Care Home: Read House

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What the care home does well Read House was clean, bright and welcoming on the day of the inspection. Decoration and maintenance tasks are completed to a high standard. There was a relaxed and homely atmosphere in the home with an established staff group and during the visits staff were seen to interact well with the residents Admission processes in the home were managed well, with care planning and record keeping for the people living at the home in good order. Consideration has been given to all aspects of health, personal and social care needs with risk assessments in place. People living in the home spoke of being able to make choices around what they wished to eat, what they wished to do and where they liked to spend their time. Two people spoken at the inspection said that they enjoyed the leisure activities on offer; one person said `I go to them all`. A third person said if they did not like the main lunchtime choice, they would be able to have something else. Other positive comments are reflected in the body of this report. What has improved since the last inspection? The arrangements for administering medicines have changed and the home no longer decants medication before giving to a resident. Furthermore all medication is now given to residents in their room and this has resulted in an improved practice with thought given to the dignity and privacy of residents as they are taking their medicines. Care planning and record keeping has improved. Records were clear and legible and clearly understood by carers and the resident. Policies and procedures have been updated and amended since the last inspection. Both the complaints procedure and the safeguarding adults procedure required further amendments, which were completed following this inspection. This is reflected in this report. What the care home could do better: Since the last inspection there has been an overall improvement in the service offered by Read House. With the installation of a registered manager and ongoing training for all staff, the home could look to achieving some excellent outcomes. CARE HOMES FOR OLDER PEOPLE Read House 23 The Esplanade Frinton On Sea Essex CO13 9AU Lead Inspector Pauline Dean Unannounced Inspection 09:40 15 & 16th July 2008 th 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 Read House DS0000017916.V368375.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. Read House DS0000017916.V368375.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Read House Address 23 The Esplanade Frinton On Sea Essex CO13 9AU 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) 01255 673654 01255 673177 info@essexblind.co.uk www.essexblind.co.uk Essex Blind Charity Vacant Care Home 40 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (40), of places Physical disability over 65 years of age (40), Sensory Impairment over 65 years of age (40) Read House DS0000017916.V368375.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Persons of either sex, aged 65 years and over, who require care by reason of Old Age (not to exceed 40 persons) Persons of either sex, aged 65 years and over, who require care by reason of a physical disability (not to exceed 40 persons) Persons of either sex, aged 65 years and over, who require care by reason of a sensory impairment (not to exceed 40 persons) The total number of service users accommodated in the home must not exceed 40 persons Date of last inspection Brief Description of the Service: Read House is a purpose built establishment for older people with sight impediments and is owned by Essex Blind Charity. It is situated on the promenade of Frinton-on-Sea, within easy reach of the town. The home offers accommodation on three levels, with all rooms being serviced by a passenger lift. The dining room is on the ground floor but there are two small lounges on each level. There is space for parking at the front of the home and a large sensory garden to the rear. All bedrooms are for single occupancy, with en-suites, and two are designated for respite care. Attached to Read House is a day centre. Service users are encouraged to participate in the weekly programme of activities and attend special events, such as concerts. The weekly charge for a room is between £383 and £510.00, with a large single room at £620.00. Additional charges are made for chiropody, hairdressing, newspapers, toiletries and other personal items. Read House DS0000017916.V368375.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 the people who use this service experience good quality outcomes. On the 15th July 2008 we made an unannounced visit to Read House to use a formal way to observe people. This is called a Short Observational Framework for Inspection (SOFI). This involved us observing up to five people who use the service for one hour and recording their experiences at regular intervals. This included their state of well being, and how they interacted with staff members, other people who use services, and the environment. The unannounced inspection of Read House took place on the following day on 16th July 2008 over a ten-hour period. The inspection involved checking information received by Commission for Social Care Inspection (CSCI) since the last key inspection in August 2007. At the site inspection, records and documents were inspected and the inspector spoke to the Manager, General Manager (Responsible Individual), Training Officer, Chef Manager, care staff and catering staff and the people living at the home. In addition the Annual Quality Assurance Assessment (AQAA) completed in May 2008 was considered as part of the inspection process and a tour of the premises was completed. Surveys were sent to the home prior to the inspection. The people living at the home completed and returned five surveys, staff completed and returned three surveys and health care professionals completed and returned three surveys. Their comments are reflected in this