Care Home: Seymour House

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What the care home does well Comprehensive assessments are made with people who are considering using the service, their relatives and anyone else involved in their care. People who use the service have choice about who provides any intimate personal care. People who use the service have good access to healthcare professionals. People who use the service are encouraged to spend their day as they wish. Some people have to depend on staff for direction. Those people who choose to spend time in their bedrooms have their call bells and refreshments within easy reach. A good range of nutritious and varied meals is provided. People are consulted about the menus. Choice is provided at each meal and fresh fruit is available.Staff are trained in recognising abuse. They are confident in using the local safeguarding adults procedure. Staff have good access to training provided by the organisation. A robust recruitment process is in place. No one starts work unless their suitability to work with people who may be vulnerable has been checked. Housekeeping staff work hard to ensure that all areas of the home are cleaned to a good standard. What has improved since the last inspection? Mrs Maslen has now been registered as manager. She has met all of the requirements and recommendations from the last inspection. These had been made over a number of inspections, during a period of time when the home had a number of different managers who were seconded by the organisation to run the home. Only up to date care management assessments are acceptable when the home considers new people who want to use the service. A new care planning format has been introduced. Care planning documentation is more detailed and identifies all care and support needs. There is guidance to staff on how those needs are to be met and monitored. Significant efforts have been made to ensure that the new documentation captures all the information from the old format. All of the people who use the service have assessments of their risk of developing pressure damage and their nutritional status. Any preventative action is documented in the care plan. Staff have been trained in tissue viability, visual impairment and mental health. Further training is planned. Named staff have been trained by the district nurse in carrying out delegated specialised techniques, for example, taking blood glucose levels of those people with a diagnosis of diabetes. The arrangements for administration and control of people`s medication remains well managed. Records are made of unused and unwanted medication as it becomes discontinued. Records are made of specific applications of medication prescribed to be administered via an adhesive patch. The home does not accept prescriptions with the administration detailed `as directed`. We are now being notified of events in the home as required by regulation. Improvements are being made to the amount of activities provided to people who use the service. People who use the service are consulted more about issues that are important to them. Records are kept of all complaint investigations together with outcomes and response to complainants. Further improvements have been made to the environment for the comfort of people who use the service. Clinical waste is being more regularly collected by the contractor. Mrs Maslen has reviewed and revised the cleaning schedules so that all areas are regularly considered. Extra staffing hours have been allocated in the budget so that care staff can concentrate on providing care. These extra hours also enable care leaders to spend some time each week to attend to their delegated administrative duties. What the care home could do better: The nutritional risk assessment document does not relate to the nutrition section of the pressure damage risk assessments form. The liquid medication that is registered and stored in the controlled drug cupboard should have an entry in the register for the balance of the liquid after it is administered. A record should also be kept of the opening of each new bottle. CARE HOMES FOR OLDER PEOPLE Seymour House Monkton Park Chippenham Wiltshire SN15 3PE Lead Inspector Sally Walker Unannounced Inspection 09:30 13 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 Seymour House DS0000028133.V367628.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. Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Seymour House Address Monkton Park Chippenham Wiltshire SN15 3PE 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) 01249 653564 manager.seymourhouse@osjctwilts.co.uk www.osjct.co.uk The Orders Of St John Care Trust Kathryn Lesley Maslen Care Home 42 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (8), Old age, of places not falling within any other category (34) Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP - maximum of 34 places Mental disorder, excluding learning disability or dementia aged 65 years or over on admission - Code MD(E) - maximum of 8 places The maximum number of service users who can be accommodated is 42. 14th August 2007 2. Date of last inspection Brief Description of the Service: The home is situated on the outskirts of Chippenham near to the park. The building was originally built by the local authority in the 1970s and is the subject of an ongoing programme of redecoration and refurbishment. The accommodation is on the ground and first floors accessed by a lift and two staircases. Forty-two registered beds provide accommodation for older people, eight of whom may have a mental disorder. The home provides one of these beds for respite care. All of the accommodation is single bedrooms. The home also provides a 12-place day service during the week, which is separately staffed. The staffing rota provides for a minimum of 4 care staff and a care leader for the mornings, 3 care staff and a care leader for the afternoon and evenings, and 3 waking night staff. Mrs Kathryn Maslen is the registered manager. The fees for the home are between £390.00 and £460.00 per week. Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection took place on 13th August 2008 between 9.30am and 6.10pm. Mrs Maslen was present during the inspection and Mrs Debra Yates, Care Services Manager, was present during the feedback at the end of the inspection. We spoke with 5 people who use the service, 4 staff and one relative. We made a tour of the building. We looked at care records, staff records, medication, menus and risk assessments. As part of the inspection process we sent survey forms to the home for residents, relatives, staff and healthcare professionals to tell us about the service. Comments can be found in the relevant section of this report. We asked Mrs Maslen to complete an AQAA (Annual Quality Assurance Assessment). This was completed in full and returned on time. 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. What the service does well: Comprehensive assessments are made with people who are considering using the service, their relatives and anyone else involved in their care. People who use the service have choice about who provides any intimate personal care. People who use the service have good access to healthcare professionals. People who use the service are encouraged to spend their day as they wish. Some people have to depend on staff for direction. Those people who choose to spend time in their bedrooms have their call bells and refreshments within easy reach. A good range of nutritious and varied meals is provided. People are consulted about the menus. Choice is provided at each meal and fresh fruit is available. Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 6 Staff are trained in recognising abuse. They are confident in using the local safeguarding adults procedure. Staff have good access to training provided by the organisation. A robust recruitment process is in place. No one starts work unless their suitability to work with people who may be vulnerable has been checked. Housekeeping staff work hard to ensure that all areas of the home are cleaned to a good standard. What has improved since the last inspection? Mrs Maslen has now been registered as manager. She has met all of the requirements and recommendations from the last inspection. These had been made over a number of inspections, during a period of time when the home had a number of different managers who were seconded by the organisation to run the home. Only up to date care management assessments are acceptable when the home considers new people who want to use the service. A new care planning format has been introduced. Care planning documentation is more detailed and identifies all care and support needs. There is guidance to staff on how those needs are to be met and monitored. Significant efforts have been made to ensure that the new documentation captures all the information from the old format. All of the people who use the service have assessments of their risk of developing pressure damage and their nutritional status. Any preventative action is documented in the care plan. Staff have been trained in tissue viability, visual impairment and mental health. Further training is planned. Named staff have been trained by the district nurse in carrying out delegated specialised techniques, for example, taking blood glucose levels of those people with a diagnosis of diabetes. The arrangements for administration and control of people’s medication remains well managed. Records are made of unused and unwanted medication as it becomes discontinued. Records are made of specific applications of medication prescribed to be administered via an adhesive patch. The home does not accept prescriptions with the administration detailed ‘as directed’. We are now being notified of events in the home as required by regulation. Improvements are being made to the amount of activities provided to people who use the service. People who use the service are consulted more about issues that are important to them. Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 7 Records are kept of all complaint investigations together with outcomes and response to complainants. Further improvements have been made to the environment for the comfort of people who use the service. Clinical waste is being more regularly collected by the contractor. Mrs Maslen has reviewed and revised the cleaning schedules so that all areas are regularly considered. Extra staffing hours have been allocated in the budget so that care staff can concentrate on providing care. These extra hours also enable care leaders to spend some time each week to attend to their delegated administrative duties. 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. Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable as the home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient information is gained from people who are considering using the service, their relatives and care managers so that the home can decide whether their needs can be met. People’s social as well as health and care needs are also taken into consideration. EVIDENCE: A new pre-admission assessment format had been produced by the organisation. This is being used to assess all new people who are considering using the service. The home has also used the document to assess the needs of current people using the service. Senior staff carry out the assessments. The pre-admission assessment process takes into account people’s life history, capturing information about people’s social as well as medical history. Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 10 Information is gained from the person considering the service together with others involved in their care. One of the people who use the service told us: “the manager came to see me in hospital and asked me lots of questions”. One of the relatives told us that they had chosen this home because they had been welcomed when they first visited. They also said that there was no smell when they walked in. They said that their relative had settled in well and achieved a better quality of life since moving to the home. Action has been taken to address the good practice recommendation we made that the home should consider whether out of date care management assessments are valid when admitting people in an emergency. One person told us in a survey form: “Attend day centre which sadly is now closing. It gave a good insight for would-be residents.” One of the relatives told us in a survey form: “We had no information about the home only word of mouth that it had an excellent reputation.” Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have all their care and support needs identified in a care plan. People have good access to healthcare professionals. Safe arrangements are in place for administration and control of medication. Staff uphold people’s privacy and dignity. EVIDENCE: Action has been taken to address the requirement we made that care plans must be reviewed and revised as needs change. We said that the care plans must direct the care. The home is now using the organisation’s new care planning format. Significant efforts have been made to transfer all of the information from the old format into new care plans for each person. All of the care plans have been audited. Generally all care plans identified current care needs with guidance on how they are to be met. We saw evidence in good detail of how changing need had prompted revision of care plans in relation to Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 12 nutrition and behaviour management. One of the care leaders immediately reviewed and revised two care plans, which had omitted to record details of the arrangements for treating one person with diabetes and another person who was prescribed Warfarin. They also addressed an issue with a referral to a community psychiatric nurse that we saw had not been followed up. We saw evidence that staff had informed one person’s GP that they had moved to Seymour House. We were able to see how people’s care needs were met and monitored in all the other care plans we saw. Action has been taken to address the requirement we made that everyone who uses the service must have their risk of developing pressure damage assessed. We said that the outcome of the assessment and any action to be taken must be identified in their care plan. Staff have undertaken training in tissue viability and further training is planned. The care leaders carry out the pressure damage risk assessments. We saw pressure-relieving equipment in place for some people. We saw that the nutritional risk assessment document did not relate to the nutritional section of the pressure damage risk assessment. This means that the form does not allow the assessor to enter the nutritional outcome number into the pressure risk assessment. Food and fluid supplements were available to people whose nutrition was assessed as compromised. People were regularly weighed and any significant loss referred to their GP. Action has been taken to address the requirement we made that a policy for the giving of intimate personal care by staff of a different gender must be in place. We said that male staff must know the parameters of their role. Mrs Yates told us that the organisation is in the process of publishing its policy on intimate personal care giving. We saw that care plans identified people’s choices in having personal care by staff of a different gender. Three ladies told us that male staff helped them get washed and dressed. They said they were very respectful in this support. They said they could choose to have a female staff if they wanted. Action has been taken to address the requirement we made that: if any specialised procedures are delegated to staff by a district nurse or other healthcare professional, they remain the responsibility of the district nurse. We said that staff must be willing to carry out the procedure. Named staff must be trained by the district nurse and this training never cascaded to other staff. The district nurse retains responsibility for ensuring continued competence of those staff. One of the staff told us that they had received this training from the district nurse who had issued them with a certificate. One person told us about the wound on their hand that was being dressed regularly by the district nurse. One of the care leaders told us that they would accompany the district nurses when dressings were changed in order to record Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 13 progress in healing. There is a communication book used with the district nursing service. One of the people who use the service told us about seeing their GP about their leg. They said that staff were consistent in applying the prescribed cream. Another person told us that staff administered their medication “exactly as I had it in hospital”. Another person who had recently come to live at the home told us they had been able to keep the same GP that they had had at home. One of the relatives told us that they were kept up to date with their relative’s care and informed of any significant events. The care leader with the delegated responsibility for medication showed us the arrangements for administration of medication. The home operates a monitored dosage system put up by the supplying pharmacist. People who use the service can administer their own medication following a risk assessment. Staff only administer medication once they have been assessed as competent and received training in the process and the organisation’s policy and procedure. We looked at the controlled drug register. We saw that balances of a liquid medication were not being recorded after each administration. Our Pharmacist Inspector advises that records should be kept of the opening of a new bottle together with the number of bottles held. Whilst it is recognised that it is difficult to assess remaining liquid, the medication should not be poured out after each administration. This medication is not strong enough to be considered as a controlled medication. However it is good practice to register and store the medication in a controlled drug cupboard. We saw details in the person’s care plan as to why this medication was prescribed and when it was to be given. The care leader told us that a daily written audit is carried out of the controlled medication. The care leader told us that a new medication storage cabinet, complying with current storage regulations (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007, was to be installed. Action has been taken to address the requirement we made that any medication errors, allegations of staff misconduct and reduction in staffing levels must be notified to us without delay as required by regulation. The home now regularly tells us of any events in the home. Action has been taken to address the good practice recommendation we made that records should be made of any unused or unwanted medication when it is discontinued rather than just before it is returned to the pharmacy. All unwanted medication is placed individually in an envelope with details recorded before it is returned to the supplying pharmacist. Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 14 Action has been taken to address the good practice recommendation we made that care plans should identify application sites for medication administered via an adhesive patch. We said that rotating sites should be recorded in the medication administration record at each application. We saw evidence of this in people’s care plans and the medication administration record. Action has been taken to address the good practice recommendation we made that the exact medication administration requirements should be requested from the prescriber rather than accepting ‘as directed’ on the prescription. As a matter of good practice, a copy of the Pharmaceutical Society’s Formulary was available for staff information about medication prescribed to people who use the service. All of those people that we visited in their bedrooms had their call bells within easy reach. They also had jugs of water of juice to help themselves. We saw that all of those people we spoke with were well groomed. One person told us in a survey form: “Happy atmosphere to live in and staff are generally kind. However, some do not appreciate how difficult it is for me to live with my disability.” One of the relatives told us: “When a medical situation has occurred the staff have acted quickly and notified the family.” A healthcare professional told us in a survey form: “Sometimes not pro-active in seeking solutions to individual need. Example – new resident 4 weeks placement still had not had continence assessment. Care manager had to follow up. Often feels like lack of thought about what might offend and upset people, i.e. removing soiled laundry from room ASAP and ensure room looks appropriate. If highlighted they try hard to meet need. Evidence of 2 residents with hearing loss not having their need met – seems to be a time and thought difficulty. No evidence of increased care banding meeting individual need. Generally risk assessments and care plans are well maintained.” One of the GPs told us: “Respects the individual.” Another GP told us: “Caring, good atmosphere.” Another comment from a GP was: “Excellent example of a caring residential home.” Another GP told us: “Some residents should have been placed in nursing home instead of residential home. Despite this, the care staff try their best to provide all care needed. Care staff give care over and beyond their duty to try and provide everything that is needed. Atmosphere is always warm and open with good sense of humour. [Could do better] Probably by being more selective who to accept as residents, so that care staff do not spend excessive time with the few residents that should be in a nursing home.” Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Opportunities for people to join in with different activities have improved. The home takes into consideration people’s social histories when initial assessments are made. People are being given more opportunities to make comments and decisions. People enjoy a range of healthy meals. EVIDENCE: People who use the service generally spend their day as they wish. Some people relied on staff for direction. One person told us they liked to sleep a lot. They said they could go back to bed if they wanted to. We met with another person who was enjoying staying in bed for the day. We saw evidence of assessment of people’s social as well as care needs in the pre-admission documentation. Action has been taken to address the requirement we made that people’s social interests and access to the community facilities are maintained as per their wishes. In the AQAA Mrs Maslen told us that she continues to improve daily activities. People have been out to local events such as a fire works display and competitions with other homes in the organisation. The day Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 16 service has moved to the sun lounge to give more communal space for people living at the home. Mrs Maslen told us that eventually the day service would be integrated into the home. The staff working in the day service told us that they would eventually be responsible for providing the activity programme for people living at the home. One of the relatives provides a monthly quiz. A group of local schoolchildren comes in regularly to sing with people. There had also been a trip to ‘Horse World’. One of the staff who was running the day service told us they include the people who live at Seymour House in different events that they organise. They told us about taking a group of people out to lunch recently. One of the people who use the service told us about being taken out to a pub lunch. We saw notice boards advertising a barn dance to be put on centrally by the organisation. The programme that we had seen at the last inspection had been taken down. There was also an advert for a trip to Longleat. There were notices about the visits from the mobile library and services provided by churches of different faiths. One of the people who use the service told us about the Sunday services. They also told us that they had lots of visitors who were always made welcome with a cup of tea. All of the people we spoke with told us they enjoyed the meals. People described favourite dishes. One person described the meals as ‘marvellous’. Another person told us that if they did not like either of the two choices on the menu they would be given something else. People could have their meals either in the dining room or in their bedrooms. One person had chosen to eat their lunch in one of the sitting rooms. The 5-week menus are compiled following discussions with people who use the service. The menus are also varied with the seasons. Each table had a copy of the day’s menu choices so that people could easily see what was available. There were at least two choices for lunch and the evening meal. We spoke with two people who were having their lunch. One told us that the beef casserole was very tender. The other person was enjoying the milk pudding. They both told us they enjoyed the variety and quality of the meals. Fresh fruit is available on the refreshment trolley that is taken to bedrooms in the mornings, afternoons and evenings. Mrs Maslen told us that some people had made comments about the same tables always being served first. Meals are now served starting with a different table each time. Mrs Maslen told us this had proved successful. One person told us in a survey form: “Due to my disability unable to attend the majority [of activities] can only attend a quiz. Meat too tough. Too bland. Usually cold as I do not have help to eat them – just cut up for me.” Another comment was: “There are many activities going on, but as I cannot see very well or hear, I do not join in very much, although I always enjoyed them in the Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 17 past.” One GP told us in a survey form: “The food always smells very good at lunchtime!” Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 18 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. Systems are in place for people who use the service to make complaints and have them investigated. Staff are trained to recognise abuse and report any allegations to the local safeguarding procedure. EVIDENCE: The home works to the organisation’s complaints procedure which is displayed on notice boards around the home. Action has been taken to address the requirement we made that a record must be kept of all complaints. We said that this record must show actions taken to address each complaint. There had been two complaints investigated in the last year. There were no unresolved complaints. Most of the people we spoke with told us they would talk to staff or Mrs Maslen if there was anything they were unhappy with or wanted to make a complaint. One person directed us to their service users guide for information about the home’s complaints procedure. Another person told us they were ‘encouraged to complain’. In discussions with staff it was clear that they were aware of and confident in using the local safeguarding procedure. In the AQAA Mrs Maslen told us that during interview, all potential staff are questioned about safeguarding issues. We saw copies of the local procedure in the office and staff were able to tell us Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 19 about it unprompted. Staff had recently been trained in recognising abuse and neglect. One person told us in a survey form: “Normally ask my daughter to sort out problems.” One of the relatives told us: “Due to mental health problems this is not always easy but the family has always been able to discuss problems with staff.” One of the GPs told us in a survey form: “I have not had any cause for concern.” Seymour House DS0000028133.V367628.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service benefit from a comfortable, well-maintained and clean environment. Further improvements are planned to enhance many areas of the home. EVIDENCE: Mrs Maslen told us about her plans to refurbish the home. Her next project is to redecorate the dining room. In the AQAA Mrs Maslen told us that the upstairs corridors had been re-carpeted and the stairwells had been redecorated. There is a new hairdressing salon. One of the sitting rooms had been re-decorated and re-carpeted. An upstairs bathroom had been refurbished. Mrs Maslen told us that the old hairdressing room will be fitted out as a tearoom for people and their visitors to make refreshments. There is Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 21 a plan to take out the fitted units in some of the bedrooms and install new vanity units. Mrs Maslen told us that the home’s fire alarm system has been linked to the Fire and Rescue Authority but the emergency services are still called in the event of the alarms sounding. All of the bedroom doors had been fitted with name and number plates in large print to assist some people with recognising their bedrooms. Action has been taken to address the good practice recommendation we made that the contractual arrangements for collection of clinical waste bins should be reviewed. This was to ensure that they are more regularly replaced if the bins become full and creating odour or risk of infection. Mrs Maslen told us that extra bins were now supplied. The home was cleaned to a good standard in all areas. People told us they were very satisfied with the cleaning of their bedrooms. Mrs Maslen told us about the appointment of a head housekeeper. She also said that she had reviewed and revised the cleaning schedules so that all areas were covered. We spoke with the laundry person. They told us they worked from 9am to 2pm, for four mornings a week, with one weekend shift a month. Care staff are expected to carry out laundry duties at other times. Mrs Maslen told us she was recruiting for a further 10 hours laundry person. The laundry was well organised and arrangements were in place for dealing with soiled or infected laundry. Seymour House DS0000028133.V367628.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Increased staffing hours mean that care staff can spend more time with people who use the service. Staff have good access to the organisation’s training programme. This now includes training relevant to the care needs of current people who use the service. Over 50 of staff hold an NVQ Level 2 or above. A robust recruitment process is in operation. EVIDENCE: The care staffing rota showed a minimum of four care staff and a care leader during the mornings. There were three care staff and a care leader during the afternoons and evenings. At night there are three waking night staff. Action has been taken to address the requirement we made that staffing hours must be considered to ensure that people’s needs are met with full provision of care and support staff. We said that management and administrative duties must be excluded from the care hours. On the day of the inspection there were four care staff and a care leader. Mrs Maslen told us that 43 extra care hours had been provided in the staffing budget. There were also and extra 21 hours care support that had been advertised. This role is to support care staff with bed making and serving meals. The role does not involve giving personal Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 23 care. Mrs Maslen also told us that she was recruiting for a new head of care post. These hours were taken from one of the care leader posts. She said that the care leaders now have at least two shifts each week between them to carry out their administrative duties. Action has been taken to address the requirement we made that staff must be trained in working with people with a visual impairment. In the AQAA Mrs Maslen told us that further training was planned. Staff told us about other training they had undertaken. This included: moving and handling, fire safety, first aid, health and safety, safeguarding adults, food hygiene, dementia and mental health. Other training included: risk assessment, customer care, abuse and neglect and communication. In the AQAA Mrs