Care Home: Glenfields Care Home

What the care home does well The service carries out thorough assessments of people’s needs. It produces good working care plans that are regularly reviewed and it makes changes in care when it identifies changes in need. There are good systems for handling medicines in the home that offer people protection and some choice. Privacy and dignity are well maintained. There are some good opportunities to take part in activities and pastimes in the home, and opportunities to be self-determining are also good. There isGlenfields Care HomeDS0000069413.V375815.R01.S.docVersion 5.2excellent provision of food and meals from a very organised and hygienic kitchen and choices are respected. The service has good and effective systems for dealing with complaints and for safeguarding people and there are also good procedures in place to ensure any injustice is reported to the appropriate organisation or body. The environment is very good in many places with personalised, well decorated and furnished bedrooms and communal areas being available to people. Bathroom and toileting facilities are good. There are some isolated issues though that present as only adequate. Hygiene and infection control systems are improving. There are good staffing levels usually within the home, almost sufficient numbers of staff have the recommended qualifications, and there are good recruiting policies and practices in operation, while staff training is generally good, but needs competence checking. There is a very competent manager in post, who needs to be registered. The quality assurance system is adequate and needs developing. There are some very good safe working practices in operation and maintenance checks are sufficient to ensure a safe living and working environment prevails. What has improved since the last inspection? The service has relocated all of the home’s staff recruitment files within the building making them accessible to inspection. It has improved recruitment practices by ensuring references are not testimonials and are now being sent to the manager. The service made changes to how information is recorded in care plans and health care plans and how medication administration is recorded. It has also improved the quality of information held on people. The service has updated the training for staff in safeguarding issues and reporting, and has enabled the manager to be an infection control trainer. The service has developed group training and development plans and is monitoring training needs. What the care home could do better: The service could make sure staff administering drugs are competence checked annually and that this is recorded. Staff should complete full training every three to five years, so people are protected from the risk of harm from taking the wrong medication.Glenfields Care HomeDS0000069413.V375815.R01.S.doc Version 5.2 The service could consider fitting hand washing facilities in the medication room to promote infection control and to protect people from the risk of infection. It could also consider more ways of supporting and facilitating people to take part in the local community, so they can lead fulfilling lives of their choosing. The service could make sure all staff having undertaken training on safeguarding adults, are then competence checked annually to ensure that they are aware of the action to be taken should they observe or suspect any form of abuse. This is to ensure people are protected from the risk of abuse. The service could consider improving the function and safety of the stair lift by having it extended so it fully runs to the ground floor. This may require relocating the access to the bedroom by the stair lift or changing the use of that room. Whatever is decided on there should be a full and detailed risk assessment carried out for use of the stair lift in all situations. This is so people using the stair lift are better protected from the risk of accident. The service could ensure there is at least 50% of care staff with NVQ level 2 or equivalent working in the home. There should be an action plan in place to record how staff will achieve this. This is so people are cared for and supported by staff with the recommended qualifications and skills to do the job. The service could make sure all staff either complete mandatory training each year or at least be competence checked annually, especially in such as safeguarding, medication, fire safety etc. so people are cared for and supported by competent staff. And it could also make sure the manager’s application for registration is submitted to the CQC as soon as possible. Key inspection report CARE HOMES FOR OLDER PEOPLE Glenfields Care Home 7 Montgomery Square Driffield East Yorkshire YO25 9EX Lead Inspector Janet Lamb Key Unannounced Inspection 22nd May 2009 & 1st June 2009 09:15 DS0000069413.V375815.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. Glenfields Care Home DS0000069413.V375815.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 Glenfields Care Home DS0000069413.V375815.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Glenfields Care Home Address 7 Montgomery Square Driffield East Yorkshire YO25 9EX 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) 01377 254042 01377 250688 laura_ann_harding@tiscali.co.uk Glenfields Care Home Ltd Ruth Vine (Unregistered) Care Home 28 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (16) of places Glenfields Care Home DS0000069413.V375815.