Care Home: Puttenhoe

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What the care home does well The home had maintained good standards of care delivery and good working relations with the service users` and their family members, staffs and relevant professionals. This had been useful for appropriate care delivery and in meeting the service users` assessed needs. One relative commented that "I visit here every day to see my wife and am always made very welcome". One person using the service commented that "I like the food, we get a choice and other foods are always available", "I like the ice cream". Menus are diverse and nutritious. The service received a recent Environmental Health inspection where the findings were excellent. The environmental health inspector commented, "Again an excellent standard seen during the inspection, regarding cleaning, structure and food safety management as a whole". Staff were observed to interact well with all people using the service and respecting and dignifying their individual needs. The service in general is very homely with personal touches having been made to make sure that the environment reflects their home as much as possible. Medication is well managed to ensure that people health and social care needs are being met at all times. In the services recent customer satisfaction survey the service received 91% of very good / excellent of overall satisfaction who were asked to judge the service on the staff, the building, the grounds, their rooms, being treated like an individual, communal rooms, the food and the activities. What has improved since the last inspection? The service continuously strives to make and continues to make improvements, this includes improvements in medication practices and management, areas of the environment have been improved, including replacement windows, ski mats and automatic fire door guards have recently been fitted The new manager is now successfully registered with the Commission for Social Care Inspection.The provision of training has improved with a training plan in place for the forth coming year. The Quest care planning programme is fully operational ensuing that all social and health acre needs are being met. What the care home could do better: The deputy manager identified that continued work is required to ensure that supervision sessions are maintained and recorded by all. A system of managing this has been implemented to support in its continued increase for compliance. The service should ensure that the inspection report is on display. The fire risk assessment should be updated. CARE HOMES FOR OLDER PEOPLE Puttenhoe 180 Putnoe Street Bedford Bedfordshire MK41 8HQ Lead Inspector Louise Bushell Unannounced Inspection 24th June 2008 10:00 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 Puttenhoe DS0000014949.V367058.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. Puttenhoe DS0000014949.V367058.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Puttenhoe Address 180 Putnoe Street Bedford Bedfordshire MK41 8HQ 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) 01234 261396 01234 345347 BUPA Care Homes (Bedfordshire) Ltd Linda Cornfoot Care Home 29 Category(ies) of Dementia - over 65 years of age (29), Old age, registration, with number not falling within any other category (29), of places Physical disability over 65 years of age (29) Puttenhoe DS0000014949.V367058.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th June 2007 Brief Description of the Service: Puttenhoe was a purpose built care home for 29 service users. The service was situated in the Puttenhoe area of Bedford, within walking distance of shops and services. The service offers accommodation in en-suite bedrooms. The practical division of the service into three working units made the home more personalised and increased respect for service users individuality. The service accommodated people who have physical disabilities, dementia, or the frailty of old age. The service is able to accommodate respite stays. Some service users are admitted straight from hospital or from their own homes. The service was visited by HM the Queen in 1976 and had this fact displayed in their main foyer. The fee range for the service is £352.00 - £602.00 dependant on assessed needs. This cost excludes all toiletries, personal items, hairdressing, chiropody and newspapers. Puttenhoe DS0000014949.V367058.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Standards identified as ‘key’ standards and highlighted through the report were inspected. In addition to the key standards a number of other standards were inspected to assess the services ability as part of case tracking people that use the service from the admission stage to placement stage. The key standards are those considered by the Commission to have a particular impact on outcomes for residents. Inspection of the standards was achieved through review of existing evidence, the previous annual quality assurance assessment, pre-inspection planning, an unannounced inspection visit to the home, any information sent to us from the service and other professionals, collating information received in person from relatives and the people who use the service, and drawing together all of the evidence gathered. The service has received one formal written complaint since the last inspection. The pre-inspection planning was carried out over the period of a day and involved reviewing the service history, which details all contact and correspondence with the home and previous inspection reports. The last full inspection took place on the 15th June 2007. This unannounced inspection visit was carried out by one inspector and covered the morning and afternoon of a weekday. The inspection was carried out by ‘case tracking’, which involves selecting samples of residents’ records and tracking their care and experiences. Observations of the homes routines and care provided were made and views on the care provided were sought from people who use the service, visitors and staff. Additionally questionnaires were sent to a random selection of people to ascertain their views. Responses had been received from seven staff. In addition to this the views of a visitor, staff and people that use the service were obtained on the day of the inspection. The management of medication was checked through reviewing