Care Home: Southfield

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What the care home does well Detailed assessments are made with potential residents and others involved in their care. Care plans are in place on the day when residents are admitted to the home. Residents are consulted about who provides their intimate personal care. Residents` healthcare needs are regularly monitored and any concerns referred to the relevant professional. Care plans identify specific administration instructions for medication that is prescribed to be taken only `when required`. There is also clear instruction for other medication with specific prescribing instructions. Those residents who can decide, spend their day as they wish. Others rely on staff for direction. Residents who like to spend some of their day in their bedrooms have easy access to their call bells and are provided with jugs of juice or water. Jugs of juice and glasses are provided in all of the sitting rooms for residents to help themselves.The organisation provides a range of inter-home activities and entertainment. A range and variety of meals are provided. Fresh ingredients are used. Residents can choose where they have their meals. Residents are encouraged and appeared confident in making their views known and complaining about the service to staff or management. Complaints are taken seriously and thoroughly investigated. Staff are confident in reporting any suspected abuse of residents using the local Safeguarding Adults procedure. A programme of upgrading the environment for residents` comfort and safety is well underway. Residents and families are informed of any works that may have an impact on the care of the residents. Over 50% of staff have NVQ Level 2 or above. Staff have good access to mandatory training and regular updates. A robust staff recruitment procedure is in place. The organisation regularly audits the quality status of the home. Results are actioned. Residents have opportunities to feed into the audits as well as at their regular residents meetings. What has improved since the last inspection? New care planning documentation is being used. Care plans are now more comprehensive and show how care needs are met and monitored. Details of some residents` medical conditions and how they are to be met and monitored are now recorded in care plans. A member of staff has the delegated responsibility for the provision of dementia care and is liaising with families about the residents` care and support. Residents` risk of developing pressure damage is now better assessed. Staff have been trained in prevention of pressure damage. Care plans for managing the risks are now in place. The `resident of the day` system enables staff to review and revise residents` tissue viability care plans. The language used in care plans and daily reports is now factual and nonjudgemental. The records for the administration of controlled medication are being properly maintained. All care staff who carry out blood glucose monitoring have been trained to do so by a nurse manager in the organisation.Residents are being provided with more one to one time with staff. The staffing rota has been revised to allow for better cover at peak times. Staff training has been carried out in subjects related to the care and support of residents. What the care home could do better: The form for assessing residents` risk of developing pressure damage should identify whether the resident has a history of pressure damage. It should also be clear which score outcomes prompt the district nurse to be informed. The nutritional risk assessment should relate to the numbering system for nutrition in the pressure damage risk assessment. The bathing risk assessments should identify whether residents bath alone or with staff support. When fluid charts are indicated, the amount to be achieved each day should be identified on the chart for ease of monitoring. The totals for each day should be recorded. The hot drink making facilities in the visitors` sitting room should be kept stocked with milk and sugar. The care staffing levels must not be reduced at the weekends. CARE HOMES FOR OLDER PEOPLE Southfield Victoria Road Devizes Wiltshire SN10 1EY Lead Inspector Sally Walker Unannounced Inspection 10th April 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Southfield DS0000028318.V359750.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. Southfield DS0000028318.V359750.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Southfield Address Victoria Road Devizes Wiltshire SN10 1EY 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) 01380 723583 01380 728647 manager.southfield@osjctwilts.co.uk The Orders Of St John Care Trust Valerie Weston Care Home 42 Category(ies) of Dementia - over 65 years of age (12), Learning registration, with number disability over 65 years of age (2), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (8), Old age, not falling within any other category (42), Physical disability over 65 years of age (2) Southfield DS0000028318.V359750.