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC: To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of people who can be accommodated is: 28 2. Date of last inspection 12th July 2007 Brief Description of the Service: Glenfields is a private residential care service that provides accommodation and care for up to 28 older people, including those with dementia. It is situated on the outskirts of the market town of Driffield, in the East Riding of Yorkshire. The home has been extended and refurbished in the last three years, giving an increase in the number of places from 23 to 28. Private accommodation is provided mainly in single rooms but there are also a small number of shared rooms; most bedrooms have en-suite facilities. Communal space consists of two dining areas, a small lounge and a large lounge conservatory. The home, including a garden and secure paved patio area, is accessible to people via the provision of a portable ramp to the front of the house and internally via a stair lift. There is a car parking space to the side of the building for approximately five cars. The registered provider informs us that current accommodation fees range from £398.00 to £575.00 per week. There is a top up charge of £20.00 to £40.00 per week depending on the room size, en-suite or view. Information about the service can be obtained in the statement of purpose and the service user guide on request from the manager. Glenfields Care Home DS0000069413.V375815.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. The key inspection of Glenfields took place over a period of time and involved the sending of an annual quality assurance assessment (AQAA) document to the provider in April 2009. This requested details of the systems and procedures within the home as well as information on the people living there. The AQAA was returned to us just in time, at the end of May 2009. Before receiving it the commission requested surveys be sent to people in the home, their relatives, health professionals and some staff. All of the information gathered in surveys and the AQAA and from notifications etc. was then used to determine what it must be like living there. Then on 22/05/09 Janet Lamb carried out a site visit to test the theories about living in the home and on 01/06/09 a second visit was made to complete the process and to give feedback to the provider, who was unavailable on the first day. During the first site visit people, staff and the manager were spoken to and documents and records were viewed, along with a brief look around the home and in some bedrooms, all with the permission of people concerned. This report sums up the overall findings of the key inspection carried out this year. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: The service carries out thorough assessments of people’s needs. It produces good working care plans that are regularly reviewed and it makes changes in care when it identifies changes in need. There are good systems for handling medicines in the home that offer people protection and some choice. Privacy and dignity are well maintained. There are some good opportunities to take part in activities and pastimes in the home, and opportunities to be self-determining are also good. There is Glenfields Care Home DS0000069413.V375815.R01.S.doc Version 5.2 Page 6 excellent provision of food and meals from a very organised and hygienic kitchen and choices are respected. The service has good and effective systems for dealing with complaints and for safeguarding people and there are also good procedures in place to ensure any injustice is reported to the appropriate organisation or body. The environment is very good in many places with personalised, well decorated and furnished bedrooms and communal areas being available to people. Bathroom and toileting facilities are good. There are some isolated issues though that present as only adequate. Hygiene and infection control systems are improving. There are good staffing levels usually within the home, almost sufficient numbers of staff have the recommended qualifications, and there are good recruiting policies and practices in operation, while staff training is generally good, but needs competence checking. There is a very competent manager in post, who needs to be registered. The quality assurance system is adequate and needs developing. There are some very good safe working practices in operation and maintenance checks are sufficient to ensure a safe living and working environment prevails. What has improved since the last inspection? What they could do better: The service could make sure staff administering drugs are competence checked annually and that this is recorded. Staff should complete full training every three to five years, so people are protected from the risk of harm from taking the wrong medication. Glenfields Care Home DS0000069413.V375815.R01.S.doc Version 5.2 Page 7 The service could consider fitting hand washing facilities in the medication room to promote infection control and to protect people from the risk of infection. It could also consider more ways of supporting and facilitating people to take part in the local community, so they can lead fulfilling lives of their choosing. The service could make sure all staff having undertaken training on safeguarding adults, are then competence checked annually to ensure that they are aware of the action