Inspection on 30/01/09 for Nightingales Residential Home

This is the latest available inspection report for this service, carried out on 30th January 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nightingales Residential Home 15/06/07

Nightingales Residential Home 14/08/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Nightingales Residential Home Wolverley Court Wolverley Road Wolverley Kidderminster Worcestershire DY10 3RP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Emily White     Date: 3 0 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Nightingales Residential Home Wolverley Road Wolverley Court Wolverley Kidderminster Worcestershire DY10 3RP 01562850201 01562852530 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Frances Jane Butterell,Miss Dawn Lillian Wilkes,Miss Samantha Tracey Wilkins Name of registered manager (if applicable) Miss Dawn Lillian Wilkes Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Age: Physical disability (PD) age 55 and above. The maximum number of service users who can be accommodated is: 23 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 23 Physical disability (PD) 23 Date of last inspection 0 23 Over 65 23 0 care home 23 Care Homes for Older People Page 4 of 30 Brief description of the care home Nightingales Residential Care Home Wolverley Court is a large Grade two-listed country house. It is situated in a rural area and is served via a private driveway. The village of Wolverley is on the outskirts of Kidderminster. The house was converted a number of years ago into a care home providing residential care for older people. The house has three floors which can accomodate 24 people in total, in addition is a two bedded self-contained flat bringing the total number of registered places to 26. Within the main house bedrooms are situated on the ground floor, first floor and second floor these can be reached by means of a passenger lift. The house retains its historical status as a grade two listed building - most of the original windows are in place. Planning permission is required for any changes to the building both internally and externally. The gardens are extensive and well maintained. Ample car parking is available to the front of the house. For up to date information regarding fee levels at Nightingales the reader should contact the provider directly. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before we visited the service we received six surveys from people using the service, four from staff and one from a social worker. We looked at the information from these and we also looked at information sent to us by the service. This is called an Annual Quality Assurance Assessment and tells us about what that service does well and what it is doing to improve. We visited the service and met people who live there, staff and the managers. Spoke to everyone we met and looked at records such as care and support plans and recording by staff. We observed life at the service throughout the day, including a formal observation at lunch time. This is called a Short Observational Framework for Inspection (SOFI) and involved us observing five people for an hour over lunch. We Care Homes for Older People Page 6 of 30 recorded their experiences at regular intervals, including their state of well being, interactions with staff and others. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a service that they know is right for them because they have been given information before they move and have had a detailed assessment of their needs. Evidence: During our visit we met people using the service and some of their relatives, and asked them what it was like to move to the home. People tell us they or their relative were able to visit on several occasions, and they had good information about the home. We also received six surveys from people, four said they had enough information when they moved, two did not. These two people had come from hospital. The previous inspection report required the service to review the terms and conditions of the service, and recommended a review of the statement of purpose and service guide so that it accurately describes the service offered. We received a copy of these, which meets the requirement standards and offer a good description of the service. We Care Homes for Older People Page 10 of 30 Evidence: note that everyone has a copy of the guide and terms and conditions in their room. The Annual Quality Assurance Assessment tells us that the service plans to set up different formats for information to take into account individual needs and preferences. The Annual Quality Assurance Assessment also tells us that the service has revised their assessment procedures to ensure it is more comprehensive and meets the required standard. Everyone who moves to the service has a full assessment of their physical, emotional and social needs before they move there, so they can be sure it is the right service for them. We looked at four peoples records which show they have a full assessment which records all their abilities and the level of support they need. The service also carries out a pre service family review which looks at the persons immediate circumstances before they move, for example whether they were cared for at home and what prompted them to look for a care home. People also have a pre admission form which gives further detail of their needs, for example medication, appetite, dressing, mobility on stairs. This provides information for staff as soon as the person arrives at the service, and ensures they can meet that persons needs. The Annual Quality Assurance Assessment tells us that 13 people stayed at the service on a temporary basis during the past year. We met one person who is staying on a temporary basis, who told us they are being supported to return home for five days with domiciliary care to see how they get on at home, but their room is being kept for them. This person has a full plan for her support. Another person we spoke to describes how she has been supported and encouraged to stop using her wheelchair and start to walk with a stick after an illness. This shows that the service understands the importance of rehabilitation, even with their permanent residents. Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to medications practice so people are supported in safe way. Peoples health care needs are met and staff have enough written information to support people in a consistent and timely way. Evidence: During our visit we met several people and spoke to them about the support they receive. We also looked at their care plans and other support records. The last inspection report required that the service keep peoples care plans up to date so that staff are given sufficient guidance and instruction regarding peoples needs. The service has revised its care planning system so that it uses a completely new system, which now meets the required standard. Peoples care files contain all their assessment information, which is used to set up a plan for their support. When a person moves to the service, they have several detailed assessments covering their physical, social, and emotional needs, for example whether someone is able to wash themselves, difficulties with mobility arising from arthritis, and whether they may Care Homes for Older People Page 12 of 30 Evidence: experience depression or have been recently bereaved. Peoples care files may contain as many as 30 different assessment sheets but they are only completed if necessary to that person. Risk assessments also completed where a need is identified for example if someone falls, or becomes disoriented. People also have a detailed daily routine which covers their preferences for support during the morning, mid morning, lunch, afternoon, tea and night time, for example, X is usually up at around 7, When tired will Y become quiet and go out of the room, On a nice day Z is usually found in the garden. There is also a detailed plan for areas identified by the assessments, which sets out the persons difficulties, their goals and what needs to happen to support them, for example for support with eating, wheelchair use, dressing, showering, medications, and use of the stairs. We received a survey from a social worker who says that the service supports people to live the life they choose, responds to the different needs of individuals, and respects the individuals needs and wishes, provides a caring safe environment. The service does not have a key worker system but the assistant manager carries out all monthly and annual reviews which makes sure peoples support is stable and continuous. Peoples care plans are signed by them to show that they agree to them and people also have a copy of their plan in their room. One person we met explained what is in their plan. Although there is nothing recorded to say that people are involved in the monthly reviews of their support, people tell us they are involved. People also have an annual review which may involve family and other professionals. We saw that one person had been involved with their annual review with their son. The annual review covers peoples assessments, daily routine and care plan, however the date on the original assessments are not changed, so the service needs to make clear what information has been reviewed. We received six surveys from people using the service. Four people say they always get the care and support they need and two usually do. All six say they always get the medical support they need. Comments include, The care and support is first class, The staff are very caring and kind, nothing is too much trouble, If I want it, I get it. We also met several people and their relatives during our visit who made comments such as I am very pleased, they were very good after being in hospital recently, They are very good at getting doctors in if you need it, They have helped me to walk, last year I had a wheelchair, We have exercise to music every week. One person commented that it had taken a long time to get the chiropodist to come to visit. We looked at other records such as the staff handover books which contain the daily notes. Staff record when people have had showers and baths, and medical Care Homes for Older People Page 13 of 30 Evidence: appointments. If needed, staff monitor peoples continence. At present staff are not carrying out any regular assessment of nutrition, apart from the annual assessment of dietary requirements. It would be good practice for the service to have in place nutritional screening, including weight gain or loss, for those who may be at risk in this area. For those people who are more independent the daily notes are limited, often with just the night staff recording their checks. We note that day staff record when someone is unwell, or a difference in their mood or physical well being is noticed. However, daily notes are well written with lots of detail for people who are more dependent, for example in relation to treatment of pressure sores or district nurse visits. The notes show appropriate concern from staff and attention to peoples needs. Where there are concerns with physical and mental health, appropriate referrals are made to the right professionals. We discussed with the manager the importance of keeping accurate records so that decisions about peoples health care are clear to all involved in that persons care. Staff should be aware of the need to record significant information about all people using the service, even those who are usually very independent. The last inspection report identified a concern with medications running out and required that medication records must be an accurate account of items given and must be completed at the time of administration. The Annual Quality Assurance Assessment tells us that the service has devised a new medication policy which is more comprehensive. The assistant manager carries out a weekly check of medications administered. We saw that most of peoples medications are given from a monitored dosage system. We checked the loose medications of four people, three of which were correct. One person who has recently changed her medications had more tablets left than she should have done. While it is clear that the service has improved their medications system and meets the requirement, care must be taken that mistakes are not made when medications are changed or a change of system takes place. Most people using the service have