Care Home: Homesdale

Similar services:

• Henry Nihill House
• Birchwood
• The Infirmary
• Orchard House Nursing Home
• St Josephs Rest Home
• Red Court Nursing Home
• Spinney (The)
• Queen Elizabeth House

What the care home does well The outcome for residents is positive. One resident told of her experience since moving to the home, "It is a restful and pleasant house with caring staff at hand" The relative of a resident wrote the following comments in the questionnaire, "Homesdale creates an environment which is in it`s title, it is indeed homely and successful in how it looks after elderly people in it`s care", the resident had lived at the home for thirty years. The home retains a stable and skilled staff team that relate and understand residents` needs. The consistency in staffing results in staff quickly recognising and responding to any changes in conditions and seeking the appropriate help from healthcare professionals. Another relative remarked in the comment card, "Staff are good at informing me immediately of any changes in mother`s condition, always consulting with doctor when needed" What has improved since the last inspection? The home has undertaken pre admission assessments for all residents admitted since then. The complaint`s procedure at the home is improved and residents find it satisfactory. The home responds more positively and records fully any concerns or complaints raised. There is more equipment available for residents; two hoists are supplied to assist with any transfers where equipment is required. Further refurbishment has taken place; the dining area has been redecorated with new wallpaper and blinds giving it an attractive appearance. Additional bathrooms have also been made available. What the care home could do better: A number of requirements are stated in relation to shortfalls found at inspection. The following areas are highlighted in the report for attention and need to be addressed. The staff team are skilled, reliable and approachable and have the caring qualities that residents need. However the supervision process is a little weak and is not adequately supportive. Staff need to be adequately supervised and aware of the importance of the obligation to participate in regular and consistent supervision, evidence made of this must be documented. The passenger lift has not been operating effectively and has been out of order frequently and causing inconvenience to residents. Attention is needed so that the lift is working efficiently. The home has introduced a safeguarding adults policy, procedures are also in place for staff to follow, amendments are needed in some of these to make sure that staff respond promptly and to appropriate bodies if there any safeguarding issues. Medication procedures are good with residents receiving medicines at the times prescribed. Storage for medicines is not always maintained at the appropriate temperatures. CARE HOMES FOR OLDER PEOPLE Homesdale 5-7 New Wanstead Wanstead London E11 2SH Lead Inspector Mary Magee Unannounced Inspection 29thOct 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Homesdale DS0000025904.V349605.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. Homesdale DS0000025904.V349605.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Homesdale Address 5-7 New Wanstead Wanstead London E11 2SH 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) 020 8989 0847 020 8989 0847 Woodford Baptist Homes Limited Ms Brenda Jean Jones Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Homesdale DS0000025904.V349605.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one named individual with learning difficulties aged over 65 years at Homesdale. 4th December 2006 Date of last inspection Brief Description of the Service: Homesdale is registered as a residential care home for eighteen people. It has been in operation since 1947. Woodford Baptist Ltd, a Christian organisation withcharitable status, owns it. The home is located in a residential area of Wanstead, close to bus and train services and local shopping facilities. Bedrooms are located on the ground, the first and second floors. All rooms are spacious, airy and bright. They all have hand basins, toilets, TV points and a call system. Some bedrooms also have either bathrooms or showers. There is a separate lounge and dining area downstairs overlooking a well maintained garden to the back of the house. There is disabled access to the front of the building. Car parking facilities are available at the front and side of the building. Fees are £500.00 per week. Homesdale DS0000025904.V349605.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken over one day. The inspector met with the registered manager, the deputy and five members of staff including the administrator and maintenance person. The inspector is grateful to staff and residents for their help and cooperation in facilitating the inspection. Fifteen residents were spoken to, two relatives also present talked with the inspector. The inspector had discussions with the district nurse who was present attending to residents’ health care. A selection of personnel records for staff and residents were viewed. A completed AQQA was received from the home. Six comment cards were received in total, two of these from relatives. The findings from all of the above are used as evidence in the inspection report. What the service does well: The outcome for residents is positive. One resident told of her experience since moving to the home, “It is a restful and pleasant house with caring staff at hand” The relative of a resident wrote the following comments in the questionnaire, “Homesdale creates an environment which is in it’s title, it is indeed homely and successful in how it looks after elderly people in it’s care”, the resident had lived at the home for thirty years. The home retains a stable and skilled staff team that relate and understand residents’ needs. The consistency in staffing results in staff quickly recognising and responding to any changes in conditions and seeking the appropriate help from healthcare professionals. Another relative remarked in the comment card, “Staff are good at informing me immediately of any changes in mother’s condition, always consulting with doctor when needed” Homesdale DS0000025904.V349605.