Maslen told us that there is a plan for all staff to attend Equality and Diversity training. She also told us that sixteen of the thirty care staff have NVQ Level 2 or above. One of the staff told us they had NVQ Level 3. Mrs Maslen showed us the individual training records and training certificates she kept for each staff member. These records are also kept electronically. Staff have access to the training provided by the organisation. Further training in mental health was planned for the beginning of September. The mental health team planned to provide training in specific medication prescribed to people with mental health issues. Mrs Maslen has a robust recruitment process with evidence of all of the documents and information required by regulation in place, except recent photographs of staff. Mrs Maslen told us that she was in the process of taking the photographs and showed us some of the photographs. We saw evidence that no one commences working at the home without checks on the Protection of Vulnerable Adults list. This ensures that they are suitable to work with people who may be vulnerable. One of the newer staff told us they had received two days induction. All of the people we spoke to made very positive comments about the staff. One person told us that they were sad that their keyworker had left. They said they had not been allocated another keyworker, but other staff were attending to any special requests and supporting them with having a bath. Another person told us that the staff looked after them very well. Another person described the staff as very kind. They said staff attended to the little things that made them comfortable. One of the relatives told us that staff were very friendly and helpful. We saw that all staff knocked on people’s bedroom doors before being invited to enter. Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 24 One person told us in a survey: “Very slow to answer the emergency call bell. Some staff are better than others at recognising my disability.” Another person told us: “This is a very caring home. Staff are always very kind and go out of their way to help and keep you happy.” One of the staff told us in a survey form: “We are supported with our supervisor on a regular basis. We are in the middle of recruitment. If we are short of staff we cover the shift with agency staff. [What the home does well] Experience, knowledge and hands on experience. Able to update our knowledge regularly.” Another staff told us: “Promotes independent living. I think we do all we can to provide a good service.” Another staff told us: “Been on training courses for dementia and how to look after people who have had strokes. I think there could be more staff to meet the needs of residents as there seems to be a shortage of good carers. But manager is trying to recruit. Offers a safe and homely environment for its residents. [Could do better] Invest in air-conditioning as it’s always hot all year round.” A healthcare professional told us in a survey: [Could do better] “Better staffing ratio to meet level of need. Better training. Better communication i.e. handovers between staff. Improved documentation of daily records. Home odour! If issues are highlighted staff are keen and willing to address. There has been an improvement but this wavered when present manager was off. Residents appear positive about staff group. Families observe a very stretched workforce.” Seymour House DS0000028133.V367628.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, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Mrs Maslen is clear about her priorities for developing the home. The home is run in the best interests of the people who use the service. Staff have good access to supervision. Systems are in place to ensure the health and safety of those who use the service, staff and others. EVIDENCE: Mrs Maslen was registered as manager on 20th September 2007. She holds NVQ Level 4 in care and management. Mrs Maslen told us that she is nearing completion of the Registered Managers Award. She has also undertaken training in supervisory management, personal development, dementia care, Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 26 visual awareness, health and safety and water hygiene. Mrs Maslen told us about her plans to develop care planning, the staff group, the environment, staff training and the activities programme. Many of the people told us that they could air their views at the ‘residents meetings’. Some people told us that they would go directly to Mrs Maslen to talk about issues. The organisation had recently carried out a quality audit of the home. An action plan has been drawn up and Mrs Maslen is addressing any recommendations. We did not look at the arrangements for safekeeping any money held on behalf of people who use the service. At the last inspection we judged that this area was being well managed by the home’s administrator with regular audits of the records and all transactions. Staff told us they received regular supervision. They also told us that they could contribute to the agenda at regular staff meetings. The risk assessments of the environment and tasks were reviewed and revised in June 2008. Mrs Maslen told us she held regular meeting with staff about health and safety. She went on to say that assessments were carried out as risks arose. There are two handymen who carry out minor maintenance and decoration. The organisation contracts with suppliers for other maintenance and repair of equipment and services. Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 27 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 X 3 X 3 Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 28 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP8 OP37 OP9 OP37 Good Practice Recommendations The nutritional score in the pressure damage risk assessment should relate to the outcome score in the nutritional risk assessment. The liquid medication registered and stored in a controlled drug cupboard should show a balance in the controlled drug register after each administration. Records should be kept of the opening of each new bottle together with the number of bottles held. The medication should not be poured out after each administration to measure the remainder. Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Seymour House DS0000028133.V367628.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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