Care Home: Herewards House

Similar services:

• St Vincents
• The Cotswold Home
• Winton House
• Rush Court
• Hillyfield Rest Home
• The Maypole Nursing Centre
• The Briars

What the care home does well What has improved since the last inspection? There have been a number of improvements since the last inspection including meeting all three Requirements made at that time. These concerned staff training records, risk assessments on the premises, and health and safety monitoring. The manager also acted on the three Recommendations which were made. Since then some decorative improvements have also taken place including decorating the disabled WC on the ground floor, painting the hallway and dining room, and replacing the lights. They have also bought a new menu board for the dining room, which clearly sets out the mealtime choices, and some new kitchenware including glassware, a microwave, a fryer and a fridge have been purchased. Some bedrooms have been redecorated and the central heating boiler has been replaced. The home has improved the garden by replacing paths and fences, and installed a new safety grab rail on the ramp from the conservatory. The home has also purchased a stair lift. One resident`s room has had ensuite facilities added. More staff have completed NVQ Level 2, and some have started NVQ Levels 3 and 4. A senior member of staff has now been promoted to the deputy manager position. What the care home could do better: Three Requirements have been made as a result of this inspection and include having more detail in resident`s care plans, and ensuring relevant risk assessments are on each resident`s file. The home must also ensure the recruitment checks include all the information set down in Schedule 2 of the Care Homes Regulations. CARE HOMES FOR OLDER PEOPLE Herewards House 15 Ray Park Avenue Maidenhead Berkshire SL6 8DP Lead Inspector Helen Dickens Unannounced Inspection 17th April 2009 10:40 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 Herewards House DS0000060965.V374765.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. Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Herewards House Address 15 Ray Park Avenue Maidenhead Berkshire SL6 8DP 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) 01628 629038 Mr Bedanan Guru Seegoolam Mrs Dhanwantee Seegoolam, Mrs Sangeeta Rukunny, Mr Bolah Rukunny Mr Bolah Rukunny Mr Bedanan Guru Seegoolam Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (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 (OP). The maximum number of service users to be accommodated is 27. Date of last inspection 17th April 2008 Brief Description of the Service: Herewards House is situated in a quiet residential area of Maidenhead. There is a parade of shops in walking distance with the River Thames close by. The building has been converted and extended to provide residential accommodation for 27 elderly persons. The home has a conservatory with access to the garden, a dining room and separate lounge. Some bedrooms have en-suite facilities. The home is managed by the proprietors. The current scale of charges is £400-£550 per week. Additional items include sweets, cigarettes, hairdressing, chiropody and newspapers. Herewards House DS0000060965.V374765.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 people who use this service experience good quality outcomes. This key inspection was unannounced and took place over 6 hours. The inspection was carried out by Mrs. Helen Dickens, Regulation Inspector. Mr. Bolah Rukunny, known as Jeet, the Registered Manager, represented the establishment. A partial tour of the premises took place and a number of files and documents, including three resident’s assessments and care plans, two staff recruitment files, quality assurance information, and the annual quality assurance assessment (AQAA) were examined as part of the inspection process. Ten questionnaires returned to the Commission from residents, staff and social care professionals, were used in writing this report. The inspector met many residents and ten were spoken with over the lunch period. Two relatives, and a community nurse were also interviewed during this inspection. The inspector would like to thank the residents, staff and manager for their time, assistance and hospitality. What the service does well: Herewards House offers a homely and comfortable environment, which is well maintained with a rolling programme of refurbishment. Residents were pleased with their rooms and the facilities on offer. All five residents who returned surveys to the Commission said the home was always fresh and clean. There were no unpleasant odours in any part of the home. There are a number of activities for those residents who choose to take part and family and friends are made welcome and speak well of the home. Relatives commented positively on the home and the staff. One relative said of Herewards House: ‘The home is cosy, warm, friendly and clean.’ This person also said that the manager pays great attention to detail, and they have a lot of confidence in him as a manager. There is a settled and conscientious staff team at this home, and 65 of them have already got a qualification in care work, exceeding the recommended 50 in the National Minimum Standards. A number of positive comments were received about the staff at the home including, in their own compliments book: ‘Thank you for the care received whilst staying with you and all the kindness of Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 6 all I came into contact with.’ This was a written compliment from a temporary resident. The meals at Herewards House were also the subject of many compliments and no complaints were received on this subject. The dining room is very pleasant and residents are offered a choice of mainly home made food. One resident who said their meal was ‘Lovely’, thought the other residents enjoyed it too; ‘You can see by the way we have cleared the plates.’ This home does well on respecting people’s individuality and each resident has their own key worker. There were many examples of the home supporting residents to be more independent. The care managers who completed surveys and spoke with the inspector by telephone said the home has worked well with social services – including making very individualised care arrangements. ‘Herewards House have assisted social services staff to work in a creative way to enhance the quality of life for the residents.’ Herewards House and garden is accessible to those with mobility impairments, with a variety of aids and adaptations to enable residents to be more independent. Assessments and care plans sampled took into account each resident’s religious and cultural needs. What has improved since the last inspection? What they could do better: Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 7 Three Requirements have been made as a result of this inspection and include having more detail in resident’s care plans, and ensuring relevant risk assessments are on each resident’s file. The home must also ensure the recruitment checks include all the information set down in Schedule 2 of the Care Homes Regulations. 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. Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are assessed prior to them moving into this home, and each service user has a written contract with the home. EVIDENCE: Three resident’s files were sampled during the inspection. Files have been reorganised since the last inspection and the layout is very straightforward and much improved. The manager uses his own admission format, which he said had been devised to fit with what was set out by NCSC in the National Minimum Standards. Assessments sampled contained a basic overview of peoples’ needs including personal and family details, and their past medical history. There followed an overview of the activities of daily living including needs in relation to personal care, diet and weight, vision, hearing, oral health, foot care, mobility, continence, medication, mental state, personal safety, and social interests. An adult assessment of need from the Royal Borough of Windsor and Maidenhead, which is very detailed, is on file for those whose care has been arranged by the local authority. Only one of the three residents Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 10 had a falls risk assessment in place, and this is discussed in the next section of this report. The inspector received two pre-inspection surveys from care managers who have placed clients at this home. Both ticked that they thought the home ‘Always’ had satisfactory admission arrangements, and one added that ‘Herewards House manager and staff always tried to best accommodate the residents, and do whatever is required to best meet the service user needs. Herewards House staff have gone out of their way to support the residents.’ Five surveys were returned from service users who all ticked that they had a contract with the home, and three said they had enough information about the home before they moved in. One had been admitted via the care manager from hospital, and the other had been too unwell to take part in the admission process when they moved in. This second person was interviewed and was very complimentary about the care and support they had received at Herewards House. Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ care plans provide an overview of their needs but more detail is needed on how they would like their support to be delivered. The health care needs of residents are met, and there are good systems in place for the administration of medication. Residents are treated with dignity and respect at Herewards House. EVIDENCE: Three care plans were sampled and discussed with the manager. He said all residents have individual care plans on personal care, mobility and diet, and then those with needs in other areas have additional care plans. Care plans contained an overview of resident’s needs. In some respects they were set out in a person centred way, for example using each resident’s name when noting personal preferences. Care plans were reviewed regularly, and contained risk assessments relating to activities of daily living. However, care plans lacked detail, and were in a very standard generic format which reminded staff to support residents with mobility and personal care, but not the detail about how each person would like that support to be delivered. This new format, introduced since the previous inspection, needs to be Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 12 reviewed. During discussion with the manager both during the inspection and in a subsequent telephone conversation, an alternative format was discussed and he decided he would use the Berkshire Care Association format for care planning for all existing residents, and start using the Berkshire Care Association assessments for all new residents. Two of the three files