Care Home: Quinton House

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What the care home does well What has improved since the last inspection? What the care home could do better: The manager who had been in post since 2006 has yet to apply to CSCI to be registered. This was despite a recommendation being made at the previousinspection for her to do so. The providers must ensure they have a registered manager for the home. The manager had intended to complete her NVQ Level 4 accreditation by November 2007 but had been unable to do so. She was now working to a future deadline. Although some information had been gathered regarding residents` views about the service, it remained for a meaningful quality assurance system to be developed, as required at the previous inspection. Though some activities were organised by the home for residents the management could consult with residents about these as mixed views were reported by residents on this topic. CARE HOMES FOR OLDER PEOPLE Quinton House Harvey Street Watton Thetford Norfolk IP25 6EH Lead Inspector Mrs Ginette Amis Unannounced Inspection 30th April 2008 11:00 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 Quinton House DS0000027480.V364172.R02.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. Quinton House DS0000027480.V364172.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Quinton House Address Harvey Street Watton Thetford Norfolk IP25 6EH 01953 882101 01953 882101 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) Quinton Care Homes Limited Manager post vacant Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Quinton House DS0000027480.V364172.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th May 2007 Brief Description of the Service: Quinton House is registered care home providing residential care for twentythree people. At the time of this inspection, an application to alter the registration categories under which the care home might operate was in the process of being considered by CSCI. Quinton House is a classical Georgian building with a modern extension. There are 23 single rooms, 15 of which have en suite facilities. There is a car park at the front of the home. The home is situated in a residential street in the market town of Watton in Norfolk, and is within walking distance of the main street, which has shops and other facilities. The home receives its medical nursing, and other professional services via the local Health Centre. Fees £320 - £390 per week. Quinton House DS0000027480.V364172.R02.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 two Stars. This means that people who use this service experience good quality outcomes. At the time of this inspection, Quinton House was undergoing a considerable change. The providers were in the process of applying to the Commission for Social Care Inspection (CSCI) Registration Unit for changes in use of the premises and alteration to the Registration Categories and Numbers of people it was planned would in future be provided with a service. The furtherance of these plans involved physical changes being made to the premises, with a view to its division into two separate units to be known as Quinton and Cardinal. Quinton would continue to provide permanent residential care to 10 older people and to 1 older person in need of short stay services. These services would be confined to the existing ground floor accommodation. The Upper 2 floors and a portion of the ground floor were being converted into short stay accommodation for a possible maximum of 8 people with Learning Difficulties. Given that the application for a change in use remained at a preliminary stage at the time of this inspection, only those parts of the care home that remained available to current residents were inspected, and only those policies and practices affecting those residents were taken into account. Although a tour of the newly appointed areas awaiting registration was made, any opinions passed as to the value of work already undertaken should not be construed as contributing to or affecting the pending outcome of the registration application. Although the alterations underway continued to affect that portion of the building which current residents would have enduring access to, it was possible to see how these residents would in the longer term benefit from the improvements in progress. All but one of the 10 residents was happy and positive about these changes. Members of the staff team were likewise pleased and relieved that Quinton House was being renovated and improved on. In the course of the inspection, the manager and head of care were helpful in providing as much information as they could about the home, its’ current practices and long-term aims and objectives. All members of the staff team met with were pleasant and welcoming. Four residents were interviewed in private and others were chatted with informally. Three residents had returned survey forms to CSCI. By far the majority of views expressed were positive about the service. A number of builders were on site during the day and while there was some obvious disruption it could be seen that efforts had been made to keep this to a minimum and residents themselves seemed largely unaffected by what was Quinton House DS0000027480.V364172.R02.S.doc Version 5.2 Page 6 taking place. Those parts of the care home residents continued to have use of, which included their private accommodation, were warm, clean and tidy and free from any offensive odours of any kind. What the service does well: What has improved since the last inspection? What they could do better: The manager who had been in post since 2006 has yet to apply to CSCI to be registered. This was despite a recommendation being made at the previous Quinton House DS0000027480.V364172.R02.S.doc Version 5.2 Page 7 inspection for her to do so. The providers must ensure they have a registered manager for the home. The manager had intended to complete her NVQ Level 4 accreditation by November 2007 but had been unable to do so. She was now working to a future deadline. Although some information had been gathered regarding residents’ views about the service, it remained for a meaningful quality assurance system to be developed, as required at the previous inspection. Though some activities were organised by the home for residents the management could consult with residents about these as mixed views were reported by residents on this topic. 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. Quinton House DS0000027480.V364172.R02.