Care Home: Royal Court

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What the care home does well What has improved since the last inspection? The Home`s environment has continued to improve with an ongoing programme of refurbishment and decorating. What the care home could do better: Look at storage arrangements and record keeping of medications to ensure that systems in place are safe and in accordance with policies and legal requirements. Ensure that all required documentation is in place with regards to recruitment. CARE HOMES FOR OLDER PEOPLE Royal Court Fiddler`s Green Lane Cheltenham Glos GL51 0SF Lead Inspector Mrs Janet Griffiths Key Unannounced Inspection 09.20 19 & 20th August 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 Royal Court DS0000016568.V350024.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. Royal Court DS0000016568.V350024.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Royal Court Address Fiddler`s Green Lane Cheltenham Glos GL51 0SF 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) 01242 221853 01242 518827 royal.court@bromford.co.uk Bromford Housing Group Mrs Susan Elizabeth Charlton Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (44), Physical disability (4) of places Royal Court DS0000016568.V350024.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A designated respite flat will be used to accommodate a named person who is under 65 yrs of age & who has a physical disability for periods of respite care. 17th July 2006 Date of last inspection Brief Description of the Service: This Care Home is purpose built and is divided into six units of self contained flats offering independent living for older people, with personal care available as required. The flats vary in size but all contain an inner lobby, bathroom, airing cupboard, lounge and kitchenette. There are communal dining rooms in each unit and one main lounge. A well-equipped hairdressing room is also on site. Communal bathrooms are equipped with specialised bath hoists and some adapted toilets. All doorways are wheelchair friendly. In addition there are two passenger lifts giving access to all floors. The forecourt, which has been planted with shrubs and flowers, can be enjoyed in the warmer weather. The patio area has been upgraded recently with the help of a government grant. There is ample, level parking and the local bus route into Cheltenham Town runs outside the Home. There is also a local grocery shop nearby. The ranges of monthly fees are from £1502.36 to £1876.92. The home has a Statement of Purpose and Service User Guide that are offered to both residents and relatives. Royal Court DS0000016568.V350024.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. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This unannounced key inspection site visit took place over ten hours on two days in August 2008. The inspector, during this time, spoke to staff working in the home, residents, one relative and the manager and deputy manager of the home. The area manager also visited the home on the second day of inspection. Communal areas and some resident’s rooms were visited on this occasion. Five residents’ files were examined in detail to include their medication records. Other records examined included staff recruitment and training records, accident, and quality assurance records. Survey forms were issued to the residents, staff and health professionals prior to the inspection, to complete and return to CSCI if they wished; five responses were received from service users; two surveys were received from health professionals and five from staff. An Annual Quality Assurance Assessment (AQAA) was completed and its contents used as part of the inspection process and report writing as was the collation of survey results from service users. What the service does well: The Home is able to offer private accommodation, which allows the resident to remain as independent as possible. Residents are actively supported to remain in control of their own lives and to make choices for themselves. Staff are well trained and supported in the work they carry out. Royal Court DS0000016568.V350024.R01.S.doc Version 5.2 Page 6 When asked what they felt the home does well in surveys returned staff replied: • “Provide care for all different types of service users. A happy home”. • “ Meet the needs of service user wherever possible in their daily routines”. • “The service covers all the different needs of every service user by being flexible in its approach to care (working within the legal framework). This also includes its support and training to staff on all levels”. 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. Royal Court DS0000016568.V350024.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 Royal Court DS0000016568.V350024.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 3. Standard 6 not applicable. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective residents and their families have all the information they need to make an informed choice regarding placement at the home, and pre-admission visits take place to carry out an assessment and ensure that needs can be met. Residents normally move in on a long-term basis therefore Std. 6 was not assessed. EVIDENCE: A copy of the Statement of Purpose and Service Users Guide was seen and is held in reception and accessible to everyone. This has been reviewed this year. Royal Court DS0000016568.V350024.R01.S.doc Version 5.2 Page 9 It was confirmed by the manager that all prospective residents or their families are provided with a copy of the service users guide and resident’s surveys also confirmed that they had all received enough information about the home prior to admission. The Annual Quality Assurance Assessment (AQAA) states that “ If a prospective resident wishes to