement in the plan of care. All had been reviewed within the last two months. The care plan pages were in enough detail to enable a Care Worker to support the person as they would like. There were appropriate risk assessments in place, including for the risk of pressure damage, falls and self medication. Fletcher House DS0000016001.V359629.R02.S.doc Version 5.2 Page 12 There were instances where the care plan was not accurate, for example the care plan stated that medication was being administered covertly or religious observances were not kept. These inaccuracies could be misleading for care staff and could mean that the person does not receive the care they need. Similarly the Manual Handling document was not clear or accurate in two care plans and could cause confusion. Mrs Mohide said that all the care plans were being reviewed and re-written and she would be auditing them when this has been completed. It was reported that a Nutritional screening tool is used and that weights are monitored regularly. People who live in Fletcher House nave access to GP services, mainly from two surgeries in Wells, one of which is nearby. Sometimes people are escorted to the surgery, which helps to maintain their privacy and dignity. District Nurses visit and provide equipment when necessary, for example, equipment to reduce the risk of pressure damage. A record is kept when other professionals help and advise. In surveys of people who live in the home 50 said that they ‘always’ receive the medical support they need. 50 said they ‘usually’ or ‘sometimes’ did. Medication was seen to be generally well managed. Records are kept for the following:- drugs received into the home - drugs removed from the home - administration of drugs - management of controlled drugs - temperature of the clinical room - temperature of the drug fridge. All of these records were well kept. On the first visit to the home it was observed that the temperature of the drug fridge ranged from 9 – 14 degrees Celsius for the previous 2 weeks and this is above the recommended temperature range of between 2 – 8 degrees Celsius, as set out in the Royal Pharmaceutical society guidance for Social Care (October 2007) This may affect the efficacy of the medications. On the second visit Mrs Mohide said that the problem had been resolved and the fridge was now at the correct temperature. Care should be taken to correct any temperature variation as soon as possible, so that there is no risk of medication being damaged. In the AQAA Mrs Mohide stated that thirteen people are being supported to self medicate. This is good practice and promotes independence. Also in the AQAA it was stated that all Senior Staff have received training medication and this was confirmed by one member of staff who was asked. Fletcher House DS0000016001.V359629.R02.S.doc Version 5.2 Page 13 All but one person said that staff listen and act on what they say. During the inspection people who live in the home said that staff were kind and caring and staff were seen to attend to people in a kindly way. There were many positive comments from relatives, carers and advocates about the caring nature of staff. One person said that they were ‘very patient and attentive to individual needs’. Another person said that ‘care is provided with tact and dignity’. People can have a telephone in their room if they would like and there is a public phone as well. How people like to be addressed was recorded in three of the care plans sampled. The home aims to meet the different needs of people in terms of race, ethnicity, age, disability, gender, faith and sexual orientation. The care plans showed support in terms of religious needs. In the surveys from relatives, carers and advocates 41 said that these needs were ‘always’ met and 50 said they ‘usually’ were. New staff receive an induction programme which includes an awareness of equality and diversity. The manager and staff aim to care for people in Fletcher House to the end of their lives if they can. They are supported by other professionals, for example District Nurses. Staff said that they found this aspect of their work very rewarding. Fletcher House DS0000016001.V359629.R02.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): Standards 12, 13, 14, 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents can choose how to spend their time within a limited programme of activities. At present meals and mealtimes are not well managed to suit all residents for every meal. EVIDENCE: There are some opportunities for occupation in the home, but these were not found to be regular and enough to keep people occupied as they would like. There was no regular activities organiser between October and December 2007. One post was filled in December and the second post has been filled since the inspection. Care Assistants have been helping with this area of care. Of the 10 surveys from people who live in Fletcher House 3 said there were ‘always’ activities arranged by the home to take part in, 4 said ‘usually’ and 3 said ‘sometimes’. Those who were asked were not aware of any programme of activities or schedule to refer to. They did not know what was planned and when. Fletcher House DS0000016001.V359629.R02.S.doc Version 5.2 Page 15 The ‘Expert by Experience’ reported the following:I understand from the manager that a new activities organiser has been appointed