Care Home: Heathers, The

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What the care home does well The home provides people living there with a warm and caring environment and a comfortable place to live. The standard of care is very good with staff understanding individual needs. One resident spoken to told the inspector that staff were "very good" and, whilst she could do most things for herself, staff gave help where she needed it. She felt safe and would, if looking for more permanent care, consider The Heathers. Relatives wrote the following: "My mother is very happy and I feel fortunate to have found such a lovely home for her." "The Heathers is a very comfortable, homely and friendly place."Care staff provide individuals with an environment where they can choose how to spend their days and make decisions for themselves balancing independence with risks as they would in everyday life. "I feel X is being cared for exceptionally well at "The Heathers". She has many needs after a long stay in hospital and the carers have made every effort to help her and make her feel at home" a relative wrote on the comment card sent to us. Staff have built good relationships with people in the home and understand their needs very well and ensure any healthcare issues are dealt with appropriately and within a good timescale. The GP said "The service provides a high standard of care, taking professional responsibility and seeking advice appropriately" and the District Nurse told us that the home was "excellent" particularly the manager`s healthcare knowledge. The good relationships between people living there and the manager and staff enables any concerns or complaints to be raised and responded to appropriately to improve the care for individuals. Many spoke of Helen`s kind, caring yet professional approach to the people living in the home. Food is of a satisfactory quality and quantity and provided in a relaxed and social manner for people to enjoy not only the meal but also the company. What has improved since the last inspection? The Providers have been involved in improving the environment to ensure they offer a well-maintained and comfortable place for people to live. The new manager has been busy since commencing in January. She has reorganised the office area and started to improve the care planning and risk assessment information for all residents. She has also reduced the overstocking of medication and set up a system for monitoring and auditing medication practices. What the care home could do better: We understand that the manager has been in post for a few months and see signs of improvements taking place particularly in relation to the management and administration. We also recognise that this is a continuing process and that time is needed to make the necessary changes.However there are some areas that are repeated from the last inspection that remain outstanding and that may affect the health, safety and well-being of residents and therefore must take priority. There were two areas regarding the environment that must be addressed to ensure the comfort and safety of residents. One of these was completed prior to the inspection report being sent. The Provider and manager are also reminded of the need to ensure all areas of the home inside and out are accessible to all residents. An immediate requirement was also made regarding the fire alarm system and the checks required. A second visit to the home confirmed the immediate requirement was met. The Provider and manager were also reminded of the need to ensure checks are made on the water system for legionellas and to undertake a review of the service to ensure they are providing the care required by those living in the home. CARE HOMES FOR OLDER PEOPLE Heathers, The 35 Farnaby Road Shortlands Bromley Kent BR1 4BL Lead Inspector Wendy Owen Key Unannounced Inspection 15th April 2008 09:00 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 Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heathers, The Address 35 Farnaby Road Shortlands Bromley Kent BR1 4BL 020 8460 6555 020 8697 6979 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) The Heathers Residential Care Home Ltd Care Home 12 Category(ies) of Old age, not falling within any other category registration, with number (12) of places Heathers, The DS0000067267.V362692.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 (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 12 27th July 2007 Date of last inspection Brief Description of the Service: The Heathers is two adjoining, older style converted and extended semidetached houses located in a quiet residential area of the London Borough of Bromley. It is within a short walking distance of local shops and public transport. The home is on three levels with service users accommodated on all three floors, accessed by a lift. All bedrooms have single occupancy with some benefiting from en-suite facilities. Each floor has a kitchenette and there is a lounge and dining room on the ground and first floor. There is limited off street parking to the front of the house, which has an attractive, well-maintained garden to the rear. A veranda provides extra outside space for residents wishing to spend time in the open air. The home came under new ownership in 2007 and a new manager has been post since January 2008. Information is provided in the form of a Service Users Guide and Statement of Purpose both of which are in written format. Details of the terms and conditions of residency are included in this information. Fees range from £500.20-£600.00 (for en-suite rooms). Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 5 Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 2 star. This means the people who use this service experience good. This unannounced inspection included a visit to the home over two days. During the visit we toured the home, spoke to people living there, staff the manager and health professional. We also looked at a variety of records. The inspection also included obtaining written feedback from residents, relatives and other professionals and viewing of the current information we have on the service. The service has only recently been sent the annual quality assurance form to be completed and therefore this has not been included as part of this inspection. The manager is new to the home, being appointed in January 2008 and she is currently applying for registration with the Commission. What the service does well: The home provides people living there with a warm and caring environment and a comfortable place to live. The standard of care is very good with staff understanding individual needs. One resident spoken to told the inspector that staff were “very good” and, whilst she could do most things for herself, staff gave help where she needed it. She felt safe and would, if looking for more permanent care, consider The Heathers. Relatives wrote the following: “My mother is very happy and I feel fortunate to have found such a lovely home for her.” “The Heathers is a very comfortable, homely and friendly place.” Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 7 Care staff provide individuals with an environment where they can choose how to spend their days and make decisions for themselves balancing independence with risks as they would in everyday life. “I feel X is being cared for exceptionally well at “The Heathers”. She has many needs after a long stay in hospital and the carers have made every effort to help her and make her feel at home” a relative wrote on the comment card sent to us. Staff have built good relationships with people in the home and understand their needs very well and ensure any healthcare issues are dealt with appropriately and within a good timescale. The GP said “The service provides a high standard of care, taking professional responsibility and seeking advice appropriately” and the District Nurse told us that the home was “excellent” particularly the manager’s healthcare knowledge. The good relationships between people living there and the manager and staff enables any concerns or complaints to be raised and responded to appropriately to improve the care for individuals. Many spoke of Helen’s kind, caring yet professional approach to the people living in the home. Food is of a satisfactory quality and quantity and provided in a relaxed and social manner for people to enjoy not only the meal but also the company. What has improved since the last inspection? What they could do better: We understand that the manager has been in post for a few months and see signs of improvements taking place particularly in relation to the management and administration. We also recognise that this is a continuing process and that time is needed to make the necessary changes. Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 8 However there are some areas that are repeated from the last inspection that remain outstanding and that may affect the health, safety and well-being of residents and therefore must take priority. There were two areas regarding the environment that must be addressed to ensure the comfort and safety of residents. One of these was completed prior to the inspection report being sent. The Provider and manager are also reminded of the need to ensure all areas of the home inside and out are accessible to all residents. An immediate requirement was also made regarding the fire alarm system and the checks required. A second visit to the home confirmed the immediate requirement was met. The Provider and manager were also reminded of the need to ensure checks are made on the water system for legionellas and to undertake a review of the service to ensure they are providing the care required by those living in the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 6 N/A Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good information is provided on what the home has to offer and information gathered on people prior to their moving into the home. This gives staff a picture of the individual’s needs and how to meet these. People can spend time in the home to find out what it would be like to live there and to enable the service user to make a choice about living in the home, within their capacity to do so. Service users have contracts and therefore have information about the service that they are entitled to. EVIDENCE: Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 11 The Service Users Guide and Statement of Purpose have been updated and a new brochure in place. These are comprehensive and well-written documents that give the reader a very good idea of the type of care provided and the service offered. The Service Users Guide is written in large print and together with the brochure provides good information. It is also available on tape for those that request it and a copy provided to all residents. The brochure presents a warm and inviting picture and is written with sensitivity. We recommend the Service Users Guide includes a service users’ view of the home. The admission procedures are good and the pre-admission information on the last three people admitted was complete with assessments and letters confirming they were able to meet their needs. The exception to this was the lack of a record of the property brought in with them. There was evidence from the files that terms and conditions are provided and signed by resident or their relatives. This is also the case for respite service users. Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive the care and support that meets their individual needs and the staff team support them to get the healthcare that they need. People are given regular prescribed medication safely. The principles of respect, dignity and privacy are observed in the practice of the staff team. EVIDENCE: The manager is currently updating the care planning and risk assessments for each person which includes changing the format. We viewed three of these and they appear to have good information about the individuals needs and Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 13 include some risk assessments. As the manager is currently reviewing all of these and implementing the new system this is not yet complete and there were gaps in some of the risk assessments. Viewing these and talking to the manager it is clear if this system is adopted in full for all individuals then staff will have comprehensive information about the individuals needs. Written feedback and feedback on the day was generally positive about the care provided. We were told that staff understand their needs although, for some, the use of agency staff does upset this at times because they are not so aware and need to be told what to do etc. The care manager of a recent person admitted recently