Care Home: The Orchards

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What the care home does well The home was well managed and the manager had worked hard to meet standards and further develop and improve the home. The home was very clean and tidy. The staff were very friendly and knew about the care people needed. The manager had assessed peoples care needs before they went to live in the home. The care people needed was written down in detail by the manager and was checked often by the staff to make sure that there had been no changes. The activities were varied and organised in consultation with people who lived in the home. People said that they enjoyed the activities on offer. The people who lived in the home said that they enjoyed the meals. They said that there was a good variety of food provided. Comments included `the food is always good`, `the meat is good`, ` the meat is tender` and the meals are `very tasty`.The majority of the home had been redecorated and the home was warm and comfortable. Bedrooms were personalised with peoples own belongings. Equipment to help people get around the home was provided. Staff had received training to help them to provide care safely. The home was committed to helping staff to take qualifications in care and the majority of the staff had achieved an NVQ qualification. Staff felt well supported and received regular supervision. People were protected from abuse through the homes policies and procedures, staff training and the recruitment processes. The home displayed the complaints procedure in the home, there had been no complaints about the service. The manager monitored the quality of the service in order to improve the quality of the care provided and regularly spoke to people who lived in the home for their opinion on the care they received. What has improved since the last inspection? As the home had been taken over by new providers in 2007 this home is considered to be a new service. CARE HOMES FOR OLDER PEOPLE The Orchards The Orchards 13 Peakes Lane New Waltham Grimsby North East Lincs DN36 4QL Lead Inspector Mrs Kate Emmerson Key Unannounced Inspection 9th April 2008 09:30 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 DS0000070726.V362674.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. DS0000070726.V362674.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Orchards Address The Orchards 13 Peakes Lane New Waltham Grimsby North East Lincs DN36 4QL 01472815876 01472815876 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) Care People Private Ltd Linda Rose Hewitt Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places DS0000070726.V362674.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 17 2. Date of last inspection Brief Description of the Service: The Orchards is a care home registered for providing personal care and accommodation for 17 older people. The accommodation is provided over two floors. Originally it was a large detached house, but it has been extended to its current position. The accommodation comprises nine single bedrooms, and four double bedrooms. There is a passenger lift to the first floor. The home is situated in the village of New Waltham, which is on the outskirts of Grimsby. It is close to local amenities including shops and public houses. The fees for the home £361 per week. Additional costs were for the hairdresser £4 -£20, chiropodist £8.00, hospital/GP staff escort – variable cost. DS0000070726.V362674.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 stars. This means that the people who use this service experience good quality outcomes This was the first inspection of the service since Care People Private Ltd had purchased the home. This inspection was unannounced and took place over two days in April 2008. To find out how the home was run and if the people who lived there were pleased with the care they received we spoke to the manager and the staff working in the home at the time of the inspection. We also spoke to people who lived in the home and visitors. One of the providers visited the home during the inspection and we discussed the future plans for the home with him. Some of the records kept in the home were checked. This was to see how the people who lived in the home were being cared for, that staff were safe to work in the home, that they had been trained to their job safely and to make sure that the home and the things used in it were safe and were checked regularly. We also looked around the home to see if it was kept clean and tidy. What the service does well: The home was well managed and the manager had worked hard to meet standards and further develop and improve the home. The home was very clean and tidy. The staff were very friendly and knew about the care people needed. The manager had assessed peoples care needs before they went to live in the home. The care people needed was written down in detail by the manager and was checked often by the staff to make sure that there had been no changes. The activities were varied and organised in consultation with people who lived in the home. People said that they enjoyed the activities on offer. The people who lived in the home said that they enjoyed the meals. They said that there was a good variety of food provided. Comments included ‘the food is always good’, ‘the meat is good’, ‘ the meat is tender’ and the meals are ‘very tasty’. DS0000070726.V362674.R01.S.doc Version 5.2 Page 6 The majority of the home had been redecorated and the home was warm and comfortable. Bedrooms were personalised with peoples own belongings. Equipment to help people get around the home was provided. Staff had received training to help them to provide care safely. The home was committed to helping staff to take qualifications in care and the majority of the staff had achieved an NVQ qualification. Staff felt well supported and received regular supervision. People were protected from abuse through the homes policies and procedures, staff training and the recruitment processes. The home displayed the complaints procedure in the home, there had been no complaints about the service. The manager monitored the quality of the service in order to improve the quality of the care provided and regularly spoke to people who lived in the home for their opinion on the care they received. What has improved since the last inspection? What they could do better: They must ensure that administration instructions, which are hand transcribed on to the medication administration records, are double checked and signed and witnessed to minimise errors, They must give people the choice of managing their own medication where they are able and develop risk assessments to ensure that they will be safe to do this. They must ensure that the policy and procedure for infection control gives guidance on how to deal with spillages. They must make sure guidelines are correctly applied when assessing staffing levels. They must provide evidence that equipment in the home is regularly serviced. They must ensure that bedroom doors are not wedged or propped open to minimise the spread fire in the home. DS0000070726.V362674.R01.S.doc Version 5.2 Page 7 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. DS0000070726.V362674.