Care Home: Horsfall House

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What the care home does well What has improved since the last inspection? The building work in progress will provide a number of improved facilities to include more communal space and better dining facilities. Although some comments from relatives and staff do not agree, there was evidence that there were more organised activities, social events and entertainments in place, with the help of several volunteers, but recruitment of more volunteers could be very beneficial in providing social interaction for residents especially within the Cotswold unit, and particularly as more of the staff time is now taken up with meeting increasing physical needs. What the care home could do better: CARE HOMES FOR OLDER PEOPLE Horsfall House Windmill Road Minchinhampton Stroud Glos GL6 9EY Lead Inspector Mrs Janet Griffiths Key Unannounced Inspection 10:00 28th November 2007 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 Horsfall House DS0000016476.V350132.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. Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Horsfall House Address Windmill Road Minchinhampton Stroud Glos GL6 9EY 01453 731227 01453 886371 rosemary.wright@horsfallhouse.co.uk 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) Minchinhampton Centre for the Elderly Miss Jennifer Martin Care Home 42 Category(ies) of Dementia (20), Old age, not falling within any registration, with number other category (22) of places Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Temporary Variation to admit one named person under 65 years of age on a respite care basis one week in every six. 24th April 2006 Date of last inspection Brief Description of the Service: Horsfall House is a purpose- built home accommodating elderly people who need nursing care, residential care or dementia care. The Home also provides a day centre offering a range of facilities for the elderly residents of the local community and is also open to the residents in the home by arrangement. The Home is situated on the outskirts of the town of Minchinhampton near to the common. The accommodation is attractively furnished and maintained. A shaft lift accesses the upper floor to the nursing General unit, which consists of 18 single and 2 double rooms, all with en suite facilities. The Cotswold (EMI) Unit comprises 20 single en suite rooms. The main dining room is situated in the front of the Home next to the kitchen and is currently used mainly for the Day Centre. However, a programme of redevelopment has now commenced. This will enlarge the day centre and provide new kitchen and dining facilities, where it is hoped residents from the General unit will join day centre clients. It will also upgrade the laundry and bathrooms and create new offices and additional day space to include dining facilities for Cotswold Unit. This will take some of the garden areas but once the building work is completed, work will be undertaken to ensure that there are a choice of garden areas for residents and visitors to enjoy, to include an area where residents may wander in safety. At the time of inspection the weekly fees are £745 RNCC in the General Unit and £770 RNCC for Cotswold Unit. Additional charges are made for chiropody, hairdressing and physiotherapy. People funded through the Local Authority have a financial assessment carried out in accordance with fair access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms can be accessed from the Office of fair trading web site at www.oft.govuk http:/www.oft.gov.uk Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 5 Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service, their relatives and staff. This unannounced key inspection site visit took place over twelve hours on two days in November 2007. During this time the inspector spoke to a number of residents, three visitors, staff and the registered manager. Some areas of the home to include communal areas, some residents’ rooms and areas where building work is underway were all seen during this inspection. Four residents’ files, two from each unit, were examined in detail to include their medication records. Other records examined included staff recruitment and training records, complaints and compliments and maintenance/servicing records. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was completed and its contents used as part of the inspection process and report writing, as was the collation of survey results from service users, relatives and staff. What the service does well: The home has a warm and friendly atmosphere and is very welcoming to visitors. There is an excellent training programme available for the staff, who are all very committed to the well-being of the residents and to providing the best possible quality of life for them that they can. Residents and their families all confirm that they are very happy with the standards of care received and the facilities offered in the home. When asked what the home does well, these are some of the comments received: Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 7 • • • • ‘Wonderful raport with all; attention to all details; flexible with care when need is available -yet allows families to participate fully; lovely atmosphere; cleanliness 100 ; great care over my mothers skin (which is very delicate); great care with mobility and hygiene; really everything!!’ ‘Attends to their needs and builds a relationship with the person in the home, all the staff are very helpful and friendly’. ‘Staff are always welcoming and willing to talk about my mother and how to keep her as well and happy as possible. You get the feeling that they care in every sense of the word’. ‘Has a very considerate and caring attitude to both residents and visitors. staff show kindness, professionalism and patience. Time is taken for explanation; care is always taken to be friendly and cheerful and to respond to needs’. • • ‘My mother-in-law is always well looked after, the staff make sure she goes to the day centre each morning as she is a person who likes a chat and to be kept mentally entertained. The staff are very nice to all the family when visiting and always have time to chat’. ‘ Fantastic staff who have excellent relationships with the unit nursing managers. I can visit my mother any time of the day or evening and she is always comfortable, washed and well attended’. What has improved since the last inspection? What they could do better: Although activities have apparently improved, and not every resident wishes to be involved in organised activities, there are still a number of comments from Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 8 the surveys received about lack of activities and social interaction for residents (see observation made in standards 12-15). There were also concerns raised, mainly by staff, about the reduced staffing during the afternoons, and although nothing specific was observed during the inspection, levels must be constantly monitored against dependency levels to ensure needs are being met. Staff morale did not appear very high on this occasion with a number of issues being discussed that are causing staff concerns. Regular meetings must be held to give staff the opportunity to air their views and raise the concerns they have. When asked ‘what the home could do better’ the following comments were made: • • • • • • • • • ‘Allowed to continue with assistance from authorities without changes unless requested by staff within Horsfall’. ‘More encouragement /facilities to get residents out of their rooms and to use their limited mobility to the full. Easier access for wheelchairs to garden, e.g.2 way gates? remote controlled doors’. ‘It cant-it is always doing something to improve’. ‘ Not possible’ ‘If staff numbers increased then the individual residents would have better service, i.e.more contact with the staff’. ‘Perhaps trying to create a more stimulating environment’. ‘Difficult to say as I think they do a very good job’. I think it would be difficult to improve the excellent care and service my mother has received now for six years’. ‘Wonderful as it is. Not too big-very homely’. 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. Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 3. Standard 6 not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their families have all the information they need to make an informed choice regarding placement at the home, and pre-admission visits take place to carry out an assessment and ensure that needs can be met. Residents normally move in on a long-term basis therefore Std. 6 was not assessed. Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 11 EVIDENCE: Because the home only accepts people from the local community (within a 6 kilometre radius of the Ragged Cot), most people who choose to live at Horsfall House know the home well and many have attended their day centre, received their home care services or stayed at the home for respite care prior to longterm care. All of these factors help people to settle in to an already familiar environment. A copy of the Statement of Purpose and Service Users Guide, which has been reviewed this year, was provided at inspection, is displayed in reception and a copy provided in each residents room. People spoken with during the inspection and surveys received confirmed that they all felt they had received enough information about the home prior to the inspection. The annual quality assurance assessment (AQAA) states that ‘prior to admission all service users have a full nursing and social evaluation by the unit manager who is a trained nurse’. Copies of these assessments were seen. Whether self-funded or funded by Social Services, all residents are given a contract and again copies of these were seen and surveys confirmed that they had received them. A number of residents were spoken with who had been admitted since the last inspection and they, together with surveys received, confirmed that most felt their needs were fully met. However, two surveys completed by relatives did make the following comments: • • ‘Lack of mental stimulation. Not sufficiently encouraged to make social contact or to optimise physical mobility’. ‘As my mother doesnt remember things in the recent or immediate past we have no way of knowing which if any activities she has participated in. it would be helpful if staff could fill in some sort of diary on a daily basis so that we cold judge if the home is meeting her needs and also it would be something we could talk to her about’. Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. These judgements have been made using available evidence including a visit to this service by the key inspector. People who live in this home have their health care needs met through individually planned care. This clearly sets out needs and how they are met, to include healthcare referrals and interventions where required. They are also protected by the medication administration procedures that the home has in place and are treated with respect; their privacy and dignity are protected. EVIDENCE: A total of four care files (two from each unit) were examined and a number of residents and three relatives/visitors were spoken with. Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 13 All had very full assessments completed based on the activities of daily living (ADSL’s). Within the general unit care plans were completed for those problems identified; whereas on Cotswold unit, each ADL was identified as an problem but care plans were not in place for all of these and in one case seen was not up to date and did not reflect the resident’s current needs. All the care plans seen were core care plans and in most instances these had been individualised and added to where appropriate. In both units care plans were reviewed monthly; in Cotswold there was evidence that this was completed with relatives but this was not evident on the general unit although a relative liaison form was in place and used for specific communications. Moving and handling and pressure sore (Waterlow) risk assessments were being completed on both units and reviewed monthly, and weights were also monitored monthly. Again, in the one case mentioned above, the pressure sore risk assessment was not up to date, to reflect that this resident had returned from hospital following surgery and was now much less mobile, with a higher Waterlow score. On general unit it was reported that there was one resident who had been admitted with a sacral pressure sore and one other being monitored closely, having had pressure sores in the past when admitted from home. Eight residents were named as requiring wound care/dressings, mainly to minor skin flaps and around feeding (PEG) tubes. One third of the residents on general unit now require assistance/prompting with meals and approximately two thirds on Cotswold unit; this can vary from day to day. A number of residents on each unit were also being nursed in bed at the time of inspection and the nurse on General stated that they usually help half of their residents back to bed before the night staff come on-duty. It was their opinion that their dependency levels are increasing. Day and night profiles were also completed and were quite informative especially for new staff indicating day and night routines for each resident but it was advised that when changes are made to these they should be dated and signed. Other documentation such as records of doctor’s visits and visits from other health care personnel confirmed regular liaison with other health professionals and staff on the general unit spoke of referral with District Nurses to successfully treat leg ulcers for one resident; another resident was attending a speech and language therapy appointment that day, a relative mentioned an audiology appointment as her husband’s hearing aid had been mislaid and a doctor was visiting Cotswold unit on the second day of inspection to see several residents. Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 14 Residents and relatives surveys received stated that they always/usually received the care and support they required and received medical support. One survey stated that the care could not be better but another voiced some concern about reduced staffing levels in the afternoon saying that ‘staff who are overstretched are less likely to give best attention to those they care for. The good staffing ratios were one of the reasons we choose Horsfall for our mother’. From observations during the inspection and residents spoken with it was confirmed that their privacy and dignity are maintained. Staff knock on doors before opening them and address residents by their preferred name. The AQAA states that ‘staff are courteous and responsive to the individual characteristics of the service users. Service users privacy and dignity is respected by all employees and this is taught within their training’. All of the medication records were examined during the inspection and were well maintained. The dispensing pharmacist carries out regular inspections and is always available for any queries staff may have. It was noted however on general unit that reinforcement rings around the punched holes of the medication records are covering resident’s names which would be difficult for new/agency staff when identifying residents. Qualified nurses on each unit always handle, administer and store all medication in accordance with the medication policy, the Medicines Act 1968, Misuse of Drugs Act 1971 and the Misuse of Drugs (safe custody) Regulations 1971. All trained staff complete medication training with regular updates. Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Some people who live in the home, particularly those able to make their own choices, are supported to realise their own preferences and expectations, both within the home and in the community and are able to maintain contact with friends and family. However, others unable to make their own choices, do not always appear so well supported. They also receive a wholesome, appealing and balanced diet in pleasant and comfortable surroundings. EVIDENCE: Activities programmes were on display in each unit with a variety of activities, entertainments and social events available for those who wish to participate. Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 16 One lady on the general unit spoke of enjoying the quizzes each week, the exercises to music, the entertainers and meeting her friends in the day centre. A volunteer comes to the general unit every Monday, Wednesday and Friday when music, films, quizzes and sing- a-longs take place in addition to regular entertainers visiting. Cotswold unit are helped in their activities organisation by a relative of one of the residents and on the afternoon of the inspection was about to make cards with some residents after their communion service. Other activities include scrabble, tai chi, reminiscence and flower arranging. A Christmas activities programme was also on display offering a full months programme of events including ‘haggis tasting’. Surveys received from residents stated that they usually/sometimes took part in the activities arranged and make the following comments on the subject: • • • ‘Would like to have gone out. Used to be involved in activities in the past. Presently not well and able enough’. ‘Only activities arranged by family away from Horsfall’. ‘We have a very good volunteer and day room so that I can visit and see local friends’. One relative survey made the following comments; • ‘Regular transport to church not provided by home as promised (now provided by church). Not enabled to partake in day centre activitiesunderstood there would be more opportunities to be out of their own room. Recently had two games of scrabble with volunteer and communal lunches’. and another said when asked what the home could do to improve: ‘Perhaps trying to create a more stimulating environment’. From the staff surveys, when asked ‘what the home could do better’, it also appeared that staff do not feel there are enough activities for the residents with the following comments made: • • • • • ‘Social activities’. ‘Take the clients out more, it is the only chance most of them have of getting out of where they live’. ‘Put more into social activities spending more time with the clients’. ‘ Incorporate more outings and activities’. ‘Have more outdoor space for the EMI unit-provide more activities and stimulation’. Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 17 • • . • ‘Social activities could be better, having use of the homes buses on occasions’. ‘ Could attend more to the social needs of clients, many clients are sitting in their rooms 24/7-week in week out-staring at 4 walls’. ‘Offer more entertainment to service users and time in which to do this, e.g. extra staff in afternoons to maybe offer to play cards, board games etc to service users who like to stay in their rooms’. As part of this inspection, the inspector spent an hour sitting in one lounge of Cotswold unit just observing the activities taking place. Six residents were present. Because staff were engaged elsewhere, for much of the time, no staff were present and two residents sat staring at the television but did not appear to be watching it, two sat with their eyes shut, only opening them occasionally, one sat rubbing their hands together and another sat staring into space. When a member of the staff from the day centre came in to help, she related very well to the residents and tried to involve each one in turn, talking to one or two about the television and then looking at a magazine and doing a crossword with one, and they appeared much more alert then, but this was for a very short period of time. One doing the crossword stated that it was so boring and she repeated this later to the inspector when speaking to her with her visitor. Once lunch and other staff arrived the whole atmosphere changed again, as staff served meals and started to assist residents with their meals. The visitors spoken with are generally satisfied with the care in the home and stated that they are kept informed of their relative’s conditions and any changes. One visitor on the General unit said how supportive the staff are to relatives as well as the residents which is so important, and another relative said how pleased they were when their mother got a place at Horsfall House. From the surveys received, most also felt that the residents were able to live the sort of life they would choose, with the following comment made: ‘ Although my mother might choose to live her life differently and in her own home we know it would not be possible due to the level of support she requires. The care service supports her to live in the environment that we and others feel is the only option for her’. But one did state: • The requirements of the residents cannot always be fulfilled because of staff numbers/duties’. • Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 18 Menus are displayed in both units and choices are offered at each meal and special dietary needs catered for. From the surveys received most liked the meals provided, with one stating they were repetitive and another saying they offered quite a good variety. One staff survey stated: ‘The meals are becoming very bland, old people eat meat and vegetables not curry, rice and modern day pastas, and they should be allocated more money for the meals’ and another said: ‘Offer more choices of meals to service users’. Meals served, looked appetising and offered choices on both days of the inspection. There are some dining facilities in each unit, but these are currently limited as indicated in the following comment: • ‘Meal arrangements; dining room too small for wheelchairs etc-room not always available due to meetings-but enjoy mealtimes when possible’. However, as this is part of the redevelopment programme, this situation should improve greatly in the next year. Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People in the home are protected by the systems in place. EVIDENCE: The home has a clear complaints procedure, which is on display in the home and also included in the service users guide provided to each service user. The new address of their local CSCI office is included but not the new telephone number, which will need to be added. Residents spoken with and surveys received confirmed from both residents and their relatives that they are fully aware of how to complain, adding the following comments: • • • • ‘Form provided’ ‘But at the moment we have only praise’. I would look in the brochure, or just ask’. ‘If I am concerned I approach the managemen’t. DS0000016476.V350132.R01.S.doc Version 5.2 Page 20 Horsfall House • • ‘We believe our complaint or concern should be addressed to Social Services’. ‘ But never needed’. The home keeps a record of any complaints and compliments received and these were examined during the inspection and have been dealt with in accordance with the homes complaints policy. The home has policies on disclosure of abuse and bad practice (Whistle Blowing), and safe guarding adults and prevention of abuse last reviewed in November 2006. Staff also receive training on Protection of Vulnerable Adults, confirmed by the staff spoken with and further training is planned. The AQAA also confirms that all staff attend adult protection courses and during the first 6 months of employment will attend a Protection of Vulnerable Adults course and will have 2-yearly updates. Each unit has a copy of Social Services Adults at Risk Procedural Guide for Professionals and copies of the abuse policy and Codes of practice booklet are provided on induction. Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 21 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, 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained, clean and hygienic throughout. Equipment is provided to aid mobility and promote independence. Individual bedrooms are decorated and equipped to meet the needs of their occupants. EVIDENCE: Over recent months a major building project has commenced. Once completed dining facilities in the day centre will be increased and new kitchen facilities will be provided; new offices and new reception area will be created; a new office Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 22 and additional storage has just been completed in Cotswold Unit and in the New Year the two small lounges will be joined by a dining area, to make one large communal space in that unit; the laundry and bathrooms are all being upgraded and once the building work has been completed work will be undertaken to ensure that there are a choice of garden areas for residents and visitors to enjoy, to include an area where residents may wander in safety. A tour of the communal areas of the home, the building work ongoing and some residents’ rooms was undertaken during the inspection. All of the rooms seen were clean and in good decorative order, with just one room where some of the paintwork needed to be renewed and was said to be from the resident’s chair, according to his wife. There was evidence that each person had had the opportunity to personalise their rooms with photographs, items of their own furniture and other treasured possessions. Furnishings also appeared to be in excellent condition, the only comment being that the new profile beds recently introduced had quite a high ‘foot board’ and the resident had to have the television raised up to be able to see in bed, and the small tables were a bit fragile and liable to drop/tip at times. This was fedback to the manager. All spoken with and surveys received confirmed that the rooms were always fresh and clean, as observed and comments included: • • • • ‘Lovely atmosphere; cleanliness 100 ’; ‘Home clean, nicely furnished, no unpleasant smells’. ‘The home always smells nice’. ‘Very meticulous on cleaning.’ The AQAA states that they have a programe of routine maintenance (seen) which the handyman makes sure is ongoing and up to date. Plans for further improvement over the next 12 months are said to be further work on the water supply system, to replace and upgrade the bathing faclities in each unit and to install a new nurse call system. There are generally two cleaners on each unit seven days a week to maintain a high standard of cleanliness but there was one only on General unit on one day of the inspecton as one was sick. However, all areas seen appeared clean and odour free and infection control proecedures were also in place and observed with staff wearing appropriate protective wear for specific tasks. The infection control policy is being updated by one of the registered nurses and was seen, and six staff have started Level 2 Infection Control training by distance learning. Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29, & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home feel that there are sufficient, skilled staff, to meet their needs, but not all of the staff agree with this. Residents are also protected by the homes recruitment system. Staff are supported to undertake regular and relevant training. EVIDENCE: Staffing levels in the home have recently been adjusted so that there are six care staff and one qualified nurse on each unit on the early shift, then three care staff and one qualified nurse on the General unit on the late shift and four care staff and one qualified nurse on Cotswold unit on the late shift. Some of the staff spoken with on the general unit, feel that the drop from four to three carers on a late shift is detrimental to the care being provided. This is because most of the residents require two staff to attend to most of their needs, which is what is provided in the morning. When the qualified nurse is otherwise engaged with medicines or attending visitors/health professionals Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 24 etc, one carer is working alone. This feeling is confirmed by the following comments in the staff surveys received, when they were asked ‘are there enough staff to meet the individual needs of the people who use the service?’ • ‘If there were more staff on each shift more time could be spent with each resident. Residents have memory loss and do take their time when doing things especially seating. Out of 20 residents at least 10 need feeding or prompting (financial issue)’. ‘Not always possible as due to sickness, annual leave etc’. ‘Sometimes one or two clients are having to wait as we can only deal with one at a time’. ‘Except when there is staff sickness; this cannot be helped’. ‘There are always times when more staff would be welcome, i.e. depending on clients needs’. ‘ At night staffing levels are low and mean that we cannot always give residents the time we would like to when putting to bed or changing in the morning. Most of the residents need two carers so it would be easier if there were always two carers working together as a unit’. ‘Staff sickness or annual leave can sometimes lead to staff shortages on a shift. But every effort is made to bring in replacement staff. Residents suffer from dementia and alzheimers. Many need one to one care which when busy not always possible to achieve and extra time cannot be spent with individuals’. Staff have been cut in the afternoons on our unit, therefore I feel our service users will suffer, i.e. being unable to take so many around the garden for a walk as basic needs to be met’. ‘Our staffing rota is changing i.e. one care staff down on afternoon shift’. • • • • • • • • Generally, observations over two days showed a very calm atmosphere throughout, with no complaints from residents about having to wait and no call bells sounding for long periods of time. There was just one comment made by a resident within their surveys which stated: • I generally only see any staff at meal times or medication times. It would be nice if occasionally staff could spare a few minutes each day to come and talk to discuss daily issues. I get more communication through the television. Other indications of staff shortages such as higher incidence of pressure sores, accidents or complaints were also not in evidence. However, dependency levels as a whole are gradually increasing as people become frailer and live longer and dependency levels must be constantly monitored and staffing levels adjusted accordingly to ensure residents needs are being met. Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 25 The only signs that more staff would be beneficial was to provide better social interaction in Cotswold lounge (see standards 12-15) and some relatives were overheard on general unit expressing their dismay that after ringing the home to speak to their mother on her birthday one evening the staff did not ring them back as promised and they were unable to wish her happy birthday. The nurse on-duty apologised profusely for this explaining that the evenings are busy with suppers, medicines and helping people to bed and it may not have been possible to do so on this occasion. Seven new staff files were examined during the inspection and all were found to have all the required documentation and checks completed, to include an application with full career history; two references; identification to include a photograph, a health declaration, an interview record and Criminal record Bureau (CRB) and Protection of Vulnerable Adults (POVA) First checks. Also on file were seen records of induction and probationary supervision meetings at 6 weeks, 12 weeks, 3 months and 6 months. The AQAA states that the home now has 62 of staff trained to NVQ 2 and 30 trained to NVQ 3. All courses are arranged by the training co-ordinator and staff are paid for attending all 5 mandatory courses. Staff spoken with and staff surveys received confirmed that they felt they had a thorough recruitment process and that their induction covered most of the things that they needed to know to start their job adding the following comments: • • • • ‘I started to work at Horsfall House 13 years ago therefore things have changed’. ‘With so many people with different needs it is difficult to assimilate all the information at once’. ‘ New employees shadow established staff for a while when they first come onto unit. New staff well supported. Induction carried out by nurse manager’. ‘The induction was given until I felt comfortable working in the home’. They also confirmed that they received training relevant to their job, helping them to meet the needs of the service users and keeping them up to date. Several mentioned the training coordinator keeping them informed of relevant courses that are available but one member of staff felt frustrated at not being able to do NVQ 3. Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 26 Several staff have just commenced NVQ 2 in dementia care with a local college and are finding it very helpful. It is an aim of the home that all care staff will receive dementia training in the future. Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32, 33,35, 36, & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home have their best interests met by the manager and staff who are committed to their responsibilities. They and the staff are generally protected by the health and safety systems in place in the home. EVIDENCE: The registered manager is a first level nurse with five years experience running a care home. She achieved the registered manager’s award (RMA) and NVQ level 5 in management in 2006. She also attends regular training workshops to assist her to undertake her duties and to keep up to date. Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 28 Unit Managers are in charge of each unit, and both of these are qualified nurses. When staff were asked in the surveys if they were given enough support by their manager nine said regularly, three often, two sometimes and two never with one feeling that although the unit manager was very supportive the unit manager was not so approachable as they did not see her on the unit a great deal. The following comments were received: • • • • • • Never home manager. Except for unit manager who gives full support. We have our three- month appraisals, and yearly appraisals with unit manager. In staff appraisals every 6/12 months. Appraisal and supervision meetings held at regular intervals for all staff. Staff have good relationships with nurse manager and problems can be discussed on a daily basis if need be. My unit manager gives the support. The manager takes part with the care needs as in ‘hands on’ approach so is always available and supportive to care assistants. Records of staff appraisals and regular supervision were seen within the staff files examined and staff spoken with confirmed that they had received supervision. Staff meetings do take place but some staff felt some levels of communication were not good; staff in the units did not always feel they were involved in the decision making concerning residents care and when changes were made memos were sent to the unit managers to communicate rather than having a chance for issues to be discussed with the registered manager or Board. This was discussed with the manager who is very aware of some current issues that have to be dealt with and meetings were being set up for this purpose. When staff surveys asked what the home does well the comments included were: • • • ‘We provide good personal care, and as much as we can promote their independence’. ‘ I feel we look after our service users well (general unit). We meet their needs and give them dignity and choice’. ‘The service promotes the individuality of residents with all aspects of care being adapted, appropriate and specific to each person, e.g. different forms of communication e.g.(verbal, non-verbal, body language) applied to ensure that individuals values, choices and preferences are met using the holistic person-centred approach’. DS0000016476.V350132.R01.S.doc Version 5.2 Page 29 Horsfall House • ‘ Making service users comfortable in their environment and helping them to settle into their new home’. When staff surveys asked what the service could do better, the following comments were included: • • ‘Instead of treating each unit as a single, the whole home should run as one, and each unit be treated as equal’. Actively encourage staff in training particularly to understand dementia. Better communication between night and day staff especially in EMI unit. Too often night staff are just seen as ‘holding reins’. There were also nine comments asking for more activities or more time to spend with the residents. The home does not act as appointee for any resident but has secure facilities available for small amounts of money and valuables residents may wish the home to hold for them. Records are kept of any cash transactions or any property stored. A quality assurance programme is in place and satisfaction surveys are sent to residents and relatives on an annual basis and a report compiled and made available in the service users guide (copy provided). Thirty responses were received from relatives in this years survey and were generally positive with the lowest score concerning activities. Records were seen to confirm that regular servicing and maintenance of equipment is carried out and hot water and fire safety checks are also completed. The home has recently had a visit from the fire safety officer, when the risk assessment and fire evacuation procedures were discussed. Staff surveys, staff spoken with and records seen confirmed that staff all attend mandatory health and safety training on induction and receive regular updates. Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 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 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X 3 3 X 3 Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 31 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(b & c) Requirement Ensure that the residents care plan is kept under review to reflect their current needs and reviewed with the residents/their family where possible. Ensure that all residents have the opportunity to engage in social activities and social interaction on a daily basis. Constantly monitor the dependency levels of the residents accommodated and taking into account the size of the home, ensure that suitably qualified, competent and experienced staff are working in such numbers as are appropriate to meet the residents needs. Timescale for action 31/01/08 2. OP12 16(m) 31/01/08 3. OP27 18(1) 31/01/08 Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 32 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. Refer to Standard OP8 OP32 Good Practice Recommendations Ensure that pressure sore risk assessments are reviewed regularly and any preventative measures taken as appropriate. Hold regular meetings with all staff to ensure an open, positive and inclusive atmosphere in the home. Horsfall House DS0000016476.V350132.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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