prescribed medication for a sample of people as part of case tracking A sample of staff files were reviewed to check the adequacy of the recruitment procedures in protecting people who use the service. Puttenhoe DS0000014949.V367058.R01.S.doc Version 5.2 Page 6 Communal areas and a sample of bedrooms were viewed and observations were made of people’s general well being, daily routines and interactions between staff and people who use the service. Verbal feedback was given to the deputy manager and a manager of another service. What the service does well: What has improved since the last inspection? The service continuously strives to make and continues to make improvements, this includes improvements in medication practices and management, areas of the environment have been improved, including replacement windows, ski mats and automatic fire door guards have recently been fitted The new manager is now successfully registered with the Commission for Social Care Inspection. Puttenhoe DS0000014949.V367058.R01.S.doc Version 5.2 Page 7 The provision of training has improved with a training plan in place for the forth coming year. The Quest care planning programme is fully operational ensuing that all social and health acre needs are being met. 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. Puttenhoe DS0000014949.V367058.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Puttenhoe DS0000014949.V367058.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service had made appropriate arrangements for the assessment of needs of the people who use the service and they and were aware of the care and services they would receive from the home prior to their admission. EVIDENCE: The service has developed a statement of purpose, which sets out the aims and objectives of the service, and includes a guide, which provides basic information about the service and the specialist care that is available. The guide details what the prospective people using the service can expect and gives an account of the specialist services provided, quality of the accommodation, qualifications and experience of staff and how to make a complaint. Puttenhoe DS0000014949.V367058.R01.S.doc Version 5.2 Page 10 All people who use the service are given a copy of the guide. The inspection report was not on display at the service. One visitor to the service commented that, “We had all the information we needed to make the choice and the home is very welcoming and the staff are very kind, my wife is very settled”. Admissions are not made to the service until a full needs assessment has been undertaken. A senior person always completes the assessment prior to admission to the service. A number of pre assessments were seen and completed well. The service also completes a secondary assessment on admission to review any changes in need; this information is used to inform the personal plan. The assessment explored areas of diversity including preferences, religious and cultural needs, involvement from family, partners and advocates, race and disability. It was evident that the service strives to seek the information and assessment through care management arrangements, prior to admission. The service has the capacity to support people who use the service and respond to diverse needs that may have been identified during the assessment process. All relatives and people who use the service confirmed that they had enough information about the service. Puttenhoe DS0000014949.V367058.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has suitable care plans and arrangements in place for the receipt, storage, administration and disposal of medication, meeting all people’s medical, health and social care needs. EVIDENCE: A total of three care plans were case tracked fully, it was established that people who use the service receive personal and healthcare support using a person centred approach. Personal healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each persons care plan. The care plan provides clear information and a comprehensive guide for staff to know how to support the person. The care plan is generated from the pre admission assessment and includes guidelines, risk assessments for the management of falls, manual handling assessments and self medication Puttenhoe DS0000014949.V367058.R01.S.doc Version 5.2 Page 12 risk assessments and care plans. Where a short term need had been identified through the review of assessments a short term care plan was in place to support the person through the management of the particular issue. The falls risk assessment had been reviewed, including the care plan review. The accident was recorded in the accident book and the Commission had been notified correctly. It was observed that personal support is responsive and tailored to meet the individual choices, needs and preferences. Staff were observed to respect the privacy and dignity of all people. A good practice was observed by a member of staff positively engaging with a number of people who use the service, singing, reading news papers and relaxing in the court yard garden area. It was pleasing to see a number of people engaging and being stimulated by the positive engagement. The service listens and responds to individual choices and decisions about who delivers their personal care. The care plan also details another additional personal preferences, this included food types, night time preferences, activities, religion, personal appearance, personal time and how the person would like to be addressed. The people who use the service have access to healthcare and remedial services. The health care needs of those residing at the service who are unable to leave the service are managed by visits from local health care services. The service is not registered as a nursing home and therefore has vital links with the district nursing team. From the information gathered it is clear that good relationships are held. Clear evidence was seen in the care plans of specialist health care support services visiting the service and in addition to the care plan there were detailed notes made by the specialist visiting the service for example the District Nursing team and General Practitioners. A number of comments were received directly from people that use the service, their relatives and friends. One person commented that, “I like it here, the staff are