wrote how much the individual had improved since being admitted and cared for by staff. We received a number of positive comments including those from families who were very positive about the care provided by the manager and staff “My mother has been treated warmly by the staff and she has been extremely well looked after. She loves the food and her attractive room. She enjoys the pleasant surroundings, the garden and the company of other residents. She feels safe and secure. She particularly likes Helen, the manager, who has put in a special effort for her. All my relatives share my very positive attitude to the home.” Another said “My father has only been in The Heathers since January and he seems to have settled very well. He looks healthier and well cared for.” “I feel my mother is being cared for exceptionally well at “The Heathers”. She has many needs after a long stay in hospital and the carers have made every effort to help her and make her feel at home.” We observed a number of individuals and spoke to three in detail as well as receiving comment cards from 3 residents, 2 relatives and one health professional. We noted how well cared for people looked and the attention to the personal care and grooming. The hairdresser visits once a week and private chiropody appointments are made regularly. One resident spoken to told the inspector that staff were very good and, whilst she could do most things for herself staff gave help where she needed it. She felt safe and would, if looking for more permanent care, consider The Heathers. Most people spoken to were positive although there is some issues about the suitability of a resident and how this has an impact on others. This is possibly Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 14 affecting some individuals’ current views. The manager is in the process of reviewing this individual’s needs. There was evidence that the healthcare of residents is being well met with all being registered with the local GP. The GP feedback was positive and she wrote “The service provides a high standard of care, taking professional responsibility and seeking advice appropriately.” Relatives also feel pleased because staff are very good at communicating with family and health professionals where they believe there to be some concern about the individuals’ health. “Any problems are discussed with me either in person or on the telephone” said one relative. We were particularly impressed with a letter from consultant caring for one resident commending the home on the care of their patient. “My view is that they (staff) should be very proud of the care they are able to provide their residents.” One District Nurse spoken to told us about the “excellent care” provided by staff and of the excellent knowledge of the manager in respect of individuals’ health care. She was most positive about the care and had no doubts about the health and well-being of the residents with staff communicating well and appropriately. An audit of the medication practices and procedures took place. The manager has re-organised this since commencing in the home. There is a mobile drugs trolley and a lockable store cupboard to store medication. There is an agreement/contract between Boots pharmacy and the home for the supply of medication and monitoring of the systems and therefore all prescribed medication is dispensed by Boots in the form of blister packs along with preprinted medication administration records. (MAR) All mars had a photo of the resident attached. We noted that a the pharmacist had not audited the system for a considerable time (over 18 months) although prior to writing the report a visit had taken place. A new fridge had been purchased a result of the visit. Auditing of the records showed them to be generally complete, although there were some issues. Seven records were viewed and showed generally medication was signed in by staff. A number of the records did not have the allergies recorded and medication had not been carried forward from one month to the next. These areas had been addressed prior to the report being written and a monitoring system set up with an audit already completed. Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 15 Where there were hand transcriptions these had been counter –signed and where variable doses required this had been recorded. Currently one person has controlled drugs prescribed. These had been recorded appropriately and stored in a CD cupboard within another locked cupboard. An appropriate CD cupboard had been obtained and fitted a few days later. A number of residents are self-administering some of the prescribed medication. This is good practice as it shows individuals independence is being promoted. However, the last inspection identified the need for risks assessments and records to be in place where this is the case. Homely remedies are in place, although there are no records as to what medication is received into the home and what is administered. It was positive to note that whilst visiting to check compliance with an immediate requirement the manager provided evidence that showed the areas identified to be met and procedures developed to ensure staff follow good practice. One person had been prescribed oxygen and it is positive to note that the manager had undertaken a risk assessment to ensure people are kept safe. The manager was advised of CSCI guidance on controlled drugs and the guidance for care homes on administration of medication and had by the second visit obtained a copy of the guidance and had commenced a number of improvements. It is clear from observation and feedback that staff are well aware of how to treat people and that they value them as individuals. They also ensure they respect their right to privacy and choices that they make. Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The routines of the home enable individuals to live the life they choose. Meals provided are healthy and varied providing people with adequate nutrition. EVIDENCE: Residents are encouraged to spend their days as they wish with many preferring to spend their days in the their rooms reading, listening to the radio, TV etc. There are some activities provided including gentle exercise, movie afternoons, library service monthly bringing books and tapes and regular religious service. A hairdresser visits weekly and one of the students visiting the home does manicures and hand care etc. Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 17 The last report identified some improvements required to stimulate residents. This is mainly due to the fact that care staff are undertaking many tasks and don’t have the “time” to stop and chat etc. The manager is aware of this and has tried to address this by encouraging people to take part in other activities. This is recognised by relatives with one saying “The new manager has been trying to arrange more activities for the residents.” This has not been entirely successful, as residents appear to be happy as they are, although some would residents to be encouraged to use the communal rooms more to enjoy the company of others. When asked how could the home be improved a relative and resident feedback by “greater use of the lounge area to enable people to be together.” Meals in the home are prepared and cooked by care staff. A night staff member organises and prepares much of the food. This has worked well in the past, although could be at present too much for one person. The manager and provider are considering employing a part time chef to take responsibility for this aspect. This is a good idea and we would hope that the good home cooked food provided would continue whilst releasing staff to general care tasks. Written and verbal feedback from six residents about the quality of food showed mixed reviews but generally satisfactory although lacking in variety for some. One commented “High tea (6pm) leaves one pretty peckish by breakfast time.” This feedback came in after the inspection. The manager is aware of the need to ensure residents do not go 11hours or more between their last meal and breakfast and said that snacks/biscuits were available. This may need monitoring to ensure that this is taking place and residents are not left “peckish” especially if there are diabetics living in the home. The manager may also wish to look at ways in involving residents in what choices they would like on the menu. Meals are taken in the main dining room and is seen by residents as an opportunity to spend some time relaxing and enjoying other people’s company. Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure, available in a user-friendly format that would be followed in the event of any complaints being made. Concerns and issues are listened to and addressed in a sensitive, caring yet professional manner. Staff have received safeguarding adults training to ensure that they are clear about what constitutes abuse and what to do if abuse is seen or suspected. This gives residents a greater protection from abuse. EVIDENCE: It is clear from the feedback provided in writing and verbally from the majority of people spoken to that they are more than happy with the care received. Service users and relatives were generally aware of who to speak to in case there were issues they wanted to raise and the more formal complaints procedure is on display in the main entrance and copies in the service users guide. Two people who provided feedback (one in writing and one verbally) were not as positive, although we judged that this is more to do with preferences of Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 19 style rather than not taking action where things were raised. The majority of people provided “glowing” reports of how well the home is being managed, how good staff are and the positive effects the new manager is having on the quality of care. The majority of residents are able to voice their concerns although some prefer to discuss with relatives first. There have been no complaints about the home either through the home’s procedures or the Commission. There is a file where complaints and compliments are held and in this there were two compliments and another letter still on the notice board for staff to read. The compliments showed that the staff and manager are doing an excellent job. One letter said about Helen (the manager) that, “she brought back the warmth and personal touch that made The Heathers a special place for residents and visitors alike. Even Heather said so!” Another letter said of her that as a manager she is excellent and they also wrote about her professionalism and her support. Written feedback shows that people are aware of how to make a complaint and that the manager is aware that they need to be recorded. She was also advised of the need to record the investigation, outcome and action taken. There are adult protection and Whistle-blowing procedures in place. These do need to be updated to reflect changes in guidance and regulations eg POVA. However, they do provide good information for staff and are written in a simple and clear way for them to be followed. Inter-agency guidelines are in place for Bromley, although not for other authorities who have placed individual in the home. These should be obtained to ensure staff understand what they expect if there are allegations of abuse about individuals who are placed by them. The training records relating to staff training on adult protection were mixed. The one person I spoke to (a senior doing NVQ 3) had not received POVA or adult protection training and whilst had a sound knowledge and was very clear about her role in protecting people would like to attend to further enhance her understanding. We spoke to one person who said to me “ I feel safe here”. She also said that she overhears staff talking with another resident who is quite confused and can be quite difficult. She said they are very kind and patient with her. She has never heard them “raise their voices” She also said she would have not doubt about raising any concerns with staff or the manager and finds them all very approachable. Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,23,24,25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made to ensure people continue to live in a clean, homely and comfortable environment that suits their needs. EVIDENCE: Since the last inspection the new providers have been busy with redecoration of communal and private rooms which have given a boost to the overall environment. Some carpets have been replaced and a new bath fitted. The front door has also been painted giving the front of the house a welcoming feel. Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 21 On the day of the inspection new kitchen cabinets were being fitted to the ground floor kitchen/diner. This is bringing the home a little more up to date. The last Environmental Health report of June 2007 rates the kitchen service as good but that it needs a refit within twelve months ie by June 2008 and that appropriate fly screening needs to be fixed to the external doors etc. The manager is in the process of purchase some equipment to meet this requirement. A new call system is also in place and hoists serviced as required by LOLER. There is still a continuing problem with the plumbing and hot water system that requires constant attention by the maintenance person. We understand that the system cannot be changed at present and so the manager was made aware of the need to record the times when the system failed and how long it took to resolve the issues. The last inspection also required the Providers to look at how the internal areas of the home, specifically the ground floor kitchenette, balcony area and front door could be made more easily accessible for those with mobility issues. This had been highlighted in the feedback cards once again at this inspection. The front entrance has a tiled floor and there were some tiles missing making it a hazard for residents. The manager confirmed that this area is to be carpeted sometime during May and would make this area safe. There is also a need to review risk assessments in respect of use of material hand towels in communal areas; window restrictors and COSHH items not being stored securely. The assessments must take into consideration a person’s cognitive ability, mental health and physical ability. Rooms viewed looked personalised, comfortable and homely and residents spoken to were very happy, especially as they spend so much time in them. Four bedrooms benefit from en-suite facilities and the remainder have wash hand basins. On speaking to one resident who has an en-suite she was troubled with the noise made by her wc. On testing the flush the noise made was very loud and affects the resident and others and certainly would restrict someone from using it. This was reported to the manager straight away and addressed by the second visit to the resident’s satisfaction. Discussions with a District Nurse showed that staff had a very good understanding of infection control and particularly what is needed where a person has an infection. She felt the practices to be very good and “better than those in the hospital setting.” A member of staff spoken to had a good knowledge of infection control procedures. Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 22 We also found the laundry to have the required hand-washing facilities and laundry bags for any clothing that required separate washing. Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 23 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 adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are sufficient, and staff are competent to provide the care to meet individuals’ needs. Although induction and core training for staff requires to be improved to ensure residents and staff are safe. People are supported by a friendly and caring staff team. Staff and the necessary checks carried out. This helps to protect service users and keep them safe. EVIDENCE: Staffing levels in the home is three staff members each morning with a housekeeper; two in the afternoons/evening and one at night plus a sleep-in staff member for emergencies. Discussions with staff have highlighted that with the increase in dependencies staff are finding it harder to undertake care and ancillary tasks. The manager is aware of this and is looking to review the staffing levels. Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 24 There are vacancies that are currently being filled by agency staff although the same agency and preferably staff who have visited the home before are used for consistency. The manager is aware of the need for sound recruitment procedures and practices with the necessary checks to be undertaken. We looked at the files of the two new staff employed since the last inspection and whilst the previous manager was in situ. There were some issues with these in that on one there were no checks or very few checks made. Discussions with one member of staff showed that she had brought in various documentation for the manager including Criminal Records bureau check (CRB) but these could no longer be found. The current manager recommenced the checks without delay and later confirmed that and provided evidence her CRB had been completed in November 2007. She demonstrated with the potential recruitment of one staff member that she is aware of the checks required. `She was awaiting these before commencing their employment. The Provider confirmed in writing to us that the required checks had been made and that work was already underway to obtain copies of the information. The home allows students to come into the home as part of their health and social care studies. Two students currently visiting have had inductions, CRBs and have been given guidance on the limitations. Of the two new staff there was only one with evidence of induction (in this case a foundation training booklet had been commenced and left unfinished) despite the staff member being employed for a number of months. Certificates of training and qualifications had not been obtained for the two new staff, although one staff member did bring in their certificates on the second day. In the second file there was little evidence of any mandatory training taking place during the induction period and no certificates to say they had received training prior to commencing employment. The manager is aware that these issues require addressing and she will commence the required induction training and ensure checks are being completed on staff before employment commenced. This will be monitored more closely at the next inspection. The home uses the Bromley training consortium to provide staff with core training. Viewing of the training records shows there to be some gaps in these in some of the core training especially fire, adult protection and specifically for new staff. Of ten staff working in care six have NVQ 2 or above and one person is undertaking their nurse training. This is above the 50 required by the commission. Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager ensures that there are good systems in place for ensuring the health, safety and well-being of people using the service. Improving the quality of care and involving those using the service is a priority of the manager and organisation. EVIDENCE: Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 26 The manager has been in post since January 2008 having worked for a few years in a deputy and management position in the care of older people. She is qualified with NVQ 4 and the Registered Manager’s award and has a diploma in health and social care. This gives a very good grounded of the current social care environment. She has commenced the application for registration with the Commission. She has made a good start to making sure the requirements from the last inspection are being met and improving the administration, record keeping and organisation of the home, where the improvements, were in the main, required. She has, since starting, commenced regular meetings with residents and started improvements of the care planning and risk assessments systems and was very receptive and involved in the inspection process and having a desire to make the required changes. She demonstrated a good knowledge of her role as a manager, to improve the systems in place whilst maintaining the good standard of hands on care provided. It was also positive to note that a number of the areas requiring improvement had been addressed by the second visit undertaken to check compliance with the immediate requirement stated below. Feedback from residents and relatives has been in the majority of cases very positive. Other agencies, including health professionals have also provided feedback that has shown her not only to be competent but also caring and sensitive to peoples needs and knowledgeable about healthcare. The Provider has been visiting the home each month and completing the report as required under regulation 26. The reports whilst following the CSCI guidance give limited information about the service. It would therefore be beneficial for some kind of auditing/quality assurance system to be introduced to monitor the practices. A system is in place but yet to be used. The manager confirmed that she is to commence quality audits during May 2008. This will be monitored at the next inspection. We also advised at the last inspection of the need to review the service and in doing this include consultation with residents, relatives and other stakeholders. This information should then be collated and analysed with a report written on the outcome. The report should show any action identified to meet areas for improvement. This is a repeated at this inspection. The manager is aware of the need to update policies and procedures and benefits from the implementation of more up to date equipment including fax and a computer with internet access. However, as previous policies and procedures were either hand written or types on a typewriter this will take sometime. Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 27 The health and safety systems were also sampled including fire, lift, hoists, gas and electric including portable appliance testing. These were all satisfactory with the exception of a lack of legionella checks and the weekly fire alarm checks not being undertaken since 6/3/08. This, the manager explained, has been due to call bells not able to be activated and therefore tested as required ie different call bells tested each week. An immediate requirement was made for the weekly testing of the fire alarm and for the replacement of the call bells to ones that can be activated. A visit was made to the home and confirmed compliance. A fire risk assessment is in place and dorguards have been serviced. There is evidence of some staff being trained in fire procedures but there are a number of gaps and the need to ensure staff are trained at least annually and when they first start in the home. There are a number of procedures in respect of emergencies in the home including gas, electric, fire and water. Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 2 X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 X x 2 Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP19 Regulation 23 Requirement The missing tile/s in the hallway must be replaced, as it is currently a trip hazard for residents. Please provide us with confirmation when this has been made safe. The Provider must provide the Commission with an action plan detailing how they intend to make all areas of the home accessible for residents to use safely. This is a repeated requirement with timescale of 01/10/07 expired. Training for new staff in core areas must be provided without delay (unless there is evidence that this training has recently been completed) to ensure the health and safety of people living and staff working in the home. The Provider must ensure that a review of service is carried out. This must involve consultation with residents and other interested parties. This is a repeated requirement with timescale DS0000067267.V362692.R01.S.doc Timescale for action 01/06/08 2 OP19 23 01/07/08 3 OP30 18 01/07/08 4 OP33 24 01/08/08 Heathers, The Version 5.2 Page 30 of 01/11/07 expired. 5 OP36 18 Staff must be provided with formal supervision to ensure care practices provide a consistent quality of care. This requirement was not fully inspected on this occasion. The timescale is therefore amended. Legionella checks must be carried out on the water system in the home 01/08/08 6 OP38 23 01/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. 3 4. Refer to Standard OP1 OP36 OP7 OP8 Good Practice Recommendations Service users’ views should be included in the Service Users Guide. The policies and procedures should reflect the changes in the service provision. Care plans should reflect health, personal, social, financial and spiritual needs identified. Staff should record visits by health professionals and all health checks on the records provided by the home’s systems. Contracts for staff should be provided without any further delay. The use of hand towels in communal areas and the need for window restrictors should be reassessed to determine the current risks to residents and taking into account individual risks. 5. 6 OP27 OP38 Heathers, The DS0000067267.V362692.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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. 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