Care Home: Old Well House

What the care home does well Staff obtained detailed information about people`s needs and preferences. This helped staff to understand and meet people`s needs. Care plans focussed on people`s individual needs and preferences and were easy to follow and understand. Spiritual care plans provided guidance for staff about the action they should take to maintain and improve resident`s happiness and wellbeing. Staff worked in partnership with other health care professionals to promote resident`s health and wellbeing. Staff were polite and helpful and respected people`s privacy and dignity. People could choose where and how they spent their time and staff encouraged people to make decisions. One relative said, "Staff allow the resident to choose what they would like to do, whether that be with the community or alone". Staff supported people to take part in a wide variety of activities and to attend parties and outings. People received a varied and well balanced diet.Visiting hours were flexible and relatives and friends were invited to social events and meetings. Most relatives were satisfied with the care provided in the home and described the atmosphere as "friendly", "cheerful" and "happy". Records were kept about complaints. Relatives said their concerns were usually taken seriously. The home was clean, tidy and warm. There were lots of interesting items for people with dementia to explore and touch. People could bring their own furniture and possessions into the home and arrange their room to suit their needs. Staff had access to a varied and relevant programme of training. Regular audits and surveys were completed to monitor the homes performance and to obtain feedback about the service. Maintenance staff carried out a regular programme of health and safety and fire safety checks. Equipment was serviced regularly to ensure that it was in working order and was safe for use. What has improved since the last inspection? The management of medicines had improved. The company arranged extra training and support for senior staff and regular checks were carried out to ensure medication procedures were followed. An office was converted into a multi sensory room. This provides a quiet area where residents can relax. The arrangements for supervising staff had improved in recent months. Staff discussed their work and personal training needs during supervision and said they found the sessions helpful. The company appointed a permanent manager shortly after this inspection. The manager knows the home and most of the residents and staff. What the care home could do better: The resident guide provides useful information for residents and relatives. The document should be reviewed regularly to ensure that information is up to date and complies with regulations. Care plans were not always reviewed regularly. As a result some plans did not provide up to date information about the support that people required.Staff did not always encourage and remind people (that ate independently) to eat. There were no condiments or sauces on the dining tables and none were offered. Fresh fruit was provided but it was not placed where residents could see or reach it. Staff knew what they should do if they witnessed or received information about abuse but some staff were concerned that confidential information was discussed with other staff. Although there was no evidence to support these concerns the company should ensure that staff know what protection `whistleblowers` will receive and how their information will be handled. Staff that were still waiting for an enhanced CRB disclosure were not always properly supervised. Valuable items were stored securely but records were incomplete and were not checked. There was no soap or handtowels in the laundry rooms. There were some sharp edges on some of the broken air conditioning units. This is a potential hazard. Health and safety records were good overall but there was no evidence that night staff had an opportunity to take part in drills or window restrictors were checked. CARE HOMES FOR OLDER PEOPLE Old Well House Frognal House Frognal Avenue Sidcup Kent DA14 6LS Lead Inspector Maria Kinson Key Unannounced Inspection 10th September 2008 10:15 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 Old Well House DS0000006787.V371073.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. Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Well House Address Frognal House Frognal Avenue Sidcup Kent DA14 6LS 020 8302 1600 020 8300 8204 frognal.rc@sunriseseniorliving.com 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) Sunrise Operations (UK) Limited Manager post vacant Care Home 44 Category(ies) of Dementia (44) registration, with number of places Old Well House DS0000006787.V371073.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 (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 44 10th January 2007 Date of last inspection Brief Description of the Service: Old Well House is owned and managed by Sunrise Operations UK Ltd, an American based company with extensive experience of operating assisted living schemes in the USA. The home (Old Well House) is one of three buildings that are located on the same site in Sidcup. All of the buildings provide housing for older people and offer different levels of support. Old Well House is the only building on the site that is registered as a care home. The home is registered to provide personal care for forty-four older people with dementia. The home is divided into two units. Each unit has an assisted bathroom, toilet, a kitchen and a laundry room. All of the bedrooms are single occupancy and have en suite facilities. Some of the bedrooms are called companion suites as they include a shared area where residents can spend time together or prepare light snacks and drinks. The bedrooms are arranged around a central open plan lounge and dining area. The main kitchen and laundry are located in Frognal House. There is an enclosed secure garden on the ground floor and a roof garden on the first floor unit. The home is located within easy reach of the A20 and a local bus serves Queen Marys hospital, which is within walking distance of the home. There are car parking facilities within the grounds. The fees charged by the home range from £931.00 to £1071.00 per week. People that require more than three care hours a day pay an additional fee of £18 per day for the ‘Reminiscence Care Plus Programme’. On admission to the home people are charged a “one off” community fee, which is calculated by Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 5 multiplying the daily room rate x 45. The fees include ‘in house’ activities and entertainment and mini bus travel to and from planned outings. The fees do not include hairdressing, chiropody, toiletries or dry cleaning. This information was supplied to the commission on 10.09.08. Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 6 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 inspection was unannounced and was carried out over two days in September 2008. We examined some of the records that were kept in the home, assessed the management of medicines and observed staff supporting people to undertake basic tasks such as eating, drinking and moving around the home. We visited all of the communal areas and three bedrooms on each floor. We received written comments about the service from three members of staff and six relatives. We spoke to four members of staff and one resident during the inspection. There were thirty-eight people living in the home and six empty beds at the time of the inspection. What the service does well: Staff obtained detailed information about people’s needs and preferences. This helped staff to understand and meet people’s needs. Care plans focussed on people’s individual needs and preferences and were easy to follow and understand. Spiritual care plans provided guidance for staff about the action they should take to maintain and improve resident’s happiness and wellbeing. Staff worked in partnership with other health care professionals to promote resident’s health and wellbeing. Staff were polite and helpful and respected people’s privacy and dignity. People could choose where and how they spent their time and staff encouraged people to make decisions. One relative said, “Staff allow the resident to choose what they would like to do, whether that be with the community or alone”. Staff supported people to take part in a wide variety of activities and to attend parties and outings. People received a varied and well balanced diet. Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 7 Visiting hours were flexible and relatives and friends were invited to social events and meetings. Most relatives were satisfied with the care provided in the home and described the atmosphere as “friendly”, “cheerful” and “happy”. Records were kept about complaints. Relatives said their concerns were usually taken seriously. The home was clean, tidy and warm. There were lots of interesting items for people with dementia to explore and touch. People could bring their own furniture and possessions into the home and arrange their room to suit their needs. Staff had access to a varied and relevant programme of training. Regular audits and surveys were completed to monitor the homes performance and to obtain feedback about the service. Maintenance staff carried out a regular programme of health and safety and fire safety checks. Equipment was serviced regularly to ensure that it was in working order and was safe for use. What has improved since the last inspection? What they could do better: The resident guide provides useful information for residents and relatives. The document should be reviewed regularly to ensure that information is up to date and complies with regulations. Care plans were not always reviewed regularly. As a result some plans did not provide up to date information about the support that people required. Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 8 Staff did not always encourage and remind people (that ate independently) to eat. There were no condiments or sauces on the dining tables and none were offered. Fresh fruit was provided but it was not placed where residents could see or reach it. Staff knew what they should do if they witnessed or received information about abuse but some staff were concerned that confidential information was discussed with other staff. Although there was no evidence to support these concerns the company should ensure that staff know what protection ‘whistleblowers’ will receive and how their information will be handled. Staff that were still waiting for an enhanced CRB disclosure were not always properly supervised. Valuable items were stored securely but records were incomplete and were not checked. There was no soap or handtowels in the laundry rooms. There were some sharp edges on some of the broken air conditioning units. This is a potential hazard. Health and safety records were good overall but there was no evidence that night staff had an opportunity to take part in drills or window restrictors were checked. 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. Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5. Standard 6 does not apply to this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People could visit the home and were given information about the service. This helped people to decide if they would like to live in the home. The assessment process was thorough and provides a detailed picture about each person as an individual. EVIDENCE: The registration certificate was displayed in the reception area. People that visited or expressed an interest in the service were given a copy of the homes ‘Information Guide and Resident Handbook’. This document provides useful information about the service. The manager had identified some changes that need to be made to this document to comply with regulations. The contact details for CSCI should be amended as this had changed in the period since the document was last updated. See Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 11 recommendation 1. The information Guide was