Care Home: Prospect House

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What the care home does well The home has an enthusiastic team of people working within the service, who like doing their jobs and learning more about how to do it well. The people working in the home want to make sure that the people who live in the home receive good care. All of the people spoken to are positive about the home and like living there. People living in the home and relatives expressed their satisfaction during this visit regarding the care given, service received and the living environment of the home. Staff are hard working and do their best to meet the needs of those people living in the home. People being cared for have good access to professional medical staff and are able to access external services such as dentists, opticians, physiotherapists, chiropody and dieticians, so their health is looked after and they are kept well.People living in the home said they are offered a good choice of meals and they enjoyed the quality of food. Specific wishes are catered for and they have plenty to eat and drink throughout the day. Relatives of the people living in the home said that they are made to feel welcome by the people working in the home and that they can visit when they please. What has improved since the last inspection? This is the first visit to a new service, so no previous reports exist. What the care home could do better: The manager of the home must make sure that there is a robust assessment of need for people who fund their own care, and that the offer of a place in the home is put into writing for all prospective users of the service. So people can be assured their needs can be met by the service before committing themselves to placement within the home. Staff in the home must improve the quality of the information in the care plans to include details of action to be taken to give appropriate care to the people in the home and include up to date assessments of risk. This will help people in the home receive consistent care to a high standard and protect them from risk of harm. We would like to thank everyone who took the time to talk to us during this visit. Your comments and input have been a valuable source of information, which has helped create this report. CARE HOMES FOR OLDER PEOPLE Prospect House Low Street Swinefleet Goole East Yorkshire DN14 8DF Lead Inspector Eileen Engelmann Key Unannounced Inspection 7th April 2008 09:30 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 Prospect House DS0000070752.V361525.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. Prospect House DS0000070752.V361525.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Prospect House Address Low Street Swinefleet Goole East Yorkshire DN14 8DF 01405 704259 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) Mrs Sarah Jane Slack Mr David Michael Slack Mrs Sarah Jane Slack Care Home 15 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (15) of places Prospect House DS0000070752.V361525.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 - Code OP; Dementia - Code DE(E) The maximum number of service users who can be accommodated is: 15 New Service 2. Date of last inspection Brief Description of the Service: Prospect House is a family run business which provides a service for people who meet the following criteria of need – older people and older people with dementia. There are fifteen people in residence, both male and female. The home is situated in the quiet village of Swinefleet, which is near to the town of Goole and within easy access of the M62. The home is on the bus route between Goole and surrounding areas and there is parking for visitors at the front of the home. Accommodation is provided in thirteen single rooms and one double. At the moment the home is in the process of registering a further three rooms, with the Commission for Social Care Inspection, which will be en-suite. People living in the home are provided with a variety of communal spaces including two lounges, one dining room and an enclosed garden to the rear of the property. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home, and copies are on display in the entrance hall of the home. Information given by the manager during this visit indicates the home charges fees from £325.00 to £371.50 per week. The level of fee is dependent on the type of care required. People will pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these is available from the manager. Prospect House DS0000070752.V361525.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 stars. This means that the people who use this service experience Good quality outcomes. Information has been gathered from a number of different sources over the past 6 months since the service was registered with the Commission for Social Care Inspection, this has been analysed and used with information from this visit to reach the outcomes of this report. This unannounced visit was carried out with the manager, staff and people using the service. The visit took place over 1 day and included a tour of the premises, examination of staff and people’s files, and records relating to the service. Informal chats with a people living in the home and one relative took place during this visit; their comments have been included in this report. Questionnaires were sent out to a selection of relatives, people living in the home and staff. Their written response to these was adequate. We received 2 back from relatives (20 ), 2 from staff (20 ) and 5 from people using the service (50 ). The manager completed an Annual Quality Assurance Assessment and returned this to the Commission within the given timescale. What the service does well: The home has an enthusiastic team of people working within the service, who like doing their jobs and learning more about how to do it well. The people working in the home want to make sure that the people who live in the home receive good care. All of the people spoken to