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th July 2007 Brief Description of the Service: Southfield is a purpose-built residential home for 42 older people, some of whom may have dementia or be experiencing mental health difficulties. The home was formerly owned and run by the local authority, but has for some years been provided by the Orders of St John Care Trust. This is one of a number of homes provided by them in Wiltshire and elsewhere. Accommodation is all in single rooms, located on two floors, with a passenger lift to the first floor. All bedrooms have wash hand basins and two have ensuite facilities. Toilets and bathrooms are located conveniently. There are sitting rooms on each floor, whilst behind the home are extremely attractive and secure gardens, including a patio area. The dining room overlooks the gardens. The home is located in a residential area a short walk from Devizes town centre, where shopping and social facilities are available. There are good bus links to neighbouring towns, whilst the home has its own adjacent car park. Weekly fee levels range between £410.00 and £485.00, according to assessed dependency. Southfield DS0000028318.V359750.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 was carried out on 10th April 2008 between 9.00am and 5.50pm. Mrs Valerie Weston was present during the inspection. Mrs Yates, care services manager, was present for feedback at the end of the inspection. We looked at care records, medication records, staffing records, rotas, menus and risk assessments. We spoke with 6 residents and 3 staff. 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 Weston to complete an Annual Quality Assurance Assessment. This was completed in full and received 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: Detailed assessments are made with potential residents and others involved in their care. Care plans are in place on the day when residents are admitted to the home. Residents are consulted about who provides their intimate personal care. Residents’ healthcare needs are regularly monitored and any concerns referred to the relevant professional. Care plans identify specific administration instructions for medication that is prescribed to be taken only ‘when required’. There is also clear instruction for other medication with specific prescribing instructions. Those residents who can decide, spend their day as they wish. Others rely on staff for direction. Residents who like to spend some of their day in their bedrooms have easy access to their call bells and are provided with jugs of juice or water. Jugs of juice and glasses are provided in all of the sitting rooms for residents to help themselves. Southfield DS0000028318.V359750.R01.S.doc Version 5.2 Page 6 The organisation provides a range of inter-home activities and entertainment. A range and variety of meals are provided. Fresh ingredients are used. Residents can choose where they have their meals. Residents are encouraged and appeared confident in making their views known and complaining about the service to staff or management. Complaints are taken seriously and thoroughly investigated. Staff are confident in reporting any suspected abuse of residents using the local Safeguarding Adults procedure. A programme of upgrading the environment for residents’ comfort and safety is well underway. Residents and families are informed of any works that may have an impact on the care of the residents. Over 50 of staff have NVQ Level 2 or above. Staff have good access to mandatory training and regular updates. A robust staff recruitment procedure is in place. The organisation regularly audits the quality status of the home. Results are actioned. Residents have opportunities to feed into the audits as well as at their regular residents meetings. What has improved since the last inspection? New care planning documentation is being used. Care plans are now more comprehensive and show how care needs are met and monitored. Details of some residents’ medical conditions and how they are to be met and monitored are now recorded in care plans. A member of staff has the delegated responsibility for the provision of dementia care and is liaising with families about the residents’ care and support. Residents’ risk of developing pressure damage is now better assessed. Staff have been trained in prevention of pressure damage. Care plans for managing the risks are now in place. The ‘resident of the day’ system enables staff to review and revise residents’ tissue viability care plans. The language used in care plans and daily reports is now factual and nonjudgemental. The records for the administration of controlled medication are being properly maintained. All care staff who carry out blood glucose monitoring have been trained to do so by a nurse manager in the organisation. Southfield DS0000028318.V359750.R01.S.doc Version 5.2 Page 7 Residents are being provided with more one to one time with staff. The staffing rota has been revised to allow for better cover at peak times. Staff training has been carried out in subjects related to the care and support of residents. 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. Southfield DS0000028318.V359750.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 Southfield DS0000028318.V359750.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. The home makes sure that sufficient information is gained about potential residents so that decisions can be made about whether their care and support needs can be met. EVIDENCE: The home’s statement of purpose and service users guide were reviewed and revised during February and March 2008. Southfield DS0000028318.V359750.R01.S.doc Version 5.2 Page 10 Either Mrs Weston or one of the senior staff carries out the pre-admissions assessments. The assessments take into consideration a visit to the potential resident to assess their needs, the care manager’s assessment if a person is funded by a local authority, the comments and views of the families, healthcare professionals and others involved in the care. This enables the home to decide whether the person’s care needs can be met. Potential residents and their families are encouraged to spend time at the home to view the room and discuss any issues. We saw that people who were using the respite service had care plans in place for the day of their arrival. Comments in a healthcare professionals survey forms included: “A comprehensive assessment is provided when we place someone at Southfield – they are usually good at following up any health issues and contact district nurses, GPs, mental health, CPNs etc.” Southfield DS0000028318.V359750.