sampled did not contain a falls risk assessment. One of these was for a new resident and the manager arranged for this to be drawn up immediately. The manager thought the other had been misplaced during the recent reorganisation of the resident’s files. He undertook to check all resident’s files contained the relevant falls risk assessments and on 22nd April, wrote to the inspector to confirm this had been done. Nutritional risk assessments are discussed below under health matters. Surveys from care managers stated the service ‘Always’ supported residents to live the life they choose wherever possible, and staff ‘Always’ had the right skills and experience to support residents. All five surveys from residents said they got the care and support they needed. Residents spoken with praised the home and the staff. And whilst one relative said the home could pay a bit more attention to detail, another relative thought that the home did well on following up any issues to do with the care of their relative, even keeping them up-dated by e-mail when they were out of the country. Initial assessments contained a good overview of residents’ health needs including diet and weight, vision and hearing, oral and foot health, continence and mental state. They also covered whether residents had had, or were prone, to falls. The home ensures residents have access to healthcare support and this included on the day of the inspection, liaising with community nurses, and making a GP appointment and accompanying a resident to the health centre. The manager ensures residents can have support with health improvement e.g. giving up smoking and encouragement to lose weight. Residents are encouraged to be independent and to access community health services, e.g. going to the health centre and joining external exercise classes. There is also an exercise group held at the home. Aids and equipment are available in the home to support residents for example with bathing, and there is a special ‘disabled’ WC on the ground floor, which has recently been redecorated. Four service user surveys showed they ‘Always’ got the medical support they needed, and one ticked ‘ Usually.’ There are no pressure sores at this home, though the community nurses attend to do dressings of other wounds. One was interviewed and they stated that the ‘Staff are very helpful’, and they follow advice they are given. Two staff files that were sampled showed that staff had done relevant training including first aid, moving and handling, and infection control. Residents were seen to be treated as individuals, for example one resident needed a lot of emotional and psychological support and this was seen to be Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 13 given by the manager and staff. The manager was advised to ensure that the resident’s care plan reflected this. One resident who was interviewed said staff had previously supported them with losing weight, and would like to try again. This was passed on to the manager. This resident who had been very unwell on admission said ‘I owe a great deal to the home and the manager in particular’ and added ‘They would do anything to try and help you’. Residents have a basic diet and weight assessment on admission, and are weighed regularly thereafter, but the home should consider whether residents should each have an ongoing nutritional risk assessment, using a recognised nutritional risk assessment tool. The manager was asked to consult a community nurse about this. The manager was asked to discuss with the relevant authorities whether anyone currently living at the home needed an assessment under the new Deprivation of Liberty Safeguards Guidance as the inspector noted at least one resident wanted to leave the home and was unable to do so. The manager followed this up with the relevant authorities on the next working day and the appropriate steps are now being taken. Compliments records showed a great deal of gratitude from relatives for the care and attention given by the staff. One wrote; ‘Thank you for the great kindness and understanding you are showing to our dear Mum in her illness.’ The community pharmacist last visited the home to inspect their medication arrangements in March 2009. The visit looks at the storage and safe administration of medication. Their report showed that there were only two minor areas which needed improvement, including the ongoing issue with regard to the temperature of the medicines cabinet, which is too warm at times. The manager had re-sited the cabinet to a cooler part of the home but on occasions it was still warmer than the recommended maximum of 25C. He said he will continue to monitor this and may have to move the cabinet again, or install an internal fan. The manager said their pharmacist brings CSCI guidance to hand out to the home, and is offering some more training for staff. Residents were observed to be treated respectfully by the staff and manager at this home. There were several instances during the day when the manager protected the privacy and dignity of residents tand staff were heard to be courteous and respectful at all times. All five service users who returned surveys said they ‘Always’ got the care and support they needed, and none raised any concerns about how they were treated by staff. Two care managers who have placed people at this home both noted that the home ‘Always’ respected the privacy and dignity of residents, one added ‘Herewards House staff team is very diverse and they seem to be very respectful towards all.’ Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are offered some options for activities though they would benefit by having more resources dedicated to this area. Family and friends are made welcome at the home and contact with relatives is encouraged. Residents are offered some opportunities to exercise choice and control over their lives, and meals and dining arrangements offer a pleasant mealtime experience. EVIDENCE: The AQAA states that ‘We provide a variety of daily activities to promote residents’ lifestyles and engage them in such activities to suit their expectations, preferences and abilities.’ There is an activities plan on the wall in the hallway, and the notice board contains leaflets and posters about forthcoming activities. The manager said regular residents’ meetings are held, and they often discuss activities. On the day of the inspection it was noted that card games were being played before lunch in the dining room for those who wished to join in, and others were following their own interests. One resident is very keen on doing crosswords and said the manager had bought them a giant crossword book because they got through so many. Others were seen going out independently for example to the local pub, and other residents went out into the garden for a cigarette. Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 15 The manager said activities are recorded, including who takes part in each session. He also said residents are taken out when the weather is nice. Currently they a allocate a staff member to do each activity from the plan, depending on who is on duty, but no one has overall co-ordinating responsibility for activities; the home does not employ an activities coordinator at present. Staff are currently collating an album of photos taken during various activities and outings. However, on their surveys, three out of five residents ticked that there were suitable activities available only ‘Sometimes’; two others ticked that there were ‘Usually’ suitable activities available. Residents spoken with said they would like more activities, and a relative who was interviewed said that was really the only shortfall with the home and they would like to see their relative taken out more often, if only into the garden. Garden paths and rails have been replaced, and the back garden now offers a spacious and secure environment for residents; new garden furniture has also been ordered. The inspector felt there were insufficient resources being allocated to activities at present. Following some discussion on the subject of activities, the manager said he is considering having one senior staff member taking overall responsibility for activities, including publicising activities in a newsletter type format. He agreed that the current activities ‘plan’ was not always followed, and recording in the activities book such as ‘All those present joined in’ was not very useful. He said he would also consider the comments from residents and relatives that residents would benefit by more activities, and especially by being able to get out more often. Residents are allowed visitors at reasonable times, and the two visitors spoken with said they were made welcome at Herewards House. One resident has had support from staff to have their elderly relative brought over to the home for meals, and a care manager’s survey confirmed that staff have arranged for residents to visit their families. One relative currently living overseas said the home kept him up to date by e-mail and even let him know when the flowers he had on regular order have arrived at the home each month. This relative also described how the home had worked with him to improve the bedroom facilities available, including sharing the cost of some of the improvements which would have been over an above what was usually provided at the home. Residents are given opportunities to exercise choice and control over their lives and it was noted that several lead a fairly independent lifestyle. Residents are encouraged to manage their financial affairs if possible, and during the inspection this was seen in practice. Residents who are able to, go out for walks, for shopping, or to the pub. Others were seen to go out into the garden for a cigarette. The home has ensured that Advocates are arranged as necessary where a resident needs that type of independent support. As noted earlier, it would be nice to see less independent residents being enabled to have more outings and outside activities. Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 16 Mealtimes offer a pleasant experience at Herewards House and there were many favourable comments about the food. One of the relatives interviewed confirmed the food was good, and in surveys from residents, all five ticked ‘Always’ in response to the question about whether they liked the meals at the home. Around ten residents were spoken with in the dining room at lunchtime and only one did not enthuse about their lunch. It was fish and chips, which the staff said was always popular with residents on Friday. One described the food as ‘superb’, and said they thought a lot of the food was home made by the chef, and this included making cakes for tea. They said there was plenty of traditional meals like shepherds pie, and always a roast dinner on Sundays. One resident who said their meal was ‘Lovely’, thought the other residents enjoyed it too; ‘You can see by the way we have cleared the plates.’ Choices were listed on the board so that people realised what the options were, and those spoken with knew they could ask for something different. Those who needed assistance from staff were being supported in a sensitive way, and special diets can be catered for if necessary. Residents are weighed on admission and regularly thereafter. The Recommendation regarding nutritional risk assessments is discussed under the previous section of this report. Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives can be confident their complaints will be listened to, and there are policies in place which should protect residents from abuse. EVIDENCE: The home has a complaints procedure in place and this is displayed throughout the home. They have a minor complaints log and a number of minor complaints were received by the home and dealt with. No formal complaints have been made within the last 12 months. No complaints were received at the Commission about this service. All five residents who returned surveys said they would know who to speak with if they weren’t happy, and said they knew how to make a complaint. The AQAA states that the home complies with the local Strategic Policy for safeguarding vulnerable adults and they ensure staff receive training in this area. Staff training records seen during the inspection confirmed this was the case, including the two latest recruits. At the last inspection, some shortfalls on recruitment records could have had an impact on the safety of residents and the manager rectified this within one week of the inspection. Some continued discrepancies on checking staff records are the subject of a Requirement under the staffing section of this report. No safeguarding adults matters have been referred to social services in regard to this home in the last 12 months. Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Herewards House offers a homely environment, which is clean and hygienic throughout. EVIDENCE: Herewards House offers a homely environment with a pleasant conservatory overlooking the garden, which is accessible to residents. The outer gate to the car park has a door entry system, providing a safe environment for residents. Those residents who wish to go out independently do so, but the manager was asked to ensure that where the gate and front door act as a restraint to other, less able residents, advice is sought from the local authority in relation to the Deprivation of Liberty Safeguards Guidance from the Department of Health. A partial tour of the premises took place and this included visiting the lounge, three bedrooms, the dining room and conservatory, the kitchen and the laundry room. Bedrooms visited were clean and comfortable, and personalised with residents’ own belongings. As mentioned earlier, one bedroom had had ensuite facilities and a number of other improvements made, which had been Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 19 a joint venture between the home and the relatives of this resident. There is a separate lounge with a large screen TV and comfortable sofas and armchairs. The residents using this room commented very positively on the level of comfort. The dining room and the conservatory were very popular with residents, with one room leading on to the other. Residents used the dining area for socialising and used the tables for card games when the tables were not been used for meals. The downstairs disabled toilet has been redecorated and minor repairs recommended at the last inspection have now been completed. The manager has sent a list of improvements and planned work to the Commission prior to this inspection and included repainting the dining room and fitting new lights, repainting the hallway, providing a new menu board for the dining room, replacing the fencing, pathways and grab rails in the garden, and providing benches. The manager said new net curtains were being purchased together with some more easy chairs for residents, and new staff lockers. The home is clean and pleasant throughout, with no offensive odours. Five residents who returned surveys to the Commission ticked that the home is ‘always’ fresh and clean. One of the two visitors interviewed also remarked on the cleanliness of the home. There were soap dispensers and paper towels at the communal hand washing facilities and one minor issue raised at the previous inspection about where the clean clothes are dried, has been dealt with. There are lidded bins for transporting laundry to the laundry room, and the laundry area itself was clean and tidy, with washable flooring, a commercial washing machine and a separate tumble drier. The manager said that staff had attended health and safety, and infection control training and that advice had been sought from the PCTs infection control specialist nurse. The environmental health officer has visited the home and inspected the kitchen since the last inspection and they noted ‘Good improvement’ and ‘All matters satisfactory.’ Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit by the numbers and skill mix of staff at Herewards House, and by the number of care staff who have a qualification in care work. Recruitment procedures need more work, but training arrangements are satisfactory and supported by good record keeping. EVIDENCE: On the day of the inspection there were sufficient staff on duty to meet residents’ needs. There is a written rota in place and senior staff were on duty as the manager was due to be on leave that day. The home operates a key working system and details are posted on a large whiteboard in the passageway to the office. There are sufficient domestic staff to keep the home clean and fresh. A number of positive comments were received in relation to staffing including; ‘Staff very good.’ (from relative) ‘Staff very helpful.’ (from community nurse) ‘I owe a great deal to the staff and manager.’ (from a resident) ‘Staff come and help when asked.’ (from a resident) ‘Herewards staff have gone out of their way to support the residents.’ (from a care manager) ‘The manager and staff have always responded well to our (social services) requests and worked well in partnership with us, in a very creative way.’ (from a care manager). Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 21 The AQAA states that the home now has 65 of its care staff with a qualification of at least NVQ Level 2 in care work. This was confirmed with the manager during the inspection and exceeds the National Minimum Standard, which recommends at least 50 of care staff should hold a care qualification. The manager pointed out that 30 of staff also have NVQ Level 3, and others will be starting NVQ Level 3 and 4 this year. Recruitment files at this home are kept in good order with individual documents easy to find. Two staff files were sampled during the inspection. Both had application forms, and CRB and POVA checks, to ensure they had not been deemed unsuitable to work with vulnerable adults. They also had photographic identification. The CRB checks were made available for inspection and these were kept securely and separately. The first file had some shortfalls including not being clear when this worker left school so therefore it was difficult to work out when a full employment history started. There were three small gaps in employment history. The manager said he remembered what the worker said they were doing in these gaps but had not written this down. On the next working day following the inspection the manager wrote to the Commission to say he had spoken with the staff member and this shortfall had now been corrected on the staff file. The second file also did not show when the candidate left full time education and there appeared to be a three-year gap after the normal school leaving age. There was a further small gap in their employment history in 2008. The manager also thought he knew what this gap was about but it was not documented. As above, in a letter to the inspector following the inspection, the manager confirmed these shortfalls have now been rectified. There followed some discussion about references as, in addition to references from their last employer, one candidate had a reference from a work colleague, and the other from a relative. The inspector asked the manager to consider the suitability of taking up references from colleagues and relatives, and he later confirmed in writing that alternative, more suitable, second references were being sought. In his follow up letter to the inspector he also said he would check all staff files contained the correct information, and from now on would use Schedule 2 of the Regulations as a checklist on staff files. As there were minor shortfalls on recruitment at the previous inspection, and to ensure the safety of residents, a Requirement will be made in this regard. The staff files that were checked for new staff members showed they had undergone induction training based on the Skills for Care Common Induction Standards. Training arrangements continue to improve at this home and the manager had a fully completed training matrix, which showed staff had completed the relevant training and also noted when refresher training was due. Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a home which is well run, and where their views are sought and taken into account. Policies are in place to protect residents’ financial interests. Health and safety arrangements continue to improve at this home. EVIDENCE: The current manager has been in post for over four years and is experienced and qualified; he has completed the Registered Manager’s Award and also has a background in nursing. He is also one of the home’s registered owners and is therefore in a good position to take responsibility for the management of the home. There are clear lines of accountability within the home and its external management. Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 23 The manager creates an open, positive and inclusive atmosphere within the home and there were several comments on his personal style, which are noted at the end of this report. There are a number of ways in which the service maintains a good quality service. Firstly, one of the joint owners is in day-to-day charge of the home and, as noted above, has an open and inclusive management style. Residents and relatives views are sought both in surveys and in meetings at the home. The manager is currently collating the results of the most recent survey. All those spoken with said they knew who to go to if they had any suggestions or concerns. The manager said he meets with the other homeowners regularly to discuss current issues and to plan ahead. There are regular reviews of certain aspects of the service for example residents’ care plans, which are reviewed each month. Surveys from two care managers, and a further telephone conversation with one of them, demonstrated that, when