are positive about the home and like living there. People living in the home and relatives expressed their satisfaction during this visit regarding the care given, service received and the living environment of the home. Staff are hard working and do their best to meet the needs of those people living in the home. People being cared for have good access to professional medical staff and are able to access external services such as dentists, opticians, physiotherapists, chiropody and dieticians, so their health is looked after and they are kept well. Prospect House DS0000070752.V361525.R01.S.doc Version 5.2 Page 6 People living in the home said they are offered a good choice of meals and they enjoyed the quality of food. Specific wishes are catered for and they have plenty to eat and drink throughout the day. Relatives of the people living in the home said that they are made to feel welcome by the people working in the home and that they can visit when they please. What has improved since the last inspection? What they could do better: 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. Prospect House DS0000070752.V361525.R01.S.doc Version 5.2 Page 7 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 Prospect House DS0000070752.V361525.R01.S.doc Version 5.2 Page 8 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, 4 and 6. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wanting to use the service undergo a needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met. EVIDENCE: The service has developed a statement of purpose, which sets out the aims and objectives of the home, and includes a service user’s guide, which provides basic information about the service and the specialist care the home offers. The guide is made available to individuals in a standard format. Time was spent during this visit discussing with the manager ways in which the documents could be developed further, and it is recommended that the Prospect House DS0000070752.V361525.R01.S.doc Version 5.2 Page 9 registered person consider providing the information in different formats, which will meet the capacity of the people using the service. The people and relatives we spoke to said they received sufficient information to make an informed choice about the service before accepting the placement offer. These individuals have also received a contract/statement of terms and conditions from the home. One relative said ‘my mother has been in a number of other care facilities. The care she receives here is superb and she is extremely happy and well cared for’. Each person has his or her own individual file and the funding authority or the home, before a placement is offered to the individual, completes a need assessment. The four files looked at during this visit were for three funded individuals and one self-funding person, and all were living in the home at the time of its purchase and re-registration by the current owners. The home develops a care plan from the assessments, identifying the individual’s problems, needs and abilities using the information gathered from the person and their family. Checks of the home’s needs assessment showed that this is very basic and needs to be developed to include all aspects of care outlined in Standard 3.3 of Care Homes for Older People and good practice would be to ensure risk assessments are included as part of the information gathering process. Information gathering around issues of equality and diversity should also be included, such as age, disability, gender, sexuality, race and religion/beliefs. Discussion with the manager indicated she goes out to assess individuals who have expressed an interest in coming into the home, and each person is given information about the service and life in the home. At present the manager said she gives a verbal offer of placements, and it was discussed that she must make this a more formal written practice. People using the service and relatives are very pleased with the care and support given by the staff, they said ‘the staff are caring and friendly and everyone is well care for’. Information from the Annual Quality Assurance Assessment and discussion with the manager and people living in the home indicates that all of the people are of white/British nationality, and everyone is currently of Church of England faith. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. Prospect House DS0000070752.V361525.R01.S.doc Version 5.2 Page 10 Checks of the staffing rotas and observation of the service showed that the home employs all white/British, female staff, except for the handyman who is also part owner of the home. Discussion with the manager indicates that this is due to a lack of suitable applicants and that an equal opportunities policy is used when employing staff. Information from the training files and training matrix indicates that the majority of staff are up to date with their basic mandatory safe working practice training, or they are booked onto training in 2008. The home is registered with us to accept placements for people with dementia and the manager is aware of the need to introduce more robust staff training around dementia and challenging behaviour to ensure the staff are able to meet people’s needs. Most of the care staff enrolled on a distance-learning course for Dementia and related behaviours in April 2008; this should be completed within three months. The home does not have any intermediate care beds and therefore standard six does not apply to this service. Prospect House DS0000070752.V361525.