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 DS0000070726.V362674.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): 1, 2, 3, 4 and 5. Standard 6 was not assessed, as the home does not provide intermediate care. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Detailed information about the service was provided, people’s needs were assessed and they had the opportunity to spend time in the home prior to admission. This enabled people to make an informed choice about living in the home. EVIDENCE: People had access to detailed information about the home and the services provided within the statement of purpose, service users guide, brochure and contract/statement of terms and conditions. The information was up to date and the documents were displayed throughout the home. People were provided with contract/statements of terms and conditions on admission, this included information as to the terms and conditions of occupancy and fees to DS0000070726.V362674.R01.S.doc Version 5.2 Page 10 be paid. These were updated at each admission for those who were on a rolling respite programme. Information as to the views of people living in the home about the service, contact numbers of social services and the health care authority and a copy of the inspection report need to be included in the service users guide to meet the standard. Everyone living in the home had had their care needs assessed and recorded by the manager. The homes policies and procedures included information on the processes to be followed in the case of an emergency admission. There was evidence that an assessment was completed prior to admission and assessment continued after admission to ensure all needs and preferences were identified. Where people had been admitted on a rolling respite programme, assessments had been checked at each visit to ensure there had been no changes. Nutritional risk assessments were completed and action had been taken where necessary to involve a dietician in the planning of care, weight was also measured on admission. Risk assessments were completed where people had reduced mobility and carer’s assistance was required for transfers. Risk of pressure damage to skin was identified and action plans developed. There were detailed assessments and care plans for people with significant vision or hearing impairment. There was evidence that social services assessments and care plans were obtained. The manager was able to demonstrate that staff had undertaken training to be able to meet the care needs of those admitted to the home. People were able to visit the home prior to admission and the contract identified that the first four weeks stay at the home were on a trial basis. DS0000070726.V362674.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, and 11 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s health and personal care needs were met and detailed in individual care plans. There were medication policies and procedures to support practice and staff worked to these. Processes for self-administration of medication need further development. The home promoted privacy and dignity and people felt that they were treated with respect. Procedures for end of life care ensured people received quality care and support. EVIDENCE: A random selection of four care plans were inspected, these had been developed from information gathered at assessment. The level of detail contained in the care plans about peoples needs and preferences for how care was to be delivered provided evidence that people had been involved in their development. For example one care plan contained information about how the person preferred their pillows, another indicated the occasional assistance that DS0000070726.V362674.R01.S.doc Version 5.2 Page 12 may be required with grooming their hair and attending to facial hair even though the person was self caring in all other aspects. One care plan stipulated the time of rising on a particular day to enable the person to attend an activity. Diary records were recorded on a daily basis and identified how the care plans were being met. There was evidence that care plans in the home had been evaluated on a monthly basis. Nutritional screening was completed and people’s weights were taken on a regular basis. In one case the screening records hadn’t been correctly completed and weight loss identified. There was also some inconsistency in the care plan and risk assessment in terms of the level of care required. These issues had not been identified in the evaluations and care must be taken to ensure that the evaluations take into account all the monitoring records. There was evidence that risk assessments and action plans were in place to minimise the risk of pressure sores but these need to more specific in terms of frequency of the care to be provided. Very detailed care plans had been developed for people with sensory impairment. There was evidence from the care plans that people had access to appropriate health professionals and referrals for specialist advice had been completed where required. The home had a policy and procedure in place for the safe handling of medication. Records of ordering, receipt, disposal and administration were maintained. There was evidence that the manager had been auditing medication processes on a monthly basis. The staff records evidenced that staff had had completed an accredited twelve-week distance-learning course in the