to be taken should they observe or suspect any form of abuse. This is to ensure people are protected from the risk of abuse. The service could consider improving the function and safety of the stair lift by having it extended so it fully runs to the ground floor. This may require relocating the access to the bedroom by the stair lift or changing the use of that room. Whatever is decided on there should be a full and detailed risk assessment carried out for use of the stair lift in all situations. This is so people using the stair lift are better protected from the risk of accident. The service could ensure there is at least 50 of care staff with NVQ level 2 or equivalent working in the home. There should be an action plan in place to record how staff will achieve this. This is so people are cared for and supported by staff with the recommended qualifications and skills to do the job. The service could make sure all staff either complete mandatory training each year or at least be competence checked annually, especially in such as safeguarding, medication, fire safety etc. so people are cared for and supported by competent staff. And it could also make sure the manager’s application for registration is submitted to the CQC as soon as possible. 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. Glenfields Care Home DS0000069413.V375815.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Glenfields Care Home DS0000069413.V375815.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. 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. Information provided to people about the service is good, contracts are appropriate, and assessments of need are good and carried out thoroughly. Intermediate care is not applicable. EVIDENCE: Discussion with people in the home, the manager, staff and provider and administrator, and viewing of some of the home’s documents and files with permission from those they concern shows people have their care and other needs well assessed and documented. Glenfields Care Home DS0000069413.V375815.R01.S.doc Version 5.2 Page 10 The ‘statement of purpose’ and ‘service user guide’ are both current having been updated since the last inspection we are told, though these were not viewed on this site visit. Contracts of residence were only briefly discussed, and not viewed. The provider informs us almost two thirds of people in the home are privately paying for their care with the East Riding of Yorkshire Council and North Yorkshire County Council funding about one third. A blank private paying contract only was seen, as the provider maintains strict confidentiality. Assessments of need are carried out using the Standex range of care plan documentation, which are all inclusive and are colour coded for the different forms used. The assessment itself covers physical and psychological needs and contains information on ‘physical needs’ (personal care, dressing, observations, sleeping, vision, hearing, oral hygiene, foot care, GP, eating and drinking, breathing, mobility, elimination, skin integrity, falls, safety and risks), and on ‘psychological needs’ (work and play, personal history, cognition, personality, memory, contentment, numeracy, sexuality, emotions, hobbies, medical report, hospital stays, family details, social aims and objectives, and home circumstances). People say they are asked about their needs before coming to the home and are part of the on-going process to make sure their needs continue to be met. One says she was initially given a room on the upper floor but was offered a ground floor room as her mobility deteriorated. Another says he wishes to remain independent and though his slowness makes this difficult the manager and staff have acknowledged his need to do as much as possible for himself. There are also risk assessment documents in place that cover such as build and weight and height, skin integrity, continence, mobility, sexuality, special risk factors, and a malnutrition screening tool. There are also risk result sheets showing such as falls and injuries. Finally there is a dependency profile that is completed monthly. Assessments of need follow the basic format of the Standex system but also relate to individuals in that they cover individual and specific needs relating to specific areas. People have good assessments of need in place. Glenfields Care Home DS0000069413.V375815.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. 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. People have their health and personal care needs well met and their privacy and dignity satisfactorily upheld, because there are clear and current care plans in place for staff to follow, and handling of medication is good, well managed and recorded, and staff are respectful and well guided by their manager. EVIDENCE: Discussion with people in the home, manager and staff and the provider and administrator and viewing of some documents in files with permission from the people they refer to, reveals the area of health and personal care continues to be well monitored and met. Glenfields Care Home DS0000069413.V375815.R01.S.doc Version 5.2 Page 12 There are good, clear care plans in place that contain information on people’s individual and diverse needs and which inform staff how to meet assessed needs. Care plans are completed using the Standex system showing care plan and any relating records and documents and they only cover the areas relevant to each