report. During the inspection three people who live at the care home and three care staff were spoken with. Their comments are reflected in this report. What the service does well: Read House was clean, bright and welcoming on the day of the inspection. Decoration and maintenance tasks are completed to a high standard. There was a relaxed and homely atmosphere in the home with an established staff group and during the visits staff were seen to interact well with the residents Admission processes in the home were managed well, with care planning and record keeping for the people living at the home in good order. Consideration Read House DS0000017916.V368375.R01.S.doc Version 5.2 Page 6 has been given to all aspects of health, personal and social care needs with risk assessments in place. People living in the home spoke of being able to make choices around what they wished to eat, what they wished to do and where they liked to spend their time. Two people spoken at the inspection said that they enjoyed the leisure activities on offer; one person said ‘I go to them all’. A third person said if they did not like the main lunchtime choice, they would be able to have something else. Other positive comments are reflected in the body of this report. 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. Read House DS0000017916.V368375.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 Read House DS0000017916.V368375.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): 3 & 6. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who come to live at the home can be confident that their needs will be fully assessed and these will be met. EVIDENCE: At the inspection visit, the files and paperwork for four people living at the care home were sampled and inspected and we were able to speak to three of these residents. The pre-admission paperwork for two people who had moved into the home since the last inspection was sampled and inspected. These had a completed application form, which detailed physical and health assessments, medication, mobility, personal care requirements and social activities they wished to participate in. Read House DS0000017916.V368375.R01.S.doc Version 5.2 Page 9 Prior to moving in prospective residents, their relative or representative make an application to come to live at Read House. Both of those sampled were for respite care, which in one case had been extended to a permanent stay. The Manager and the General Manager said that the normal practice of the home was to visit the prospective resident and invite them to visit Read House to enable them to meet other residents, see the home and their room. If the prospective resident lived some distance away then this was not always possible. In which case the home would encourage relatives to visit on behalf of the new resident and telephone communication would be established to gain as much information as possible before the new resident moved in. In addition, further information would be sought from the person’s GP, family and social workers. Evidence was seen on the files sampled of these documents and of a local authority assessment of needs and completed medical assessment forms. Within the Annual Quality Assurance Assessment (AQAA) there was confirmation of the admission process as detailed above. It was stated that that every effort would be made to ensure that Read House can ‘meet the needs of the prospective resident and can care for them satisfactorily’. The AQAA went on to say that as they are specialist home, (a home for older people with sight impediments) they do accept people from a wide area. It was said ‘it is not always possible to make a personal visit, although we now make more personal pre-admission visits than before.’ All four surveys completed and returned by people living at Read House said that they had received enough information about the home before moving in so that they could decide if the home was the right place for them. Two of the people spoken to at the inspection were also clear that they had sufficient information to make an informed choice before they came into the home. Read House does not offer intermediate care. Read House DS0000017916.V368375.R01.S.doc Version 5.2 Page 10 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. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home can be assured that their care needs will be met through their individual plan of care and they can be assured that their medication will be administered in a safe and secure way. EVIDENCE: The care plans for four people living at the care home were sampled and inspected. The pre-admission assessment including the Residents Admittance Form are considered when developing the care plan which covered all aspects of health, personal and social care needs. Within the care plan the need or problem is identified and headings such as ‘How can we help’ and ‘How will we help’ were seen. This was followed by section, which detailed any aids Read House DS0000017916.V368375.R01.S.doc Version 5.2 Page 11 needed. Care planning records seen were in good order and gave detailed information enabling care staff to care for residents, as they would wish. Two residents spoken to at the inspection said that staff were ‘very good’ and they were happy at the home. One person confirmed that they have been asked for personal information to complete their Personal Profile, which was seen on file. A carer confirmed that they had found this section both informative and interesting. The AQAA gave a detailed account of the care planning processes as found at the inspection. Alongside the care plan both a general and room assessment are completed and evidence of these were seen on the files. In addition an assessment detailing Moving and Handling needs were located in the resident’s room. The manager and a carer who was spoken to at the inspection confirmed this. Daily records were seen on each file. These were completed over the three shifts covering 24 hours and some headings