Care Home: The Oaks Nursing Centre

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What the care home does well The service was well managed and the unit care managers provided valuable support for the manager, staff, residents and relatives. Care plans continued to improve and were more person centred. Medicines were safely managed. Staff had developed good working relationships with external professionals such as the GP, psychiatrist and dietician. There was a strong commitment to providing relevant staff training. A quality audit system was in place and complimented by in house audits. Communication between management, staff, relatives and residents was good. Complaints were well managed and recorded. Regular relatives meetings were held. Staff received regular supervision and staff retention was good. Attention was given to providing a safe environment. Relatives spoke positively about the service and with their satisfaction with the quality of care provided. What has improved since the last inspection? New more person centred care plans had been introduced. Medicine management had improved and internal audits undertaken to maintain improvement. CARE HOMES FOR OLDER PEOPLE The Oaks Nursing Centre 904 Sidcup Rd New Eltham London SE9 3PN Lead Inspector Ms Pauline Lambe Unannounced Inspection 18th January 2008 08:30 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 DS0000006767.V353127.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. DS0000006767.V353127.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Oaks Nursing Centre Address 904 Sidcup Rd New Eltham London SE9 3PN 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) 020 8857 9980 020 8851 0261 the.oaks@craegmoor.co.uk Speciality Care (EMI) PLC Miss Lynn Carol Jones Care Home 113 Category(ies) of Dementia - over 65 years of age (113), Mental registration, with number disorder, excluding learning disability or of places dementia (5), Mental Disorder, excluding learning disability or dementia - over 65 years of age (113) DS0000006767.V353127.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 5 places for people with mental health problems 40-59 years excluding learning disability or dementia A further 3 places in the above category for named service users as agreed in the letter from the NCSC dated 10/12/03 The Registered Person must provide additional supernumerary management time on each Unit as detailed below:KnoleUnit 10 hours per week Burstead Unit 10 hours per week Oxleas Unit 10 hours per week Joydens Unit 15 hours per week Lessness Unit 15 hours per week Belvedere Unit 18 hours per week Category DE(E) agreement was in place to allow admission of service users from 60 years of age prior to the implementation of the Care Standards Act 2000. The Commission for Social Care Inspection endorses this agreement. maximum number of service users at any one time must not exceed 113 8th August 2006 4. 5. Date of last inspection Brief Description of the Service: The Oaks Care Centre is owned by Speciality Care (EMI) plc and is part of Craegmoor Healthcare. The home is registered to provide nursing care for 108 older people with dementia and 5 younger adults with a mental health disorder. The home is located on the busy A20 dual carriageway between Eltham and Sidcup and is within walking distance of public transport or local shops. The building is divided into six self-contained units. The largest unit accommodates twenty-five residents and the smallest thirteen. Each unit is accessed through a combination lock and has a number of bedrooms, bathrooms, toilets and open plan dining / lounge area with kitchenette to accommodate resident groups. Accommodation is provided on two floors. The home has 71 single and 21 shared rooms, all bedrooms have en-suite toilet and washbasins. There are parking spaces to the front of the property. The current fees in the home ranged from £588.24 - £1,000.00 and residents pay privately for personal items, hairdressing, chiropody and physiotherapy. DS0000006767.V353127.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 key inspection was completed on 18th January 2008 by two inspectors. The last key inspection was on 8th August 2006. The manager was in charge of the home and with staff assisted with the inspection. At the time of the inspection one hundred and nine residents were in the home and there were four vacancies. This inspection process included a review of information held on the service file, a tour of the premises, a review of records, talking to residents, relatives, staff, management, visiting professionals and reviewing compliance with previous requirements. Information provided in resident, relative and staff surveys were also reviewed. The annual quality assurance assessment (AQAA) sent to the Commission was viewed and provided information on the current service and included planned improvements. Time was taken to review compliance with previous requirements. The service was well managed and the standard of care continued to improve. Relatives indicated satisfaction with the quality of care provided and residents who were able agreed with this. What the service does well: The service was well managed and the unit care managers provided valuable support for the manager, staff, residents and relatives. Care plans continued to improve and were more person centred. Medicines were safely managed. Staff had developed good working relationships with external professionals such as the GP, psychiatrist and dietician. There was a strong commitment to providing relevant staff training. A quality audit system was in place and complimented by in house audits. Communication between management, staff, relatives and residents was good. Complaints were well managed and recorded. Regular relatives meetings were held. Staff received regular supervision and staff retention was good. Attention was given to providing a safe environment. Relatives spoke positively about the service and with their satisfaction with the quality of care provided. DS0000006767.V353127.