Care Home: Four Seasons

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What the care home does well People are well assessed before they move into the home to help ensure that their needs can be met, and that the staff prepares for their admission. The care plans have excellent actions for staff to follow that are agreed with the person or a relative. Healthcare professionals support is sought when required and staff are well trained to help ensure that any instructions are carried out. Medication is well managed, and staff are well trained and supervised to help ensure safe administration. The medication records are audited monthly to maintain good practice. People have a choice of group and individual activities, to include occasional trips out in the community and are able to make decisions about how they spend their day. There are two activity co-ordinators, both have completed an activities course, we spoke to one of them, she was very enthusiastic and we saw many people involved in exercises to music. One person told us, `the activities are excellent for the more able residents`. There is a good daily choice of freshly prepared food that people enjoy, and special diets can be catered for. A variety of fruit cordials are served with meals. People have a copy of the homes complaints procedure, which is also recorded on an audiotape for people with sight impairment. The manager takes complaints seriously and staff are trained to protect people from abuse and procedures are followed to ensure they are safe. We spoke to people living in the home and they told us they felt safe there. The surveys told us that seven out of the eight people that replied knew how to make a complaint. The home was clean throughout and free from offensive odours. People told us in our surveys that the home was `always` clean. The home employs a domestic for thirtysix hours each week. The manager has attended an infection control course and has cascaded the information to the staff, providing some good policies to maintain a safe and hygienic home, which includes the importance of correct hand washing. The home organises staff training and development to help provide a well trained and motivated team. The staff told us that they were well supported and that their training needs had been met. Staff recruitment records were well recorded, and staff are supervised when required to help ensure that vulnerable people are protected. The home is well managed by a competent registered manager providing good support to the staff , which helps to ensure that people are safe and well cared for. Quality assurance systems monitor what people think about the service, and helps to identify where improvements can be made. What has improved since the last inspection? The addition of a conservatory has improved the communal space provided and has given people more choice where they can relax during the day. We looked at the new wet room that is used by most people in the home to shower. The heated towel rail there was guarded to help ensure that the room was completely safe for everyone. The home has a new spacious medication storage cupboard, which was well organised, and the temperature was monitored and controlled. In the last twelve months the lounge carpet has been replaced and the room redecorated. People were able to agree the colour scheme in the lounge. One bedroom has had non-slip wood effect flooring fitted for hygiene purposes. The maintenance person told us that all bedrooms had been redecorated in the last two years. The staffing levels have recently increased, to meet the needs of the number of people accommodated, and this includes the night staff. People commented that; `the staff are always very kind`, `the staff treat me with respect, `the staff are very good and respectful` and `sometimes there is not enough time for staff to stop and listen`. One carer told us that communication in the home had improved with regular staff meetings, the senior carer on night duty also told us that she arranges meetings for the night staff. The AQAA told us that the local Partnerships for Older People Project (POPP) had made accessing training easier and that staff development is progressing well. We looked at the comprehensive training list for 2008, which included dementia care, first aid, safe handling of medicines, infection control, The Mental Capacity Act, and fire safety. All staff have regular supervision with the registered manager or the deputy manager. What the care home could do better: The residents` handbook, if used as the service users guide, requires more information to help ensure that people are fully informed about all aspects before they make a choice. The home is generally well maintained, however, some areas relating to health and safety were noticed by us and rectified immediately by the maintenance person. Other minor environmental issues were noted for the manager to address, and as the person responsible for health and safety additional training may be required to help ensure people are safe at all times. CARE HOMES FOR OLDER PEOPLE Four Seasons Back Lane Mickleton Nr Chipping Campden Glos GL55 6SJ Lead Inspector Mrs Kate Silvey Key Unannounced Inspection 09:45 19th & 20th January 2009 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 Four Seasons DS0000061877.V373322.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. Four Seasons DS0000061877.V373322.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Four Seasons Address Back Lane Mickleton Nr Chipping Campden Glos GL55 6SJ 01386 438300 01386 430071 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) Four Seasons Mickleton Limited Ms Tracey Jayne Elizabeth Jary Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Four Seasons DS0000061877.V373322.