safe handling of medication. None of the people living in the home were self-medicating and none expressed a preference to do this during the inspection. The home did not have a risk assessment for those who may wish to self medicate and this is recommended. Some administration instructions had been hand transcribed on to the medication administration records, where this occurs the entries must be double checked and signed and witnessed to minimise errors and this had not been completed. People stated that their privacy and dignity was respected and staff interacted appropriately with people during the course of their work. Care plans DS0000070726.V362674.R01.S.doc Version 5.2 Page 13 specifically identified personal care requirements in detail to ensure a person’s dignity was maintained. The home took into account peoples wishes on death and these were recorded in the care plans. Policies and procedures described the care requirements to support end of life care and included the support of relatives during this period. The manager had recent written evidence from relatives praising the quality of the care and support provided during end of life care. DS0000070726.V362674.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, 13, 14 and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People had choice in most areas of their lives and care was provided to meet individual needs. People were enabled to maintain contact with family, friends and their local community. People enjoyed a varied and nutritious diet appropriate for their needs. EVIDENCE: People confirmed that they had choices in all areas of their life and personal care was usually delivered within their preferred routines. Assessment and care planning processes identified areas in which people required support to express choice and maintain preferred routines whilst living in the home. Where people had sensory impairment care plans were detailed to ensure that people could maintain their independence as far as possible. Even where people were mostly independent the care plans were very specific in the support required to maintain their chosen lifestyle. DS0000070726.V362674.R01.S.doc Version 5.2 Page 15 The manager stated that they had been fund raising to enable them to provide a greater variety of activities. They had purchased music, games and quiz books. They had also had external entertainment in the home. Activities were decided on a daily basis with the people who lived in the home and staff were proactive in the provision of activities. Staff considered activities as part of peoples care and not as an extra task if there was time. Records of activities that individuals had taken part in had been consistently recorded. People who lived in the home said they enjoyed the activities held in the home and during part of the inspection a lively reminiscence session was taking place. This incorporated music, poetry, discussion and hand massage with aromatherapy oils. Most people took part in this and enjoyed the activities. Some staff joined in with the activity but others were noisy when going about their work, which was distracting to this activity. There were no church services held in the home at the time of the inspection but there was evidence that people’s religious needs had been identified and care planning identified ways to enable people to attend religious services of their choice. Visitors stated that they were able to visit their relative/friend in private and said they were welcomed into the home and were kept informed of important matters relating to their relative. They were very positive about the home and the care provided. People enjoyed the meals offered to them and meals observed were well presented with different portion sizes. Comments included ‘the food is always good’, ‘the meat is good’, ‘ the meat is tender’ and the meals are ‘very tasty’. The home provided a four-week rotating menu with choices at all meals. The manager stated that the menus were reviewed every couple of weeks to ensure that they were being enjoyed and were changed every four to six weeks to ensure variety. The menus were displayed in the home on a blackboard in the dining room. Staff were observed assisting people individually in a discreet and sensitive manner and diets were provided to meet individual needs. Aids to encourage independence were available if required. DS0000070726.V362674.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, 17 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People indicated that they knew how to make a complaint and the homes policy and procedure was displayed. People were protected from abuse and their legal rights were protected. EVIDENCE: The homes complaint procedure was up to date and displayed prominently in the home and in the information provided to people. Neither the Commission nor the home had received any complaints about the service or care provided. The manager was advised to record any minor niggles as part of her quality monitoring. People stated that they knew who to complain to if they were not happy with any aspect of the service they received but they and their visitors all spoke positively of the home, staff and care provided. The home had a copy of North East Lincolnshire Councils Protection of Vulnerable Adults policy and procedure. The homes policy and procedures linked to these policies although the untoward incident policy was a little inconsistent with some of the directions in the main policy. Training records identified that the manager and all staff in the home had received training in safeguarding procedures with Local Authority. DS0000070726.V362674.R01.S.doc Version 5.2 Page 17 All recruitment checks had been completed prior to staff commencing employment in the home. The manager was keen to ensure that peoples rights were promoted, she stated that people were enabled to vote and postal voting was arranged for some people. Information relating to advocacy services was made available within information about the home. DS0000070726.V362674.