kind, we get treated well and the ice cream is always tasty”. One relative commented that “I have no concerns about the home, if I did I know who I would make a complaint to, its very difficult sometimes to look after the people here but they really do try they are very responsive”. The service has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records are fully completed, contain required entries, and are signed by appropriate staff. The management of controlled drugs is effective with records being accurate and stock balances being correct. A total of four people’s medication was case tracked in order to ensure compliance. Fridge temperatures were being recorded where medication was stored. Room temperatures were not being recorded. Dates of opening was recorded on the majority of the bottles and boxes observed. Ordering and returns documentation was up to date and accurate. The service works with individuals regarding any refusal to take medication. The people using the service are given the support they need to manage their medication. If individuals prefer or where they lack capacity, care Puttenhoe DS0000014949.V367058.R01.S.doc Version 5.2 Page 13 staff can manage medication on their behalf. This is assessed and detailed in the care plan. The service has a good record of compliance with the receipt, administration, safekeeping, and disposal of controlled drugs. The service has recently transferred to using Boots as the provider of the medication. Feedback from staff determined that this appears to be a successful transition. Staff have completed and passed an appropriate medication course. An assessment has been carried out to ensure each member of staff is competent to handle, record and administer medication properly. The majority of care plans tracked contained suitable and sensitive plans and arrangements for the management of end of life. Puttenhoe DS0000014949.V367058.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that they will be able to be involved in meaningful activities of their choice reflecting were ever possible their personal tastes and preferences. EVIDENCE: People who use the service have the opportunity to develop and maintain important personal and family relationships. Feedback from one relative on the day of the inspection confirmed that relatives / representatives are always welcome into the service. One relative stated that “I visit here every day to see my wife and am always made very welcome”. On the day of the inspection a number of visitors were seen in the building visiting their relatives / friend / partners. The service respects the human rights of people using the service with fairness, equality, dignity, respect and autonomy underpinning the care and support being provided. This was indirectly observed through the practices of Puttenhoe DS0000014949.V367058.R01.S.doc Version 5.2 Page 15 the staff on duty. A number of people who use the service were seen to be very relaxed and calm within their own environment and engaging with staff in an equal manner. People using the service are involved in some meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. The care plan details life maps for each individual which supports the service in providing meaningful activities of their choice. There is also reference in the care plan to the preferences of each individual for activities and previous interests. The people using the service can access and enjoy the opportunities available in their local community, such as a library services, the local pub, and local leisure facilities. Trips were arranged and planning taking place. The manager discussed a number of local trips that were being arranged for the people using the service. The service is also providing a Caribbean Cruise event, where by each day of the week the people can experience the different food types of the places visited. Each of the smaller living areas have a television and DVD player including a music system. A limited amount of activity materials is available direct on the unit. There is also a large communal activity room, which people who use the service can access. It was observed in one of the lounge seating areas that a radio programme was playing not suited to the preferences by the people using the service – this was brought to the attention of the deputy manager. The deputy manager confirmed that the service is aiming to further develop the provision and variety of activities being made available. The service does not currently have an activities coordinator working. The manager stated that the staff are facilitating activities in the interim. The vacant post is actively being recruited. The people who use the service stated that they enjoy the activities provided. Through observation a number of activities were seen to be available. Activity records were not fully up to date to reflect the activities that were occurring. The menu is varied with a number of choices including a healthy option. It includes a variety of dishes that encourage individuals to try new and sometimes unfamiliar food. The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals. Menu’s were on display. The food provided appeared appetising and well presented. Comments received included; “I like the food, we get a choice and other foods are always available”, “I like the ice cream”. Snacks are available 24 hours a day and the kitchenette areas were seen to be well stocked. Puttenhoe DS0000014949.V367058.R01.S.doc Version 5.2 Page 16 The care staff are sensitive to the needs of those people who find it difficult to eat and give assistance with feeding. They are aware of the importance of feeding at the pace of the resident, making them feel comfortable and unhurried. Puttenhoe DS0000014949.V367058.