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000006767.V353127.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000006767.V353127.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3, 4 and 6 not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Relevant information was provided about the service. Residents were admitted based on care needs assessment and they received written confirmation that the home could meet the assessed needs. EVIDENCE: Care records viewed showed that residents were admitted to the home based on a pre-admission assessment of need. Some of the files seen also included care manager assessments and information from other professionals such as psychiatrists. A statement of purpose and service user guide was provided and as these documents had not been changed since the last inspection they were not reviewed on this occasion. Copies of the service user guide were seen in some of the bedrooms viewed. Residents received written confirmation that based on the care needs assessment the service was suited to meeting their needs. DS0000006767.V353127.R01.S.doc Version 5.2 Page 9 Staff had appropriate qualifications to care for residents and on some units visited staff were observed to be particularly skilled at distracting or reassuring people that were agitated or anxious. DS0000006767.V353127.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7 – 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans had improved and were more person centred and residents received appropriate healthcare. Medicines were safely managed and no concerns were noted in relation to resident’s dignity and respect. EVIDENCE: Since the last inspection person new care planning documentation was implemented for all residents. The new documentation was more person centred. The ‘things’ and ‘people’ that were important to the resident were recorded and their understanding of the reason for their admission to the home. The files also included a comprehensive life history, which relatives were encouraged to complete. Care records for four residents were inspected and found to include care needs assessment, risk assessments and care plans to show how assessed needs were met. The care plans seen were mainly well written and provided guidance for staff on how to meet assessed needs. For example care plans included clear details in relation to moving & handling, continence management and management of challenging behaviour. One care plan viewed for a resident recently admitted was not completed however staff DS0000006767.V353127.R01.S.doc Version 5.2 Page 11 had written the most relevant care plans to ensure the resident’s immediate needs were being met. Risk assessments were completed in relation to the use of bedrail and the provider had purchased a number of ‘low rise’ beds, which meant residents at risk of falling out of bed did not require bedrails. The manager said that the plan was to replace most of the beds in the home with the ‘low rise’ type. The wound care record viewed for a resident included an up to date assessment of the wound but the frequency of dressing changes was unclear. Advice had been obtained from the tissue viability nurse and the resident had the appropriate pressure relief equipment. The resident was admitted to the home with the pressure sore and staff said the wound was healing well. An assessment seen in care records for another resident indicated the person was at risk of developing pressure sores and had a history of urinary tract infections but there was no reference to these issues in the care plan. The third care plan seen stated that the person’s blood pressure should be checked twice weekly but this had not been done since November 2007. The staff nurse on duty acknowledged that the care plan should have been amended. Care plans and risk assessments seen were kept under review. Daily evaluation records provided little information in relation to implementation of care plans or activities the resident joined in with. Feedback from relatives, residents and two visiting professionals indicated satisfaction with the care provided, the attitude of staff and the way staff followed professional advice. Requirement 1 and recommendation 1. All residents were registered with a GP and supported by staff to access healthcare services such as dental, optical, chiropody, tissue viability nurse, dietician and physiotherapy. The GP was seen in the home during the inspection and said that staff referred residents to the service appropriately. The GP said he routinely visited the home weekly and at other times when requested by staff. The visiting psychiatrist was also seen and also said she was very pleased with the care provided to residents, the appropriateness of referrals to her service and the way staff implemented advice given regarding resident care. Residents were weighed regularly and their vital signs were monitored. Relatives were informed about significant events such as GP visits or accidents. On one unit visited a resident felt unwell and was assisted back to bed. Staff checked the person regularly and ensured they had plenty to drink. Residents who were able and relatives seen expressed satisfaction with the care provided. Relatives said staff kept them