they carried out reviews, they were happy with the care and services provided for their clients at Herewards House. The home carries out regular audits and maintenance checks and the AQAA gives examples of issues which have been highlighted by these checks, and then rectified, for example changing the lighting in the hallway to make it brighter for residents to see well. As mentioned earlier, the Environmental Health Officer had no concerns during a recent inspection, and the community pharmacist had only two minor issues following the inspection of the home’s medication arrangements. The home has an annual development plan, which the manager said was last reviewed earlier this month. The home does not manage residents’ overall finances and where this assistance is needed, it is provided either by relatives, an advocate, or by social services. However, some residents opt to leave money in the safe at the home and each resident has a book to record any income and outgoings. Those residents who are fairly independent come and collect their money from the office as they need it. One such transaction was observed during the inspection. The resident was shown the record and signed for the amount they had withdrawn. The home should be congratulated for the way this is managed as it empowers individual residents and ensures they have control over their own day-to-day spending money. The AQAA states that ‘We constantly carry out health and safety checks within the environment. Staff report any failures, breakages or faulty equipment in the breakage book, which is acted upon by the manager and maintenance services.’ It goes on to say that qualified companies regularly service equipment, and certificates are held at the home. The health and safety shortfalls referred to in the previous inspection report have now been satisfactorily dealt with. The AQAA notes when relevant policies such as fire safety, and health and safety were last reviewed, and some of these appeared to be out of date. This was discussed with the manager who said this had been Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 24 an oversight when completing the AQAA, and he was able to give dates in 2007 and 2008 when the most crucial policies had been reviewed. They have arrangements in place for preventing legionella such as annual water samples being sent off, and weekly monitoring of water temperatures. The manager was asked to consult the Health and Safety Executive website or the local Environmental Health Officer to ensure that current arrangements at the home met with the latest good practice, including having a legionella risk assessment in place. The manager said that the signs in the home referring to water temperatures were about to be reviewed by their handyman, who is a qualified plumber, to ensure they contain the correct information for staff reference. The manager was able to demonstrate, from the home’s training matrix, that staff have completed the relevant training including health and safety, infection control, first aid, and moving and handling. However, out of three resident’s files checked during the inspection, only one had a current falls risk assessment. One, for a new resident, was drawn up immediately, and another had been misplaced during the recent review of care files and the manager said he would either find it, or re-write it. The manager needs to ensure that each resident’s file contains the relevant risk assessments, and a Requirement will be made in this regard. A number of very positive comments were made both on surveys and directly to the inspector regarding the manager and staff at this home including; ‘I have a good deal of confidence in the manager.’ (from a relative) ‘I owe a lot to the manager and staff.’ (from a resident) ‘The manager has a health background and is an experienced, knowledgeable and skilled manager. He is a great asset for the residents and staff at Herewards House.’ (from a care manager) ‘Thank you for the care received whilst staying with you and all the kindness of all I came into contact with.’ (from a temporary resident) Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15(1) Requirement Timescale for action 17/05/09 2. OP29 19 3. OP38 13(4) The current care planning format must be reviewed to ensure each care plan contains details about how residents would like their support to be delivered. Staff recruitment files must 17/05/09 contain all the information set down in the Care homes Regulations 2001 (as amended) and in Schedule 2, including a full employment history, evidence that any gaps have been followed up, and suitable references. Residents’ files must contain all 24/04/09 the relevant risk assessments, to ensure the safety and well being of residents and staff. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 27 1. OP8 2. OP12 Advice should be sought from the community nurse or the dietician about whether the home should be carrying out nutritional risk assessments on a regular basis, and which tool would be most suitable. The manager was asked to think about and consult with residents on how he might promote the current range of activities and perhaps extend these to ensure all residents feel there are stimulating activities on offer. Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Herewards House DS0000060965.V374765.R01.S.doc Version 5.2 Page 29 - 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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