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd January 2007 Brief Description of the Service: Four Seasons provides personal care to persons over the age of 65 years of age. The home does not provide qualified nurse cover however; the Community Nursing team provide some nursing care when needed. The care home is situated in a residential area in the village of Mickleton, which is near Broadway and Chipping Campden in Gloucestershire. There are buses from and to Stratford, Evesham and Chipping Camden within a short walking distance of the home. The nearest train station is in Honeybourne, two miles from the home. Accommodation is on two floors with the upper floor accessed by stairs and a passenger lift. There are seventeen single bedrooms, eight of which have ensuite facilities and both double bedrooms also have en-suite facilities. The ground floor communal areas provide a separate lounge, dining room and conservatory. There are gardens to the front and rear for residents to enjoy in the good weather. There is ample parking at the front and a graduated slope to aid wheelchair access into the home at one entrance. The current fee range is £450.00 - £575.00 per week and there are extra charges for the following; personal telephone, chiropody, trips and entertainment outside the home, newspapers, periodicals and escort duties for appointments. The latest inspection report by the Commission for Social Care Inspection (CSCI) is available in the entrance hall along with the home’s Statement of Purpose for those who wish to read it. Four Seasons DS0000061877.V373322.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 three star. This means the people who use this service experience excellent quality outcomes 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. We, the Commission, inspected this home over two days with one inspector. Twenty people were accommodated and all were seen and spoken to. Three people had a conversation with us in their own rooms and we also spoke to people in the communal rooms and three relatives/friends who were visiting the home. There was direct contact with the home’s registered manager, the deputy manager, the activity co-ordinator, the cook, the maintenance person and three members of the care staff. A number of records were looked at including care plans, risk assessments, health and medication records. The care records of three people accommodated were looked at in detail. The environment was inspected and staff were observed engaging with people living in the home. Surveys were returned to us from seven staff and eight people living in the home. The registered manager had completed the Commissions’ Annual Quality Assurance Assessment, this is an annual self-assessment about the home and is a legal requirement. What the service does well: People are well assessed before they move into the home to help ensure that their needs can be met, and that the staff prepares for their admission. The care plans have excellent actions for staff to follow that are agreed with the person or a relative. Healthcare professionals support is sought when required and staff are well trained to help ensure that any instructions are carried out. Medication is well managed, and staff are well trained and supervised to help ensure safe administration. The medication records are audited monthly to maintain good practice. Four Seasons DS0000061877.V373322.R02.S.doc Version 5.2 Page 6 People have a choice of group and individual activities, to include occasional trips out in the community and are able to make decisions about how they spend their day. There are two activity co-ordinators, both have completed an activities course, we spoke to one of them, she was very enthusiastic and we saw many people involved in exercises to music. One person told us, ‘the activities are excellent for the more able residents’. There is a good daily choice of freshly prepared food that people enjoy, and special diets can be catered for. A variety of fruit cordials are served with meals. People have a copy of the homes complaints procedure, which is also recorded on an audiotape for people with sight impairment. The manager takes complaints seriously and staff are trained to protect people from abuse and procedures are followed to ensure they are safe. We spoke to people living in the home and they told us they felt safe there. The surveys told us that seven out of the eight people that replied knew how to make a complaint. The home was clean throughout and free from offensive odours. People told us in our surveys that the home was ‘always’ clean. The home employs a domestic for thirtysix hours each week. The manager has attended an infection control course and has cascaded the information to the staff, providing some good policies to maintain a safe and hygienic home, which includes the importance of correct hand washing. The home organises staff training and development to help provide a well trained and motivated team. The staff told us that they were well supported and that their training needs had been met. Staff recruitment records were well recorded, and staff are supervised when required to help ensure that vulnerable people are protected. The home is well managed by a competent registered manager providing good support to the staff , which helps to ensure that people are safe and well cared for. Quality assurance systems monitor what people think about the service, and helps to identify where improvements can be made. What has improved since the last inspection? The addition of a conservatory has improved the communal space provided and has given people more choice where they can relax during the day. We looked at the new wet room that is used by most people in the home to shower. The heated towel rail there was guarded to help ensure that the room was completely safe for everyone. Four Seasons DS0000061877.V373322.R02.S.doc Version 5.2 Page 