had been introduced to prompt entries. This record keeping was clear, easy to read and covered care needs identified. Within the care plan files sampled records were seen of visits to the home and visits to the practices of GPs, chiropodists, ophthalmic optician and District Nurses. At the inspection there was evidence of aids and equipment to aid mobility, prevent pressure sores and ensure continued independence. One resident spoken to spoke of being able to use a stick around their room, but also had the provision of wheelchair for use in the home and outside the home. They said that this enabled them to choose how they are able to move around the home and maintained their independence. Two residents who had completed the Commission‘s surveys said that they ‘always’ received the medical support they needed, whilst two residents said that they ‘usually’ received the medical support needed. Two health care professionals said that the care service ‘usually’ sought their advice and acted upon it to manage and improve each individual’s health care needs, whilst one person said that they ‘always’ sought advice and acted upon it to manage and improve the resident’s health care needs. One health care worker said that the home ‘Communicates well with us.’ All three said that they felt that the health care needs of individuals are ‘usually’ met by the care service. Within the AQAA a clear detailed record of how the home ensures that the residents health care needs are met was noted. Reference was made to the equipment held in the home e.g. pressure relieving mattresses for each Read House DS0000017916.V368375.R01.S.doc Version 5.2 Page 12 resident and the ‘good relationship’ and service they received from their local surgery and GP, and the visiting District Nurses and the chiropody service. By working with these services the home is able to ensure that residents receive the medical and health care, as they need it. Medication administration, storage and record keeping was sampled and inspected at the inspection visit. The deputy manager of the home who has responsibility for ordering and returning medicines was on duty and was able to show us the practice and procedures for ordering, receiving, recording and administering medication. Of the four residents used in the case tracking at this inspection, one person was on no medication. The remaining three people had some medicines and these were administered and recorded through a Monitored Dosage System (MDS) or in the case of a resident on respite care they were noted on a Medication Administration Record (MAR) and given from the packaging received as they entered the home. Record keeping was both accurate and in good order. A good practice recommendation was made that the list of staff dispensing medication needs to be reviewed and updated as some staff had left since this was created. The Manager said that this would be completed immediately. Five residents were on Controlled Drugs. These were stored in a locked Controlled Drug cupboard found in the First Aid/Medical Room. Records of administration of these medications were noted in a Controlled Drug Register, with a second signature of a staff member who had witnessed the administration of the Controlled Drugs. This ensures that residents are safeguarded from poor medication procedures, as there is an ongoing monitoring and auditing process. We were told that risk assessments were in place for those residents who are self-medicating. These were not inspected at this inspection, although the General Manager said the provision of lockable storage for medicines in each resident’s room is being progressed as needed. Read House has two medication trolleys, which are used to dispense medication on each floor. The practice of dispensing medication in the dining room has ceased. Instead both trolleys are used to dispense medicines around the home. This means that the home is no longer decanting tablets into small pots and medicines are given when residents return to their room after breakfast, lunch and teatime, with both privacy and dignity respected and the giving of medicines has become a more personal experience. During the inspection a medication round was observed and it was managed in both a professional and friendly manner, with each resident being told what their medicines were for and what they were taking. Read House DS0000017916.V368375.R01.S.doc Version 5.2 Page 13 Evidence was seen of medication training. Two of the staff spoken to confirmed that they had attended medication training and the home’s staff training programme confirmed this. The Training Officer of the home was able to evidence both training planned and completed, which related to medication. The Manager, Deputy Manager and one of the care staff spoken with confirmed that they had attended an Advanced Medication training course, which gave them information about the medicines used in the home and how to recognise and deal with any problems that residents might have from using this medication. The carer said that they had found this very informative and interesting. Within the AQAA it was stated that ‘More staff have attended an advanced administration of medication course. We have had an ‘in-house course for all staff who administer medication. There has been more individual monitoring by the Care Manager of staff administering medication.’ This was acknowledged and confirmed by both staff members spoken to. During the inspection staff were seen to treat people with respect and to promote privacy as the entered their bedrooms. They were seen to knock at the bedroom door and wait until the resident said they might come in. All three health care professionals who had completed the Commission ‘s surveys said that they felt the care service ‘usually’ respected each individual’s privacy and dignity. Both members of staff spoken to at the inspection, were aware of the need to respect resident’s privacy and dignity and one gave an example of how they had ensure that the dignity of a resident was safeguarded by ensuring that all health and personal care is attended to in their room. The lists on display in both the dining room and public areas have been removed and no longer impinge on people’s privacy and dignity. This information is held elsewhere either in catering records or care plans. Read House DS0000017916.V368375.