Care Home: Victoria

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What the care home does well The service provides general nursing care to twenty three older people. The home provides a homely and comfortable atmosphere and residents are encouraged to bring in their own possessions to personalise their rooms. The standard of care planning is comprehensive and reflects resident`s health and personal care needs and ensures that that residents receive the correct care. The standard of catering is generally good, with a varied menu which allows residents choices of meals, being provided. Residents said that they enjoyed the food. The manager has been in post for several years and many of the staff have been working at the home for a number of years, giving residents the benefit of a stable work force with whom they are familiar, and who know the residents and their needs well. The home operates a robust recruitment system and residents are safe in the knowledge that all staff have undergone all the pre employment checks required by regulation to ensure the resident`s safety. What has improved since the last inspection? The home has fitted automatic closures to all doors, which activate in the event of fire and the entrances to the home are secured by keypad. Most of the resident`s rooms have now been provided with variable height nursing beds and more are on order. It is anticipated that all the rooms will be equipped with these beds. A medication trolley is now used for the administration of medications and the home is transferring the medication system to a blister pack system. This help in preventing medication errors. The deputy manager has attended an infection control course held by the Health Protection Agency and is now ` Infection Control Champion`. This will entail her updating her infection control training at intervals, liaising with the Health Protection Agency and ensuring that the practices within the home are in line with their guidance. What the care home could do better: The home has not followed the good practice recommendations made by the CSCI Pharmacy inspection at the random inspection. These have been repeated as failure to address these issues could result in medication error. An immediate requirement was made at this inspection regarding an unguarded portable radiator in a resident`s room. The provider has subsequently informed the CSCI that this requirement has been met. The manager must monitor the use of cables to equipment within the home. These could prove hazardous to residents. The provider gave assurances that this would be addressed, therefore a requirement has not been made. Risk assessments must be put in place for the use of any equipment by residents, particularly when this has not been provided by the home. The Statement of Purpose and Service User Guide must be kept under review and amended to reflect that a core member of staff no longer is available to the home. There is scope for the amount and variety of leisure activities for residents to be increased. Other issues found in this inspection have not been made the subject of requirement or recommendation due to the manager or provider having given assurances that these would be addressed. They will be checked at the next inspection. CARE HOMES FOR OLDER PEOPLE Victoria 96 The Drive Hove East Sussex BN3 6GP Lead Inspector Elizabeth Dudley Unannounced Inspection 10:00a 12 December 2008 th 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 Victoria DS0000014073.V373532.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. Victoria DS0000014073.V373532.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Victoria Address 96 The Drive Hove East Sussex BN3 6GP 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) 01273-723938 01273 881627 suekingths.victorianursing home@virgin.net Victoria Nursing Homes Ltd Elizabeth Jayston Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23), Physical disability (23), Terminally ill (23) of places Victoria DS0000014073.V373532.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is twenty-three (23) Service users must be older people aged sixty-five (65) years or over on admission Service users may have a physical disability or terminal illness Date of last inspection 30th July 2008 Brief Description of the Service: Victoria 96 The Drive was the first established home of the five homes owned by the Victoria Group. All are situated in Hove. This home is registered to provide care with nursing, care of the terminally ill and care for those with a physical disability. Registration is for 23 older people. The home is a detached property, on three floors, all served by a passenger lift. It has a pleasant lounge on the lower ground floor that looks onto an attractive garden that is easily accessed by wheelchair users. There are parking spaces for approximately five cars directly in front of the home on the small forecourt. There is also a regular number 81 and 81a bus service that stops near to the home. Hove mainline station is close by and Brighton mainline station can be reached by public transport. There is meter parking in Grand Avenue, The Drive and The Upper Drive. Hove promenade, George Street shopping area and the Sussex County Cricket Ground are all within a short distance. Those who wish to walk into town or to the seafront may have to take transport back as it is uphill. Hove Park is also within easy walking distance and has a café. Victoria 96 The Drive, with the other four homes in the Victoria group, has the Quest for Quality Award. The current fees charged range from £600 to £800 per week. The fees do not include extra services such as chiropody and hairdressing, and these can be obtained from the management. The home provides newspapers of residents choice and telephone calls with the UK free of charge. Victoria DS0000014073.V373532.