Care Home: Innisfree Residential Care Home

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What the care home does well Outcomes for the residents are positive. For example five residents spoken with said, "The home is nice, the staff are kind and caring, and the food is good." A good rapport between staff and residents was observed. The home has a warm and pleasant environment with a good standard of fixtures and fittings. The staff work well as a team and ensure the well-being and comfort of the residents` and treat them with great respect and kindness. People living at the home feel valued and cared for. Staff feel well supported and enabled to provide a high standard of care. Meals are varied, healthy and nicely presented offering choice and variety. Residents` health and personal care needs are well met by knowledgeable staff in an understanding way. Residents feel that if they had something to complain about they would speak to a member of staff. All residents spoken with said they had nothing to complain about. One resident said `the home is excellent; I would recommend it to anyone".` What has improved since the last inspection? This is the first inspection under the current ownership. What the care home could do better: Residents would benefit from robust systems and practices of medicines management. Staff should ensure that they clearly record medicines received into the home, administered and disposed of accurately. Tighter controls on the use of Controlled drugs, homely remedies and self administration of medicines would provide a safer environment for residents. Residents would benefit from risk assessments that include actions to minimise risk especially around pressure sore prevention. The implementation of a robust recruitment system would enable residents, and their relatives, to know that they are well protected from potentially harmful people being employed. Residents could benefit from more consistent care if records relating to care needs were appropriately completed and maintained. CARE HOMES FOR OLDER PEOPLE Innisfree Residential Care Home 12-16 Severn Road Weston Super Mare North Somerset BS23 1DN Lead Inspector Patricia Hellier Unannounced Inspection 09:30 31st July 2008 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 Innisfree Residential Care Home DS0000071865.V366111.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. Innisfree Residential Care Home DS0000071865.V366111.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Innisfree Residential Care Home Address 12-16 Severn Road Weston Super Mare North Somerset BS23 1DN 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) 01934 621611 kate@innisfreeresidentialhome.com Brooks Healthcare (Weston) Ltd Miss Katie Rae Baker Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Innisfree Residential Care Home DS0000071865.V366111.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 either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 28. New Service Date of last inspection Brief Description of the Service: Innisfree Residential Care Home is situated in a quiet residential area of Weston-Super-Mare to the south of the town. The sea front is only a short walking distance away and is within close to proximity to some local shops and amenities. The home is a converted older property; all residents have single rooms, located on two storeys. There is a separate dining area on the ground floor and communal lounge areas on either side of the house. There are pleasant gardens to the rear and side of the property. A passenger lift provides access to resident areas. The home has a mezzanine floor and access to this is provided by a stair lift. All parts of the home are accessible to people in wheelchairs. The provider makes information available through a brochure and information pack. The information pack contains the Statement of Purpose and Service User guide and all relevant information about the home. CSCI reports are available for visitors or residents to read. The fees range between £370 and £410 a week with additional charges being made for hairdressing, chiropody, newspapers, and toiletries. This information was provided in July 2008. Innisfree Residential Care Home DS0000071865.V366111.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 key inspection took place over 7 hours on one day. The Registered Manager, Ms K. Baker and the Registered Provider Mr S Lyons, were present throughout. Before the inspection the information about the home was received from the file held in the office, surveys received from four people who use the service and one relative. The Annual Quality Assurance Assessment (AQAA) form, from the provider was reviewed. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We (The Commission) also reviewed all correspondence and regulatory activity since the last Key inspection. The accumulated evidence for this report comes from the above and also fieldwork that included discussions with eleven residents, two relatives, and four staff. Practices were observed and documents relating to care, recruitment and health and safety were reviewed. Of the six resident surveys sent four were returned. The replies indicated that responsive staff meet their care needs, and they are provided with all that they need. Comments from residents were “I can’t fault the home” “excellent service and care.” “The staff are always there when you need them”. “I like living here”. No areas of concern were raised. Of the six relatives surveys sent one was returned. They felt that their relative is well cared for by competent staff. Comments were “friendly staff and atmosphere”. “A caring and active home”. The relatives spoken with felt they were kept up to date with information regarding their relatives’ health and well being. There were no comments of concern. All residents and relatives spoken with told us that the home was good and the staff very kind. Comments received were “staff are exceptionally kind”. Nice home with things to do, and the food is good”. Innisfree Residential Care Home DS0000071865.V366111.