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal and social care needs of people living in the home are being met by the service and staff. EVIDENCE: Information from this visit indicates that the people who spoke to us are satisfied that the staff give appropriate support and care to those living in the home. People said they are able to make their own decisions about their daily lives most of the time; that staff treat them well and listen and act on what they say. Comments from the relatives were that ‘the home gives people excellent care, staff are friendly and it really is a “home from home” environment’. One person told us that ‘my relative is really settled in the home, they are well looked after and their health has improved tremendously since going into Prospect House’. Prospect House DS0000070752.V361525.R01.S.doc Version 5.2 Page 12 The care of four people was looked at in depth during this visit and included checking of their personal care plans. The content of the plans is basic, easy to follow and on the whole completed to an acceptable standard. It was discussed with the manager that there are a few areas in the care plans that staff need to take more time over and these include • Making sure that all the information areas on the admission sheets are completed in full. Areas seen to be missing are information around disabilities and ethnicity. • Risk assessments must be consistently completed for all people around moving and handling, nutrition, falls and pressure area care. These must be completed on admission and reviewed on a regular basis, ideally every month when the plan is evaluated by the staff. • The problem/need/ability sheet completed for each area of care must be more detailed, so that staff are given sufficient information to meet the needs of each person using the service. It is recognised by us that the staff have worked at the home for a number of years and know each person living in the home very well. However, a lot of information about people’s personal preferences and choices is stored mentally by the staff, and is not being put onto paper. We recommended that the manager carry out a monthly audit of the plans; to ensure the plans are up to date. Two areas of good practice within the care plans are: • The meticulous recording of professional visits, reasons for the visits and the outcomes, and • The communication sheets for relatives. The relatives spoken to have told us that the staff are extremely conscientious about letting them know how their relatives are doing and inform them immediately of anything that affects their wellbeing. People said that they have good access to their GP’s, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Comments from the people and relatives indicate they are satisfied with the level of medical support given to the people living at the home. One person said ‘we have only to tell the staff that we are not well and we are seen to immediately’. The staff weigh everyone on a regular basis and evidence in the plans show that dieticians are called out if the home has particular concerns about an individual. It was noted by us that there were no pressure sore risk assessments in the care plans we looked at, but the manager told us that these are in some of the plans where people had been recognised as at risk, but not in all. Information Prospect House DS0000070752.V361525.R01.S.doc Version 5.2 Page 13 given to us indicates that no one at the home has a pressure sore and there is a good relationship with the District Nurse team who provide staff with advice and help around this area of care. The manager assured us that she would update all the care plans to include risk assessments around pressure areas. Individuals who have dementia have good access to mental health team nurses and their GPs, who review their condition and the person’s medication on a regular basis. The care plans include risk assessments around challenging behaviours and have management plans in place. The medication policy for the home says that individuals can self-medicate if they want to and after a risk assessment has been completed and agreed. All of the people spoken to prefer to have staff administer their medication and the manager confirmed that at the moment there is no one in the home who self-medicates. Checks of the care plans show that there is a very basic self-medication risk assessment in place, but this must be improved to show the reasons for deciding if a person can self-medicate or not, include the date of the assessment and the signature of the person using the service or their representative. Good practice would be to include the views of person’s GP in this assessment. Checks of the medication records show that overall these are well maintained and kept up to date and the controlled drugs and register are monitored carefully, stored correctly and records are accurate. As a good practice measure we recommended that two staff sign next to transcribed (handwritten) medication instructions. This is to signify they have checked that the instructions contain the right medication name, strength of medication, route to be given, form of medication (tablets, liquid, cream etc.) and when it is to be administered. People and relative comments show they are very satisfied with the care and support offered by the staff. Chats with people using the service revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Individual comments were that ‘my relative is happy and well cared for’ and ‘staff are friendly and helpful’. Observation of the service showed there is good interaction between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives. Prospect House DS0000070752.V361525.