live a Royal Court they are invited to come and visit the home, where an initial brief assessment is made through conversation, an application completed and submitted and they are then placed on the waiting list. When nearing the top of this list they are invited to spend some time in the assessment flat to experience first hand how it feels to live at Royal Court and gives staff the opportunity to undertake a detailed assessment”. This has proved to be a very good way to introduce people to long-term care, thus hopefully making this transition, when the time comes, that much less stressful, as they already know the staff, environment and routines. However, the AQAA also states in plans for the next 12 months that “As part of the current review Bromford Housing group is looking at changing the use of the respite flat and staff accomodation on site, giving a financial increase which could be invested in improving standards etc”. Resident surveys also confirmed that they had all received a contract, examples of which were seen. A pre-admission form is completed prior to admission and a fuller assessment completed on and following admission, as more information is gain. Examples of both were seen. Staff surveys also confirmed that they received the training relevant to their roles and to meet the residents needs. Royal Court DS0000016568.V350024.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 Quality in this outcome area is good. These judgements have been made using available evidence including a visit to this service by the key inspector. People who live in this home have their personal care and health needs met through individually planned care. They are also protected by the medication administration procedures. Residents are treated with respect and their privacy and dignity are protected. EVIDENCE: A total of five care files of a selection of those people admitted since the last inspection and those with more high dependency needs were examined, and a number of residents and one relative were spoken with. Royal Court DS0000016568.V350024.R01.S.doc Version 5.2 Page 11 All but one of the files examined had very full and informative assessments completed to include a moving and handling and general risk assessment and these showed evidence of regular review. Where possible reviews were completed by the key worker and signed by the service user or their representative. Where problems were identified, appropriate care plans were completed and again reviewed regularly with the service user where possible, and these all reflected the current needs of the resident. Some residents are now choosing to keep their care plans in their flats and one relative spoken with stated that this was very helpful to him, to keep up with how his mother was on a day to day basis as she is no longer able to converse easily with him. Full and informative daily records were kept, signed and dated and gave a good indication of action followed through when any untoward event was recorded. We joined the afternoon hand over period, which was very informative and well done with each carer contributing by giving information about each of the residents in their care that day. All the staff who took part had good knowledge of all the residents needs. From the records examined references were made to visits from the doctor and district nurse as well as the chiropodist and other health professionals as required, to include the Parkinson’s specialist nurse and the continence advisor. Visits from professionals are highlighted in the daily records so that it can clearly be seen when a visit has been made. It did appear from one survey returned from a health professional that there may have been a problem with communication on occasions, but the manager and deputy stated that when any changes to care are made, this is added to the handover record and fed back to all staff at the next handover. Another survey however was happy with communication stating that there was always a senior member of staff to confer with and staff demonstrate clear understanding of care needs. This survey also stated “ If I could recommend a home it would be Royal Court” Specialist equipment such as pressure relieving mattresses and cushions, and hospital beds were also seen as being used where appropriate. Medication records were checked for those resident’s whose care records were examined in addition to several others specifically selected. Medication is dispensed by a local pharmacy; dispensing arrangements have recently changed from one supplier to another and appear to be working well. Royal Court DS0000016568.V350024.R01.S.doc Version 5.2 Page 12 Since the last inspection lockable medication cabinets have been fitted in the bathroom of each resident and when a delivery arrives from the pharmacy their medication is put into this cabinet along with their medication record sheet. Where someone may have a large number of medicines two cabinets have been fitted. A locked room is available for the supplies on arrival until moved to the rooms and another locked cupboard holds some stock or medication waiting to be returned. A controlled drug cabinet is also available in the training room but there are no medications held there currently. The controlled drug register was checked and the manager advised that the medication Temazepam should be recorded in this book on receipt. The pharmacy inspector later advised that if the home is managing this for the resident then it should comply with the regulations to store Temazepam in a controlled drug cabinet. The storage of medication in a cabinet in the bathroom was discussed as there could be issues with condensation or excessive heat, causing medicines to deteriorate, but the manager was advised to keep a check on the temperature and condition of medicines