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Residents would benefit from robust systems and practices of medicines management. Staff should ensure that they clearly record medicines received into the home, administered and disposed of accurately. Tighter controls on the use of Controlled drugs, homely remedies and self administration of medicines would provide a safer environment for residents. Residents would benefit from risk assessments that include actions to minimise risk especially around pressure sore prevention. The implementation of a robust recruitment system would enable residents, and their relatives, to know that they are well protected from potentially harmful people being employed. Residents could benefit from more consistent care if records relating to care needs were appropriately completed and maintained. Innisfree Residential Care Home DS0000071865.V366111.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. Innisfree Residential Care Home DS0000071865.V366111.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 Innisfree Residential Care Home DS0000071865.V366111.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose and Service User Guide is comprehensive and provides prospective residents with information to make an informed choice. The home’s assessment process is satisfactory and ensures that it is able to meet residents’ needs. EVIDENCE: Residents are provided with a comprehensive Residents’ booklet containing the Statement of Purpose, Service User Guide and all the information required to ensure they, or their relatives, have access to the relevant information at all times. The Statement of Purpose includes information regarding equality and diversity issues and the homes philosophy of care that includes meeting cultural and diversity needs. All residents spoken with had a copy of this. A copy of the Statement of Purpose and Service User Guide is available and on display in the entrance hall of the home. Innisfree Residential Care Home DS0000071865.V366111.R01.S.doc Version 5.2 Page 10 All residents were aware they had a contract of residency and were happy with the provision that they receive. The contracts reviewed as part of the case tracking exercise were signed and contained information about fees and the obligations of the provider and resident. The contract terms and conditions were clear and understandable. The registered manager carries out a needs based pre-admission assessment on all prospective residents. Admissions to the home take place once the registered manager is confident the residents care needs can be met. The registered manager does not always write to new residents, or their relatives, to confirm the home can meet their individual needs and provide confirmation of discussions. Two residents assessment documentation were read to find out how well the needs are assessed. The assessments were informative, and showed the residents had been consulted about their range of physical and mental care needs. In one record the social care needs assessment had been left blank. In discussion with the manager, staff and residents it was evident that good practice outcomes are achieved in the admission process however gaps in documented information do not always support this, to enable consistent and knowledgeable care provision. Residents were able to recall having been visited by the manager prior to admission, and also being invited to visit the home. Thus enabling the prospective residents to meet other residents, see the facilities offered and look around the accommodation available. The residents’ when spoken to said ‘I am well looked after; they know what I need”. Social services care plans had been obtained where relevant. Care practices observed showed that staff were fully aware of the residents needs as stated in their assessments. The home does not provide intermediate care Innisfree Residential Care Home DS0000071865.V366111.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from care plans that are well formulated and give clear information to enable staff to meet residents’ health and social care needs. Personal and environmental risks are well managed. Residents’ cannot be sure that the management of medicines is safe and protects their health and well being. Respect and dignity are well maintained by kind and caring staff. People who use the service are enabled to discuss, and plan, their end of life care in a sensitive way. EVIDENCE: The residents and visitors with whom we spoke said that they were very satisfied with the standards of care and felt the staff were good. One relative told us that the staff are “always understanding about the residents needs and wishes. The resident told us “I can do what I like and they support me. They are very good”. Innisfree Residential Care Home DS0000071865.V366111.R01.S.doc Version 5.2 Page 12 Relatives felt that they are kept well informed of any significant issues, and that their involvement is welcomed. Another relative told us that assistance with personal care “is sensitively and discreetly given” for the comfort and well being of the individual. Individual records are kept for each of the residents, which include key personal information. There were some gaps seen in the documentation that did not