Care Home: Tower View

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What the care home does well In the surveys sent out, a question asked was if there is anything else that you would like to tell us. These are some of the quotes: "Just to say how grateful I am to have this opportunity to express my gratitude from my family and myself to have this opportunity to gain my independence in this small care sector, and have the freedom of choice." "I am very happy with Tower View and am pleased to live here." "I feel the move to No. 34 is a positive step in the direction to return home and normal working and family life." People can come and go from the home as they please, they have keys and have lifestyles, which suit their personal needs. Health needs are met and people have retained their health professionals from their previous home.The home is comfortable, clean and safe. The garden is being improved and has an area at the back which is being turned into a vegetable patch. What has improved since the last inspection? This was the home`s first inspection. What the care home could do better: Tower View is clearly a sister home from Dunraven House. Once the home is more established, it can move towards being more independent and run independently as a home. As the home is a new service, it is hoped that it will develop and settle into its own character. People are supported by one out of 25 staff members but there is a core group of seven staff members. Food is delivered from Dunraven and we were told by a member of staff that the chef tells the staff what to cook (but people can ask for different food); there are no set activities but people can access the activities at Dunraven. A risk assessment needs to be written and followed for those people who look after their own medication. The recruitment practices for staff need to follow procedure and further assessments and checks need to be undertaken when staff have previous convictions to ensure that people are safeguarded. People`s contracts need to clearly explain arrangements for annual holidays and the restrictions in the home regarding the rules on smoking and alcohol. CARE HOME ADULTS 18-65 Tower View 34 Manor Road Salisbury Wilts SP1 1JS Lead Inspector Nicky Grayburn Unannounced Inspection 28th May 2008 09:30 Tower View DS0000069948.V355126.R01.S.doc Version 5.2 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 Tower View DS0000069948.V355126.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 Adults 18-65. 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. Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tower View Address 34 Manor Road Salisbury Wilts SP1 1JS 01722 321055 01722 321055 Eoconnormarsh@aol.com 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) Mrs Eileen O`Connor-Marsh Mrs Eileen O`Connor-Marsh Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places Tower View DS0000069948.V355126.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 - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Mental disorder, excluding learning disability or dementia (Code MD) The maximum number of service users who may be accommodated is 3. Date of last inspection Brief Description of the Service: Tower View is a detached home in a residential area outside Salisbury. The home blends in with the area. It has 3 bedrooms, one being on the ground floor. There are 2 bathrooms and a downstairs toilet. There is a good-sized garden at the rear and a garden area at the front of the home. The home has local facilities in the area and people can access public transport near by. The home does not have access for people with physical disabilities. There is 1 member of staff on duty at a time and no one sleeps in. The home is for people who are relatively independent. The home does not have laundry facilities and staff take people’s washing to Tower House which is opposite and has full laundry facilities. The home operates a no-smoking and no-alcohol policy. The Registered Manager, Eileen Marsh, is also the manager of Dunraven House, which is close by. The range of fees are from £459.45 to £636.76 per week. The fees do not include things like newspapers; hairdressing; dry cleaning; chiropody; dentistry work or prescribed glasses. Tower View DS0000069948.V355126.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 was Tower View’s first inspection since their registration in May 2007. Surveys were sent to the manager to distribute to people living in the home; relatives; the General Practitioner, and Health Care Professionals. 3 surveys from people living in the home were returned and form part of this report. The registration report was read prior to the visit and gave us some background information about the home and the manager. The manager sent us their Annual Quality Assurance Assessment (AQAA) when we asked for it. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us numerical information about the service. This gave us good clear information about the home. The Registered Manager is also the manager at Dunraven Lodge and is linked to 2 other homes in the vicinity. What the service does well: In the surveys sent out, a question asked was if there is anything else that you would like to tell us. These are some of the quotes: “Just to say how grateful I am to have this opportunity to express my gratitude from my family and myself to have this opportunity to gain my independence in this small care sector, and have the freedom of choice.” “I am very happy with Tower View and am pleased to live here.” “I feel the move to No. 34 is a positive step in the direction to return home and normal working and family life.” People can come and go from the home as they please, they have keys and have lifestyles, which suit their personal needs. Health needs are met and people have retained their health professionals from their previous home. Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 6 The home is comfortable, clean and safe. The garden is being improved and has an area at the back which is being turned into a vegetable patch. 