Care Home: The Close

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What the care home does well The home`s approach to caring for people with dementia is based on a personcentred perspective, which was reflected in the quality of care interactions and how care plans are written. We found the same calm but involving atmosphere as at the previous inspection, and which was described in surveys returned by some people`s relatives. There was a proactive approach to health promotion, including regular opportunities for movement and mental stimulation, combined with ensuring people ate and drank enough. Weight records were kept and, for some people, there were measured fluid intake and output charts. All residents received free chiropody treatment. The home also provided a visiting physiotherapist. A GP indicated confidence in the care provided by the home, and satisfaction with the home`s level of liaison with the surgery. There has been similar appreciation of the home from community nurses. All instances of giving care that we observed were skilled and patient. There was a high level of eye contact between residents and staff, and a lot of conversation. Members of staff gave people explanations of what they were doing, encouraged choice and gave praise. Examples of statutory care reviews, conducted by the mental health team, all noted that people`s families were very satisfied with the nature of care received by their relatives. At the previous inspection, a relative had commented on "The imaginative daily exercises and activities". We saw that members of staff took up opportunities for conversation with residents, both one-to-one and in small groups. People were helped in orientation to the time of day, day of the week and the weather. A group of children from a local secondary school visited the home twice weekly as a community service project within the Duke of Edinburgh Award scheme. They engaged residents in conversation and simple games. The home is an extended family home and as such, has a number of attractive and homely features. Furniture and soft furnishings were of good quality. People were seen to use many parts of the home and garden as they chose, including the kitchen with supervision. Standards of cleaning around the home were good, with no offensive odours. The home has had a largely stable staff team, who receive regular training opportunities and individual supervision. One person had been recruited to bring the team up to full strength. Records showed their appointment was confirmed only after interview and full checks on their background were completed, to be sure they were a safe person to work with vulnerable people. The member of staff had completed an induction and was about to commence NVQ (National Vocational Qualification) in care, level 2. The deputy manager had completed NVQ to level 4. What has improved since the last inspection? Mr Roche supplied an improvement plan as required in response to the previous inspection, and the required improvements have been carried out within the intervening six months. Most significantly, all radiators and exposed hot pipes have been fitted with covers, to remove the risk of burn injury to frail people who could fall against them. The environment as a whole has benefited from attention to paintwork, beginning with areas which we had identified as presenting a high risk to hygiene because they were in too poor a condition to be cleaned adequately. As required, Mr Roche has instituted an audit tool to ensure standards are maintained in these areas. Hygiene has also been promoted by a commitment to avoid soaking of soiled laundry, something we had observed at the previous inspection.An appropriate cabinet has been obtained and installed for the safe keeping of any controlled drugs that might be prescribed to residents in the future. This replaced a very poor previous provision. The home`s quality assurance process has been restarted by way of a survey of relatives and other supporters of residents. We saw that returns were analysed in a way that assisted forward planning of the service. The requirement at the previous inspection was that this process must be sustained annually. What the care home could do better: We did not identify any shortfalls in meeting regulations, and so no new requirements have been set. We recommended at the previous inspection that the home should provide improved signage to doors, suitable to the needs of people with dementia and in keeping with the environment of the home. Whilst improved identifying signs have been put in place, there remains scope for a more imaginative approach, including use of pictures. This may be a task that could be shared with the young people who visit the home. CARE HOMES FOR OLDER PEOPLE The Close The Close Littleton Panell Devizes Wiltshire SN10 4ES Lead Inspector Roy Gregory Key Unannounced Inspection 25th March 2009 2:00 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 The Close DS0000028334.V374647.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. The Close DS0000028334.V374647.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Close Address The Close Littleton Panell Devizes Wiltshire SN10 4ES 01380 812304 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) theclose@hotmail.com Mr John Roche Mrs Aurora Roche Mrs Aurora Roche Care Home 12 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (12) of places The Close DS0000028334.V374647.