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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a robust complaints procedure in place, good staff awareness and attitude towards safeguarding issues so people who use the service are safe and protected. EVIDENCE: The service has an open culture that allows people who use the service to express their views and concerns in a safe and understanding environment. Complaints leaflets were on display at the service. People who use the service have commented that they are happy with the service provided; feel safe and well cared for. A number of comments received determined that people who use the service and relatives and friends are aware of what to do if they have any concerns. A new verbal complaints log is now in place and records appeared to be effective. One person using the service commented “I don’t have any worries, its good here; the staff are kind and gentle”. It was evident that verbal complaints are also well managed, resolved quickly in the best interest of the person using the service. Puttenhoe DS0000014949.V367058.R01.S.doc Version 5.2 Page 18 The service has a complaints procedure that is clearly written and easy to understand. It is available in a number of formats such as different languages on request. The complaints procedure is supplied to everyone living at the service and is displayed in a number of areas within the service. There is a detailed record of all complaints and compliments made and received. The service has received one written complaints since the last inspection. Feedback from a relative determined that if they have any concerns that the staff are always attentive. Not all the investigation findings were found to be held on site in the complaints file. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff commented that they have received training in safeguarding and felt confident in reporting any issues as they occurred. Staff had a clear understanding of the Whistle-blowing policy and when the use of this may be put into practice. The service understands the procedures for safeguarding adults and attends meetings or provides information to external agencies when requested. Puttenhoe DS0000014949.V367058.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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is pleasant, clean and comfortable, ensuring that the people who use the service are comfortable and relaxed within their environment. EVIDENCE: The service provides a physical environment that is appropriate to the specific needs of the people who live there. The environment provides a homely feel with specialist aids and equipment to meet needs as required. The service is a pleasant place to live. The bedrooms and communal room provide a personal and homely feel. Decoration throughout the building is tired with areas worn. The Deputy manager stated that there is a rolling programme of redecoration in place. The layout of the building enables people to move freely. Puttenhoe DS0000014949.V367058.R01.S.doc Version 5.2 Page 20 The people who use the service appear to like the environment, were relaxed, comfortable, and settled. Each of the living areas has a small courtyard garden, which is secure, and people who use the service can use this space with support. The garden areas have flowers and tables and chairs, promoting independence and a homely feel. The people who use the service are encouraged to personalise their bedrooms. All the home’s fixtures and fittings meet the needs of individuals and can be changed if their needs change. The building design supports the needs of people with Dementia. The manager discussed the improvements that he is planning on making to the environment and this included a phased redecoration programme, some refurbishment, the introduction of memory box’s and themes in the units encouraging reminiscence. The dining rooms are laid out to encourage communal dining with a calm relaxed atmosphere. The environment promotes the privacy, dignity and autonomy of residents. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. The service did not have automatic door closures on the bedroom doors or the smoking room. The deputy manager stated that the closures had been delivered to the service and were awaiting fixing. Following the inspection contact was made to report that these had been fitted. The fire safety risk assessment held on site did not contain all of the updated information for the service. The home has an infection control policy. The service is clean, well lit and smells fresh. A number of people using the service commented that they liked living at the service and the decoration was “nice”. The deputy manager stated that a number of new windows had recently been replaced and fitted, including new fire safety equipment such as new ski mats to further support people evacuating the building in the event of a fire. There was restricted access to high risk areas such as the main kitchen and the laundry areas to reduce the risk of cross infection. Puttenhoe DS0000014949.V367058.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The skill mix, numbers of staff and recruitment processes of the service are sufficient and robust, ensuring that the wellbeing of the people using the service is maintained at all times. EVIDENCE: Feedback from the people who use the service shows that they have confidence in the staff who care for them. Staff Rotas were seen and displayed sufficient numbers of staff on duty to meet the needs of the people using the service. A deputy manager, team leaders and the manager was usually on shift in addition to the care staff. This enables staffing levels to be maintained for the safety of all and that record keeping was completed and monitored as required. A number of staff commented that they would like more staff to be on duty to ensure that activities and individual needs are being met. Staff members are able to undertake external qualifications beyond the basic requirements. One staff member commented, “we are provided with lots of training here”. The managers encourage and enable this and recognise the benefits of a skilled, trained workforce. Accurate job descriptions and Puttenhoe DS0000014949.V367058.R01.S.doc Version 5.2 Page 22 specifications clearly define the roles and responsibilities of staff. People who use the service report that staff working with them are very skilled in their role and are consistently able to meet their needs. There is a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the service recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. Four staff files were audited and were seen to contain all the required documentation. All staff surveyed commented on the positive team culture of the service and felt that following recent recruitment. Staff confirmed that the service was clear about what was involved at all stages and was robust in following its procedure. There are clear contingency plans to cover