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience Good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with choice and diversity in the meals and activities provided by the home. Individual wishes and needs are catered for and people have the option of when and how they participate in mealtimes. EVIDENCE: Activities at the home are mainly a low-key affair, with staff carrying out recreational activities on a daily basis. Information about forthcoming events is on display in the entrance to the lounges. Although there is not a formal written programme of events there is a staff record book, which shows that people are able to attend a number of events and that outside entertainers are booked every two months. The mobile library visits every six weeks and this provides reading books and audiotapes for people to enjoy. People told us that ‘there are enough things for me to do’, ‘I can join in when I want to’ and ‘I like to spend time on my own and the staff respect this’. Prospect House DS0000070752.V361525.R01.S.doc Version 5.2 Page 15 Information from people’s files indicates that there are a number of individuals who follow the Church of England faith. The manager said that there is a monthly communion service within the home and people could go to the local church services and religious celebrations as requested. One person who spoke to us enjoys regular visits from the local vicar. The home helps people celebrate all major Christian festivals such as Easter, Harvest Festival and Christmas. Discussion with the people living in the home indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly was a good relationship between all parties. Relatives and visitors to the home are very positive about the service and the staff. Comments made to us on the day of this visit showed a high level of satisfaction. Individuals said ‘there is a friendly and happy atmosphere amongst the people and staff’, ‘staff are patient, kind and polite to people and visitors’, ‘good atmosphere and my relative is kept involved and has a good rapport with the staff’. The manager said that there is no formal visitors policy for the service, but that this would be developed as soon as possible and put on display. The home acts positively to promote people’s independence and will offer individuals support to achieve this aim. One person who spoke to us looks after his/her own finances and they take pride in the fact they are still able to control their own affairs. Other people spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. People spoken to are satisfied that they can access their personal allowances when needed. There was no evidence of information about external agencies who can act in the interests of people using the service (e.g. advocates), within the home, other than a list of contact numbers in the back of the service user guide and some brief information in the manager’s office. It was discussed with the manager that it may be helpful to the people using the service and their representatives if more information such as leaflets were made available to them. It is recognised by us that the manager does have a good understanding about advocacy, but this information must be readily available to others. Information given to us indicates that the manager has attended a course on equality and diversity issues, but there is no evidence that staff have access to this course or others that will highlight the rights of individuals such as the Prospect House DS0000070752.V361525.R01.S.doc Version 5.2 Page 16 Data Protection Act 1998, Disability Discrimination Act and the Mental Capacity Act. The registered person must ensure that staff are able to promote and protect the rights of people using the service through up to date knowledge and awareness of current legislation. Comments from the people living in the home and their relatives are on the whole very positive about the meals and kitchen service provided. Individuals said ‘the dining room is very clean and the food is excellent’, ‘I love the meals and have a good appetite’ and ‘we get three good meals a day and the cooks are wonderful’. The lunchtime meals for the majority of the people were well presented and offered a good choice of food. Staff were organised when serving the meal and they told us that there are sufficient staff on duty to help people who need assistance with eating and drinking. The soft diets offered to four people did not look very appetising, as the food had been pureed together. It was recommended that the cooks consider a different presentation of the soft meals so they looked attractive and appealing in terms of texture, flavour and appearance. Discussion with the kitchen staff indicated that they both have their basic food hygiene certificates and that the food prepared is home made using fresh ingredients. Prospect House DS0000070752.V361525.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system with some evidence that people’s views are listened to and acted upon. EVIDENCE: Checks of the records in the home show that there have been no formal complaints received since the service was registered in October 2007, and that the manager deals with any niggles and grumbles on a daily basis. The home has a complaints policy and procedure that is found within the statement of purpose and service user guide. It is also on display within the home. People’s responses showed individuals have a clear understanding about how to make their views and opinions heard and those people spoken to said ‘the manager comes round every day to see us and will discuss any problems at this time’. Relatives are aware of the complaints procedure and are confident of using it if needed. Those who spoke to us said that the manager was efficient and effective in answering queries and they were satisfied with her actions. Prospect House DS0000070752.V361525.R01.S.doc Version 5.2 Page 18 The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of people’s money and financial affairs. The manager said she is booked to attend Safeguarding of Adults training for managers in September 2008 and that staff have been given Abuse and restraint training through the use of workbooks within the home. This training was done in 2006 and new staff completed it in 2007. The staff on duty displayed a good understanding of the safeguarding of adults procedure. They are confident about reporting any concerns and certain that any allegations would be followed up promptly and the correct action taken. The manager understands how to make a safeguarding referral to the appropriate authorities and has a copy of the local policies and procedures to follow in the event of an allegation of abuse being made. Prospect House DS0000070752.V361525.