informed as to the well being of their family member. The home used boots MDS medicine system. Medicine management was viewed on two units. On Knole unit records of receipt, administration and disposal of medication were found to be very good. There were no errors, no gaps on administration charts and stocks checked were accurate. The medication room and refrigerator temperature were checked regularly. Controlled drugs were stored securely and suitable records were maintained about the use of these medicines. Good records were maintained about the DS0000006767.V353127.R01.S.doc Version 5.2 Page 12 use of homely remedies and the balance for two homely medicines were checked and found to be correct. On Oxleas unit medicines were well managed as on Knole unit in relation to records and storage. One resident required medicines to be administered covertly and the decision for this and GP agreement recorded correctly. One resident was prescribed one ‘as required’ medicine for pain relief and a protocol was prepared to show how and when this was to be given. One issue noted was that staff had not countersigned all hand written entries they made on administration charts. A discussion took place with the manager about the need to introduce medicine profiles for residents and annual competency assessments for staff responsible for medicine management. Requirement 2 and recommendation 2. Staff were observed interacting appropriately with residents and were seen knocking on bedroom doors before entering. Residents were appropriately dressed including socks or stockings and personal clothing was nicely laundered. One resident on Joydens had been out shopping to choose their own cloths. Screening was provided in shared rooms but there were no locks on the en suite doors in these rooms. Consideration should be given to providing these. The manager ensured residents were included on the electoral register and arrangements made for those able to vote to do so by post. A policy and procedure was provided in relation to death and dying and the manager said that she planned to introduce ‘The Gold Standard Framework’ in 2008. DS0000006767.V353127.R01.S.doc Version 5.2 Page 13 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): Standards 12 – 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory visiting arrangements were in place and staff supported residents to make decisions. Residents were provided with a varied and nutritious diet. Social care plans and activity records required some improvement. EVIDENCE: Based on the findings of this inspection there was a difference is how activities were provided to individual units. For example on Joydens unit (a unit with more active and younger people) residents said they enjoyed taking part in activities. A number of people said they enjoyed the exercise class and playing bingo. On this unit residents were observed reading newspapers, playing card games and dominoes with staff and making use of art equipment and puzzles. One person liked to go out shopping and used dial a ride for this purpose. Care staff on this unit engaged people in meaningful conversations, spent time listening to residents and records of activities were good. On Knole unit there was little evidence of activities taking place in the care records for one resident and no activities were observed. The staff nurse on this unit said most residents were too tired after their bath to do activities so these usually took place in the afternoon. However records did not support this. One resident on Knole unit had an individual activity plan that said staff DS0000006767.V353127.R01.S.doc Version 5.2 Page 14 would support them to fold laundry, read, watch TV and have some ‘one to one’ activities. However there was no evidence in the file to show that the care plan had been implemented. The orientation board on Knole unit said it was Wednesday 2007 and the weather was cool and sunny but the day was Friday 2008 and it was raining heavily. On Oxleas unit residents and activity staff were observed enjoying a balloon and bat game. One relative seen said that they had not often observed activities taking place during their visits. In the care records viewed for one resident there was little information about activities and this also applied to the records viewed for one resident on Belvedere unit. Activity staff were spoken with and said they prepared a weekly programme and implemented this flexibly. The programme was displayed in each unit, however the presentation of the programme was not ‘eye catching’ as it was written in small print and did not have any colour or pictures to prompt or attract residents particularly those suffering from dementia. It was unclear who wrote activity care plans and management must ensure this is clarified for staff. Activity staff said they had difficulty keeping records up to date as they had to write on individual care records, which was very time consuming and detracted from the time spent doing activities with residents. Consideration should be given to simplifying activity records and so reduce the time staff spent writing records. Two full and two part time activity staff were employed and said they had an activity budget and access to relevant training including some NVQ training. Activities took place on individual units or in groups in the separate building called ‘The Cedars’ at the rear of the property. Requirement 3 and recommendation 3. Relatives for seven residents were seen during the inspection and all said they were able to visit when they wanted, had no concerns about the care provided in the home and were able to contribute to their