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th September 2008 Brief Description of the Service: The Close provides accommodation and personal care for older people with dementia. It is registered to accommodate 12 people, but the owners have opted to use two double rooms as large single rooms, unless exceptional circumstances arose where two people, such as a married couple, wished to share a room. The owner Mrs Roche is registered as the manager and the coowner Mr Roche is closely involved with the home on a regular basis. The Close is a detached house set in its own grounds. The residents’ bedrooms are on the ground and first floors, connected by passenger lift. There is a sitting room, divided by arches from a dining room. From there, patio doors lead out to a garden area. Further shared space comprises a small former dining room and a conservatory, either of which may be used as a quiet area or for receiving visitors. The home is situated on the main road through Littleton Panell, a village south of Devizes. There are local shops, pubs and a GP surgery nearby, and it is on a bus route. The home has on-site parking. Bedrooms do not have en suite facilities, but all have wash hand basins. Commodes are provided in the bedrooms. There are six toilets for residents. There are three bathrooms, but only one is equipped with a hoist and the others are little used. There are at least two staff working at all times during the day. At night there is one waking staff member and another person who provides ‘sleeping-in’ cover. Fees payable are between £450 and £500 per week. The Close DS0000028334.V374647.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. We visited The Close unannounced on Wednesday 25th March 2009 between 2:00 p.m. and 5:15 p.m. Whilst this was a key inspection of the service, the primary focus of the visit was how the service had addressed requirements set at the previous key inspection on 18th September 2008, when most aspects of the service had been found to be good or excellent. We recommend that readers of this report also refer to the report of our key inspection of 18th September 2008. We met with the proprietor Mr Roche. We talked with a member of care staff who had been recently recruited, and checked records of how they were recruited and appointed. We looked at a range of other records, including staff training and supervision, staffing rotas, cleaning schedules and infection control audit, and the home’s quality assurance processes. The entire home was toured. We were able to observe residents using different parts of the home, and saw both task-based and informal interactions between staff and residents. We looked at risk assessments and how they related to individual care planning. We examined the storage and handling of medicines. We did not look at meal preparation or delivery on this occasion. Prior to the inspection visit, Mr Roche had provided an improvement plan, as we required from the previous inspection. The judgements contained in this report have been made from evidence gathered during both inspections, which included the visits to the home. They take into account the views and experiences of people who live there. What the service does well: The home’s approach to caring for people with dementia is based on a personcentred perspective, which was reflected in the quality of care interactions and how care plans are written. We found the same calm but involving atmosphere as at the previous inspection, and which was described in surveys returned by some people’s relatives. There was a proactive approach to health promotion, including regular opportunities for movement and mental stimulation, combined with ensuring people ate and drank enough. Weight records were kept and, for some people, there were measured fluid intake and output charts. All residents received free chiropody treatment. The home also provided a visiting physiotherapist. A GP indicated confidence in the care provided by the home, and satisfaction with The Close DS0000028334.V374647.R01.S.doc Version 5.2 Page 6 the home’s level of liaison with the surgery. There has been similar appreciation of the home from community nurses. All instances of giving care that we observed were skilled and patient. There was a high level of eye contact between residents and staff, and a lot of conversation. Members of staff gave people explanations of what they were doing, encouraged choice and gave praise. Examples of statutory care reviews, conducted by the mental health team, all noted that people’s families were very satisfied with the nature of care received by their relatives. At the previous inspection, a relative had commented on “The imaginative daily exercises and activities”. We saw that members of staff took up opportunities for conversation with residents, both one-to-one and in small groups. People were helped in orientation to the time of day, day of the week and the weather. A group of children from a local secondary school visited the home twice weekly as a community service project within the Duke of Edinburgh Award scheme. They engaged residents in conversation and simple games. The home is an extended family home and as such, has a number of attractive and homely features. Furniture and soft furnishings were of good quality. People were seen to use many parts of the home and garden as they chose, including the kitchen with supervision. Standards of cleaning around the home were good, with no offensive odours. The home has had a largely stable staff team, who receive regular training opportunities and individual supervision. One person had been recruited to bring the team up to full strength. Records showed their appointment was confirmed only after interview and full checks on their background were completed, to be sure they were a safe person to work with vulnerable people. The member of staff had completed an induction and was about to commence NVQ (National Vocational Qualification) in care, level 2. The deputy manager had completed NVQ to level 4. What has improved since the last inspection? Mr Roche supplied an improvement plan as required in response to the previous inspection, and the required improvements have been carried out within