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key unannounced inspection took place on the 12th December 2008 over a period of seven hours and was facilitated by the registered manager, Ms E Jayston. Methods used to collect information about the home included examination of documentation in the home, observation of staff working with residents, the serving of lunches and conversations with residents, staff and visitors to the home. All residents were spoken with during the inspection, and three residents were spoken with in depth and gave their views on life in the home. Documentation examined included care plans, personnel files, staff training and supervision records, catering records and health and safety files. The Annual Quality Assurance Assessment, required by the CSCI, which gives an overview of what has been achieved in the home and issues to be addressed, was received by the CSCI prior to the inspection. This accurately reflected the current status of the home. This was used as part of the inspection process. An unannounced random pharmacy inspection took place on 29th July 2008 due to the CSCI having concerns around medication administration. The requirement made at this inspection has been complied with. Thanks are extended to the residents, staff and management of the home for their courtesy and help during this inspection. What the service does well: The service provides general nursing care to twenty three older people. The home provides a homely and comfortable atmosphere and residents are encouraged to bring in their own possessions to personalise their rooms. The standard of care planning is comprehensive and reflects residents health and personal care needs and ensures that that residents receive the correct care. Victoria DS0000014073.V373532.R01.S.doc Version 5.2 Page 6 The standard of catering is generally good, with a varied menu which allows residents choices of meals, being provided. Residents said that they enjoyed the food. The manager has been in post for several years and many of the staff have been working at the home for a number of years, giving residents the benefit of a stable work force with whom they are familiar, and who know the residents and their needs well. The home operates a robust recruitment system and residents are safe in the knowledge that all staff have undergone all the pre employment checks required by regulation to ensure the residents safety. What has improved since the last inspection? The home has fitted automatic closures to all doors, which activate in the event of fire and the entrances to the home are secured by keypad. Most of the residents rooms have now been provided with variable height nursing beds and more are on order. It is anticipated that all the rooms will be equipped with these beds. A medication trolley is now used for the administration of medications and the home is transferring the medication system to a blister pack system. This help in preventing medication errors. The deputy manager has attended an infection control course held by the Health Protection Agency and is now Infection Control Champion. This will entail her updating her infection control training at intervals, liaising with the Health Protection Agency and ensuring that the practices within the home are in line with their guidance. Victoria DS0000014073.V373532.R01.S.doc Version 5.2 Page 7 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. Victoria DS0000014073.V373532.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 Victoria DS0000014073.V373532.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6. People who use the service experience good quality outcomes in this area The Statement of Purpose and Service User Guide require amendment to reflect the current staffing and assessing systems in the home. The current admission system does not allow prospective residents or their representatives to have complete choice in their choice of home. Preadmission assessments fully reflect the holistic care needs of the prospective residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Victoria DS0000014073.V373532.R01.S.doc Version 5.2 Page 10 The home produces a Statement of Purpose and Service User Guide. Residents receive a copy of the Service User Guide on their admission to the home. Both these documents require reviewing in the light of staff and policy changes. Residents receive a copy of the homes Terms and Conditions of Residence and the manager stated that all residents whether privately or local authority funded, receive a contract. However the Annual Quality Assurance Assessment states that only residents who are fully or partially contributing financially towards their care receive this. The National Minimum Standards and the regulations do not make this discrimination and state that residents should be in receipt of a statement showing how the fees are paid and by whom. Three contracts and Statement of Terms and Conditions showed that for these three residents, this was in place. Prospective residents are assessed by a member of qualified staff from the company prior to being admitted to the home, and a written preadmission assessment produced. Three preadmission assessments were seen, and these provided full and comprehensive information. This information is required to inform the planning of care and to ensure that the home has sufficient staff skills and equipment to meet the needs of the individual. The process enables prospective residents to decide whether the home will meet their expectations and give them the quality of life that they wish to have. A brochure, detailing the services offered by the home is provided to interested parties. Prospective residents or their representatives are encouraged to visit the home prior to the individual making a decision over whether they wish to live there. The inspector was informed that on occasion the prospective resident or their representative have visited the home and made this decision, but have been admitted to another of the homes in the group. This practice takes away peoples freedom of choice and the company should reconsider this policy. The Victoria homes do not admit residents who show signs of Clostridium difficile and this is clearly stated in the Statement of Purpose. The home accepts people for respite, permanent and continuing care, but not for intermediate or transitional care at the current time. Victoria DS0000014073.V373532.