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. Care plans are more comprehensive and give details of all residents care needs and how they are to be met and monitored. Residents have good access to healthcare professionals. Residents can administer their own medication following a risk assessment. Safe systems are in place for the administration of medication. Staff uphold residents rights to dignity and respect. EVIDENCE: Action had been taken to address the requirement we made that all residents current care and support needs are recorded in their care plan. The organisation had recently produced a new care planning format. Mrs Weston told us that care staff had implemented the new format. Monthly meetings are held to discuss any care issues with staff. Southfield DS0000028318.V359750.R01.S.doc Version 5.2 Page 12 Staff told us that the new care plan system was much improved. There was good information about residents’ care and support needs and how they were to be met. There was good evidence in the daily reports that the care plans directed the care. There was good evidence of how residents’ emotional wellbeing was being managed and monitored. As a matter of good practice we saw details in some residents care plans that they must be offered a wheelchair if they were experiencing any difficulties in walking. Those residents with diabetes had detailed care plans on how their condition was managed and monitored. We saw records of residents’ decisions as to who provided their intimate personal care. Mrs Weston told us that the organisation was in the process of producing a gender working policy with regard to the provision of intimate personal care. It was clear that staff took time to ensure that residents were well groomed. All personal care was carried out in private. Mrs Weston told us that a member of staff had the delegated responsibility for the provision of dementia care in the home. They were due to talk with families about the care and support in the home. The new care planning format included a pressure damage risk assessment and a separate nutritional assessment. We saw that the pressure damage form did not take into consideration any history of pressure sores. We also noted that the scores on the nutrition form had a different numbering system that did not relate to the number system of the pressure damage risk assessment. The pressure sore risk assessment format did not state which score prompted the district nurse to be notified. We noted that one care plan identified that the resident was ‘prone to leg ulcers’. Moving and handling risk assessments were identified in residents care plans. The bathing risk assessments showed good details. However there was no record of whether residents needed staff support when bathing. We were told that none of the residents bathes alone and are never left in the bathroom alone. We advised that this should be recorded in the assessments. The organisation had reviewed and revised all the policies and procedures relating to care provision. Staff were required to familiarise themselves with the new documents. Action has been taken to address the good practice recommendation we made that consideration is given to the appropriateness of some of the language used in records. We said that staff should record only what is observed or said rather than their own projections. We found the language used in records and report to be factual and non-judgemental. Southfield DS0000028318.V359750.R01.S.doc Version 5.2 Page 13 Action has been taken to address the good practice recommendation we made that measuring different sizes of drinking vessels should enable better monitoring of fluid intake. We said that daily totals would also enable better monitoring. A file of fluid charts was kept in the office. Not all the charts had the daily totals. We talked with staff about why we had recommended this. We also talked about the need to identify on each chart the amount each resident was expected to achieve each day. We advised staff to discuss these charts with the district nurse so that the individual amounts could be decided upon. We saw that those residents who were visited in their bedrooms had fresh juice or water in a jug and a glass within easy reach. We also saw that these residents had their call bells within easy reach. There was also a jug of juice and some glasses on a tray in all of the sitting rooms for residents to help themselves. One of the residents told us about the hot drink making facilities available to them and their visitors in one of the small sitting rooms. When we looked at these facilities we found that there was no milk in the fridge and no biscuits or sugar in the containers. Mrs Weston said she would immediately address this with the staff responsible. Residents were weighed on admission and monthly thereafter. Any significant weight loss was referred to either the GP or the dietician. Food intake charts were in place when indicated. One of the residents told us they went to see their GP at the surgery. They