individual, so that someone fairly self caring has fewer cards or areas of need to be assisted with, while someone much more dependent has more. Two plans seen were dated 15/05/08 and 29/01/09. Recommendations at the last key inspection to show consistency in monthly reviews of care plans, make sure elimination charts are only used if really needed and for all personal care given to only be recorded in care plans are now being met. Details re changes in need are recorded on diary notes, on hand over sheets and activity sheets if appropriate. Care plans cover all health care needs as well, and there are records of weight, visits from or to the GP and hospitals, treatment from the District Nurse and so on. There is good evidence of monthly reviews of care plans and of twice yearly reviews involving placing councils and relatives and other stakeholders. Diary notes, charts and records all evidence how and when care or health care or support is provided. People say their health needs are well met and that they only have to place their finger on the call system and someone is there to assist them. There is a medication administration policy and procedure in place that also covers self-medication, and practice observed shows staff performance is satisfactory and safe as far as can be determined. The recommendation made at the last key inspection to make sure medicines not required are recorded on medication record sheets is being met, but fitting of a wash hand basin in the medical room has not been completed. As an alternative measure there is now a dispenser for alcohol scrub in the medical room. A wash basin is still recommended and should still be considered whenever possible. Practice in handling medicines is satisfactory. They are receipted into the home by the manager, they are stored in a locked facility in a designated medical room and they are administered in a methodical manner. Senior staff administers medicines by identifying the person requiring them, selecting the correct medication, offering it to the person in a plastic pot and with water and waiting for them to take it. Then staff records the administration on the medication administration record sheet. Medicines are taken round the home in a lockable dispensing trolley. Recording sheets seen are completed appropriately. Information from staff in interview shows those administering medicines have satisfactory training to do so, completing a Boots Chemist course that involves the completing of a competence booklet and having this externally checked. Certificates are held in files or displayed on the home’s walls. Once trained Glenfields Care Home DS0000069413.V375815.R01.S.doc Version 5.2 Page 13 staff should then have their competence to administer medications checked annually by the manager, and this should be recorded as evidence. This is a recommendation of this report. People say they are happy with the medication arrangements. One says she keeps her eye drops in her bathroom cabinet, but her tablets are brought to her. When she was at home she looked after all her medicines, but now it is easier for the staff to administer them. People have their privacy and dignity satisfactorily upheld, as any medical consultations or personal care is carried out in their room, they are addressed according to their wishes, they receive their mail unopened and they may have a key to their room if capable and risk assessed as such. People say they are very well cared for and treated with respect. Glenfields Care Home DS0000069413.V375815.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 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. People have opportunities to engage in good activities in the home, but any outside event is with family or friend assistance. People are satisfactorily helped to exercise choice and control over their lives and they receive a very good, wholesome and appealing balanced diet. EVIDENCE: Discussion with people in the home, manager and staff, and viewing of some of the records and documents with permission from the people they refer to shows the daily life and social activities within the home are varied and satisfying. People have contact with relatives and friends and with the local community if relatives etc. take them out, but the company policy and practice does not facilitate routine outings and contact with the community, though there are no restrictions on going out. Glenfields Care Home DS0000069413.V375815.R01.S.doc Version 5.2 Page 15 Information to this effect should be very clearly stated in the home’s statement of purpose and service user guide, so people are informed of the policy before admission. Evidence that outings are scarce comes from people spoken to in the home and in surveys returned from people and staff. People say “There are always things to do here and we can go out anytime with our families.” Another person says, “I am moving to another home shortly and when I do they will take me out more if I am well enough.” Staff say, “I would like to see the residents go out more on day trips or just out for fresh air,” “More activities could be offered on a regular basis and if possible outings now and again,” and “We could possibly take residents out on outings, in a group or singly,” and finally “Families often take people out.” Activities that take place in house are, people tend to listen to radio, watch television later in the day, converse with visitors, feed