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): 7,8,9,10,11 People who use the service experience good quality outcomes in this area Care plans reflect the current and ongoing needs of the residents and the care given to meet these needs. Residents generally looked well cared for and residents nursed in bed appeared comfortable. Nursing charts in residents rooms have not always been updated to show evidence of nursing intervention, this could lead to residents not receiving care in a timely manner. Registered nurses have not signed medication charts following administration of medication in some instances. This may put residents at risk. Testimonials from residents representatives evidenced their satisfaction with the standard of care given to residents at the end of their lives. This judgement has been made using available evidence including a visit to this service. Victoria DS0000014073.V373532.R01.S.doc Version 5.2 Page 12 EVIDENCE: During this inspection four (33 ) of the care plans were examined. These were comprehensive and showed evidence of monthly review, had been formed in consultation with the resident or their representative where possible, and included the current and ongoing care needs of the residents. Care plans included nutrition, continence and wound care plans, and continence care plans included the Bristol Stool Chart. Residents are weighed on a monthly basis and the home uses the Malnutrition Universal Screening Tool, both this and other nursing reference charts such as the Waterlow score tool (a nursing tool used for assessing the risk of pressure damage) have been reviewed monthly. Some residents had a night care plan in place and social care plan. The social care plans require expanding and should include records of residents participation in leisure activities. Night care plans should be formed for all residents and include preferred times of rising and retiring. The home is commencing a new care planning system which will assist staff in ensuring that the care needs of the residents are assessed and met. Several residents were being nursed in bed, they appeared comfortable but it was noted that one resident had not changed position for several hours and the nursing charts in the room did not show any evidence that this had taken place, apart from the logged times of 05:30 and 10:00, or how often turning was required. In another room the relative of the resident said that the resident was nursed in bed continually, but there was no evidence of any charts to show intervention. The manager stated that some residents refuse turning or fluids, but there should be evidence in the rooms that staff have tried nursing interventions, with refusals documented. Nursing charts in individual rooms were not always up to date and it is good practice to maintain turning, fluid and other charts giving evidence of nursing intervention for those residents who are continually or intermittently nursed in bed for long periods. Bed rail risk assessments were in place but a risk assessment for a specific chair for one resident had not been commenced. This should be put in place and include the reason why this resident requires this chair, as this could be seen as restraint. Residents appeared well cared for; and those spoken with made positive comments about the care received and the staff. They look after me alright, Victoria DS0000014073.V373532.R01.S.doc Version 5.2 Page 13 the staff are very nice. Its fine here, the staff are pretty good, and generally do as I ask. They get the doctor when I need it and they answer my bell reasonably quickly. Residents said that they thought that their privacy was maintained and that staff attended to their care in a manner, which upheld their dignity and respect. Residents can have their own phone and the home does not charge for this or for any calls made, this enables residents to make phone calls when they wish and respects their privacy. Due to the CSCI having concerns regarding the administration of medication in the Victoria homes, random pharmacy inspections were undertaken in this and another of the homes on in July 2008. Requirements were made following this inspection relating to the practice of potting up medication before it was administered to the resident. The home now administers medication directly from a medicine trolley and the original labelled containers. The home is commencing the administration of medication by the MDA (blister pack) system. A recommendation was made at the random inspection that the nurse and a witness sign handwritten prescriptions on the MAR charts. This has not been complied with and in the interests of the safety of residents and to reduce the possibility of medication errors, this recommendation has been repeated and it is strongly recommended that the home comply with this. Not all medications, creams and supplement feeds had been signed for following administration. This puts the resident at risk and could result in medication errors. Registered nurses are reminded about their accountability in this matter, and their responsibility to the resident and to their registered nurse registration. The storage and recording of controlled drugs met the regulations, but staff must ensure that controlled drugs are correctly signed out when returned to pharmacy. Medication policies require review now that the medication administration system has