easy to read and was available in other formats and languages if requested. Relatives were satisfied with the amount and type of information that they received from the home. People could visit the home before they moved in. This provides an opportunity to view the facilities and speak to staff. Before people moved into the home, staff carried out an assessment to establish what support the person required and if they needed any special care or equipment. The assessment visit was usually carried out in the residents own home and involved their relatives or carers. The residents GP provides written information about health issues and details of any medicines that the person was taking. Relatives completed a resident profile form, which provides information about the person’s life history, preferences and routines. We looked at four assessments forms for people that had moved into the home in the past year. The information that was obtained before people moved into the home focused on the person as an individual and was very detailed. Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was detailed information in the records about the support that people required but procedures for reviewing and updating plans and assessments were not always followed. Staff worked in partnership with other professionals to meet people’s health and medication needs and respected people’s privacy. EVIDENCE: We looked at the care records for four residents. Some of the files that we looked at were for people that had only recently moved or transferred into the home and some were for people that had lived in the home for some time. Staff used the information that was obtained during the assessment visit to develop an individual care plan for each person. Care plans provided detailed information for staff about people’s individual needs and preferences and were easy to follow. For instance one of the plans that we looked at stated what type of nightwear the person liked to wear, what Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 13 tasks they could do independently and indicated that they didn’t use soap on their face. Another plan stated what equipment the person required to move and said the resident liked to call their zimmer frame their “Ferrari”. The spiritual care plans that we saw were excellent. Staff provided clear information about the activities that people found comforting such as listening to classical music and seeing their family and about individual cultural or religious practices. Although the plans that we saw were well written and person centred, they were not always reviewed regularly. This meant that some information was out of date or did not reflect the person’s current needs. For instance one care plan indicated that a resident’s food and fluid intake was monitored and recorded on a chart. Staff could not locate the chart and told us that they had stopped using the chart because the person was eating better. Another plan indicated a resident had a urinary catheter, discussions with staff indicated the catheter had been removed. The monthly care plan review forms that we saw in two files were blank. See requirement 1. There was some variation in the care plans that we saw for people who required assistance to use the toilet. One plan provided clear information for staff about how often they should support the person to use the toilet and stated what action staff should take to ensure the resident was comfortable. Another plan for a resident with similar needs did not provide any information about how frequently the person should be helped to use the toilet or what staff should do to protect their skin. Care plans included information about people’s health needs and stated what staff could do to manage challenging or socially unacceptable behaviour. The ‘wellness team’ provide advice and support for staff about health and medication issues and offer residents regular health checks. The GP visits the home regularly and other professionals such as district nurses and a psychiatrist provide ongoing support. We assessed the management of medicines on both floors. All medicines were in stock. Good records were kept about medicines that were bought by residents into the home or were supplied by the local pharmacist. Records of administration were good and medicines that were left over from the previous months supply were carried forward and recorded on the new chart. A code was recorded on the chart when people refused or were unable to take their medicines. This provides an explanation of why the medicine was not given. Medication was audited regularly to identify concerns and some additional staff hours had been allocated to support staff and provide ongoing training. This had improved the records that were kept about medicines and the overall management of medicines. We observed staff interacting and supporting residents throughout the day. Staff ensured that people’s privacy and dignity was maintained. Some of the staff that we observed had an excellent understanding of dementia and good Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 14 communication skills. For example one resident looked bewildered when the lights were dimmed. The staff member immediately held the residents hand and said, “It’s my friends birthday today would you like to help me sing happy birthday”. The explanation provided by the staff member was easy to understand and effective. One relative told us that staff made residents “feel loved and wanted”. Most of the relatives that provided written feedback about the home commented about the staff team. They said staff were “kind and patient”, “caring” and “respect” each resident. Old Well House DS0000006787.V371073.