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. Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Quality in this outcome area is good. People living in the home received information prior to making a decision about whether to move in or not. People’s needs were assessed prior to moving in and are regularly reviewed. People were able to visit the home to make sure it was right for them. People have basic contracts in place detailing the fees, and terms and conditions of their home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Tower View was registered in May 2007 by The Commission for Social Care Inspection to provide personal care to people with a mental health disorder. The home is registered for 3 people to live there. The Manager, Ms Marsh, was present during the inspection and provided us with a current copy of the home’s Service User Guide and Statement of Purpose. It gives good information about the home. The manager needs to ensure that the registered age range of the people living in the home for whom it is intended to accommodate is included, and if nursing care is provided. The appendices were not included in our copy but the index listed that the fire procedure and complaints procedure would be included. The 8 appendices Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 9 must be sent to The Commission to ensure that standard 1 is fully complied with. The manager has since sent us the full current document. The 3 surveys from people living in the home stated that they were given enough information prior to making a decision about moving into the home. The 3 surveys returned all stated that they were asked whether they would like to move into the home. An added quote on a survey was “yes I was given the choice to move here which I was very pleased, and I had many opportunities to come and see the home when I wished. I was also given the choice of which bedroom I wanted. I also brought my family to visit on many occasions and they were very pleased I had the choices I did, and I spent time getting to know the home and I felt more relaxed and happy to be able to come and move here.” Another comment was “I had a number of visits before moving in, also my family have visited and commented on how nice the house is.” The Annual Quality Assurance Assessment stated that people were able to choose their individual bedrooms. Two people confirmed this, and one person told us that they were given their room. The registration report, by the Commission in May 2007, confirmed that people moving into the home had been assessed as being more independent and had lived at Dunraven House for many years. This was further confirmed by the Annual Quality Assurance Assessment. The assessments were held in people’s files. People’s care manager had agreed to the move and this was documented in people’s files. Contracts were read for each person and details the terms and conditions of the home. The manager told us that they have separate contracts with the placing authority. It is recommended that rules regarding smoking and alcohol are detailed in this document as it is a restriction within the home. The smoking policy is included in the ‘Service User Guide’, but not the alcohol policy. The address of the home also needs to be correct. Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. People’s individual needs are personal goals are clearly written in their care plans. People can make decisions about their lives and supported to take risks as part of their lifestyle. People are involved in the development of their home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 2 people’s care plans were read, and 1 person’s was spot-checked. As all 3 people had lived at Dunraven previously, the manager and involved external professionals already knew their care needs and preferences. The manager uses the Standex system to record people’s care needs. Reviews are held regularly and these are recorded in people’s files. It was clear that the person is involved in the process and sign entries and review notes. The AQAA confirmed that “care plans are updated every 6 months and reviewed by the Service user and key worker every month.” People have also added what Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 11 their personal aims and objectives are. One person had added “I am quite happy with things as they are for the time being.” People living at the home have ‘Service User meetings’ every 2 months and the minutes from the last 3 meetings were read. All 3 people were present for these meetings, along with management and 2 staff members. Issues to do with the home are discussed, such as the garden; bus passes; menus; and activities. It seemed that people were still adjusting to the transition from Dunraven to Tower View and were enjoying their new lifestyle. From the surveys, all 3 people stated that they can ‘always’ make decisions about what they do each day, and can do what they want during the day, evening and at weekends. 1 person made a further comment of “I can make decisions every day on what I am going to do, I have the day planned on how I would like to do things.” People are encouraged to help around the house with ‘chores’, and this was discussed in the house meeting in November. People told us that they clean their room. People also have clear notes regarding their daily skills, and for staff to support people in building up their independent skills. Most people have contact with family relations, however, if they would like to contact an advocate, there is information on the notice board. This was stated in the AQAA and was seen during the visit. The manager said that no one has yet contacted them, but would be supported to do if necessary. Risk assessments were in place for people living in the home which detailed the identification of the hazard; who might be harmed; the control measures; the preventative measures and the severity of the risk. There were generic assessments which could be more specific to the home. Individual assessments are held in their file. These are reviewed regularly along with the care plan reviews. Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. People have a lifestyle which suits their needs, and their daily routines are respected. People enjoy their meals but could be more involved with the process. People are supported to maintain their relationships with their family and friends. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at the home told us about the lifestyles they have. For example, watching films; going to the library; going for walks, and going to the local shops. As people living in Tower View are more independent, there are no organised activitities as such. The manager told us that they can still access activities provided at Dunraven, but they don’t really do this. One person goes to a drop-in centre, and people’s daily notes record what they do. Some Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 13 people need more encouragement than others to engage in activities and, again, this is recorded in their care plan. It was observed how people can come and go from their home as they please. People have keys to their bedrooms and the front door. One bedroom has another exit door for fire safety and they confirmed that they have an additional key for this door. It was also observed that people have unrestricted access within their home and the grounds. They can choose whether to spend time on their own or with other people. People told us that they enjoy living in the home as it much quieter than their previous home, which they prefer. However, as people have moved from a large home it is important for staff to monitor whether people become isolated or not. Added quotes from people’s surveys were: “There are plenty of organised activities which we can be involved with if we choose” “Staff support me with my activities, I can make myself a drink or a meal when I please. I like to go shopping at weekends.” “During the days I have the choice to come and go as I please as on Tuesdays and Saturdays I like to visit the local market. I also help staff with various maintenance tasks. In the evenings I like to watch TV or listen to my radio whilst doing crossroads and Suduko.” The AQAA stated that the home has an open door policy, and people are supported to maintain contact with their family. We spoke with people about their family relations, and visits and phone calls are supported. The office area is also a visitor’s room which people can use if they wish, in addition to the communal lounge. 2 people had visited the Isle of Wight last year, and people told us briefly about this. The manager told us that people usually pay for this themselves. This needs to be explained in their contract, in contrast to the good practice National Minimum Standard of a 7-day annual holiday being included in their fees. 2 meals were observed during the visit. These were relaxed and all 3 people ate together. No one in the home has specific dietary requirements. Food for the home comes from the sister home ‘Dunraven’ and a member of staff explained that the chef from Dunraven tells them what to cook. Cupboards and the fridge were quite bare, with a stock of just 2 or 3 tinned items, and ‘value’ products. The manager explained that they do not operate within a budget for food shopping and a member of staff goes to the shops daily and food is stocked when necessary (daily and weekly). The menu is discussed at Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 14 house meetings and the minutes from January showed that “everyone agreed it was good, plentiful and hot”. A dietician had recently been involved with some people’s care to make sure that they were healthy and eating properly. As the home develops, it would be better if the people in the home take a more active role in the shopping and planning for meals. This will be followed up at the next visit and through the annual quality assurance assessments. Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21 Quality in this outcome area is good. People’s health needs are met and personal support is given in a way they prefer and require. People are generally protected by the home’s medication procedures; however, people need to be assessed if they are looking after their own medication. People’s wishes in the event of their death have been recorded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at Tower View still have the same level of input from external health professionals as they did whilst living at Dunraven, which ensures that they remain supported whilst living in a less supportive environment. People’s health appointments are generally recorded. It was recorded that most people make their own appointments, as they are more independent. A local optician visits Dunraven and people go there to get their eyes tested. Regular blood tests, monitoring medication levels, are also carried out at Dunraven. Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 16 The Community Psychiatric Nurse and Psychiatrist visit regularly and people have retained the same professionals for continuity. Clear records are maintained in people’s care notes. People’s weight is recorded on a monthly basis. This was discussed with the manager as it could be viewed as an institutional practice. She said that it is expected of the staff to know people’s weight at reviews with external health professionals. It is recommended that this practice is reviewed with the people living in the home to ensure that they would like this practice to continue or not. People’s needs regarding their personal hygiene is recorded with good detail, explaining it stage by stage. Staff also record when people have showered or bathed. This is to monitor people’s personal hygiene and can be an indication of people’s well being. One person’s care plan states