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Inspection on 24/11/08 for Westcliffe Care Home

Also see our care home review for Westcliffe Care Home for more information

This is the latest available inspection report for this service, carried out on 24th November 2008.

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.

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

People get lots of information about the service to decide whether they want to live there. They have their needs properly assessed before they come to live at the service to make sure these can be met at the home. We found that people`s health care needs are properly assessed, provided for and that people are referred on for specialist advice and treatment to keep them healthy and well. People like living at the service and they told us the staff are respectful towards them and uphold their rights, choices and protect their personal dignity. A good range of activities are provided in the home and in the community, which people can enjoy if this is their choice. People told us that their choices are upheld by the staff and they can spend their time as they wish. Relatives are welcomed into the home and staff tell us there are good links with them. People have choices for every meal and other alternatives to the menu are available to make sure people have what they would like to eat. Each person who lives at the service has a copy of the complaints procedure, there are also residents` meetings and people get the chance to raise concerns and express their views at these meetings. People told us they feel safe at the home and the staff said they would report anyone who was being unkind or unpleasant to people living at the service. They said the manager would act on any information quickly. The home is warm, comfortable and clean throughout. People like their rooms. There are enough staff on duty to meet the needs of the people living there. The staff are kind, caring and observant. The staff have done a lot of training since we last visited the home and it is clear from our discussions with staff that they understand and are committed to meeting the needs of people living at the home in the most positive and enabling way. The home is being managed well, and they respond quickly to any area of concern. Health and Safety testing is done when it is required to make sure people who live at the service are safe.

What has improved since the last inspection?

We found that the care planning systems have improved and that the risks people who use bed rails and people who have Diabetes face are now being properly assessed and there are plans in place to manage these. The environment has been improved, renewed and redecorated. We found that people now have all of the documents needed by Law to show that they are suitable to work with vulnerable people on their staff files. Since our last visitalmost all of the staff have either completed their National Vocational Qualification Level 2 or are doing this.

What the care home could do better:

We found care plans could be further improved by focusing on people`s strengths and abilities so staff can help them retain these. We also feel they could be more detailed and offer more guidance to staff about how to meet complex needs (such as aggressive behaviour.) We found the staff could benefit from more information or training on the signs of hypo and hyperglycemia so they can act quickly to keep people who have Diabetes well and healthy. We found that the managers need to make sure that people are always administering medication safely and not lapsing into poor practice. There could also be better auditing of boxed medication to make sure medication can be checked. We found the managers may have to review some decisions because of new Laws about assessing people`s capacity to make decisions. We feel the service could record concerns and niggles as well as formal complaints to make sure they always respond to people appropriately and continue to improve their service. We found that the managers need to be careful to make sure they have checked the Protection of Vulnerable Adults First list before staff start to make sure that people are suitable to work at the home.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Westcliffe Care Home Westcliffe Country House 78 Shelford Road Radcliffe-on-Trent Nottingham NG12 1AW     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: Linda Hirst     Date: 2 4 1 1 2 0 0 8 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. the things that people have said are important to them: They reflect 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 31 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 31 Information about the care home Name of care home: Address: Westcliffe Care Home 78 Shelford Road Westcliffe Country House Radcliffe-on-Trent Nottingham NG12 1AW 01159335197 01159110089 o.owen@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Vance Lloyd Garnet Owen Type of registration: Number of places registered: Mrs Beverley Owen,Mr Vance Lloyd Garnet Owen care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Westcliffe is registered to provide care for up to nineteen older people. Westcliffe is a converted and extended period house set in the village of Radcliffe on Trent which is registered to provide care for up to nineteen older people. The home is on the outskirts of the village and is about a ten minutes walk from the local shops, public houses, cafes and public transport. Accommodation is provided in the home in single and double rooms, some with ensuite facilities. There is a large dining room, a lounge and a conservatory sitting room, people also use the reception area to sit with their visitors. The grounds to the rear of the property are inviting, well kept and accessible. There is a lift and levelled areas throughout the home making it easy for people with mobility needs to get around. One area of the home has some steps due to the nature of the house, therefore mobile service users occupy this part of the home. We saw Care Homes for Older People Page 4 of 31 0 Over 65 19 Brief description of the care home evidence in peoples files to show they have received a copy of the statement of purpose and service user guide. We also saw a copy of the last inspection report in the reception area for people to read. The summary of this report is included in the service user guide. The current weekly fees are £430; this includes all services with the exception of dry cleaning. Care Homes for Older People Page 5 of 31 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 Quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people who live at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people Care Homes for Older People Page 6 of 31 who live there and how they can and intend to improve their service. We did not receive this back from the manager when we asked for it but we were given this when we visited. The form was well completed. We also reviewed all of the information we have received about the home since we last visited and we considered this in planning the visit and deciding what areas to look at. The main method of inspection we use is called case tracking which involves us choosing three people who live at the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. One person who lives at the service does not have English as their first language and we case tracked the person to make sure that their equality and diversity needs are met. Unfortunately we were unable to communicate effectively with the person concerned on the day. The staff team come from a variety of backgrounds and experiences, but unfortunately no one speaks the preferred language of the person identified. We spoke with two members of staff and three people who live at the service to form an opinion about the quality of the service being provided to people living at the home. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who live at the service. What the care home does well: What has improved since the last inspection? We found that the care planning systems have improved and that the risks people who use bed rails and people who have Diabetes face are now being properly assessed and there are plans in place to manage these. The environment has been improved, renewed and redecorated. We found that people now have all of the documents needed by Law to show that they are suitable to work with vulnerable people on their staff files. Since our last visit Care Homes for Older People Page 8 of 31 almost all of the staff have either completed their National Vocational Qualification Level 2 or are doing this. 