said the district nurses came to dress their leg. They said that care staff put cream on their legs, but not the male staff. One of the care leaders showed us the arrangements for the medication. Residents can administer their own medication following a risk assessment including the GP or social worker. The staff told that the pre-admission assessment would identify whether prospective residents were administering their own medication. These residents sign to say the have received their medication. The home operates a monitored dosage system put up by the supplying pharmacist. The medication of those residents who were using the respite service remained in the original packs and were kept in separate containers. Staff can only administer medication following training and an assessment of their competence by a senior member of staff. Continued competence is monitored regularly. All medication received or returned to the pharmacist is recorded. Records of all administrations were being properly recorded. Care plans identified when medication that was prescribed to be taken ‘when required’ should be given. Care plans were clear about the different sites for administration of medication delivered via an adhesive patch. Southfield DS0000028318.V359750.R01.S.doc Version 5.2 Page 14 Action had been taken to address the requirement we made that proper records are kept of the administration and control of controlled medication. This related to staff witnessing each administration, signing and dating the register and making sure the details are entered into the correct part of the register for the named resident. Action has been taken to address the requirement we made that only staff who have been trained to do so by the district nurse, carry out the tests of residents blood glucose levels where indicated. We said that the training must not be cascaded to other staff. We also said that either a certificate of competence or a record of who had attended the training and who had carried it out must be in place. A nurse manager from the organisation had carried out the training with named staff and this was recorded in individual care staff training records. One of the relatives who was visiting told us that they thought the care was good. They said they could visit at any time and were kept up to date on their relative’s progress. They said the staff would ask their relative’s GP to visit if they had concerns about their health. Action has been taken to address the good practice recommendation we made that the ‘resident of the day’ system was used as an opportunity to consider whether obvious risks to pressure areas have increased, e.g. by a person becoming more sedentary and adding new detail to tissue viability care plans. Care staff told us about the system and showed us the checklist of areas they were considering with the ‘resident of the day’. They were focussing on 2 residents that day. As well as reviewing the care plan; arranging appointments or tidying their room, staff would also arrange trips out for shopping and one to one time. Comments in a healthcare survey form included: “I have not reviewed anyone with outstanding health care needs. When attending an ‘out of hours’ carol service before Christmas 2007 – some of the residents were wet and smelly. One lady had soiled herself on the way to the day centre – this was dealt with quickly and unobtrusively.” Two GPs responded in survey forms. Both said yes to the question as to whether the home communicated and worked in partnership with them. Both said yes to the question as to whether senior staff were always available to confer with. Both said they were able to see their patients in private. Both said residents’ medication was appropriately managed. Both said staff make appropriate decisions when managing residents care needs. Both said yes to the question as to whether they were satisfied with the overall care in the home. Southfield DS0000028318.V359750.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): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ social interests are taken into account in assessments and care plans. Contact with family and friends is encouraged. Most of the residents decided how they spent their day. Others relied on staff for direction. Residents enjoyed the range and variety of meals prepared from fresh ingredients. EVIDENCE: Most of the residents spoken with spent their day as they wished. Other residents relied on staff for direction. One resident told us they often liked to go back to bed during the day for a rest and this was respected by staff. Some action had been taken to address the good practice recommendation we made that consideration is made to identifying and providing occupation for those residents unable or disinclined to join group activities. Southfield DS0000028318.V359750.R01.S.doc Version 5.2 Page 16 In the Annual Quality Assurance Assessment Mrs Weston told us that an extra 36 hours a week had been added to the establishment hours to provide more one to one time for residents. She also told us that the range of activities had increased including more one to one activities. Care plans identified residents’ hobbies and interests. An activities co-ordinator works 20 hours a week and staff also help with activities provision. The activity programme for the week was displayed on notice boards. There were at least 2 activities each day. Residents were having a game of bingo on the afternoon of the inspection. Other activities included: music sessions, hang man, skittles and snakes and ladders. Residents are