changed. Clinic room temperatures recorded were generally high (28°), which is above that which is recommended as being the optimal temperature for storage of medicines. Victoria DS0000014073.V373532.R01.S.doc Version 5.2 Page 14 End of Life care plans which included preferred place for terminal care were not generally in place, but the home maintains records of residents wishes regarding resuscitation. Although the home admits residents for continuing care, the home does not practice the Liverpool Care Pathway or Gold Standards Framework. However the home liaises with the Macmillan nurses and they visit the home as required to give advice and two members of staff have attended palliative care training at the local hospice. Letters of thanks from representatives of deceased residents were seen, and these laid testimony to their satisfaction with the quality of care delivered to these residents. Victoria DS0000014073.V373532.R01.S.doc Version 5.2 Page 15 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): 11,12,13,14,15. People who use the service experience good quality outcomes in this area. There is scope for improvement in the frequency and variety of leisure activities. Residents are enabled to maintain contact with friends and family and to practise their own religious beliefs. There is a varied menu, which provides choices for residents, and food is presented in a manner, which will stimulate the appetite. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager said that the home had now increased leisure activities for residents to two hours twice a week. Activities provided now include some crafts, quizzes, one to one conversation with room bound residents and listening to music. The home also has a keyboard player and singer visiting the home on occasion to entertain the residents. Victoria DS0000014073.V373532.R01.S.doc Version 5.2 Page 16 Residents were making Christmas cards on this day, and said that they had enjoyed doing this. Some residents were involved in a quiz later in the morning. There is scope to provide more activities and the provider should be aware that leisure interests are important both as a form of mental stimulation and as part of the holistic care. The activities organiser has now commenced records of which residents participate in activities and this information should be transferred to the care plans. Currently there is no programme of activities in place and this should be commenced and produced in consultation with residents. The lounge has only one call bell, this may prove difficult if staff are required in an emergency and the provider is required to ensure that residents in the lounge are able to contact staff at all times. The home provides daily newspapers free of charge to all residents and residents have telephones in their rooms. Calls to the UK are free of charge, therefore enabling residents to maintain contact with their friends and relatives. Residents said that their visitors are made welcome by the staff and visitors spoken with said that they could visit at any time and could join residents for lunch. Local ministers of religion visit the home and a Christian service is held once a month. The manager said that ministers of other faiths could be contacted if required and has made contact with a Rabbi for residents of the Jewish faith. Residents said that generally they have a choice around activities of daily living, they can choose their times of retiring, although the night staff give breakfasts out and therefore they are woken before 8 am, often at 06.30. Routines around the home should be sufficiently flexible to consider residents choice. The home provides a varied and nutritious menu, which allows for two choices at lunch and supper. Lunch and supper consist of three courses. Staff were unaware of whether a cooked breakfast could be provided. Residents generally spoke highly of the food provided and said The food is pretty good. Good plain cooking but not always hot enough. There is a good choice of menu and we get asked what we want to eat. The presentation of food was good, pureed foods were of a suitable texture and presented in a manner whereby residents could identify the food. Trays and tables were well laid out and residents encouraged to sit in the dining room to eat their meals. It was noted that paper serviettes are provided instead of clothes protectors, therefore maintaining residents dignity. Victoria DS0000014073.V373532.R01.S.doc Version 5.2 Page 17 Staff were seen sitting down to assist residents with meals and maintaining eye contact and conversation with the resident whilst they provided assistance. Fresh fruit was available in the home. The catering takes place at another Victoria home and is transported over to this home and served out by kitchen servers. Catering staff undertake some food hygiene training in their induction, but the main catering staff have the full food hygiene course. Records, as required by the Environmental health authority, were in place and the kitchen was in a clean condition. Victoria DS0000014073.V373532.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): 16,18. People who use the service experience good quality outcomes in this area Residents are confident that any complaints they may have would be dealt with in an open and transparent manner. Staff receive training in safeguarding adults, and were aware of their responsibilities towards those in their care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure displayed in the entrance hall and included in the Service User Guide, and residents and relatives spoken with were aware of how to make a complaint, and said that they believed that any complaints made would be investigated in a fair and transparent manner. Residents felt comfortable with making a complaint, although most said that they would go to the manager rather than invoke a formal complaints procedure. The home has had no complaints this year, records of previous complaints were examined and these had been dealt with in a thorough manner. Victoria DS0000014073.V373532.R01.S.doc Version 5.2 Page 19 Records are not currently being kept of minor concerns and it is recommended that this be recommenced. These records will provide evidence of how the home has managed individual concerns. Staff have received adult safeguarding training but it is recommended that senior members of staff receive safeguarding training with the local authority in order to ensure that they are confident with the recently reviewed protocols Victoria DS0000014073.V373532.