Care Home: Hylands House

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What the care home does well On a cold and snowy day, the atmosphere at the home was warm in all ways. Hylands House impressed as being homely, cosy and friendly, with a warm and positive relationship between all staff and those living in the home. People living in the home were full of positive comments for the staff and the home. Relatives were unstinting in their praise for the home. The lounges are laid out in ways that foster choice and homeliness, with chairs being in small groups, rather than all against the wall, and there being a choice of areas to sit. The home is now registered for dementia, and living arrangements and staff interactions helped reassure and support people so that a calm, content atmosphere prevailed. In spite of a relative shortage of staff, the staff on duty were attentive to individual needs, so that no-one showed frustration or annoyance at having to wait or being denied any aspect of needs. Visitors remarked on the friendliness and welcoming nature of the home. Although staff were obviously busy, they never appeared rushed, and managed to find time for residents, visitors, as well as the inspector. Comments by visiting relatives included "Hard to find a better home," "fabulous," "everywhere is clean, and everyone is caring" and "the manager is very good at her job". The cleanliness and freshness of the home is assisted by effective continence management via regular toileting prompts and support. What has improved since the last inspection? There is now a lift enabling easier access to the garden. The previous small lift to the first floor has been replaced by a larger one. Relatives remarked how much the manager had improved the home generally. "She`s worked wonders here" was one comment. What the care home could do better: Improvements to carpets need to be completed. All radiator surfaces need to be made safe, so that vulnerable people are not at risk of burns from them. Chairs in communal areas should be more suitable for the needs of people with continence difficulties, so that the undignified use of highly visible incontinence covers can be avoided. Reports relating to the providers` visits should focus more on the needs and well-being of the residents, rather than the costs of items. The issue of staff shortages need to be addressed, so that existing staff do not work excessive hours, and that the home does not have to rely on agency staff too much, and so that residents do not have individual activities curtailed because of a shortage of staff available to lead them. CARE HOMES FOR OLDER PEOPLE Hylands House Warwick Road Stratford upon Avon Warwickshire CV37 6YW Lead Inspector Martin Brown Unannounced Inspection 11:30 5 February 2009 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 DS0000004247.V374463.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. DS0000004247.V374463.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hylands House Address Warwick Road Stratford upon Avon Warwickshire CV37 6YW 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) 01789 414184 01789 414383 hylandshouse@btconnect.com Mrs A Barton Mrs F Roebuck, Mrs Sheila Sandle Elaine Yvonne Gibbs Care Home 19 Category(ies) of Dementia (19), Old age, not falling within any registration, with number other category (19) of places DS0000004247.V374463.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 Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 19 Dementia (DE) 19 The maximum number of service users to be accommodated is 19 2. Date of last inspection 24th May 2006 Brief Description of the Service: Hylands House is registered for 19 older people requiring personal care. The home does not provide nursing care other than that available from the local community nursing teams. The home is set close to the town centre of Stratford Upon Avon with all the towns facilities close at hand and is located close to a busy main road out of the town. Local and national buses provide good transport links. The railway station is about 15 minutes walk away. Hylands House is an adapted former hotel with residents accommodation on the ground and first floors. A shaft lift is provided which enables access to all but one bedroom in the main building without having to negotiate any stairs. There is a lift to provide access to the garden. The home also has an annexe consisting of four bedrooms, all of which can be reached via the stairs or a stair lift. There is a choice of two linked sitting areas on the ground floor and an integral dining area. A conservatory has also been added to provide an additional sitting area. The conservatory leads off from the large lounge. In addition seating is provided in the reception area. Car parking is available to the rear of the property. The current fees for the home are stated as ranging from £381.10 to £597.40 per person per week. DS0000004247.V374463.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This report has been made using information that has been accumulated by the Commission for Social Care Inspection. The inspection visit was unannounced and took place on 5th February, 2009, between 11:30am and 4:30 pm. All people living in the home were seen over the course of the inspection, and many were spoken with, concerning their experience of living at Hylands House. Care, administrative and ancillary staff were spoken with. The manager was not present on the day of the inspection, but was later spoken with by phone. A tour of the premises was made, relevant documentation was looked at, and observations of the interactions between residents, staff and their environment were made. Policies and procedures, and care records were examined, and the care of three people living at the home was ‘case tracked’, that is, their experience of the service provided by the home was looked at in detail. Four visiting relatives were spoken with. The Annual Quality Assurance