Care Home: Villa Adastra

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What the care home does well The home provides personal care for older people in very pleasant surroundings. The home is well maintained and decorated and there is a programme of refurbishment and renewal on going. Prospective residents receive a good range of information and can visit the home prior to deciding whether they wish to live there. Residents in the home can participate in activities provided by the day centre when there is sufficient space for them, these activities are very varied and are well advertised throughout the home. The home also employs its own activities organiser three days a week. The organisation that owns the home shows a commitment to staff training and over 70% of the care staff have the National Vocational Qualification level 2 or 3 in care, other training relevant to the care of the people who live in the home is provided, and staff are encouraged to participate in this. What has improved since the last inspection? There were no requirements made at the last inspection. The home has purchased a people carrier to replace the minibus and this will enable outings to be recommenced. Two new washing machines have been purchased and it is hoped that this will improve the standard of the laundry service. The introduction of communal dining was initially not popular, but residents, relatives and staff made generally positive comments about this during the inspection. The home has commenced a recruitment drive and is in the process of recruiting new staff, thus reducing the number of agency staff used. This had been a concern identified on many of the surveys received. What the care home could do better: The standard of risk assessments regarding individual residents and some areas of the home require improvement, including risk assessments for bed rails, residents who self medicate and risk assessments to access to areas of the home which could impact on residents safety. Staff administering topical and invasive medication; require specific training to do this. The controlled drug cupboard was used for the storage of other items which could result in abuse of the medication, the manager has been asked to ensure that the controlled drug cupboard meets the criteria set down under the `Misuse of Drugs (Safe Custody) Regulations 1973`.Admendents must be made to the current methods of storing and recording a specific drug, which must be used as a controlled drug in a care home environment. The company has reviewed staffing levels, and whilst there were sufficient staff on duty to meet the assessed needs of the residents currently living in the home, the company and the manager should ensure that any change to staffing levels must reflect the size of the home as well as the needs of the residents. This was discussed with management who have agreed to review this; therefore a requirement has not been made. This issue will re examined during the next inspection Comments received from surveys and from talking to people on the day of the inspection confirmed this view. Concerns regarding the standard of catering had featured in surveys, thirty residents were spoken with and twenty-nine of them were not satisfied with the quality of the meals provided, particularly at suppertime. The quality of the meals provided was not up to the standard that would be expected in this home. Requirements have not been made around all the areas of concern noted in this report as the manager has given assurances that these will be addressed. These will be examined at the next inspection. CARE HOMES FOR OLDER PEOPLE Villa Adastra 79 Keymer Road Hassocks West Sussex BN6 8QH Lead Inspector Elizabeth Dudley Key Unannounced Inspection 24th January 2008 09:00 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 Villa Adastra DS0000035172.V358789.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. Villa Adastra DS0000035172.V358789.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Villa Adastra Address 79 Keymer Road Hassocks West Sussex BN6 8QH 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 842184 01273 841420 The Salvation Army Territorial Headquarters Christopher Shields Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Villa Adastra DS0000035172.V358789.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th November 2006 Brief Description of the Service: Villa Adastra is care home registered to provide personal care and accommodation for up to forty older people. The accommodation is provided in single bedrooms each offering en-suite facilities. The accommodation is divided into five separate units each containing eight bedrooms, a lounge and dining room, which are located on three floors. A vertical passenger lift provides access to all floors. The property is situated in well-maintained grounds, which are accessible to residents. The property is located in Hassocks, close to shops and other local amenities. The Registered Provider is The Salvation Army and Ms Elaine Furminger is the Responsible Individual, who acts on behalf of the Registered Provider. The Registered Manager is Mr Chris Shields who is responsible for the day to day running of the care home. The CSCI was informed on the 24th January 2008 that the fees are £583.17 per week and do not include extra services such as chiropody, hairdressing and newspapers. Charges for these can be obtained from the manager. Villa Adastra DS0000035172.V358789.