offered trips in the locality. A small charge may be made but the amenities fund generally pays for any trips. Seven residents had recently been to a tea dance organised by the organisation for all the homes in the Wiltshire area. Photographs of the event were displayed on the notice boards. The organisation’s planned inter-home activities were displayed in a programme for the coming year. One of the residents told us about the hairdressing salon where they had their hair done each week. Another resident told us they liked gardening as a hobby. A relative told us that they were always made welcome by staff when they visited. The meals for the day were displayed in large print at the entrance to the dining room. Residents could have a range of cereals, fruit and a cooked dish for breakfast. There were 2 cooked choices and a salad for lunch. For the evening meals there were 2 choices for the main course. One of the residents said they liked their own company and spent a lot of their time in their bedroom reading. They said staff brought them their meals in their bedroom. They said they got up and went to bed when they chose. They also told us that they had been out with family the day before. Another resident told us they went to the dining room for their meals. They described the meals as ‘ordinary’. Although they did say that they were always asked what they wanted and that there was usually an alternative if they did not like what was on the menu. They said they did not like pasties. They went on to say that the salads were very good. They said that the cutlery was very heavy. They also said that cups of tea were always delivered hot. Another resident told us that the soups were ‘made from scratch’. They described the soups as ‘out of this world’. We looked at the menus. There was a range and variety of mainly traditional dishes with salads and vegetarian options. Southfield DS0000028318.V359750.R01.S.doc Version 5.2 Page 17 The lunch was well presented and tasty. Residents could choose which dish they wanted as it was served. Residents could help themselves to juice and condiments on the table. There was a choice of four juices or water. Residents were given support to eat or reminders by care staff as needed. The meal time was quiet and unhurried. At the last inspection we saw that the quiet atmosphere of the meal time was marred by the amount of noise coming from the kitchen. At this inspection the kitchen was quiet. However we noted that the voice of one of the members of staff serving meals and collecting plates was very loud. We discussed some of their comments to residents who had asked for attention with Mrs Weston and Mrs Yates. Comments in a healthcare professionals survey form included: [Can improve?] “More activity – so that the lounge and entrance area are not populated by people doing nothing.” Southfield DS0000028318.V359750.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. Complaints are taken seriously and fully investigated. Staff are confident in referring any concerns about abuse of residents using the local Safeguarding Adults procedure. EVIDENCE: Residents seemed confident in reporting complaints or anything that they were not happy with. One of the residents told us they would talk to their keyworker if they wanted to make a complaint. Another told us that information about making a complaint was displayed on the notice boards. They went on to say that they could not read it, or the other notices because the print was too small. They said they would take any concerns to the administrator, the manager or their keyworker. One of the visiting relatives told us that any concerns they had raised had been dealt with immediately. They did not know whether they had been given a copy of the complaints procedure. Southfield DS0000028318.V359750.R01.S.doc Version 5.2 Page 19 Mrs Weston kept a file of all the complaints received. It was clear from the records that complaints were taken seriously. Records were kept of all investigations, any interviews and responses to complainants. In the Annual Quality Assurance Assessment Mrs Weston told us that the issues would be addressed to ensure that the complaints would not be repeated. Staff had attended a safeguarding adults conference. Staff were confident in reporting any concerns they had to the local Safeguarding Adults procedure. Mrs Weston told us that most of the staff had completed a training pack in abuse awareness. Staff told us about the whistle blowing policy. Two GPs responded in survey forms. Both said no to the question about whether they had received complaints about the home. Southfield DS0000028318.V359750.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. The environment continues to be upgraded for residents’ comfort and safety. The home was cleaned to a good standard. Staff are trained in infection control. EVIDENCE: Great effort has been made over the past 2 years to improve the environment for residents’ comfort. In the Annual Quality Assurance Assessment Mrs Weston told us about further planned refurbishments for the year. The building has been re-carpeted and redecorated. Residents had been involved in choosing colour schemes. Southfield DS0000028318.V359750.R01.S.doc Version 5.2 Page 21 The old bar had been removed to provide a visitors sitting room. Over half of the bedrooms had been refurbished with a further 8 to be complete this year. One of the bathrooms would be re-fitted and new sinks provided in residents bedrooms. A new lift and a new fire detection system had recently been installed. Mrs Weston had sent us her