7 The home has a new spacious medication storage cupboard, which was well organised, and the temperature was monitored and controlled. In the last twelve months the lounge carpet has been replaced and the room redecorated. People were able to agree the colour scheme in the lounge. One bedroom has had non-slip wood effect flooring fitted for hygiene purposes. The maintenance person told us that all bedrooms had been redecorated in the last two years. The staffing levels have recently increased, to meet the needs of the number of people accommodated, and this includes the night staff. People commented that; ‘the staff are always very kind’, ‘the staff treat me with respect, ‘the staff are very good and respectful’ and ‘sometimes there is not enough time for staff to stop and listen’. One carer told us that communication in the home had improved with regular staff meetings, the senior carer on night duty also told us that she arranges meetings for the night staff. The AQAA told us that the local Partnerships for Older People Project (POPP) had made accessing training easier and that staff development is progressing well. We looked at the comprehensive training list for 2008, which included dementia care, first aid, safe handling of medicines, infection control, The Mental Capacity Act, and fire safety. All staff have regular supervision with the registered manager or the deputy manager. 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 Four Seasons DS0000061877.V373322.R02.S.doc Version 5.2 Page 8 be made available in other formats on request. Four Seasons DS0000061877.V373322.R02.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 Four Seasons DS0000061877.V373322.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with information to help them make a decision about moving into the home, however, minor amendments are required to the Service User Guide. The pre-admission assessments we looked at had sufficient information to help ensure that the home can prepare for and meet people’s needs. EVIDENCE: We recommend that the policy for taking a daily blood test is reviewed with a healthcare professional. We looked at the Residents Handbook, which if used as the Service User Guide should contain more information regarding the fees and what additional extras there are. It should also have a sample contract for people to see before they decide to move into the home. We looked at the Statement of Purpose, a summary of which should be in the Service User Guide. It contained some good information including staff qualifications. The information in the Four Seasons DS0000061877.V373322.R02.S.doc Version 5.2 Page 11 Statement of Purpose is recorded on an audiotape for people with sight impairment. The manager agreed with us to review the statement about the home being able to meet the needs of people in the early stages of dementia, as it refers to all mental health needs. We looked at two pre-admission assessments, which are usually completed during a visit to the person in their own home or in hospital. The deputy manager generally accompanies the registered manager or sometimes the keyworker may go. The keyworker will be responsible for ensuring that all the person’s identified needs are met when they move in. We looked at the assessment for an emergency admission, which included details of the manager contacting the person’s doctor before admission. Healthcare professionals are contacted before admission, when required, to help ensure that the home can meet any physical or dementia care needs. We spoke to two people about their admission and both told us that the staff were very welcoming and their needs were being met. The assessments we looked at had sufficient information to help ensure that the home can prepare for and meet peoples needs. In a survey retuned to us one person stated that they had come to the home for a fortnight to make up their mind if they liked it and then chose to live there permanently. Intermediate care is not provided in the home. Four Seasons DS0000061877.V373322.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. All people have detailed individual care plans that are regularly reviewed to help ensure that their needs are always met. Minor improvements could be made to help with the continuity of care The healthcare needs of people are well met by professionals when required. Medication is well managed, and staff are well trained and supervised to help ensure safe administration. EVIDENCE: We looked at three care plans in detail, two were for people recently admitted to the home. The individual care plans were well written identifying particular care needs and obtaining peoples or a relative’s signature that the information was agreed. We spoke to the relative of a person admitted in an emergency and Four Seasons DS0000061877.V373322.R02.S.doc Version 5.2 Page 13 they were very pleased with the care and felt their relative had been treated with dignity and respect, and they were confident this would continue. The areas covered in the care plans seen included; mobility and a manual handling risk assessment, hygiene and help with dressing, an assessment of tissue viability to help prevent pressure ulcers, continence care, socialising and activities, nutrition and diet, mental health and a night care plan. There were some excellent actions in the care plans for staff to follow, which were reviewed monthly. However, one monthly review could have been more meaningful, and include what had happened during the last month using information from the daily records. Risk assessments are also completed and reviewed monthly. A good example of a falls risk assessment was seen as the person had fallen several times recently. It was identified that the person was reluctant to ring the bell for assistance. The plan to help this was an assessment of how and when the