Care Home: Henlow Court

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What the care home does well Henlow Court provides a safe and well-maintained environment for residents, and is also welcoming to its visitors. Residents are admitted here when they have had the opportunity to consider a good amount of information about the home and its services, and after a very full and thorough assessment of their needs has been undertaken. Good care planning and multidisciplinary working has contributed to a good standard of care here, with residents speaking positively about the way in which they are looked after. Residents and their families made many positive and satisfied comments, with very isolated exceptions to this who felt that they could sometimes be kept waiting too long for things, or that `some staff were better than others`. Residents and visitors spoke well of the staff generally, confirming they were `kind and caring`, although some felt there should be more of them. There are some good social opportunities here for residents, with a variety of activities to suit different tastes. Residents` levels of independence and their choices are respected here, with people enabled to pursue their particular interests. A good choice of menu is offered, and residents generally spoke very positively about the food, with several saying it was `excellent`. Staff have received training in safeguarding the interests and welfare of vulnerable people, and were knowledgeable about the issues and the home`s polices and procedures in this area. The home has had cause to implement these procedures in the past year, and has adopted an open and communicative manner with all agencies involved. Staff had been recruited in accordance with the required pre-employment safety checks, and had the benefit of regular supervision and good training opportunities. Very good progress was being made with the National Vocational Qualification (NVQ) training programme for care workers. There has been a change of manager at Henlow Court, but a good focus on monitoring standards in the home has remained, and the home`s AQAA was very well completed. What has improved since the last inspection? The home has introduced some new and improved care planning documentation. A sensory garden has been created, which provides a very pleasant outdoor space for residents` use and enjoyment. Better car parking facilities have been provided for visitors. New carpets have been fitted to areas of corridor and hallway, and in some bedrooms. A new vanity unit has been provided in many of the residents` bedrooms. In addition to the existing key worker system, the regular allocation of a designated carer to each resident has aimed to promote consistency for residents, and has promoted carers` accountability to them. What the care home could do better: There are some good, safe systems for managing residents` medications overall, but some improvements are recommended in relation to isolated aspects of record keeping, with more robust dating of medications for auditing purposes also needed. There was limited time between breakfast and lunch for some residents, and it is recommended that the service times of these two meals be reviewed to ensure that there is sufficient time lapse for the needs of the residents. The home has a very good system for dealing with complaints and concerns, however there were a small number of residents who felt that not all staff took some of their concerns as seriously as they might. The home is generally very clean, but there is an ongoing odour problem in one particular area, which the staff work hard to address. One particular practice in the laundry has posed a cross infection risk, and this must be addressed to ensure it does not reoccur. There are generally safe systems for safeguarding any money that residents place with the home for safekeeping, although any lapse on the home`s part to maintain completely up to date records, however isolated, could pose the risk of errors being made. Fire drills had not been carried out regularly during this year as part of the otherwise good fire safety training programme for staff. CARE HOMES FOR OLDER PEOPLE Henlow Court Henlow Drive Dursley Glos GL11 4BE Lead Inspector Mrs Ruth Wilcox Unannounced Inspection 11th August 2008 08:30 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 Henlow Court DS0000064619.V365370.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. Henlow Court DS0000064619.V365370.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Henlow Court Address Henlow Drive Dursley Glos GL11 4BE 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) 01453 545866 01453 549949 manager.henlow@osjctglos.co.uk The Orders of St John Care Trust Manager post vacant Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Henlow Court DS0000064619.V365370.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th August 2006 Brief Description of the Service: Henlow Court is a care home for older people, which provides nursing and personal care. It is situated in the town of Dursley, and is managed by The Orders of St John Care Trust. One room is available to provide respite care, and is contracted to Social Services for this purpose. The home is purpose built and provides easy access throughout, including access for wheelchairs. The home has two floors, with a shaft lift providing access to the first floor. There are two lounges, a lounge dining room, and a spacious dining room divided between the floors. Residents accommodation is situated on both floors, and are all single rooms, each of which has its own washing facilities. Only one room has its own full en-suite facilities. There are spacious and easily accessible bathing and toilet facilities conveniently situated throughout the home. Information about the home is available in the Service User Guide, which is issued to prospective residents, and a copy of the most recent CSCI report is available in the home for anyone to read. The charges for Henlow Court range from £533.00 to £733.00 per week, and the home also can provide care at the rate funded by the local authority. Hairdressing, Chiropody, Newspapers, Toiletries and Transport are charged at individual extra costs. Henlow Court DS0000064619.V365370.