Care Home: Florence Nursing Home

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What the care home does well The home has retained a stable team of senior RGN’s, which ensures that residents receive consistent care from staff that are fully conversant with their needs and the workings of the home. There was evidence that recruitment checks were undertaken prior to employment to ensure staff are safe to work in the home. The staff we met had a working knowledge of dealing with adult protection issues and more importantly the reporting of such matters. DS0000071180.V375421.R01.S.doc Version 5.2 The home has good working relationships with members of the multi disciplinary team and refers to these experts for guidance and advice. Ms Southwood works collaboratively with other team members and seeks out appropriate guidance when needed. What has improved since the last inspection? The home had worked hard to address the requirements arising out of the last key inspection. It was evident that more information was obtained prior to admission and that residents are assessed. In addition the care plans were more comprehensive and provide good information from which staff can deliver the care. Wound care and auditing of wounds has significantly improved with regular input and checks made by the Acting Manager. It was evident that money had been invested in the building, there was a new sign to the front of the building and refurbishment of some areas had taken place although more work is required. Activities had improved and residents had more choices incorporated into their daily lives. What the care home could do better: More comprehensive assessment information needs to be obtained prior to assessment to ensure that all of the resident’s needs can be met. Whilst physical health care was well assessed other care needs were less well explored. There needs to be a permanent manager appointed so that a period of stability can occur. Supervision records need to be amended and not as they are currently more reflective of a work audit. Quality assurance measures need to reflect the views of all those who use the service and where shortfalls are identified, action taken.DS0000071180.V375421.R01.S.docVersion 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE Florence Nursing Home 47 Park Avenue Bromley Kent BR1 4EG Lead Inspector Rosemary Blenkinsopp Unannounced Inspection 09:45 19 and 27th May 2009 th DS0000071180.V375421.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. DS0000071180.V375421.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address DS0000071180.V375421.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Florence Nursing Home Address 47 Park Avenue Bromley Kent BR1 4EG 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) 020 8460 5695 020 8466 0481 Safecare UK Ltd Mrs Susan Ann Clarke Care Home 30 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (1), Old age, of places not falling within any other category (30) DS0000071180.V375421.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP (maximum number of places: 30) Mental Disorder, excluding learning disability or dementia, over 65 years of age - Code MD(E) (maximum number of places: 1) The maximum number of service users who can be accommodated is: 30 26th June 2008 2. Date of last inspection Brief Description of the Service: The home is a registered nursing home providing care for 36 residents, although it only operates with 30 beds as several doubles are now used for single occupancy. The category of residents is older people with one bed for a resident in the category mental disorder. This had been requested and approved under a variation of conditions. The home is an adapted building spread over four floors. The sitting and dining areas are located on the lower ground floor. Individual bedroom accommodation is located over the first and second floors. There id parking to the front of the building as well as of street parking. There is a garden that is accessible through the lower ground floor lounge. The home is without a permanent Manager and the Head of Care is acting up until a permanent one is found. Waking staff are provided throughout the 24hour period. Qualified nursing staff are always on duty as this is a nursing DS0000071180.V375421.R01.S.doc Version 5.2 Page 5 home. GP cover and other health provision are provided locally. The fees range between £590 - £850 a week. Fees vary between private paying residents and those local authority placements. DS0000071180.V375421.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 1 star. This means the people who use this service experience adequate. The inspection was conducted over a one and a half day period by one inspector. The Head of Care facilitated the inspection. Periods of observation were undertaken in the communal areas where some residents were spending time. Prior to the inspection the AQAA had not been completed nor were there any comment cards received prior to the visit, although some were given out and returned during the course of the day. Those comment cards received included five from residents, seven from staff and two from health professionals. During the site visit we met with several residents. Staff were interviewed during the day. All of the information obtained from the sources identified above has been incorporated into this report. Documents were inspected during the site visit including care plans, staff personnel files as well as health and safety records. Feedback was provided to the Acting Manager Ms Southwood, at the end of the inspection. Other information, which was considered when producing this report and rating, consisted of information supplied and obtained throughout the year including Regulation 37 reports and complaints. What the service