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 Quinton House DS0000027480.V364172.R02.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 and 6. Quality in this outcome area is good. Prospective residents could be confident admission would only be agreed on if the care home was sure of its’ ability to meet these needs. Residents were able to gain sufficient experience and information about the home prior to forming a decision to live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In light of the changes in progress at Quinton House at the time of this inspection, we did not examine the existing statement of purpose or service user guide as these were no longer relevant. The manager stated that new documents that would explain the alterations in registration category and what types of services would be available were in the process of being compiled. It was evident how, since the last inspection, considerable work had been undertaken updating the care home’s other policies and procedures to ensure Quinton House DS0000027480.V364172.R02.S.doc Version 5.2 Page 10 these were appropriate for use. We recommended that the new service user guide should be made available as soon as possible. There were 10 older people in permanent residence at Quinton House. The files of 6 people were examined including that of one resident who had originally come to the care home for a short stay but had reached a decision to live there permanently. All 5 of the other residents had been living at the care home for a considerable time. All 6 files contained evidence that assessment of a wide range of needs had, for each individual, been undertaken. The manager described the procedures involved whenever a person was considering coming to stay at the care home. This invariably involved her visiting that person in their own home or in hospital to determine whether the care home could appropriately meet their needs. There had been 20 short stay admissions resulting from social services’ referrals. Four of these had been emergency referrals from Norfolk County Council Social Services that had taken place over the Christmas holiday period. Others were people who took regular breaks at the home. The manager related how, since the providers took their decision to limit Quinton House to just 10 permanent places for older people and partly as a consequence to the services the home had provided over the Christmas holiday, Quinton House now had a small waiting list of people being referred to them by NCC social workers. Of the 3 residents who returned CSCI comment cards to us, all had received a contract from the care home and said they had received sufficient information about the home prior to being admitted there. Quinton House DS0000027480.V364172.R02.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. Quality in this outcome area is good. Improvements had been effected to the way care needs were identified and to daily working practices that helped to ensure residents’ safety, health and welfare were safeguarded and their satisfaction with the service promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The files of 6 residents were examined to see how plans to meet their care needs had been formulated. It was evident that a full range of personal and health care needs had been assessed, including some social, emotional and recreational needs, and that these assessments were periodically being reviewed. Files contained a considerable quantity of information about each resident. In some cases an information sheet written in the first person and giving some idea of the resident’s background, likes and dislikes was included in their file. Quinton House DS0000027480.V364172.R02.S.doc Version 5.2 Page 12 In addition, daily record folders had been introduced for each resident and we found that these were well maintained. However, whilst accepting how, in a wide range of respects, files were informative as to residents’ current needs, they appeared unwieldy and difficult to navigate. There was insufficient evidence that residents had participated in the formulation of any overarching plan designed to show how needs would be met. We felt that anyone coming to work at the care home would find it difficult to gain an impression as to the residents’ general needs and preferences because of the volume of information they would need to first read through and digest. It was noted none of the residents had signed any part of their file to indicate their agreement with the content. When discussing this the manager related that her line manager who had joined the organisation at the end of 2007 had recognised the need for care plans to be more concise and user friendly and was in the process of producing them in a new format. Taking account of the overall improvements to documentation, we accepted this was the case although evidence of this work in progress was unavailable for inspection. At the time of this inspection there was one resident being cared for in bed. We found that the requirement made at the previous inspection for fluid intake and turning charts to be put in place and used to record actions was being met. Records in this respect had been well maintained and were up to date. The resident in question indicated they were comfortable and felt well cared for. We examined the way in which medication was stored, administered and records relating to this maintained. As was noted at the previous inspection, we found medication to be carefully managed. All those members of staff who had responsibility for administering medication had been well trained to do so, having recently undertaken advanced refresher courses. Medication was appropriately and securely stored with facilities in place for storing controlled drugs and medication requiring refrigeration. Medication administration records were up to date and properly maintained and bore photographs of the resident concerned together with any incidental information about their medication and its’ use. One resident spoken with was in receipt of regular attention from the district nurses and described how her needs were monitored and how well members of staff had responded to the nurse’s instructions. This had helped progress and contributed to the healing process for the resident. Following a recommendation made at the last inspection, the manager had accessed the assistance of a ‘Falls Advisor’ to help a resident who was prone to falls. Advise with the maintenance of continence was also available through the local NHS health care centre services. Quinton House DS0000027480.V364172.R02.S.doc Version 5.2 Page 13 Residents spoken with were particularly positive about the quality of the care they received at the home, describing staff as kind and caring and very helpful in every way. One resident said, “You just couldn’t wish for a more caring bunch of girls – they do everything they can to make sure we’re comfortable and well cared for.” This was a view others repeated on several occasions during conversation. Observing interactions between residents and staff it was evident that staff knew their residents very well, understood their needs and were on close but respectful terms with them. Quinton House DS0000027480.V364172.R02.