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 unannounced key inspection took place on the 24th January 2008, over a period of eight and a half hours. It was facilitated by the registered manager, Mr C Shields. Judgements made at this inspection were made by touring the home, examining various records, which included care plans, medication records personnel files, staff training records, health and safety documents and catering documentation. Interaction between staff and residents was observed and five residents, two visitors and six members of staff were spoken with. During the day the views of thirty residents were obtained regarding specific issues in the home that had been identified from pre inspection surveys Prior to the inspection, questionnaires were sent to residents and relatives and nineteen were returned, these provided information about the daily life in the home and whether this was meeting the needs and expectations of the residents in the home. The CSCI requires services to complete and return an Annual Quality Assurance Assessment; this identifies the current status of the home and the achievements of the home in the past twelve months and plans for the future. The Annual Quality Assurance Assessment received accurately stated developments that had taken place in the service and the areas that the manager wishes to improve. The home has undergone several changes in the past six months, these have included a streamlining of the staffing and a change from unit based care and dining facilities to staff caring for residents throughout the home and the introduction of a large communal dining room Comments received on the day of the inspection and surveys were variable and included the following: ““ I am so happy to be cared for night and day. The carers are delightful and always so helpful in every way.” “I feel this a well run establishment”. “Quality of food could be improved”. “Laundry poor”. “Lunch is disappointing” “ I am well cared for, the staff are always smiling, but the food is not good” “ Please can we have some activities in the afternoons and weekends.” Catering, laundry and cleaning services are provided by contractors. Villa Adastra DS0000035172.V358789.R01.S.doc Version 5.2 Page 6 Whilst there were several issues in the home that require addressing, outcomes for the people that use the service are generally good. The manager was supportive of the inspector’s comments throughout the inspection and gave assurances that he would address the issues found. What the service does well: What has improved since the last inspection? What they could do better: Villa Adastra DS0000035172.V358789.R01.S.doc Version 5.2 Page 7 The standard of risk assessments regarding individual residents and some areas of the home require improvement, including risk assessments for bed rails, residents who self medicate and risk assessments to access to areas of the home which could impact on residents safety. Staff administering topical and invasive medication; require specific training to do this. The controlled drug cupboard was used for the storage of other items which could result in abuse of the medication, the manager has been asked to ensure that the controlled drug cupboard meets the criteria set down under the ‘Misuse of Drugs (Safe Custody) Regulations 1973’.Admendents must be made to the current methods of storing and recording a specific drug, which must be used as a controlled drug in a care home environment. The company has reviewed staffing levels, and whilst there were sufficient staff on duty to meet the assessed needs of the residents currently living in the home, the company and the manager should ensure that any change to staffing levels must reflect the size of the home as well as the needs of the residents. This was discussed with management who have agreed to review this; therefore a requirement has not been made. This issue will re examined during the next inspection Comments received from surveys and from talking to people on the day of the inspection confirmed this view. Concerns regarding the standard of catering had featured in surveys, thirty residents were spoken with and twenty-nine of them were not satisfied with the quality of the meals provided, particularly at suppertime. The quality of the meals provided was not up to the standard that would be expected in this home. Requirements have not been made around all the areas of concern noted in this report as the manager has given assurances that these will be addressed. These will be examined at the next inspection. 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. Villa Adastra DS0000035172.V358789.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 Villa Adastra DS0000035172.V358789.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 home provides sufficient information to allow prospective residents to decide whether the home can meet their needs and expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and Service User Guide meet the regulations and accurately reflect both the current management status in the home and the services offered. All prospective residents receive a copy of the Statement of Purpose, Service User Guide and Terms and Conditions of Residence prior to their admission to the home, they are also sent a copy of the home’s brochure. They may visit Villa Adastra DS0000035172.V358789.R01.S.doc Version 5.2 Page 10 and meet the other residents and the staff before they decide whether they wish to live there. Residents spoken with said that the information gave them good insight into home and whether it would meet their expectations. Either the manager or a senior member of care staff carries out an assessment of the resident before the decision is made whether the home can meet the individual’s needs and expectations. Three preadmission assessments were examined and these were comprehensive, giving details of the resident’s personal and social care needs. The home informs the prospective residents about whether the home can meet their needs and offer them a place by telephone, in order to comply with Regulation 14(1)(c) this should be followed up in writing. The manager said that he would commence this. The home admits people for respite care but not for intermediate care Villa Adastra DS0000035172.V358789.