Care Home: Hungerford House

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What the care home does well Residents are able to follow their preferred routines. This includes how and where they spend their day, what time they get up and whether they have meals in their room. A robust recruitment process is in place, which gives residents additional protection. Staff have built positive relationships with residents and rights, such as privacy and dignity are promoted. Good teamwork was apparent and staff appeared friendly and motivated within their roles.Residents have regular access to health care professionals and are well supported by the local surgery. Health and safety is given high priority with various audits, policies and procedures and risk assessments in place. Residents benefit from close links with the local community. Important relationships are promoted and hospitality is evident. What has improved since the last inspection? Since the last inspection, the environment has been significantly improved upon through redecoration and re-carpeting of the main areas. A programme of redecoration of residents` bedrooms is underway. All small kitchenettes have been refurbished. The garden has been enhanced through areas for flowers and vegetables. A new assessment and care-planning format has been introduced. Staff have completed the documentation in greater detail, thus ensuring a higher standard of recording. All residents now have manual handling and tissue viability assessments. The assessments detail potential risks and preventative measures. All plans are up to date and are regularly reviewed. What the care home could do better: Residents and staff members commented that the standard of food provision is improving. The need for further development has been highlighted within the home`s quality assurance system. An action plan has been devised to address the identified issues. While staffing levels are determined accordingly to dependency levels, it is the experience of some residents, relatives and staff that the home is short staffed. Staffing levels, especially at key times of the day, need to be reviewed to ensure residents` individual needs are fully met. On some shifts a care support worker is counted as part of the staffing levels. Consideration should be given to the impact, a care support worker rather than a carer, has on the provision of personal care. While acknowledging that a programme to refurbish toilets is in place, the standard of cleanliness needs to be kept under review, to minimise the risk of infection. CARE HOMES FOR OLDER PEOPLE Hungerford House Beechfield Road Corsham Wiltshire SN13 9DR Lead Inspector Alison Duffy Unannounced Inspection 09:40 5 December 2007 th 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 Hungerford House DS0000028283.V353235.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. Hungerford House DS0000028283.V353235.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hungerford House Address Beechfield Road Corsham Wiltshire SN13 9DR 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) 01249 712107 manager.hungerfordhouse@osjctwilts.co.uk www.osjct.co.uk The Orders Of St John Care Trust Ms Jane Marie Ridgwell Care Home 48 Category(ies) of Dementia - over 65 years of age (19), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (4), Old age, not falling within any other category (25) Hungerford House DS0000028283.V353235.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category- Code OP- maximum of 25 places. Dementia aged 65 years and over on admission- Code DE(E)- maximum of 19 places. Mental disorder, excluding learning disability or dementia aged 65 years and over on admission- Code MD(E)- maximum of 4 places The maximum number of service users who may be accommodated is 48. 15th January 2007 2. Date of last inspection Brief Description of the Service: The building was originally purpose built by the local authority in the 1970s. The home is now managed by The Orders of St John Care Trust. The registered manager is Ms Jane Ridgwell. The home is registered to provide accommodation and personal care to a total of 48 residents over the age of 65, who require care primarily through old age. Within the 48 places, the home is registered to accommodate 19 residents with dementia and 4 residents with a mental disorder. There are 2 beds available for respite care. The home also provides day care facilities for a further 25 clients a day. There are 48 single bedrooms, which are all on the ground floor. The home is divided into three units: Roberts, Lilley and Hall. The units have their own lounge, dining room, small kitchen area, bathroom and toilets. Staffing levels are generally maintained at 7 care staff during the morning. This includes a care leader and sometimes a care support worker. There are 4 staff in the afternoon and generally 6 care staff including a care leader in the evening. There are 3 waking night staff. The home also employs cooks, housekeepers, a maintenance person, an administrator and an activities coordinator. The fees for living at the home are from £386.61 - £506.75 a week dependent on dependency levels and the room accommodated. This does not include chiropody, hairdressing, dry cleaning and personal items. Hungerford House DS0000028283.V353235.