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Inspection on 27/04/09 for Resthaven Nursing Home Limited

Also see our care home review for Resthaven Nursing Home Limited for more information

This is the latest available inspection report for this service, carried out on 27th April 2009.

CQC 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Resthaven provides a welcoming atmosphere for visitors and ensures that there is a good amount of information about the home, its services and facilities to assist residents and their families. Residents are admitted here on the basis of an assessment of their individual needs, and upon admission each has their own personal documented plan of care to address them. The staff were knowledgeable about residents and their needs, and were working collaberatively with external health care professionals to improve the health and lives of the residents. The home generally had an open approach towards working with and learning from other specialist health care services. One visiting health care professional told us that `the home addresses residents` nutritional needs brilliantly`. Residents generally spoke well of the staff and of the care they received. The home had clear policies and procedures in place for investigating concerns, and for the protection of the vulnerable residents, with appropriate training provided for staff in this area. There was a stable staff team and there were good opportunities for their training, development and supervision. The home has stable and consistent management, and there were some good systems used to ensure that the quality of the service was regularly monitored.

What has improved since the last inspection?

Major ongoing works to the original part of the home have addressed a number of health and safety risks, with the overall environment in this part of the house being gradually improved over the coming months for the comfort of residents accommodated there.

What the care home could do better:

There have been isolated instances of residents` call bells not being answered in a timely way as staff were busy in other areas. Many aspects of the medication systems were safely managed, however there are certain aspects of the associated recording that now require some improvement if the home is to remove any risk of a resident not receiving their medications as prescribed. The quality and choice of food served to residents was generally good, with residents saying that they enjoyed it. However the home should make more effort to ensure that a choice of evening meal is more readily accessible to those residents who are unable to express themselves so easily. The arrangements for sourcing new care staff through an agency supplier must be reviewed to ensure that all of the required elements for pre-employment checks on staff have been robustly carried out. This is to avoid any possible risk to vulnerable residents from unsuitable workers.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Resthaven Home Of Healing Resthaven Home Of Healing Pitchcombe Nr Stroud Glos GL6 6LS     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: Ruth Wilcox     Date: 2 8 0 4 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 33 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Resthaven Home Of Healing Resthaven Home Of Healing Pitchcombe Nr Stroud Glos GL6 6LS 01452812682 01452812192 Resthavenhome@AOL.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Resthaven Home of Healing Limited care home 32 Number of places (if applicable): Under 65 Over 65 32 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 Resthaven is situated in quiet countryside overlooking the surrounding valley. The home completed a major new build and part refurbishment in 2005, and a second major refurbishment project to upgrade the original part of the home has now commenced. Resident accommodation comprises single bedrooms, from which many enjoy superb views. The home has its own chapel attached that is used for prayer and worship. At the front and side of the building there is ample car parking, and access for wheelchair users. The home has a qualified nurse on duty at all times and provides access to all other health care services. Specialised equipment is available if required. Information about the home is available in the Service User Guide, which is issued to all prospective residents, and a copy of the most recent CSCI report is available in the Care Homes for Older People Page 4 of 33 Brief description of the care home home for anyone to read. The private charges for Resthaven are 730 pounds, and the home also provides care at the local authority rate of funding where applicable. Hairdressing, Chiropody, Newspapers and Toiletries are charged at individual extra costs. Care Homes for Older People Page 5 of 33 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: The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This home was last inspected on the 8th May 2008. One Regulatory Inspector carried out this inspection over two days in April 2009. Care records were inspected, with the care of five residents being closely looked at in particular. We also inspected the management of residents medications. Care Homes for Older People Page 6 of 33 A number of residents and relatives were spoken to directly in order to gauge their views and experiences of the services and care provided at Resthaven. Some of the staff were interviewed. Survey forms were also issued to approximately a third of residents and staff, with five sent to visiting health care professionals to complete and return to us if they wished. Some of their comments feature in this report. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, provision, training and supervision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to health and safety issues, the refurbishment plans and maintenance, and the cleanliness of the premises. We required an Annual Quality Assurance Assessment (AQAA) from the home, which was provided; the contents of this informed part of this inspection. What the care home does well: What has improved since the last inspection? What they could do better: There have been isolated instances of residents call bells not being answered in a timely way as staff were busy in other areas. Many aspects of the medication systems were safely managed, however there are certain aspects of the associated recording that now require some improvement if the home is to remove any risk of a resident not receiving their medications as prescribed. The quality and choice of food served to residents was generally good, with residents saying that they enjoyed it. However the home should make more effort to ensure that a choice of evening meal is more readily accessible to those residents who are unable to express themselves so easily. The arrangements for sourcing new care staff through an agency supplier must be reviewed to ensure that all of the required elements for pre-employment checks on staff have been robustly carried out. This is to avoid any possible risk to vulnerable residents from unsuitable workers. Care Homes for Older People Page 8 of 33 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 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 10 of 33 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. Access to information about the home and a detailed assessment prior to admission gives prospective residents an assurance that their needs can be met. Evidence: The homes AQAA told us that an information folder with the Statement of Purpose was issued to all residents. One family confirmed to us that they had been issued with the home information brochure prior to their relative moving in here. We inspected three examples of pre-admission assessments, two of which were for residents more recently admitted to the home. Each assessment had been carried out prior to admission being agreed, and had been recorded on the homes designated tool for the purpose. The assessments had not been signed and dated however, and the location where it was conducted not clearly identified either, as we would recommend. Care Homes for Older People Page 11 of 33 Evidence: The assessments took account of the residents personal details and their past medical history, their health and care needs, their medications and health and safety aspects. The home made efforts to obtain a General Practitioners summary of the residents health and treatments on the day of their admission, and also obtained written information from the hospital as well where applicable. Detailed admission notes were recorded for people upon admission to the home ensuring that all staff had access to comprehensive information. The AQAA told us that letters confirming individual placements in the home were issued to the resident and family concerned, and we saw evidence of this within residents care records. Prospective residents and their families were encouraged to come and visit prior to their admission to Resthaven in order to help them make their decision about coming here. One family told us that they had been able to visit and look around the home ahead of admission and have their questions and concerns answered. We witnessed the manager extending such an invitation to an interested party during the course of this visit. Resthaven does not provide intermediate care. Care Homes for Older People Page 12 of 33 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. People living in this home can expect to have their health and care needs met, although there are some aspects of medication management which could be better in order to remove any possible risk of residents not receiving their medications as precribed. Evidence: Each resident had a documented plan of care that was based on an assessment of their needs. We chose three particular care plans for closer inspection. Each contained a regularly reviewed needs assessment, with plans of care drafted to meet the identified areas. Risk assessments had been carried out to address mobility and risk of falls, vulnerability to developing pressure sores, and nutritional risks. We saw some excellent examples of care planning to address weight loss, swallowing difficulties and risks, and where there were communication difficulties we saw examples of sensitive care planning to address them. Personal care and hygiene plans reflected the persons dignity and choices. Any continence needs had been Care Homes for Older People Page 13 of 33 Evidence: incorporated into personal hygiene care planning, and we recommended that in cases where there was such a need separate care plans be devised, which reflect the specific support necessary to meet the continence need. Each had a mental capacity assessment on file and family history forms, although the latter had not been completed in full for any of the three. Full reviews of the plans were recorded at least monthly, but the majority stated Care as plan only, with little else recorded to demonstrate changes and progress in most circumstances. There were records to show the multidisciplinary involvement from visiting healthcare professionals to meet residents health needs. A visiting healthcare professional told us that staff consult with the Care Home Support Team very well for the benefit of the residents. They said that staff adhered to care plans, but that some of the documented care planning could be improved. One member of staff who responded to our survey told us that not all staff adhered to documented care plans. Those residents who responded to our survey all indicated their satisfaction with the care they received at Resthaven, with comments such as we are well looked after. Those whom we met directly appeared comfortable, with some where possible, telling us that they were satisfied with their care. One visitor told us that although they were generally very happy with the care their relative was receiving there had been isolated occasions when their relative had been kept waiting too long when ringing the call bell for assistance from the staff. There were varying degrees of dependency amongst the residents, with some being poorly and nursed in bed. One dependent resident required much closer attention to her mouth and fingernails than she had received that morning and we pointed this out to staff. The home had changed its pharmacy supplier since the last inspection. The Care Home Support Team had been giving support to the home regarding the safe management of medications. Residents wishes regarding the management of their medications were not recorded, although anyone wishing and able to self medicate could be supported to do so on the basis of a risk assessment. There was no-one currently doing this however. There was safe, clean storage for medications with regular checks made on ambient temperatures. The Controlled Drug cupboard was securely fixed to a solid wall, however we were not clear about whether the bolts were of the