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 address the ongoing needs of the residents. Lack of bed rail risk assessments and lack of review of existing moving and handling assessments could compromise the resident’s well being and the care given. The standard of medication administration generally safeguards the residents but lack of training in the correct method of administering external medication could impact on this. The storage of some drugs used as controlled drugs does not comply with legislation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Villa Adastra DS0000035172.V358789.R01.S.doc Version 5.2 Page 12 A total of six care plans (15 ) were examined in depth. These generally gave comprehensive and clear information regarding the care to be given to the residents and addressed current needs, although one care plan did not contain information on the care to be given to a resident following an injury from a bed rail, although this was included in the review. Accident forms were in place but no risk assessments for bed rails were included in the care plans. It is good practice to use bed rails with protective covers to prevent injury to residents. Staff would benefit from instructions in some areas, such as moving and handling, to be given in greater detail. Care plan reviews take place monthly, and annual reviews, which include the resident, relative and senior care staff take place, these can be undertaken more frequently if required. Most care plans showed that they had been formed in consultation with the resident, but not all care plans had been dated and signed by the person writing them. Details of the personal care given by carers were generally not up to date and continence care plans gave no details on the type of continence aid to be used. Residents spoken with said that the care was good and that ‘ Staff take good care of us’. There had been some comments in surveys sent in by relatives that the standard of personal care had deteriorated since the staffing review, but there was no evidence of this found during the inspection. Staff were knowledgeable about the care of the residents and most spoke positively about the relocation from unit based care to home based care saying that ‘ This way we can get to know all the residents and care for all of them’. All residents spoken with said that the staff were very prompt in gaining medical and nursing advice and care when required. Documentation showed that staff reported pressure damage in its early stages and sought the relevant nursing advice. Electric pressure relief beds are provided for residents at risk of pressure damage. Some surveys showed that there was a lack of communication from staff when residents were ill or required hospital attention. This was discussed with the manager. Any requests made for gender specific care should be noted in the care plans and should take place. Although residents said that staff responded to call bells quite quickly, this was not found to be the case in one instance on the day of the inspection. The manager should ensure that staff are aware of the importance of answering call bells promptly. Villa Adastra DS0000035172.V358789.R01.S.doc Version 5.2 Page 13 All medications had been signed for on administration and only staff with the relevant training are responsible for giving out the medication, however topical medications and eye drops are being given by untrained staff which could result in overdosing of prescription creams or, in the case of eye drops, damage to the eyes. A medication round was observed and this was undertaken in a manner that safeguarded the residents. The stock rotation of medication was good but staff must ensure that some liquid medication is disposed of within a month of opening. A medication, which is required to be used as a controlled drug in care homes, was neither stored nor recorded as such, due to the home having received conflicting advice on this. Staff addressed this on the day of the inspection. The manager was advised to look at the CSCI guidance on the professional website, the manager was also advised to take advice regarding whether the controlled drugs cupboard meets the criteria of the ‘Misuse of Drugs (Safe Custody) Regulations 1973’. Other items and other medication were being stored in the controlled drug cupboard. This also breaches the above regulations. The risk assessment for the assessment of residents that self medicate should show regular review of these residents for this area and be signed by the assessing staff to ensure that the resident still has the ability to do this. The manager gave assurances that he would ensure that all the issues raised would be addressed. Residents can stay in the home when reaching the end of their lives, the nursing care being provided by either community or Macmillan nurses. The manager stated that he wishes to get some staff involved in the end of life training. The manager must ensure that the current forms used for recording residents wishes regarding resuscitation are in line with national and local Primary Care Trust guidelines. Villa Adastra DS0000035172.V358789.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience adequate quality outcomes in this area A variety of activities are provided but not always at times as preferred by residents, attendance at activities run by the day centre is dependable on numbers attending. The standard of catering is poor; generally residents do not enjoy the variety or quality of the food offered by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides a variety of activities, which includes outings, craft sessions and musical entertainment. These mainly take place in the Day centre attached to the home providing there is room for residents from the home to be included, but an activities co-ordinator spends three days a week in the home, and an activities person comes in once a week. Three residents, in both surveys and discussion, said that they would like some activities in the home in the afternoons and at weekend. One resident said that although the activities in the day centre were good, there were not Villa Adastra DS0000035172.V358789.R01.S.doc Version 5.2 Page 15 always places available for residents and that she felt rather uncomfortable going in there. Other residents were aware of the activities in the day centre and said that sometimes they liked to join in. One relative said ‘ I am amazed at the number of