and watch the birds in the garden, engage in board and card games if inclined as many are available, and sit out in the courtyard in fine weather. People tell us there are seasonal celebrations and such as a garden party in the summer, and one person has a computer and says he spends time dealing with business matters. There is also a volunteer activity person who visits once a week to discuss current issues and facilitate a sing-along or a reminiscence session. People gather for this in the large conservatory lounge in the new extension, and several were observed requiring motivation to join in. Staff say they would like to spend more time with people, passing the time of day doing activities or going for walks, in their roles as key workers. The recommendation made at the last key inspection to show people’s previous lifestyles in their care plan is now being met with a brief history. These are being worked through with people and are nearly all complete. People are able to exercise choice and make their own decisions where possible, and to handle their own finances. People say they can go out when and if they wish to, can rise and go to bed when they choose, decide on seeing visitors, can have a key to their room if they wish, though few do, and have a phone line in their room. Newspapers and books are available and people may join in with activities in the home if they choose. Those that are less able rely on staff to advocate for them and to include them in whatever is happening in the home. The policy of the home on handling peoples’ money is that it shall not be handled under any circumstances. People tell us they usually have family members or solicitors to handle their finances and that they are quite satisfied with the arrangements. Everyone says they have sufficient money in their possession for their needs. One person says “My daughter overseas handles Glenfields Care Home DS0000069413.V375815.R01.S.doc Version 5.2 Page 16 my finances, though I have my own cheque book and can obtain money when I need it. I have no worries about money.” Many people have brought possessions of their own to furnish their room and to personalise it. People enjoy a very good standard of food provision, which is prepared in and presented from a very well organised and well equipped kitchen, run by an efficient and experienced chef. There is a newly upgraded and equipped kitchen that has had new floor covering, units, work surfaces, windows and fly screens, cooker, extraction, sinks and storage. A new dish washer has also been purchased and is soon to be fitted. All of the work was planned in consultation with the environmental health department. The kitchen is extremely clean and organised. The chef says he has good budgets to work with and orders food stores as he needs them from a local supplier and a local butcher. The registered provider purchases necessary cleaning materials on a regular basis. Systems work well. There are nutritious menus in place that are changed every four weeks and that take account of medical diets, preferences and requests, and this is done in consultation with the manager and from information obtained from people living in the home. The chef says there is always plenty of fresh fruit available to people, their weights are regularly checked, special diets are prepared for diabetics and those wishing or needing to loose weight, and each person has their own intake record. The chef meets with people in the home to determine satisfaction, choices and preferences or requests for different meals, though people say they are not consulted about menu compilation. It seems they contribute to compiling menus without realising. They do say they would be given an alternative meal if they did not like what was offered. One person says, “The food is very good. I am not particularly fussy though as I was in the army three years, and I’ve learned to take what comes.” Another says, “The food is lovely, we have nothing to grumble about.” People observed taking lunch show satisfaction with the meal, which was fried fish, chips and mushy peas, on the day of the site visit, it being Friday. People sit at tables set with table cloth, placemats, napkins, salt and pepper and tartar sauce, with fruit juice served in wine glasses. The outcome score for the standard on ‘meals and mealtimes’ is ‘exceeded.’ Glenfields Care Home DS0000069413.V375815.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 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. There are good systems in place to deal with complaints, for people to be represented and for people to be protected from risk of harm. Systems and procedures have been tested for effectiveness and prove to be appropriately effective. EVIDENCE: Discussion with people in the home, manager and staff and viewing of some of the records and files with permission of the people they refer to show the home continues to have effective complaint and protection systems in place and in use. There is a written policy and procedure on dealing with complaints, which is clearly written in the ‘statement of purpose’ and ‘service user guide’ and of which people are informed verbally as well. People spoken to say they would talk to any carer first, then the manager to make their representations and generally show confidence in the process. People also say they have no cause to complain. There is a record held in the home of complaints made, as