Care Home: Underhill House

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What the care home does well People have told us that as soon as they visited the home and decided to move in they were "made very welcome" and "told to treat it as their home". The team are very good at finding out about people and ensure that every person has a care plan that is discussed with them and/or their relatives, which is then followed. The team of staff have good links with professionals, which helps to improve peoples` health. People who live at the home say that the staff are "very kind and caring" and feel they are treated as individuals day to day. The home has an open feel. People living there say that they have the freedom to do what they want to, when they want to. They feel able to voice their concerns, if they have any, and know that these are taken seriously and looked into by the manager and provider. People say that their friends and families are encouraged to visit whenever they wish to. Additionally, a lot of events have taken place that families have been invited to, for example the Christmas Party. The people living at the home get support to keep in touch with their families and friends if they need to. Underhill House is a converted house that is a comfortable place to live. At the same time, people who use walking aids find it easy and safe to get around the home. People living there say that they are encouraged to see it as their own home and that it is always clean and well maintained. Staff feel well supported and are encouraged to do training so that they care for people properly. What has improved since the last inspection? The way people are assessed and information given to them about the home prior to moving in had significantly improved since the last inspection. People are given a `guide` about the home and are sent a letter confirming that the home can meet their needs before they move in. Therefore, we were satisfied that the legal requirements we made last time had been met. Similarly, legal requirements that we made to ensure that people are safeguarded from injury when being moved have also been met. The home had bought a hoist and staff had been trained to used it. The safeguarding procedures to protect people from abuse had been tightened up and procedures included contact information about the local authority adult protection team.Funding was won so that the garden could be renovated, which has been fitted with decking and will become a sensory garden with fragrant flowers and plants. This has made the garden a pleasant and usable outdoor space for everyone living in the home. The number of staff that holds an NVQ award in care has increased (2008- 51%) and another 1% (3 staff) is in the process of doing the award. This means that more staff has the appropriate experience, skills and knowledge to care for older people living in the home. Information about the safe use of chemicals in the home had been moved to the hallway to ensure that everyone can read and follow the guidance. CARE HOMES FOR OLDER PEOPLE Underhill House Underhill Road Stoke Plymouth Devon PL3 4BP Lead Inspector Susan Taylor Key Unannounced Inspection 09:30 8th February 2008 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 Underhill House DS0000003486.V352438.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. Underhill House DS0000003486.V352438.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Underhill House Address Underhill Road Stoke Plymouth Devon PL3 4BP 01752 561638 01752 606377 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 Linda Ruth Turner Mr Michael Turner Mrs Linda Ruth Turner Care Home 28 Category(ies) of Dementia (28), Dementia - over 65 years of age registration, with number (28), Old age, not falling within any other of places category (28) Underhill House DS0000003486.V352438.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age 60yrs Date of last inspection 30th October 2006 Brief Description of the Service: Underhill House is a Residential Care Home owned by Mr and Mrs Turner. Mrs Linda Turner is also the Registered Manager. Underhill House is a large detached property in the residential area of Stoke Village, Plymouth. The home is within walking distance of the local shops, facilities and amenities and close to the bus route into the city centre. The home provides care and support for up to 28 older people, including those with dementia. The home has 4 double bedrooms and 21 single rooms. The current scale of charges are: £350 to £455 (as at 8th February 2008) An additional charge is made for: some transport, some in-house activities, hairdressing, chiropody/podiatry and toiletries/personal items. Information about the home is made available to all prospective service users and a copy of the most recent inspection report is available in the entrance hall. Underhill House DS0000003486.V352438.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 three (3) stars. This means the people who use this service experience Excellent quality outcomes. This was the first key inspection of Underhill House under the ‘Inspecting for better lives’ arrangements. We were at the home with people for 7.5 hours for one day. The purpose for the inspection was to look at key standards covering: choice of home; individual needs and choices; lifestyle; personal and healthcare support; concerns, complaints and protection; environment; staffing and conduct and management of the home. We looked at records, policies and procedures in the office. A tour of the home took place. We tracked the care of three people and met some of their relatives. We also spoke to a group of four people that live in the home about their experiences there. We sent surveys to all of the people living in the home and received 14 back. The comments of these people and our observations are in the report. We sent surveys to three GPs and other healthcare professionals and received 1 back. We also sent surveys to 29 staff and received 7 back. We have included some of their comments in the report. As at February 2008, the fees ranged between £350 and £455 per week for personal care. Extra charges are made for chiropody, hairdressing, newspapers and magazines and toiletries and these vary. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk People living there described Underhill House as being a “first class home with great staff”. In a survey, staff told us that they enjoy working at the home and that the managers have an “open door” and “always listen and try to improve things for people”. A healthcare professional told us ‘Underhill has a friendly and homely atmosphere’. Underhill House DS0000003486.V352438.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The way people are assessed and information given to them about the home prior to moving in had significantly improved since the last inspection. People are given a ‘guide’ about the home and are sent a letter confirming that the home can meet their needs before they move in. Therefore, we were satisfied that the legal requirements we made last time had been met. Similarly, legal requirements that we made to ensure that people are safeguarded from injury when being moved have also been met. The home had bought a hoist and staff had been trained to used it. The safeguarding procedures to protect people from abuse had been tightened up and procedures included contact information about the local authority adult protection team. Underhill House DS0000003486.V352438.R01.S.doc Version 5.2 Page 7 Funding was won so that the garden could be renovated, which has been fitted with decking and will become a sensory garden with fragrant flowers and plants. This has made the garden a pleasant and usable outdoor space for everyone living in the home. The number of staff that holds an NVQ award in care has increased (2008- 51 ) and another 1 (3 staff) is in the process of doing the award. This means that more staff has the appropriate experience, skills and knowledge to care for older people living in the home. Information about the safe use of chemicals in the home had been moved to the hallway to ensure that everyone can read and follow the guidance. 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. Underhill House DS0000003486.V352438.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 Underhill House DS0000003486.V352438.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, 3 & 6 Quality in this outcome area is excellent. The assessment process had significantly improved since the last inspection. People are supported to be fully involved in the process and information is gathered from a range of sources to ensure that individual’s needs are met. The home does not offer intermediate care; therefore no judgement has been made about this. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information sent to the Commission by the manager verified that the admission policy had been changed and that relatives are made aware that for the first couple of days they prefer new people to have a settling in period without visits from relatives and friends. A relative wrote to the Commission Underhill House DS0000003486.V352438.R01.S.doc Version 5.2 Page 10 about their experiences of finding a home for their relation and told us that their family has been ‘thrilled at finding such a wonderful place’. Another relative in a survey told us ‘we took Mum around to look and she felt at home very quickly on the visit’. People living in the home that responded to our survey verified that the received enough information about the home before they moved in so that they could decide whether it was the right place for them. Similarly, everyone that responded in the survey had received a contract. Additionally, they made comments like ‘the home came highly recommended’ and ‘when I visited I felt very welcome’. We saw a copy of the ‘service users guide in every bedroom. The deputy manager told us that people are assessed by herself or the manager who go to visit the person in their current setting to make an assessment. The pre admission form seen included information about their current abilities, medication, next of kin and equipment required. We examined three care files and tracked the needs of the individual’s concerned. A thorough assessment of needs had been completed with people and their relatives when they moved into the home. A requirement made at the last inspection had been met and we read letters that had been sent to people prior to them moving in that confirmed their needs could be met at the home. Assessments completed covered establishing any risks for an individual about their tissue viability, falls, and nutritional status. Additionally, information about the individual had also been obtained from social services if the care package had been commissioned by them. A professional verified that Underhill’s assessment arrangements ‘always’ ensure that the accurate information is gathered and that the right service is planned and given to individuals. 100 of staff responding in a survey verified that they were given up-to-date information about the needs of the people they support or care for. The deputy manager verified that intermediate care is currently not provided at Underhill House. Underhill House DS0000003486.V352438.