required rag or rawl type. We asked that this be looked into as part of the planned resiting of the cupboard. Care Homes for Older People Page 14 of 33 Evidence: Medication administration records were clearly printed by the supplying pharmacist and any handwritten entries or amendments had been signed and countersigned by staff. However we saw examples of certain medications being prescribed as directed, which did not give clear instruction to staff for its use. We were told that the home had requested clearer instruction from the prescriber and the pharmacist but so far these had not come through on the charts. We made it clear that in cases such as this it remained the homes responsibility to ensure that the administration chart contained clear instruction for any items used. Although there were generally good clear records of medicine administration we saw examples where items such as eye drops, analgesia, and external creams had not been administered in strict accordance with the prescribed instructions. This had been due to the resident either refusing it or not actually needing it, such as in the case of the analgesia. In cases such as this staff should make an entry to reflect the refusal, or that the medication was not needed, or the prescription should be reviewed and amended to reflect something more appropriate to the residents needs. In many cases the care staff were applying prescribed topical creams as part of the residents daily care and routine. In these cases there was no clear record of administration apart from occasional entries in the daily records. We have recommended a clear and separate record of signatures from care staff to confirm when they are applying topical creams. We carried out random audits on medications, and in the main they had been administered correctly. In one case however we found there was a slight excess of tablets over what there should have been given the date of opening the box and the number of dosages signed for as having been given. The manager agreed to investigate this, and on the second day of our visit had discovered that it appeared as though there were some resident refusals that had not been recorded. This was being taken up with the nurse concerned as part of the disciplinary procedures. One resident told us that a particular medication had been allowed to run out by the home on one occasion, and that they had gone without their medicine for a couple of days. Upon investigation during the course of this inspection this transpired to have been certain eye drops, which although ordered by the home, were temporarily unavailable at the supplying pharmacist, with assurances provided to us that this was not a normal occurrence. Residents personal dignity, individual levels of independence, and personal choices and preferences were observed by staff through appropriate care planning and Care Homes for Older People Page 15 of 33 Evidence: knowledge of the resident themself. Care was delivered in the privacy of residents own rooms. Staff were sensitive and discreet when helping residents. The Care Home Support Team had delivered training to staff in the Care of a Dying Person and there was more training planned. The AQAA stated that staff seek residents individual wishes for the end of their life, and that particular wishes are fully recorded in the home. We saw that residents spiritual needs and dying wishes were generally recorded as part of their assessment. Records of special wishes and any existence of a Living Will were recorded where applicable. The manager spoke confidently that the home managed end of life care very well. Care Homes for Older People Page 16 of 33 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 living in this home have the opportunity to remain socially active, exercise choice and have a nutritious diet. Evidence: The home had extended its range of social opportunities for the residents, and this also included evening and weekends. Two social activity coordinators had been employed and had received training in this area. A notice was displayed, which invited ideas and input for social activity and engagement with the residents from their families and friends. An activity profile was recorded in residents care plans, which took account of their interests and preferences for activity. A weekly programme of activities was issued to all residents, and the current one included video shows, word games, nail care, exercises, pets as therapy, bingo, musical entertainers and a trip out. A group meditation class was being held on the first day of this visit, which was being carried out with a local therapist. This reportedly proved very soothing and comforting for some of the residents. The AQAA told us that they were trying to devote greater social contact time with residents on an individual basis, but that greater involvement within the local Care Homes for Older People Page 17 of 33 Evidence: community was needed, with residents supported to maintain their particular hobbies wherever possible. The manager told us about links being forged with local villages, a school and a playgroup. One particular resident was being supported to maintain a membership with the local Womens Institute in order that they might continue with their past interest. A computer with internet access had been provided for residents use. A regular religious service was being held in the homes integral chapel, with a visiting minister, and pastoral support was also available each week for those residents of the Roman Catholic faith. One resident told us that they personally had difficulty joining in with activities as they had some hearing and sight problems. They said that staff regularly offered encouragement and that they did enjoy music and entertainments, and also enjoyed a talking book. There were many residents who were not socialising in groups and were sitting alone in the conservatory or in their bedrooms unattended. They were watching television, reading their newspaper, or resting quietly. We met one regular visitor to the home who told us that they felt welcome in the home, and could visit their relative at any time of their choosing. They told us that staff were helpful and often offered visitors refreshments. The AQAA told us that staff try to make routines for residents as flexible as possible, and consider individual choices and levels of independence. One member of staff who responded to our survey told us that certain staff put pressure on