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place initially on the 5th December 2007 between the hours of 9.40am and 3.30pm. Ms Ridgwell was on duty until lunchtime. The inspection was concluded on the 11th December 2007 9.20am and 6.05pm. Ms Ridgwell and Mrs Mitchener, a lead manager within the organisation, received feedback. We met with a number of residents in the privacy of their bedrooms. We spoke to staff members on duty. We examined the management of residents’ personal monies. We observed the serving of lunch. We looked at careplanning information, training records and recruitment documentation. Mrs Mary Collier, Pharmacy Inspector examined the medication systems. As part of the inspection process, we sent surveys to the home for residents to complete, if they wanted to. We also sent surveys, to be distributed by the home to residents’ relatives, their GPs and other health care professionals. The feedback received, is reported upon within this report. We sent Ms Ridgwell an Annual Quality Assurance Assessment (AQAA) to complete before the inspection. Ms Ridgwell completed this thoroughly and in detail. Some of the document’s content is taken into account within the evidence sections of this report. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. 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. What the service does well: Residents are able to follow their preferred routines. This includes how and where they spend their day, what time they get up and whether they have meals in their room. A robust recruitment process is in place, which gives residents additional protection. Staff have built positive relationships with residents and rights, such as privacy and dignity are promoted. Good teamwork was apparent and staff appeared friendly and motivated within their roles. Hungerford House DS0000028283.V353235.R01.S.doc Version 5.2 Page 6 Residents have regular access to health care professionals and are well supported by the local surgery. Health and safety is given high priority with various audits, policies and procedures and risk assessments in place. Residents benefit from close links with the local community. Important relationships are promoted and hospitality is evident. What has improved since the last inspection? What they could do better: Residents and staff members commented that the standard of food provision is improving. The need for further development has been highlighted within the home’s quality assurance system. An action plan has been devised to address the identified issues. While staffing levels are determined accordingly to dependency levels, it is the experience of some residents, relatives and staff that the home is short staffed. Staffing levels, especially at key times of the day, need to be reviewed to ensure residents’ individual needs are fully met. On some shifts a care support worker is counted as part of the staffing levels. Consideration should be given to the impact, a care support worker rather than a carer, has on the provision of personal care. While acknowledging that a programme to refurbish toilets is in place, the standard of cleanliness needs to be kept under review, to minimise the risk of infection. Hungerford House DS0000028283.V353235.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. Hungerford House DS0000028283.V353235.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 Hungerford House DS0000028283.V353235.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): 3. Standard 6 is not relevant, as the service does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential residents are assessed before admission, which enables an appropriate placement. Documentation enables staff to have clear information about individual need and the support, the resident requires. EVIDENCE: Within discussion with staff and residents, it was evident that prospective residents are assessed prior to being offered a placement within the home. Residents told us they had the opportunity to visit the home, if they wanted to. Some residents told us that they knew the home, as they had attended the day centre. Another told us they had been in one of the organisation’s other homes, for respite care. A permanent bed was unavailable so they came to Hungerford House. One resident was unsettled and said ‘it’s not what I thought it would be.’ They continued to tell us ‘it’s not here, it’s just homes, they’re not for me.’ Ms Ridgwell was aware of this view and explained that the situation is being addressed. One relative raised the difficulty of booking respite care in Hungerford House DS0000028283.V353235.R01.S.doc Version 5.2 Page 10 advance. Ms Ridgwell confirmed, that unfortunately, respite bookings are beyond the home’s control but the responsibility of the local Social Services. We looked at the assessment documentation of the two most recent admissions to the home. Both were recorded on the organisation’s new assessment format. The person undertaking the assessment had written additional notes to complement the areas, needing a tick style answer. The information was informative and demonstrated the support the potential resident required. Life histories sometimes completed by the resident and/or their family, were evident. The dates of required appointments, such as an optician were stated. A dependency assessment tool had been used, as part of the assessment process. The assessment was dated and demonstrated who had been involved in the assessment process. Information within the assessment had been transferred to the initial care plan. Hungerford House DS0000028283.V353235.