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is excellent. People that live at Underhill House receive good personal and healthcare support that is person centred and is based upon the rights of dignity, equality, fairness, autonomy and respect. Care is delivered to people in a sensitive way that promotes their dignity and privacy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living in the home that respond to our survey verified that they always received the care and support they need. We examined three care files and saw that the needs of people living in the home are translated into detailed care plans that staff and the individuals Underhill House DS0000003486.V352438.R01.S.doc Version 5.2 Page 12 themselves have access to. People’s weight was being monitored and risk assessments had been completed and regularly reviewed. We tracked care for the individuals that had a range of health and social care needs including insulin dependent diabetes, dementia and mental health. Advice had been sought from healthcare professionals such as the diabetic and mental health nurse specialists. The person with diabetes told us that they were well cared for and encouraged to continue giving themselves insulin as they had done all their life. The person concerned was pleased about this and felt that it was important that they retained their independence by doing this every day. The insulin was stored appropriately in a refridgerator and brought to the individual so that they could inject themselves with it at specific times of day. The nutritional needs for this person were also tracked. A care plan had been written outlining how the person would be monitored, the type of diet they needed and medication they were prescribed. Additionally, we saw that risk assessments had been done covering the individual’s nutritional needs and extent of their capability to self adminiter their medication. At lunchtime the individual concerned told us that they always had a meal that was suitable for them, reduced sugar and low fat. They told us that their weight was regular monitored and we saw a record that had been kept in the individuals file. Daily records documented when the person had attended the eye clinic at the local hospital for regular screening, and correspondence about this was also examined. In a survey a professional verified that individuals health care needs of ‘always’ properly monitored and attended to by the home. We tracked the care of a person with dementia, who was being treated for an infection as detailed in their care plan. Daily records demonstrated that the GP had visited this person regularly. Antibiotics and pain relief that had been prescribed by the GP was given as prescribed. Continence advice had also been sought from a specialist practitioner. Staff told us that they were working to the guidance given. Training records verified that none of the care staff whose files we looked at had attended courses on dementia awareness. However, we saw a booking form and advertisment that demonstrated that dementia awareness courses had been booked for March 2008 and that the majority of staff were going to attend. We spent time observing the person whose care we were tracking and how staff interacted with them. Staff engaged with the person continuously at the right speed and demonstrated genuine warmth and attention, which the person appeared to respond to and enjoy. A relative in a survey wrote, “we have always been very impressed by the care and support Mum receives and the willingness and friendliness with which it is given especially at times of illness”. Another relative whose relation has dementia told us ‘we have always been very impressed by the care and support mum receives and the willingness and friendliness with which it is given’. In a survey, people living in the home verified that their privacy and dignity was respected, with comments like ‘when I tell them to leave my room they Underhill House DS0000003486.V352438.R01.S.doc Version 5.2 Page 13 always do’. We observed interactions between staff and people living in the home, which were respectful and caring. Similarly people we spoke to at the inspection verified that they have freedom to live how they choose to with comments like “we do what we want” and “I’m going off to the pub later”. The home uses a monitored dosage system. Senior staff are responsible for stock taking. Records of ordered drugs and a register of controlled drugs were seen and tallied with those being stored. The system was easy to audit and the inspector tracked medication administered to three people. Records accurately reflected medication having been administered as prescribed by the GP. All medication was kept in a secure place. We observed medication being given to people after the lunchtime meal. This was done safely and records were completed appropriately after each person had taken their medication. Other care staff that were spoke to during the inspection told us that medicines are only adminstered by people that are trained to do this. We examined 3 staff files, 2 of which had certificates demonstrating that the people responsible for giving out medication had done the ‘Advanced medication management’ course. Underhill House DS0000003486.V352438.