Assessment, containing information about the service, completed by the service, and returned before the inspection, also informed the inspection. The home is now primarily a service for people with varying degrees of dementia. People living at the home were able to offer views, in varying detail, on the care and support they received. These were almost all very positive. All the visiting relatives were extremely positive about the home, the manager, and the staff. Staff and residents were welcoming and helpful throughout. What the service does well: On a cold and snowy day, the atmosphere at the home was warm in all ways. Hylands House impressed as being homely, cosy and friendly, with a warm and positive relationship between all staff and those living in the home. People living in the home were full of positive comments for the staff and the home. Relatives were unstinting in their praise for the home. The lounges are laid out in ways that foster choice and homeliness, with chairs being in small groups, rather than all against the wall, and there being a choice DS0000004247.V374463.R01.S.doc Version 5.2 Page 6 of areas to sit. The home is now registered for dementia, and living arrangements and staff interactions helped reassure and support people so that a calm, content atmosphere prevailed. In spite of a relative shortage of staff, the staff on duty were attentive to individual needs, so that no-one showed frustration or annoyance at having to wait or being denied any aspect of needs. Visitors remarked on the friendliness and welcoming nature of the home. Although staff were obviously busy, they never appeared rushed, and managed to find time for residents, visitors, as well as the inspector. Comments by visiting relatives included “Hard to find a better home,” “fabulous,” “everywhere is clean, and everyone is caring” and “the manager is very good at her job”. The cleanliness and freshness of the home is assisted by effective continence management via regular toileting prompts and support. What has improved since the last inspection? What they could do better: Improvements to carpets need to be completed. All radiator surfaces need to be made safe, so that vulnerable people are not at risk of burns from them. Chairs in communal areas should be more suitable for the needs of people with continence difficulties, so that the undignified use of highly visible incontinence covers can be avoided. Reports relating to the providers’ visits should focus more on the needs and well-being of the residents, rather than the costs of items. The issue of staff shortages need to be addressed, so that existing staff do not work excessive hours, and that the home does not have to rely on agency staff too much, and so that residents do not have individual activities curtailed because of a shortage of staff available to lead them. DS0000004247.V374463.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. DS0000004247.V374463.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 DS0000004247.V374463.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People considering moving to the home can be confident that their needs will be assessed to ensure that the home can meet them. The home’s ethos of involving and informing people in all aspects of their care and life at the home is reflected the information provided to prospective residents and their relatives. EVIDENCE: A relative of someone who had recently moved to the home was spoken with. They were very pleased with the introductory process, which involved visiting for lunches and longer periods in the day, to both see if there were any initial needs apparent, and to help the person concerned become familiar with the home, staff and other residents. Assessments were seen for people recently admitted to the home, and these showed needs and how they were to be met. DS0000004247.V374463.R01.S.doc Version 5.2 Page 10 One resident advised that they had been on a waiting list to be in the home. Another relative advised that they felt fortunate to find a vacancy here. The home has clear brochures detailing what the home can provide and what people can expect. The monthly newsletter, welcoming individual residents by name to the home, added an additional personal touch appreciated by people spoken with. Contracts were seen in individual files. DS0000004247.V374463.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home benefit from clear care plans that help ensure their health needs are met. They are well-served by effective medication dispensing, and treated with respect and their right to privacy is generally upheld. EVIDENCE: A sample of three care plans were looked at. These were clear, informative, and concise, containing medical details, brief personal histories, likes and dislikes, risk assessments, and relevant health recordings, such as weight charts, body charts. Records were up-to-date, with reviews of those plans looked at seen for the previous month. Care plans were based on Supportive Care Pathways, a template provided by the local Primary Care Trust. Records showed good evidence of consultation with the person concerned, whether it was regarding signed consents, or with statements concerning individual likes, preferences or support needs. DS0000004247.V374463.R01.S.doc Version 5.2 Page 12 Staff spoken with were aware of how particular risks were managed, for example, that one person had a pressure mat at night to alert staff, and another had a weight chart and was to be encouraged in eating. One relative spoke of good staff were at diverting and calming people, citing one instance of how a staff had calmed and settled someone who had got temporarily agitated because they wished to go out. The call bells were answered promptly throughout the inspection. The relatively few staff on duty, especially during the afternoon of this inspection, did not impact on care needs being met on this occasion, although staff acknowledged that this could be the case if it continued