well as compliments. Several letters of compliment and satisfaction, received since the last key inspection, are available for viewing. Only two issues have arisen Glenfields Care Home DS0000069413.V375815.R01.S.doc Version 5.2 Page 18 in that time and these have been appropriately dealt with. One was about restricting a person using their electric mobility aid and the other was about inappropriate foods being brought in. Both were satisfactorily resolved. There is a safeguarding adult’s policy and procedure in place for staff use and staff interviewed show they are aware of their responsibilities for reporting issues. Staff have received some protection of vulnerable adult’s training and have completed in-house safeguarding adult’s training via completion of workbooks and so the recommendation made at the last key inspection to make sure all staff completes safeguarding adult’s training has now been met, with the exception of new staff. Certificates are available as evidence. The manager has also completed the manager’s training on safeguarding adults. Staff should have their understanding of and competence to handle safeguarding issues checked annually and recorded, and full training should be completed every three years minimum. People spoken to say they are treated politely and are not aware of any issues in the home regarding mistreatment or abusive behaviour. They say they would surely recognise or get to know if anyone was being badly treated. Glenfields Care Home DS0000069413.V375815.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People experience a well decorated, clean and comfortable environment that in many parts is very good. Infection control systems are adequate though and could be better. The safety of the home is not entirely good and could be better. The laundry is adequate and almost meets requirements of the standard. EVIDENCE: Discussion with people in the home, manager and staff and viewing of some of the communal areas and private areas of the home with permission shows the environment is well maintained, clean and comfortable. Glenfields Care Home DS0000069413.V375815.R01.S.doc Version 5.2 Page 20 Rooms seen are very well decorated and furnished and some are very personalised. People spoken to say they are satisfied with their environment and the cleanliness of the home in general. There is a general programme of maintenance and the company maintenance man deals with other issues as they arise. A recommendation made at the last key inspection to make sure all fire door closers on bedrooms are connected to the fire safety system, has been partly met and where this could not be achieved magnetic self closers have been fitted. However, three people living in the home purchased these for their bedrooms and the cost should have been borne by the provider, who following discussion agreed to reimburse people. The provider supplied magnetic self closers to the kitchen and to the small lounge. The laundry is adequate for the volume of washing to be done, though staff say they would prefer to have a few more resources such as specialist wash bags that deal with soiled linen. The laundry meets the requirements of the Water Supply (Water Fittings) Regulations 1999, as far as can be determined. There is no hand washing facility in the medical room. The recommendation to fit a wash hand basin in the medical room on the last key inspection report has not been addressed, though alternative measures have been put in place and alcohol scrub is now available in this room. The recommendation to fit a basin in the medical room remains on this inspection report. We are told there is one person with an ileostomy bag and several people have double incontinence. In May 2009 the manager trained to be an infection control trainer and is to provide infection control training to all staff in the very near future so the recommendation made at the last key inspection to make sure all staff completes infection control training will soon be met. Other observations on the day of the site visit reveal the stair lift to be inadequately fitted resulting in it stopping one stair short of the ground floor to enable safe access to a person’s bedroom. This means people have to get on and off the lift on the last step, so those with walking aids are at a disadvantage. A platform has been made to act as a wider step and is put in place each time someone with a frame uses the stair lift. This is then a hazard to the person whose bedroom door is by the stairs. The home is making the best of a difficult and hazardous situation, but this is by no means ideal. Future plans for the extension of the home or the relocation of bedrooms must take this into consideration. Suggestions have been discussed. Providers are asked to seriously consider these. Glenfields Care Home DS0000069413.V375815.