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: A number of requirements are stated in relation to shortfalls found at inspection. The following areas are highlighted in the report for attention and need to be addressed. The staff team are skilled, reliable and approachable and have the caring qualities that residents need. However the supervision process is a little weak and is not adequately supportive. Staff need to be adequately supervised and aware of the importance of the obligation to participate in regular and consistent supervision, evidence made of this must be documented. The passenger lift has not been operating effectively and has been out of order frequently and causing inconvenience to residents. Attention is needed so that the lift is working efficiently. The home has introduced a safeguarding adults policy, procedures are also in place for staff to follow, amendments are needed in some of these to make sure that staff respond promptly and to appropriate bodies if there any safeguarding issues. Medication procedures are good with residents receiving medicines at the times prescribed. Storage for medicines is not always maintained at the appropriate temperatures. Homesdale DS0000025904.V349605.R01.S.doc Version 5.2 Page 7 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. Homesdale DS0000025904.V349605.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 Homesdale DS0000025904.V349605.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): 1 2 3 4 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The home is careful to assess the needs of prospective residents before they offer a place at the home. This ensures that a placement is not offered unless the home is confident it can meet the person’s needs. EVIDENCE: The Statement of Purpose and Service Users Guide include detailed information about the service provided. According to residents this is provided to all residents on admission. Evidence was seen on the files of the two residents case tracked that they each have a contract in place. The contract specifies the services that the home will provide. Contracts for both self-funding residents recorded the weekly costs. The inspector found evidence that the home completes needs assessments for all residents before they move to the home. The files for recently admitted residents (two) were observed. The needs had been assessed; further Homesdale DS0000025904.V349605.R01.S.doc Version 5.2 Page 10 information was recorded on the lifestyle choices preferred. Additional information regarding medical history was also held for one of the residents. The inspector met the residents during the day. Since admission both have settled well into the care setting. In some areas of the assessment the information recorded is quite brief and needs to be expanded more. A recommendation is made. At the rear of the home and sharing some garden facilities is a large sheltered unit for seventy older people. Many of the residents have previously resided in the sheltered housing. They were familiar with the home and choose to move there when they needed residential care. Prospective residents when possible visit the home before making a decision to move there. There was evidence that residents recently admitted had visited the home prior to admission. The home demonstrates that it has the capacity to meet the needs of people that are admitted. Older people lead fulfilling lives but feel safe and secure in the knowledge that familiar staff are ever present to provide any support necessary. The inspector met all the residents as she toured the premises. There is a great sense of feeling treasured as a person with the inclusive feel experienced by all. All the residents reported that staff are very good at caring and that they relate well to older people. The majority of staff have worked at the home for more than three years. Some have worked there eighteen years. There have been very few placements that have not been successful. The home has a history of many residents remaining at the home until the end of their life. “I wouldn’t be anywhere else, I am happy and safe here” was the comment from an elderly resident that has lived at the home for many years. “Staff know me and I know staff” was the comment of another resident. The service user’s guide should be revised to reflect changes to management. Homesdale DS0000025904.V349605.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): 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. Residents receive a good quality of care. Personal care is provided by caring staff that is familiar with residents’ needs. Health care is promoted with staff monitoring and supporting individuals to maintain a positive a state of well being, Residents are safeguarded by the medication policies and procedures of the home. EVIDENCE: To assist in evaluating the quality of service delivered the inspector cased tracked care arrangements for two residents. Both residents were admitted in recent months. The needs had been assessed prior to admission. Further assessments took place when residents moved into the home. From these assessments were care plans were agreed and recorded. The care plans describe clearly all the areas of health and social care where assistance and support are required. Consideration is given to promoting independence and enabling residents to make decisions about how they like