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 this service experience good quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. One inspector carried out this inspection on one full day in August 2008. Care records were inspected, with the care of five residents being closely looked at in particular. The management of residents’ medications was also inspected. A number of residents and relatives were spoken to directly in order to gauge their views and experiences of the services and care provided at Henlow Court. Some of the staff were interviewed. Survey forms were also issued to a number of residents, visitors and staff to complete and return to CSCI if they wished. Some of their comments feature in this report. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, provision, training and supervision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. We required an Annual Quality Assurance Assessment (AQAA) from the home, which was provided, the contents of which informed part of this inspection. Henlow Court DS0000064619.V365370.R01.S.doc Version 5.2 Page 6 What the service does well: Henlow Court provides a safe and well-maintained environment for residents, and is also welcoming to its visitors. Residents are admitted here when they have had the opportunity to consider a good amount of information about the home and its services, and after a very full and thorough assessment of their needs has been undertaken. Good care planning and multidisciplinary working has contributed to a good standard of care here, with residents speaking positively about the way in which they are looked after. Residents and their families made many positive and satisfied comments, with very isolated exceptions to this who felt that they could sometimes be kept waiting too long for things, or that ‘some staff were better than others’. Residents and visitors spoke well of the staff generally, confirming they were ‘kind and caring’, although some felt there should be more of them. There are some good social opportunities here for residents, with a variety of activities to suit different tastes. Residents’ levels of independence and their choices are respected here, with people enabled to pursue their particular interests. A good choice of menu is offered, and residents generally spoke very positively about the food, with several saying it was ‘excellent’. Staff have received training in safeguarding the interests and welfare of vulnerable people, and were knowledgeable about the issues and the home’s polices and procedures in this area. The home has had cause to implement these procedures in the past year, and has adopted an open and communicative manner with all agencies involved. Staff had been recruited in accordance with the required pre-employment safety checks, and had the benefit of regular supervision and good training opportunities. Very good progress was being made with the National Vocational Qualification (NVQ) training programme for care workers. There has been a change of manager at Henlow Court, but a good focus on monitoring standards in the home has remained, and the home’s AQAA was very well completed. Henlow Court DS0000064619.V365370.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: There are some good, safe systems for managing residents’ medications overall, but some improvements are recommended in relation to isolated aspects of record keeping, with more robust dating of medications for auditing purposes also needed. There was limited time between breakfast and lunch for some residents, and it is recommended that the service times of these two meals be reviewed to ensure that there is sufficient time lapse for the needs of the residents. The home has a very good system for dealing with complaints and concerns, however there were a small number of residents who felt that not all staff took some of their concerns as seriously as they might. The home is generally very clean, but there is an ongoing odour problem in one particular area, which the staff work hard to address. One particular practice in the laundry has posed a cross infection risk, and this must be addressed to ensure it does not reoccur. There are generally safe systems for safeguarding any money that residents place with the home for safekeeping, although any lapse on the home’s part to maintain completely up to date records, however isolated, could pose the risk of errors being made. Fire drills had not been carried out regularly during this year as part of the otherwise good fire safety training programme for staff. Henlow Court DS0000064619.V365370.R01.S.doc Version 5.2 Page 8 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. Henlow Court DS0000064619.V365370.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 Henlow Court DS0000064619.V365370.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&3 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. A very thorough and comprehensive assessment process prior to admission to the home gives prospective residents an assurance that their needs can be met. EVIDENCE: The home’s AQAA stated that all prospective residents were issued with a copy of the home’s Service User Guide (information brochure), and that all interested parties were given the chance to view and tour the home to meet other residents and staff. It also confirmed that residents were able to stay at Henlow Court on a trial basis. A copy of the home’s Service User Guide and Statement of Purpose was on display in the entrance hall. Henlow Court DS0000064619.V365370.R01.S.doc Version 5.2 Page 11 We inspected three examples of pre-admission assessments, each of which were for residents more recently admitted to the home. Each assessment had been carried out prior to admission being agreed, and had been comprehensively and fully recorded on the home’s designated tool for the purpose. The assessments had been signed and dated, with the location where it was conducted identified. They also identified if the person’s family or representative was present. The assessments took account of their personal details and their past medical history; their health and care needs; their medications; their ethnicity, socialisation and cultural needs; their understanding and legal status. There was also a manual handling assessment; a pressure sore vulnerability and overall skin assessment; a nutritional and a falls risk assessment. Confirmation letters regarding residents’ admission to the home were issued. Henlow Court does not provide intermediate care. Henlow Court DS0000064619.V365370.