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are well supported and cared for by staff in sufficient numbers and with the right qualifications to meet their needs. Staff are well recruited and they have good training opportunities. EVIDENCE: Discussion with provider, manager and staff and viewing of some of the staffing records and documents in the home shows there are sufficient staff on duty each shift, that are appropriately qualified and trained. Recruitment systems are adequately followed. There is a written staff roster that reflects the actual numbers of staff on duty each shift, usually four care staff plus manager in the morning, three carers plus manager in the afternoon, three carers in the evenings and two carers at night. The manager spends some of her contracted hours assisting with care tasks. This reduces to just care staff at the weekends. Staff in interview say they usually cover when vacancies arise or holidays are taken, but they also say there could be more care hours allocated to allow them to spend more quality time with people. However rosters and observation of workload and Glenfields Care Home DS0000069413.V375815.R01.S.doc Version 5.2 Page 22 discussion with people who say their needs are well met, show there are adequate staffing hours for the numbers and needs of people in the home. Staff have opportunities to undertake NVQ level 2 and 3 and AQAA information provided shows there are 4 with level 2 and two with level 3. Further down the AQAA says there are eighteen care staff in total and 9 of them have or are soon to complete level 2. This is contradictory and shows there are either 33.5 or 50 of care staff with the recommended qualifications. Either way the home needs to continue efforts to ensure at least 50 of care staff achieve the qualification. There is a recruitment policy and procedure in place and practice generally seems to follow these. Two files seen show application forms, references, dates of employment, full security checks, though no initial security checks for either staff, induction for only one and training certificates etc. People have contracts of employment. Requirements made at the last key inspection to hold recruitment files in the home and to have references returned to the manager and not rely on testimonials are now being met. Training opportunities are available and backed up in interview with staff and with certificates on display. People have done such as fire safety, diabetes, safeguarding adults, medication administration, first aid, dementia, and health and safety. Assisting people to move and Parkinson’s courses are booked for the end of June 2009. Infection control is also to be completed shortly. Mandatory training courses need to be kept up to date and either be completed annually, or where appropriate staff should be competence checked annually and have this recorded. All other training should be done as necessary. This should now be easier to maintain as there is a training and development plan in place for all staff, following a recommendation made at the last key inspection to produce group and individual staff training and development plans. This is now overseen and managed by the deputy manager. Individual staff training and development plans are still to be set up. Glenfields Care Home DS0000069413.V375815.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well run care home, run by a competent and trained manager, though one that is still not registered. People benefit from a satisfactory quality assurance system, though their finances are not dealt with by the home as a matter of policy and are therefore not applicable. People do have the benefit of their health, safety and welfare being satisfactorily promoted and protected. EVIDENCE: Glenfields Care Home DS0000069413.V375815.R01.S.doc Version 5.2 Page 24 Discussion with provider, manager and staff and viewing of some of the homes records and maintenance certificates etc. show the home is still managed by an unregistered manager, that the quality assurance system has developed somewhat and needs further development to include some in-house quality audits, that handling of people’s finances continues to not be the responsibility of the home, and that generally safe working practices are followed. An application for the current manager to become registered was sent to the Commission in June 2006, but a search through the Commission’s file for this service shows it was returned as incomplete. (It needed a security check form from the Criminal Records Bureau, a medical form, the correct fee since an increase had occurred in April 2006, and it needed a new format application form, which also changed April 2006.) A security check form was sent to us in August 2006 but this was also returned as the address history had not been completed. In October 2006 copies of the new forms were sent to provider and we wrote to the provider early in November 2006 asking for the new application to be returned. On 11 November a second set of forms were sent to provider and a third set sent in December. Meanwhile an application to extend the property and increase the number of places to 28 was processed and on 12 January 2007 a new certificate for the extension was issued. The manager application had still not been resolved and no application has been received since 2006 so the recommendation made at the last key inspection to submit an application to register the manager has not been met. Discussion with the provider and her spouse and administrator show a determination and willingness on all parts to have the current manager registered with the Commission. Details of the situation have been passed to the Commission’s Regional Registration Team for information on how to move forward, but it is still a recommendation of this report that an application is necessary, unless information to the contrary comes forward. Any such information will be passed to the provider. There is a quality assurance system in place which involves surveying people, relatives and