but was not yet in post. Activities are currently being run by a care assistant who was running an exercise session that morning which I joined briefly. I understand that activities are offered which include discussion sessions, exercise etc. However there was no programme of activities in evidence and the board at the entrance hall simply said ‘Good Morning’ rather than list the activities for the day. Some residents clearly chose not to join activities, others said there used to be bingo and quizzes, but these seemed to have stopped and were missed. Some residents told me there used to be regular monthly outings but these were now few and far between, and many said they would welcome more trips out. When I asked about individual time with those residents who stayed in their rooms or preferred not to join group sessions I was told that in the summer residents are taken out locally, and one member of staff had offered to do manicures with residents which would offer individual time to talk. One resident said she would welcome someone reading to her. Mrs Mohide is aware that this area needs to be improved and hopes this will happen once the new organiser is in post. The home aims to support people to make decisions for themselves about how they live their lives. They have a choice about how they spend their time. Visitors are welcomed in the home and this was evident during both days of the inspection. People who live in the home can choose to see visitors in the privacy of their room, in one of the communal rooms, quiet room or out in the garden weather permitting. A group of volunteers manage a shop and licensed bar. People can buy an alcoholic drink to have with their lunch. There are links with the local community via a Bridge Club, local schools and local churches. There is a Christian service weekly in the home and Holy Communion is celebrated monthly. Other ministers and preachers visit regularly. The inspector checked a sample of records held on service users monies with the administrator. These were correct and are audited by the registered manager. The home has a large dining area, which is light and airy. On both days of the visits the tables were laid with coloured napkins and place settings. People can choose to have their meals here or in their rooms. On both days the dining room was well used at breakfast and lunch time. The ‘Expert by Experience’ was asked to find out about food provision during the inspection. She was able to do this in a number of ways. She spoke to five residents individually in Fletcher House DS0000016001.V359629.R02.S.doc Version 5.2 Page 16 lounges, out of the hearing of other people. She also discussed this aspect with three people in their own rooms and eight residents in a group in the presence of a member of staff. Three residents approached her later and also gave her their views, particularly about the food. The ‘Expert by Experience’ also joined the residents for lunch and was able to observe how the meal was presented and how staff supported people. Her findings were as follows:The manager told us that she had recently introduced a new menu in order to ensure a healthy well-balanced diet for residents. Staff and residents confirmed that there was a choice of two dishes at all meal times, and one resident told me she thought this had been an improvement in having the new menus. The printed menus were available in the dining room, but the one for the day I was there was very different to what was served that day. Residents are asked at breakfast what they wanted for lunch, but could change their minds at the meal if they so chose. However I did not observe staff checking with residents if they wanted to change their minds. Three residents said they thought the food was excellent, and two said they were used to accepting what was served, one saying she did not like to make a fuss. However five residents told me quite strongly that they thought the quality of the food was not very good, describing it as tasteless, not well cooked and not like home-cooking. The group I spoke with identified two dishes they did not like, one was an omelette served with spinach mixed in with the egg, and the other was a minced meat pie with egg. I observed a number of residents left part or all of the steak and kidney pie served the day I was there, one resident told me that the meat was quite tough. The vegetables were served in dishes so that residents could serve themselves. Help in serving was mostly given by more able residents rather than by staff, although one resident was given some help by staff to cut her food. Puddings were served by staff from two trolleys, with a choice of four alternatives. One resident said the food was quite cold and it did take about forty minutes for the 2/3 staff to serve all the residents their main course. The process would have been much faster with more staff, although I understand from one resident that other staff may have been involved in taking trays to residents that preferred to eat in their bedrooms. A bowl of fruit was in evidence in the dining room but residents told me they were not allowed to help themselves and that it was only available as an alternative to the pudding. Residents do have meetings with both the manager and staff, at which the views about the food have been expressed, but apparently there has been no