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 living in this home can expect to have all their health and care needs met in a way that is mindful of their privacy and dignity. EVIDENCE: New and improved assessment and care planning documentation had been implemented since the last inspection. Residents had their own documented care plan that had been drafted on the basis of an assessment of all their health and personal needs in consultation with them. Recorded risk assessments in each case included pressure sore vulnerability, falls, nutrition and moving and handling. Where other risks existed, such as with personal safety and challenging behaviours for example, these too had been taken fully into account. Each had been regularly reviewed. Henlow Court DS0000064619.V365370.R01.S.doc Version 5.2 Page 13 Care plans were well written in a fully detailed and comprehensive way, and provided very good guidance for staff when delivering the care. The plans reflected individuals’ dignity, levels of independence and personal choices and preferences. We found that each person had been medically reviewed on a regular basis, and saw that a wide and comprehensive range of health care interventions had been provided where necessary. Four care plans were selected for case tracking, and in each case the practised care delivery was in full accordance with the recorded plan of care, with recorded monitoring charts and support equipment fully observed as well. We spoke to a number of residents, and heard comments such as ‘I’m happy with my care’, and ‘I get very well looked after’. One resident said that ‘some carers were better then others’, and that they had to ‘sometimes wait a long time’ if they needed anything. Another said that ‘nursing staff were attentive and prompt’. One relative said that the home ‘did well in all respects’, whilst another said ‘my relative is well cared for’. Assessments took account of individuals’ wishes in relation to the medication aspects of their healthcare. At least two residents had chosen to manage their own medications. This was generally done within an appropriate risk management framework, although staff had not recorded this in full in one case; this was immediately addressed. Medication administration charts in these cases did not identify the amount and date of any supply when it was given to the resident. Medications were safely stored, and medication administration charts were clearly printed by the supplying pharmacist. Two members of staff had signed any additional handwritten entries, and any boxed and bottled items had been dated to identify date expiry. Variable dosages were largely recorded in accordance with the dose actually administered, although there were some gaps in this. Records of administration had been introduced into residents’ care plans for when external creams needed applying by care staff. Where medication had been prescribed for use ‘as directed’ we found that a corresponding care plan included direction for staff in its usage. There were records of pulse checks and blood glucose monitoring where this was applicable to a resident’s medication management. Henlow Court DS0000064619.V365370.R01.S.doc Version 5.2 Page 14 Due to some apparent dating discrepancies on tablet containers, it was not possible to carry out a meaningful audit on selected medication. The arrangements for controlled drugs were safe and well managed. We observed staff knocking on residents’ doors before entering their rooms. Staff were repeatedly witnessed adopting a kind and sensitive approach when addressing residents. Some of the residents told us that the staff were ‘kind’ or ‘respectful’. One relative commented on survey that the home enabled their relative ‘to be his own person’. They also said that staff ‘strived to help him maintain his independence’. Henlow Court DS0000064619.V365370.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home have the opportunity to remain socially active, exercise choice, and have a nutritious diet that offers choice and variety. EVIDENCE: The home has a designated social activities coordinator; the AQAA stated that the number of hours this person works had been increased. The AQAA also stated that the coordinator plans social events for residents on a two weekly basis, with visiting entertainers, and group and individual activities organised. Social opportunities were advertised on the home’s notice board, and a two weekly newsletter, ‘The Henlow Herald’ was produced for the residents and their families. Forthcoming activities included a quiz, a current affairs discussion, bingo, games, a film show and a reminiscence session. Henlow Court DS0000064619.V365370.R01.S.doc Version 5.2 Page 16 A sensory garden had been created for residents’ enjoyment, and this had been very attractively done, providing a pleasant outdoor space for residents’ use. At least two residents were pursuing their personal enjoyment of gardening activity out here. A library visited the home to bring large print books for the residents, and the local newspaper was available on compact disc for those who needed or wanted this service; some also had a talking book. Holy Communion was provided every two weeks, and communal