does well: The home has retained a stable team of senior RGN’s, which ensures that residents receive consistent care from staff that are fully conversant with their needs and the workings of the home. There was evidence that recruitment checks were undertaken prior to employment to ensure staff are safe to work in the home. The staff we met had a working knowledge of dealing with adult protection issues and more importantly the reporting of such matters. DS0000071180.V375421.R01.S.doc Version 5.2 Page 7 The home has good working relationships with members of the multi disciplinary team and refers to these experts for guidance and advice. Ms Southwood works collaboratively with other team members and seeks out appropriate guidance when needed. What has improved since the last inspection? What they could do better: More comprehensive assessment information needs to be obtained prior to assessment to ensure that all of the resident’s needs can be met. Whilst physical health care was well assessed other care needs were less well explored. There needs to be a permanent manager appointed so that a period of stability can occur. Supervision records need to be amended and not as they are currently more reflective of a work audit. Quality assurance measures need to reflect the views of all those who use the service and where shortfalls are identified, action taken. DS0000071180.V375421.R01.S.doc Version 5.2 Page 8 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. DS0000071180.V375421.R01.S.doc Version 5.2 Page 9 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 DS0000071180.V375421.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Acting Manager ensures that all prospective residents are assessed prior to admission to ensure that the home can meet their needs. The home needs to obtain comprehensive assessment information on all areas of health care as only physical aspects of care were considered. Staff have some information on which they can base an initial care plan in order to address care required. EVIDENCE: DS0000071180.V375421.R01.S.doc Version 5.2 Page 11 At the time of the visit there were 29 residents on site and one was in hospital. We were advised that there are 30 beds, which can be used. We were advised that no residents had MRSA and two had pressure sores. Assessment information was inspected of those residents recently admitted and were included as part of case tracking. The home’s own assessment, did in parts, provide some good information especially in relation to physical health needs although psychological care was less well recorded. There were personal details and next of kin information in each of the files inspected. In addition the assessment records included information from Social Services namely the Community Care Assessment, and discharge letters from the referring hospital. There was little evidence of what information residents had been provided with prior to admission or whether trial visits had been undertaken either by the resident or their advocate. There was little evidence of how the resident had been supported or had had input into the decision regarding placement. All of this information is important when considering placements. Residents are issued with contracts and a copy retained in their file. One relative’s comment card indicated that the billing accuracy was not very good. This needs to be looked into to ensure that residents are charged the correct amount for all things. The Statement of Purpose will need to be updated again to include the new management arrangements and staff members. DS0000071180.V375421.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All resident’s health care needs are met by staff in the home supported by members of the multidisciplinary team. Care plans are reflective of resident’s needs and assist staff to provide the care. Medications are safely managed and residents and be assured that they will receive medications correctly. EVIDENCE: Care plans were in two different styles, some with standard headings and pre prepared formats, others that were hand written without standard headings. The standard care plans had been introduced by a previous manager and these were found not to be suitable, it had already been an area identified for change. DS0000071180.V375421.R01.S.doc Version 5.2 Page 13 The standard care plans are limited in some respects and insufficiently personalised to meet residents needs. They focus on the headings, which follow the “ Activities of daily living” format, and these are completed whether this is a problem to the resident or not. The staff should be clear that if a problem is identified, then it is specific to that resident and not simply completed, as it is currently, simply part of the documentation. One such problem was stated as maintaining temperature; this would not be a problem to every resident and therefore should not routinely be completed. Some care plans had signatures of residents, and or their relatives, as confirmation that they had had input into them. Interventions for those problems identified were to a good standard and would provide staff with the information they need to give the care. Risk assessments were in place for manual handling, mouth care, skin integrity falls and cot sides. It was evident that some of the information obtained through these assessment was not being utilised, for example the “Oral scores”, indicated that the resident needed hourly oral care – this was not being done, hence this may need to be revised. Also, with the” Deprivation of Liberty Act “, now in operation then documentation must be in line with this. Weight charts were completed with no significant variations in weight indicated. Daily records were well completed and relevant to the residents needs. Records referring