change. Additional comments from people who live in the home showed a variety of comments. In respect of food in surveys from service users 36 said they ‘always’ liked the food. 64 replied ‘usually’ or ‘sometimes’. In the surveys there were very few comments on food from relatives – one said it was ‘very good’, another said it was ‘not elderly friendly’. A recent complaint to CSCI related in part to poor food provision. Fletcher House DS0000016001.V359629.R02.S.doc Version 5.2 Page 17 Some people said they waited a long time for their meals once seated in the dining room. Since the last inspection the timing of breakfast has been changed to provide a longer time for serving, so that it is not so rushed. On the first morning of inspection it was observed that at least one resident did not arrive at the table until after 10am. This was a person who needed considerable support with personal care. This may mean that mealtimes are not evenly spaced out, if lunch is then served at 12.45. Also the interval between an evening snack and breakfast may be more than 12 hours. On the first morning of the inspection one person was waiting for breakfast at 9.15am and said she was ‘hungry’. The timings of meals should be kept under review to make sure everyone has the support they need when they need it to eat meals regularly. In discussion with the kitchen staff it was not clear that they were aware of who had been assessed as at risk of malnutrition using the home’s screening tool (“MUST). All staff should be clear on what care is needed to minimise the risk of malnutrition. In summary, it was not confirmed that current arrangements for meals and mealtimes is adequate for all residents to meet the standards. However, it is acknowledged that Mrs Mohide has recognised that this is an area needing improvement and she plans to examine in more detail what are the problem areas and review how changes can be made. The following aspects must be included in any review:- staffing levels at meal times - length of time between meals - provision of extra nutrition to those identified as ‘at risk’ – defining the terminology between staff groups - menus – providing nutritionally balanced meals, which residents like - waiting time once at the table. Fletcher House DS0000016001.V359629.R02.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): Standards 16, 17, 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who live in the home are protected by the homes processes. EVIDENCE: There is a clear complaints procedure, which the company has devised, called ‘Seeking your Views’. In the survey from people who live in the home, the majority said they knew how to make a complaint and knew who to speak to. When asked during the inspection people who live in the home said they would feel comfortable in talking to the manager about any concerns. One person said that they were never unhappy. In surveys from relatives all but one knew how to make a complaint. 54 said that their concerns had been responded to appropriately. Most comments supported this. 45 said they were ‘usually’ or ‘sometimes’ were. Within the limitations of community living, individual concerns are acted upon, as demonstrated in the action taken following the Quality Assurance monitoring. CSCI has received one complaint since the last inspection and this has been investigated and responded to appropriately, as far as it was possible to draw definite conclusions. Fletcher House DS0000016001.V359629.R02.S.doc Version 5.2 Page 19 The home has systems in place to uphold people’s legal rights. Some staff have had recent training in the Mental Capacity Act (2005). Residents are registered on the electoral role. Advocacy services are available through Age Concern. The manager dealt appropriately with a recent incident which put residents at risk. Although residents have a lockable space in their rooms, some ask the home to keep money and valuables safe for them. Records are kept of the money and these accounts are audited annually by an outside auditor. The inspector checked the staff files to ensure the recruitment procedure was being followed. All the required security checks and information had been obtained prior to the staff commencing employment. Fletcher House DS0000016001.V359629.R02.S.doc Version 5.2 Page 20 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): Standards 19, 20, 21, 22, 23, 24, 25, 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Apart from the sluices the home is warm, well maintained and well equipped. EVIDENCE: Since the last inspection a large extension has been built increasing the capacity of the home from 40 to 58 beds. The home started to accommodate 58 people from May 2007. It is acknowledged by all groups of people that this increase in size has not been easy to adjust to. Comments in the surveys from staff, people who live in the home and their relatives confirmed this. There were several comments about the home not being so ‘homely’ since the extension and increase in size. The AQAA confirmed that some people have found the increase in size difficult. Mrs Mohide has identified areas which need attention. She accepts that increase from 25 to 58 in May 2007 has had its Fletcher House DS0000016001.V359629.R02.S.doc Version 5.2 Page 21 challenges for all groups of people. However the changes in the home have had a positive effect in some