to lead their lives. Homesdale DS0000025904.V349605.R01.S.doc Version 5.2 Page 12 Assessments also consider any risks identified that include falls, how to minimise these and manage them effectively. Manual handling assessments are also completed for those requiring assistance with transfers, these are appropriate and consider the number of staff required to transfer the individual safely. For both care plans and risk assessments regular monthly reviews take place, these are documented consistently. If there are any changes to individuals’ that impact on care arrangements these are also recorded and reflected in revised care plans. For residents at risk of developing pressure sores suitable arrangements are made, pressure relieving equipment is provided. Monitoring takes place of residents’ progress, records are maintained of all observations made. Daily records are maintained for each resident. The senior carers now print these, they are clear and are easy to read. The information recorded gives a good indication of residents’ well being. The health care needs of residents are promoted. Residents are registered with local GP practices, choice afforded where possible. Residents find they experience a good service from the doctor. In general residents unless in emergency attend surgeries and have regular check ups, medication is reviewed frequently by the relevant GP. Records are held on files of all consultations with health professionals and of follow up appointments. A district nurse was visiting the home and attending to residents. Her feedback on the care provided by staff to residents was positive. She has confidence in the staff team, she finds that staff follow recommendations made, always keep nurses informed if there are any concerns about a residents health. There is access to chiropody, opticians and dentists. Records are held of all appointments with these services. As many statutory services are unable to provide service as frequently as individuals require residents also receive a chiropody service at an additional cost. A medication profile is held for all residents. All senior staff have completed training in the administration of medication. Signatures are held for each member of staff competent in administering medicines. The home has developed an effective system for requesting prescribed medications. Following receipt of prescriptions medications are delivered weekly in monitored dosset boxes. Mar sheets, medication returns book were examined during the inspection, all were found to be in good order, no omissions were noted on records kept. Staff monitor the condition of residents on medication and if there are any concerns, they would call in the GP. Currently there are no residents assessed as able to self-medicate. One area that requires attention is the storage of medicines. A fridge is provided to store medicines that require storage at lower temperatures. One of the eye drops in use was not stored in the fridge. The registered person must ensure that medicines are stored at appropriate temperatures and use the fridge provided. Homesdale DS0000025904.V349605.R01.S.doc Version 5.2 Page 13 This home provides a service where residents feel valued and respected and where a state of positive well being is promoted. The ethos of caring and valuing people is demonstrated in working practices. Observations made during the day provided evidence of the emphasis placed on promoting a caring environment, staff were seen respecting residents’ privacy, keeping bathrooms and toilet doors closed when assisting individuals with personal care. Body language demonstrated a warm and inclusive approach, carers responded positively and promptly to residents requesting assistance. They were seen to listen closely when conversing with individuals. Residents feel comfortable and appreciate having a staff team that they are familiar with, “ Staff know my ways and the things that I enjoy” was the comment from a resident that has lived at the home for some time. Staff were observed to knock on a bedroom door before entering, and obviously had a good knowledge and understanding of the needs of residents with regards to what they preferred to be called. Staff were seen to treat residents with respect, understanding and kindness. Homesdale DS0000025904.V349605.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): 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. Residents find that the lifestyle experienced in the home generally matches their expectations and preferences with regard to social, cultural, religious and recreational interests and needs. The home is particularly good at being able to meet the cultural and religious needs of the residents, all of whom have a strong Christian background. Residents exercise choice and control over their lives and are supported to maintain contact with family and friends and the local community as they wish. Residents enjoy mealtimes and receive a wholesome appealing balanced diet in congenial surroundings, at times that are convenient to them. EVIDENCE: Choice on how residents wish to lead their lives is respected. A variety of activities is available for those that choose to engage, both in the home and externally. The home has it’s own transport for ten people. Weekly trips out are organised to local shopping centres, parks, also toutings to country places. Residents have the choice whether to engage in activities or not. There are those that prefer a quieter lifestyle and engage in pursuits such as reading, Homesdale DS0000025904.V349605.R01.S.doc Version 5.2 Page 15 knitting. One resident told the inspector of her previous lifestyle before retirement, “I like to spend time in my spacious bedroom, read or watch television, this preference is respected. The home also has a range of in house activities, games, puzzles, and