the intervening six months. Most significantly, all radiators and exposed hot pipes have been fitted with covers, to remove the risk of burn injury to frail people who could fall against them. The environment as a whole has benefited from attention to paintwork, beginning with areas which we had identified as presenting a high risk to hygiene because they were in too poor a condition to be cleaned adequately. As required, Mr Roche has instituted an audit tool to ensure standards are maintained in these areas. Hygiene has also been promoted by a commitment to avoid soaking of soiled laundry, something we had observed at the previous inspection. The Close DS0000028334.V374647.R01.S.doc Version 5.2 Page 7 An appropriate cabinet has been obtained and installed for the safe keeping of any controlled drugs that might be prescribed to residents in the future. This replaced a very poor previous provision. The home’s quality assurance process has been restarted by way of a survey of relatives and other supporters of residents. We saw that returns were analysed in a way that assisted forward planning of the service. The requirement at the previous inspection was that this process must be sustained annually. 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. The Close DS0000028334.V374647.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 The Close DS0000028334.V374647.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. (The Close does not provide intermediate care, so key standard 6 does not apply). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Efforts are made to ensure that as much information as possible is gained about prospective residents to ensure their needs can be met. Prospective residents and their families are encouraged to visit to see for themselves what is being offered. EVIDENCE: We looked in detail at the assessment and admission process at the previous inspection in September 2008. The assessment for the most recently admitted person at that time showed how information had been gathered. It displayed a “person-centred” approach, identifying “intact skills” to be maintained, before going on to the difficulties the person encountered living in the community. The person’s care plan on admission was developed from this information. People’s needs, and how to meet them, were reviewed four weeks after being admitted, usually with input from a community psychiatric nurse. There was evidence of a high level of understanding between Mrs Roche and the The Close DS0000028334.V374647.R01.S.doc Version 5.2 Page 10 community mental health team. There had been no new admissions since the previous inspection. The Close DS0000028334.V374647.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 – 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s personal and health care needs were met through care planning. People were treated with respect and their right to privacy was upheld. Residents were protected by the home’s procedures for the safe handling of medicines. EVIDENCE: There was a care plan for each resident. These were concise, but covered identified social and physical needs. They included recognition of the aims of care interventions, for example, “that X will remain able to attend to herself” and, “That Y will be more orientated and free from distress.” A daily care record was kept for each person, which demonstrated that care plans were followed. Care plans included guidance to details, such as attention to denture comfort and hygiene, and use of sunscreen in hot weather. Plans were reviewed six-monthly, or more often in response to significant changes. There was evidence that people’s relatives or other advocates were able to contribute to care planning. The Close DS0000028334.V374647.R01.S.doc Version 5.2 Page 12 All residents were registered with the same local GP practice, although an alternative choice was also available. Individual care records included a log of all appointments with and attendance by health professionals. Mrs Roche conveyed a proactive approach to health promotion, including regular opportunities for movement and mental stimulation, combined with ensuring people ate and drank enough. Weight records were kept and, for some people, so were measured fluid intake and output charts. All residents received free chiropody treatment. The home also provided a visiting physiotherapist. Urine tests were carried out at any time when a change of behaviour suggested a person might have acquired an infection, so GP attention could be arranged if necessary. By way of a survey form returned for the previous inspection in September 2008, a GP indicated confidence in the care provided by the home, and satisfaction with the home’s level of liaison with the surgery. A community staff nurse who visited during the previous inspection said she never had any concerns about the quality of care she had seen at The Close. Calls on the community nursing service were appropriate and never too late to enable an effective intervention. Pressure area problems were few, which she considered a reflection of the home’s emphasis on stimulation, mobility and good nutrition. We saw that all care plans included pressure area risk assessments. Some care records contained copies of correspondence between consultant psychiatrists and GPs. These might, for example, confirm changes in medication, which showed the home shared in multi-disciplinary assessments and influenced care strategies. One person’s records showed how a particular medication had been supplanted by a weaker one, which in turn had been reduced in use. For the same person, staff had noted approaches that helped the person cope with the aspect of their dementia, which had initially been the reason for giving medication, resulting in a person-centred care plan. Examples of statutory care reviews, conducted