person uses the bell. This person was referred to a physiotherapist and had recently started using a walking frame. There were no recorded life histories but ‘life history boxes’ had been started to help people recall the people, places and events important to them. There was a risk assessment for a person with some short-term memory loss, as they sometimes wander near the unsecured front door, and advise with a strategy plan from the Community Psychiatric Nurse. We looked at the care records of a person with diabetes receiving oral medication and daily assessment of blood glucose levels. The protocol for managing a rise or fall in blood glucose should be individual, however, the general principles were recorded in the homes procedure book for staff to follow. We recommend that the policy for taking a daily blood glucose test is reviewed with a healthcare professional. The daily records were generally detailed, for example we identified that where diet was a problem food and drink taken was recorded there. Activities were recorded separately, it was recommended that the record is kept in the care plan for regular review. Healthcare professional visits are usually recorded in the daily records, however, in one example, discussed with the manager, there was no record. We recommended that an individual record be kept of all health care professional visits and their outcomes to help maintain continuity of care and ease of planning, for example the continence adviser, dentist and optician. We looked at an example of the care plan audits, which helps the deputy manager identify any omissions. We looked at the medication administration procedures and storage. Four Seasons DS0000061877.V373322.R02.S.doc Version 5.2 Page 14 The medication is stored in a new room where there is a fan to assist with keeping the medication at the right temperature. All medication was appropriate and securely stored. A trolley is used to administer medication, however, the home should consider using a carrying case when transporting medication upstairs, if the trolley is not used, ensuring that the records and the medication are both with the person before they are administered to promote safe practice. All liquid medication should be dated when started to ensure safe administration. The medication records were well documented to include controlled drugs, and the use of any homely remedies had been agreed with the doctor. We looked at the homes medication procedure and recommended that the manager downloads the latest medication guidance form the Royal Pharmaceutical Society website. The home had a 2008 copy of the British National Formulary for reference. External trainers train all staff that administer medication, and all were updated in 2007. Staff are supervised regularly to assess their capability to administer medication safely. A visual monthly medication audit is completed, we looked at the record where comments had been made to help improve the records. The monthly count of tablets is brought forward, where required, to ensure that an accurate tablet count can be completed. We recommend that a spot check tablet count be completed regularly and recorded. Four Seasons DS0000061877.V373322.R02.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 excellent. This judgement has been made using available evidence including a visit to this service. People have a choice of group and individual activities, to include occasional trips out in the community and are able to make decisions about how they spend their day. People have a daily choice of freshly prepared food which they enjoy and meets their individual needs. EVIDENCE: All people are provided with a weekly timetable of events, which are also recorded on an audiotape. We saw the activities person playing the tape for people with sight impairment. There are two activity co-ordinators, both have completed an activities course, we spoke to one of them, she was very enthusiastic and we saw many people involved in exercises to music. People choose what to do, which may mean they do not complete any organised activities, as they wish. One person spoken to was content to entertain herself, and also had a talking book as she was registered blind. Other activities include craft sessions, skittles when small prizes are given, watching a film in the afternoons and playing hangman as a group. Individual Four Seasons DS0000061877.V373322.R02.S.doc Version 5.2 Page 16 activities include jigsaws, board games, reminiscence and applying nail polish for the ladies. We also saw some bird seed cakes made previously with the activity co-ordinator. The activity co-ordinator intends to look into providing more free transport for people to go out individually. However, the activity co-ordinator told us there currently no resource restrictions for providing activities in the home. Spiritual needs are met with regular Holy Communion provided in the home and other religious ministers that visit. A new sensory garden was being constructed to allow people to use raised flowerbeds, with additional paving for wheelchair access. We looked at the monthly newsletter, two trips out for people had been organised and two staff have insurance to take people out in their own car. The carers are encouraged to become involved with the activities which helps to ensure that more people have individual attention when required, or that individual trips out locally can be arranged more often. The AQAA told us about the activities the home had completed recently which included going to see the Christmas lights in Stratford-upon-Avon and visits from the local children to sing. Taking people shopping to the local supermarket has become a regular activity for some people. As one activity co-ordinator lives in the village people often get involved with local events, which help them to feel part