and individual residents developed higher needs. One relative had commented, although without indicating any shortfall in care: “there is usually enough staff.” Residents’ health care needs were recorded, and staff were clear on the role of district nurses and the involvement of other professionals. One relative commented that the home is always prompt in getting outside help in if ever they have a concern. Another commented that the home managed well with Parkinson’s, while another noted that staff were very good at calming down people who may get distressed, giving a particular recent example. All residents were clean, tidy and well-presented. One relative commented that ‘clothing is changed every day – everyone is always clean’. Medication administration and recording was looked at. Medication is stored and dispensed securely, and was observed being given out in a sensitive, safe and efficient manner. Controlled medication was stored and recorded appropriately. All amounts checked tallied with records. Most medication is dispensed via ‘blistered’ medication packs. These were all seen to be accurately recorded and properly dispensed. Some medications have to be dispensed directly from packaging. Recordings of these were accurate and all amounts checked tallied with records of what had been dispensed. The same was true for ‘as required’ medication. The staff dispensing the medication was clear on the purpose of the medication being dispensed. One person was having their blood pressure monitored, and there was a separate chart recording these levels amongst the Medication Administration Record Sheets. This person’s name was not on the sheet. The staff promptly rectified this when it was pointed out as a possible source of error. Throughout the inspection, staff were observed being respectful of residents and listening to them. The only arguable exception to this was when a hearing specialist called with a new hearing aid at meal time. The person concerned had the new aid fitted in the lounge, rather than going to her room. The lounge was empty, as people had moved into the dining room, although one person DS0000004247.V374463.R01.S.doc Version 5.2 Page 13 did return into the lounge during the fitting. The person concerned appeared content to have the aid fitted and tested in the lounge, and may well have preferred this to going to their bedroom for this relatively brief task. However, a member of the staff team later agreed that the service needs to be clear about the risk of individual dignity and privacy being compromised for the convenience of others. DS0000004247.V374463.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service welcomes and supports visitors to people living in the home, helps people to exercise choice and control in their lives, so long as they are able to do so independently. They benefit from a wholesome, appealing and balanced diet in congenial surroundings. More staff at key times would enable more structured support in activities for those who need a higher degree of motivation and support to undertake stimulating activities. EVIDENCE: The main communal areas are divided so that those who wish to watch television can do so, and those that do not wish to have a television-free area. On the day of the inspection, two or three people appeared to be watching the television passively, whilst one person was actively watching it throughout the day. Elsewhere, people occupied themselves with jigsaws, newspapers, and conversation with each other and staff. There were insufficient staff on duty during the inspection to engage in more structured activities, although no resident complained of ever being bored, and this was not something raised by residents. One relative commented that “staff do their best to try and get individuals to get involved in activities and games.” The lay-out of the home, DS0000004247.V374463.R01.S.doc Version 5.2 Page 15 the sociable nature of residents, and the hard work of staff ensured a busy, lively atmosphere was maintained. One person commented that they thought an activities organiser would help there be more regular activities for all, on a group and individual basis. Tactile items were in evidence; staff showed a good awareness of particular residents enjoying particular sensory experiences, whether it be feeling different materials, or tearing tissues. Some residents and relatives mentioned, approvingly, how the manager’s dog is a frequent and welcome visitor to the home. Risk assessments and guidelines are in place regarding this. Religious needs are currently met by a monthly religious service and by a visiting priest, with some residents going to church. Relatives were full of praise for the home, the staff and the manager. One commented that “you are always made welcome,” adding that relatives visiting from any distance were always offered tea and biscuits. Another relative noted that the home always informed them promptly of any incident, accident or illness, and that professional advice and support was always sought when necessary. The main meal, at lunchtime, was enjoyed by all in a relaxed, easy-going manner. Those residents who needed additional help were given it in a sensitive manner, and the varying needs and dietary wishes of residents were catered for. One person commented that the food is ‘excellent’ and others made similar appreciative remarks. Staff showed a good awareness of individual preferences and dislikes. I was advised that there were no special diets at present, other than two people with tablet controlled diabetes, who were offered and advised on reduced or sugar-free foods. The cook explained how they had catered for a celiac diet, and how they had advice from dieticians when necessary, and staff had done training in Health and Nutrition. The kitchen had recently been awarded a Gold star after a recent Food Hygiene inspection. DS0000004247.V374463.