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): 19, 20, 21, 22, 23, 24, 25 and 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a comfortable and well-maintained home that is suitable for their needs. The home was kept clean, tidy and free unpleasant odours. EVIDENCE: The home was clean and tidy and free from unpleasant odours. There was evidence of ongoing improvement, redecoration and maintenance in the home and the handyman maintained records of work completed. Some new bedroom furniture had also been provided. The home provided two bathrooms and a shower room. One bathroom had had a new bath hoist fitted. High seat toilets were fitted in the home. DS0000070726.V362674.R01.S.doc Version 5.2 Page 19 To aid mobility the home had handrails, a passenger lift and ramps out into a secure garden. The home also provided hoists and accessed appropriate slings for use with these via the district nurse. The home accessed pressure-relieving aids such as mattresses via the district nurse and they had also purchased a pressure-relieving mattress for the home. Three of the bedrooms were shared rooms and privacy screens were available to protect people’s privacy and dignity. Not all the furniture as listed in standard 24 was provided due to space constraints but the rooms were comfortable and well decorated and the furniture provided was of good quality. Locks to bedrooms were not provided as standard but people were asked at assessment if they wished to have locks fitted. There was evidence in records that monthly checks of hot water temperatures was complete, the manager was advised that the handyman should record actions taken where the temperatures were outside of an acceptable range. There was evidence that controls were in place to prevent the risk of Legionella. Staff had received training in infection control. Policies and procedures were in place but didn’t include information on management of spillages for example of bodily fluids. Staff stated that they always had sufficient personal protective equipment such as gloves and aprons. DS0000070726.V362674.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): 27, 28, 29 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who lived in the home felt there were sufficient staff on duty and needs were being met. The home was committed to the provision of training and all staff had received training in their role. People were protected by the homes recruitment policies and procedures. EVIDENCE: The home has had a very stable staff group since the new providers have been in place and no new staff have had to be recruited. There was documentary evidence that Residential Forum guidelines, which requires assessment of the dependency of each person living in the home on a regular basis, had been used the to determine the staffing levels in the home. However part of the guidance had not been completed and this would affect the calculations and possibly require the home to have to provide some more staff hours over the week. At the time of the inspection the manager arranged the staffing to have at least two care staff on duty at all times. The staff rota was clearly maintained and identified staff with responsibility for the shift or tasks such as medication. The home had an on call system to alleviate pressures when care staff call in sick. Staff thought this worked very DS0000070726.V362674.R01.S.doc Version 5.2 Page 21 well. The cook was employed for thirty hours per week and care staff prepared and served tea. A cleaner worked in the home thirty hours per week. The manager was generally supernumerary but covered caring shifts on an as required basis. People and visitors stated that there were sufficient staff on duty at all times and needs were met. Staff felt that there were sufficient staff on duty but sometimes found tea times busy. All care staff except one had achieved NVQ level 2 or 3 and the cleaner had achieved NVQ 2 in housekeeping. The manager stated she had completed the Registered Managers Award. The manager had audited all the staff files regarding training needs and had developed an overview of the training completed to date. Staff had received external training in mandatory areas such moving and handling and safeguarding. Certificates for Moving and handling and safeguarding indicated that this training was valid for two years. It is recommended that refresher training be provided annually as these are high-risk areas. The manager had completed training to be able to instruct staff in moving and handling. Staff had received training in fire safety, basic food handling, health and safety, first aid, safe handling of medication and infection control. Three staff had completed dementia training to level 2 and the manager was arranging other courses specific to the needs of people who lived in the home. Staff comments about the training included ‘we have loads of training’, ‘good training’ and ‘training has improved’. There had been no staff leave and no new staff had been employed since the new providers had taken over the home in October 2007. Two staff recruitment files were checked of the most recently employed and all checks were in place. In one case however where a staff member had worked for the manager previously the manager had written a reference. This is not recommended and an additional reference should have been sought from another employer. There was evidence of induction and training in each file. The manger provided evidence that she had obtained induction workbooks to support training to skills for care standards for future employees. Policies and procedures were in place to support recruitment and training processes. DS0000070726.V362674.