reflect the staff’s knowledge of residents’ care and social needs. Clear information in care records ensures safe and consistent care for all residents. Three care plans were inspected and two reflected clearly, where information had been recorded, current identified health and social care needs. Clear actions to met identified needs were recorded and regular evaluation noted. All of the three care plans showed resident’s involvement. In discussion with residents although they were not aware of their care plans they talked of their Key Worker and the discussions with them about their needs. In one care plan inspected there was no clear guidance given in relation to the management of diabetes or pressure sores. Staff when interviewed were clearly able to describe the needs of the residents being case tracked and demonstrated a person centred approach to care. This is good practice. Health care professionals such as GP’s and district nurses visit the home as required to carry out health care checks and offer advice to staff. Evidence was seen of residents being taken to other appointments as needed. Resident’s comments supported this. One care plan contained well-formulated risk assessments for Manual Handling and falls. One care plan did not have any risk assessment or plan of action to minimise falls for the resident, despite this being recognised as a need. Another did not contain clear risk assessment or actions to minimise the risk of pressure sores developing, or how to manage the care of a resident if these did occur. In discussion with the staff they do have some knowledge in this area, however when asked to describe the care of the resident the responses received did not reflect a consistent approach to their care. Other personal and environmental risk assessments were present to ensure the safety of the resident while promoting independence as able. One resident said, “It is just nice to have the reassurance of someone there to help”. Daily records were up to date and written in a respectful manner. Care practices observed showed caring interactions and good communication skills from staff. Choices and preferences were observed being discussed and offered. Detailed conversations with eight of the residents confirmed a satisfactory standard of personal care. Two residents said, “it’s homely” another resident said, “people are very kind, we are well looked after” and a third said “they are very respectful and helpful”. Another resident told us “I would recommend the home to anyone”. Innisfree Residential Care Home DS0000071865.V366111.R01.S.doc Version 5.2 Page 13 Medication storage, receipt and disposal are not well managed for the safety of residents. A full audit trail of medicines entering and leaving the home is not correct giving rise to concern that medication is not always managed in the best interests of, or for the safety of, residents. Facilities for the storage of medicines were seen to be secure. The Medication Administration Record (MAR) sheets had been well completed with only a few gaps. The staff who administer medication have received appropriate accredited training, to ensure they have the skills and knowledge for the safety of residents. A list of specimen signatures was recorded in the medicine administration record for accountability purposes. Hand written prescriptions had been signed for accountability purposes, and good practice guidelines of two signatures implemented. A few residents self medicate, keeping the medication in their rooms, which can also be locked. All rooms are provided with a lockable space however unsecured medicines were seen in residents’ rooms. Two residents told us they “keep them by me in case” but do not lock them away. This potentially poses a risk to other residents in the home who may gain access to them. A risk assessment for self medication had been completed for one resident, but not for a second resident who also has sight problems. This potentially puts the resident at risk and there is no indication as to how the home are managing or minimising the risk while respecting the individual’s choice. In the medicines trolley we found medicines in use that were out of date, and an unmarked container of loose tablets. This does not show safe management of medicines and may put residents at risk. On checking the audit trail of a number of medicines we found that the number recorded in the book did not tally with the number of tablets in the home. Records in the register were incomplete and did not clearly show the use or disposal of medicines thus a number of tablets showed as missing. This potentially puts residents at risk of harm from mismanagement of medicines, and is poor practice. The systems for the receipt and disposal of medication were satisfactory. The home uses Homely Remedies but does not have a policy or agreement with the local doctors as to what medication may be given without consultation, or for how long. Staff when spoken with did not have clear understanding of the potential harm that could befall residents, should inappropriate homely remedies be used or for too long. In discussion with the manager she told us she would arrange for this to be implemented in the near future for the safety of residents. The interactions of the care staff observed, demonstrated respect for individuals and their right to privacy. Residents spoken to say, “the staff are Innisfree Residential Care Home DS0000071865.V366111.R01.S.doc Version 5.2 Page 14 very thoughtful and kind and treat you very well”. All residents spoken with felt that kind and caring staff respected their dignity and privacy. The home has an Equality and Diversity policy that recognises the cultural and social needs and differences that are present in society. Both management and staff demonstrated clear knowledge and desire to meet cultural and diversity needs as and when they should arise. Staff interviewed said, “We are all one happy family here”. Clear information about race, age, gender and religion is given in the Statement of Purpose and staff have the knowledge and confidence to discuss diversity issues with residents and their relatives. Innisfree Residential Care Home DS0000071865.V366111.