family members care. All relatives mentioned the manager by name and said they saw her visiting the units regularly. Relatives also referred to the unit care managers and some staff by name. One visitor said the home had improved “vastly” in the period since their relative became a resident. Relatives said communication was better and staff listened to their concerns and acted on them. Families were aware of relatives meetings and one person said they were asked to check that the minutes were correct. Where possible residents were encouraged to make decisions about their care and everyday lives. Staff were observed assisting residents to make choices for example as where they sat, what meal they preferred or whether they wished to join in with an activity. Care records included a form in relation to resident’s giving consent to share confidential information. The top section of the form related to capacity but had not always been completed. The bottom section was for relatives to complete if the person did not have capacity or the resident to complete if they had capacity. It was not clear who made the decision as to the resident’s capacity to make the decision. Recommendation 4. DS0000006767.V353127.R01.S.doc Version 5.2 Page 15 Lunch was observed on Knole and Belvedere units. The daily menu was prominently displayed and residents who could make decisions were asked what they wanted to eat. Residents who were able to provide feedback said they enjoyed lunch. On both units a high number of residents required assistance with feeding and food was not served until staff were ready to assist people to eat. One resident on Knole unit liked to eat Bangladeshi food such as tandoori chicken, curry and traditional Bangladeshi fish dishes. Staff said they had informed the kitchen about this but these foods were not very often provided. Since the last inspection the manager had requested a dietician to view the menus to ensure these met the nutritional needs of the residents. Suggestions made by the dietician were incorporated into the menu planning. Consideration should be given to extending the gap between lunch and supper. Currently lunch is served at 13:00 and supper at 16:30. Appropriate meal portions were served, staff assisted residents where needed, plate covers were used to take meals to bedrooms and other equipment such as plate guards were available. Relatives seen said that they felt the quality of meals provided was good. Some visitors seen said they planned visits round mealtimes to assist their relative with their meal. Recommendation 5. DS0000006767.V353127.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): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Safe systems were in place to ensure safeguarding residents. Complaint records were very good and the complaints policy and showed that the complaints procedure was adhered to. EVIDENCE: Policies and procedures were provided in relation to management of complaints and adult protection. The complaints procedure was displayed in the reception area and on the units visited and a complaints log kept in the front office. This record showed that the home had received twelve complaints since the last inspection. Some of the issues listed such as unexplained bruising sustained by residents were referred to the local authority for investigation under their safeguarding procedures. Records for two complaints were examined. One related to the development and treatment of pressure sores and the other to communication issues. The manager acknowledged receipt of the complaints in writing and completed a thorough investigation. The investigations involved obtaining statements from and questioning staff and examining records. The complainant was advised about the outcome of the investigation and any action they were taking to address their concerns. The manager should ensure that where investigations take longer than 28 days a letter explaining the cause of the delay is sent to the complainant and recorded in the complaints log. Feedback received from relatives and where possible from residents DS0000006767.V353127.R01.S.doc Version 5.2 Page 17 indicated that they would have no hesitation speaking to the manager if they had concerns but also that they felt confident staff on the unit would address their concerns. Relatives seen knew the home and unit care managers by name. Staff spoken with about safeguarding adults displayed a good understanding as to how they would deal with an allegation of abuse or challenging behaviour. Staff said they would report concerns to a senior member of staff and record information in the resident’s notes. Staff said they had attended safeguarding and mental capacity act training. The staff training matrix seen confirmed this information. Since the last inspection six allegations of abuse were referred to the local authority for investigation. Four were investigated, three were not proven and one investigation resulted in a member of staff being referred to the protection of vulnerable adults list. DS0000006767.V353127.R01.S.doc Version 5.2 Page 18 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): Standards 19, 21, 24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was tidy, mainly odour free and attention given to the safety. A number of repairs were identified and recorded below. A copy of the new refurbishment and redecoration programme must be sent to the Commission. EVIDENCE: Time was spent in three units and areas seen were tidy and generally odour free. In Joydens unit there was an unpleasant odour in one of the toilets, the one off the lounge and the toilet pan was very stained. In