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 Quality in this outcome area is adequate. Residents’ views on activities were mixed which left us with the view that further consultation could be made in this area. Residents generally liked the food, though interim food preparation arrangements were in place during improvement works. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection, due to on going building work, the care home was not functioning in its’ usual way. The care home’s kitchen was being completely refitted and it was not possible for meals to be cooked on the premises. Meals were being prepared at a local community centre and collected by a member of staff, who delivered them to the care home. This arrangement would continue till the new kitchen was finished and ready for use. Residents were asked if they had been adversely affected in any way by this disruption to routine and all said they had not. When asked about the quality of food in their general experience, all 4 of those residents spoken with about this said they found the food to be good and plentiful. Three residents who returned comments to CSCI expressed similar opinions. CSCI had Quinton House DS0000027480.V364172.R02.S.doc Version 5.2 Page 15 however received one anonymous, negative comment about the meals. The manager was not aware of anyone having a poor opinion of food quality. Records sampled showed how on one day in the previous week 7 residents chose fish and chips as a main meal and 3 had had poached fish. Teatime choices had ranged from soup, scrambled eggs, cheese-on-toast and ham salad. The manager said they had been obliged to buy cakes and puddings in but no one had really minded. Since the previous inspection members of staff had been trained to use the Malnutrition Universal Screening Tool to help them safeguard any resident who might be at risk from malnutrition. It was evidently difficult for activities to be organised in the usual way while alterations were being made to the access routes into communal areas. Residents were unsure about there being any activities organised at the present. Two residents said that there never was any activities organised for them but that they did not think they would be interested in joining with a group in any case. Another 3 believed there sometimes were activities organised by the home One spoke of a musician coming to the home but had not enjoyed the entertainment. Another said they went for short walks into the nearby town but did nothing else and frequently felt bored. Records did show that staff spent time with individual residents, chatting, doing manicures and playing games such as cards and puzzles. Residents’ meetings had been introduced, as recommended at the previous inspection. These were used as an opportunity to inform residents about what was going on in the home. The manager hoped residents would soon be planning ahead their own menus and activity programmes. The manager described having set up a film night, showing old films in the lounge with ice cream and popcorn served during the interval. In the Annual Quality Assurance Assessment (AQAA) she described the plans to bring in themed activity days on a regular basis such as a Caribbean or an American Day. Quinton House DS0000027480.V364172.R02.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. The complaints procedure was straightforward and easy to follow. The manager listened to residents’ views and they were confident she and other senior members of staff would be sympathetic and respond appropriately to any concern they might raise. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care home had a recently updated, appropriate complaints procedure and a copy of this had been given to every resident. We examined the records relating to the one complaint made to the care home since the last inspection. This showed the matter to have been dealt with in an appropriate and timely manner. Although the issue had not been completely resolved it would be on completion of the planned refurbishment. Two out of 3 of the residents who returned CSCI surveys said that they knew to whom they could turn if they needed to make a complaint. All the residents spoken with were clear about this too. Residents spoken with were confident that any issue they might raise would be sympathetically dealt with. One resident spoken with, whose needs had recently grown beyond the home’s capacity to fully meet them was planning to leave the care home at the end of the week. This decision had been Quinton House DS0000027480.V364172.R02.S.doc Version 5.2 Page 17 precipitated however by the request for the resident to move room to facilitate the home’s changes and refurbishment programme. While agreeing a choice of 3 rooms had been offered, none had been satisfactory in the resident’s view. The manager was aware of this but insisted that every effort had been made to accommodate the resident’s wishes but without success. Residents’ safety was safeguarded in that all staff employed at the care home had recently satisfactorily renewed they Criminal Records clearance checks. All staff had undergone training to protect vulnerable adults from abuse. In addition it was planned staff would shortly receive training to access the Independent Mental Incapacity Advocacy Service which would help further promote residents’ rights. Quinton House DS0000027480.V364172.R02.S.doc Version 5.2 Page 18 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 and 26. Quality in this outcome area is good. Although many improvements remained work in progress it was possible to see clearly that the final outcome, incorporating features of greater safety and comfort, and increasing the attractiveness of their surroundings could only benefit the people living at the care home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was made immediately following our arrival at the care home, including areas residents were occupying