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home can be confident that the ethos and running of the home, and the policies and procedures of the home, protect them from abuse, and that complaints will be listened to and acted upon. EVIDENCE: We have received no complaints regarding this service in the last twelve months. The complaints log in the home showed only one complaint, from several years previously. Regular residents meetings are arranged and recorded. These showed issues of concern being raised and responded to. All those residents spoken with were fulsome in their praise of the home and the staff. One person asked to speak to me about some minor concerns, which they had raised with the manager, and were seen in the minutes of the residents’ meetings. These were, they acknowledged, to be set in the context of overall satisfaction with the service, and were, they advised, known of by the manager. Relatives spoken with had nothing but compliments for the home, the staff, and the management. One relative felt that the open and welcoming atmosphere of the home provided a good safeguard against abuse, saying that there is a constant flow of visitors, district nurses and other health professionals in the home. Staff spoken with were aware of how and when to raise concerns regarding safeguarding, and residents and/or their relatives were aware of how to make concerns known. DS0000004247.V374463.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,23,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from a ‘homely’ and comfortable environment. Improvements to the environment continue to be made, and need to continue. Homeliness, and dignity is compromised by the use of obvious incontinence covers on communal chairs. Residents’ safety is compromised if hot radiators are not adequately covered. EVIDENCE: The home is not purpose-built, and this has caused difficulties in access and suitable provision. Nevertheless, the home continues to adapt so that it provides a warm and welcoming environment, with a variety of spaces and facilities. There is an ‘l’ shaped lounge and dining room, which provides sufficient separateness for one to be a TV room without impinging on the other, larger area. The larger area has been made more homely by the simple but effective DS0000004247.V374463.R01.S.doc Version 5.2 Page 18 move of creating two groupings of chairs, rather than one large one. There is also a conservatory, and a welcoming reception area, which individual residents were using at various times in the day. As one of the staff acknowledged, the home is a ‘bit of a rabbit warren’, with a lift and stairs lifts needed to access all rooms, as well as a lift to access the garden more easily. Chairs had individual and obvious continence covers on them, which detracted from the otherwise homely, ordinary feel of the home. Staff were not aware of any reason why more suitable chairs and covers were not in place, other than possible cost. There is a crack in one wall of the dining room. Radiator surfaces were very hot to touch. This is further detailed in the ‘management’ section. Bedroom doors had pin boards with favourite photos or other pictures on them, as a help for individuals in identifying their rooms. A number of bedrooms were seen; these were individualised according to preference, with pictures, furniture, and other possessions. Some stairs carpeting is worn; I was shown invoices for renovation and replacement of carpets due to be carried out. One downstairs bedroom had a gap under the door, awaiting a full fitting of a new carpet. This compromised the fire safety of that room, as well as being a tripping hazard. The laundry routine was explained, as were infection control procedures. Relatives and residents all expressed satisfaction with the laundry and management and cleanliness of clothing. The laundry room is rather small, and exterior to the main building, with staff having to iron in other areas. Staff advised that, at present, there was no-one with continence problems. A relative commented that ‘the girls are very good at toileting regularly’. The home smelt fresh and pleasant throughout. DS0000004247.V374463.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. Although the high quality of the current staff is much appreciated by residents and relatives alike, their relatively low number has the potential to compromise the good care and support currently given, particularly if the needs of residents increase. EVIDENCE: There were two staff on duty on the morning of the inspection, with two additional ‘housekeeping’ staff, and a cook. The housekeeping staff advised they also helped out in care, helping at key times such as meals. In the afternoon, there were only two staff on duty, owing to sickness, and inability to get short-term cover. The rota showed that there would normally be three care staff on duty. The competence of those staff on duty, and the relatively low needs of the needs of those living at the home, enabled this to be sufficient on this occasion, but staff acknowledged that it gave little time for activities, and that if there were residents, as there has been in the past, who required a lot of staff time and attention, then this could pose problems. Comments from residents and relatives concerning the quality of the staff were unanimously positive. “Wonderful staff, they really care” was a typical comment. Residents and relatives were less certain whether numbers were sufficient. While no-one said that residents’ well-being or care suffered from a shortage of staff, some thought that there might be more opportunity to do DS0000004247.V374463.R01.S.doc Version 5.2 Page 20 more if there were more staff at times. “Enough staff – a bit short sometimes” was one comment. One person felt that there was a lot of staff sickness, and felt that two staff effectively doing the work of three should be paid proportionately more. One person felt that the home would benefit from a pool of ‘bank’ staff who could be called upon at short notice, rather