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): 19,2021,22, 24, 25,26 People who use the service experience good quality outcomes in this area The home is well presented and provides a pleasant environment for those that live there. Residents are protected by staff s awareness of infection control This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is pleasantly decorated and fairly well maintained. Communal space consists of a lounge, separate dining room and a rear garden, which is accessible to all residents. Victoria DS0000014073.V373532.R01.S.doc Version 5.2 Page 21 The lounge has only one call bell and a requirement has been made around this. The dining room is not large enough to accommodate all the residents in the home and therefore some residents have to have their meals on small tables in the lounge. Residents accommodation is provided in single rooms, all of these rooms have an ensuite washbasin and toilet and fourteen of these rooms have a bath or a shower. The manager stated that all residents have been consulted regarding whether they wish to have a key to their room and that this has been recorded in the care plans; this was not checked at the inspection. All rooms, with the exception of one room, are provided with a lockable facility for residents money or valuables. The temperature of the hot water in residents outlets is monitored on a monthly basis and records were seen, these were within recommended parameters. One room contained unguarded portable oil filled radiator. No risk assessment was in place. The manager stated that it was in the room because the fixed radiator is not maintaining heat. An immediate requirement was made and subsequent to the inspection the CSCI have been informed that the fixed radiator in this room has been replaced, and a risk assessment was put in place on the night of the inspection. The home is clean and there were infection control policies in place. The deputy manager has undertaken the infection control course with the Health Protection Agency and is now the Infection control champion for the home. This will result in her attending further training sessions as they arise and liaising with the Health Protection Agency. Information from the course is cascaded to the rest of the staff. Staff were seen maintaining universal procedures (recognised infection control practices). There was evidence of alcohol gel throughout the home and staff were seen using this. Soap and paper towel dispensers were available throughout the home including assisted bathrooms and no block soap is used in communal areas. The infection control policy requires reviewing to include the information gained on this course Victoria DS0000014073.V373532.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): 27,28,29,20. People who use the service experience good quality outcomes in this area. There are sufficient staff on duty over a twenty-four hour period for the needs of the residents in the home. Recruitment practices safeguard the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides one registered nurse and four carers in the morning, one registered nurse and two care staff in the afternoon and one registered nurse and one care staff at night. There are currently twenty-one residents in the home. Staff spoken with said there were sufficient staff on duty to meet the needs of the residents during the morning but identified that late afternoons could be difficult as some residents wished to go to bed after the evening meal. Staff said that they thought the night hours were sufficiently staffed. Victoria DS0000014073.V373532.R01.S.doc Version 5.2 Page 23 Sixteen care staff are employed at the home and currently two members of staff have attained their National Vocational Qualification level 2 in care. Efforts should be made to recruit more staff onto the National Vocational Qualification programme. The company employs a trainer who updates staff in basic training, including mandatory training, or new training required. The majority of the training is done in house although staff receive extra training from the Nursing Home Support team and registered nurses can update their training at the courses offered with the local university. Records showed that some members of staff had not updated their moving and handling training. The home does not currently use the recognised induction course Skills for Care, but undertake a local induction in the company training department. This is not currently compatible with Skills for Care, and the Annual Quality Assurance Assessment says that the provider is planning to make the current course compatible with this. During the course of the inspection six personnel files were examined, these contained all the documentation and checks required by regulation. There was evidence that no member of staff had commenced work until the relevant checks were in place. Staff have received the General Social Care Code of Conduct. Victoria DS0000014073.V373532.