of the community. One visitor we spoke to was concerned that their relative did very little during the day, however the manager told us that was his choice. We spoke to the person briefly but we were unable to find out what he wanted to do, and we recommended that his doctor be contacted for a review of medication. Of the eight surveys returned to us six stated that there were ‘always’ or ‘usually’ activities people could join in with, one person declined to comment and one said ‘sometimes’. One person told us that the activities were excellent for the more able residents. Three people we spoke to did not want to join in with group activities but would welcome talking to staff more often in their own rooms. Two staff commented in our surveys that; ‘the activities are generally good’ and ‘there are excellent activities and entertainment’. We looked at the menu in the dining room displayed in large print for people to easily read, there was a choice of foods for lunch, we also looked at the recent menus. The two cooks prepare lunch and supper daily, and one plans the weekly menu to take into account seasonal foods and preferences. The care staff ask people about their choice of food the day before. The cook told us that when a new person arrives time is spent with them and they are asked about their food preferences. We saw information in the kitchen Four Seasons DS0000061877.V373322.R02.S.doc Version 5.2 Page 17 about preferences, and any known food allergies or support people may need when eating. Fresh soup is prepared daily as a starter choice for lunch, melon was the other starter choice on the day of the inspection. The food looked appetising and the people we spoke to said the food was good. In the surveys returned to us people told us that they ‘always’ or ‘usually’ liked the food provided. Special diets are catered for to include one high calorie and three diabetic diets. Desserts are made sugar free to provide the same choice for everyone. The cook also has experience in preparing vegetarian meals. The night staff start breakfasts and more choice has recently been added to the menus, to include egg on toast, on Saturdays people can have a fried breakfast if they wish. Supper dishes are prepared by the cook during the morning and served by the three evening care staff later. The dining room looked attractive and a variety of different flavoured squashes and plain water was ready for lunch. Some people preferred eating in their bedrooms. Staff preparing food have a basic food hygiene certificate, this includes nine carers. The Environmental Health Officer’s recent visit had resulted in the home being awarded 4 stars from the local council for their catering environment. We spoke to people about the food and they told us ‘there is always a choice, we have homemade cakes and soup and there is always plenty of food’, ‘’food is quite good’, food alright’, and relatives told us; ‘my mother is eating well’, and ‘the food is very good’. Four Seasons DS0000061877.V373322.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): 16 & 18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People have access to the homes complaints procedure, and the manager takes all complaints seriously. Staff are trained to protect people from abuse and procedures are followed to ensure they are safe. EVIDENCE: The complaints procedure is displayed in the hall and recorded on an audiotape. People also have their own copy of the complaints procedure in the residents’ handbook. We looked at the record of a formal complaint, which was well recorded, and the manager had written a letter to the complainant. The surveys told us that seven out of the eight people that replied knew how to make a complaint. There has been one safeguarding issue investigated in 2008 by the home, where the councils Adults at Risk team were involved and an Independent Mental Capacity Advocate supported the person with dementia care needs. The manager explained to us what happened and we looked at the homes Safeguarding procedures. There was good information available for staff to follow, however, we recommend that the contact details for the local councils Adults at Risk team be added to the procedure. Four Seasons DS0000061877.V373322.R02.S.doc Version 5.2 Page 19 The manager and deputy manage have completed external enhanced Protection of Vulnerable Adults (POVA) training and had trained five care staff as part of their induction training. Eight staff have had specific POVA training. We spoke to four staff individually and they all knew how to recognise abuse and what to do if they suspected abuse with regard to ‘whistle blowing’. We spoke to people living in the home and they told us they felt safe there. Four Seasons DS0000061877.V373322.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): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and safe, the addition of a conservatory has improved the communal space provided and given people more choice where they can relax during the day. The home is clean and free from offensive odours and there are good infection control measures. EVIDENCE: Since the last inspection a new conservatory has been added to the home, providing a quiet space for people to sit and an additional activity area when required. We looked at the conservatory and noted portable heaters that required fixing to the wall to prevent accidents. The maintenance man completed this during the inspection to ensure people were safe. There are also plans to alter the step into the conservatory to improve access and safety. Four Seasons DS0000061877.V373322.R02.S.doc Version 5.2 Page 21 We looked at the new wet room that is used by most people to shower. There were no paper towels for staff assisting to dry their hands and the manager agreed to provide them. A large heated towel rail provides heat for the wet