and areas intended for reregistration with CSCI. Builders were working in the entrance hall and stairwell and were in the process of converting access ways into some of the communal areas. As a result of the work in progress, there were parts of the care home designated to no longer be accessible to current residents. Other areas would be returned to them once the work was completed and it was safe Quinton House DS0000027480.V364172.R02.S.doc Version 5.2 Page 19 for them resume occupancy. At the time of this inspection, work was well advanced but remained some way from completion. Work completed at an earlier stage had been inspected by the Fire Officer, Environmental Health Officer and CSCI Registration officer, all of whom would be returning to conduct their final inspection once the work was finished. An open day had been held to enable Norfolk County Council Social Services staff to see for themselves the kind of accommodation that would ultimately be available to people accessing the new Cardinal unit (Short Stay accommodation for people with Learning Difficulties). Given the pending change in use, we did not closely inspect this part of the care home. The kitchen was located in the part of the care home where older residents continued to live but was not functioning. Here the cooker awaited installation and flooring had yet to be laid. Some painting was in progress in the hallways. A new assisted bathroom had been installed and was virtually complete. The plumber was able to verify that water temperatures were now governed to safe levels in all areas accessible to residents. As required at the last inspection, a COSHH cupboard had been provided so that residents would not be in any danger from cleaning chemicals stored at the home. This was locked and located in the newly refurbished bathroom. The cleaning assistant spoken with verified COSHH information sheets were now available. The majority of the rooms assigned to the current residents had en suite shower rooms. The manager described how it was planned to make these easier to access so safer for residents (Currently none of the residents used their own showers). Painting and decorating had occurred in a number of areas around where residents now lived to brighter, smarter effect. New flooring was also on order, to be laid throughout the remainder of the care home (Bedrooms and all communal areas). From the above it was evident that considerable investment had at last been made in the premises and that once the work in hand was completed, the home should attain an acceptably good standard. Residents spoken with were pleased that the care home was being improved. Each resident had a comfortable room of their own and all the people spoken with, save one as already detailed, were happy and pleased with their accommodation. It was evident that residents had been able to furnish their rooms how they wished, had added many personal items and arranged for their own TVs, radios and telephones to be installed. Radiators were covered and rooms were well lit. While some of the communal areas were cold due to the builders’ activities, residents’ own accommodation was warm and comfortable. One resident had made considerable efforts with pot plants outside the patio doors of her room. Another resident related he would soon Quinton House DS0000027480.V364172.R02.S.doc Version 5.2 Page 20 be doing the same. All the residents’ rooms were located on the ground floor and each had access to some garden space. Although not at their best due to the weather it was evident these areas could be very pleasant, providing secluded outdoor seating, with each separate area shared between 2 or 3 people. None of the doors were wedged open. Magnetic fire closures had been fitted to all fire doors in response to the requirement made at the last inspection. At the time of this inspection, the builders to facilitate their work had temporarily removed some of the magnetic closures. It was understood these would all be replaced once the paint had dried. Despite the upheavals caused by the presence of the builders, the care home was clean and tidy in all those areas frequented by residents. Residents returning comment cards to CSCI said this was always the case. The care home’s frontage was occupied by the builders but had the potential to be attractive, with easy access, its own car park and trees screening the house from the road. Quinton House DS0000027480.V364172.R02.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. Quality in this outcome area is good. To safeguard residents’ security, appropriate information was being held about people employed at the home. Members of staff were available in sufficient numbers to attend to residents’ needs. They were receiving training that would further their skills and competence and were appropriately supervised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As was found at the previous inspection, the number of staff available was appropriate to meet the needs of the 10 permanent residents living at the care home. The manager and 2 carers were available throughout the morning and afternoon. The duty rota was arranged so that during the night there was one carer awake while another person slept on the premises to be available in case of need. One of the 2 retired nurses employed for the purpose provided the extra ‘sleeping-in’ cover. Including the manager the care home employed 12 carers, 2 cooks and 2 domestic assistants and the 2 sleeping in carers. Of the carers, 2 were designated ‘Head of Care’ and able to take responsibility for the home when ever the manger was absent. It was evident from conversation with the head of care on the day of the inspection that she was very knowledgeable as to the needs of residents. Quinton House DS0000027480.V364172.R02.S.doc Version 5.2 Page 22 One of the head carers had achieved the NVQ Assessors award. Five carers had attained NVQ Level 2 accreditation and an additional 4 had gained Level 3. Every member of the care team had completed the advanced training course designed to ensure competence in handling medication. On going training arrangements had been set up for the year ahead with Breckland Medical Services, ensuring that all mandatory and refresher courses were undertaken. Pre booked course included fire safety, food hygiene, manual handling, infection control, protection of vulnerable adults from abuse, first aid, dementia care and helping with a bereavement. An additional update/refresher session would be provided at the end of the year. During the previous inspection it was