interesting things that they do’. The home has recently purchased a people carrier and intends to recommence outings and the manager is also meeting with the male residents to discuss what activities they would like to participate in. He said that he is trying to tailor the activities for the whole home to reflect residents past and present interests, and by encouraging a resident to continue with her painting has resulted in an art group meeting at the home at intervals and this has now encouraged other residents to join in. Residents said that they had a choice in what time they went to bed, but residents and staff said that they had to make sure they were at breakfast by 9am. The manager disputed this and was asked to inform both staff and residents on the home’s policy regarding this. Residents are able to have visitors as they wish, either in their rooms or in one of the communal areas in the home. Morning prayers take place daily and attendance at these is up to the resident’s preference. The manager is liaising with various ministers of religion who currently visit the home to try to arrange interdenominational services within the home. One resident said ‘ I like the morning prayers and the services, and enjoy the choral services.’ The catering, laundry and cleaning services are provided by outside contractors. Menus provide two cooked options at lunchtime, neither of which is vegetarian. Supper menus were poor. There were few fresh vegetables in the home and there was a heavy reliance on tinned goods. A cooked breakfast is provided three times a week, but the menu showed that a full cooked breakfast was only offered once a week and some residents spoken with said they wished that this was offered more frequently, and also that white toast and bread was available. Residents said that they were aware of the choices available, but one relative wrote in a survey “‘ Residents who are able to communicate well tend to respond to the last item on the list which is salad, not always suitable’. Another relative said that the last meal of the day was a ‘light tea which is not sufficient to last until 9am the following morning’. The manager said that sandwiches are available with evening drinks; residents said this did not always happen. Fruit is available, both in the dining room and taken around on the tea trolley. On Sunday a buffet meal is held in the evening. Efforts should be made to ensure that this provides a nutritional and balanced meal. Villa Adastra DS0000035172.V358789.R01.S.doc Version 5.2 Page 16 The cook has not attended a nutrition course for the older person and this is recommended. Thirty residents in the dining room were spoken with; only one said they enjoyed the food. Comments ranged from: ‘ Its ok’ ‘ The food is fine today, some days it is awful’, ‘Food not too good’ ‘Food sometimes better than others’. Several comments were received about the Sunday meal with residents saying ‘ Poor quality’, ‘Meat always tough’ ‘ Waste of time coming in to dinner on a Sunday’. Surveys also commented on the tough meat, lack of fresh vegetables and general dissatisfaction with the food, one relative said ‘ Lunch is disappointing’. Since the inspection a further concern has been made about the standard of the food, particularly at weekends and the lack of availability of staff to assist residents who are unable to feed themselves. There are kitchenettes on all floors in the home; risk assessments must be put in place for these. Examination of the kitchen showed that cleanliness in the storeroom requires improvement. Generally residents liked the new method of communal dining rather than having it on their units, they said it had taken some ‘getting used to’ but they found it was good to be able to talk to other people rather than those in the eight roomed unit. They all appeared to be aware as to where meals were held. Villa Adastra DS0000035172.V358789.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People who use the service experience good quality outcomes in this area The home addresses any complaints received in a fair and thorough manner. Lack of training of domestic, catering and other ancillary staff in what constitutes abuse of the vulnerable adult could put residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents and visitors to the home are aware of the home’s complaints procedure by it being displayed on the notice board and included in the Service User Guide. The home received sixteen complaints in the last few months, these mainly related to the standard of catering, laundry and cleaning services. Twelve of these were upheld and records relating to these were seen. The manager was made aware of the concerns raised in various surveys and has said he will address these. Since the inspection a further concern has been raised by a relative concerning the catering and the lack of availability of staff to assist residents with meals. Villa Adastra DS0000035172.V358789.R01.S.doc Version 5.2 Page 18 Two residents said that since the home is no longer run in small units they did not know who to go to if things were not right, but said that the manager was always walking around the home and that he resolved any concerns to their satisfaction. There have been two adult protection issues relating to the homes failure to notify health care professionals of health issues, neither of these was substantiated and the home was able to produce their documentation to verify this. Whilst all care staff have received training in the safeguarding of vulnerable adults, no members of the catering or domestic staff have received this. The manager said he would address this. Villa Adastra DS0000035172.V358789.