in these areas. Monthly medication records are provided by the pharmacy but staff have found it very difficult to enter their initials when administering medicines because of the lack of space and have been all allocated a number. As it would be easier to fake a number or confuse with dosage it is advisable that staff should sign or initial, provided a specimen signature list is held, when administering drugs, so they have been advised to revert to entering their initials. It may also be easier to consult with the pharmacist about providing improved medication records, which allow more space for initials. Most medication records seen were accurate, clearly indicating all the specific instructions given by the dispensing pharmacist. Relevant codes are used when a medication is omitted. Variable doses are also recorded. One instance was noted where a change to the times had been made and staff have crossed out and written over this entry instead of cancelling the old entry and writing in a new section of the chart. This makes it difficult to read and could cause confusion. Most of the records seen are well maintained although not every entry appeared to balance with the numbers in the blister packs. This was being followed up and it was advised that someone should do spot checks at regular intervals to ensure that no mistakes are being made. Most medication containers are dated to indicate when they commenced, but there were one or two instances where medication such as sachets or soluble Paracetamol had been removed from their labelled container and were not on the MAR sheet, so that there was nothing to confirm they were prescribed for that person. It was explained that this needs to be discussed with the Royal Court DS0000016568.V350024.R01.S.doc Version 5.2 Page 13 pharmacy as it was reported that they do not always include all medication on each MAR sent, only medicines ordered on that occasion. With recent pharmacy guidance it has also been advised that medication with a ‘when required’ dose ‘prn’ should have a record in the care plan ideally kept with the MAR charts on why the medicine has been prescribed and how to give it. A copy of this guidance has been provided. The AQAA states that ‘All staff responsible for dispensing medications are required to undertake training before doing so and are assessed by either the training coordinator or senior carer. They are required to be familiar with the policies and procedures of medication. Senior staff are trained to deal with the receipt, storage, handling and disposal of all medication’. Risk assessments are completed in addition to care plans for those residents who chose and are assessed as able to self medicate. These are also reviewed regularly. Observations made confirmed that resident’s privacy and dignity is respected and staff were observed knocking on doors and addressing residents by their preferred name. All of the residents have either a one or two bedroom flat with en suite facilities and their own key and letterbox. The AQAA states with regard to privacy and dignity “The high standard of accommodation means that residents can live as if they are at home rather than in a home. They have visitors, family, financial advisors, solicitors, doctors etc in the privacy of home. They can ask for a staff member to be with them if they prefer. Equally staff can ask permission to be present if necessary e.g. GP. Many residents have a telephone in their own flat. We have a payphone available or residents may use the office phone on request if they wish to make a call in a more confidential setting. All residents are advised that their clothing should be clearly marked in order that it can be identified and returned to the owner after washing. They wear their own clothing at all times. Residents advise their choice of term of address and this is recorded on the front page of the care plan”. Royal Court DS0000016568.V350024.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home are supported to realise their own preferences and expectations, and are able to maintain contact with the larger community, friends and family. They receive a wholesome, appealing and balanced diet in pleasant and comfortable surroundings. EVIDENCE: A programme of activities has been planned by the activities co-ordinator in conjunction with the residents and what they have said they enjoy. The weekly programme consists of Monday- ‘fun and games’; Tuesday- nails; Wednesday-crafts; Thursday-quizzes and word games; Friday- keep fit/bingo; Saturdays Film show with ice creams and Sundays either a service or hymn singing. Members of staff have selected an activity each day, which they feel happy to lead and this appears to be going well. It was reported that one resident Royal Court DS0000016568.V350024.R01.S.doc Version 5.2 Page 15 hardly leaves the lounge because she doesn’t want to miss anything that is going on. In addition to this, coffee is served in the lounge each morning as part of a social get together and the manager and deputy manager join the residents at the weekends, when it gives people an opportunity to air their views or raise any issues and for the staff to share information about the home. The AQAA stated that “ at a staff supervision session a staff member asked to have time set aside so that she could provide gentle exercise but with the emphasis on fun. Any residents for example who wishes to go for a walk, go to the shops or go to town is able to ask the key worker to arrange this. Although a high priority is given to group activities for those who like to join it, a similar priority is given to those who prefer to spend time with one of the team on an individual basis”. A variety of entertainers also visit regularly. A large number of residents go out with their families or attend external