Care Home: Upton House

What the care home does well The home had filled in the AQAA and returned it to us on time. It was completed to a good standard and told us how the home plans to improve its service for those who live there. Upton House provides a friendly, homely and comfortable environment for people to live in. There is good atmosphere and residents, relatives, staff and management all said that they get on well together. The majority of people living there appeared relaxed and content in their environment. Residents said the staff are very kind and good.The home makes sure that peoples needs have been fully assessed before they come to stay. This ensures the service can give them the support and care that they need. All relatives and friends are made welcome at any reasonable time. One relative commented, "There should be more places like Upton House". Another said," Upton House is an efficiently and friendly run home. I am always made feel welcome and offered tea or coffee with home made cakes and biscuits". There is a skilled and stable group of staff who know how to look after the people in their care. The staff spoken to have a knowledge and understanding of the client group. The care staff on duty talked and interacted with the residents in a respectful and caring way. They always took time to ask the residents questions. The residents are encouraged and supported to do as much as possible for themselves. One visiting professional commented, "They treat all the residents with gentleness in a calm environment. They allow time with each person and treat everyone as individuals" The home provides a variety some activities and entertainments, which residents said they enjoyed and looked forward to. Any complaints or concerns are taken seriously and acted on. Residents are protected and kept safe. What has improved since the last inspection? The home now has a registered manager who demonstrated she is committed and determined to improve the service for the people who live at Upton House. She is pro-active and has a clear understanding of the principles and focus of the service. She is open and transparent in all areas of running the home. She wants to develop and improve the service for the people who live at the home. The home showed us their Statement of Purpose and the Service Users Guide. It is up-to date so people have the information to assist people to make the decision as to whether the home is the right place for them to live. Everyone now has updated terms and conditions of residency and contracts are in place. This tells people who live at the home about the amount of fees they pay and what the service offers for the fees. Their places are protected. We saw that the home has developed new care plans for all the residents, which are individualised and meet their needs in a way that suits them best. Residents can be sure the staff are able to look after them and keep them as safe as possible while enabling them to live comfortably and happily. There are now assessments in place to identify people who are at risk of developing pressure areas. The result of this is that people have the appropriate pressure relieving equipment and no one has any skin breakdown. The home no longer uses communal records, which name individual residents. This ensures that individual confidential information is not shared. CCTV cameras have been removed from the communal areas of the home so people`s privacy is respected. All safety checks have been completed and are up to date including all the fire regulations. This means that residents live in an environment that has been made as safe as possible. All residents living at the home have access to the garden areas. So they are able to enjoy being out-side in the better weather. Staff receive the necessary induction training when they start to work at the home. This ensures that all staff have been given the opportunity to develop the competencies and skills to look after the people in at the home in a safe a manner as possible. What the care home could do better: The home needs to further develop some of the areas of care planning and risk assessment especially with regards some of the resident`s health care needs. This will ensure the staff have clear guidance on health complication so any problems can be quickly identified and dealt with. This will promote health and well being for residents living at the home. The medication practises and procedures need to be tightened up to make sure that the residents receive the medication they are prescribed and that it is beneficial to their health. The home needs to further develop and evidence the activities and leisure pursuits so as to allow and encourage people to have meaningful and active life`s that suit their preferences and capabilities. The registered manager needs to make sure that 2 references are obtained for all staff before they work at the home this will make sure that residents are fully protected by the homes recruitment procedures. The home needs to further develop its quality assurance systems to ensure that it is meeting its aims and objectives and is improving the service for the residents. The manager needs to develop an on-going maintenance plan for the decoration and up- keep of the service. CARE HOMES FOR OLDER PEOPLE Upton House Deal Road Worth Deal Kent CT14 0BA Lead Inspector Mary Cochrane Unannounced Inspection 9th June 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Upton House DS0000023288.V365619.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. Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Upton House Address Deal Road Worth Deal Kent CT14 0BA 01304 612484 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) triciajolin@hotmail.com Mr Peter Edward Jolin Mrs Patricia Jolin Jacqueline Jolin Care Home 20 Category(ies) of Dementia (0) registration, with number of places Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Dementia (DE) The maximum number of service users to be accommodated is 20. Date of last inspection 22nd June 2007 Brief Description of the Service: Upton House is a large, Georgian style, listed building which is situated in a quiet rural area, near to the village of Worth, and on the main road between Deal and Sandwich. The homeowners are Mr. & Mrs. Jolin, who live in separate premises in the same grounds as Upton House. They have owned the home for the past 20 years. Mr. & Mrs. Jolin take an active and visible role in overseeing day-to-day aspects of running the home, and they are very committed to caring for the residents. The home has a no smoking policy in the home but residents can smoke in the grounds. The registered manager is Mr. & Mrs. Jolin’s daughter in law and a dedicated team of care and ancillary staff supports her. Accommodation is provided on 2 floors and a selection of mezzanine levels. There is a stair lifts enabling access to rooms on the first floor. Some rooms need to be accessed via a few steps, and the level of mobility required is taken into account during service users pre-admission assessment. The style and layout of the home allows plenty of space for residents to wander around, and the well laid out and extensive grounds are secure, enabling the people to walk or sit and enjoy the gardens. The current scale of fees are: £595.00 - £780.00 per week. Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 5 A copy of the most recent inspection report is available on request from the home or can be down loaded from commissions’ web-site. www. csci.org.uk. Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 6 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 visit to the service was an unannounced “Key Inspection” which took place over one day. All the core standards were looked at during the visit. The registered manager was available through out the site visit. The people living at the home and the staff on duty were helpful and cooperative throughout the visit. To collect evidence for this report we spoke with residents, relatives and had discussions with the management team and staff. We observed how staff supported residents during social activities and when offering care and support. We looked at and discussed residents individual support plans and their risk assessments and saw some polices. We also looked at staff training records and the homes quality assurance. During this visit, we saw a part of the home. An annual service assurance assessment (AQAA) was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Information received from the home since the last inspection was used in the report. We also took into account the things that have happened in the service, these are called ‘notifications’ and are a legal requirement. What the service does well: The home had filled in the AQAA and returned it to us on time. It was completed to a good standard and told us how the home plans to improve its service for those who live there. Upton House provides a friendly, homely and comfortable environment for people to live in. There is good atmosphere and residents, relatives, staff and management all said that they get on well together. The majority of people living there appeared relaxed and content in their environment. Residents said the staff are very kind and good. Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 7 The home makes sure that peoples needs have been fully assessed before they come to stay. This ensures the service can give them the support and care that they need. All relatives and friends are made welcome at any reasonable time. One relative commented, “There should be more places like Upton House”. Another said,” Upton House is an efficiently and friendly run home. I am always made feel welcome and offered tea or coffee with home made cakes and biscuits”. There is a skilled and stable group of staff who know how to look after the people in their care. The staff spoken to have a knowledge and understanding of the client group. The care staff on duty talked and interacted with the residents in a respectful and caring way. They always took time to ask the residents questions. The residents are encouraged and supported to do as much as possible for themselves. One visiting professional commented, “They treat all the residents with gentleness in a calm environment. They allow time with each person and treat everyone as individuals” The home provides a variety some activities and entertainments, which residents said they enjoyed and looked forward to. Any complaints or concerns are taken seriously and acted on. Residents are protected and kept safe. What has improved since the last inspection? The home now has a registered manager who demonstrated she is committed and determined to improve the service for the people who live at Upton House. She is pro-active and has a clear understanding of the principles and focus of the service. She is open and transparent in all areas of running the home. She wants to develop and improve the service for the people who live at the home. The home showed us their Statement of Purpose and the Service Users Guide. It is up-to date so people have the information to assist people to make the decision as to whether the home is the right place for them to live. Everyone now has updated terms and conditions of residency and contracts are in place. This tells people who live at the home about the amount of fees they pay and what the service offers for the fees. Their places are protected. We saw that the home has developed new care plans for all the residents, which are individualised and meet their needs in a way that suits them best. Residents can be sure the staff are able to look after them and keep them as safe as possible while enabling them to live comfortably and happily. There are now assessments in place to identify people who are at risk of developing Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 8 pressure areas. The result of this is that people have the appropriate pressure relieving equipment and no one has any skin breakdown. The home no longer uses communal records, which name individual residents. This ensures that individual confidential information is not shared. CCTV cameras have been removed from the communal areas of the home so people’s privacy is respected. All safety checks have been completed and are up to date including all the fire regulations. This means that residents live in an environment that has been made as safe as possible. All residents living at the home have access to the garden areas. So they are able to enjoy being out-side in the better weather. Staff receive the necessary induction training when they start to work at the