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 9 of 31 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 31 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 who want to live at the service have access to clear information to help them make an informed decision about living in the home. Their needs are fully assessed before admission so they can be assured these will be met at the service. Evidence: The owners told us in their Annual Quality Assurance Assessment that they give each person living at the service a service user guide which explains how the service operates and what they can expect. We read the statement of purpose and this clearly explains the service to be provided. The home is not registered for people with Dementia and the owners want to continue to focus on providing a service for more able and independent people. One person we spoke with told us, I got lots of information about the home which Care Homes for Older People Page 11 of 31 Evidence: helped me to decide whether the place was right for me. The owners told us in their Annual Quality Assurance Assessment that each person who wants to live at the home has an assessment to make sure their needs can be met at the service. They told us that if the person is funded by the Local Authority they obtain a copy of the social workers assessment as well before deciding whether they can offer people a place. We saw evidence to show that each person has a full assessment of their needs before admission. We also copies of peoples terms and conditions and where people are funded by the Local Authority we saw evidence that the placement has been formally reviewed regularly. People who live at the service told us, My daughter and my granddaughter chose this home as they live nearby, I have settled very well. I have the right attitude towards it and I chose to come here. Another said, I came to look at the home before I moved in and I thought it was very nice, I had a nice interview with the owner about what help I need. The staff we spoke with were clear about the pre admission process and told us, The manager goes out to assess people. I am given verbal feedback about peoples needs and if there are any notes we read those. We are told about all of the information we need to support people with their care needs. Intermediate care is not provided at the service and the standard is not applicable. Care Homes for Older People Page 12 of 31 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 have their personal and healthcare needs met at the service in a way which respects their dignity and privacy. The arrangements for ensuring that staff administer medication safely need to improve. Evidence: The owners told us in their Annual Quality Assurance Assessment that care plans and risk assessments are in place for personal and healthcare needs. The care planning system has been overhauled and redeveloped. We looked at the care plans for three people who live at the service and found that the service has made some developments in terms of person centred planning and we saw some good personal histories, likes and dislikes in plans. This process could still be improved by incorporating peoples strengths and abilities into care plans so staff can help people to retain these. We also found the plans could be more detailed in giving guidance to staff about how to meet needs. We found clear evidence that the staff are reviewing the plans regularly. Care Homes for Older People Page 13 of 31 Evidence: The people we spoke with told us that they have been asked about their care plans, they told us, I dont need any help, I am very independent, I was asked about what help I need before I moved in, and this has been discussed with me many times since. People told us they are satisfied that they receive the care they need to meet their needs. When we spoke with staff they told us, The initial care plan is written by the manager and senior carers add to this where there is a need, we are responsible for monthly reviews. The care staff write in the daily notes and there is an ongoing communication between the care team. Peoples care plans are always discussed with them and I believe (the manager) always asks them if they would like to see their care plan. I feel the care plans could be improved by giving us a bit more information or detail to get to know the person. We have been doing person centred planning with (the manager) and I think this will bring about a lot of changes. The owners told us in their Annual Quality Assurance Assessment that wherever possible people are supported to manage their own healthcare needs, but where this is not possible they are supported through the care planning process. We found peoples health care needs are considered as part of the care planning process. One person we case tracked, has Diabetes and the owners have downloaded information about this and placed it on the plan along with information about the symptoms of hypoglycemia. However, when we interviewed staff they were unsure about the signs of hypo and hyperglycemia. We found evidence which shows that peoples weight is being monitored and recorded to make sure they are not losing weight and we saw risk assessments in place to try and prevent falls. We found that one person can present with aggressive behaviour but there was no plan or risk assessment in place to give guidance to staff on how to support the person and manage this situation. When we spoke to staff about this, they told us, Some people can be aggressive, I think you learn to deal with it, one has medication if (they) become agitated. People we spoke with told us, I fell recently and bruised my hip recently and the Doctor was called, another said, My health has not been too good recently but they are very good, they get the Doctor if you need them. I stay in bed if I am not well. I have to go to the Hospital for appointments and my family or the owner will take me. They are very good. Staff commented to us, We get good support from the District Nurse with one person Care Homes for Older People Page 14 of 31 Evidence: who has Diabetes, they also visit another person to reapply their dressings. One person has ongoing issues with their skincare and has an airflow mattress, the District Nurses are really good. The Doctor comes when requested. I would like to think we recognise and respond to peoples healthcare needs. The owners told us in their Annual Quality Assurance Assessment that there is a policy regarding the safe receipt, storage, handling, administration and disposal of medication which the manager makes sure is being adhered to. We looked at the storage of medication and found this to be well organised, safe and appropriate. The Medication Administration Records are clear, well recorded and no gaps in administration were noted. If people have variable doses of medication, the staff are recording the actual number given. We did random checks on boxed medication and found that the amounts being received are being recorded but the stock which is being carried forward is not which makes auditing in this area impossible. The manager told us he will start doing this. We observed people giving out the lunchtime medication. People are asked if they would like their paracetamol rather than this