to those visits made by the multi disciplinary team including the GP, were in the form of short statements, which advised you of the date of the visit and treatment, provided. Other health care records included referral to specialist teams, the optician as well as hospital out patient appointment letters. Soap dispensers had been purchased and put in every bedroom and all communal toilets to promote hand washing and prevent the spread of infection. The home has a mix of male and female staff, which enables gender, care issues and preferences to be addressed. There were two comment cards received on the second site visit, from members of the multi disciplinary team, and they included the following comments: “ Staff are helpful and appear to know the patients well” DS0000071180.V375421.R01.S.doc Version 5.2 Page 14 A second comment card stated, “ They (staff) are fully aware of patients medical needs. Helpful and conscientious staff”. This person further indicated that there were issues around obtaining pharmacy prescriptions and regular physiotherapy would benefit residents who were bed bound. These points should be investigated. We have also been advised that the staff in the home seek advice appropriately, in particular on wound care. Another member of the Nursing Home Liaison Team was very positive about how things had improved in the home in respect of care and wound care specifically. She felt Ms Southwood had raised the standards of care and that she was very aware of what was happening at the grass roots level. She felt staff knew the residents well and related information in a timely manner. Four reviews undertaken by two Social Services teams have been conducted recently, and they too were happy with their findings and the care that the residents received in the home. The Acting Manager audits all wound care by viewing the wounds when they are re dressed and then follows up on documentation ensuring care plans reflect the actual dressing. In addition timely referral to other specialists for advice if wounds need more input, is regularly done. Soap dispensers had been purchased and put in every bedroom and all communal toilets to promote hand washing ad prevent the spread of infection. The medications systems were inspected currently there are no residents who self medicate. The medications are safely stored and this area was clean and tidy, although the space is limited. Overall the medication systems were to a good standard. The medication records were inspected and the practice observed. The medication charts themselves were well completed with resident’s photograph and allergies recorded. There was a signature list for those staff administering medications. Dates of opening for those with a short self life were in place. The information for the administration of “as required “, medications was comprehensive. On sampling the medication charts these were well completed. Hand transcriptions had two signatures to confirm the information documented was correct. Those medications received into the home had been entered onto the MAR sheet. DS0000071180.V375421.R01.S.doc Version 5.2 Page 15 Those records for controlled drugs were well completed and checks on the actual amount in stock showed them to be correct. Medications are subject to frequent auditing internally and the supplying pharmacy had also completed an audit March 2009. DS0000071180.V375421.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,1,4,15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Daily routines are flexible to accommodate resident’s personal preferences and lifestyles. Florence House provides a range of varied activities, which are age appropriate. EVIDENCE: During the morning of the first site visit, periods of observation were undertaken in the lounge area, and there were a number of activities taking place. It was pleasing to see that one gentleman who had spent almost all of his time in his bedroom was in the lounge with two other gentlemen playing dominoes. This, I was advised, has become a regular feature with the men all enjoying it so much they play it daily. DS0000071180.V375421.R01.S.doc Version 5.2 Page 17 The activities lady is enthusiastic in her role and tries hard to engage residents in some activity although this is not always possible. She has been in this post approximately one year and said she really enjoys it. She has no formal training in organising activities, and training is something that the home must look into to maximise her ability to undertake the role. The home has a number of items for recreational purposes, including board games, art equipment magazines and daily newspapers. Most residents have their own TV’s and radios. Signs of well being were apparent during the two site visits. Residents engaged with one another and responded to staff and other forms of stimulation. Visitors were seen to come and go –all welcomed and well received. Those seen said they could visit at any time within reason. During the second site visit the hairdresser was in. She had great praise for the home and the helpful staff who worked in it. She visits many residential care homes and said this was the best service she had ever attended. Relatives comment cards indicated the following – “the home provides a good service by meeting his (the resident’s) needs, staff are friendly and professional”. Residents comment cards included the following, “ The home is caring and provides nice food, the home carers for every one”. One resident told us that “ the food is very good - more than enough – all meals are good- the staff are kind and I am well looked after, if you want to go to bed you can – I have no complaints”. The kitchen was given a three star rating at the last Environmental Health visit. We were advised that fresh fruit and vegetables is delivered three times a week and fresh meat twice. The lunch looked very appetising and good portion sizes were served. There was little waste. Staff were seen to assist residents with their meal in an unhurried manner, sitting to feed residents. Drinks were served with the meal. DS0000071180.V375421.