home. This ensures that all staff have been given the opportunity to develop the competencies and skills to look after the people in at the home in a safe a manner as possible. What they could do better: The home needs to further develop some of the areas of care planning and risk assessment especially with regards some of the resident’s health care needs. This will ensure the staff have clear guidance on health complication so any problems can be quickly identified and dealt with. This will promote health and well being for residents living at the home. The medication practises and procedures need to be tightened up to make sure that the residents receive the medication they are prescribed and that it is beneficial to their health. The home needs to further develop and evidence the activities and leisure pursuits so as to allow and encourage people to have meaningful and active life’s that suit their preferences and capabilities. The registered manager needs to make sure that 2 references are obtained for all staff before they work at the home this will make sure that residents are fully protected by the homes recruitment procedures. The home needs to further develop its quality assurance systems to ensure that it is meeting its aims and objectives and is improving the service for the residents. The manager needs to develop an on-going maintenance plan for the decoration and up- keep of the service. Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 9 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. Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 10 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 Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 and 6. People who use the service experience good outcomes in this area. Prospective residents have the information they need to make an informed choice about living in the home; their needs are assessed; and they will only be admitted if the home are confident of meeting these needs This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a Statement of Purpose and a Service Users Guide. The Statement of Purpose contains the information needed. It sets out the objectives and philosophy of the service and is up to date to reflect the present situation in the home. The Service Users Guide has been reviewed and updated and contains information to assist people in making a decision about whether the home is the right place for them to live. The manager needs to develop other formats for the guide so that it will be more accessible and Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 12 understandable for the people the home caters for. It does include information on how to make a complaint. This requirement has been met. Everyone who uses the service has a terms and conditions/ contract in place. Which explains what the service provides for the money paid. The terms and conditions/contracts are kept within the individual file of each person so they are accessible to residents and their families and representatives. They are signed by the person/ representative and the owner of the home. This requirement has been met. The home has recently reviewed their assessment procedures. The service has developed an assessment format which looks at the person as a whole. It identifies the persons care/support needs and also looks at all aspects of their lifes. It gives a information about their past, their likes and dislikes. Pastimes and religious and cultural preferences. The pre-assassent tool is also supported by assassesments for nutrtion, skin integrity and cognition. These can be used as baseline information to monitor whether people improve or deteriorate after they have come to live at the home. The home does not offer intermediate care. Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 13 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 and10 People who use the service experience good outcomes in this area. Residents have an individual plan of care; their care needs are met by the home and supported by a multi-disciplinary health care team. The ethos of care ensures that residents throughout the home are treated equally. They are treated with respect and their dignity is maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has just started to use a new format for care planning. 3 plans were looked at. The plans are person centred and are developed from the resident’s perspective. They reflect what people can do for themselves as opposed to what they can’t do. They are of a good standard easy to follow and are accessible. On the whole the plans are reviewed and kept up to date. Staff said that they use the plans on a daily basis and keep them up to date. This was observed at the time of the visit. Daily records are maintained but Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 14 they do not always give a clear picture about how residents spent their time and do not relate to the individual care plans. Staff were able to say what people did during the day and because they know the residents so well they are able to anticipate peoples needs. Observations of staff offering personal support were good. People were spoken to discreetly and with respect. Staff were observed assisting the residents in a caring and supportive manner and were seen treating them with respect and understanding. They were seen demonstrating good body language and communication skills when interacting with the residents. Members of staff spoken to confirmed an understanding and commitment to this aspect of care. Risk assessments are individualised. The service does need to make sure that risk assessments are in place to assist people to live a full a life as possible and not act as a restriction. On admission to the home all residents now have a skin integrity assessment. This ensures that anyone who is a risk of developing pressure areas is identified on arrival. The appropriate aids and can be put in place immediately to prevent skin breakdown. The assessment is then reviewed at regular intervals. We did see evidence that some identified health needs are not being closely monitored. Examples of this were people with diabetes, people with catheters and those who had dietary requirements. The care plans do identify the residents’ need and give staff guidance on what support and input that is needed