residents to go to bed earlier than they otherwise would choose. This was discussed with the manager and we were told that this had arisen in the past with isolated staff and that it would be contrary to the ethos of the home and would not be tolerated. One resident told us that she had chosen to have a rest on her bed after lunch and that staff had supported them in this. Another preferred to take communion alone rather than with the group, and this too was supported. Residents personal choices were reflected in their documented care plans, and the manager told us that staff try to build relationships with residents in order to get to know their preferences. The AQAA told us that the cook regularly meets with residents in order to seek their views regarding the menus. However one of the staff who responded to our survey told us that the records of residents choices for meals did not always correspond with what they were served on occasions. They also expressed concern over the lack of choice for those residents needing a blended meal. In view of this we looked closely at the menus and found that there was a limited choice at suppertime, with only one type of blended meal available in the evening. Following discussion with the manager and the cook they said that other options would be available if requested, but they would Care Homes for Older People Page 18 of 33 Evidence: increase the suppertime choices to see if residents actually wanted a wider range of foods, whether blended or otherwise. We said that it may be that they do not, however unless they are actually directly offered more choice there was a risk that more vulnerable people would be very limited in terms of a choice of evening meal. One resident told us that they personally would appreciate some Italian food. The manager agreed to address this. We observed service of the lunch time meal, which on the first day of our visit was good quality gammon with fresh vegetables, or salad, or an omelette. Each meal looked wholesome and was plentiful, and residents confirmed their enjoyment of it. We saw a total of ten blended diets being served, which we considered to be a high incidence. We recommended that individual circumstances regarding the need for a blended meal be reviewed in conjunction with a Speech and Language Therapist or a Dietician. A visiting healthcare professional told us that Resthaven catered to residents nutritional needs brilliantly. Staff were providing assistance wherever necessary. We discussed special diets with the cook, who appeared very knowledgeable and clearly understood individual needs very well. The kitchen was clean and orderly, and good catering records were being maintained with the appropriate safety checks in place. We were told by the manager that the catering facilities had been awarded a four star rating from the Environmental Health Authority. Care Homes for Older People Page 19 of 33 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 living in this home can be reassured by the homes complaints procedure and the policies regarding the prevention of abuse. Evidence: The home had a procedure for managing any complaints that were received. The written procedure was displayed on a notice board, although due to some ongoing building works the area in which it was located was no longer so accessible to people, and therefore needed resiting in a more suitable position. Also the procedure contained the previous regulators contact details and needed to have those updated with The Care Quality Commission (CQC) details. There was a system for recording any complaints or concerns made, but the home had not received any since the last inspection. Issues raised on one particular persons satisfaction survey issued by the home were being addressed through the quality assurance process. One of the residents who responded to our survey told us that they were unaware of how to make a complaint; all residents were reportedly issued with a copy of the homes complaints procedure, and the manager agreed that she would look into this, although the identity of this resident was unknown by us. Another resident told us that although they had no concerns to raise, they had confidence in the staff to help them Care Homes for Older People Page 20 of 33 Evidence: resolve matters should any arise. A visitor told us that they had had cause to raise a concern in the past, and that the manager and staff had been approachable and helpful. They said that the manager had been concerned about their problem, and had acted very promptly to address it. The home had documented policies and procedures for safeguarding the vulnerable residents from abusive practice and harm. An Alerters Guide, as published by the Local Safeguarding Authority, had been issued to all staff. A notice was publicly displayed to advise people of the local safeguarding contacts and points of information. Staff had undertaken safeguarding training, and those spoken to were able to discuss what might constitute abusive practice, and the protocols to follow if any concerns were identified. The manager and her deputy had undergone Mental Capacity Act 2005 (MCA) training and the deputy manager had also done training in Deprivation of Liberty Safeguards (DoLS) with the Local Authority. Five senior staff had also done MCA training, and the manager had sourced an electronic learning package for staff from the Local Authority and Gloucestershire Care Sector for further safeguarding training, plus MCA and DoLS. The topic of abuse and protection was also covered during the induction training. MCA assessments were in each residents care file, although these had not been reviewed since their introduction a year ago. However the deputy manager had plans to introduce new assessment forms for this purpose. Care Homes for Older People Page 21 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An ongoing major refurbishment programme will ensure that people living in the original part of this home can be accommodated in a more suitable and safe environment, as those living in the newer part already are. Evidence: The development, refurbishment and overall upgrading of the original part of the house had commenced with the builders now working on site. This was obviously proving to be disruptive to the residents and staff in this area, however the whole project will ultimately provide much improved facilities for the residents, although it was not possible to actually assess this in any