hymn singing was held fortnightly for those who were interested. Residents all confirmed that there was a good range of enjoyable social activities available for them. A visitor commented that their relative was being enabled to pursue his love of gardening at the home, and was also able to pursue other interests as well. Conversely one relative felt that the home should provide more activity for residents. We saw visitors being welcomed into the home with no restrictions imposed upon them. An invitation had been extended to families and friends of residents to attend a quiz evening with refreshments in the home. Two relatives stated that they were ‘made to feel welcome here’. Some of the residents were seen moving around the home and spending their time as they chose. Some were rather more dependent on the staff to assist them in this regard however, and staff were generally around and available should any resident need anything. Staff demonstrated their respect towards residents’ personal preferences, and also confirmed in survey responses to us that they were enabled to observe and respect residents’ diversity. Residents confirmed during conversation with us that staff were mindful of their personal choices, with one specifically saying that he could ‘do what he wanted’. Residents’ rooms were personalised to a degree, with many opting to introduce their own treasured items and belongings. One gentleman had his own DVD and video recorder, with a large collection of discs of his choice. He said that he had been staying up late to watch the Olympic Games on his personal television. All relatives who responded to our surveys confirmed that the home supported their relative to live their life as they chose. Henlow Court DS0000064619.V365370.R01.S.doc Version 5.2 Page 17 There was useful information and leaflets available to anyone in the home, covering issues such as fees and advocacy, general Care Home and external support agency information. We found that residents were given a choice with all of their meals. Menus and residents’ daily choice lists showed a range of choices for breakfast, lunch, teatime and supper. Dietary advice and information regarding individual nutritional needs had been given to the cook when residents had been admitted to the home. The cook on the day of this visit was knowledgeable and appeared very committed to ensuring choice and good quality for all residents regardless of their specific health and dietary needs. We saw some breakfasts and lunches served to residents, and food appeared wholesome, nutritious and appetising. Staff were available to assist where needed. Some of the breakfasts were served between 9:00am and 9:30am, with lunch then served between 12:30pm and 1:00pm. This gave little time in between for some, which should be reviewed to allow a more suitable space of time between the meals. Some of the residents said that ‘the food was excellent’. One said that she ‘liked some food better than others’. The kitchen was well organised and clean during the lunchtime preparations, with catering and cleaning records in place. The AQAA stated that the home had achieved a four star rating award from the local council for its standard of catering. Henlow Court DS0000064619.V365370.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. Most people living in this home are generally reassured by the home’s complaints procedures and the policies regarding the prevention of abuse. EVIDENCE: The home had a clearly written and accessible procedure for addressing any concerns and complaints; a copy was issued to all residents and their families. The AQAA stated that the home had dealt with eight complaints in the past year. We viewed the records in relation to these concerns, and each contained evidence of actions taken and resolutions reached in each case. All residents and relatives who were surveyed confirmed that they were aware of how to raise concerns if they had any, but two residents said that not all staff listened and took seriously what they were saying. Another confirmed that he had confidence in the manager’s approachability and ability to address any concerns. Two relatives also made similar comments, although one said that some of her concerns remained despite this. Henlow Court DS0000064619.V365370.R01.S.doc Version 5.2 Page 19 The home had documented policies and procedures to address forms of abuse and whistle blowing, which were readily available for staff to read. Staff had access to the Mental Capacity Act 2005 ‘easy-read’ version, and had received some in-house instruction in this area. The manager and one of the nurses were booked to attend more detailed training in this. Staff had received training in safeguarding vulnerable adults, and during interview some were more able to demonstrate their understanding of the issues to us than others; at least two were vague when we asked them about the existence of the designated adult protection unit within the local authority. There were two thefts in the home last year, with the appropriate steps taken in response at the time. Staff reported the incidents, and gave advice to protect residents and their families. Despite the police investigating each incident no firm outcomes were reached, and the perpetrator remained unidentified. The home had made an appropriate referral to the Adult Protection Unit within the past year, as part of safeguarding the interests of one particular resident, who at the time of this visit was no longer resident at Henlow Court. CSCI was kept fully informed at every stage of these proceedings. One visitor said that their relative ‘had very good relationships with the staff’ and had ‘great faith in them’. Henlow Court DS0000064619.V365370.