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. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service People who live at the home can expect to be given choices about how they spend their time, visiting arrangements and meals. EVIDENCE: A Short Observational Framework for Inspection (SOFI) was completed on the first day of the inspection. This was an hour’s long observation and a recording which focused on group of residents taking part in a quiz. The home’s Activities Co-ordinator led this activity. On the second day of the inspection we were able to speak with the Activities Co-ordinator who confirmed that they are responsible for speaking with residents to ascertain their choices and wishes with regard to the daily activities in the home. Within the AQAA it was stated that the home devises a Read House DS0000017916.V368375.R01.S.doc Version 5.2 Page 15 weekly programme of activities and the co-ordinator said that they speak to the residents to involve them in choosing activities for both the morning and afternoon sessions. The programme of activities included quizzes, card games, dominos, a game of skittles, armchair exercises, newspaper reading and outings, both individual in the locality or further a field in the home’s minibus. The Activities Co-ordinator said that outings had been arranged to a local garden centre, a farm park and for picnics. In addition some residents attend the local blind club and enjoy concerts put on by this club. Within the survey work completed by residents in the home, two people said that there are ‘always’ activities in the home that they can take part in, one person said that there were ‘usually’ activities arranged that they could take part in and another person said that there were ‘sometimes’ activities arranged that they could take part in. The Activities Co-ordinator said that they were looking to complete ‘Life History’ accounts for each resident and this would be added to the individuals care plan. Both the Manager and the General Manager confirmed that this was being considered. They said that they are keen to involved the relatives of the residents in the home and thought is being given to arranging coffee mornings and afternoon teas to invite relatives to. The annual garden party/fete was planned for the following weekend and residents spoken to were aware of this and had invited their families. Consideration is given to the religious needs of individual residents. Regular in-house church services led by leaders from local churches are held and a bible study group meets regularly in one of the small lounges. Within the AQAA it was stated that the home does ‘endeavour to take residents to their preferred church in the local area or try to find a volunteer by approaching the church itself’. Both the Manager and General Manager stated that visitors are welcome at any time. The AQAA stated that ‘visitors are welcome to have a meal with the resident’ and visitors can be received in the resident’s room or in one of the lounges if possible. All three residents spoken with said that they were able to receive visitors as they wished. Refreshments were offered and one person said that they were regularly taken out for a meal by their relatives. Both the Manager and General Manager stated that visitors are welcome at any time. The AQAA stated that ‘visitors are welcome to have a meal with the resident’ and visitors can be received in the resident’s room or in one of the lounges if possible. Read House DS0000017916.V368375.R01.S.doc Version 5.2 Page 16 All three residents spoken with said that they were able to receive visitors as they wished. Refreshments were offered and one person said that they were regularly taken out for a meal by their relatives. At this inspection we were able to speak with the home’s Chef Manager. They told us that meals are planned a week ahead and the likes and dislikes of residents are considered in the menu planning. On the menu at lunchtime there is only one choice noted, but we were told that residents are offered soups, salads and omelettes. Records seen evidenced this. A variety of desserts are offered including fresh fruit as the resident wishes. As well as cooking for the home catering staff cook lunches for visitors to the attached day centre. The Chef Manager said that they receive the same meals and they usually cook for an additional thirty people. Food supplies were purchased from local wholesalers and supermarket, local butchers and greengrocers. In addition there are daily deliveries of milk and bread and local eggs and ham is delivered twice a week to the home. The Chef Manager said this enabled the home to offer a variety of good quality food for residents. Records were seen of meals eaten with the exception of breakfast. This was discussed with the Chef Manager, the Manager and General Manager and the home is to adopt a recording system for all meals including breakfast. Currently a cooked breakfast is offered three days a week and the Chef Manager said that some residents enjoy this. Since the last inspection, the dining room has been decorated. It was light, bright and airy. New colour contrasting has been introduced in the new dining room carpet and new place mats. The people living at Read House are able to choose whether they wish to eat their meals in the dining room or in the rooms. The majority of the residents choosing to eat in the dining room. Care staff were seen to assist some residents and this was completed in a sensitive manner. The Training Officer of the home said that staff are taught to be aware of how to support residents who are visually impaired through professional visual awareness training offered in- house by a training company which specialises in working with people who have a visual impairment. Read House DS0000017916.V368375.