for vacancies and sickness and the use of agency staff is limited. Once recruited staff receive induction and training. The induction process, known as “personal best” is a process where the staff member is trained and mentored through a complete programme. The programme is then signed at the end of each stage. Following discussions with a number of staff and the manager it was determined that this process was being reintroduced to the service to ensure that all staff had fully received this and that evidence was held on their file. The service has scheduled specific mandatory training for the year and is conducted by qualified trainers within the group. Following discussion with the staff and manager, it was determined that the analysis of individuals needs were being added to a central matrix and personal training plans. Comments were received from staff regarding the Dementia training that is made available to staff. BUPA offers all staff an initial awareness training into supporting people with Dementia, this is later backed up through the attendance on the Dementia course. The completed Annual Quality Assurance document determines that the service is providing training to the staff ensuring that they can meet the needs of the people using the service. Staff confirmed that staff meetings occur and a number of comments received on the staff surveys determined that the staff feel fully involved and updated. The mix of staff is suitable to meet the cultural needs and mix of people that use the service. Puttenhoe DS0000014949.V367058.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, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the services ensures that the people who use the service are kept safe. EVIDENCE: The Registered Manager has the required qualifications and experience and is competent to run the home. The Registered Manager and the deputy managers have a clear understanding of the key principles and focus of the service, based on organisational values and priorities. They work to continuously improve the service. Feedback received on the day of the inspection from staff Puttenhoe DS0000014949.V367058.R01.S.doc Version 5.2 Page 24 and as part of the feedback questionnaires received determines that the management are effective and approachable. With the introduction of the new care planning format and training around its implementation, there is a focus on person centred thinking, with the people who use the service becoming increasingly more involved. The Registered Manager and deputy managers lead and support a stable staff team who have been recruited and trained to satisfactory levels. The manager is aware of the continued need to ensure that enough staff hold a National Vocational Qualification In Care Level 2. The managers promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. The service has sound policies and procedures, which are corporately and internally reviewed and updated, in line with current thinking and practice. The manager ensures that staff follow the policies and procedures of the home. The staff team are positive in translating policy into practice and showed good knowledge of care principles, health and safety and safeguarding issues. This includes the management of finances within the service, where systems were directly observed to be transparent and open, with detailed records being maintained at all times. There was some evidence on staff records that staff have supervision but this is not always carried out on a one to one basis where staff have the opportunity to discuss their personal development. The deputy manager confirmed that continued development and progress is being made with training and supervision and it was seen that progress had been made. Staff meetings take place regularly and minutes of the meetings are available. The home works to a clear health and safety policy. Safeguarding is given high priority and the home provides a range of policies and guidance to underpin good practice. In house training is scheduled for safeguarding. Staff showed a sound working knowledge of action to take in such an event. A training matrix has been developed. Individual training plans are being devised along with the completion and introduction of “personal best”. Through discussions with the management team and it was determined that priority is given to ensure that all staff are in receipt of adequate training, including in house refresher courses and a full complete induction programme. Individual training plans are being developed and will be used, once complete to review the annual performance of staff in their appraisal. Puttenhoe DS0000014949.V367058.R01.S.doc Version 5.2 Page 25 The fire safety risk assessment held on site did not contain all of the updated information for the service. The automatic door closures were to be fitted to all internal bedroom doors and the smoking room. Contact with the service has determined that these have now been fitted. A recent Environmental Health inspection occurred and the finding were “again an excellent standards seen during the inspection, regarding cleaning, structure and food safety management as a whole”. Puttenhoe DS0000014949.V367058.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 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 3 3 Puttenhoe DS0000014949.V367058.R01.S.doc Version 5.2 Page 27 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP9 OP9 OP12 OP36 OP27 Good Practice Recommendations Dates of opening medication should be recorded on all bottles and box’s of medication to ensure medication administered is within expiry dates. Daily room temperatures should be taken of the storage site of medicines to ensure medication is stored at the correct temperature. Records of activity engagement should be recorded to accurately reflect the involvement of the person using the service. Supervisions should occur at least six times a year on a one to one basis with records maintained to enable staff to raise issues. The provision of staff should be reviewed periodically to ensure that the staffing levels accurately reflect the changing needs of the people who use the service. Puttenhoe DS0000014949.V367058.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge CB21 5XE 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. 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