this room there was a gap between the edge of the vinyl flooring and the toilet base. The shower on this unit was not working and some of the wall tiles required attention. The extractor fan in the en-suite toilet in room 3 on this unit was not working and a relative seen expressed concerns that their family members bedroom had not been redecorated. DS0000006767.V353127.R01.S.doc Version 5.2 Page 19 On Oxleas unit the conservatory roof required attention and cleaning, the rubber seal on the bath had started to fall off and the lounge carpet required cleaning. On Belvedere unit the assisted bath was very dirty and this was brought to the attention of the manager who had the issue address immediately. The microwave in the kitchen area on Belvedere unit was stained and rusting and must be replaced. Some of the bedroom furniture seen in the units visited was chipped, broken and worn particularly the wardrobes. The lounge carpets in Joydens, Oxleas and Belvedere units were quite stained. The manager said that the provider had agreed a large budget for refurbishment in 2008. This included installing air conditioning, replacing bedroom furniture where needed, fitting laminate flooring to lounge/dining rooms and redecoration as needed. Money had also been allocated for the refurbishment of all shower and bathing facilities. In the meantime the environment must be satisfactorily maintained and kept clean. The Commission must be provided with a copy of the planned refurbishment programme to include start and end dates. Requirement 4. Staff had access to adequate supplies of protection clothing. Hand washing facilities were provided in areas where waste was handled. Systems were in place to safely store and dispose of clinical and other waste. Records seen showed that a number of staff including domestic and kitchen staff had received training in relation to infection control in the last twelve months. DS0000006767.V353127.R01.S.doc Version 5.2 Page 20 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): Standards 27 – 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Adequate staffing levels were maintained and additional staff on duty when needed to provide one to one care. Management were committed to staff development by providing relevant training and supporting staff to achieve NVQ qualifications. Relatives were very complimentary about the staff. EVIDENCE: A random selection of care staff rosters were viewed including those for the day of the inspection. These showed that the home maintained adequate staffing levels with additional staff on duty to provide one to one care for specific residents in line with assessments and care plans. Domestic staff spoken with said they had adequate hours to complete their work. Relatives spoken with were complimentary about staff and comments made included “I have never seen a “bad” member of staff”, “residents are always well presented and look content”, “I cannot fault the home” and “staff do a wonderful job often in very difficult circumstances”. The staff team comprised of a manager, unit care managers, qualified nurses, care assistants, domestic and ancillary staff. A system was in place to check that nurses employed were registered with the Nursing and Midwifery Council. Of the 107 care staff employed 88 had achieved NVQ 2 qualification or above and 7 were working towards the qualification. A number of domestic and kitchen staff had completed basic NVQ training in housekeeping. Activity staff DS0000006767.V353127.R01.S.doc Version 5.2 Page 21 also had NVQ training and had received training on dementia care and infection control. Kitchen and domestic staff were also being supported and encouraged to achieve NVQ qualifications. Staff spoken with were knowledgeable about the residents in their care. Staff turnover was an issue in this service in the past so it was pleasing to see that in the last year only 3 staff left the service. Management is to be commended on the improvements made with staff retention. Two recruitment files were viewed and found to comply with regulation. Staff said access to training was “excellent”. Internal and external training sessions took place regularly and staff were automatically put down to attend mandatory updates sessions. Some staff said they had attended mental capacity act training and completed distance learning dementia and infection control training packages. One of the unit care managers was responsible for organising staff training. The training matrix seen showed that since the last inspection staff had access to relevant training for example NVQ, moving & handling, safeguarding adults, basic food hygiene and management of challenging behaviour. Management is to be commended on their commitment to staff training. DS0000006767.V353127.R01.S.doc Version 5.2 Page 22 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): Standards 31, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service was very well managed and systems in place to ensure the safety of residents and others. A quality assurance system was in place and resident’s personal allowance safely managed. Staff received regular supervision. EVIDENCE: The manager has been in post for approximately 5 years and having management stability has raised standards in the home. Staff and relatives spoken with were satisfied with the management of the service. Comments made were that the manager was “very accessible” and always had time to talk and smile. Staff said “her door is always open and you can go to her at anytime”, “she lets us get on with managing things on our unit and doesn’t interfere but is there if we need her”, “communication