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 excellent. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from flexible routines and menus. A variety of activities is offered, and residents’ right to choice and control over their lives is well respected, and encouraged. Friendly staff always welcome relatives and visitors. EVIDENCE: Many residents commented on the atmosphere of the home. One person described it as nicely informal, and residents’ felt that their visitors are also helped to feel relaxed and at home. When asked about activities and their daily routine two residents said, “we have singing sometimes”. While another said “we go out for lunch sometimes”. A range of activities is provided with a diary of events displayed on the dining room notice board. This included hair and nails, arts and craft and music and movement sessions. Three residents told us there are things to do if you want. Two residents said they liked to just sit and read the paper. There is a quiet lounge and a lounge with a television. Innisfree Residential Care Home DS0000071865.V366111.R01.S.doc Version 5.2 Page 16 During the inspection some people who use the service were seen exercising choice of activity, and being encouraged to undertake the activity they chose. All people who use the service enjoy meeting in the lounge and said they have “many stimulating and enjoyable conversations”. We saw one member of staff discussion current issues in the paper with a resident, while another member of staff was seen supporting a resident with a craft activity. In the afternoon we saw a number of residents enjoying a sing a long session. People who use the service told us they can see their visitors at any time, helping them to feel this is their home. Relatives spoken with told us they feel “welcomed” when they come, and that “there is a warm, caring feel to the place”. The dining room is homely and tables well presented providing an atmosphere that is conducive to an enjoyable meal. All residents said they liked the meals, and felt a good and balanced diet is provided. Minutes of residents’ meetings showed that food is a topic of discussion at most meetings and residents’ suggestions are listened and acted upon as the home are able. Choices are offered at all meals and snacks of residents’ choice are always available. In addition to the usual cups of tea and coffee, a choice of cold drinks was regularly offered throughout the day. All residents were seen to have juice in their rooms and jugs of varied juice, with glasses, were available for residents to help themselves to in the main lounge. The home has recently undergone an inspection from Environmental Health (Food) who approved their provision and practice by awarding the home a five staff rating. Innisfree Residential Care Home DS0000071865.V366111.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): 16,17,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ are protected from abuse, and they can be confident that complaints are taken seriously and acted upon. EVIDENCE: The home has a comprehensive complaints procedure and all residents receive a copy on admission. There have been three complaints since the last inspection and all were appropriately handled, to provide the best outcome for the resident. Residents stated that if they were not happy about anything they would speak to the manager. Residents said that the manager and staff are “very approachable” and they would always raise any niggles or concerns with them. Staff and residents spoken to, say the manager is very approachable and understanding. One resident said ‘I’ve nothing to complain about, it’s just like home – we are one family”. A system for keeping clear records of complaints received, with actions taken, and outcomes is available to demonstrate the homes wish for satisfactory outcomes. The registered manager promotes the resident’s individual rights in the home. Information leaflets were available on how to contact advocacy agencies, and resident’s can vote at political elections if they chose, with staff enabling them to go to the polling station or obtaining a postal vote for them. Innisfree Residential Care Home DS0000071865.V366111.R01.S.doc Version 5.2 Page 18 The home has a copy of the ‘No Secrets’ in North Somerset guide and a comprehensive local policy and procedure for responding to allegations of abuse for the protection of residents. Staff interviewed were conversant with the home’s Safeguarding policy and demonstrated good knowledge of the adult protection procedure that should be followed, if abuse is suspected for the protection of residents. The home also has a Whislteblowing policy and staff are aware of this and their duty of care in relation to whistle blowing for the safety of the residents. Staff have received formal training regarding Safeguarding Adults and how to whistle blow should the need arise. Staff when interviewed were aware of the policy, had an understanding of what constitutes abuse and how best to respond to any allegations or incidents, should they occur for the protection of residents. All residents said, “The staff are very kind and take time”. “I can’t fault them”. Innisfree Residential Care Home DS0000071865.V366111.