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of environment within the home is good, providing people with a comfortable and homely place to live. EVIDENCE: Since the new owners of the home took over the service in October 2007 they have put a lot of time and effort into refurbishing and redecorating the premises. People living in the home and their relatives told us how satisfied they are with the improved environment, and said they appreciated the hard work and effort that was taking place to make life more comfortable for those using the service. Prospect House DS0000070752.V361525.R01.S.doc Version 5.2 Page 20 Currently the home is waiting for the registration of three additional bedrooms with en-suites, which will take the occupancy levels from 15 to 18 placements. A further extension to the service is planned for 2009 and this will see four more rooms made available, a new laundry facility, refurbished kitchen area, a treatment room and new bathroom/shower room provided for the people living in the home. Walking around the home there is evidence of decorating going on throughout the building, where necessary rooms are being upgraded with new windows, lights, furniture and carpets. In the corridors there are new handrails being fitted and downstairs a new carpet has been laid. Discussion with the owners, who also manage the service, indicates there is a rolling programme for replacement of smaller items of equipment such as commodes. The dining room is bright and comfortable, with new dining tables and chairs making eating a more enjoyable experience for people using the service. Both lounges have been redecorated, with new carpets fitted and a selection of easy chairs provided. Areas that are next on the list for improvements are the two bathrooms and the laundry room, although these may wait until the new extension starts in 2009. The laundry room is located outside of the main premises and is accessed from the front of the building. The owners have recognised that the laundry is too small and cramped for long-term use and that the fabric of the laundry building is in need of refurbishment. A new facility is planned for 2009 when an extension to the main home is to be built. At present the ceiling, walls and floor of the laundry room need attention. None are impermeable or readily cleanable, although the floor does have a Linoleum covering. Infection control policies and procedures are put into practice within the home, and communal bathrooms have paper towel and hand wash dispensers in place. Staff have received infection control training and use personal protective equipment (gloves and aprons) when giving care. Prospect House DS0000070752.V361525.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff morale is high resulting in an enthusiastic workforce that works positively with people to improve their whole quality of life. EVIDENCE: Comments from the people using the service, relatives and staff are on the whole very positive about the staffing levels within the home, and individuals feel that there is a high standard of care being given to the people living in the home. At the time of this visit there were 15 people living in the home and staffing levels were as follows: Morning 8am – 3pm Two care assistants plus the manager and service manager (Monday to Friday). At the weekend there are three care assistants Afternoon 3pm – 8pm one care assistant 3pm – 10pm two care assistants Night 10pm – 8am two care assistants. Prospect House DS0000070752.V361525.R01.S.doc Version 5.2 Page 22 Information from the annual quality assurance assessment about the number of staffing hours provided, and information gathered during the visit about the dependency levels of the people using the service, was used with the Residential Staffing Forum Guidance and showed that the home is meeting the minimum hours asked for in the recommended guidelines. 82 of care staff at the home have an NVQ 2 or above in care and four more staff are in the process of completing this training. The home has a mandatory staff training programme in place and information from the staff training matrix indicates that the majority of the staff are up to date with this or are booked onto refresher training for 2008. The manager is aware of the need to expand the range of training to include sessions on conditions relating to old age, dementia and challenging behaviour. At the time of this visit no new staff have been employed in the past six months since the new service started, but the home has a recruitment policy and procedure that the manager understands and will use when taking on new members of staff in the future. Checks of four staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and are satisfactory. Prospect House DS0000070752.V361525.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, 33, 35 and 38. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is satisfactory overall and the home regularly reviews aspects of its performance through a good programme of audits and consultations, which includes seeking the views of people using the service, staff and relatives. EVIDENCE: Mrs Sarah Slack is the new owner and manager of the service. She is registered with the Commission for Social Care Inspection and has completed her Registered Managers Award and NVQ 4 in Care. Sarah has worked at Prospect House as the registered manager (for the previous owners) since Prospect House DS0000070752.V361525.R01.S.doc Version 5.2 Page 24 2006, and before this she worked her way up from a care assistant, senior care assistant and deputy manager at other care homes. Sarah has attended a number of training sessions over the past year to ensure her skills and knowledge are up to date. She is aware of the improvements needed to the service and has planned how these are to be achieved. Staff told us they feel supported by the manager and there is an open door policy so they can go to her at any time if they need advice or help. Comments from the people using