aspects on the building, including a new dining room, new lounges and the home now has good proportion of en-suite facilities. There were few comments in surveys from people about the environment, but they were mainly positive and said the home is clean. There were several comments about the safety in the garden, as people had fallen. One relative commented that the laundry provision was not good, with other people’ clothes being found in their relatives cupboards. The home is well maintained, safe and comfortable. All the necessary equipment is available to meet the needs of people who live there. The rooms are furnished to a high standard and the new build has en-suite bathrooms. A number of communal rooms enable people to choose whether they wish to sit quietly or join in with others. On the day of the visit the home was clean and warm. The registered manager and staff observe a high standard of infection control. All bathrooms and toilets were clean with appropriate hand cleaning materials available in each. The home was well lit and tidy. There was one area of malodour and the manager was informed about this. The two sluices have not yet been upgraded. The paint was seen to be peeling from the walls and this means that the walls cannot be cleaned sufficiently. This may compromise infection control. Fletcher House DS0000016001.V359629.R02.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, 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Staffing numbers may not be adequate at all times to ensure needs are met. All necessary checks are completed before a new employee starts work. However the processes of supervision before a CRB has been completed are not robust and could put residents at risk. There is a systematic process of induction and staff are well trained. EVIDENCE: Since the last inspection the home has increased in size from 25 while the building works were being completed to 58 people on full occupancy. More staff were therefore needed and more have been employed. In surveys from people who live in the home and those close to them said that staff were good. All but one person said that staff listen and act on what they say. On the inspection people confirmed that staff are good and one person said they were ‘excellent’. Some comments suggested that there were not enough staff in number at all times. 81 said staff are available ‘usually’ or ‘sometimes’. Only 19 said they were ‘always’ available. Fletcher House DS0000016001.V359629.R02.S.doc Version 5.2 Page 23 On the inspection people said they can wait long periods for the bell to be answered. In the surveys from staff, 83 said staff there is enough staff ‘usually’ or ‘sometimes’. None said ‘always’. Comments were that more staff is needed. In discussion with staff they have noticed that people need more care and support than previously and consequently more staff are needed. At present there are two vacant posts for care & support workers and current staff are working these unfilled shifts. Staff have a sense of commitment to the home and the residents and want to work extra shifts rather than request agency staff, who will be unfamiliar to residents. Feedback from the ‘Expert by Experience’ found the following in respect of staffing:All residents confirmed that the staff were respectful, friendly and gave help when needed, mostly responding to alarm buzzers quite quickly. Help in personal care was given whilst maintaining the dignity of the resident. The manager has identified that staffing numbers may not be adequate, especially at mealtimes. The inspection confirmed this. It is required that the numbers of care staff on duty are reviewed, including at night. In the inspection response it was stated that there are 3 people are on duty at night. It is required that a copy of the report from this review be sent to CSCI. NVQ assessment is well managed in the home and 79 have achieved or are working towards NVQ Level 2 or above. This is above the recommended minimum of 50 . A sample of three staff files was inspected to review the recruitment processes. All the necessary checks had been completed before recruitment started. A Criminal Records Bureau (CRB) had been applied for and a POVA First check had been completed before new staff met with residents. A record had not been kept of the shifts where new staff ‘shadow’ other staff as part of their induction. This was completed between the first and second inspection visits. A member of staff had not been appointed to supervise the new staff member, when the CRB check had not been completed before he/she had contact with residents. This is to ensure that people who live in the home are adequately protected from staff whose checks have not been fully completed before they have contact with residents. Commencing work before a CRB has been completed should be only in exceptional cases. Mrs Mohide said that staff usually worked in pairs during this period. Staff have access to a good range of training which is appropriate for their roles. The records were kept on computer and these showed that all staff had completed training in Health & Hygiene, Fire and Moving & Handling in the last year. Other topics for training included Medication, Dignity in Care, Dementia Awareness and Food Hygiene. Induction is well planned and is based on the Skills for Care standards, which is the recommended format. Staff in the Fletcher House DS0000016001.V359629.R02.S.doc Version 5.2 Page 24 surveys said that their induction ‘covered everything’. All said that training is good. Fletcher House DS0000016001.V359629.R02.