noted how staff files did not contain all the information they were meant to hold about that person. The files of 3 existing members of staff were chosen at random and each found to have been updated. All staff had renewed their CRB clearance. Files also contained evidence of past training and supervision records. The files of 3 additional people who were in the process of being recruited were also examined. These people had not yet started work as some of their information was not yet in place. As noted in the last inspection, appropriate induction training was made available to all new starters. In the course of the day, a staff handover was conducted during which progress records for each resident were taken into account and members of the team were informed about events in the care home. Staff meetings were held each month and minutes taken. News of the planned changes to the premises, once delivered by the regional manager, had made a tremendous difference to the way staff felt about their employment there. In the course of the inspection staff were observed to be cheerful and confident, supporting residents in a positive but friendly manner. All members of the staff team had recently had new photographs taken and these were to be used on identification badges that were shortly to be brought into use at the home. Quinton House DS0000027480.V364172.R02.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 and 38 Quality in this outcome area is good. A meaningful quality assurance process is needed. Despite this, residents did benefit from the relaxed and friendly atmosphere at the home. They were not overly inconvenienced by the disruptions of the building work going on and safety had improved to acceptable standards since the last inspection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection the manager had been in post since 2006 but despite our previous recommendations had still not applied for registration with CSCI. The manager explained that she had commenced an application then failed to follow it through. She had just received a new application pack from CSCI. Quinton House DS0000027480.V364172.R02.S.doc Version 5.2 Page 24 Similarly, the manager had commenced work towards NVQ Level 4 accreditation and at the previous inspection stated this would be completed by November 2007. This deadline was not met. Accepting that uncertainty over the care home’s future may have affected progress, and that the manager had now recommenced the programme, she reported that she should gain accreditation by the end of this year 2008. The manager was not aware of a systematic approach to monitoring quality assurance having been put in place. The introduction of a formal quality assurance system was a previous requirement. Although some elements of quality monitoring had been introduced, for example residents’ meetings, surveys of what residents thought of their admission procedure, improved policies and procedures, and the introduction of Regulation 26 monitoring visits by the provider’s representative, it remained for information about the perceived quality of the services provided to be gathered together, collated and evaluated in a manner capable of informing future development of the service. Regulation 26 monitoring visits had taken place since the start of year 2008. The requirements made at the previous inspection for wedges under fire doors to be removed and replaced with magnetic closures had been acted upon. Similarly the requirement for a lockable COSHH cupboard to be made available and for COSHH information sheets to be supplied had also been acted on. Both the Fire Officer and Environmental Health Officer had been involved in the planned changes and improvements in progress at the care home. Both officers were due to return for a final inspection of the premises once the work in hand was completed. Records were made available to us showing that equipment in the care home had been regularly serviced for example the lift 1/03/08, hoists 19/03/08, fire fighting equipment 14/03/08. A fire risk assessment was in the process of being re written to take account of the changes being made to the care home. Fire training for staff had taken place in the previous September and another course was booked to take place in June 2008. Only one resident had cash held for them in safe keeping by the care home and appropriate records of this were being maintained. As noted in the previous section, records of staff supervision were held in staff files. The manager stated (AQAA) that it was planned to introduce formal supervision agenda forms in 2008. Quinton House DS0000027480.V364172.R02.S.doc Version 5.2 Page 25 Following a recommendation made at the last inspection, the manager had accessed the assistance of a falls advisor to help a resident who was prone to falls. This had been of some benefit to the resident concerned. Records of accidents were examined and found to be well recorded. The manager was aware of the need to monitor these records to see if any patterns in accidents occurred. Quinton House DS0000027480.V364172.R02.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 3 3 X X 3 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 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 2 X 2 X 3 3 X 3 Quinton House DS0000027480.V364172.R02.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES 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 OP33 Regulation 24 Requirement An effective quality assurance monitoring system must be developed for the care home Timescale for action 01/12/08 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 A statement of purpose and service user guide capable of explaining how the care home has changed and the services it is registered to offer should be introduced as soon as possible Residents or their representatives should be asked to sign the new care plans to show they are aware of and agree with their contents. They should repeat this whenever a review leads to a substantial change in the content of their care plan. Residents meetings should be used as an opportunity to DS0000027480.V364172.R02.S.doc Version 5.2 Page 28 3. OP7 4. OP12 Quinton House discuss with residents what kind of organised activities they would enjoy taking part in. 5. OP31 The manager should complete NVQ Level 4 accreditation in care management by the end of 2008 Quinton House DS0000027480.V364172.R02.S.doc Version 5.2 Page 29 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 Quinton House DS0000027480.V364172.R02.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!