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. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home can expect their concerns to be taken seriously by the care home. EVIDENCE: Read House has a complaints procedure. This was inspected at the inspection and some amendments were required. Prior to writing this report, these amendments were made to reflect the changes in management at the home and the new contact address for Commission for Social Care Inspection (CSCI). It is understood that the Commission will not investigate complaints, but will review the management of complaint investigations through inspection and regulation. Within the AQAA it was stated that copies of the complaints procedure are made available to all residents and their representatives as they enter the home. Two people who had completed the Commission‘s surveys said that they did know how to make a complaint and they would know who to speak to if they were not happy. One person had not answered either of these Read House DS0000017916.V368375.R01.S.doc Version 5.2 Page 18 questions. The fourth person said that they did not know who to complain to and they were unsure who to speak to if they were not happy. They had gone on to suggest ‘Maybe someone could speak to the resident, once a week, to talk about general health and problems, then report to the relatives’. Obviously matters of confidentiality would need to be considered by the home, but this had been proposed by a relative of a resident who was said to have dementia and was seen of a way to ensure that relatives are kept fully informed. The General Manager said that Read House had had one complaint since the last inspection. They were able to outline the action taken. Whilst this was appropriate, no records were completed and found on the resident’s or staff file. It was however logged on in a central file. The General Manager and Manager acknowledged that there is a need to make reference to this complaint on both the files of the resident and carer involved to ensure that residents are confident that all complaints are taken seriously, with a thorough investigation and action taken, should the outcome of the investigations warrant it. At the inspection the home’s Policy for Safeguarding Adults was inspected. As with the complaints procedure some changes were required and once changes were made, a copy of the policy and procedure were sent to the Commission. These documents met requirements detailing the different types of abuse and the action to be taken. Reference was made to the local authority alert process and a copy of the Alert Form is to be added to the policy. This is to aid senior carers should they need to make an alert in the absence of a manager. Since the last inspection, the home has raised a safeguarding issue with the Police and Essex Safeguarding Adults unit. The home had fully co-operated with the Police and Social Services, but following Police investigation no action had been taken and the safeguarding referral closed. Discussion took place between the management of the home and the inspector on a possible adult protection issue. At the time of writing this report, the home’s concerns are being considered between the parties concerned and Social Services and an alert maybe required. Both the Care Manager and the General Manager have attended a course in Management Responsibilities in Adult Protection and the majority of care staff have completed adult protection training, initially in their induction training and subsequently as refresher training. This was noted in the training records seen for three carers. Two care staff spoken to at the inspection were aware of the need to raise concerns with management should they have a concern or receive a complaint from a resident or relative. Both said that the Manager and the General Read House DS0000017916.V368375.R01.S.doc Version 5.2 Page 19 Manager were ‘approachable’ and they would raise any concern with them or a Senior if they were not on duty. Three staff who had completed the survey work sent by the Commission said that they knew what to do should a resident, relative or a friend raise a concern and one staff member said ‘As well as supervisions our manager makes sure we know her door is always open and we see her on the floor’. It was evident that care staff felt they would be able to raise concerns with management and therefore residents are safeguarded and protected. Read House DS0000017916.V368375.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at Read House have homely, surroundings, which are kept clean and tidy. comfortable and safe EVIDENCE: A tour of the premises was conducted at the inspection. All of the communal areas and some private bedrooms were seen. Read House was light, bright and clean and was well signposted for blind and partially sighted residents. As noted earlier in this report the dining room had been decorated and new Read House DS0000017916.V368375.R01.S.doc Version 5.2 Page 21 carpet and curtains fitted. A bathroom had been made into a shower room, which was now being used by the residents. The General Manager and the Manager said that as rooms become vacant they are re-decorated and the carpets are either professionally steamed clean or replaced. Decoration and maintenance were good in order and as maintenance tasks are identified they are added to maintenance programme of the home. Read House has gardens for the front and rear of the property. A gardener is employed to maintain these areas and shrubs and plants are cut back so as not to overhang the pathways. In the rear garden, there is a sensory area, a water feature, lawn and wide paths around the garden giving wheelchair access to all areas. A summerhouse, gazebo and garden seating are there for the residents to enjoy. Read House has