is “excellent” we are DS0000006767.V353127.R01.S.doc Version 5.2 Page 23 kept informed about everything, staff meetings are held and we receive memos and copies of important information or articles to read”. The unit care managers’ worked with and supported staff with all aspects of their work and monitored progress. The manager held meetings with staff groups such as trained nurses, care staff and unit heads. The clinical governance team completed quality review audits of the service. A copy of the last audit was seen and showed satisfactory scores for different areas of the service such as food provision, record keeping, complaints and safety. The manager was provided with an action plan based on the audit findings and was working on this to improve and raise standards. The manager and unit care managers completed in-house audits on areas such as care planning, medicine management, food provision and accidents. A relative questionnaire was sent out in December 2006 and the findings available to view. The survey showed a high level of satisfaction with the service and the manager planed to address issues raised. Regular relative meetings were held and relatives seen confirmed they attended these, found them helpful and informative and received copies of the minutes. A policy and procedure was in place in relation to the management of resident’s personal allowance. A safe system was in place to manage this money and the administrator managed the accounts on behalf of the residents if this was requested. Receipts were kept for money received and spent and records available for residents or relatives to view. Records for three residents were checked and found to be correct. Staff spoken with said they received supervision about every two months and said notes were made and agreed about the issues discussed. Records on supervision seen supported this and showed that one to one and peer group supervision sessions were held. The opportunity to address staff training and development was discussed during supervision sessions. From the information provided in the AQAA and records seen attention was given to providing a safe environment for residents and others. A number of safety records were checked and found to be up to date. This included fire safety, gas, clean water, moving & handling equipment, electricity and the last environmental health inspection report. Fire drills were held for both night and day staff. The manager said that successful efforts had been made to reduce the number of bedrails being used in the home. This had been achieved through improved assessment and the provision of ‘low rise’ beds. The manager had a health & safety committee, which included staff representatives from the different designations to monitor and improve safety in the home. Accident records were well completed and a system in place to follow up unexplained injuries sustained by residents. Notifications were sent to the Commission in compliance with regulation 37. DS0000006767.V353127.R01.S.doc Version 5.2 Page 24 DS0000006767.V353127.R01.S.doc Version 5.2 Page 25 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 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 2 X 2 X X 2 X 3 STAFFING Standard No Score 27 3 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 3 X 3 DS0000006767.V353127.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15 Requirement The registered person must ensure wound care records include information in relation to frequency of dressings. Care plans must show how all assessed needs will be met. The Registered Person must ensure safe management of medicines. When staff write medicine details on the administration charts these must be signed by two people to ensure accuracy they reflect the information written on the pharmacist’s label. The registered person must ensure social care plans are prepared for and with each resident and records kept for activities provided. The registered person must ensure the home is kept clean and well maintained. Lounge carpets must be kept clean. The repairs identified under the environmental standards must be addressed. The microwave in Belvedere unit DS0000006767.V353127.R01.S.doc Timescale for action 07/03/08 2 OP9 13 07/03/08 3 OP12 16 07/03/08 4 OP19 23 07/03/08 Version 5.2 Page 27 must be replaced. The Commission must be provided with a copy of the planned refurbishment programme to include start and end dates and the upgrading of the bathing facilities. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP9 Good Practice Recommendations The registered person should ensure daily evaluation records reflect the resident’s day and support the implementation of the care plans. The registered person should ensure a medicine profile is prepared for each resident and that there is evidence to show that an annual competency assessment is completed for staff responsible for medicine management. The registered person should review the method of recording activities provided to ensure staff manage this task easily and efficiently without losing time spent doing activities with residents. The registered person should ensure that records used to show resident capacity to make decisions were assessed are fully completed. The registered person should ensure residents regularly get meals of preference such as ethnic foods. Consideration should be given to extending the time gap between lunchtime and supper. 3 OP12 4 5 OP14 OP15 DS0000006767.V353127.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 DS0000006767.V353127.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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