than depending on agency staff or the relatively small number of existing staff. Staff spoken with talked favourably of training, listing those they had undertaken. These included the statutory training, as well as relevant training such as stroke awareness and dementia training. A recent recruit spoke of their induction training and of having started National Vocational Qualification level 2 A sample of two staff files were looked at. These were seen to contain appropriate information, including Criminal Records Bureau checks and suitable references. Records of staff supervision records and appraisals showed that these took place. Some agency staff are used. Staff spoken with said that agency staff are rarely used, with the last one being at Christmas. There were records of agency staff but there was no record of suitable Criminal Records Bureau checks having been seen. The manager later advised that she had been verbally reassured by the agency that all staff had satisfactory Criminal Records Bureau checks, but had nothing in writing concerning individual workers. DS0000004247.V374463.R01.S.doc Version 5.2 Page 21 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): 31,32,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home benefit from a home that is run in their best interests, and where the manager works hard and effectively to continue improvements. Safety is potentially compromised if radiators are not suitably covered. EVIDENCE: Relatives and residents spoke favourably of the manager and of progress made in the home during her time there. There was only one dissenting voice, from a resident who had not been happy with one or two things. Even this person acknowledged that, overall, it was a very good place to live, and that they would not wish to be anywhere else. One relative noted that the manager had ‘worked wonders’, referring to improvements in the home. DS0000004247.V374463.R01.S.doc Version 5.2 Page 22 Records of residents’ meetings showed issues being raised and discussed. Several relatives noted approvingly that they were always kept informed of what was going on the home. A monthly newsletter gave useful information in a friendly format, and helps convey the prevailing ethos of warmth, friendliness and concern with individuals. A previous requirement had been to evidence visits by the owner or their representative. These are noted in recorded meetings with the manager. These show a predominant concern with costs and fixtures and fittings, and very little evidence that the owners are also checking on the general well being of residents. The administrator was able to show the system whereby monies that the home looks after on behalf of residents is safeguarded. A sample was looked at and seen to be accurate. It was noted that the majority of radiators had surfaces that were very hot to touch, both in communal areas and in bedrooms. Staff agreed that these were a potential hazard, either from direct burning, or from a fall. Most have a shelf to shield the top, but all have the potential, to a greater or lesser extent, depending on their positioning, to cause burns or other injuries. Staff agreed that a risk assessment should be done to establish a priority for putting proper guards on them. One such suitable guard as noted in the reception area. It had been noted in a manager’s report that some of the rooms had ‘very hot water.’ the staff said that hot water records were kept by the maintenance man, but in his absence, these could not be located. The manager later advised that they were kept by the maintenance person. A number of taps in rooms were tried, and were comfortably hand hot. Mixer valves were in place on sinks looked at. The manager later advised that unsatisfactory ones were in the process of being replaced. DS0000004247.V374463.R01.S.doc Version 5.2 Page 23 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 x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 x x 3 x 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 x 3 x x 2 DS0000004247.V374463.R01.S.doc Version 5.2 Page 24 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 OP19 Regulation 13(4)(c) Requirement There must be a risk assessment to prioritise work to ensure all radiator surfaces are sufficiently guarded to minimise the hazard of vulnerable people coming to harm from them. Carpeting that is worn to the extent of being a potential hazard must be replaced. Timescale for action 11/03/09 2. OP19 23(2)(b) 11/03/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP9 OP10 OP19 OP19 Good Practice Recommendations Any monitoring charts should have the name of the person concerned on them, to minimise the possibility of error. Staff should ensure that residents’ privacy and dignity is taken fully into account during visits by health professionals. Residents’ dignity would be better served by having more discrete incontinence provision on communal chairs. The crack in the dining room wall should be made good, to DS0000004247.V374463.R01.S.doc Version 5.2 Page 25 5. 6. 7. OP27 OP27 OP29 8. 9. OP33 OP38 ensure safety and not detract from the homeliness of the dining room. The home should have sufficient numbers of staff available, to avoid any shortfalls of staff compromising the well-being of residents. Employing an activities organiser would help ensure that all residents benefited from regular activities to meet individual needs. The home should ensure it has recorded confirmation that individual agency workers have satisfactory Criminal Records Bureau checks, prior to them commencing work at the home. Recorded feedback by the owners or their representatives should include comments on the well being or otherwise of residents. Records of hot water temperatures should be more readily available. DS0000004247.V374463.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 DS0000004247.V374463.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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