facilities like the local library and one or two still feel able to walk the short distance to the local shops (about twenty minutes walk- one said). However, although the home is able to loan the use of a mini-bus, they have no-one to drive it at present so trips out are limited. One survey returned commented on a recent jumble and bric- a- brac sale, hoping for fine weather and another about the entertainers. The home has its own hairdressing salon and many of the residents were enjoying having their hair done during the inspection. Two hairdressers visit or resident can make their own arrangements with mobile hairdressers who are able to use the facilities provided. The homes’ shop was being operated by one of the residents on the second morning of the inspection. The AQAA states how they have improved over the last 12 months stating that “ two new team members have a particular interest and talent in encouraging residents to participate in many activities. Their charismatic personalities and enthusiasm have successfully encouraged participation of those residents who often choose not to join in”. Plans for the future include putting the new outside space to good use. New garden furniture and plants will be purchased for the garden and outside activities arranged eg barbeques, cream teas, just enjoying conversation in the sunshine etc. The use of space and scented plants will be carefully considered in conjunction with the residents. Royal Court DS0000016568.V350024.R01.S.doc Version 5.2 Page 16 All residents are provided with choices at lunch and evening meal from a three-week menu rotation, and are offered a well balanced and nutritous diet. Meals are served in one of six small dining rooms or can be served in their flat by arrangement. Special diets are catered for which currently include just diabetic diets. One resident requires a pureed diet and it was noted that to ensure this resident also has a varied diet especially at supper time, a list is displayed in the kitchen of what is provided each day so that items are not repeated too often. Residents have breakfast in their flat where they can either prepare their own breakfast in their kitchenette or staff will assist. They are also able to prepare other drinks and refreshments themselves if they are able. If residents require assistance to eat or drink this is undertaken in a sensitive manner either in the dining room or their flat. The meals observed being prepared and served during the inspection were well presented and both looked and smelt very appetising. Six hot trolleys have been purchased in the last 12 months to ensure the safe delivery of food to the dining rooms. Residents confirmed in the surveys returned and when speaking to them during the inspection that they were very happy with the food provided, with one saying “ there is always good food and the best of everything and you can have what you want”. Staff were very visible and attentive creating a warm and friendly atmosphere whilst also being respectful of residents needs. One resident commenting on their life at Royal Court “they try to make it as good as they can”. One staff comment when asked what the home could do better stated “ Find the way to spend more time on a one to one basis with service users. Although there are plenty of activities its difficult to get quality time on a one to one basis”. Most stated that they joined in with the activities arranged and that they usually enjoyed the meals provided. Royal Court DS0000016568.V350024.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People in the home are protected by the systems in place. EVIDENCE: A copy of the complaints procedure is on display and available in the Service Users Guide. This has been reviewed recently and new leaflets are to be issued shortly with up to date information. Resident’s surveys confirmed that they knew who to speak to if they were unhappy and how to make a complaint. All of the staff also stated that they knew what to do if a resident or relative had any concerns about the service. The AQAA states “We have an open door policy and residents are encouraged to talk to us about any subject whether it is a complaint, suggestion or to give a compliment. Residents are encouraged to discuss a problem initially in order to resolve any difficulties but we ensure that residents can make a complaint in a positive way. Bromford Support has a simple and clear complaints procedure which indicates all timescales. Complaints are dealt with promptly and Royal Court DS0000016568.V350024.R01.S.doc Version 5.2 Page 18 effectively and will be responded to within 28 days. This information is included in the residents guide, statement of purpose and everyone is given a copy of the complaints procedure in their welcome pack”. It was reported that no complaints had been received in the last 12 months. Future plans for the next 12 months include the presence of the manager or her deputy manager in the lounge for the coffee mornings each weekend. This will give opportunities for residents to discuss any subject and will hopefully encourage people to comment -positively or negatively - without needing to resort to making a formal complaint. Training records confirmed that staff have attended Protection of Vulnerable Adult training, the deputy manager is to attend the mental capacity act training shortly and will cascade this information down to the other staff. A flow chart on this subject was observed in the training room. Policies and procedures are in place and are reviewed annually. Royal Court DS0000016568.V350024.