the service and their relatives are also positive about the management approach within the home saying ‘we find Sarah to be friendly and open to suggestions of how to improve the service. She listens if you have any concerns and takes action to sort things out’. The home has just recently achieved Investors in People status and was awarded the local Council’s Quality award part 1 (QDS) in October 2007. The service is now working towards QDS part 2. The manager is completing monthly audits of the service and feedback is sought from the people living in the home and relatives through regular satisfaction questionnaires. The service manager is looking to produce a development report in 2008 as part of this process; to highlight where the service is going and/or indicate how the management team is addressing any shortfalls in the service. The manager said she is going to carry out 1-1 talks with the people in the home, and the issues discussed and any action taken will be recorded in a diary. The manager said this is a more effective way of getting peoples views than holding meetings, as people in the home are more open to discussion on an individual basis than as a group. People spoken to in the home said they felt that some changes are taking place due to their views being expressed to the management. These include changes to personal care and menus. Checks of the financial records showed that people are able to have personal allowance accounts in the home. These records are hand written and detail the transactions undertaken and the money held for each person, the manager updates these each week. Information from the manager indicates that the majority of people have a family member or representative who looks after their monies and these individuals make sure the personal allowances are sent/brought into the home. Two accounts were checked and found to be up to date and accurate at this visit. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Prospect House DS0000070752.V361525.R01.S.doc Version 5.2 Page 25 Staff have received training in safe working practices and risk assessments are in place for fire, smoking, bed rails and daily activities of living. Prospect House DS0000070752.V361525.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 2 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Prospect House DS0000070752.V361525.R01.S.doc Version 5.2 Page 27 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 OP3 Regulation 14 Requirement The registered person must ensure that a robust needs assessment is completed for all prospective self-funding individuals and that people using the service or their representatives receive formal written confirmation that the home, taking into consideration the assessment, is able to meet their needs. This must be given to people prior to their admission. This is so people can be assured their needs can be met by the service before committing themselves to placement within the home. The registered person must ensure the individual care plans are detailed and outline the action staff must take to meet a person’s needs. The plans must also include risk assessments around moving and handling, falls, pressure sores and nutrition. This will make sure that staff Prospect House DS0000070752.V361525.R01.S.doc Version 5.2 Page 28 Timescale for action 01/07/08 2. OP7 15 01/07/08 3. OP26 13(3) have access to information that will help them to provide person centred care and support, and protect people from risk of harm. The registered person must 01/07/08 ensure the laundry floor is impermeable and wall finishes are readily cleanable. This will help prevent the spread of infection and protect people’s health and wellbeing. 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 OP1 Good Practice Recommendations The registered person should consider providing the statement of purpose and service user guide in different formats, which will meet the capacity of the people using the service. The manager should carry out regular audits of the care plans; to ensure staff are completing these in full and that risk assessments are reviewed on a monthly basis. The manager should ensure that pressure sore risk assessments are completed for each person on admission and reviewed on a continuing basis. The registered person should make sure that the selfmedication risk assessment is improved so that it offers a robust and detailed explanation of why or why not a person can self-medicate. This assessment should involve the person concerned, their representative and the person’s GP. The manager should make sure that where staff are hand writing medication onto the sheets (transcribing), there should be two staff signing the entry to indicate they have both witnessed that the information on the sheet (name of medication, strength and administration methods) is correct. The registered person should develop a visitor’s policy for the home, which can be given to relatives and friends of DS0000070752.V361525.R01.S.doc Version 5.2 Page 29 2. 3. 4. OP7 OP8 OP9 5. OP9 6. OP13 Prospect House 7. 8. OP14 OP14 9. OP15 the people who are on the point of admission to the service. The registered person must ensure that people using the service and their representatives have access to information about external agencies. The manager should enable staff to access training around current legislation in equality, diversity and disability matters, to improve the staffs knowledge and understanding of a person’s individual rights within the care home and out in the community. The registered person should ensure that food, including liquefied meals, is presented in a manner, which is attractive and appealing in terms of texture, flavour and appearance, in order to maintain appetite and nutrition. Prospect House DS0000070752.V361525.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Prospect House DS0000070752.V361525.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. 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