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 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in this home are generally provided with comfortable and pleasant accommodation, which is suitable and safe to meet their needs, however there was a degree of risk posed to this through isolated lapses in hygiene standards. EVIDENCE: The home’s AQAA stated that the improvements made to the home recently had included improved car parking to the rear of the home; new carpets to the corridors, hallway and some bedrooms, and also new vanity units in some of the bedrooms. A sensory garden had also been created; this provided a very peaceful and attractive outdoor space for residents’ enjoyment. New flooring was being planned for the dining room. Henlow Court DS0000064619.V365370.R01.S.doc Version 5.2 Page 21 The home had a committed maintenance person, who kept thorough records of all cyclical maintenance works carried out. The sluice disinfector on the first floor had broken down and had been reported for repair. At least six used commode pans had been stacked up in here whilst awaiting removal to the downstairs sluice for cleansing and disinfecting, which would have been better taken straight there when used. The AQAA stated that the home had a regular cleaning and ‘deep-cleaning’ programme. One relative commented that there were times that their relative’s commode had not been emptied, leaving the room unpleasantly odorous. Most areas were fresh, clean and odour free, however, there was a very transient odour detected in one area of the home during the morning, with a more evident and ongoing odour problem easily detectable along one of the first floor corridors. The laundry was well equipped, with machines capable of sluicing and disinfecting foul items. However, we saw that the laundry assistant had placed freshly laundered wet items on the floor in front of the tumble driers ready for drying. We witnessed that she then proceeded to place them in with other clean items that were drying at the time. We halted this practice straight away and discussed the infection control and hygiene risk with the laundry assistant. The items were put back through the wash. The stainless steel sink unit was heavily marked and stained. Clinical waste was correctly managed. There were copious amounts of gloves, aprons, liquid hand washes, paper towels and sanitizers around all areas of the home. Henlow Court DS0000064619.V365370.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home receive care from a competent work force, who undergo full pre-employment checks, and who are supported to train and develop professionally. EVIDENCE: Staff rotas were recorded, and these showed that there is routinely at least one qualified nurse on duty over a twenty-four period, with seven, six and three care staff on duty during the morning, evening and overnight respectively. Some agency staff had been used, and this had been increased recently due to some staff sickness. An ancillary team of catering, cleaning, laundry, maintenance and administrators supported the care team. There were some isolated occasions when a member of the care team had to serve the residents’ supper, due to gaps with catering support in the evening. Care staff had been allocated to individual residents each day, so as to take direct responsibility for their needs at that time, with a view to improving continuity and consistency for the residents, and to promoting the carers’ accountability to them. Henlow Court DS0000064619.V365370.R01.S.doc Version 5.2 Page 23 Staff were evidently very busy throughout this visit, but seemed to be available to the residents around different areas of the home much of the time. One resident said that ‘the home needed more staff’, with some of the resident survey comments reflecting this. One person said that ‘some were better than others’, which was also said by one of the visitors. One relative said that the home generally had ‘excellent staff’. Another commented on ‘the cheerful and caring’ attitude staff had. A member of staff said that in their view the home was ‘short of staff’, whilst another said that ‘staff were rushed, and could do with more time to spend with residents’. The home was making excellent progress with the National Vocational Qualification (NVQ) training programme for care staff. Twenty-four carers were qualified to at least level 2, with a further two staff planned to start a course. We inspected two staff files of recently recruited carers. In each instance, the prospective employee had completed an application form providing details of their employment history, with evidence that any gaps in it had been explained. Interview notes were recorded. Two written references had been provided in each case, with at least one of each of these having been obtained from the previous employer. Where any concern had been identified regarding an employment history there was clear evidence that this had been thoroughly explored and considered through a risk management framework. Proof of identity and medical statements had been obtained; in one case a copy of the photographic evidence had not been retained in the file, which the manager was addressing. Correct POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) screening had been completed for each person. Each file contained an employment contract, a job description, and evidence of equal opportunities and sickness monitoring. The home had recently appointed a new training coordinator. The paper based training matrix had not been kept up together and was out of date; the new coordinator had identified this as a priority for review. However, individual training records contained certificated evidence of training undertaken in each case. Staff had received training in infection control, moving and handling, food hygiene and health and safety. Instruction in care planning had been delivered to relevant personnel, and senior care leaders had undergone medication training. Two staff said that they had also received training in bereavement and dementia care. Henlow Court DS0000064619.V365370.R01.S.doc Version 5.2 Page 24 The home had a range of DVD learning material that was being used to provide updated instruction in a number of areas relevant to the work. One of the nursing staff was a trained moving and handling trainer, and provided refresher training in this area. We saw examples of certificated evidence of induction training for new workers, which had included induction to the Trust, the home and the Common Induction Standards for care workers. One carer confirmed that she had worked under supervision during her induction, and had felt very well supported during that period. Staff were encouraged to maintain their own personal and professional development portfolio. Henlow Court DS0000064619.V365370.