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can feel safe in the knowledge that complaints will be dealt with appropriately and staff have sufficient knowledge to refer on any areas of concern. EVIDENCE: The home has in place policies and procedures for dealing with complaints and protection. These are available to staff and they are instructed on the need to refer to them during induction and supervision. The policies need to clearly state, that any adult protection matter, suspected or otherwise, must be referred to the safeguarding teams based in the Local Authorities, before the home commences it’s own investigation. In the current policy this is not quite clear. The complaints information was on display and included in several other documents such as the Statement of Purpose. These will need to be reviewed to reflect the new regulatory body the CQC. The complaints records set out the reason for the complaint, the action taken and the final outcome. One addition to this, there needs to be a record to DS0000071180.V375421.R01.S.doc Version 5.2 Page 19 include a statement as to whether the complainant was satisfied with the outcome or not. The complaints log had one recent complaint recorded which was resolved internally. Two newly appointed staff met with the inspector. They demonstrated a good knowledge of adult protection procedures as well as whistle blowing issues. They confirmed that they had received instruction on it during induction. They were aware of what the two topics were about and that they need to report items which fall within whistle blowing and suspected abuse. There is one adult protection investigation, which has been on going for almost a year. Bromley Social Services are leading on the investigation of this. To date this has not been concluded DS0000071180.V375421.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides clean and comfortable accommodation, which is adequately maintained. EVIDENCE: The exterior of the home has improved. There is a new sign to the front of the building. The waste bins were clearly labelled and securely stored. On entering the home the entrance hall, which had frequently been malodorous was fresh and pleasant without odours. DS0000071180.V375421.R01.S.doc Version 5.2 Page 21 Other areas of the home were clean and fresh. They were hazard free and care had been taken to ensure areas were safe for residents to mobilize in. The first floor office had been reorganised and gave a more spacious appearance to the room. There are areas that do need further work in respect of upgrading and this is something that the new owners are planning to address. Equipment was seen to be in use including pressure relieving mattresses wheelchairs, hoists and mobility aids. A new weighing machine had been purchased as the old one was reading inaccurately. Only 30 bedrooms are in operation as those previously used as shared facilities are now only for single occupancy. Many bedrooms were personalised with resident’s own items. The bedrooms had new soap and towel dispensers installed as infection control measures. The home is not purpose built or a new build, and therefore it requires more in the way of maintenance and upgrading to keep it to an appropriate standard. Areas of note were bedroom 10 where the paintwork needed attention and the first floor carpet, which was worn. In some areas the hot water was running cold. We were advised that this was due to the high usage during the morning period for addressing personal hygiene. On the second site visit this was found to be satisfactory The building was described as” rather disappointing”, in one relative’s comment card. DS0000071180.V375421.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, 29 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are provided in sufficient numbers to address care although the increased dependency of residents and staff absences can cause shortfalls. Mandatory training is addressed and training provided to equip staff with sufficient skills to do their work. EVIDENCE: The home employs approximately 33 staff including qualified nurses, carers and ancillary workers. We were advised that currently the home has two vacancies one for a qualified nurse the other a care staff member. The home works with two qualified and six care staff plus ancillary support during the morning period. Within the majority of comment cards there was reference to staffing levels in particular the need to have more staff available. Comments such as” make sure staff are covered at all times i.e. sickness”, was one such reference. DS0000071180.V375421.R01.S.doc Version 5.2 Page 23 With the Head of Care acting up into the managers position this leaves less staff working on the floor and this must be addressed to ensure that resident’s needs can be met. We inspected the staff personnel recruitment files to check that staff had been safely recruited. Evidence of good recruitment checks made prior to employment were retained on file. The records evidenced CRB and POVA first, checks on identity, two references and for qualified staff, confirmation of their registration through the NMC. Induction records covered the mandatory topics and other specific issues. Staff confirmed that supervision took place with one of the management team. The supervision standard form was viewed. The form was more related to auditing of care and cleanliness than a formal supervision document. The Head of Care needs to refer to