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well maintained, clean and hygienic throughout. The whole ethos of the home, which provides flats for each resident, helps to promote and maintain independence. These flats and the communal areas are decorated and equipped to meet the needs of their occupants. EVIDENCE: As this home was new to this inspector a tour of the premises took place with the manager, viewing communal areas as well as the kitchen and laundry, and with the permission of the residents, a number of their flats. Each resident has a one or two bedroom flat, incorporating a lounge with kichenette, toilet and bath or shower. This is provided unfurnished so that Royal Court DS0000016568.V350024.R01.S.doc Version 5.2 Page 20 residents can bring in their own furniture, to help them feel more at home, although furniture can be provided if necessary. These are redecorated as they become vacant unless a need is identified in between times. All the rooms visited were personalised in this way and residents spoken with said how pleased they were to be able to bring their own furniture into the home which went a long way to helping them to settle in. There is a main lounge, which leads onto a patio area where residents are able to enjoy the sunshine, in a safe environment, including level access for wheelchair users. The deputy manager has taken responsibility to ensure that there are well-maintained plants and hanging baskets here, and residents may help if they feel able. A large assisted bath and hoist is available in a communal bathroom for anyone who is assessed as needing that level of care. Small hydraulic bath lifts are available to se in resident’s own baths. A great deal of work has been carried out since the last inspection. New furniture has been provided in four dining rooms; new window catches have been put on the downstairs bedroom windows to allow the windows to be open during the night without compromising safety; eight bathrooms have had level access showers installed; all water tanks have been removed and new boilers installed; a new addressable fire alarm system is in place making the environment safer for residents and quicker for staff to detect the origin of the problem; the external cyclical decorations have been completed; the dustbin area has been improved and the design and arrangement of the laundry has been improved. Residents spoken with and the surveys received confirmed their satisfaction with the accommodation provided and most saying the home is always fresh and clean with one adding “ the cleaners do their best to keep it clean”. All areas observed by the inspector appeared to be clean, in good decorative order and well maintained. Everywhere visited smelt fresh with no malodours present. Plans for the next 12 months according to the AQAA include redecoration of all the communal space and refurbishment of the lounge, which has apparently not been refurbished for a number of years. The manager has also been exploring a source to purchase automatic washing dispenser without success to date. Royal Court DS0000016568.V350024.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29, & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home have their needs met by sufficient skilled staff who are able to meet the needs of the current number of people living at the home. They are protected by the homes recruitment system and staff are supported to undertake regular and relevant training. EVIDENCE: On-duty on the day of inspection were the manager, two senior carers and five carers during the morning and the manager with one senior, three care staff and a general assistant on the late shift. In addition to care staff there was a cook and kitchen assistant, cleaning staff and laundry staff, and maintenance staff on-duty. Most of the surveys received from residents stated that staff were usually available when they needed them although one survey felt that they were always short staffed. No residents spoken with or observed voiced or displayed any concerns over having to wait for attention. It was explained that this is a very large building and all the staff on-duty are allocated to certain Royal Court DS0000016568.V350024.R01.S.doc Version 5.2 Page 22 areas each day, some residents may only see one or two staff and perceive that the home is short of staff. Staff generally felt that they had enough time to meet the needs of the residents. Staff observed during the inspection appeared to be carrying out their work in a professional and organised manner and all of the residents spoken with were very happy with the care provided. A number of staff were also spoken with to include some who had not worked at the home very long and had had no previous care experience and some who had worked at the home since it opened in 1987. All said they enjoyed working at the home and they appeared a very happy team. The home has twenty-six care staff in total and eight of these have NVQ 2, four have NVQ 3, two have NVQ 4 and five are working towards level 2 currently. Two new staff are also about to be appointed and both have NVQ 2. One carer spoken with had been very apprehensive prior to commencing this training but had been given a lot of support and encouragement from senior staff and now feels very proud to have achieved this qualification. There have been five new staff appointed since the last inspection and their files were examined. All had completed applications and all gave a full career history; there was no health declaration on file but it was reported that this is checked and held at head office in their HR department. It was advised that a written confirmation should be sent from them to hold on file. All had two references with one from the last employer given. Start dates were in place in a separate file. There was no identification documentation to include a photograph in place but it was explained that all this documentation had been checked ready to apply for Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (POVA) checks. Confirmation