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, 35, 36, 37 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People in the home benefit from a clear management structure. Their views are sought so that improvements can be made if necessary. Systems are in place to help keep safe the people who live, work and visit the home. The reports from visits from the Responsible Person were brief and did not give a clear view of the outcomes for people who live in the home. EVIDENCE: Mrs Mohide, the Registered Manager, has good knowledge and experience of caring for older people. She has achieved the Registered Manager’ s Award. All Fletcher House DS0000016001.V359629.R02.S.doc Version 5.2 Page 26 comments were complementary about her approach to the role. During the inspection Mrs Mohide was seen to be accessible to people who live in the home, staff and visitors. Relatives in the surveys praised the friendliness of staff and their good communication skills. A survey of residents had been conducted in August 2007 and 86 had completed the survey. This showed that 95.3 felt that they were treated well. 97.6 felt their needs were met. Mrs Mohide had recorded the action she intended to take in any areas which needed improvement. A company audit was carried out in October 2007 and the outcomes were generally good. The Area Manager for the company must visit every month and keep a record of her visits. These records were inspected and found to be brief, but gave an overview of her findings. No financial records were inspected apart from insurance, which was appropriate. Records were inspected for monies kept by the home. These showed a clear process. The reports of visits required under Regulation 26 were not always full enough to show the outcomes for people living in the home. For example, the number of people who were asked for their views and what topics they were asked about were not clear. In view of the findings of the inspection in relation to food, activities and staffing, these would be useful areas of discussion by the visiting manager and a full record should be kept, so that changes can be made accordingly. The records for staff supervision are held on computer and these were inspected. These showed that the majority of staff employed for more than a year had received five or six sessions of supervision between 1/4/07 and 13/3/08. In the surveys staff said that they met with their manager ‘regularly’ or ‘often’ for support or discussions of their work. Records were well kept and made available for inspection. People who live in the home who were asked were aware of their care records. Computer held care plans can be printed for people to see and comment on. Computer held records are password-protected. A sample of records was inspected to review the safe working practices in the home and these were found to promote the safety of staff and people who live in the home. Mrs Mohide had recently requested the Fire Officer to advise, as the fire safety assessment is due to be reviewed. He had visited on 11/03/08. Mrs Mohide had identified areas in need of improvement, for example, staffing, meals & meal-times, and has said she is committed to make any necessary improvements for the benefit of all in the home. Fletcher House DS0000016001.V359629.R02.S.doc Version 5.2 Page 27 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 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 4 4 3 3 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 2 3 Fletcher House DS0000016001.V359629.R02.S.doc Version 5.2 Page 28 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 17(3)(a) Requirement Service user plans must be kept up to date and accurate so that service users will have their needs met. A review of staffing numbers must be carried out so that staff in sufficient numbers are on duty at all times to meet the needs of service users. A staff member must be appointed to supervise a new member of staff if the CRB has not been completed before they have contact with service users. This helps to protect residents from unsuitable staff. People living in the home, staff and relatives should be asked their views on the quality of service in the home and a report written, so that changes can be made to improve services. Timescale for action 10/05/08 2. OP27 18(1)(a) 10/05/08 3. OP29 19(11) 10/05/08 4. OP37 26(4) 10/05/08 Fletcher House DS0000016001.V359629.R02.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP12 OP15 OP26 Good Practice Recommendations Service users should be consulted on how they would like to spend their time and arrangements made, so that they are meaningfully occupied. A review of meals provisions and arrangements at meal times should be carried out so that all service users have their nutritional needs met. The two sluice rooms should be refurbished to ensure they can be kept clean and comply with current infection control guidelines Fletcher House DS0000016001.V359629.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Fletcher House DS0000016001.V359629.R02.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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