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 & 15 Quality in this outcome area is good. The people living in the home enjoy a range of activities. These could be individualized further to take account of the diverse needs of people living there to ensure that everyone leads a full and stimulating life. The food in the home is of good quality and is well presented. The level of choice and control for individuals could be improved by greater involvement and consultation with them, and with their relatives or representatives, about meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Responding to a survey, 78 of people were satisfied with the activities available. Their comments included, ‘there are a lot of activities arranged by the home for the family as well as patients, which are well organised and enjoyable’ and ‘activities take place weekly such as bingo, chair aerobics’. However, some people felt that it would be nice to ‘sometimes …..go on a short trip somewhere’. We spoke to a number of people that live in the home Underhill House DS0000003486.V352438.R01.S.doc Version 5.2 Page 15 and were told that there is a wide range of events throughout the year including birthday celebrations that are “special” and “fun” to be at. Staff made comments like I think the service users always seem to enjoy the barbecues we have in the summer and outings to cream teas, they are always well-organised and everyone seems to have fun.” Similarly, a relative wrote to the Commission about their visiting experiences at the home. They told us the ‘residents and relatives enjoyed a lovely buffet and Christmas party and on Christmas day the owner made sure that every resident received a present’. They went on to tell us that they were ‘always greeted at the door and staff go out of their way to speak to us’. Additionally, ‘without prompting, we have received regular phone calls to let us know how he is settling in’. Conversely, families with relatives that have dementia and responded to our survey had mixed views about the suitability of some activities for people with dementia. A relative told us “I would like to see care assistants checking and interacting with residents on other levels away from the lounge area more often”. Another relative in a survey told us ‘Mum can’t really take part’. We spent short periods observing what people with dementia were doing in the main communal areas. During the period of observation, staff involved people to participate in activities such as chair aerobics. Staff engaged with people continuously at the right speed and demonstrated genuine warmth and attention, which some people appeared to respond to and enjoy. However, the activities were group based and did not always reflect the level of ability that the person had given the stage of their dementia. To illustrate this point, some people might be more responsive to sensory activities such as painting or aromatherapy. Alternatively other people might be more responsive to cognitively based activities, such as a reminiscence quiz. Dementia awareness training had been booked for virtually all the staff in March 2008 and this should provide staff with a greater understanding of how they can improve activities for people with dementia to ensure that they are person centered. A relative wrote ‘there seems to be no spiritual provision’. We tracked the needs of three people, two of who had no preferences with regard to their spirituality when we either spoke to them or read their assessments in their care file. We read the ‘entertainments book’, in which it was recorded that four people had attended Stoke Church on 31/1/08 and one person had had communion at the home on 5/2/08. The deputy manager told us that they find out about people spiritual needs when they move into the home and try to meet these wherever possible. We joined a group in the dining room for lunch, which was appetising and nutritious. People we spoke to told us that they usually found out about what choices there were on arrival at the dining room. They felt that it would be “nice to know this in advance so that they had time choose” and “I’ve sometimes been given something I don’t like”. We discussed this issue with the cook and kitchen staff and made suggestions about how they might facilitate better choice for people living in the home. The cook told us that a Underhill House DS0000003486.V352438.R01.S.doc Version 5.2 Page 16 system would be easy to set up and that it would be discussed amongst the team. We asked the cook whether they did quality assurance checks, for example by asking people living in the home for feedback. We were shown a folder containing evidence of daily checks of the refrigerator temperature, food temperature checks before cooking and stock rotation. They went on to tell us that they carefully monitored what food came back to the kitchen and made alterations to the menus accordingly. Two People we spoke to told us that the evening meal was usually served around 4pm. For some people who choose to stay up late, one person felt that the meal could be “a little more substantial”. Another person said they “would like more to eat at tea time as it is a long time to wait until breakfast”. We discussed this with the deputy manager and suggested that further feedback be sought from people about menus, mealtimes and choice. In a survey a professional wrote ‘Underhill has a friendly and homely atmosphere, [the] catering is excellent for the resident age group’ and ‘visiting arrangements are flexible’. Underhill House DS0000003486.V352438.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. The arrangements at Underhill House ensure that people are both protected and able to voice their concerns. Quality assurance initiated by the home has highlighted that some staff have training gaps with regard to their knowledge about protecting people from abuse. This should be prioritised to ensure that all staff have up to date knowledge to protect the people they care for. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We read the concerns and complaints procedure, which is displayed on a notice board and outline in the ‘service users guide’ seen in every bedroom. Information sent to us by the manager verified that one complaint had been received, which had also been sent to the Commission. We read the records, which demonstrate that the manager had investigated the matter thoroughly and had reported the outcome to the informant. As a result of this, clearer information about the admission process is given to relatives when their relation moves into the home. 100 of staff responding in a survey verified that they knew what to do if a person living in the home, a relative or member of staff had concerns about the home. In a survey a professional verified that the service had ‘always’ responded appropriately if they or a person using the Underhill House DS0000003486.V352438.R01.S.doc Version 5.2 Page 18 service had raise any concerns with them. 100 of people living in the home who responded to our survey or who we spoke to knew who and how to complain if they needed to. Additionally, everyone we spoke to was confident that any concerns they might have would be taken seriously and investigated by the manager or deputy manager. In surveys relatives and people living in the home wrote comments like ‘the staff are always happy and supportive’ and ‘I find the staff very kind and very helpful always’. Similarly, a professional wrote ‘the staff are cheerful and welcoming’. We spent time in the lounges observing how staff interacted with the people living there. During the period of observation, we saw that staff engaged with people continuously at the right speed and demonstrated genuine warmth and attention, which people appeared to respond to and enjoy. Other people we spoke to told us that the staff were “very gentle” and “always explained” what they were going to do. We saw a copy of the ‘Alerters guide’ in the office. The home also had a whistleblowing policy, which all of the staff we spoke to understood. This had been updated since the last inspection to reflect local safeguarding arrangements. We spoke to four staff who were all aware of adult protection procedures. The manager showed us a training pack that is used for in house training about adult protection that is being given to staff. We were shown the training matrix for the home that demonstrated that the managers’ knew exactly what training gaps individual staff had. Two out of four staff whose files we looked at had attended recognised training about safeguarding people. The two staff that had not yet done training on this subject, were new, and in the process of doing an induction course that incorporates basic information about abuse and how to prevent it. 51 (15) of care staff held the national vocational qualification in care and a further 1 (3) are in the process of doing it. A component module is about abuse and adult protection therefore the staff doing this will be more aware of how to protect the people living in the home. Information sent to the Commission hightlighted that no referrals had been made to POVA (Protection of Vulnerable Adults List). No referrals had been made to the local authority to safeguard the interests of a person living in the home. Underhill House DS0000003486.V352438.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. People living at Underhill House live in a well maintained, comfortable and clean environment. Further development of the home’s quality assurance measures should be considered to ensure that the risk of infection is reduced for people living, people visiting, and staff working there, and that best practice is followed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living in the home told us “its very cosy”, “spotlessly clean” and “very comfortable”. A relative in a survey wrote, “this is one of the nicest homes we’ve been”. We toured the premises and saw that radiator guards were fitted Underhill House DS0000003486.V352438.R01.S.doc Version 5.2 Page 20 throughout to reduce the risk of scolding to people. All parts of the home were well maintained. We tracked the care needs of three people, one of whom had dementia and visited their bedroom. The window opened fully without any restriction and the occupant was potentially at risk of falling from it due to their health condition. We met the maintenance person who showed us the risk assessment for the home that had been reviewed in 2007. New windows had been fitted throughout the home as a result of this, with the exception of a couple of rooms that still had to be done (one of which was the bedroom described above). The windows had a restricted opening to minimise the risk of people falling from them. We also spoke to the deputy manager who showed us a letter from the double-glazing company confirming that windows would be fitted throughout during the period of the inspection. The deputy manager told us that the maintenance person would fit a restrictor to the window in question later that day to restrict opening and therefore prevent the occupant potentially falling from it, until the new window was fitted. We agreed that this would be a satisfactory interim measure. Information that the manager sent to the Commission verified that they had won funding to renovate the garden. We went outside and looked around the garden, which has been fitted with decking and will become a sensory garden once fragrant flowers and plants have been planted. This has made the garden a pleasant and usable outdoor space for everyone living in the home. Fire exits were clear and accessible. All the bedrooms were inspected and found to be clean, individualised and comfortably furnished. People living in the home told us that there is “always” a housekeeper on duty. All of the wcs and bathrooms had locks on the doors. Communal areas were comfortable and homely. Maintenance certificates were seen for the lift, assisted baths, electrical installation, fire alarm systems and portable