detail on this occasion due to the work being in progress. New bedrooms were being created with ensuite facilities, and existing bedrooms were being generally upgraded, as were bathrooms and toilets. The lounge and dining room also featured in the improvement programme. A maintenance person was employed, who was working on site during this inspection. One of the newer bedrooms had some damaged paintwork on the walls, which was pointed out to the manager; it was agreed that this would be referred to the maintenance person for attention. Facilities in the more recently constructed part of the home were generally in very good order. Care Homes for Older People Page 22 of 33 Evidence: A new stainless steel sink unit and shelving had been fitted in the washing up area of the kitchen. The home continued to use a contracted cleaning company, and the home was clean and odour free. The two sluice rooms were clean and orderly, and provided sluicing disinfectors and clinical waste collection points. The laundry provided sluicing and disinfecting washing machines, and was operating efficiently. There were copious supplies of gloves, aprons and handwashing facilities around the home, and staff had received Infection Control training. Care Homes for Older People Page 23 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home receive care from a well trained and competent work force, however the manner in which new staff have been recruited through an agency is posing a degree of risk to the interests of those who live here. Evidence: Staff rotas were recorded. The morning shifts were covered with one registered nurse plus eight carers; afternoons and evenings were covered with one nurse plus five carers; and there was one nurse plus two carers overnight. There had been only minimal use of agency staff in the past three months and the staff team was reasonably stable. The nursing and care team was supported by an ancillary team of social activity coordinators at times, catering, laundry and cleaning staff, plus administration and maintenance support. The manager worked in a supernumerary capacity. Most of the time staff appeared to be meeting the needs of the residents, with staff available and accessible. However at one point during the afternoon a resident was observed ringing their bell for several minutes before a member of staff responded to it, each reportedly being busy with other residents. This was at a time when there were six staff on duty. Care Homes for Older People Page 24 of 33 Evidence: Some of the residents we spoke to directly told us that staff were helpful and kind. One even said they were very good. One resident said that although they had no significant concerns, some of the staff were much nicer than others. We spoke to a number of the staff and each demonstrated knowledge and interest in the residents welfare and needs. Staff spoke of good team communication, and confirmed that they received a good handover of information between shifts. They indicated that they had clear lines of accountability, with a team leader on each shift. There were currently fourteen care staff who had achieved the National Vocational Qualification (NVQ) at a minimum of level two. There was a general expectation that care staff will progress to the NVQ training programme when they join the home. The home had not directly recruited any staff for some time, however two carers from overseas had been supplied for work through an agency with whom the home has an arrangement to supply staff. Care staff supplied through this means remain employed by the agency and not the home. Recruitment procedures had been carried out by the agency and we inspected the staff files to assess how safe and compliant with the Care Home Regulations 2001 this had been. Statements of health, proof of identity, and copies of two written references were held. An enhanced Criminal Records Bureau disclosure (CRB) and a Protection of Vulnerable Adults (POVA) check had also been obtained before work had commenced. There was no record of their application form or interview notes, or a signed criminal conviction declaration. Neither was there written verification of why one of them had left their last place of employment, given that it had involved working with vulnerable adults. There was nothing to show that the authenticity of the references had been verified. We discussed the risks of this type of recruitment with the manager given that she does not get to see all the paperwork that the agency reportedly completes when recruiting staff. We emphasised that the onus and responsibility to ensure compliance with Regulation 19 Schedule 2 for recruiting staff was firmly with the home and not the agency. She said that as far as she was aware the agency covered all of the above. We have strongly recommended that she investigate this further and have some sort of written proof from them. Four staff told us that they had excellent opportunities for training and development, and that the manager was highly supportive of any learning opportunities for the staff. Other staff who responded to our survey also indicated the same. However one member of staff wrote in their survey that in their view there was a need to provide additional training in Diabetes and Parkinsons Disease. Care Homes for Older People Page 25 of 33 Evidence: A training matrix and associated records were maintained. Staff had received training in Moving and Handling, Equality and Diversity, Infection Control, Nutrition, Food Hygiene, MCA, Stroke Awareness, Parkinsons Disease, Dementia Care, and End of Life Care. The activity coordinators had received specific training in this area. We inspected two carers induction training arrangements. Each had dates to receive training in the Common Induction Standards for Care Workers from an external training provider. Each had received in-house induction as well. Staff told us that they had received induction training and had done training in moving and handling, health and safety, and fire safety training as part of it. They said they had been supervised by a senior carer during their induction period, and said they had not been permitted to perform any moving and handling tasks until they had received the correct training. The deputy manager should be commended for her success in achieving the Registered Managers Award through a local college. Care Homes for Older People Page 26 of 33 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. The