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area Residents live in a well-maintained and pleasant environment. Risk assessments for kitchenettes and controlled access to the laundry are not in place. Towels and other items left in bathrooms may impact on infection control and residents choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home and gardens are well maintained and generally well decorated. The manager had stated in the Annual Quality Assurance Assessment that replacement carpets are required in some areas. The home was originally arranged in units each having eight rooms, this has now been changed and a communal dining room is used. There are small Villa Adastra DS0000035172.V358789.R01.S.doc Version 5.2 Page 20 lounge areas on each unit, and all the residents living in the home can use these. The day unit is at present accessed through the home, but this is to be changed to a separate entrance being provided. Resident’s rooms are of a good size and have seated shower areas; all residents have a lockable drawer and are able to have keys to their rooms if they wish. They are able to bring in personal possessions and items of furniture from their homes. Windows in rooms above ground floor have restricted opening and water temperatures to resident’s basins and baths are monitored monthly and recorded. These were within recommended parameters. Residents spoken with said ‘ I have a lovely room, its quite big and there is plenty of room for when I have visitors’, ‘ I was so glad to be able to bring some of my favourite furniture and pictures in’. ‘ It’s a blessing having a shower you can sit down in’. The home has purchased some variable height beds for those residents who require these. Assisted bathrooms were clean and new power assisted baths have been put in. Other aids to maximise independence are in place, including rails, ramps, hoists and wheelchairs. The cleanliness of the home was adequate apart from some areas in the kitchen, one room was malodorous but this was due to the resident’s condition. Access to laundry and other staff areas needs to be limited to ensure the safety of residents. Most staff have had training in infection control and the policies relating to infection control in the home are in the process of being reviewed. There was evidence of good infection control practices with staff washing their hands and using alcohol gel and red bags for soiled linen. However towels left in the bathroom for both staff and residents and personal toiletries left in bathrooms could impact on this. Villa Adastra DS0000035172.V358789.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. People who use the service experience adequate quality outcomes in this area. It is difficult to find staff when needed, particularly in a situation of urgency. Lack of sufficient staff for the size of the home may put residents at risk. Staff receive sufficient training to enable them to give knowledgeable care to the residents but some mandatory health and safety training has been overlooked, which could affect the well being of residents and staff. Robust recruitment systems safeguard the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has recently reduced staffing levels by one member of staff during the day and provides four care staff and one principal senior carer during the day and three care staff at night. Whilst the number of night staff remains unchanged, concerns were raised with the manager over whether this was sufficient in the busy periods of the night Villa Adastra DS0000035172.V358789.R01.S.doc Version 5.2 Page 22 and early morning to ensure the safety of the residents in the home. Senior care staff are not on duty at night. Day staff are well supported by administrative, catering and domestic staff and only do caring duties. Staff are concerned that staffing levels have been dropped to this level and staff morale was low. Senior care staff said that they had difficulty in getting the documentation completed due to pressure of work. It was evident that some staff have found the new routines and the reduction in staff unsettling and difficult and have found it hard to respond to change. Residents also felt that they had lost contact with some of the staff and one said ‘lost the sense of belonging.’ All residents looked well cared for and documentation showed that care had not lapsed during this period. It was difficult to find staff in the home and when the inspector rang the bell for a resident needing urgent assistance, it was not answered. The manager must ensure that staffing is tailored to both the geography of the home and the varying needs of residents, as opposed to gauging this by the number of residents currently in the home. One resident said that it was difficult to get hold of staff when there were two on instead of three, however the off duty rota and conversations with staff showed that the home has not been without three at night. Several surveys brought up concerns over the amount of agency staff being used, the manager said that this has abated since recruiting more staff and the duty rota and staff verified this. All staff undertake an induction course on commencement of work at the home, and a national induction course, which is the introduction module for the National Vocational Qualification in Care, has been commenced. Staff employed who already have this qualification undertake an induction course specific to the home. The training matrix showed that moving and handling training, which is mandatory, has not been updated over the past year for some staff members. Staff receive other training relating to the care of the residents in the home, which includes dementia care, and sight awareness, but few staff have attended this latter training. Over 70 of the staff have the National Vocational Qualification level 2 or 3 in care, the home is proactive in ensuring that staff have the opportunity to undertake this training. Villa Adastra DS0000035172.V358789.R01.S.doc Version 5.2 Page 23 Four (14 ) of staff records were examined, these contained all the information and relevant checks as required by the regulations. Volunteers undergo the same process as regular staff and the hairdresser and chiropodist have a Criminal Records Bureau check. Staff files relating to the domestic catering and laundry staff were not examined but the hotel services manager said these contained all information as required by regulation, including Criminal Records Bureau checks. Villa Adastra DS0000035172.V358789.