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): 19,20,21,22,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with homely, safe and comfortable surroundings. Outdoor space is attractive and accessible for residents to enjoy. The home has suitable equipment to maximise resident independence. Satisfactory Infection Control practices are followed. EVIDENCE: The home is nicely decorated and well maintained with a welcoming atmosphere, and made comfortable with homely communal spaces. Accommodation is provided over three floors with a shaft lift to access the two main floors. For residents on the mezzanine floor there is a stair lift. All rooms are provided with vanity units or en suite facilities. Residents’ rooms are personalised and comfortable. Innisfree Residential Care Home DS0000071865.V366111.R01.S.doc Version 5.2 Page 20 The décor, fixtures and fittings are in good order. The lounges are furnished with a variety of suitable and comfortable chairs to suit residents’ needs. The home has a well maintained garden for residents to enjoy. Since the last inspection, (under previous ownership) some areas of the home have been redecorated for the benefit of residents, and an ongoing maintenance and refurbishment plan was available at the inspection. The plan clearly showed the timeframe for the renewal and refurbishment of the home to ensure the safety of residents. There are plenty of toilets within easy access of all communal rooms, for the comfort of residents. The home has grab rails situated at relevant points and a shaft lift to all floors that is easily used to assist resident mobility, and aid independence within the home. The home has sufficient bathroom facilities with aids for the benefit of residents. Equipment was clean and well maintained to ensure protection for residents from cross infection. Hot water outlets are thermostatically controlled and temperatures measured were within the guidelines of 43ºC for the safety of residents. Thermometers were present for staff to check the water temperature before baths for the safety and protection of residents. The home was clean and free from offensive odours throughout. The laundry facilities were well organised to minimise potential cross infection. Staff interviewed and observed demonstrated good understanding of Infection Control procedures and practices and maintained a clean and hygienic environment. Dispenser soap and paper towels have been provided in communal areas, thus providing good facilities for ensuring that staff can maintain good hand washing practices, between caring for residents. Innisfree Residential Care Home DS0000071865.V366111.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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from staffing levels that are adequate to meet their needs. Residents are not always protected by recruitment practices. Residents benefit from staff that are trained and competent to do their jobs. EVIDENCE: Staff went about their duties in an unhurried manner and were observed spending time talking with residents. Residents reported, “staff make time for a chat when they can.” Staff approached residents with directness, openness and consideration. Each of the residents with whom we spoke said, “the staff are very good”. One resident said, “they are lovely people here”. The staffing rotas for the two weeks prior to the inspection were reviewed. Staffing levels appear to provide sufficient care staff to meet residents’ needs. A good team of ancillary staff supports them. In discussion with residents they told us “the staff are very good and always there when you need them.” Other comments received were “staff know their job and do it well”. “You only have to ring the bell and they come”. Staff interviewed said that they were kept busy, but still had time to chat with the residents. Person centred interactions were observed with staff taking care to ensure the residents needs and wishes had been met, before moving on to Innisfree Residential Care Home DS0000071865.V366111.R01.S.doc Version 5.2 Page 22 their next activity. Call bells were answered promptly during the inspection. The home has a Key Worker system in place for all residents. Relatives were aware of the role and said, “it works well”. The home currently has 75 of staff with a National Vocational Qualification (NVQ). This ensures that staff have the skills and knowledge to care for the residents in a safe and competent manner. Recruitment procedures do not ensure all the necessary safeguards are in place prior to employment of staff, potentially putting residents’ at risk. Three recruitment files were inspected. In all files a Criminal Record Bureau (CRB) check had been received prior to the commencement of work to ensure the protection of residents. In two of the files there was only one written reference and no interview records; and in all three files gaps in employment had not been explored or evidence of qualifications recorded. This information should be documented and evidence obtained to ensure the required checks are completed for the protection of residents. All staff said they worked well, as a team and sought to provide a happy atmosphere. Comments from residents, and observations of practice during the inspection, verified this. Evidence was seen of staff induction in the files of two new members of staff to ensure they have the skills and knowledge to care for residents appropriately. When interviewed we were told that the induction “was helpful and covered all the things I needed to know”. The training file showed that staff have received