management systems in place here have ensured that the interests and health and safety of the residents living in the home are safeguarded. Evidence: The manager of Resthaven is an experienced manager and is registered with CQC for her role. She is a qualified nurse and has been managing the home for eight years. She told us that she regularly attended the Persons in Charge meetings and peer group meetings, which she found useful in terms of networking and a learning exchange in particular. Residents had the opportunity to complete a satisfaction survey annually. The latest one done in March of this year, covered care and support, the home and its services, and management. The manager said she had endeavoured to liase with one particular family who had given some negative feedback on behalf of their relative in their survey. The manager was collating the results of the surveys and was planning to Care Homes for Older People Page 27 of 33 Evidence: devise a written report and action plan to present to Trustees and staff. Formal meetings for residents were only conducted annually, and we were told that there was only minimal attendance at the last one, despite invitations being extended to all residents and their families. The AQAA showed us that all policies and procedures had recently been reviewed. Care plan audits had been undertaken through the CHST, with certain recommendations made for improvement. The CHST Pharmacist had also undertaken an audit of medication systems. The Trustees of the organisation carry out regular quality monitoring visits to the home, and are keen to promote good standards here. The home provided central safe storage for residents valuables and money, however there continued to be no-one choosing to use this facility, as had been the case at previous inspections. The home encouraged independence and autonomy in this area, with family assistance in some cases. One member of staff who responded to our survey told us that they never met with their manager for support, whilst three others said that they regularly did. One staff member commented particularly on how good the communication amongst the team was. This was also reiterated by staff during the inspection, with them speaking of a good team ethos. Each confirmed that they received regular support and supervision, but that this may not always be from the manager but from another senior nurse. The manager was addressing supervision requirements through group sessions as well as individual sessions. Records were maintained, and topics covered included work loads, professional relationships, policies and procedures, training needs, and health, safety and welfare. Records for the group supervision sessions were not seen. Since the last inspection self-closing fire doors had been fitted in the original house further to the Fire Officers recommendations. Work was currently ongoing to upgrade the fire alarm system. Fire Safety training for staff had included practical evacuation in the event of a fire, which had been provided by an external fire safety training provider. We were told that the home aims for three training sessions each year from the training provider, which includes fire dangers, prevention and procedures. Regular fire drills were carried out. Fire safety records showed that regular checks were carried out on the fire alarms and emergency lighting. Fire extinguishers had been recently checked. The necessary safety checks and maintenance of utilities and equipment had been undertaken in a timely fashion and the associated records were kept in these areas. Care Homes for Older People Page 28 of 33 Evidence: Since the last inspection the home had consulted with the Environmental Health Department regarding Legionella risks. An assessment had been carried out by external experts, with an action plan devised to address any risks. Water sampling tests were scheduled for March of this year but these had not yet taken place. The heating boilers were due to be replaced under the refurbishment programme, but had been serviced anyway at the end of last year. Regular checks on the hot water temperatures in the new wing were carried out, which were shown to be at safe levels. There were no hot water blending valves in the original part of the home, but these were reportedly being fitted as part of the refurbishment and upgrade of that part of the home. A suitable training provider had supplied First Aid training for staff and we were told that this was due to be updated with the Appointed Persons training in June. Accident records were maintained where necessary, all of which went to the manager for auditing. We saw a free standing unguarded heater in one of the residents rooms. We discussed this with the manager who said that it had been provided as a back-up to the central heating in there, but with upgrading to the system being carried out, this would no longer be needed in the future. In the meantime she agreed to supply a safety guard to it, although the risk to the resident was considered to be negligible by the manager. Care Homes for Older People Page 29 of 33 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 30 of 33 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 9 13 The registered manager 31/05/2009 must ensure that residents precriptions are reviewed to ensure that there are clear directions for use of all medications recorded on the medication administration charts. This is so that all directions remain appropriate to the needs of the residents, and so as to ensure that all residents receive their medications as prescribed. 2 9 13 The registered manager must ensure that a clear record is maintained of: Administration of topical creams; Refusals or omissions of medication dosages. This is to reduce the risk of residents not receiving any medication as prescribed. 31/05/2009 Care Homes for Older People Page 31 of 33 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 3 The registered manager should ensure that all preadmission assessments are dated and signed, with the location where it is carried out clearly identified. The registered manager should ensure that residents personal wishes for managing their medications are recorded. The registered manager should ensure that the use of an As Directed instruction on medication charts is avoided. 2 9 3 9 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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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