risk assessments and management plan for the continued safe delivery of care and support to residents whilst this work being carried out. Families had been made aware of the progress of these works and the arrangements for care of their relative. Mrs Weston had also spoken directly to some visitors. One of the residents told us that they had experienced little disruption when the works were being carried out. They said they were able to use the stairs so they were not confined when the new lift was installed. One of the residents showed us their ensuite toilet and washbasin. Another resident told us that housekeeping staff vacuumed their room twice a day. Another resident told us that they had to move out of their room once a week for it to be cleaned. There was a part time laundry person. At other times care staff carried out these duties. Mrs Weston told us that she had provided 20 hours extra laundry hours in the new budget. The laundry area was clean and well ordered. Laundry was separated into different types as it was collected. It was then washed accordingly. One of the staff told us that one of the washing machines had been out of action for 11 days. They did not know when it would be fixed. Despite this it appeared that staff were managing to service the laundry. Staff are trained in infection control. Comments in a healthcare professionals survey form included: “The smell of urine is sometimes overpowering – this can really put visitors off as they enter.” Southfield DS0000028318.V359750.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. Staffing hours are better allocated throughout the waking day. However care staffing levels at the weekends remain reduced. Over 50 of staff hold NVQ Level 2 or above. Staff are well trained. A robust recruitment procedure is in place. EVIDENCE: The staffing rota provided a minimum of 4 care staff and a care leader during the mornings and three care staff and a care leader during the afternoons and evenings from Monday to Friday. At the weekends this reduced to three care staff and a care leader during the mornings. At night there were 3 waking night staff. Mrs Weston told us that all new staff had been appointed to duties times of either 7.30 to 3.00 or 2.30 to 10.00. She said that this allowed better support for residents at peak times and for a handover period in the middle of the day. The photographs of those staff on duty that day were displayed on the notice board by the office. Southfield DS0000028318.V359750.R01.S.doc Version 5.2 Page 23 Mrs Weston told us in the Annual Quality Assurance Assessment that she had provided 36 extra care support hours in the new budget. This role was not for providing intimate personal care. The post was to serve meals, make beds and other non-care duties. Mrs Weston had also requested a head of care post for 37 hours a week. This post will replace one of the care leader hours and the person would over see the provision of care. There were four care leaders each with a delegated management responsibility. These areas were health and safety, medication, infection control, dementia care training and overseeing respite services. The care leaders also allocated duties for each staff during the shifts. All of the residents spoken with made very positive comments about the staff. One of the relatives told us that they thought the keyworker system was a good idea. They said that staff were very helpful to their relative. It was clear that staff had established good relationships with residents. Action had been taken to address the requirement we made that the staff training programme includes subjects relevant to the care needs of the residents. This included managing diabetes, prevention of pressure damage and tissue viability, mental health awareness and visual impairment. Action has also been taken to address the good practice recommendation we made that opportunities were sought for staff training in mental health issues besides dementia. Mrs Weston kept a record of individual staff’s training profiles. This information was in the process of being transferred into the organisation’s computer system so that training needs can be matched to courses. The organisation provides much of the training and a programme is regularly sent to the home. A nurse manager from the organisation had trained staff in managing diabetes. Staff had attended training in mental health in later life, care planning, nutrition, depression, first aid, health and safety, bereavement, medication, the Mental Capacity Act 2005 and dementia care. One of the staff was undertaking training in supervisory management. Five of the new care staff had NVQ Level 2. Two care staff had commenced NVQ Level 3. One of the housekeepers had NVQ Level 2 and another had commenced the award. In the Annual Quality Assurance Assessment Mrs Weston told us that over 50 of staff hold NVQ Level 2. Mrs Weston also told us that staff are undertaking elearning provided by the organisation. Some of this training has included equality and diversity, and death and dying in relation to the needs and requirements of different faiths and beliefs. The chiropodist was due to give care staff basic podiatry training. One of the care staff told us about their recent training and their previous experience working in different care settings. Southfield DS0000028318.V359750.R01.S.doc Version 5.2 Page 24 We looked at staff records. All the information and documents required by regulation when taking on new staff were on file. No staff commences duties without a check on their suitability to work with