electrical appliance checks. On entering the home we saw a poster displayed reminding visitors not to enter if they had any sort of infection to prevent the people living in the home from contracting an infection. Additionally, alcohol gel was in the entrance hall and all visitors asked to use it before entering the home. The manager had verified in information sent to the Commission that an audit using the department of health guidance had not been carried out. Additional information provided verified that 1 out of 27 staff had received training about the prevention of infection and management of infection control. We read the training matrix for the home and saw that in March 2008 all of the staff would be having infection control training. We looked at staff files and saw certificates in two out of three demonstrating that the staff had in the past had infection control training. Hand towels and soap dispensers were seen in wcs, bathrooms and bedrooms. Good hand washing practices were observed as staff were seen to deliver care to people. The laundry was clean and well organised. We observed good infection control measures being followed when staff were dealing with soiled linen. Sluices were clean and fully operational. Underhill House DS0000003486.V352438.R01.S.doc Version 5.2 Page 21 People in the home told us that there had been little illness amongst the group through the winter and that everyone had been offered the opportunity to have the influenza vaccination. Underhill House DS0000003486.V352438.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, 29 & 30 Quality in this outcome area is excellent. The training and development culture at the home means that people are confident that the staff have the right skills, experience and knowledge to care for them. Rotas show well thought out and creative ways of making sure that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the people who use the service. Underhill House had excellent recruitment procedures that protect people living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People responding in a survey and those we met during the inspection verified that staff were “always” available when they needed them. People in a survey wrote comments like ‘fantastic team, the management have done well’. In a survey a member of staff commented ‘we have never needed to use agency staff. During sickness and holidays there is always staff willing to do a little extra hours’. Another person wrote ‘all shifts are always covered’. 50 of the staff responding in a survey verified that they we usually enough staff to meet individual needs of all the people who use the service. The deputy Underhill House DS0000003486.V352438.R01.S.doc Version 5.2 Page 23 manager told us that there was a “low turnover of staff”. We saw old duty rosters that demonstrated that the home was well staffed to meet the needs of people that live there. People we met as we toured the building told us that they “never had to wait long for help” and staff were “very attentive” to them. One person demonstrated this by ringing their call bell for help and staff responded immediately to it asking them if they were ok and what help did they need. 100 of staff responding in a survey verified about their employer had carried out checks such as CRB and references before they started work. We examined the files of four staff, two of which were for new staff. Two satisfactory written references had been obtained for all of the staff prior to employment. Pova checks had been undertaken and criminal records bureau certificates had been obtained also before employment commenced. The home had a written procedure about recruitment and retention of staff and it was clear that these had been followed to protect the people living in the home. In a survey 100 of staff responding felt that their induction training covered everything they needed to know about the job when they started. Similarly, all of the staff verified that they are being given training which is relevant to their role, helps them to understand individual needs and keeps them up-todate with new ways of working. Their comments included the management staff always make sure staff are aware of any courses which may be of benefit to us all regard area for the elderly [they are] very enthusiastic ambassadors for courses and like each one of us to attend’. We looked at four staff files, two of which were for new employees. The new staff did not have a record of their induction. We discussed this with the deputy manager who showed us an induction booklet that was used for new employees and told us that the individual’s concerned would have their own booklet with them as they were required to complete it before returning it to their file. The staff we spoke to verified that they had all had induction training, one person showed us their induction booklet that had been completed. In a survey a professional verified that the home is managers and staff ‘always’ have the right skills and experience to support individuals social and health care needs. At the same time, they felt that the service ‘always’ responded to the different needs of individual people. Underhill House DS0000003486.V352438.