that they are independent with their personal hygiene but “requires observation to ensure from slipping”. The manager confirmed that staff do not observe them washing but they need to be aware of when the person is showering. The plan needs to be re-written to be clear to staff who could mis-understand what they are supposed to do in order to keep the person safe. The manager said that this would be done, and will followed up at the next inspection. Specific health problems are recorded and actions are taken to resolve the issues. The medication procedure was inspected during the visit. The AQAA stated that all staff administering medication are fully trained and competent. If the member of staff who is on duty at the home is not trained (like on the day of the visit), a duty manager from one of the neighbouring homes comes to administer the medication. Staff are trained in a variety of ways: with the company’s main training provider; through the local college, and within the National Vocational Qualification course which most people do. The home’s external pharmacist visited in December and the AQAA stated that they were happy with procedures. The manager told us that they visit every 6 months to carry out a technical check. The record for this was not asked for during the visit. The medication is kept in the office/visitors room in a locked cabinet. There are no controlled drugs kept at the home. Since the registration, one person no longer takes any medication, and one person is looking after their own medication. This has been arranged with the pharmacy and they receive it in a manageable form, on a weekly basis. There was no risk assessment in place to ensure that the person is as safe as possible, and to ensure that the risk of errors is minimised. The manager confirmed that this would be done and is sending it to the Commission. Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 17 There was a box of paracetamol in the cupboard, which had been prescribed for someone, but part of the label had been ripped off, and the manager told us that the tablets were being used as a homely remedy. These should have been returned if the person to whom they were prescribed to no longer uses them. It was advised that a staff signatory list is made to ensure that any errors can be traced back. The Medication Administration Records (MAR) were all signed evidencing that the correct dose of medication was given at the right time. It was also advised that old MAR sheets could be archived. Within people’s care records, there is note regarding people’s wishes at their time of death stating that they do not have any special wishes or it will be dealt with by their family. Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. People living at the home feel comfortable with raising concerns and feel that they are listened to. People living at the home are safe from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The 3 surveys returned to us by people living in the home confirmed that they know how to make a complaint and who to speak to. An added comment was “staff on duty are very approachable.” As there are no staff on duty over night in the home, there are phone numbers on the notice board for people to contact in case of an emergency and there is a on-call duty system operating for people to use. The complaints policy was read and is also on display on the notice board. The contact details for the Commission for Social Care Inspection need to be updated in the Service User Guide and in the complaints policy. The manager confirmed that this would be done. There have been no formal complaints made, and we have not received any about the service. The AQAA stated and the manager showed us the new ‘concerns’ book which records minor issues raised by the people living in the home. All of these had been resolved with recorded outcomes. One of these was not dated. Staff must remember to date these to ensure that the procedure is adhered to. Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 19 All 3 people living in the home stated in their survey that the staff ‘always’ treat them well, and they listen and act on what they say. The AQAA stated that staff are trained in their induction about abuse and its implications. Staff also learn about protecting vulnerable people within their National Vocational Qualification in care (see under staffing). However, from the staff files read, there has been no specific training in the Protection of Vulnerable Adults. The manager said that this has been booked for the following month. The manager showed us the list of people who are fully qualified and these members of staff undertake the on-call system to ensure that any issues would be dealt with effectively and efficiently. The ‘No Secrets’ booklet is on display in the kitchen, which details the process of reporting abuse to the relevant professionals, including the local police. The training of staff in POVA will be followed up at the next inspection. The home has a no restraint policy and people living in the home do not pose any threatening or challenging behaviour. No referrals have been made to the Vulnerable Adults Team. People living at the home control their own finances and the home does not hold any monies for them. One person receives their personal allowance from the manager on a weekly basis from their funding. People’s appointees are either a family member or their local social services. Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 30 Quality in this outcome area is good. People living at Tower View live in a clean, safe and homely atmosphere. People’s bedrooms suit their needs. The bathrooms provide sufficient privacy and meet people’s needs. People benefit from having a number of shared areas they choose to spend time in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour was undertaken with the manager. The home is a 3-bedroom detached house with gardens to the front and rear of the property. People have access to all parts of the home (apart from the bedrooms). There is a lounge; a lean-to conservatory; an office/visitors room, and a kitchen on the ground floor. These were all decorated and appeared homely. Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 21 There is a ground floor bedroom off from the kitchen. The Commission’s registration report stated that the location of this room was discussed with the fire office and the Environmental Health Officer. Both were satisfied with the safety implications. The room has an external fire escape. It has an en-suite toilet and hand washbasin. There are 2 bedrooms upstairs. There is also 1 bathroom and 1 shower room. The registration report confirmed that all bedrooms were over 12 sq.m. All 3 rooms were viewed, were all personalised and fully furnished. People told us that they liked their room, and some people said that it was just a room and did not hold much attachment to it. The bathrooms were lockable, and had soap and hand towels available. The rear garden currently has a fence along the back to provide privacy for the people living in the home. There is another area behind the fence where staff have started to dig up to make a vegetable patch. The manager said that people living in the home are encouraged to help but are yet to actively participate. There are many shrubs and plants both at the front and rear, making it homely, and it is well maintained. There are no washing facilities in the home. The Environmental Health Officer requested that the home did not install a washing machine due to potential infection control issues, as there is no utility area within the home. Currently, staff take people’s washing across the road to Tower House where there is an industrial-style laundrette. This is not an ideal situation. The manager said that people living in the home are not yet able to carry out their own laundry tasks but are expected to put their laundry in a bag for staff. Once the home develops, an alternative, more dignified arrangement must be found. The water temperatures have been restricted since the registration visit. It was noted from the concerns book and the house meeting minutes that some people would prefer the temperature to be slightly hotter than 39 degrees. The manager said that she will ensure that the thermostat is changed accordingly. The home was clean and tidy on the day of inspection. Staff write in the handover book what household chores they have done, this was read, and appears that the home is kept clean and tidy at all times. The 3 surveys from people living in the home confirmed that the home is ‘always’ fresh and clean. Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is adequate. People living at the home are supported by staff who are based at the sister home and is not necessarily consistent. People are not always protected by the home’s recruitment practices. Staff achieve their qualification in care in order to effectively work with people living at the home. However, mandatory training is not always kept up-to-date to ensure that people are cared for efficiently. People benefit from having a supported team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is one member of staff on duty at a time during the day, and there are no staff members who stay over night in the home. The staff member comes from the sister home Dunraven and people living in the home can expect any 1 out of 25 members of staffs. This does not give people a consistent staff team. Once the home develops, it is recommended that there is a core team of staff who support people at Tower View. The manager uses a generic induction booklet which were seen in staff’s files. It was discussed that when the home settles, it would be better to have an Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 23 induction specific to the home and the people living there should be involved in this Staff meeting minutes were read and they occur every 2 months. The minutes from the past 3 meetings were read and contained issues such as sickness, fire instructions, NVQs, supervisions and the use of mobiles. The attendance varies and only certain people attend the meetings for Tower View. The main staff meeting is held at Dunraven. The manager told us that there are also regular management meetings. The minutes of these were not read during the visit. Recruitment files are kept at Dunraven but some were made available for the inspection, and we asked for specific files. 3 personnel files were read and contained the necessary information. One Criminal Records Bureau (CRB) check detailed previous convictions. When a CRB returns with offences and/or cautions, the manager must ensure that appropriate risk assessments and discussions take place to make sure that people living in the home are safe. In this particular case, the member of staff was dishonest on their application form and there was no evidence of a discussion about this, nor a risk assessment. This was raised with the manager during the visit, and she explained that they still employed the person but didn’t document the reasons behind their decision. This is not good practice and a requirement would have been made if the member of staff had started working more recently. Mandatory and further training is provided on a rolling programme and the manager showed us the table of completed training courses. 