by the mental health team, all noted that people’s families were very satisfied with the nature of care received by their relatives. We observed safe practice in the storing and administration of medicines. At any time, the senior member of staff on duty was the key holder. Most staff had undertaken a distance-learning course in the safe handling of medications. Mrs Roche carried out internal training and checks on individual competence. We saw that any use of “as needed” medication was recorded appropriately. Handwritten additions to administration records were counter-signed to show they had been checked for accuracy. In response to a requirement made at the previous inspection, an appropriate controlled drugs storage cabinet had been obtained and fitted, although it remained the case that no controlled drugs were currently in use in the home. We saw kindly and respectful interactions between staff and residents. Conversations were inclusive. Staff wore disposable aprons only when it was The Close DS0000028334.V374647.R01.S.doc Version 5.2 Page 13 necessary for the task in hand, rather than routinely, in order to enhance people’s dignity. Care planning records showed people’s personal preferences. The decision to use the twin rooms for single occupancy only, was a further measure by which the home sought to provide for privacy and dignity. The Close DS0000028334.V374647.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 – 14. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home identifies and meets people’s social, religious and recreational needs. People keep in contact with family and friends and go out into the community with support. People experience a homely way of life, including how meals are served. They are able to exercise choices. EVIDENCE: In a survey questionnaire returned by a relative for our previous inspection, a relative wrote about “The imaginative daily exercises and activities”. We saw that members of staff took up opportunities for conversation with residents, both one-to-one and in small groups. People were helped in orientation to the time of day, day of the week and the weather. Daily care records included many references to the activities people had joined in, and how they had responded. There was life history information to show people’s likely areas of interest. One person living at the home regularly went out to church, and a minister visited the home monthly. A small number of pupils from a local school came into the home twice a week, to talk and play games with people. This was a community service provision of the Duke of Edinburgh Award Scheme, and had The Close DS0000028334.V374647.R01.S.doc Version 5.2 Page 15 been further developed since our previous visit, when we saw that the children achieved a good rapport with people. Visitors could visit their relatives and friends in any of the communal rooms or in the person’s bedroom. A conservatory provided a suitable venue for private visits. At our previous inspection a visitor told us their friend was assisted to telephone them whenever they wanted to. People were encouraged to take their meals in the sitting/dining room. Some chose to sit with others at the table and some used individual tables over their knees, whilst remaining in an armchair. Where somebody needed assistance to eat, this was given discretely and with patience. All care staff sometimes assisted with meal preparation as part of their duties, although Mrs Roche took a central role. There was a varied menu and there was good knowledge of individual preferences and dislikes. Nutritional needs were addressed in care plans. We saw that two people in particular liked to help in the kitchen, both with food preparation and with washing and drying up. This was a valuable way of enabling people to continue familiar patterns of daily living and to experience a measure of independence. The Close DS0000028334.V374647.R01.S.doc Version 5.2 Page 16 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. There is provision for receipt of and response to complaints. Staff and management understand and exercise responsibilities in respect of keeping residents safe. EVIDENCE: The home had provision for receipt of complaints, but none had been received within the procedure in the preceding year. Mrs Roche kept a record of minor issues and how they had been resolved. There was information readily available about a local independent advocacy service. There was monitoring of people entering and leaving the home. For people living in the home, that liked to go out unaccompanied, there were risk assessments to guide staff on how to monitor this activity, and how to address any related concern. Signed records confirmed that all staff were given copies of the “No Secrets” guidance to local safeguarding procedures, and the code of conduct for social care workers issued by the General Social Care Council. The Close DS0000028334.V374647.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers a homely and safe environment that receives ongoing maintenance. EVIDENCE: The home is an extended family home and as such, has a number of attractive and homely features. There is room for ornaments, books and so on, without them presenting as obstacles or clutter. The main sitting room looks through arches into the dining room, from which there are patio doors to the outside. Furniture and soft furnishings were of good quality. People were seen to use many parts of the home and garden as they chose, including the kitchen with support. There had been attention to worn and chipped paintwork on door frames, an issue noted in previous inspections and mentioned by visitors. A repairs notification book had been commenced so staff could notify faults and Mr The Close DS0000028334.V374647.R01.S.doc Version 5.2 Page 18 Roche could address them