parties. Residents benefit from proximity to sheltered housing unit next door, there are seventy older people living there. Two lounges are available, residents from next door also attend functions and invitations are returned too. Relatives feel welcome at the home, the evidence of this gained relatives and residents . During the day the inspector spoke to two relatives, comment cards were returned from three other relatives. As part of the admission process the weight of each resident is recorded. All residents are weighed monthly and any increase/decrease in weight is monitored, together with the daily diet of each resident. Staff take prompt action and seek advice from GP and dietician if there are any concerns about nutritional intake or unacceptable weight loss. Meals are important to residents, it is a social occasion and an important time for socialising. Preparation is made for meals and for individuals to feel comfortable when dining. The dining room is homely, tables nicely set out with tablecloths, condiments and drinks provided. The meals according to residents are good; “always enjoyable” was the comment from two residents. The inspector sampled the main lunch. Homemade quiche, potatoes and pasta were served, followed by rhubarb crumble and custard. It looked appetising and tasted delicious. For individual residents the dietary needs, preferences, are recorded, the chef is fully aware of individual’s preferences. Residents choose where they like to have meals, flexibility is afforded with many having breakfast in their rooms. Homesdale DS0000025904.V349605.R01.S.doc Version 5.2 Page 16 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 17 18 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Residents have a robust complaints procedure in place and feel confident in the system to address any concerns they raise. Staff are experienced and have a good awareness of how to safeguard vulnerable people. Some amendments are needed to the policy documentation to ensure clarity of roles. EVIDENCE: Residents feel confident and able to raise complaints. Residents’ rapport with staff is good, they are comfortable with expressing their views. The views of relatives are that the home responds appropriately to any concerns raised. The complaints register was observed. The service can evidence that it has learned from the process and that the same issues are not reoccurring. At a previous inspection there was a concern that a complaint had been received at CSCI and that this was not acknowledge at the home. Since the inspection this omission was recognised and recorded. Complaints are recorded, there is also documentation held to indicate the appropriate responses including a record of investigation. Residents are aware of their rights and are actively supported to make independent choices or decisions in their daily lives. The complaints procedure is supplied with the user’s guide. Records show very few complaints received. CSCI has not received any complaints since the last inspection. As part of Regulation 26 visit a representative from the organisation interviews Homesdale DS0000025904.V349605.R01.S.doc Version 5.2 Page 17 residents to gain their views on the service, and to check if they have any issues of concern. Residents have postal votes, applications were made earlier in the year. The registered manager confirmed this. The home has developed a safeguarding adults policy and written procedures are in place on the actions to be taken in light of an allegation or suspicion of abuse or neglect. Within the policy it is clear when incidents need external input. It also lists other links such CSCI. Accompanying the written polices and procedures is a flow chart that could be a little misleading, this indicates the role of the manager in light of an allegation. It needs to be amended so that it reflects the importance of a member of staff taking immediate action. A requirement is stated in relation to this. All three members of staff, also the newly appointed manager were spoken to, all demonstrated a good knowledge of how to safeguard vulnerable adults. They demonstrate confidence and are familiar with appropriate actions to take if they have any suspicion of abuse or neglect. A copy of the local authority procedures is not available at the home. It is recommended that a copy of this is sought and shared with staff. Homesdale DS0000025904.V349605.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): 19 20 22 23 25 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a clean and homely environment with their possessions around them. Some of the rooms are exceptionally spacious. Equipment is provided by the way of handrails, shower facilities. The lift has been problematic recently and has an impact on the ability of residents to access the communal facilities. EVIDENCE: The inspector viewed all of the premises internally. Residents say they are comfortable; the home is clean, warm and well lit with sufficient hot water. The home has been formed from a row of Edwardian houses that have been adapted and interlinked. Eighteen residents are accommodated in single bedrooms, all are en suited. The majority have shower/bathroom facilities too. Homesdale DS0000025904.V349605.R01.S.doc Version 5.2 Page 19 As the property was not specifically for a care home the rooms vary in size, some are exceptionally spacious. The bedrooms were attractively presented, residents having personalised them. They are airy and bright. Communal areas offer pleasant comfortable shared space, to mix with others and socialise. There are two lounges and a dining room. There are now two hoists at the home, one on the ground and one on the first floor. No resident requires the use of a hoist for transfers. Handrails are available along the corridors. A number of showers were seen; many have special seating