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, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Despite one isolated concern regarding a shortfall in financial records, the management systems in place here ensure that the interests, and health and safety of the residents living in the home are safeguarded. EVIDENCE: The new manager of the home has been working at Henlow Court for a number of years. Prior to becoming the manager she was a shift leader and also the deputy manager. She is a first level nurse and is currently sourcing a Registered Manager Award training course through a local college. An application to register her with CSCI is currently under consideration. Henlow Court DS0000064619.V365370.R01.S.doc Version 5.2 Page 26 We found that there was a strong support network for the manager, and that management was evidently being consistent and organised, with learning opportunities being utilised as her role was developing. The home’s AQAA was very comprehensively completed. An annual survey had recently been issued to residents and their representatives in order to gain their views and experiences of the home as part of a quality monitoring approach. This survey had also included the views of some visiting health care professionals as well. The results of the survey had been collated in readiness for an action plan to be drafted to address any issues. Residents and their families had also had a six monthly review of their care, with their views and ideas about the home obtained as part of the ongoing quality monitoring approach here. Suggestions and feedback forms were available in the entrance hall for anyone wishing to use this method of making their views known regarding the home. An internal audit is undertaken each year, and the home had also been successfully assessed for the ISO quality award. A number of residents had chosen to place personal money with the home for safekeeping. The systems for managing and safeguarding these arrangements were generally satisfactory and totally transparent. However, despite this, two random checks identified that a slight discrepancy had arisen due to one of the administrators omitting to complete the record regarding a recent transaction for newspapers. As it was possible to find an audit trail in these cases we were able to confirm that the arrangements in each case were actually in order. A staff supervision programme was in progress, and some examples of associated records were seen. Supervision had been given regularly in these cases, with staff surveys also confirming to us that they had regular access to the manager to discuss their work. The home had written policies and procedures in relation to the promotion of the health and safety of the residents, visitors and staff, and associated training was provided for staff. Records showed us that regular safety checks and planned maintenance visits had been carried out on the fire safety systems. Henlow Court DS0000064619.V365370.R01.S.doc Version 5.2 Page 27 Evacuation aid equipment was in place, and residents had a fire safety risk assessment in their care plan. Evacuation and use of fire extinguisher training had been delivered to all staff. There were records of two fire drills carried out in February of this year, with no more since. Hot water temperatures were regularly checked for safe levels, and regular Legionella checks on the water supply had also been carried out, with the appropriate control measures in place, including for the cold-water storage. The necessary safety checks and maintenance of utilities and equipment had been undertaken in a timely fashion, and the associated records were kept in these areas. First aid facilities were widely available, with some refresher training in first aid planned for staff. Accident records were checked and were up to date with notifications that had been sent to CSCI. The home was secure, with coded door entries in appropriate places. Henlow Court DS0000064619.V365370.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 X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Henlow Court DS0000064619.V365370.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP26 Regulation 13(3) Requirement The Registered Person must ensure that residents’ laundry is handled in accordance with the correct procedures to prevent the spread of infection. Staff must not place clean items on the floor. Timescale for action 30/09/08 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 Refer to Standard OP9 Good Practice Recommendations • Where staff support people to look after and administer their own medicines, the medication records should include when each medication, including the quantity, is actually given to people to look after A more robust system should be implemented for dating newly opened boxed and bottled supplies of medications on initial usage, in order to facilitate meaningful and accurate audits. • Henlow Court DS0000064619.V365370.R01.S.doc Version 5.2 Page 30 2 OP15 3 OP38 The service times of breakfast and lunch should be reviewed, to ensure that there is a sufficient time lapse between the two meals that suits the needs of the residents. All staff should undergo regular fire drills as part of their fire safety awareness. Henlow Court DS0000064619.V365370.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Henlow Court DS0000064619.V365370.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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