being automatically given to them. This is good practice. However, the person doing the medication round left the medication on the table for people to take without watching them take it. The deputy manager noted this and spoke to the person who then began staying with people to make sure they had taken their tablets. We interviewed the person who told us they know they did not act appropriately or safely. They told us, I should just have given the medication out at the end. I know I am signing the sheets to say that they have taken their tablets. The person has had recent training and a competence assessment. They talked us through how they should administer medication, and showed an understanding of best practice. Such an incident must not reoccur. The people we spoke to told us, I dont look after my own tablets, the staff do this for me, they give them to me at the right time with a drink. They know they can trust me to take them. Another commented, The staff look after my tablets, which I am happy with, they bring me a drink and make sure I take them. Staff we spoke with told us, We have had training from Boots and the managers check our competence before we give out medication. The District Nurses come to administer Insulin every day and they also test peoples blood sugar levels. They assume full responsibility for this. The owners told us in their Annual Quality Assurance Assessment that they understand about the Dignity Challenge and are looking to appoint dignity champions to ensure Care Homes for Older People Page 15 of 31 Evidence: good practice. They told us that peoples privacy and dignity is respected and staff receive training in this important area. When we observed lunch we saw the staff responding kindly and respectfully to all of the people living at the services. The people we spoke with all agreed the staff are kind, caring and respectful, they commented, The staff are wonderful, they treat us with respect and they have so much patience, I wouldnt have it. I have never seen anyone treated badly. The staff are very respectful. If I am in my room they always knock, they would never just come in. I am self sufficient and I like that, I think they treat us nicely. Another told us, The staff are respectful, they talk to us nicely. Staff we spoke with gave good examples of how they make sure they treat people with respect, one told us, I think rather than feeding them, it is nice if they can do it themselves, we just guide them. I think if you are discussing private things you should do that somewhere private and treat people as you would want to be treated. Care Homes for Older People Page 16 of 31 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 lifestyles which are in line with their needs and choices. Social, recreational, culture and leisure activities meet the preferences of people who live at the service. Evidence: The owners told us in their Annual Quality Assurance Assessment that they encourage people to be involved in activities or entertainment if they wish to do so. They also told us they encourage people to access public transport and community resources. Relatives and friends are welcome anytime. We observed people playing dominoes during our visit, and saw a list of activities on display on the residents noticeboard in the dining room. We found that recent activities have included throwing bean bags, attending holy communion, nail care, attending a film matinee, playing scrabble, and playing a game called sticky fingers. People we spoke with told us, I dont really join in with activities as I cant see very well, things are provided but in an afternoon I like to go to my bedroom and I can please myself. They put on entertainment but Im not bothered. My (family) take me Care Homes for Older People Page 17 of 31 Evidence: out or I go out into the garden in Summer, its a lovely garden but its getting too cold. Another told us, I like to get up early and do the crossword and read the paper. I usually join in with the games, scrabble, dominoes, sticky fingers and then I like to spend the evening in my room. We have a trip planned shortly, we are going into town to see the Christmas lights and to do some Christmas shopping. We went on a boat trip too. I like the activities and I join in when I want. Staff commented, they do cooking, play games, we have talked about doing some music and movement. We have film matinees, and in Summer we go for walks, we do stone, painting, make cards. They are going Christmas shopping and usually go on a boat trip, we hold quizzes and we are having Christmas parties. I think it is a good balance, some people need a lot of persuasion to join in. We also make sure we maintain a good relationship with relatives. The owners told us in their Annual Quality Assurance Assessment that residents meetings are held regularly. They told us they try and make the routines of daily living as flexible as possible and they are aware of the Mental Capacity Act 2005 and hope to provide training for staff in this important area. When we looked at the care plans there are very few areas of decision making which would necessitate an assessment under the Mental Capacity Act 2005, although the use of bed rails if people lack capacity would be an area which may need assessing, especially if people are demonstrating through behaviour that they object to them. This area may also have to be considered when the Deprivation of Liberty Safeguards come into force in April 2009. People we spoke with told us their choices are respected, I get myself up and take myself to bed when I want. I am never forced to do anything, they couldnt make me anyway. I had the chance to vote in the elections but I declined. Another commented, I get up very early, (the manager) asked me before I came in whether I wanted to get up earlier or later. I can do what I want when I want. Staff we spoke with told us, Some people like a lie in, other like to get up early, its their choice. The owners told us in their Annual Quality Assurance Assessment that people are given three meals a day and snack are available all day. They told us that people get the chance to comment on meals in the residents meetings. We looked at the menus and found there is a choice at all meals with alternatives recorded. The menus are displayed in the lounge/dining area so people know what Care Homes for Older People Page 18 of 31 Evidence: choices are available. We observed lunch and found people