but there was no guidance in place with regards the risks and complications that can develop from these health issues. This means that resident’s needs may not be met if complications arise. The manager stated she would make sure this information would be incorporated in to the care plans Each resident is registered with a local G.P. and any area of concern related to health is referred to the G.P. The home has contact with the Home Treatment Service and district nursing team. Good relationships have developed. The home also has contact with the local older peoples mental health team and consultant psychiatrist. This means that people at Upton House are well supported and can easily access the specialist community services when they need them. Visiting professional reported the home offers a good standard of care. One comment was, “They always contact the District Nursing Service immediately there are any concerns. Even if this is out of hours”. The residents have regular appointments with opticians, a chiropodist and dentists. Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 15 Medication procedures were looked at. All staff who administer medication have received training and their competency are regularly assessed. The prescription sheets were all signed and no gaps were identified. The recording and administration of controlled drugs was undertaken according to requirements. Medication policies and procedures are in place. Medication is stored safely and at the correct temperatures. Some of the people staying at the home are prescribed medication (this includes topical creams) on a ‘when required’ basis. It is recommended that medication prescribed ‘when required’ needs to have written instructions and guidance for staff to ensure that the medication is administered consistently and can be monitored. There was no monitoring system when pain relief was given to people. As the resident group have varying communication difficulties, staff would be expected to observe and record the effect of such medication by using the guidance that should be in the care plan. The registered manager said she would address this. Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People who use the service experience good outcomes in this area. Residents are able to exercise choice and control over their lives. There are opportunities to participate in some activities. There is varied, healthy diet provided which offers choices at every meal. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service told us in their AQAA that it recently appointed two people to undertake activities at the home. During the inspection it was evidenced that the activities staff are included in the care staffing numbers on duty. This means that they have to undertake a dual role. As there are only 4 carers on per shift and some of the residents need two people to assist, the appointed activities staff have little time and scope to organise, plan and undertake activities in and out-side the home. The manager hopes to develop their role and increase the amount of time dedicated to activities. The home does have a weekly programme, which offers a varied selection of activities. All activities happen within the home. They include arts and crafts, Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 17 pet and music therapy and cake decorating to name a few. There are no activities arranged out-side the plans to get more people out in the future. The staff do document if residents participated in activities but this is done by listing people who attended the activity. It does not state if the person enjoyed the activity or not, whether they fully participated or whether they got fed up. We could not see any evidence to show whether or not the person was asked if they would like to do something and if they where supported and encourage to take part. Staff need to make sure they document what activities the residents do on daily basis. At the moment information on how people spend their time is limited. Residents are encouraged to maintain contact with family and friends. Residents are able to receive visitors in the privacy of their own room if they wish. The staff were observed making visitors welcome and involved. There is the facility to receive telephone calls in private. The service told us and evidence was seen if a resident expressed a wish not to see or speak to a particular person, this would be respected and recorded as their preference. In most areas residents are encouraged to maintain their independence and have control over their own lives. They have choices about what they eat, when they get up and go to bed. They are encouraged to choose what they wear. The home does show how they enable people to make choices. We did see one area where residents are restricted. On the ground floor of the home toilets and bathrooms are locked, so people have to access bathrooms by asking a member of staff. The home told us they do this because they are concerned about the risks for some residents when they go into the bathrooms unaccompanied. There was no risk assessment in place to justify this infringement. Risk assessments need to be in place to enable residents to do things and not to restrict them. A lunchtime meal was observed. The manager told us that residents are given a choice of meals on a daily basis. A cooked breakfast is now offered at least 3 times a week. People can decide where they want to eat their meals. On the day of the visit some residents had chosen to eat in the garden. The dining area is homely and comfortable. There was a friendly, relaxed and sociable atmosphere. The tables and the food were well presented. Staff were available to offer discreet assistance if required. A record is kept of food eaten by individuals is kept so any problems can be quickly identified and the appropriate action taken. Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 18 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 and 18. People who use the service experience good outcomes in this area. The people who use the service can be sure that their complaints will be dealt with. The staff have the skills and knowledge to keep residents as safe as possible. People are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure. There are systems in place to ensure residents or their representatives can raise any concerns about the service they receive. Because some of the residents do have communications difficulties the manager needs to be identifying ways to assist them to voice any complaints or concerns. Staff and relatives said told us that they would have no difficulty in complaining if the need arose. There have been no complaints made to the home since the last inspection. The manager told us all concerns and complaints are taken seriously, and dealt with appropriately. There was no complaints procedure on display in the home when we visited. The complaints procedure does need to be displayed in prominent positions through out the home and it needs to contain all the information on how to make a complaint including timescales. Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 19 The home told us that it has policies and procedures relating to safeguarding adults, which staff are introduced to during their induction training. The care staff have received training in safe guarding adults and this training also included some information on the ‘Mental Capacity Act 2005’. Staff were able to tell us about abuse and what they would do if they if they suspected or evidenced that someone was not being treated as they should be. Staff told they knew about the whistle blowing policy and would having no hesitation in reporting any suspicions or concern immediately. The home manages the pocket monies of the residents. A sample of this was checked and incomings and outgoings balanced. Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 20 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 and 26 People who use the service experience good outcomes in this area. The home is well maintained and decorated to a good standard providing residents with an attractive and homely place to live. The house is clean and hygienic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Georgian Style Listed Building has been adapted to meet the needs of the residents. The accommodation provides sufficient space to meet the needs of the residents. The premises are safe, comfortable, airy and clean and provide sufficient light, heat and ventilation. The premises are in keeping with the local community and apart from the bathrooms the ground floor is accessible to all the residents. Furnishings, fittings, adaptations and equipment are of good quality and suitable for their purpose. Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 21 Since the last inspection many of the areas of the home have been redecorated and refurbished. The registered manager plans for improvements to be on going. The service does need to develop a programme of routine maintenance and renewal of the premises. Four bedrooms were seen during the visit. Bedrooms are individualised with residents personal belongings making it feel like home and screens are provided in double rooms to ensure privacy. All the rooms were clean and tidy and all the bed linen was well laundered and ironed. A cleaner is employed and the home was clean on the day of the visit. There is a large garden to the rear of the property, which has some paved and seating areas for people to use. There is a summerhouse in the front/side secure garden. The registered manager is in the process of developing a sensory garden in this area. The home now only has CCTV cameras to the front and hall of the property. The cameras in the communal areas have been removed so resident’s privacy is now respected. The home has the right amount of equipment and aids to meet the needs of the residents. The laundry is situated in the basement and has the facilities needed to wash soiled and infected linen. Soiled linen is transported in red bags and put straight into the machine. Clinical waste is transported and disposed of safely. Disposable gloves and aprons are available and worn and liquid soap and disposable towels are sited in the necessary areas. Cleaning products are stored safely. Continence pads are now stored discreetly and each resident has their own supply. Night catheter bags are changed daily. Aprons and hats are worn in the kitchen area. The home has robust infection control procedures in place to control and reduce the risk of infection. Staff have received infection control training. Upton House DS0000023288.V365619.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 and 30. People who use the service experience good outcomes in this area. For the majority of the time there are adequate numbers of staff with sufficient training and experience to meet he needs of the residents. The staff have a good understanding of the residents and positive relationships have been formed. Recruitment practices are generally sound, but one area does need tightening up to ensure the service users are fully protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the inspection visit there were 15 residents living at the home. The duty rota showed who was working and now records staffs’ designation. This shows that there is a good skill mix of staff on duty to meet the needs of the residents. The rota was written in pencil so it remains difficult to track changes made to the shifts. The duty rota should be written in ink or done on the computer as it could be used as a legal document. It does record the hours the manager is working. The rota shows the care staff work 12-13 hour shifts a day, with 4 carers on duty during the day plus the manager or deputy manager. At night there are Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 23 two waking staff. The registered manager will need to review the staffing numbers if the number of residents increases. She also needs to consider the numbers of care staff on duty if she develops the role of the activities facilitator. Some of the residents require two carers to meet their needs. Staffing levels need to be kept under review depending on the needs of the people living at the home. One relative said, “ The staff are fantastic and work very hard but sometimes there are not enough of them”. Another said, “ the standard of care is high, the staff are wonderful”. The care staff are supported by a team of ancillary staff that includes, cooks, domestics and a maintenance person. It was reported the staff group at the home is now stable. The staff reported they have developed good