systematically. Laminated signs to identify different rooms were an improvement on the temporary-looking ones we saw at the previous inspection. They could still be further improved to meet the needs of some residents by the addition of pictures. The visiting school children could be invited to consider helping with this task. Standards of cleaning around the home were good, with no offensive odours. All survey responses for the previous inspection said the home was ‘Always’ fresh and clean. A housekeeper worked five days a week, to a cleaning schedule, and care staff undertook essential cleaning at weekends. We saw an effective infection control audit that had been introduced in response to a requirement made at the previous inspection. Shortfalls in cleanable surfaces, identified at that inspection, had been made good. So too had the former absence of covers on radiators and exposed hot pipes, also subject of a requirement, so the home had been made considerably safer. The home had been recently visited by the environmental health officer. The kitchen had been awarded four stars (out of five) for cleanliness and safety. All laundry was handled by the home. There was a laundry building in the grounds, with appropriate machinery. Care staff were able to undertake laundry tasks within their duties. Some residents liked to assist tasks such as folding clean linen, but they did not go into the laundry for safety reasons. The soaking of soiled items had been ceased, following recommendation at the previous inspection. The Close DS0000028334.V374647.R01.S.doc Version 5.2 Page 19 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 – 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported by trained, competent staff. Safe recruitment practices are in place. EVIDENCE: The home has a small care staff group. They maintain a presence of two staff on duty through the day, often with Mrs Roche in addition. Mr Roche also gets involved in supporting residents. One person is on duty through the night, with an additional member of staff “sleeping in”, who can be called on if needed. The day-time staffing level had been improved by more overlapping of shifts, to provide three staff to support people at mealtimes. One new member of staff had been recruited, bringing the staff complement up to strength since our last visit. Records for the person showed that necessary vetting and take-up of references were completed before they commenced working in the home. They had undergone an induction and were awaiting a start date for working towards NVQ (National Vocational Qualification) level 2 in care. Mrs Roche has developed a good working relationship with the local organiser for Skills for Care, which co-ordinates provision of and funding for training in the care sector. Staff had very recently undertaken refresher training in health and safety and manual handling, the latter from an external provider. The The Close DS0000028334.V374647.R01.S.doc Version 5.2 Page 20 recently appointed member of staff had received food hygiene training. Mr Roche described the difficulty for a night staff member to attend training, and the supports offered to them. We saw the home’s training spreadsheet, which was up to date. All instances of giving care that we observed were skilled and patient. There was a high level of eye contact between residents and staff, and a lot of conversation. Members of staff gave people explanations of what they were doing, encouraged choice and gave praise. The Close DS0000028334.V374647.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has responded positively to all the requirements made at the previous inspection. Supervision arrangements for staff are in place and are being further improved. There is evidence of forward planning based on obtaining the views of people with a stake in the service. There are provisions for maintaining the health and safety of people who live in the home, and staff. EVIDENCE: As required at the previous inspection in September 2008, Mr Roche supplied an improvement plan. This inspection has confirmed that the commitment to improve has been seen through, on the basis of meeting requirements and recommendations made at the previous inspection. Management of the home has also been enhanced by the deputy manager gaining NVQ level 4, and The Close DS0000028334.V374647.R01.S.doc Version 5.2 Page 22 further development of staff supervision, backed by specific training in supervision skills. We saw that people living in the home and their supporters were being canvassed for views and opinions about the service by way of questionnaires. These were attracting some very positive comments. It could be seen that forward planning was being based on the outcomes of this exercise. The home does not have any involvement with personal monies for residents. Expenditure on items such as hairdressing and toiletries is agreed with and invoiced to people’s advocates. With the covering of radiators achieved, the home was providing appropriately for the health and safety of people living there, and for staff, by way of risk assessments and recording and monitoring. The Close DS0000028334.V374647.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X N/A 3 X 3 The Close DS0000028334.V374647.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP19 Good Practice Recommendations The person registered should provide improved signage to doors, suitable to the needs of people with dementia and in keeping with the environment of the home. The Close DS0000028334.V374647.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South West Region PO Box 1251 Newcastle upon Tyne NE99 5AN National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Close DS0000028334.V374647.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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