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): 31,32,35,36,37,38 People who use the service experience good quality outcomes in this area. Management is aware of some issues in the home, which could impact on the health and wellbeing of residents and are addressing these issues. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for fifteen months and has the qualifications and experience to ensure the smooth running of the service in line with the expectations of the residents. During the time he has been in management he has managed several changes as required by the provider, this included monitoring and reducing staffing Villa Adastra DS0000035172.V358789.R01.S.doc Version 5.2 Page 25 levels and the change from residents and staff being unit based and the introduction of communal dining. Residents said that the manager is highly visible throughout the home and are happy to address any concerns or other issues that they may have, with him. Whilst surveys were not in favour of these changes, residents now appear to be accepting of this and some like it. Staff spoken with were mostly now in favour of the changes, although staff morale was low. It was recommended that more staff meetings take place and that issues raised by staff are addressed. The Annual Quality Assurance Assessment received by the CSCI showed that the manager is managing the problems caused by these changes and is aware of both the shortfalls and the actions needing to be taken. This document accurately reflected the current status of the home. The quality monitoring system has recently been recommenced after having lapsed last year. Residents and relatives meetings currently held three monthly are to be held bi monthly and views of residents are obtained during this time. It is recommended that the manager send out surveys to residents, relatives and interested stakeholder such as district nurses, social care managers and General Practitioners. Policies and procedures are in the process of being reviewed by the manager Regulation 26 visits (visits required by the regulations on a monthly basis to be undertaken by the provider) have been taking place, those looked at did not show evidence of interviews with residents or staff and it is recommended that these follow the format suggested by the CSCI. Formal supervision has been taken place and a supervision programme is in place, but some staff said that they have not received this at the intervals directed by the standards. The home does not act as appointee for residents, all financial transactions are handled by the residents or their representative. The home does hold money for residents for safekeeping and to pay extras. Records were seen and were in order. Some staff have not participated in moving and handling training and the manager is addressing this. Risk assessments need to be put in place for bedrails, and access to kitchenettes and the laundry restricted. The manager says he will address these issues. Records show that all utilities and equipment have been serviced in the past year and a fire risk assessment is in place, regular fire drills are held and staff receive training over what to do in the case of fire. Villa Adastra DS0000035172.V358789.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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 x 3 3 3 2 Villa Adastra DS0000035172.V358789.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 OP7 Regulation Reg 15 (1)(2)(a)( b)(c)(d) Reg 12(4) Requirement All parts of the care plans must be reviewed on a regular basis, formed following consultation with the service user, include any gender specific care requests and be signed and dated by the staff forming the care plan. Risk assessments regarding the use of bed rails, self medication and individual risk assessments must be put in place or regularly reviewed in line with the care plan reviews. That the registered person ensures that the storage and recording of controlled drugs or those drugs treated as controlled drugs complies with the relevant legislation and guidance. Advice to be sought from the relevant authority regarding the suitability of the controlled drugs cupboard in the home. To ensure that the standard of catering provided is of a quality to meet the service users needs and expectations, offers them choice and provides a high DS0000035172.V358789.R01.S.doc Timescale for action 30/03/08 2 OP7 OP9 Reg 13(4) 30/03/08 3 OP9 Reg 13(2) 12/02/08 4 OP15 Reg 16(2)(i) 12/02/08 Villa Adastra Version 5.2 Page 28 5 OP33 Reg 24 6 OP38 Reg 13(4) nutritional basis at all meals. That a system of monitoring the 01/08/08 quality of services offered by the home which includes the views of service users and other stakeholders is recommenced That risk assessments are put in 28/02/08 place regarding access to the laundry and the kitchenettes by residents. That the registered person ensures that staff receive all mandatory health and safety training at intervals as directed by the relevant authorities or contacts this authority for further advice. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 Refer to Standard OP7 OP11 OP32 OP33 OP36 OP36 Good Practice Recommendations That protective covers are used with bedrails to prevent injury to service users That the registered person contacts the Primary Care Trust for advice regarding the resuscitation wishes of service users That regular staff meetings are held to update staff on company policies and to listen to their views. That a system of monitoring the quality of services offered by the home which includes the views of service users and other stakeholders is recommenced That regular staff supervision takes place at intervals directed by the National Minimum Standards That the format of the Regulation 26 (provider visits) follows the guidelines of the CSCI Villa Adastra DS0000035172.V358789.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local 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. 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