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35, 36 & 38 Quality in this outcome area is excellent. The managers are qualified and very experienced and put people that live there at the centre of everything they do. Quality assurance systems are well established and ensure that the home is run safely and efficiently for the people living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager is experienced and she has owned the establishment for several years. She holds the Registered Managers Underhill House DS0000003486.V352438.R01.S.doc Version 5.2 Page 25 Award and NVQ Level 4 in Care Management. We saw the certificate for this displayed. In discussion with the manager, she told us that she used the internet extensively, in particular the Commission’s professional website, to keep up to update thus ensuring that the care delivered is best practice. Additionally, she told us that they were using KLORA and the AQAA (Annual Quality Assurance Assessment) as a framework for improving the service for people that live there. 100 of staff responding in a survey felt that communication was always very good, their comments included staff were given daily updates from senior staff which is relevant for each service user’ and ‘the manager and deputy manager always have an open door and we can always go and discuss any problems and we can be assured of them listening and advising us’. The Commission asked for, and promptly received, the AQAA (Annual Quality Assurance Assessment) document. The information provided gave us a good overall picture of what the service had done in the last year and explicitly how it is planning to improve. We were shown records, which demonstrated that external and internal audits are carried out for quality assurance purposes. As discussed under previous sections, this meant that the managers’ had already identified training gaps for individual staff and the need to fit new windows with restricted opening to reduce the risk of falls of people living there. Additionally, all of the requirements and recommendations made in the last inspection report were met. Staff, professionals and people living in the home that responded to our surveys commented that ‘this is a first class home with great staff. The owner knows exactly how to look after residents in a professional and caring manner’ and the service always puts thought into whatever they do to make enjoyable for the service users and we take very good care of all the service users, always listen to them if they have any concerns etc and give help or advice when required. Similarly, a healthcare professional praised the staff for their ‘professionalism’. People we spoke to during the inspection felt that the home was “excellent” and We looked at 4 staff files, which contained a written record of supervision with the individual concerned. The deputy manager told us that supervision was frequent. This was also borne out when we spoke to 4 staff that told us they felt well supported by the manager and provider. We looked at records showing how money is managed on behalf of three people that live in the home. All were accurate when crosschecked with the balance kept for safekeeping. Entries had been signed for. The manager told us that the records were regularly audited. Receipts corresponded with entries for items such as chiropody, hairdressing and newspapers. Secure facilities were being used to safeguard people’s money. Underhill House DS0000003486.V352438.R01.S.doc Version 5.2 Page 26 Comprehensive Health & Safety policies and procedures were seen, including a poster displayed near to the office stating who was responsible for implementing and reviewing these. We toured the building and observed that cleaning materials were stored securely. Data sheets were in place and staff spoken to understand the risks and strategies to minimise those risks from chemicals used in the building mainly for cleaning and infection control purposes. We observed hand sanitizer being used by staff to minimise the risk of cross infection. Records of accidents were kept and showed that appropriate action had been taken. The fire log was examined and demonstrated that fire drills, had taken place regularly. Similarly, the fire alarm had also been regularly checked. People living in the home, relatives and staff told the inspector that the alarm was regularly “checked once a week”. Certificated evidence verified that an engineer had checked the hoists. First aid equipment was clearly labelled. Three staff on duty verified that they held a current first aid qualification. We were shown a hoist that had been purchased since the last inspection. Good manual handling practice was observed as carers transferred people from wheelchairs to chairs in the dining room at lunchtime. Maintenance certificates were seen for the lift, assisted baths and fire alarm systems. The manager had verified in information sent to the Commission that a local electrician had inspected both the electrical system and appliances. Underhill House DS0000003486.V352438.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 4 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 4 x 3 3 x 3 Underhill House DS0000003486.V352438.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations The diverse needs of people are taken into account when organising individual and group activities so that everyone leads a full and stimulating life. For example, use an assessment tool like the ‘Pool Activity level instrument’ to establish exactly what individuals’ are able to do and indentify suitable activities accordingly. People living in the home are consulted about meals and mealtimes to ensure that their preferences are taken into account and they have more control over this themselves. People that live in the home and staff that work there are protected from the risk of infection by using the Department of Health guide ‘Essential Steps’ to audit current infection control management and make improvements as necessary. 2. OP15 3. OP26 Underhill House DS0000003486.V352438.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Region Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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