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): 31,32,33,35,36,37,38. People who use the service experience good quality outcomes in this area A system is in place to monitor the quality of the services provided by the home to ensure that they meet residents needs and expectations. Regular staff supervision ensures that staff are working to the policies of the home. Residents are protected by staff training and regular servicing of equipment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager Ms E Jayston, has managed the home for four years and is a registered general nurse, has a certificate in management and is registered Victoria DS0000014073.V373532.R01.S.doc Version 5.2 Page 25 with the CSCI. She attends ongoing training sessions held in the training department and in the home. The home conducts a quality monitoring process through the process of sending annual surveys to residents and relatives. The results obtained are collated annually. This could be improved by sending out surveys to health care professionals and other stakeholders. Staff meetings are held in the home, but the manager said that residents and relatives meetings arranged had not attracted any interest. The Annual Quality Assurance Assessment was received by its due date and reflected what had taken place in the home over the past twelve months and the plans for the next twelve months. Small amounts of money are kept for residents and records of these were seen and were in order. The home does not act as appointee for residents. Whilst the Annual Quality Assurance Assessment states that policies and procedures in the home have been recently reviewed, amendments are required to some policies to reflect recent changes in procedure across some areas. The manager should also ensure that corporate policies reflect the practice in this particular home. The Statement of Purpose and Service User Guide also require review. Regulation 26 visits (monthly visits made by the provider and reports generated as required by regulation) are now taking place; these had ceased for a number of months. Staff have regular formal supervision within the timescales directed by the National Minimum Standards. Residents care plans are kept in the managers office, which doubles as a nursing office. This is next to the entrance door, this door but is kept closed when there are no staff around. Other records are locked in various filing cupboards. There was evidence that equipment and utilities have had regular servicing and staff have undertaken mandatory training. Doors to residents accommodation are now protected by magnetic door closures, which respond to the fire alarm. General risk assessments including a fire risk assessment are in place for all areas of the home and the entrance to the home is protected by keypads. Victoria DS0000014073.V373532.R01.S.doc Version 5.2 Page 26 The provider must ensure that managers and staff are aware of their responsibility around areas such as unguarded radiators and cables used around the home and that these issues are monitored and action taken by management to prevent accident. Victoria DS0000014073.V373532.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 2 3 3 3 2 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 x 3 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 3 2 Victoria DS0000014073.V373532.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No Victoria DS0000014073.V373532.R01.S.doc Version 5.2 Page 29 STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4(1) Requirement Timescale for action 01/01/09 2 OP8 13(4) 3 OP12 16(m)(n) 4 OP14 12 (3) 5 6 OP9 13 (2) 13(4) OP25 Victoria The Statement of Purpose and Service User Guide must be updated to reflect when senior staff have left the company employment and no longer available for those duties included in the statement of purpose and service user guide. These documents must be kept current. That risk assessments are put in 01/01/09 place for equipment used in the care of service users including the use of personal chairs which may be classed as restraint. Details of why these are required must be included. That the provider consults the 01/01/09 service users about a programme of activities which takes into account their interests and abilities and puts this in place and ensures that sufficient leisure activities are provided. That there is flexibility in the 01/01/09 routines of the home to ensure that service users have choice around the activities of daily living. That all medications and other 01/01/09 prescribed items are signed for following administration. That measures are put in place 15/12/09 to ensure that service users are not harmed by the use of unguarded radiators. This was an immediate DS0000014073.V373532.R01.S.doc Version 5.2 Page 30 requirement. 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 OP5 OP8 Good Practice Recommendations That the prospective service users choice of home is upheld. That relevant nursing instruction charts are in service users rooms and these are kept updated and give clear evidence and indication that the appropriate care has been given. It is strongly recommended as good practice that there is be a robust system to check that the medication administration record charts are correct before they is used, such as the member of staff writing the chart signing and dating the chart and a second person checking the entry for accuracy. The provider is strongly advised to have clear care plans, giving detailed instructions to staff as to what constitutes ‘required’, for individual people. This will ensure that these medicines are given in a clear and consistent way for the benefit of people who use the service. That staff are encouraged to undertake the National Vocational Qualification level 2 in care to attain the required average of 50 of staff attaining this. 3 OP9 4. OP9 5 OP28 Victoria DS0000014073.V373532.R01.S.doc Version 5.2 Page 31 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 Victoria DS0000014073.V373532.R01.S.doc Version 5.2 Page 32 - 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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