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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are much improved and generally detail the support the resident requires. Residents have good access to health care provision. Residents are protected by the home’s procedures for the safe handling of medicines and are supported to self-medicate when appropriate. Residents’ rights to privacy and dignity are maintained. EVIDENCE: Residents told us they were happy with the care they received. One resident named two members of staff, who they were particularly fond of. Within a survey, one resident wrote ‘I’ve never been so spoilt in my life as I have here.’ The organisation has recently developed a new care-planning format. Ms Ridgwell told us that that the home piloted the system. All care plans are therefore in the new format. We viewed a sample of plans. All were well written and regularly updated. They generally contained information, which demonstrated individual need and the support required. In some instances, we advised greater clarity. For example, a plan detailing nutrition identified the Hungerford House DS0000028283.V353235.R01.S.doc Version 5.2 Page 12 need for high calorie snacks. We suggested staff should document specific examples. Another plan identified communication difficulties. It did not however, expand upon ways in which staff communicated with the resident. Ms Ridgwell told us these matters were immediately addressed after the first day of the inspection. Aspects of clear recording included, ensuring cutlery was placed in the hands of a particular resident and needing prompting with eating. All plans have a tissue viability, nutritional and manual handling assessment. All identified, if there was a particular risk and preventative measures. However, one resident had an ulcer and was receiving input from the district nurse. The management of the sore, including pain relief and ensuring clean dressings were not reported upon. Some tissue viability care plans stated ‘cream pressure areas.’ Staff were advised to expand upon these areas and ensure clarity with information. Daily records were well written, with factual accounts rather than the use of subjective language. The content of the records however, were largely related to physical need and the assistance staff gave. We recommended that additional qualitative issues, such as meeting social needs were also commented upon. Each care plan contains a record of all health care appointments. This may include the GP, the community nurse or chiropodist. Staff told us the home receives excellent support from all health care personnel. They said they could ring for advice and sometimes, a GP or nurse would just ‘pop in.’ Staff said they could also ask for equipment, such as a specialised mattress and it would arrive quickly. A GP telephoned during the inspection, to enquire about the wellbeing of a resident. Staff explained this was usual practice. We also overheard a district nurse giving good feedback to staff regarding the care of a particular resident. Residents are able to make their own appointments if they wish. If attending an outpatient appointment, staff are able to accompany the resident. The Pharmacist Inspector looked at arrangements for the handling of medicines. Medication was stored securely. However the controlled drugs cupboard does not comply with recent legislation. Medication administration records were clear and had been completed correctly. Changes to medicines or doses were recorded on the administration record and in the residents’ notes. Some residents had chosen to look after their own medicines. Staff supported them to do this and appropriate risk assessments were in place. Refusals were recorded on the administration records with details of the circumstances so that this could be followed up with the doctor. All medicines received and returned for disposal were recorded. One administration record showed that an error had been made in recording the dose for a recently admitted resident. This had been corrected, but extra care must be taken when booking in new residents. One resident’s chart had not been signed for eye drops. They were in stock and appeared to have been used, but there was no record to confirm Hungerford House DS0000028283.V353235.R01.S.doc Version 5.2 Page 13 this. Care staff receive medication training and regular updates. A procedure and information about medicines is available to all staff. We observed positive interactions between staff and residents. Within discussion, staff explained how residents’ rights are promoted. This included enabling residents to choose their daily routines. Residents preferred form of address was stated in care plans. Residents’ care was undertaken in private. Those residents requiring assistance to eat, received support in an attentive manner. Hungerford House DS0000028283.V353235.