room and was very hot to touch. Many people use the bathroom toilet unattended and the manager was asked to risk assess the rail. This was completed and a guard made immediately by the maintenance person and fitted during the second day of the inspection. We looked in the laundry which was clean and organised and recommended that there is an infection control procedure posted in there to help ensure that staff know the procedure to follow there to prevent cross-infection. An insecure window restrictor was also made safe during the inspection. Portable heaters were removed from two bedrooms to reduce the risk of accidents. The sluice was clean, however, all cleaning material should be locked away when not in use, and the commode in there must not be placed in front of the fire exit. One bedroom had a easy chair and bed table that needed replacing and one commode chair required a cover, the manager immediately completed a furniture audit without finding anything else to be replaced. We spoke to three people in their bedrooms who said that their bed was comfortable. People had personalised their bedrooms with their own possessions and the rooms looked comfortable and inviting. In the last twelve months the lounge carpet has been replaced and the room redecorated, with people able to agree the new colour scheme and one bedroom has had non-slip wood effect flooring fitted for hygiene purposes. The home was clean throughout and free form offensive odours. People told us in our surveys that the home was ‘always’ clean. The home employs a domestic for six days of the week for a total of thirtysix hours. The manager has attended an infection control course and has cascaded the information to the staff and provided some good policies to maintain a safe and hygienic home, which included the importance of correct hand washing. We spoke to the maintenance man who spends two days each week in the home completing any identified jobs, and can be called upon in an emergency as he also works in the companies ‘sister’ home. It was evident from the tasks completed during the inspection that he is efficient and knowledgeable. Four Seasons DS0000061877.V373322.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): 27, 28, 29 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There are sufficient staff to meet peoples current needs and staff are well trained to help ensure they have a good quality of life. The homes thorough recruitment procedures help to protect people. EVIDENCE: Twenty people were accommodated and the manager told us that two people had high dependency needs, eight had medium dependency needs and ten low dependency needs. There are three staff on every morning plus the manager and a recent increase in the evening to three care staff, and an increase at night of two care staff awake on duty and no sleeper. Seven staff surveys were returned to us, six told us there was ‘usually’ enough staff and one told us there was ‘always’ enough staff. staff surveys also told us that ‘ the home is well staffed’, ‘the manager is always there for staff and residents’, ‘the home does a good job if I had to change anything it would be getting residents out of the home more with the family also making an effort’ and ‘staff are trained well and encouraged to train to meet the residents needs’. Four Seasons DS0000061877.V373322.R02.S.doc Version 5.2 Page 23 The manager told us that staffing level are discussed at staff meetings and in supervision sessions. We recommend that a recorded review is completed regularly when dependences changes occur. Six surveys from people living in the home told us that they ‘always’ receive the care and support they need and two told us that they ‘usually’ do. People commented that; ‘the staff are always very kind’, ‘the staff treat me with respect, ‘the staff are very good and respectful’, ‘sometimes there is not enough time for staff to stop and listen’ and ‘it would be nice if staff could take time to talk to us individually sometimes’. The AQAA told us that agency staff have been used recently to cover sick leave. We looked at the staff rotas and they indicated where shortfalls in staffing were filled. We spoke to four members of the care staff individually, including the deputy manager. The staff were positive about their induction and the individual supervision sessions. They all felt well supported and that their training needs had been met. One carer told us that communication in the home had improved with regular staff meetings, the senior carer on night duty also told us that she arranges meetings for the night staff. Staff told us that a lot of training is provided and that end of life care training had just started. The care staff also told us that they had helped with taking people out for walks and with one to one activities, for example jigsaw puzzles The AQAA told us that the local Partnerships for Older People Project (POPP) had made accessing training easier and that staff development is progressing well. We looked at the comprehensive training list for 2008, which included dementia care, first aid, safe handling of medicines, infection control, The Mental Capacity Act, and fire safety. The deputy manger completes the moving and handling training for all staff. We looked at the recruitment records for two new staff and Criminal Records Bureau (CRB) checks for eight people. Care services can only keep CRB checks for six months. The records seen were well organised and contained the required information. One record for a person not yet started required a more detailed employment history to ensure any gaps could be explored. Two references had been obtained for both carers. Four Seasons DS0000061877.V373322.R02.S.doc Version 5.2 Page 24 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, 35, & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed by a competent registered manager that ensures staff are well supported and people living in the home are safe and well cared for. Quality assurance systems monitor what people think about the service to help identify where improvements can be made. Equipment and systems are well maintained to provide a safe environment, however, with the sole responsibility for health and safety the manager may need to complete a health and safety course. EVIDENCE: The Registered Manager has been managing the home since 2005 and is a Registered Nurse (RN) who holds the Registered Manager Award and a post Four Seasons DS0000061877.V373322.R02.S.doc Version 5.2 Page 25 registration teaching qualification. The deputy manager has completed NVQ level 4 in care and a Train the Trainer course in manual handling. He is also currently completing an NVQ in business administration. The manager has an open door policy, which was evident during the inspection for staff, people living in the home and their relatives. We looked at the minutes for one of the regular residents meeting, which is also provided in audiotape form for people with sight impairment. The manager told us that the meetings are used as quality assurance platforms, particularly if changes are required, to help ensure everyone has their say. We looked at the quality assurance surveys, completed by the people living in the home, about the food provided. We recommend that the surveys are audited and information about the results are given to everyone, to include any actions that may be necessary. We checked the safekeeping of personal monies for three people and they were correct, however, we recommend that two signatures are recorded for cash deposited. We looked at the Regulation 26 visit record where the provider had visited the home to help ensure it is run in the best interests of the people living there. The record seen was good as people were spoken to during the visit and care plans and medication had been looked at. The AQAA told us that equipment had been serviced or tested in line with the manufacturers recommendations and that all polices and procedures had been reviewed in 2008. The maintenance person showed us the fire safety log and the fire safety officers report from August 2008, all recommendation had been completed with the exception of the smoke seals for the new fire doors. However, the fixing of the seals were planned. All portable appliance testing had recently been completed. We looked at the monthly audit of accidents, and recommend that the time of the accident is audited as it may help with prevention should staffing levels need to be increased. Individual accident records should be kept in each persons care plan file to help with the monthly reviews. We spoke to the registered manager who is responsible for health and safety in the home. The manager told us risk assessments had been completed for all areas in the home. Appropriate training should be completed to help with the management of this important task, and an outside agency could also help provide regular checks to help ensure that all areas are safe in the home. Four Seasons DS0000061877.V373322.R02.S.doc Version 5.2 Page 26 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 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 3 X X X X X X 4 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 3 X 3 Four Seasons DS0000061877.V373322.R02.S.doc Version 5.2 Page 27 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 OP1 Regulation 5 Requirement The registered person must ensure that the document used as a service user guide contains all the required information. The registered person must ensure that the sluice room fire exit is not obstructed. Timescale for action 20/03/09 2 OP38 4 (b) 20/03/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP7 Good Practice Recommendations We recommend that the policy for taking a daily blood glucose test is reviewed with a healthcare professional. We recommend that an individual record be kept of all health care professional visits and their outcomes to help maintain continuity of care. All liquid medication should be dated when opened to ensure safe administration. DS0000061877.V373322.R02.S.doc Version 5.2 Page 28 3. OP9 Four Seasons 4. 5 6 OP9 OP9 OP18 We recommended that the manager downloads the latest medication guidance form the Royal Pharmaceutical Society website. We recommend that a spot check tablet count be completed regularly and recorded. We recommend that the contact details for the local councils Adults at Risk team be added to the POVA procedure. We recommend that there is an infection control procedure posted in the laundry to help ensure that staff know the procedure to follow there to prevent cross-infection. We recommend that all cleaning material should be locked away when not in use in the sluice room. We recommend that an identified easy chair, bed table and commode chair cover be replaced. We recommend that a recorded staffing review is completed regularly when changes occur. We recommend that the quality assurance surveys are audited and information about the results are given to everyone, to include any actions that may be necessary. We recommend that the registered manager should complete appropriate health and safety training to help with the management of this important task. We recommend that the time of all accidents is included in the audits as it may help with prevention should staffing levels need to be increased. 7 OP26 8 9 10 11 OP38 OP19 OP27 OP33 12 OP38 13 OP38 Four Seasons DS0000061877.V373322.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West 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 Four Seasons DS0000061877.V373322.R02.S.doc Version 5.2 Page 30 - 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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