to make provision for those with disabilities. It was noted that one of the newly refitted bathrooms has no hand rails or supporting mechanisms in place. A recommendation is stated in relation to reassessing this situation for residents using this facility. A passenger lift is in place. Records seen confirm that it is regularly serviced. It is just over five years old. The lift was out of action as maintenance carries out essential repairs. This poses some difficulty to residents with poor mobility living on the upper floors. In a comment card received a relative reported that the lift has been giving more problems recently and that it has frequently been unavailable. A requirement is stated that appropriate arrangements are made to make sure that residents are not restricted to their rooms due to nonavailability of lift. A lovely well maintained enclosed garden is available; this has a variety of shrubs and a water feature. Resident s were seen enjoying this in the afternoon of the inspection Homesdale DS0000025904.V349605.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): 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. Residents benefit from the presence of a stable and skilled staff team. Very few changes take place in staffing personnel; as a result there is great continuity of care and a strong sense of fulfilment within the staff team. EVIDENCE: The home benefits from a stable and consistent staff team. There is very little turnover of staff. Only one new member of staff has been employed since the last inspection. The inspector sensed that staff really enjoys working with the residents, a strong sense of community spirit has developed. Staff also have meals in the dining room. The personnel files for three staff were examined. The first file explored was for the only new staff member employed in recent years. It had three references supplied; also supplied employment record, application form, and CRB enhanced disclosure. And immigration status, contract of employment. Staff share similar Christian values to residents, relate well to backgrounds. The staff team reflect the cultural composition of residents, all English born. Staff communication is good, both in writing and verbally which helps achieve the best outcome for residents. Upon further examination of two other staff files, the inspector observed that the recruitment procedure is followed rigorously and staff files contain all required information including a photograph of each staff member. Homesdale DS0000025904.V349605.R01.S.doc Version 5.2 Page 21 Staff receive a range of training that equips them for their role. Exceptional progress has been made in recognised training. All care staff employed have acquired NVQ Level 2 in care, a large number have also achieved Level 3. All senior carer staff have NVQ level 3 in as well as a good background from working in care establishments. Staff receive all other mandatory training, this includes infection control, manual handling, dementia training, safeguarding adults. Records are not always kept in order or revised to reflect the most recent training. Eventually from speaking with staff members, examining training events booked and attended there was evidence to confirm that staff attend the training. A recommendation is made in relation to keeping training records updated. The registered person should ensure that training records are maintained on a training matrix, this should be kept updated. Staffing levels are appropriate to the needs and numbers of current residents. Out of eighteen residents only one needs the assistance of two carers for personal care. Hoisting equipment is not currently required by any resident. Four carers plus one senior are on duty in the mornings. According to staff they find this appropriate. Residents spoken to are confident that appropriate levels are available, “a speedy response is experienced when a resident uses the call bell” was a comment received. Two carers are on duty for night times. No concerns were raised by any relatives that responded to the inspector’s comment cards Homesdale DS0000025904.V349605.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): 31 33 35 38 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Residents at the home have benefited from the presence of an experienced and competent manager and deputy manager. The deputy manager has been appointed to the role of manager when gives residents and staff great reassurance. The home is maintained safely with plans to respond to fire risk assessment. Staff have their practices observed and good practice is experienced, however staff need regular and consistent supervision. EVIDENCE: The registered manager was due to retire the day following the inspection. The deputy manager had been appointed to the post of manager. Both members of staff met with the inspector. The newly appointed manager has many years experience from working as carer to the role of deputy manager. Homesdale DS0000025904.V349605.R01.S.doc Version 5.2 Page 23 Her appointment is popular with staff and residents. She has completed the registered manager’s award. A completed application form to register as the manager of the home with CSCI is required. From observation on the day of the inspection and during discussions with staff and residents it was apparent that the home is run in the best interests of residents. The care needs of residents are kept under review. Based on information received during the inspection from residents, relatives the outcome for residents is good. However the service has not fully developed an effective quality assurance process yet. This needed so that the service has robust systems for monitoring and evaluating the quality of service delivered, also to include the views of stakeholders. A requirement is stated. Staff feel supported, they speak