vulnerable people. A robust recruitment process is in place. Whilst we were visiting with a resident and their relative, one of the staff came into the room without knocking and waiting to be invited in. Both the resident and the relative told us that this was most unusual. It was their experience that staff always knocked on bedroom doors before entering. Comments in a relatives survey forms included: [Staff have skills & experience?] “As far as one can know. Due to the fact that my [relative] doesn’t speak for [themselves] very often things can be difficult. [Does well?] Treat people with dignity and are understanding. [Do better?] More staff. I think the staff are very kind to my [relative] which to myself & the rest of the family is very comforting.” Comments in a healthcare professionals survey form included: “Staff have variably skills – some are excellent. Usually able to talk to the manager about any problems – these have then been dealt with. Good relationships made between service users and key carers – especially the carers who have been there for some time.” Two GPs responded to survey forms. Both said yes to the question as to whether staff demonstrated a clear understanding of residents’ care needs. Southfield DS0000028318.V359750.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Mrs Weston has experience as a manager for over 4 years. She keeps herself up to date with current good practice through the organisation’s training programme. Quality is regularly audited by the organisation. Residents’ cash is safeguarded with a robust transaction recording and monitoring system. Systems are in place to ensure residents and staff’s health and safety. Southfield DS0000028318.V359750.R01.S.doc Version 5.2 Page 26 EVIDENCE: Mrs Weston has managed the home for over three years and has more than 20 years experience of working with older people. Previously she managed another home in the organisation. She has NVQ Level 4 in management and care and the Registered Managers Award. Mrs Weston keeps herself up to date with current good practice and attends training provided by the organisation. Recent training has included: a mental health conference, my home life; Age Concern, performance management, catering, human resources, reminiscence, dealing with difficult people and quality assurance. The organisation had carried out a quality assurance audit of the home that week. Mrs Weston had received the report and had developed an action plan to address the findings. In the Annual Quality Assurance Assessment Mrs Weston told us that surveys had been sent to the residents and families in the summer. The responses had been collated and action taken to address any issues. Mrs Weston told us that the organisation would then check on the progress. Residents can also make their views known at the regular residents meetings. Regular staff meetings were held with minutes kept. One of the staff told us that all staff are regularly supervised at least every other month. They said they contributed to the agenda and that records were kept in the office, which they agreed and signed. Residents can keep small amounts of cash in the home’s safe. Records and receipts were kept of all transactions. Residents can have access to their money at any time. The balances are regularly checked by senior staff. The environmental risk assessments were regularly reviewed and revised where necessary at least each year. The organisation provided generic risk assessments and Mrs Weston carried out more specific risk assessments related directly to the environment and tasks that staff were involved in. The organisation was in the process of updating the fire procedure in line with the new fire detection system. Fire safety training had been outsourced. This is now carried out for all staff every 6 months. During the inspection the fire alarms were tested. This was carried out on the dame day every week. Staff were prompt in attending the muster point to discuss the test. Risk assessments for individual residents fire safety were detailed in their care plans. Southfield DS0000028318.V359750.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 X 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 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Southfield DS0000028318.V359750.R01.S.doc Version 5.2 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 OP27 Regulation 18(1)(a) Requirement The person registered must ensure that staffing levels are consistent throughout the week. Timescale for action 01/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations Consider how to identify and provide for occupation needs for those residents unable or disinclined to join group activities. Consider how the nutritional risk assessment informs the pressure damage risk assessment. The process should identify whether the resident has a history of pressure damage. The form should indicate which score prompts a referral to the district nurse. Bathing risk assessments should identify whether or not the resident can bath alone and for how long. Fluid charts should state how much is to be achieved each day. The amounts taken each day should be totalled to establish whether the goal has been achieved. DS0000028318.V359750.R01.S.doc Version 5.2 Page 29 2 OP8 3 4 OP8 OP8 Southfield 5 OP15 The stocks for facilities for residents and visitors to make hot drinks should be regularly re-stocked. Southfield DS0000028318.V359750.R01.S.doc Version 5.2 Page 30 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. 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