for all but one of these was seen and a request was made for this to be faxed from Head Office. It was later reported that a photograph is held on computer for each member of staff. Royal Court has a training coordinator on their team responsible for delivering training or sourcing training from outside trainers. Induction and training records with copies of certificates were also seen and an example of an induction programme was seen. Each member of staff has individual training records and recent training updates completed included fire safety, moving and handling, first aid, food hygiene, abuse, dementia, infection control and medication training. Royal Court DS0000016568.V350024.R01.S.doc Version 5.2 Page 23 The AQAA states that: “training at Royal Court is not an event but more a way of life. The whole culture within the team is of continuous improvement and going the extra mile”. From the staff surveys received they all felt that all relevant training was given and they felt supported by their manager with one saying: “ If there’s ever a problem we can always see our manager to discuss and get advice or support on the same day if necessary”. Royal Court DS0000016568.V350024.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32, 33,35, 36, & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home have their best interests met by the manager and staff who are committed to their responsibilities. They and the staff are generally protected by the health and safety systems in place in the home, although some safer systems could be considered. EVIDENCE: The manager has been in post for 16 years and her deputy at the home for 20 years and both have NVQ level 4- Registered Manager’s award. The manager is currently on a one year course with Bromford - Liberating leadership Academy to refresh and further develop management skills. Royal Court DS0000016568.V350024.R01.S.doc Version 5.2 Page 25 The AQAA states that “The approach of the management team is open, positive and inclusive. We ensure this by having an open door policy, consulting with residents on a number of issues concerning their lives and encouraging residents to contribute to any decisions by using formal and informal ways. The managers provide a strong lead and sense of direction while encouraging other to develop and use informed initiative in their work. Colleagues are actively encouraged to be innovative and creative in the way they deliver care and given a variety of ways to share their ideas”. The home has staff meetings for both day and night staff-care staff, senior care staff and domestic staff. Minutes of meetings were seen. The home has a quality assurance programme in place, which includes Regulation 26 visits with reports that are sent to CSCI. Records of these were seen. It was discussed that by including audits of the care plans, medications accidents, these audits could be expanded. Residents meetings are also held, the last being 9/6/08 when 22 residents attended and food- new menus, the garden and activities were discussed. Satisfaction surveys are also handed out to residents and/or their families. This year they went out in April 2008. Only approximately 7-9 were returned and there was very little comment on these to develop an action plan although it was suggested that a newsletter to give out the results and thanks those who took part, is published. The deputy manager acts as appointee for one married couple’s money in the home and collects pensions on behalf of several others. The home also holds securely small amounts of money for some residents and a record is kept of any financial transaction undertaken on their behalf. There are supervision and appraisal programmes in place and evidence was seen of supervision and annual appraisals being completed. Records were provided to show that statutory maintenance/servicing of equipment is arranged in a timely fashion. Fire prevention processes are in place confirmed by training records and the recording of fire alarm and emergency lighting checks. The provider has completed a fire risk assessment as required by the Fire Safety Service. Accident forms are completed in full and regularly checked to check for any patterns emerging where action needs to be taken. Fifty- nine accidents have been recorded so far in 2008. Records seen indicated that all of these had been dealt with according to the homes policies and procedures. Royal Court DS0000016568.V350024.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 3 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 4 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 4 X X X X X X 4 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 3 3 X 3 3 X 3 Royal Court DS0000016568.V350024.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement Timescale for action 31/10/08 2. OP29 19(1)(b) Ensure that arrangements for storing and recording medications are in accordance with The Misuse of Drugs and Misuse of Drugs (Safe custody) (Amendment) Regulations 2007 The registered person should not 31/10/08 employ a person to work at the care home unless they have obtained all the documentation specified in Schedule 2 to include evidence that the person is physically and mentally fit. Royal Court DS0000016568.V350024.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP9 Good Practice Recommendations Ensure that medication stored in cabinets in en suite bathrooms are in a good condition and not damaged by excess heat or moisture. The person administering medication to a resident is to sign the medication administration record with their initials and a specimen signature list to be held in the home to identify each person’s initials. Royal Court DS0000016568.V350024.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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