training throughout the year on a variety of topics for example equality and diversity, fire training, protection of vulnerable adults, person centred care, dementia and care planning and Moving and Handling training. Staff when spoken to confirmed they had undertaken the training and demonstrated good knowledge and understanding in all the above areas, thus ensuring that residents are cared for by competent and knowledgeable staff. Residents tell us that they feel “the staff have a good understanding of their needs and how to meet them. Innisfree Residential Care Home DS0000071865.V366111.R01.S.doc Version 5.2 Page 23 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): 31,32,33,35,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager provides clear leadership and guidance to staff to ensure residents receive consistent care in a safe environment. Quality assurance processes in the home are formal demonstrating that the home consults with residents, families and visiting professionals. The management of resident’s monies in the home are well managed. Health and safety issues are monitored in the home to ensure that issues are identified and addressed where they arise. EVIDENCE: The manager has recently obtained her Registered Manager’s Award, is qualified and has a number of years experience in this area. She is supported by a team of senior carers, who together with the provider make up the Innisfree Residential Care Home DS0000071865.V366111.R01.S.doc Version 5.2 Page 24 management team. This team meet regularly to discuss issues in the home and ensure it is run in the set interests of the residents. The manger gives clear leadership, guidance and direction to staff to ensure that staff are knowledgeable and competent to meet the needs of people who use the service. People who use the service and relatives feel she is approachable, available and seeks to ensure all their needs are met. One resident said she ‘can’t do enough’, ‘she is always helping”. Staff interviewed stated that they felt supported by an approachable manager. Policies, and practice guidance, are provided in the home with regular reviews of these recorded. This ensures they provide staff with current good practice advice for the benefits of residents. . Staff are aware of the policy folder and can access it as needed. A formal quality assurance tool was available for inspection in order to demonstrate that the home consults with residents and relatives. A summary report of the most recent survey was not available at present as it is currently being prepared. The manager told us that she would feedback the results at a residents meeting, and discuss the outcomes with them. Residents felt that their comments are listened to and acted upon. Pocket monies, for people who use the service, held by the home, were inspected and found to be accurate and to have clear records for the protection of residents. All entries were supported by two signatures for any transactions made for the safeguarding of all concerned. Records inspected showed staff have received regular supervision to ensure they have the skills and knowledge to meet resident needs. Staff spoke of receiving this and it’s helpfulness in identifying areas of training they would like, and would benefit their care provision to residents. Records were available to show regular safety and fire checks are carried out, to maintain the safety of systems for the protection of residents. Certificates of safety checks, servicing of equipment and other required safety inspections were seen and showed that all equipment was maintained and safe, for the protection of residents. Staff spoken to said they had received fire instruction regularly and records supported this, demonstrating staff would have the expertise to safeguard residents in the event of a fire. Innisfree Residential Care Home DS0000071865.V366111.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 4 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 3 2 3 Innisfree Residential Care Home DS0000071865.V366111.R01.S.doc Version 5.2 Page 26 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 Regulation 4 (c) Requirement Timescale for action 28/09/08 1 OP9 13.2 2 OP29 19.1 Schedule 2 The registered person must ensure that all risks to residents are identified and appropriate actions recorded and undertaken to minimise the risk and promote the health and well being of the residents. This relates to pressure sore risk assessment and management. The registered person must 28/09/08 make arrangements for the recording, safekeeping, safe administration and disposal of medicines in the home. This refers to: -Keeping all medicines secure -Keeping records of all medicines received into the home -Keeping accurate records of Controlled Drugs -Agreeing a Homely Remedies policy with the local doctors. The registered person must 28/09/08 ensure that all required information and checks are undertaken prior to a person commencing employment at the home for the protection of residents DS0000071865.V366111.R01.S.doc Version 5.2 Innisfree Residential Care Home Page 27 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 Refer to Standard OP37 Good Practice Recommendations The registered person should ensure that all records are completely appropriately and kept up to date for the safety and well being of residents. Innisfree Residential Care Home DS0000071865.V366111.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West 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 Innisfree Residential Care Home DS0000071865.V366111.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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