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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A varied activity programme is available and residents benefit from clear links with the local community. Residents are able to follow their preferred routines and receive visitors as they wish. Experiences show that while the standard of food is improving, various developments are required to meet the satisfaction of all concerned. EVIDENCE: Since the last inspection, the number of hours allocated to activity provision has been increased to 30 hours. The activities organiser told us about their role with enthusiasm. They explained the activities undertaken and the external trips, which have been organised. Such trips, especially in the summer are regular events. The activities organiser told us they usually split their working day. They usually spend the morning on the dementia care unit, the afternoon in the main home and vice versa. They explained that they were encouraged to buy equipment, which may assist with activity provision. Residents gave variable views about the activities provided. One resident, when asked how they spent their day, replied ‘I don’t do anything, there’s nothing to do.’ Others spoke of quizzes, discussion and games. One resident commented about gardening. Others told us that they preferred not to join in with activities, but Hungerford House DS0000028283.V353235.R01.S.doc Version 5.2 Page 15 had the opportunity to do so, if they wanted to. Some followed solitary interests, such as watching television and reading. Photographs of events held are displayed on notice boards. This included a range of entertainers. Events, such as tea dances, skittles and quizzes are also arranged with other care homes within the organisation. There were positive comments from relatives in surveys, in relation to activities. These were ‘having the use of the minibus has been great’ and ‘they encourage people to take part in activities and go on outings, which if left to their own devices, many of them would just sit there and do nothing.’ As a means to improve the service, one relative said ‘by getting as many visitors as possible in, to just chat with the people living there.’ Some staff told us that it was difficult to support the activities organiser with activities, due to time restrictions. They explained however, that they used their time when providing personal care, to chat and socialise with residents. Mrs Mitchener confirmed that within training, staff were encouraged to view activities, as a whole. For example, cutting someone’s fingernails is an activity and should not be dismissed. Residents and staff told us that visitors are welcome at any time. Many residents enjoy trips out with their families. Ms Ridgwell told us that the home has strong links with the local community. This was confirmed, when local school children came in to sing carols. All residents said they could follow their preferred routines. This included getting up when they wanted to, staying in their room and watching television until late. Staff confirmed this. They said, that as some residents like to get up very early, the night staff assist them. We observed residents eating their meal in their own rooms and the lounge areas. One member of staff told us ‘it’s their choice, we’re only here to help.’ Ms Ridgwell told us that meal provision has been targeted to ensure an improved service. She said progress has been made although there is an ongoing programme to improve the provision further. This includes chef development training days. Staff told us the standard of meal provision is improving. Residents were less complimentary about the food, although were not able to give specific examples of poor provision. Seven comments within surveys were made about the need to improve the food. On the day of the inspection, the meal was beef casserole or cauliflower cheese. The meal was satisfactory and plated according to individual preference. The menus however, appeared basic. A care leader told us that within their role, they were planning to supervise the kitchen staff. This would involve giving support and developing meal provision, as a whole. Ms Ridgwell explained that she is gaining menus from other homes within the organisation. These will then be used, to share ideas. Due to the layout of the home, the kitchen is isolated from the areas, used by residents. The chef therefore has little contact with residents, other than being invited to a resident’s meeting. Staff felt the meal service could be further developed through more interaction and the chef observing mealtimes. The chef also told us, that meal provision could be Hungerford House DS0000028283.V353235.R01.S.doc Version 5.2 Page 16 improved upon, if residents made their choice of what they wanted, the day before. Hungerford House DS0000028283.V353235.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to enable concerns to be raised. However, a userfriendlier procedure may assist those residents with dementia, to express their views more readily. Appropriate use is made of the Safeguarding Adults Unit. With well-managed systems in place, residents are assured greater protection from abuse. EVIDENCE: There is a formalised system for dealing with complaints. The complaints procedure is displayed on notice boards within the home. The procedure contains the information required by regulation. The format is not, however conducive to all residents’ needs. We suggested a user-friendlier format, in particular for those residents with dementia. Ms Ridgwell told us policies and procedures are currently being reviewed. She would therefore forward this, to senior management within the organisation. Residents generally said they would tell a member of staff, if they were unhappy. Some said they would tell their family. Two said ‘it’s no good complaining – it won’t do any good.’ Ms Ridgwell was aware of the residents’ dissatisfaction and explained matters are being addressed. Issues such as improvements required with food, have been identified within the home’s quality assurance system. An action plan is in place to address the areas. Hungerford House DS0000028283.V353235.R01.S.doc Version 5.2 Page 18 All relatives told us within their survey, that they were aware of the home’s complaint procedure. All were satisfied that concerns are always dealt with appropriately. A complaint log is maintained. There was a formal complaint regarding lost clothing on file. The outcome letter identified a clear investigation and a positive outcome. During the inspection, we asked a member of staff, a hypothetical question about abuse. They said they would immediately inform a senior member of staff. The senior member of staff would then make a referral to the Safeguarding Adults Unit. In the manager’s absence, they said they would contact one of the senior managers within the organisation. Ms Ridgwell said that all staff have been given a copy of the local Safeguarding Adults policy entitled ‘No Secrets in Swindon and Wiltshire.’ The majority of staff have had recent adult protection training. Hungerford House DS0000028283.V353235.R01.S.doc Version 5.2 Page 19 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 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recent redecoration of the main corridors and communal areas significantly enhances the environment for residents. Areas are comfortable, clean and well maintained. The planned replacement of toilets will significantly minimise the risk of infection. EVIDENCE: Since the last inspection significant improvements have been made to the environment. Corridors have been redecorated and all except one have received new carpeting. Lounges and a number of residents’ bedrooms have also been redecorated. The small kitchenettes have been fully refurbished and are much improved. Ms Ridgwell told us that there are plans to replace the corridor carpet. There is also a rolling programme to target residents’ bedrooms. Improvements have been made to the garden, with areas in which, residents can maintain. One relative commented about the improvement within their survey. They said ‘the upkeep of the home has improved with nicer Hungerford House DS0000028283.V353235.R01.S.doc Version 5.2 Page 20 décor.’ Another relative commented ‘some of the fixtures and fittings need replacement.’ The laundry area was not viewed on this occasion. Ms Ridgwell told us equipment had been replaced, to ensure an improved service. The home was cleaned to a good standard yet many toilets were showing their age. Many were stained in the bottom of the toilet bowl. Others were stained around the toilet seat hinges and difficult to keep clean. Ms Ridgwell told us there was a programme to replace all toilets. At the last inspection, the toilets near the front entrance of the home, allocated to the day centre, were not clean. A requirement was made to address cleaning schedules in order to increase the standard of cleanliness. At this inspection, the toilets although improved, did not look as if they had recently been cleaned. Ms Ridgwell viewed the toilets and told us, she believed they were not unreasonably unclean. Ms Ridgwell said they are locked, after the day centre clients leave the home. They are then cleaned again the next morning, ready for the arrival of day centre clients. Two comments, within surveys were received about odour. These were ‘the only thing that could be improved on would be perhaps the smell you get’ and ‘it’s a pity that the entrance is past the toilets, as these can be really smelly. It does put visitors off.’ All hand washbasins within communal facilities have soap dispensers and paper towels, to minimise the risk of infection. Staff have received infection control training and have access to protective clothing as required. Hungerford House DS0000028283.V353235.R01.S.doc Version 5.2 Page 21 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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Experiences of residents and relatives are that of a shortage of staff. Residents benefit from a well trained, motivated staff team. Residents have built positive relationships with staff. Residents are protected through a clear, well-managed recruitment procedure. EVIDENCE: Staffing levels are generally maintained at seven care staff on duty during the morning shift. There are usually three staff in the dementia care unit. This leaves two staff in each other unit. One of these is a care leader who assists with personal care, administers medication and oversees the shift. Within some shifts, a care support worker is deployed instead of a carer. The care worker does not undertake any personal care tasks. They told us they made beds, served drinks and meals and notified the care staff if any resident required support. They also spent time, chatting to residents. We were concerned that the care support role was counted in the care hours. This meant there was one less member of staff to provide personal care support, to residents. Ms Ridgwell told us that the care support role is used to free up time, so that care staff could spend their sole time caring. Without the care support role, care staff would need to undertake the tasks of making beds and serving drinks. Ms Ridgwell or Mrs Mitchener did not see a problem with the hours being an integral part of the care staff roster. During the evening shift there are generally six staff, including a care leader. Hungerford House DS0000028283.V353235.R01.S.doc Version 5.2 Page 22 Within surveys, there were seven comments related to the need for more staff. These stated ‘more care hours – the carers always seem to be in a rush’ and ‘more staff would help, they are grossly overworked and don’t have the time to spend with us as individuals, due to work load.’ Also ‘when there is a shortage of staff, people have to wait a long time to be taken to the toilet, or put to bed or even given a bath, so this could be helped by more carers.’ Another relative stated ‘at the weekends its never very clear who is in charge, most of the staff are very caring, but I wish they had more time to talk to the more lucid residents.’ A member of staff stated ‘the staff roster needs to be better balanced as there is insufficient staff at times in the mornings to cope with the work load.’ During the visit, staff presence was limited. However, this could have been attributed to the large layout of the home. Within the dining room of the dementia care unit, there were three members of staff. This left one member of staff in each other dining room and another to complete medication administration. The dining room in the dementia care unit was chaotic. With four residents to fully support with eating and many others to assist and prompt, creating a relaxed atmosphere was a challenge. The GP also visited, so at one time, there were no staff in the room. The hot trolley was therefore left unattended and residents unsupported. When talking with staff and looking at care plans, it was evident that a high number of residents needed support at times, of two members of staff. With only five care staff providing such support, this appeared a challenge. Ms Ridgwell did not agree with the number of residents needing the support of two staff members. She explained that some residents only require additional support for short periods of time. Ms Ridgwell acknowledged that all care homes would benefit from additional staff. However, staffing levels are adjusted annually and maintained in line with residents’ dependency levels. We looked at the recruitment documentation of three most recent members of staff. All files contained the required information including an application form, documentary evidence and two written references. Criminal Record Bureau disclosures were in place. Staff do not commence employment until a check is made on the Protection of Vulnerable Adults list. There was written evidence of this on file. A care leader told us that the majority of the staff team have NVQ level 2 in care. Many staff have also completed level 3. Within the AQAA, Ms Ridgwell said that the home consistently exceeds the required 50 ratio of staff with NVQ. All new staff are expected to register for this training. Staff told us that there is always training going on in the home. They said they had recently completed manual handling, infection control and dementia care training. Posters advertising various courses were posted on the notice boards in the staff office. The administrator explained that they were in the process of Hungerford House DS0000028283.V353235.R01.S.doc Version 5.2 Page 23 updating the training records. A computerised system had recently been introduced and therefore information was being inputted. With running two systems, not all information was readily available. It was acknowledged, that once the computerised system was up and running, records would be clearer. Ms Ridgwell confirmed that care related subjects such as sensory loss and diabetic management had been completed. Certificates however, had not as yet been received. Mrs Mitchener told us that the organisation has invested in additional dementia care training. A ‘dementia champion’ group is being established and work is being undertaken with the University of Sunderland regarding life stories. Mrs Mitchener also told us, the organisation is planning to work with the Alzheimer’s Society, to develop a carers support group. Specific speakers from the Alzheimer’s Society would be accessed, to provide training for the staff team. A number of staff have completed tissue viability training. Ms Ridgwell and a care leader facilitated this with a training package. Ms Ridgwell told us the district nurse undertakes tissue viability training with staff in relation to specific, identified residents. Within surveys there were positive comments about the staff. These included ‘everyone is kind, competent and helpful and the staff turnover is minimal in my experience’ and ‘they remember that it is important to look to their patients needs and happiness.’ Also ‘they look after each individual as if they were a member of their own family. They genuinely do care for the ‘inmates’ with compassion and good humour’ and ‘the care is good and consistent.’ One resident said ‘the staff carry out their duties well and efficiently and often put themselves out for us.’ On a negative note, two comments were received about night time provision. One resident said ‘night time is not so good.’ The other comment involved a particular resident. Ms Ridgwell was informed and told us that matters had been addressed. Hungerford House DS0000028283.V353235.R01.S.doc Version 5.2 Page 24 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 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager and staff have worked hard to improve the service given to residents. Systems are in place to regularly audit and improve areas of practice. The safe keeping of residents’ personal monies is well managed therefore minimising the risk of error. Residents’ well being is promoted through clear health and safety systems. EVIDENCE: Since her appointment as manager in October 2006, Ms Ridgwell has made significant improvements to service provision. This has included the environment, reporting systems, teamwork and enabling residents’ to further contribute to the running of the home. Mrs Ridgwell told us that staff have worked extremely hard in the last year, to address identified shortfalls. Staff were pleased with the progress that has been made. Ms Ridgwell confirmed Hungerford House DS0000028283.V353235.R01.S.doc Version 5.2 Page 25 that some areas remained in need of further development. However, systems are in place to address issues. Since the last inspection, Ms Ridgwell has undertaken a high level of short training courses. These have included adult abuse and neglect, reminiscence in person centred care, dealing with difficult people and a quality workshop. Ms Ridgwell has a current first aid certificate. Within surveys, there were two comments about the manager not being sufficiently seen or involved. Ms Ridgwell explained that she is in the home, for the majority of her working week. However, the location of her office, which is away from the general hub of the home, may give the appearance of her not being around. Ms Ridgwell explained that her office is being relocated next year. The home has a quality assurance system that is used within all of the homes within the organisation. The system consists of various audits and questionnaires. Earlier this year, all residents were asked to complete a questionnaire. The feedback was coordinated and shortfalls were identified. An action plan has been devised and all aspects are being addressed. The main areas for attention included food and activities. Detailed monthly operational visits were in place. A number of residents have placed small amounts of their personal monies, for the home to hold safely. We looked at the systems for managing this. Only senior staff have access to the safe. Cash amounts corresponded with the balance sheets. Staff sign and check each transaction. The resident or another member of staff countersigns the record. Receipts were in place to demonstrate expenditures. The records are regularly audited, within the home. There are also external audits. A large number of health and safety policies are in place. Health and safety audits take place. Mrs Mitchener explained that some of these are undertaken during the monthly operational visits. Systems are in place to monitor issues such as hot water temperatures. Specific contractors undertake tasks such as portable electrical appliance testing. Equipment such as the call bell system is regularly serviced. Clear, ordered documentation demonstrates all servicing. There is a range of environmental risk assessments in place. Accident records are maintained. Any incident is also identified in the resident’s notes. We advised that greater detail be recorded, when documenting an un-witnessed fall. This should include the position in which the resident was found. Hungerford House DS0000028283.V353235.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Hungerford House DS0000028283.V353235.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement Timescale for action 01/02/08 2 OP9 13(2) 3 OP27 18(1)(a) The registered person must ensure that all medicines are given according to the prescribed instructions and appropriate records made. The registered person must 31/03/08 ensure all controlled drugs are stored in a cupboard that meets the current storage regulations (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007. The registered person must 31/03/08 ensure that staffing levels are sufficient to meet the individual needs of residents. This requirement was made at the last inspection. While there has been an increase in staffing hours, there is evidence that levels remain insufficient. Hungerford House DS0000028283.V353235.R01.S.doc Version 5.2 Page 28 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 5 Refer to Standard OP7 OP15 OP16 OP26 OP33 Good Practice Recommendations The registered person should ensure that daily records contain qualitative information as well as on going daily physical care provision. The registered person should ensure that consideration continues to be given to the development of meal provision. The registered person should ensure consideration is given to developing a more user-friendly complaints procedure. The registered person should ensure the standard of cleanliness with toilets is regularly monitored with more frequent cleaning, as required. The registered person should ensure that systems are devised to enable other stakeholders to give their views as part of the home’s quality assurance system. This was identified at the last inspection but has not been addressed. Hungerford House DS0000028283.V353235.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Regional Office 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. Extracts may not be used or reproduced without the express permission of CSCI Hungerford House DS0000028283.V353235.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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