Care Home: Silverdale House Care Home

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What the care home does well People are assured that their needs will be assessed and that staff can meet these before they make a decision to move into the care home. People using the service are very satisfied with the care on offer and they feel that staff are very kind and treat them with respect. They speak of having very good relationships and enjoying their time living at the care home. Staff spoken with are dedicated to their job role and they are able to discuss the needs of people using the service, they are also supported in their trainingSilverdale House Care HomeDS0000008790.V377649.R01.S.docVersion 5.2and development to ensure that they are able to support people using the service appropriately. A range of activities are on offer which people using the service state that they enjoy and look forward to. A traditional menu is on offer and people using the service tell us that they are very happy with the menu and standard of food. Staff are committed to National Vocational training and the majority of staff have now completed this training to enhance their knowledge and skills in caring for people. The quality assurance system has been further developed to ensure that people using the service are enabled to have a say in how the care home is run and managed. What has improved since the last inspection? Although further work is required, the care planning process has been improved upon, working towards ensuring that people’s needs are fully met. Staff practices have improved greatly ensuring that people are treated with respect and their rights to privacy and dignity are maintained. Although further development is needed the recruitment process has been improved upon, working towards ensuring that people are protected from unsuitable people being employed. Staff training has been improved upon ensuring that staff complete mandatory training, thus having the necessary knowledge and skills to support people using the service. What the care home could do better: Plans of care and risk assessments need further development to ensure that they are in place for people’s identified needs to make sure that their needs are met and they are protected. Improvements in the medication practices are needed to make sure that people using the service are protected by these. The recording of complaints needs to be improved upon to make sure that accurate records are available and these provide and audit trail making sure that they have been dealt with as required. The recruitment process needs development to ensure that there it can be evidenced that people working with only a POVA 1st check in place are supervised, ensuring that people using the service are protected from unsuitable people supporting them.Silverdale House Care HomeDS0000008790.V377649.R01.S.doc Version 5.2 The Local Authority needs to be contacted as the fire alarm systems and staff drills have not been taking place as required; this will ensure that people using the service are protected from the risks of fire. Key inspection report CARE HOMES FOR OLDER PEOPLE Silverdale House Care Home 3 Nottingham Road Hucknall Nottingham NG15 7QN Lead Inspector Karmon Hawley Key Unannounced Inspection 7th September 2009 09:45 DS0000008790.V377649.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Silverdale House Care Home Address 3 Nottingham Road Hucknall Nottingham NG15 7QN 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) 0115 964 0400 0115 963 4880 mroys@fsmail.net Rodenvine Nottingham Limited Jamil Akhter Mrs Mary Linda Roys Care Home 36 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (36) of places Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 named person may be in the category PD. Date of last inspection 9th September 2008 Brief Description of the Service: Silverdale Care Home is registered to provide care and accommodation for up to thirty-six older people. Five of these places are also registered to allow the home to admit older people diagnosed with dementia. The home is situated on a main road close to Hucknall town centre. There are twenty-four single bedrooms and four double-sized bedrooms. The accommodation is on the ground and first floors with two lifts provided to give full access to the upper floor. There large sitting room and a spacious dining room. There are contained gardens to the rear, providing further seating areas. People that smoke have a designated smoking room. Reports on their own quality monitoring and inspection reports are available to people using the service and other stakeholders on request. The registered manager has made this information available in the information corner that has been set up in the home. The weekly fees range from £378 to £420 per week. This depends on the level of assessed need and also whether you move to the home privately or are funded by Social Services. Silverdale House Care Home DS0000008790.V377649.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. The focus of inspections undertaken by the care Quality Commission is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. This inspection involved one inspector; it was unannounced and included the lunchtime period. The main method of inspection used is called ‘case tracking’ which involved selecting three residents and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. People using the service, staff and visitors were spoken with as part of this inspection to form an opinion about the quality of the service. Documents were read as part of this visit and medication was inspected to form an opinion about the health and safety of people using the service. A partial tour of the building was undertaken, all communal areas were seen and a sample of bedrooms to make sure that the environment is safe and homely. A review of all the information we have received about the home from the provider in their Annual Quality Assurance Assessment and the general public since the last inspection was considered in planning this visit and this helped decide what areas were looked at. What the service does well: People are assured that their needs will be assessed and that staff can meet these before they make a decision to move into the care home. People using the service are very satisfied with the care on offer and they feel that staff are very kind and treat them with respect. They speak of having very good relationships and enjoying their time living at the care home. Staff spoken with are dedicated to their job role and they are able to discuss the needs of people using the service, they are also supported in their training Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.2 Page 6 and development to ensure that they are able to support people using the service appropriately. A range of activities are on offer which people using the service state that they enjoy and look forward to. A traditional menu is on offer and people using the service tell us that they are very happy with the menu and standard of food. Staff are committed to National Vocational training and the majority of staff have now completed this training to enhance their knowledge and skills in caring for people. The quality assurance system has been further developed to ensure that people using the service are enabled to have a say in how the care home is run and managed. What has improved since the last inspection? What they could do better: Plans of care and risk assessments need further development to ensure that they are in place for people’s identified needs to make sure that their needs are met and they are protected. Improvements in the medication practices are needed to make sure that people using the service are protected by these. The recording of complaints needs to be improved upon to make sure that accurate records are available and these provide and audit trail making sure that they have been dealt with as required. The recruitment process needs development to ensure that there it can be evidenced that people working with only a POVA 1st check in place are supervised, ensuring that people using the service are protected from unsuitable people supporting them. Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.2 Page 7 The Local Authority needs to be contacted as the fire alarm systems and staff drills have not been taking place as required; this will ensure that people using the service are protected from the risks of fire. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.3 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 Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured that their needs will be assessed and that staff can meet these before they make a decision to move into the care home. The service does not offer intermediate care. EVIDENCE: To make sure that staff are able to meet people’s needs before they make a decision move into the care home the manager visits them in the community to carry out a preadmission assessment. On examining people’s personal files, we can see that these assessments have taken place and additional assessments from social workers have been obtained where required, to make sure that staff have all the information that they need to support people appropriately. Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.3 Page 10 People may also come to visit and spend time at the home to get a feel for what it would be like to live there before they make a decision to move in. The manager has put together a lot of information to give to people when they are thinking about moving in so that they have everything that they need to help them make a decision. Staff spoken with say that they receive all the necessary information that they need when someone moves into the care home so that they can support them appropriately. One relative tells us that they came to look at the care home before a decision was made to make sure that they were happy with the service on offer. “I came and had a look around the home, I knew straight away that I could go home knowing they would be safe and well looked after.” The service does not offer intermediate care. Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning process is improving, and the Manager is working towards ensuring that people’s wants and needs are fully met, however where the care planning process has yet not been completed people’s needs may not be fully met. People using the service are not yet fully protected by the medication practices EVIDENCE: People using the service undergo various assessments to establish their care needs. Although there are references to people’s personal preferences within assessments a lot of this information is not used within the plan of care and these remain task focussed rather than person centred to make sure that people receive care and support in their preferred way. Plans of care have continued to develop working towards ensuring that all the necessary information is available for people’s highlighted needs. The manager has spent a considerable amount of time completing these and is in the final Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.3 Page 12 stages, this meant that some of the plans of care that we examined were complete whereas others were not. Within the plan of care that had been completed, in depth information is in place in regard to complex needs such as diabetes mellitus and dementia care, to ensure that staff have all the necessary information they need to support people appropriately. The plans of care that have not been fully completed did not contain all the necessary information and specific care plans in respect of complex needs such as weight loss and terminal care were not in place. The manager sent us further evidence to demonstrate that plans of care and risk assessments have all been completed after the inspection, therefore this requirement has now been complied with. Additional training is also in the process of being arranged for care staff so that they can be more involved in the care planning process. On speaking with staff they are able to discuss people’s needs and the support that they require to ensure that these are met. Staff have a very good knowledge and understanding in regard to diabetes mellitus and can clearly outline the specialist attention that may be required. Additional summaries are also now complete, which outline people’s rights and choices and what is important to them to ensure that staff are fully aware of this and support people appropriately. We can see that plans of care are reviewed as necessary and significant changes are noted in the majority of cases to ensure that people receive continuity of care. The completion of risk assessments to ensure that risks are reduced and managed is the same as plans of care and some have been completed where others have not. Again those completed cover the assessments in respect of the daily activities that one may encounter as well as complex needs such as diabetes mellitus and the use of some medication. However within one plan of care there are no risk assessments, one of the risks being the safe use of bedrails. People using the service told us, “they help me when needed,” “I am very happy and settled, the staff are very good and polite, I am well looked after.” Plans of care show us that people are able to access specialist services such as the doctor, district nurse and optician when they need to. Two people using the service confirm this; “I can see the doctor at any time and I have done so recently, I also see the chiropodist when needed,” and “I have seen the doctor when I am unwell and they have given me some medicine.” During the brief tour of the care home we saw specialist equipment in place such as cushions and mattresses to aid the maintenance of healthy skin. Staff spoken with feel that there is enough specialist equipment for the needs of people using the service. Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.3 Page 13 Staff who administer medication are trained to do so, nevertheless on examining medication records we can see that there are some gaps in signing for medication that has been administered and instances where medication has been administered but not signed for to confirm this, which could lead to confusion as to whether people have received their medication as prescribed. We can also see that handwritten entries are not signed by two members of staff to show that these have been checked as correct to ensure that people receive the correct amount of medication, however when we checked these, the medication records did match the prescription. Although fridge temperatures are monitored and recorded to make sure that medication is stored at the correct temperature there are no records available to demonstrate that the temperature of the room is also being monitored. All other medication records such as controlled drugs and drug returns examined are maintained as required. Plans of care and risk assessments are in place in regard to staff supporting people with their medication if they are unable to do this themselves. Two members of staff are dignity champions, they attend regular meetings to gain information about how to ensure that people’s dignity is maintained, they then cascade this information to other members of staff to ensure that good practice is maintained. Throughout the visit we observed staff to treat people with respect at all times and maintain their dignity. We can see that plans of care consider maintaining people’s privacy and dignity and also promoting and supporting people’s choices. On speaking with staff they are able to discuss what they consider important and how they maintain people’s privacy, dignity and confidentiality. People using the service tell us that staff are respectful and maintain their privacy and dignity at all times. Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported to experience a lifestyle which satisfies their needs and meets their expectations and to maintain contact with those important to them. EVIDENCE: The manager has spent time talking with people using the service, asking what activities they prefer and would like to do. A member of staff is coordinating activities and we can see from the notice board that activities are arranged for most days should people wish to join in these. Activities on offer are things such as bingo, dominoes, baking, arts and crafts and outside entertainers such as music to health. The manager said that people enjoy the music to health and therefore it has been booked to come for the whole year so that people can look forward to this. Within plans of care an activity sheet has been added and we can see that people usually join in some form of activity on a daily basis. Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.3 Page 15 During the afternoon of our visit we saw most of the people using the service join in a game of bingo, which they later said that they enjoyed, especially those who had won a prize. The structural changes made in the main lounge now affords a bigger communal area where people are more easily able to interact with each other should they choose to do so. People using the service offer the following comments: “there are plenty of things to do, I also make my own activities and entertainment, you can’t always be reliant on staff, I enjoy the singers and I have friends here,” there are some activities, I enjoyed the baking, I made scones, I used to do a lot of baking so this was good,” and “there is sometimes bingo on offer.” Staff spoken with feel that there are sufficient activities for people to do to keep them occupied, they also state that they ensure that people are treated as individuals and are supported to do activities that they enjoy doing. A regular church service is held in house and the vicar also visits the home to see people if they wish and staff spoken with say that several people enjoy this. People are supported to attend day centres if they wish and events in wider community. One person using the service tells us that they attend the day centre on a regular basis, which they enjoy as it gives them to opportunity to meet their friends and another speaks of going out with their family and doing their shopping. Staff tell us that the routine of the care home is flexible and people may spend their time as they wish, people spoken with confirm this and offer the following comments; “I have my independence, I can go out with my son when I want to, I can do what I want, I often go to my room at six and watch the TV and have me time,” and “I am happy here, I can do what want and go to my room when I want.” So that people are able to maintain contacts with people that are important to them there are no restrictions on visiting and visitors may be received in private should this be requested. We saw several visitors come and go throughout the day and they staff made them welcome. Both people using the service and visitors tell us that people are made welcome at any time. Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.3 Page 16 Some staff have attended training in equality and diversity so that they are aware of people’s individual and diverse needs and how they may support people more appropriately to ensure that these are met. Assessments within care plans support people’s diverse needs and provide staff with sufficient information to ensure that they are able to support people. A traditional menu is on offer with choices available at each mealtime. The manager has also made a picture menu to assist those people who may not be able to understand a written one. Special diets such as diabetic diets are also catered for. People using the service told us, “the food is very good, there is plenty to eat and we get choices,” “the food is very good, we can have a cooked breakfast twice a week,” and “they are very accommodating with the menu on offer.” Staff feel that a nutritious diet is on offer and if people do not like what is on the menu then they will offer alternatives. Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are protected from abuse and are assured that their complaints will be listened to and acted upon, however record keeping may mean that some complaints are not fully audited. EVIDENCE: People using the service have access to the complaints procedure and they are given a copy of this when they move into the home so that they know how to use it if they need to. The annual quality assurance assessment told us that the service has not received any complaints since the previous inspection, however on examining the complaints file and from our records we can see that the service has received three complaints since the previous inspection. These are in regards to staffing levels, medication supplies, standards of care and a lack of communication. Although all of these have been investigated and resolved as required there are no records available for one complaint concerning staffing levels. As this had been referred to the service via ourselves the manager had not recorded this in the file. People using the service tell us that they are happy with the care and support that they receive, “I have no complaints, I am safe and well looked after,” and Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.3 Page 18 “I can approach the manager if I have any concerns or problems, however I do not have any.” Staff spoken with are able to discuss the action that they would take should they receive a complaint to ensure that this is dealt with effectively. The majority of staff have undertaken training in safeguarding adults to ensure that they are aware of their roles and responsibilities in keeping people protected from abuse, on speaking with them they are able to discuss their responsibilities, what they would do should they feel that abuse is occurring and they state that maintaining people’s safety is a priority. There has been one safeguarding investigation since the previous inspection in respect of a member of staff’s attitude to a person using the service. Although unsubstantiated, action was taken to address any issues to ensure that any areas of improvement could be made. Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service live in a comfortable and homely environment. EVIDENCE: The care home remains comfortable and satisfactorily maintained. There are various seating areas available around the care home that people using the service may use at any time and we saw people access these during our visit. The wall between the activity room and the main lounge has been removed making a larger and more comfortable communal space for people to use. People’s rooms are personalised and people can bring in their own furniture to make it feel more homely. Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.3 Page 20 Specialist equipment and adaptations such as specialist baths and grab rails in the corridors are in place to assist those people with a disability. Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported by staff who are well trained, however they are not fully protected by the recruitment practices in place. EVIDENCE: Although there have been concerns in respect of the staffing levels in the past, action has been taken to resolve these issues and during our time at the service we can see that sufficient staff are available to support and meet people’s needs. The manager has also completed an audit to identify people’s needs and the staff support they require to ensure that their needs are met. People using the service tell us that the staff work very hard and they offer the following comments: “staff work very hard and are good at their jobs, I have a good rapport with them, they keep me cheerful, I have a laugh and a joke with them,” “I am happy and settled here, I have been here a long time, staff are very kind and good and there are enough staff available to help but we do have to wait our turn sometimes which is understandable,” “there are enough staff in general they are sometime short due to sickness or annual leave, however the staff work so hard it does not generally affect us,” and “I am very happy and settled, marvellous staff and care.” Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.3 Page 22 Staff feel that the previous staffing concerns have now been fully addressed and the staffing levels are now much better and there are enough staff available to meet people’s needs. 78 of staff have completed the National Vocational Qualification level 2 or above in care (NVQ - a nationally recognised work and theory based qualification) which develops knowledge and skills in supporting people. One member of staff spoken with confirms that they have undertaken this qualification, “I have done the NVQ level 2 and I am now doing level 3, which is good as it enables us to develop our practice.” So that new staff are aware of their roles and responsibilities when they commence employment they undertake an induction. We saw evidence of this taking place within staff files examined. Staff spoken with both confirm that new staff undertake an induction, “I had an induction when I first started working here, all new staff have an induction, they are shown around and have support from senior carers for a few weeks, and they are given a booklet to complete,” and “new staff have inductions, they are supervised by senior staff.” Staff files examined show us that whilst a satisfactory recruitment process is followed and all the necessary documentation required by law is obtained, such as references and proof of identity before a person is employed, the process once this has happened does not fully protected people using the service from unsuitable people supporting them. The service does not have a written policy in regard to supervision when a person is employed with only a POVA 1st (a check to see if an individual has been placed on a list of know people who have abused vulnerable people) to show how staff are supervised and people using the service are protected whilst waiting for a Criminal Record to be completed. The manager stated that staff members employed with only a POVA 1st are supervised by senior staff and that they complete a signature sheet, however this was not available for inspection to substantiate this nor did the duty rota highlight who was responsible for supervising people with only a POVA 1st in place. Staff spoken with tell us that people who only have a POVA 1st in place are supervised; “staff who only have a POVA 1st in place are allocated to work with senior carer,” and “staff working with a POVA 1st are supervised.” Staff training records examined demonstrate that staff continue to undertake mandatory training such as manual handling, fire and health and safety so that they have the necessary knowledge and skills to support people. We saw that update training has also been arranged for the near future for some staff in all mandatory areas to maintain good working practices. Staff spoken with state that they are supported in their training and development, “I have done all of the mandatory training and I feel that there is Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.3 Page 23 enough training to do our job, if there is anything new we go on a course,” and “there is enough training offered to do our job, it enables us to develop practice.” Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are enabled to have a say in how it is run and managed, however some of the practices in use, such as the safekeeping of people’s personal finances whilst they ensure that these are protected they may also be restrictive. EVIDENCE: The manager has completed the Registered Managers Award (a nationally recognised work and theory based qualification to enhance management knowledge and skills) and a dementia care course, she is also due to complete all mandatory training this year to ensure that she remains up to date with good practice recommendations. Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.3 Page 25 People using the service tell us, “I have no complaints, if I did have I could speak with the manager, I have a good relationship with her,” and “the manager is nice and approachable, the home is well run.” Staff spoken with state, “things are going ok, things are smoother now that the manager is back, I feel supported and she is approachable,” and “the manager is very supportive and approachable.” People using the service and their relatives are enabled to have a say about how the service is run and managed by way of questionnaires. Several questionnaires have recently been returned and all are of a positive nature with the exception of a few minor issues, such as more variety in the menu and an odour in a toilet, which have been addressed. Many gave positive comments as follows: “I am happy here, I can come and go as I please as long as I let staff know,” “staff are all very helpful, this is the best place for a person in my position,” “as far as homes go this is the best, all staff are lovely,” and “I am happy with the meals, there is a good variety, the staff couldn’t be better, I love it.” One person using the service says, “I filled in a questionnaire, if there are any issues these are addressed.” The manager has begun to carry out some audits to ensure a quality service is delivered, these include health and safety issues, accidents and boxed medication. The arrangements for people’s personal money are clearly documented within plans of care and there are arrangements for people to have their money held in safe keeping if required. On checking these accounts we can see that receipts are kept for all transactions and these are signed by two members of staff to make sure that safe practices are maintained. The manager is the only person who has access to the safe and usually arrangements are made should people require any money when she is not in the care home, however should a person require access to their money without planning this is not available. When examining the medication we found that some money had been placed in here so that senior care staff could access it. Staff spoken with confirm that they can not access money and this is the arrangement that is used. The annual quality assurance assessment told us that regular servicing and maintenance takes place on the equipment within the care home, however when we examined the lift and gas certificate, this was out of date. The manager contacted the service providers who confirm that the necessary testing has taken place and replacement certificates will be sent. On examining the fire log book we can see that there are no records to show that staff have undertaken fire drills and the testing of the emergency lights Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.3 Page 26 and fire systems have been sporadic. This was discussed with the manager who stated that a member of staff has been nominated to ensure that these tests are carried out as required. Accident records show us that sufficient information is recorded when accidents occur and staff are taking appropriate action to ensure that people receive the correct treatment and support if necessary. Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.3 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 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.3 Page 28 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 Medication that has been administered must be signed for. Medication that has not been administered must not be signed for. This will ensure that people received their medication as prescribed. A summary of complaints received by the service must be available for inspection. This will ensure that people using the service are assured that an audit trail is available and CQC monitor their complaints. This is an outstanding requirement from 15/10/08 and further development is required to fully comply. Staff employed with only a POVA 1st in place must be supervised at all times and documentary evidence of this must be available. This will ensure that people using the service are protected Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.3 Page 29 Timescale for action 30/10/09 2 OP16 22(8) 15/10/09 3 OP29 19(1) 01/10/09 from unsuitable people being employed. 4 OP38 13(4,c) You must liaise with the Local Fire Authority in regards to the testing of fire systems and staff drills. This will ensure that people using the service are protected form the risks of fire. 30/10/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3 4 5 Refer to Standard OP7 OP9 OP9 OP31 OP35 Good Practice Recommendations Plans of care are further developed to become person centred so that people receive support in their preferred way. Handwritten entries on medication charts are signed by two members of staff to show that these have been checked as correct. Temperatures of the room where medication is stored are monitored to ensure that medication is stored at the correct temperatures. Ensure that the AQAA contains up to date and correct information. Reassess the arrangements for the safe storage of people’s personal allowances so that they have access to these at all times. Silverdale House Care Home DS0000008790.V377649.R01.S.doc Version 5.3 Page 30 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.eastmidlands@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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