assistance with medications. In their files people have a statement for example X can be forgetful so has asked that staff administer medications. It would be good practice for these medications agreements to be signed by the person. During our visit we observed that peoples privacy and dignity is maintained in the way staff work with people and through the written records. People using the service tell us that staff knock on doors before entering their bedroom. We observe staff referring to one person by their surname as preferred. The survey returned by a social worker tells us privacy and dignity is always respected and individuals are respected within the group setting. Notes in files provide good examples that peoples dignity is respected, for example, Very sociable person but occasionally doesnt understand boundaries, Care Homes for Older People Page 14 of 30 Evidence: Can get a little forgetful at times but when reminded has full understanding, More assertive than aggressive. Care plan goals include reassurance of time and promote pride in appearance to prevent embarrassment. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have meals that are nutritious and varied, and are supported to maintain their independence. They have choices about their day, but activities and community contact should be given higher priority. Evidence: During our visit we spoke to people about their daily life and activities at the service. The last inspection report identified that the records showing what activities have taken place and who attends need to be improved to show what has taken place. These records could also be a way of evaluating the effectiveness and meaningfulness of the activities. We found that still very few records are kept about activities. People do not have a life history in the care plans, but there are detailed activities and interests assessments. However we could not find evidence that this is used to inform the activities people do or for planning activities. Currently the service does not have an activities coordinator and the notice board displaying activities is a few months out of date. People using the service say that activities were very good and there were regular residents meetings, but these are now less frequent. Despite the lack of coordinated activities, of the six surveys we received, four say that Care Homes for Older People Page 16 of 30 Evidence: there are always activities to take part in, and two say there are usually activities to take part in. People using the service tell us that the staff are good at putting on activities, and give us examples, of quizzes, bingo, and games. Everyone we met says that they have a lot of opportunity to go outside and walk in the grounds during the summer. During our visit we observed staff organising two sessions of games that lasted 45 minutes, involving throwing hoops and bean bags. Four people joined in this activity, and we note that they included people whose care plan requires encouragement to join in. We saw that the service has a cupboard with a variety of different board games. The Annual Quality Assurance Assessment tells us that it plans to improve by developing more links with the community. People using the service and staff tell us that there have been some outings for example a pub lunch, visits to the railway, and there a various outside entertainers that visit the house. People also have an exercise class once a week and are encouraged to keep in contact with their church through visits out or visiting clergy. We met some peoples relatives who say that there is a good relationship with the home, and relatives are encouraged to contribute to the activities. During our visit we noted there were at most six people using the lounge, however several people had visitors or were out with their family. As part of their improvements to the activities at the home, the service should consider the needs of those who prefer to stay in their rooms and who may be at risk of isolation and lack of stimulation. Peoples daily routines in their care plans show that autonomy and choice is respected and that routines are flexible, for example people are able to go to bed and get up when they wish. People using the service tell us they are able to do as they wish for example one person does not enjoy the exercise class and does not attend it. We spent a large part of the day observing life at the service, including a formal observation at lunch time. We note that peoples interactions with staff are usually positive, in a way that supports choice and independence. A good example of this is one person who is temporarily unable to hear. Staff communicate with a written note pad, which we saw had many reassuring comments on it. The person appeared happy and the note pad was the cause of entertainment for staff and residents who all wrote on the pad. Three surveys from people using the service say the food is always good, three say it is usually good. People tell us there has been a recent improvement in the meals. Peoples food likes and dislikes are recorded in care plans as part of their detailed assessment forms. The kitchen notice board has a record of this and the cook records what people order each day. We saw that there is a variety of home cooked meals available and two choices for lunch and tea each day. The menus are changed Care Homes for Older People Page 17 of 30 Evidence: seasonally and the cook tells us she is never restricted in what she buys. We observed a lunch time and noted good staff interactions which support people to make choices, people using cutlery to aid grip, tables laid in an attractive manner, and a variety of drinks including cranberry juice available. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service know how to complain and are protected by staff who have been trained appropriately. Evidence: We received six surveys from people using the service, five of these say they always know who to speak to if they are not happy, and one person says they usually know. Six people tell us they know how to complain. We met people using the service who say they are happy to complain if they need to and staff are always approachable. Peoples relatives also tell us that the management is very approachable although sometimes it is not always clear who is in charge at the weekends. The complaints procedure is included within the guide to the service, and a copy of it is kept in peoples rooms with their care plan. A complaints and compliments log is kept, although there have been no formal complaints. It would be good practice for the service to keep a record of informal concerns that may be raised by people using the service, such as food or room temperatures. In this way the service can monitor peoples general levels of satisfaction. The previous inspection report recommended that a review of the training in safeguarding should take place to make sure it is fit for purpose and protects people using the service. The Annual Quality Assurance Assessment tells us that the service has ensured that up to date training is provided to staff with regards to protection and Care Homes for Older People Page 19 of 30 Evidence: plan to provide training to deal with physical and or verbal aggression. Since the last inspection a Training and Support officer has been employed to manage training in the service and the domiciliary care agency run by the same providers. We looked at some staff records which show that training is in place, show when it needs to be updated, and that new staff have had this training. We met staff who show understanding of safeguarding and whistle blowing procedures. We also received four staff surveys which say they know what to do if they have concerns about the people they support. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a house that is welcoming, well maintained and clean. Evidence: During our visit we looked at the house, the communal areas are laid out in a homely way and there are areas that people can choose to sit in for quiet time if they wish. Peoples rooms are personalised as they like them. The grounds are large and attractive and people tell us they make good use of the gardens in the summer. We met one person who told us their room is cold but that measurements have been taken to get the windows fixed. We note that a towel is being used as a draught excluder in this room. The service employs a maintenance man who carries out structured maintenance and health and safety checks. We received six surveys, five of which say the home is always fresh and clean and one say it is usually fresh and clean. We met one person who has complained to staff about the cleanliness of the bath. We discussed this with the management who have drawn up a schedule for the cleaning and have worked with the domestics to show how the cleaning should be done. We saw that the communal area are clean and there are no unpleasant odours. We saw one bath seat which while clean, is discoloured and looks unattractive, the management assured us this would be replaced. We looked at staff training records which show that infection control training is maintained. We note Care Homes for Older People Page 21 of 30 Evidence: that appropriate aprons are worn and there is a supply of gloves, handwash and other infection control equipment. We saw that the laundry is appropriate for its use however we note that clean laundry is not at present separated for individuals as there is not enough space in the room. The management say they plan to move staff lockers to provide more space for this. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive support from the right number of well trained staff who have been recruited safely. Evidence: We received six surveys from people using the service who say that staff always listen and act on what they say. Three people say staff are always available, three people say staff are usually available. Comments include, When Ive said something theyve usually responded to it and Have to wait occasionally. At present there are 15 people living at the service, and the rota shows there are usually three care staff including one senior on duty, as well as the assistant manager and other managers. We met staff and asked them whether there are enough staff to do their jobs. Generally staff say there is enough time to do their jobs, which confirms responses from four staff surveys. However several staff say it is more difficult when there is sickness, when there is an unexpected event or when several new people move in at once and there is less time to read the care plan information. We note that on the day of our visit one person had a hospital appointment, another person required paramedic assistance and two staff were off sick. This did not appear to affect the atmosphere of the home which was calm and staff still had time to lead activities in the afternoon. The assistant manager provides extra care support at times like this. The last inspection report suggested that the staff levels are adequate for the current number Care Homes for Older People Page 23 of 30 Evidence: of people and their needs, however should more people move in or their needs increase a review of staffing levels will be necessary. We looked at staff records which show that staff are supported with NVQ training and are only recruited after the appropriate safety checks. All four staff surveys we received say they had the correct check before they started work. We observed staff working in the communal areas of the house and all staff show they are competent to carry out their jobs in a caring and supportive manner. We checked that new staff receive a full induction, which is a pack that covers all the required standards and mandatory topics such as health and safety. The last inspection report required that all members of staff must receive appropriate training in order to carry out the full range of their duties. The Annual Quality Assurance Assessment tells us that in the past 12 months they have worked towards ensuring a more structured and comprehensive induction programme to include all relevant and required training. This includes both in house and external training. The service has a Training and Support Officer who manages training for the care home and the domiciliary care agency run by the same providers. Staff have an individual training plan in their files which shows when training is due. The majority of staff we met and who returned surveys say they have relevant training which helps them to meet peoples needs and keeps them up to date. There is some concern that part time staff do get the same access to training as full time staff. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Despite changing management arrangements people using the service receive safe support which meets their needs. The service does not monitor its own standards and does not include people in developing the service. Evidence: The last inspection report identified some concerns over the management arrangements at the service and who is responsible on a day to day basis. The registered manager and responsible person has recently returned to work from a period of absence. During this time the Training and Support officer provided temporary management cover with the assistant manager and the other responsible individual. The Annual Quality Assurance Assessment tells us that the only area affected by this has been the level of training offered to staff. People using the service tell us that they always know who is in charge and who is responsible on a day to day basis, however one relative says they are sometimes not clear who is charge at weekends. Care Homes for Older People Page 25 of 30 Evidence: It is clear from our observations and evidence in this report that the assistant manager has provided continuity during times of change and that the responsible individuals and Training and Support officer provide appropriate management and guidance as needed. Significant improvements have been made to the quality of care planning information and medications. Staff tell us through surveys or during our visit, that they get up to date information, and passing on of information usually works well. Several staff comment that while it usually takes time for the full care plans to be written, they always have enough information in the interim. We saw that peoples money is kept safely and transactions are recorded, and all health and safety procedures are being maintained. The management arrangements have not adversely affected people who use the service however the responsible individuals recognise that clarity in management would be beneficial to staff and the overall running of the service. For example, we find that staff supervision and the way the service monitors its own performance has not been kept up to standard. The last inspection recommended that a quality assurance system be set up to monitor the service and assist in continual improvement. We note that the sections in the Annual Quality Assurance Assessment have been left blank which ask for improvements following consultation with people using the service. Residents meetings have been held but are not at present. The service has a questionnaire for relatives and people using the service but has no structured way of using it. There is no annual development or action plan. The last inspection also recommended that the frequency of staff supervision should improve to include all carers employed within the home. The Annual Quality Assurance Assessment refers to supervision as a way of maintaining good practice, however we note that staff are not receiving regular supervision. We saw two staff files, spoke to staff and received four surveys from staff which confirm this. Despite this, staff say they feel supported and are able to approach managers with any concerns and they are always acted on. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 33 24 1 (a) (b) 2 3. An effective self monitoring system, including collecting the opinions of people who use the service, must be set up. This is to to measure success in meeting the aims, objectives and statement of purpose, and to ensure that future developments reflect the aims and outcomes for people using the service. 30/04/2009 2 36 18 (2) Staff must receive formal supervision six times per year. This is to ensure that staff are fully up to date in all areas of support for people using the service, as well as all aspects of practice, the philosophy of care in the home and their career development and training needs. 30/04/2009 Care Homes for Older People Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 It would be good practice for the service to consider providing information in large print and other formats for people with different communication needs. Annual and monthly reviews should clearly show what areas of support have been reviewed and who was involved. This will show that the service is monitoring peoples changing needs and involving them in planning for their own care and support. It would be good practice for the service to have in place nutritional screening, including weight gain or loss, for those who may be at risk in this area. Staff should be aware of the need to record significant information about all people using the service, even those who are usually very independent, so that decisions about peoples health care are clear to all involved in that persons care. It would be good practice for people who are able, to sign to say they have agreed to have their medications administered for them. This shows that the service has considered promoting self medication. The records showing what activities have taken place and who attends need to be improved to show what has taken place. These records could also be a way of evaluating the effectiveness and meaningfulness of the activities. It would be good practice for people to contribute to a life history so that the service can get to know them and offer a more personalised service. The service should review the way in which activities are provided at the service, to use resources more effectively and to consider the needs of those who prefer to stay in their rooms, who may be at risk of isolation and lack of stimulation. It would be good practice for the service to keep a record of informal concerns that may be raised by people using the service, such as food or room temperatures. In this way the service can monitor peoples general levels of satisfaction. 2 7 3 8 4 8 5 10 6 12 7 12 8 12 9 16 Care Homes for Older People Page 29 of 30 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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