relationships with the residents and they are able to anticipate and meet the individual needs of the client group. Residents responded positively to staff. It was observed the staff are accessible and approachable. They are able to exhibit good listening and communication skills. It was evidenced that the staff on duty put the needs of the service users first. A resident said, “The staff are lovely”. They are like my family”. “They are always there when I need them” There is an ongoing NVQ training programme and the manager says that over 50 of staff have completed or are currently completing the award. Four staff files were seen. Criminal Record Bureau (CRB) checks are all in place, however there are shortfalls in the recruitment procedures. All the files looked only had 1 reference. A full employment history was not available and there was no evidence to show that gaps in employment had been explored at interview. This needs to be addressed to make sure that residents are protected by the homes recruitment procedures. The home told us and evidence was seen to show all new staff receive a thorough induction into their role and responsibilities in the workplace as well as undertaking the Common Induction Standards. Records were seen of staff training. Training is well organised and is updated at the required intervals. Any gaps in mandatory training are quickly identified and the necessary training is then accessed as soon as possible. The home provides specialist training to ensure that staff have knowledge and skills to look after people with dementia. The majority of staff have received training in dementia, challenging behaviours, care plan writing and safe guarding adults. The registered manager is going to make the staff receive more in depth training with regards the Mental Health Capacity Act 2005. Upton House DS0000023288.V365619.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, 32,33, 35, and 38. People who use the service experience good outcomes in this area. The home is well run and in the best interest of the people who live there. The health, safety and welfare of the residents is promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home registered with the commission in April ’08. She has the skills, competencies and positive attitude to run the home and meet its stated purpose, aims and objectives. She is very pro-active and has lots of ideas and plans on how to improve the service for people who live at Upton House. The staff and the residents reported that they were well supported and responded in a positive, relaxed manner in the presence of the manager. Opportunities for change and development are on going. Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 25 Quality assurance surveys were sent to the relatives of residents and some have been returned. Surveys need to be extended to include residents/representatives, staff and other stakeholders. This will identify the strengths and weaknesses of the service and take action to address any shortfalls that are identified. It should be ensured that this information is fully accessible for residents and their representatives. An external person undertakes regular visits to monitor how the home is looking after the people who live there and identify any shortfalls. The manager deals with any issues the visits highlight. This improves the service for the residents. There are procedures in place to ensure the finances of the residents are safeguarded. The records regarding people’s monies are clear and accurate. And the incomings and outgoings balance. The manager has checked with the insurance company to make sure the storage of resident’s monies meets their criteria and their money is fully protected by the policy. Staff receive regular supervision and annual appraisals. Staff receive the support hey need to do they jobs effectively and safely. Policies are in place to strengthen safe practices. The home has informed us that all the relevant checks and inspection of equipment and system have been undertaken. An accident book is maintained. All fire assessments and checks are done to a high standard and at the required intervals. Water temperatures are taken and comply with regulations. Drug cupboard and fridge temperatures were also evidence and were within the stated ranges. The manager is aware of RIDDOR and reporting incidences to the Commission under Regulation 37. Containment of Substances Hazardous to Health (COSHH) products are locked away safely. Environmental risk assessments are in place. All staff have received the necessary training. Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 26 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 X 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 X 3 Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 19 Requirement The service needs to make sure they obtain 2 references and a full employment history for each applicant. Gaps in employment need to be explored and evidence kept. The registered person is required to further develop the quality assurance programme and systems. They need to produce a written report to identify strengths and weakness. And let people know how they plan to improve their service. Timescale for action 31/08/08 12. OP33 12 24 26 30/09/08 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. Refer to Standard OP8 OP9 Good Practice Recommendations To develop guidance for staff so they know what to do if complications arise from residents identified health needs. There needs to be individual guidelines in place for DS0000023288.V365619.R01.S.doc Version 5.2 Page 28 Upton House residents prescribed ‘when required’ medication. The effects of pain relief need to be monitored. 3. OP12 To develop the activities provided by the home and link activities to peoples interests. To monitor and record how residents have spent their time and look at ways of improving how they spend their time The complaints procedure needs to be displayed in prominent areas in the home. It needs to contain all the necessary information. It needs to be accessible to people who use the service. 4. OP16 Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Upton House DS0000023288.V365619.R01.S.doc Version 5.2 Page 30 - 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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