standard 36 and look at supervision forms in use such as those the National Care Homes’ Association produce. Approximately 60 of staff have completed NVQ training. We were advised that there are two staff doing NVQ level 2 and one other staff due to start it. Another staff member is doing NVQ level 3. There is a training record in place and this prompts the Manager when the updates are needed. Some recent training sessions have included those for incontinence, COSHH and nutrition assessments. It has been identified that more staff training is needed and the home are looking into becoming a member of the Bromley training consortium which provides a lot of appropriate training to care home staff. Staff surveys also indicated the need for more training. As well as the statutory sessions, the home should ensure that training is reflective of the type of resident’s conditions that it admits, so that staff are sufficiently knowledgeable to deal with it. Those staff interviewed including two care staff and one RGN. They had a good knowledge of infection control principals. In addition topics such as Dementia were discussed and they had a working knowledge of these. Staff with whom we met had a good knowledge of residents needs. The domestic met with us she confirmed that training in infection control COSHH and an updated fire drill had been conducted. Staff surveys, received by us, provided information in a number of areas and in one it referred to staff speaking in their own language whilst on duty was written. This needs to be addressed. Staff surveys indicated that residents were treated in a good manner and that “the home offers quality care to clients”. DS0000071180.V375421.R01.S.doc Version 5.2 Page 24 Relative’s surveys were very positive about staff saying things like “ The staff listen carefully to relatives and try to comply with requests”. DS0000071180.V375421.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is under temporary arrangements currently. The manager is a good clinician although will need support with the overall management of the home. Health and safety measure ensure that the home is safe for people to live in. Quality assurance measures are limited and do not fully include the views of all those who use the service. EVIDENCE: DS0000071180.V375421.R01.S.doc Version 5.2 Page 26 The management of the home has changed recently. The new acting manager, Jill Southwood was the previous Head of Care in the home and has recently taken on this new position. Jill Southwood has significant experience in clinical issues as well as the workings of the home although will need guidance and support on managerial issues. She has completed the NVQ level 4. There was evidence of first aid boxes located throughout the building and eight staff are first aid trained. A number of service certificates were sampled and found to be in date. There is a general fire risk assessment site. The fire systems, including the fire alarms and fire panel were subject to regular maintenance and servicing. Records indicating weekly fire alarm testing were retained. On sounding the alarm, a staff fire drill is conducted at the same time. The records did not have staff signatures of names of those attending this needs to be addressed. Emergency lights are checked during the service visits, in addition these should be checked in between these visits. Other fire precautions, which should be addressed, include checking of fire escapes and safety of fire doors. Other maintenance records included those for gas servicing, electrical inspections and legionella. The home was hazard free when we toured with safety precautions such as window restrictors and lockable COSHH cupboards. The employer’s liability certificate was current. Resident’s money is safely stored in the safe. A balance sheet records all transactions. Receipts for purchases are retained. The current reports relating to Regulation 26 visits could not be located the last one available was November 2008. We were advised that the visits had been conducted although the reports were not on site. There was little in the way of other records to evidence that quality assurance measures were in place to include the views of those using the service. Quality assurance needs to be addressed to encourage input into service developments. Please see requirements. DS0000071180.V375421.R01.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 X X 2 X X X 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 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 DS0000071180.V375421.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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. 1. OP33 24 Quality assurance measures must fully represent the opinions of all stakeholders and action plans developed for areas where shortfalls are identified. This requirement is repeated. Regulation 26 reports must be made following the visit and available on site. Fire precautions must include checking of fire exits, emergency lighting and evidence that staff have attended fire drills by way of their signature. 30/09/09 2. OP33 26 30/09/09 3 OP38 23 30/07/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 2. OP28 Refer to Standard Good Practice Recommendations It is recommended that more comprehensive training be provided to staff to reflect the needs of the residents living in the home so that they are sufficiently skilled to care for DS0000071180.V375421.R01.S.doc Version 5.2 Page 29 them. 3. OP36 Supervision sessions should include all elements of standard 36.3 and be conducted at least six times a year for the delivery of good quality services. DS0000071180.V375421.R01.S.doc Version 5.2 Page 30 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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