an internal laundry service. Within the laundry there are two industrial washers and two industrial dryers. Hand washing facilities are to be found in the laundry and there is space for clean linen and clothing to hang or be laid until they are returned to the resident. One resident when spoken to commented on receiving a good prompt laundry service with their clothes returned in good condition. The Manager said that the home employs a laundry person five days a week in the mornings only. As the laundry is completed, care staff are responsible for returning the clothes and putting them away as the resident wishes. One resident confirmed this and said that they wish to put their own laundry away. Care staff allow them to do this and this enables them to know exactly where each item was. At the weekends, whilst there is a reduction in the laundry completed, both domestic and care staff are responsible for ensuring that laundry is not left. The AQAA stated that all domestic staff have completed a National Vocational Qualification (NVQ) Level 2 in Infection Control. The home has adopted colour-coded equipment for different areas to prevent cross-infection and antibacterial soap and alcohol gel was seen to be available in bathrooms, toilets and sluice. Read House DS0000017916.V368375.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home can expect to be supported by sufficient staff with skills and knowledge to meet their needs. They can be assured that appropriate recruitment practices have been followed to safeguard their welfare. EVIDENCE: On the day of the inspection Read House had thirty-eight residents, which comprised of thirty-four permanent placements, two temporary placements and two people on respite care. The Manager and the General Manager said that the home normally has seven care staff on duty in the morning, six care staff on duty in the afternoon and evening and four awake carers at night. The Manager said that the home will never reduce below six carers in the morning for this is felt to be detrimental to the residents. In addition the home employs an Activities Co-ordinator four days a week and the Manager and General Manager and the Training Officer Read House DS0000017916.V368375.R01.S.doc Version 5.2 Page 23 are employed five days a week. Five days a week the home has an administrator. Two people cover this post, one person working in the morning and one person working in the afternoon. We were told that there are eight domestic staff to cover weekdays and weekends and two chefs and three kitchen assistants covering seven days a week. In addition the home has a suppertime chef each evening. All three people spoken to at the inspection said that staff were available when the needed them. Two people who completed the Commission‘s survey said that staff were ‘always’ available when they needed them and two people said that they were ‘usually’ available when they needed them. All three staff members who had completed the Commission‘s surveys said that there was ‘usually’ enough staff to meet the individual needs of all the people who use the service and the two care staff who were spoken to said that generally there were sufficient staff on duty, although it could be more difficult when staff went off sick. However, it was acknowledged that other care staff cover these shifts or agency staff are brought in. Within the AQAA it was stated that the home preferred to use their own staff rather than rely on agency staff as the felt ‘this provides better continuity of care’. At this inspection we were told that over 70 of care staff have completed a National Vocational Qualification (NVQ) Level 2 or above in care. In the AQAA it was stated that a number of domestic staff have completed an NVQ Level 2 in domestic duties. This includes training in Infection Control. Staff recruitment files for two care staff were sampled and inspected. One of these had joined the home in December 2007. These files were in good order with a checklist at the front of each file and good recruitment practices had been followed and recorded. There was evidence of full pre-employment checks of references and an Enhanced Criminal Record Bureau (CRB) disclosure. At the inspection we were able to speak to these two staff members and each was able to detail and confirm their recruitment and verified that preemployment checks had been completed and they had been interviewed for their post. Both confirmed that they had undergone Induction Training and they had a contract/statement of terms and conditions. Read House has a staff training and development programme. The home’s Training Officer showed us evidence of Induction Training, which follows the Skills for Care requirements. Evidence was seen of completed Induction Training workbooks, which covered topics such as the Aims and Objectives of the home, the home’s Confidentiality Policy, Whistle Blowing Policy, Charter of Rights for Residents and Health & Safety Policies. The Training Manager said that newly appointed carers are expected to complete a twelve-week induction training programme, which not only includes the Induction Training workbook, but has training appropriate to caring for the people living at Read House e.g. Read House DS0000017916.V368375.R01.S.doc Version 5.2 Page 24 information on eye conditions, use of the passenger lift and stair lift and manoeuvring and using a wheelchair for a person who has a visual impairment. Evidence was seen of completed induction training, which was signed and dated on completion and a certificate of successful completion issued. Training opportunities within the home were said to be available. All three staff who had completed the Commission’s surveys said that they received training relevant to their role. One person gave an example – updated moving and handling training had made them aware of a change of practice. Another staff member said ‘Staff are NVQ trained with additional in-house lectures/courses for all those interested.’ Within the AQAA it was stated that supervision and appraisals are used ‘to determine training needs and requests, and try to find appropriate training courses to meet these needs.’ All three staff spoken to at the inspection confirmed this. All commented on the provision of good training opportunities, giving examples such as a distance learning training course on Dementia Awareness, an Action for Blind Training Day (Refresher training) Medication Training, Fire Marshall Training, First Aid at Work (four day course) and a distance learning training course in Palliative Care. All were very positive with regard to training and were pleased that they had been able to identify training needs and they had been able to pursue them. The home’s Training Manager said that training is given a high priority and this enables the home and the carers to meet the needs of the residents and ensure that staff have the skills and expertise to do this. Read House DS0000017916.V368375.R01.S.doc Version 5.2 Page 25 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 & 38. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home should be assured of good management with an ongoing quality and monitoring system in place and health and safety systems to ensure that the people living in the home are protected. EVIDENCE: Since the last inspection, the home’s Registered Manager has retired and a new manager from within the home has been appointed. They and the General Manager assisted with this inspection. Furthermore the post of Read House DS0000017916.V368375.R01.S.doc Version 5.2 Page 26 Deputy Manager has been created to assist with the day-to-day running of the home. The Manager said that are looking to start an NVQ Level 4 in Care and the Registered Manager’s Award in the near future. They had already contacted a training company. In the near future they will be applying for registration as the registered manager of the home. The Manager is assisted by the General Manager who holds a Diploma in Management and is the Responsible Individual (RI) for the home. In addition there is a Training Officer who is a qualified NVQ Assessor and a Moving and Handling Assessor. Within the AQAA it was stated that the home felt ‘the home is managed more effectively with each manager taking responsibility for her own particular area of strength.’ From speaking to each manager it was evident that they have particular designated roles and there is clear management structure and responsibilities for each role. Care staff and catering staff spoken to were also clear as to lines of accountability in the home and had an understanding as the management structure of the home. The General Manager said that there was a Board of Trustees who they report to and regular monthly meetings are held on which two trustees are present. The General Manager said that a quality assurance checklist is sent out annually to relatives of residents at the home. This had been completed in March 2008 and the home had had a 50 response. Evidence was seen in the survey work that some action had been taken as a result of the returns from this survey e.g. poor lighting in a bedroom and as a result a lamp had been installed in the room. The General Manager said that they still need to share the results in general with both relatives and residents and this is to be progressed through care plan reviews, residents and relative meetings and newsletters. The General Manager has the responsibility for keeping records of all transactions relating to residents’ personal money held for safe-keeping by the home. The monies, records and receipts were sampled and inspected for three residents and these were found to be in good order. In addition Read House is holding personal monies for a respite resident. In this case there were no records or receipts on file. Whilst it is acknowledged that this is a short-term placement the home is recommended to adopt the same practice and arrangements for holding personal monies as they use for permanent residents. The General Manager agreed to do this immediately. Safe working practices are ensured through the promotion of training courses. As well as those detailed earlier in this report, staff records evidenced basic Read House DS0000017916.V368375.R01.S.doc Version 5.2 Page 27 training courses of moving and handling, fire safety, first aid, food hygiene and infection control. Regular supervision sessions every two months and spot checks by senior staff are also seen as ways to ensure that residents are well cared for and that there are safe working practices. At the last inspection risk assessments around the storage and use of oxygen were required. This is no longer needed. Risk assessments relating to the open balconies on the upper floor lounges have been introduced and are found in each lounge. Moving and handling assessments and charts are to be found in each resident’s room. These detailed the identified risk and give manoeuvring instructions for the individual resident. Policies and procedures were sampled and inspected at this inspection. Details of these can be found earlier in this report. In addition a policy was seen around the use of the mini bus and this had been reviewed in June 2008. Within the AQAA it was said that the home plan to review all of their policies over the next twelve months and in sampling the policies this was found to be evident. Read House DS0000017916.V368375.R01.S.doc Version 5.2 Page 28 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X 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 X X 3 Read House DS0000017916.V368375.R01.S.doc Version 5.2 Page 29 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. 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. Refer to Standard Good Practice Recommendations Read House DS0000017916.V368375.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI Read House DS0000017916.V368375.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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