of regular observations made of work practices by senior carers and management. No records were present to evidence that regular one to one supervision or team meetings are held. The inspector found a remark made by a senior carer to be of concern, she indicated that staff are sometimes not cooperative when arrangements are made to hold one to one supervision sessions. Staff need to be aware that this in breach of regulation, they must be supervised at least six times a year. Records must be maintained of this, staff also need training on delivering supervision, it must be an ongoing process to effectively support the team. The requirement stated in the previous inspection report has not been met. It is restated in this inspection report. The inspector met with the administrator to examine how residents are supported to manage their finances. For residents that require assistance clear records are held with audit trails of all financial transactions, including receipts. Personal allowances that residents request be kept by the administrator are held in safekeeping. The sums held for two residents were checked, these corresponded with totals held on transaction sheet. Residents are encouraged to manage their own finances with assistance from their families or representatives. Maintenance records such as those for gas, electric, water lift maintenance, and insurance were inspected and found to be in good order. Also seen were records of regular fire drills, fire alarm checks. The inspector met with the maintenance person, repairs are carried out promptly according to priority. He spoke of visually checking the premises and noting any area where shortfalls are found. There is no regular recorded system of how specific areas of responsibility are allocated; neither is there a log kept of weekly audits on health and safety in their areas. A recommendation made at previous inspection is restated. In line with the new fire regulations a fire risk assessment was undertaken at the home in March 2007 by an external consultant. The fire risk assessment report was viewed; it contained details and timescales for responses to be Homesdale DS0000025904.V349605.R01.S.doc Version 5.2 Page 24 actioned. According to the registered manager, also the administrator stated quotations are currently being sought from three suppliers for this work; these will then be presented to the board of trustees for implementation. A recommendation is made. Notifications under Regulation 37 and reports under Regulation 26 of the Care Homes Regulations are received at CSCI. The registered person should ensure that a report is forwarded to the inspector on the planned responses to the fire risk assessment including timescales for achieving these. Record keeping is generally good at the home; only deficit is the lack of recording of supervision sessions for staff. Homesdale DS0000025904.V349605.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 3 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 3 18 3 3 3 3 2 3 X 3 3 STAFFING Standard No Score 27 2 28 4 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Homesdale DS0000025904.V349605.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? 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 OP9 Regulation 13 (2) Requirement The registered person must ensure that medicines are stored appropriately; the fridge must be used to store medicines that require storage at a lower temperature. The registered person must ensure that information is amended on the current flow chart accompanying the safeguarding adults policies and procedures. The registered person must ensure that the passenger lift is available for residents and that it is maintained in good working order. The registered person must ensure that a completed application form to register as manager is submitted to CSCI. The registered person must ensure that effective systems are implemented to monitor, evaluate the quality of the service. The manager must ensure that all staff receives regular, planned supervision, which is evidenced. DS0000025904.V349605.R01.S.doc Timescale for action 30/11/07 2 OP18 13 (6) 30/11/07 3 OP22 23 (2) c 30/11/07 4. OP31 9(1) (2) 30/11/07 5 OP33 24 30/03/08 6. OP36 18 31/12/07 Homesdale Version 5.2 Page 27 All staff delivering supervision are required to attend a supervisory training course in order to deliver effective supervision to the staff. (Unmet in previous timescale of 31/03/07) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP1 OP3 OP22 OP30 Good Practice Recommendations The registered person should ensure that the service user’s guide is revised to reflect changes to management structure. The registered person should ensure that the pre admission care needs assessments record more detail on individual needs. The registered person should ensure that refurbished bathrooms are assessed to determine if residents when bathing require any additional equipment. The registered person should ensure that training records are maintained on a training matrix (spreadsheet) for ease of reference, this should be kept updated and reflect accurately staff training. The inspector recommends weekly health and safety audits be carried out for the premises. The registered person should ensure that the scheduled work planned (including timescales) to meet and respond to recommendations made in the March 2007 fire risk assessment are forwarded to the inspector. Confirmation to be sent when this is completed. The registered person should ensure that consultation takes place with fire prevention authority on the current fire risk assessment. 5. 6 OP38 OP38 7 OP38 Homesdale DS0000025904.V349605.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 Homesdale DS0000025904.V349605.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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!