1 of the 3 staff’s files read had completed their National Vocational Qualification in care, and the other 2 were currently doing it. Training is sourced from a variety of providers and the manager was proud of the amount of training on offer. However, not all training certificates were held on file. Some certificates were found and brought to the home during the visit. One member of staff who was cooking for the people living in the home did not have their food hygiene qualification. The manager told us that specific training, such as the Protection of Vulnerable Adults, first aid and food hygiene were booked for the following month. It is important that staff who work at Tower View are trained in all of the mandatory areas to safely undertake the tasks expected of them. Staff have done other training such as malnutrition; diabetes; death and dying, and infection control. Staff work at Tower View on their own. The manager sent us a copy of the policy. There should be a lone working risk assessment specific to the home to ensure that everyone knows what to do and be aware of the risks involved. The manager said that she would write one to ensure that staff and people living in the home are safe. Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 24 Not all staff are trained in the administration of medication and when they are working at Tower View, another member of staff goes to the people’s home and gives it out. This is not ideal and could be seen as quite intrusive considering the ethos of the home. From the files we read, it was evident that staff receive support from their line manager on a regular basis. Supervision records were read and the subject was discussed with the manager. There is not a lot of information written in the supervision notes, and goals set and/or practice issues are not clearly followed up. The manager explained the conflicting guidance she has received regarding supervisions. We said that if there are personal issues raised during a supervision meeting, this can be written separately to the work related issues. Otherwise, as the notes are kept securely within staff’s files, there should be no problems with confidentiality. Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42 Quality in this outcome area is good. People live in a well managed home. People are safeguarded by the home’s health and safety practices. People’s views are listened to and there are systems in place to review the care provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Tower View was registered in May 2007 and Mrs Eileen O’Connor-Marsh is the Registered Manager. Mrs O’Connor-Marsh is also the registered manager for Dunraven Lodge and is linked to 2 other registered care homes. She completed her National Vocational Qualification Level 4 in 2006 and trained as a nurse in 1979, and has a Certificate of Social Services from 1991. A fitperson interview was not conducted by the Commission’s Registration Team Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 26 due to our previous knowledge of Mrs O’Connor-Marsh, however, a preinterview questionnaire was completed and was satisfactory. Mrs O’Connor-Marsh was present during the inspection and answered all our questions and queries competently, and knew about the people’s care needs well. The home’s quality assurance system includes our inspections; house meetings every 2 months; staff meetings; a suggestion book and people’s individual reviews. The manager does not carry out monthly visits as stipulated under Regulation 26 as she is both the registered provider and the person in day-today charge of the home. The AQAA was completed and returned to us within the timescale. It explained the recent changes made as a result of listening to the people living in the home such as times of meals; people using the kitchen; furniture in people’s rooms. These were noted during the visit. As noted within this report, the record keeping is satisfactory within the home for the people living there. Some daily records were discussed with the manager and how some are better than others. Records were generally up-todate; clearly written and were written with a person centred approach. Some care notes and medication records dated from 2002, and these could be archived if they are no longer being used. The health and safety, and fire folder was read during the visit. It was clear that regular checks are carried out in the home. The fire authority visited the home during its registration process and found the home to be satisfactory. Fire drills are carried out and people living in the home had signed the log sheet confirming that they took part and know what to do in the event of a fire. The electrical installation and Portable Appliance testing has also been carried out within the last year. Staff are trained in fire safety during their induction and have regular training regarding this. There is a risk assessment in place for the home. Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 3 4 4 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 X 3 X 3 3 X Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 28 N/A Are there any outstanding requirements from the last inspection? 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 YA5 Regulation 5(b,c) Requirement People’s individual contracts need to detail the provision of services and facilities within the home (arrangements regarding annual holidays and the restrictions in the home). a) A risk assessment must be written for people who look after their own medication to ensure that they are as safe as possible and the risk of errors is minimised. b) Prescribed medication, no longer in use, must be returned. Timescale for action 30/06/08 2. YA20 13(2) 31/05/08 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. 2. 3. Refer to Standard YA5 YA19 YA20 Good Practice Recommendations People’s contracts to be updated with the restrictions within the home. Review the practice of weighing people on a monthly basis. Old medication needs to be returned to the pharmacy. DS0000069948.V355126.R01.S.doc Version 5.2 Page 29 Tower View 4. 5. YA33 YA36 A staff signatory list to be devised to check who has administered the medication. People to be supported by a core staff team to provide consistency. Supervision notes to have more detail about the issues, actions and how they have been followed up. Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tower View DS0000069948.V355126.R01.S.doc Version 5.2 Page 31 - 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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