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 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides a varied and interesting programme of activities that meets people’s needs and expectations. Visiting times were flexible. Staff respected resident’s choices and decisions. The food provided in the home was varied and nutritious. EVIDENCE: The home had a part time activity assistant. Care staff were also responsible for coordinating activities and events and supporting residents. The programme of activities was displayed at the entrance to each unit. The aim of the programme was to stimulate people’s senses and use some of the skills they had developed throughout their lives. The programme for the week of the inspection included cooking, games, films, manicures and music. There were regular mini bus trips to local places of interest, social events, tea dances and entertainment. On the day of the inspection some of the residents made bread pudding and fairy cakes and were entertained by a singer. Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 16 Some people spent their time walking around the lounge and corridors. There were lots of interesting things for people to look at, touch and handle during their walks. The home has a secure garden and balcony area where residents can spend time during the warmer weather. In the period since the last inspection the home had converted an office into a multi- sensory room. The room includes different lights and effects to stimulate the senses and help people to relax. Relatives said they were able to visit their family member when they wanted and one relative said they particularly liked the homes “open door policy”. There were regular social events and entertainment, which family members could attend. We received written feedback about the home from six relatives. Most people were satisfied with the care provided in the home and said they were usually informed about important issues such as accidents. There were regular support meetings for relatives. Some residents spent most of the day in their room whilst others preferred to spend their time in the communal areas. One resident did not get up until late because they wanted a ‘lay in’. Care plans provided detailed information about peoples preferred routines and reminded staff to encourage people to do what they could for themselves. We observed staff serving lunch on the ground floor unit. Residents were offered a choice of two plated meals and chose a dessert from a trolley. One person found the choice of desserts overwhelming. The staff member immediately recognised the difficulties that the resident was experiencing and selected two desserts for the resident to choose from. The starter, main meal and dessert options looked and smelt appetising. Although we were not able to get any feedback from residents about the meal most people seemed to enjoy their meal. There were no condiments or sauces on the table and we did not see staff offer any. Staff provided prompt support for people that required assistance to eat, sitting at the same level and talking to the resident. The support that was offered to some people that only required their food cut up or prompting was slow. Staff worked hard to promote peoples independence but may require some guidance about when they should intervene. See recommendation 2. Residents were offered juice or water before and during the meal and one person that did not get out of bed until late was encouraged to have extra drinks. The atmosphere in the dining room was relaxed and people were given adequate time to eat. The menu was varied and well balanced. There was fresh fruit on both of the units but the bowl was placed on top of the servery, which was out of most residents view and reach. As most of the residents are unlikely to request fruit staff should ensure that it is placed where residents can see it. Staff said most resident’s preferred soft fruits such as bananas and grapes. Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 17 Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 18 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 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures for managing concerns and complaints were followed. Staff knew what they should do if they witnessed abuse or poor practice but were concerned about how their information was handled. EVIDENCE: The complaints procedure was not displayed. This issue was addressed immediately. A copy of the procedure was printed off and displayed in the reception area. The home had received five complaints in the past year. All of the complaints were recorded in the complaints file. The file contained a number of old complaints, which should be archived. This would make it easier to locate information and identify trends. Complaints were investigated promptly and the complainant received information about the homes findings. There was mixed feedback from relatives about how complaints were handled. Three relatives said their concerns were properly investigated, one relative had never raised any concerns about the service so could not comment and two relatives said their complaints were dealt with effectively “sometimes”. One relative that was not completely satisfied with the way their concerns had been handled in the past did acknowledge that staff were “always prepared to listen Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 19 to any comments especially if I thought something was not quite right and needed attention”. We will reassess this issue at the next inspection. The commission has not received any formal complaints about this service. Staff were aware that they must report allegations or concerns to senior staff but some staff were worried that information would be written down and shared with other staff. The home needs to ensure that staff know how the home will handle this type of information, who they will inform and what steps they will take to protect the alerter. See recommendation 3. Most of the staff had attended a recent safeguarding training session. Staff informed us about significant events that occurred in the home such as serious illness and accidents and referred safeguarding issues to the local authority. Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 20 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, 23, 24 and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home was clean, spacious and comfortable. The layout of the home meant people had space to move around and were usually able to find their way back to the communal areas. EVIDENCE: The home was well maintained overall. The only concern that we identified was some broken slats on some of the air conditioning units. As a result of this some of the units had sharp edges, which could cause an injury if someone was to rub their hand along the surface. This issue was identified in previous reports and we were told that the units would be covered, as it was not possible to get spare parts. See requirement 2. Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 21 The open plan lounge and dining area was nicely decorated and furnished. One relative raised concerns about the condition of some of the furniture which they said was worn and malodorous. The annual quality assurance assessment form that was completed by one of the managers indicated that work was planned to address this issue. All of the rooms have an en suite shower and toilet. There was one toilet and bathroom and a separate toilet on each floor. Toilets and bathrooms were clean and tidy. An environmental health inspector visited the main kitchen in June 2007. A number of requirements and recommendations were made. The home should confirm that all of the issues highlighted in the report were addressed. See recommendation 4. Clinical waste was stored appropriately and staff had access to protective clothing such as gloves and aprons. The laundry rooms were clean and tidy but there was no soap or towels and there was a small pile of clothing on the floor. See requirement 3. The home had recently purchased industrial style washing machines. We viewed three bedrooms on each floor. The rooms that we saw were light, spacious and comfortable. Because the rooms are big people can bring a significant amount of their own furniture and belongings into the home. This helps to personalise the room and made it easier for residents to recognise their personal space. Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. Staff had a good understanding of residents needs and were accessible. The home carried out thorough checks when appointing new staff but the arrangements for supervising staff without criminal record disclosures needs to be strengthened. Staff were supported to develop new skills and keep up to date with current practice. EVIDENCE: There were nine care staff and two managers on duty when we arrived in the home. Four care staff were working on the ground floor unit and five care staff on the first floor unit where the residents were assessed to have higher care needs. A senior carer led the shift and administered medicines. There was one senior carer and one care assistant on duty on each floor during the night. The management team work some weekends and there was always a senior member of the management team on call. There were adequate staff on duty to meet people’s needs and staff were able to respond quickly when people required assistance. One relative told us that staff “try to engage the residents in activities and spend time chatting with them”. We saw staff talking with and Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 23 reassuring residents throughout the day. The duty roster showed that residents received good continuity of care. At the last inspection we identified concerns about staffing levels during bus trips. Trips occur twice a week and some of the staff team accompany residents. There were no planned outings during this inspection but staff told us that there were always at least two or three staff left on the unit. The manager should continue to monitor this issue. 50 of care staff had a recognised care qualification at level two or above. We examined three staff files. The records showed that thorough checks were carried out when new staff were recruited. This ensured that applicants were suitable and fit for the role they were undertaking. References were crosschecked to ensure that they were genuine. One staff member had a POVA first check but did not have a Criminal Record Bureau (CRB) disclosure. We were told the staff member was ‘paired’ with and supervised by another member of staff. The staff member that was responsible for supervising the new staff member said they had not received any specific instructions and were not aware that they should directly supervise the staff member. See requirement 4. The company provides an ongoing programme of training for staff. The programme includes structured induction training for new staff, health and safety training, distance learning packages, short training sessions called mini modules about specific topics and other sessions to meet staff needs. Staff said they received adequate training and said the sessions helped them to meet resident’s needs. Most relatives said staff had the rights skills and experience to meet people’s needs. Old Well House DS0000006787.V371073.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, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well organised and run overall but did not have a clear management structure. Action was taken by the company to address this issue. There were systems in place to monitor and improve the quality of care provided in the home. Regular checks and inspections were carried out to ensure that equipment was in working order and was safe for use. Good records were kept about resident’s personal money but the same standards were not applied consistently to resident’s valuables. Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 25 EVIDENCE: The person that we were told was managing the home had moved to another department. The company said they notified CSCI about this change but we did not receive any information about this issue. There were a number of senior staff on duty when we arrived. It was not clear who was in charge and who was managing the service. Staff that we spoke to told us that they did not know who was responsible for managing the service and some expressed concerns about frequent changes of manager. One staff member said staff found the changes very “unsettling” as every time somebody new was appointed “they change everything again”. One relative expressed concerns about frequent change of managers. The company took prompt action to address these issues. We received written notification that a permanent manager had been appointed in November 2008. The manager submitted an application to CSCI to become the registered manager and was assessed as ‘fit’ for the role in December 2008. The manager knows the home and most of the residents and staff. The Annual Quality Assurance Assessment (AQAA) form was not completed and returned to the commission as requested. Prompt action was taken to address this issue once the home was notified about this issue. There were various systems in place for assessing and improving the quality of care provided in the home. A company representative carried out unannounced visits to assess the conduct of the service and there were regular audits to assess the homes performance. The manager received written feedback about the findings from visits and audits. There were meetings with relatives to discuss their family members care and as a group to discuss the service. The minutes that we saw from the two most recent meetings showed that relatives made suggestions, some of which were adopted and made staff aware of concerns they had about the service. It was not always clear from the minutes if action was taken to address some of the issues and if relatives had noticed any improvements. The manager should consider making feedback about previous concerns, a regular agenda item. An independent satisfaction survey was carried out once a year to obtain feedback from staff and relatives. The results from the surveys and any action planned to address concerns were shared with relatives and staff. The administrator was responsible for looking after resident’s personal money and some valuable items. We looked at some of the records that were kept about people’s money and talked to the administrator about how she ensured that people’s money and valuables were kept safe. Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 26 All incoming and outgoing money was recorded and all entries were checked and signed by two members of staff. Receipts were kept for items that were purchased for residents or services that were provided by other professionals such as hairdressers and chiropodists. Money and valuables were stored securely. The money and valuables held for three people were checked. The money that was held in the safe corresponded with the records and an explanation was provided about how the money was used. Records were kept about valuable items but we found some items such as a bank card and funeral plan were not listed. There was no evidence that safe checks were carried out when the key holder changed or at any time since 2007. See requirement 5. Staff had an opportunity to talk about their work and training needs during supervision. All of the staff that we spoke with had attended supervision during the past three months and said they found the sessions helpful. The home had dedicated maintenance staff. The maintenance team carried out regular health and safety checks and routine repairs in the home and grounds. We sampled some of the health and safety records that were kept in the home. The records that we saw were up to date. Fire safety arrangements were good. Regular checks were undertaken to ensure that the fire alarm system, emergency lighting, fire extinguishers and fire doors were in working order and equipment was serviced regularly. The fire drills records were difficult to follow and we were not certain what year some of the drills related to. There was no evidence that the night staff were involved in fire drills. This issue was identified at the last inspection. See recommendation 5. One resident was using bedrails. Staff completed an assessment about potential risks and stated what checks should be carried out to ensure the residents safety. All of the windows were restricted but there was no evidence that the restrictors were checked to ensure that they were still in place and functioning properly. See recommendation 6. Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 27 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 X 4 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 X 4 4 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 3 X 3 Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 28 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. 2. 3. 4. 5. Standard OP7 OP19 OP26 OP29 OP35 Regulation 15 13 13 19 17 Timescale for action Care plans must be reviewed and 22/04/09 updated at regular intervals or when peoples needs change. Action must be taken to ensure 08/04/09 that the broken air conditioning units are repaired or made safe. Hand washing facilities must be 08/04/09 provided in the laundry rooms. Staff without CRB checks must 25/03/09 be adequately supervised. Adequate records must be 08/04/09 maintained about valuable items that are stored for residents. Requirement 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. Refer to Standard OP1 OP15 OP19 Good Practice Recommendations The ‘resident handbook’ should be reviewed and updated. People, that eat independently should be encouraged and reminded to eat, if necessary. The manager should ensure that staff know what action the company will take to protect and support DS0000006787.V371073.R01.S.doc Version 5.2 Page 29 Old Well House 4. 5. 6. OP26 OP38 OP38 whistleblowers. The home should provide written confirmation that the requirements that were highlighted in the environmental health report were addressed. Clear records should be maintained about fire drills and the night staff should have an opportunity to attend drills. Regular checks should be carried out to ensure that window restrictors are in place and fitted correctly. Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Old Well House DS0000006787.V371073.R01.S.doc Version 5.2 Page 31 - 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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