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): 31, 32, 33, 34, 35, 36, 37, and 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There was an experienced manager in the home who was registered by the Commission. The home was well managed and health and safety was promoted and protected. People who lived in the home were consulted about the running of the care home and benefited from a well-trained, supported and stable group of staff caring for them. EVIDENCE: The current manager, Linda Hewitt, had been in post since 3 July 2006. She stated she had worked in a senior position for a number of years in a care home. She stated that she had completed the Registered Managers Award. DS0000070726.V362674.R01.S.doc Version 5.2 Page 23 There was evidence that she had completed NVQ 2, D31/32, and train the trainer in manual handling. The manager had successfully completed the registration process with the Commission to be the Registered Manager of the home. There was excellent staff morale in the home and none of the staff had left the home since at least October 2007. Staff stated that they worked as a team and felt well supported by the manager. Records showed and staff confirmed that staff meetings and staff supervision sessions were held on a regular basis. Staff stated that they ‘loved’ working at the home. Although the manager did not hold residents meetings she had an open door policy and was very approachable. People felt able to voice their opinions and were regularly consulted about the running of the home and their daily routines. The home had a well-organised process to measure the quality of the service provided and there was evidence that the manager had audited and improved processes in the home. There was evidence that people had been consulted about the quality of the care in the home and the manger had provided the Commission with a summary of the results of the consultation and an action plan. The manager was advised to ensure that the people who live in the home were notified of the outcomes also. There were no records of Regulation 26 visits held at the home. These visits are to record that the provider visits the home at least monthly unannounced to check the quality of the care being given. The manager stated that the providers did visit the home regularly and she felt supported in her role. One of the providers visited the home during the inspection and discussed future plans for the home with us. Their plans indicated that they were to further develop and improve the home. There were clear records maintained of transactions made on behalf of the people who lived in the home and receipts were held. Cash held balanced with the records of transactions in the two cases checked. Care plans also identified the support people required with managing their finances. Policies and procedures were in place to support practice in this area. The manager showed an awareness of health and safety and the need to ensure staff were trained to work safely. Policies and procedures were in place to support practice in this area. There was evidence that fire alarm and emergency lighting tests were completed on a regular basis. There was evidence that the staff had received fire safety awareness training. An external company specialising in fire safety had completed a fire risk assessment in 2006, the manager was advised to review this document. DS0000070726.V362674.R01.S.doc Version 5.2 Page 24 Testing of portable electrical equipment was due and the manger stated that this had been arranged. Servicing of the gas boilers was due and the plumber was at the home during the inspection and moving and handling equipment was also due. The manager was requested to send copies of the certificates when this work had been completed. There was some evidence in care plans that people wished to have bedroom doors open and doors were propped open by various means. This is not appropriate for the control of the spread fire in the home. Equipment such as door guards may be provided following advice from the fire officer as to their appropriateness. The manager kept records of accidents in the home and these were audited. The incidence of accidents in the home was very low. DS0000070726.V362674.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 2 3 4 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 2 2 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 3 2 3 3 3 3 2 DS0000070726.V362674.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? N/A 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 OP1 Regulation 5 Requirement The registered person must further develop the service users guide to include all the information as listed in standard one. This is to ensure that people have all the information to help them to make an informed choice about the home. The registered person must ensure that administration instructions which are hand transcribed on to the medication administration records are double checked and signed and witnessed to minimise errors, The registered person must ensure that the policy and procedure for infection control gives guidance on how to deal with spillages. The registered person must make sure Residential Forum guidelines are correctly applied to ensure that staffing levels meet minimum requirements. The registered person must ensure that Regulation 26 visit reports are completed and held in the home so that these can be DS0000070726.V362674.R01.S.doc Timescale for action 01/07/08 2 OP9 13(2) 01/06/08 3 OP26 16(2)(j) 01/07/08 4 OP27 18(1) 09/04/08 5 OP33 26 01/06/08 Version 5.2 Page 27 6 OP38 7 OP38 provided to the Commission on request. 23(2)b)(c) The registered person must provide certificates to the Commission to evidence that testing of portable electrical equipment and servicing of the gas boilers and moving and handling equipment has been completed. 13(4) The registered person must ensure that bedroom doors are not wedged or propped open to minimise the spread fire in the home. 01/06/08 09/04/08 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 OP7 Good Practice Recommendations The registered person should ensure that evaluations of care plans take into account all the information on monitoring records to ensure that all aspects of heath are monitored and any issues are identified at the earliest opportunity. The registered person should ensure that the care plans to minimise the risk of pressure sores are more specific in terms of frequency of the care to be provided. The registered person should develop a risk assessment for people to self medicate. This is to ensure that people are safe to self medicate and systems are in place to enable people to continue to safely self medicate on admission to the home. The registered person should ensure that the handyman record actions taken where the temperatures of the hot water are outside of an acceptable range. The registered person must ensure that Regulation 26 visit reports are completed and held in the home so that these can be provided to the Commission on request. 2 3 OP8 OP9 4 OP25 5 OP26 DS0000070726.V362674.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 DS0000070726.V362674.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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