stakeholders, and holding ‘resident,’ staff and management meetings on a regular basis. There are no formal systems of quality auditing parts of the service though and this is where the quality assurance system needs developing. Currently seeking people’s views and holding meetings for them to comment and contribute is a satisfactory and important start. Finances belonging to people in the home continue not to be the responsibility of the home as per the home’s financial policy on handling money. There are no records or audit sheets to inspect for this reason. Glenfields Care Home DS0000069413.V375815.R01.S.doc Version 5.2 Page 25 Areas sampled to determine safe working practices are followed were health and safety checks, fire safety, legionella and hot water checks, and bath hoist and stair lift maintenance. There is a health and safety file which contains checklists for such as COSHH products, clinical waste, electric, gas and water supplies, portable appliance testing, slips, trips and falls, medications used, window restraints, and working at heights and working with stress. There are also many risk assessment documents in relation to these areas. Someone should have responsibility to ensure the risk assessments are reviewed annually and recorded as such. There is a ‘JG Fire Protection’ fire safety check file which contains a log book, a fire risk assessment, details of the last Humberside Fire and Rescue visit of 07/02/08, a second risk assessment document dated 26/07/06, which does not evidence when it was reviewed, and information on fire training and checks on the system. The home must show all staff undertakes a minimum of two fire safety training drills in each twelve month period with the signatures of those attending. The last full check on fire systems and panel and extinguishers was done 19/06/08, and therefore is soon to be renewed. There are weekly checks on the alarms, and three monthly checks as well, there are monthly checks on the lights etc. Night staff have a responsibility to check all fire doors are closed at the beginning of their shift and record that they have done so. All of this is overseen by ‘JG Fire Protection.’ There is a three yearly check on the hot water storage system for detecting legionella with the last one done 19/06/07 and weekly water outlet temperature checks, there is a maintenance check on the bath hoist by a company called LMB done 08/04/09, and there are maintenance checks on the stair lift by Brittanic Lifts done 20/10/08 and 14/05/09. Systems and equipment are sufficiently serviced, maintained, checked and recorded and certificated. Glenfields Care Home DS0000069413.V375815.R01.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X N/A X X 3 Glenfields Care Home DS0000069413.V375815.R01.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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations The registered provider should make sure staff administering drugs are competence checked annually and that this is recorded, and they should complete full training every three to five years, so people are protected from the risk of harm from taking the wrong medication. The registered provider should still consider fitting hand washing facilities in the medication room to promote infection control and to protect people from the risk of infection. The registered provider should consider more ways of supporting and facilitating people to take part in the local community, so they can lead fulfilling lives of their choosing. The registered provider should make sure all staff having undertaken training on safeguarding adults, are then competence checked annually to ensure that they are aware of the action to be taken should they observe or DS0000069413.V375815.R01.S.doc Version 5.2 Page 28 2 OP9 3 OP13 4 OP18 Glenfields Care Home 5 OP22 6 OP28 7 OP30 8 OP31 suspect any form of abuse. This is to ensure people are protected from the risk of abuse. The registered provider should consider improving the function and safety of the stair lift by having it extended so it fully runs to the ground floor. This may require relocating the access to the bedroom by the stair lift or changing the use of that room. Whatever is decided on there should be a full and detailed risk assessment carried out for use of the stair lift in all situations. This is so people using the stair lift are better protected from the risk of accident. The registered provider should ensure there are at least 50 of care staff with NVQ level 2 or equivalent working in the home. There should be an action plan in place to record how staff will achieve this. This is so people are cared for and supported by staff with the recommended qualifications and skills to do the job. The registered provider should make sure all staff either complete mandatory training each year or at least be competence checked annually, especially in such as safeguarding, medication, fire safety etc. so people are cared for and supported by competent staff. The registered provider should make sure the manager’s application for registration is submitted to the CQC as soon as possible. Glenfields Care Home DS0000069413.V375815.R01.S.doc Version 5.2 Page 29 Care Quality Commission Yorkshire & Humberside PO Box 1251 Newcastle Upon Tyne NE99 5AN 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). 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. 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