are offered a choice of drink, bread and butter and sauces are also offered to people, it is not assumed they want them. The food looked and smelled appetising and people seemed to enjoy their lunch. People we spoke with told us, We get plenty to eat and drink. The food tastes nice, we talk about it in the residents meeting. The food is very good, I get plenty of it and if I dont like what is on the menu they will always get me an alternative. Staff confirmed, the food is lovely. I think people get enough variety as there are always alternatives. We have good stocks of food. Care Homes for Older People Page 19 of 31 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 can raise complaints and these are dealt with, people are safeguarded at the service by staff who are aware of the need to protect vulnerable people from abuse. Evidence: The owners told us in their Annual Quality Assurance Assessment that the service has a clear complaints procedure displayed and that all of the people who live at the service and their family are given a copy of this in the service user guide. We have not received any complaints directly about the service since the our last visit to the home. We looked at the record of complaints held at the home but there was only one incident about a safeguarding issue recorded. We are aware of this issue, (see below). One person we spoke with told us she has raised concerns but these were not written down. The person would not tell us anything else about the complaint, what it was about or when it happened. The person told us, the matter is resolved now. However, two other people told us they would be happy to raise complaints and feel that these would be dealt with, I have never had to make a complaint but if I needed to I would and I would be confident that they would sort it out. I would not be frightened to complain, I have not made any complaints, but I would do, you have to speak up for yourself dont you? I feel the boss would do something about it. Care Homes for Older People Page 20 of 31 Evidence: Staff we spoke with told us, I have never dealt with a complaint, we have had a moan from one resident to another, really its a niggle. If someone really complained I would take it to the managers who would respond. The owners told us in their Annual Quality Assurance Assessment that all staff have received safeguarding training and that policies and procedures are in place to respond to these issues. We have received information about one safeguarding allegation since our last inspection. This was investigated by the owners but the person left the service before the investigation could be concluded. They took appropriate advice about including the person on the Protection of Vulnerable Adults list. We found that there is a copy of the local safeguarding procedures at the service, and the manager told us that all safeguarding training is now being done externally. The three people we spoke with all told us they feel safe living at the service. I am well cared for here, I feel totally safe here, I never worry, I have never seen the staff be unkind to anybody. The staff we spoke with confirm that they have received training in safeguarding, we had this in March this year, it covered all aspects of abuse, who to go to, the manager, the Commission, Social Services. I would record it and inform the manager. Care Homes for Older People Page 21 of 31 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 safe, clean, well maintained and homely accommodation which is appropriate for their needs. Evidence: The owners told us in their Annual Quality Assurance Assessment that the home is well maintained and effectively prevents the spread of transmissible infections. We did a partial tour of the home, including all communal areas and a sample of bedrooms. We found the communal areas to be clean, comfortable and homely. There are five en suite bedrooms, and many bedrooms are personalised and some very spacious with pleasant views. Some people have their own private telephone lines installed. There is a domestic style kitchen and the people who live at the service can access the kitchen. The home is clean and odour free throughout. People who live at the service told us, the home is clean and smells lovely, it is Care Homes for Older People Page 22 of 31 Evidence: spotless, I like my room and I am very happy here. The home is kept very clean, my room is cleaned every day. I find the home warm and homely. I really like living here. The staff we spoke with told us, The home is well maintained and any repairs are done pretty quickly. It is safe, warm and homely. Care Homes for Older People Page 23 of 31 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 are supported by well trained staff in sufficient number to meet their needs. The recruitment procedures are safe and protect vulnerable people. Evidence: We looked at the staff rota which shows that between 08:00 and 17:00 there are three care staff and a manager on duty and two staff on duty overnight. People we spoke with told us there are enough staff on duty, there seem to be plenty of staff on duty, I dont have to wait long for help. The staff we spoke with also told us there are enough staff for the needs of people living at the home, the managers are always willing to help us out too. The owners told us in their Annual Quality Assurance Assessment that at least 75 of the staff have achieved their National Vocational Qualification Level 2 or above. This exceeds the National Minimum Standard and is commendable. We looked at the records of training and found that staff have received training in Nutrition, Parkinsons Disease, Moving and Handling, Fire Safety, Health and Safety, therapeutic hand care and on the Mental Capacity Act 2005. People who live at the service told us, The staff seem to know what they are doing, Care Homes for Older People Page 24 of 31 Evidence: they help me well. I like all of the staff, they are very good. Another said, the staff are very nice, caring and kind; they are wonderful. Staff we spoke with confirmed they receive a lot of training and lots of training about peoples needs, such as Dementia awareness and training on Parkinsons Disease, not just the statutory training. This exceeds the National Minimum Standard. We looked at three staff files and found that in one case the persons start date was slightly before the Protection of Vulnerable Adult First check was received. The managers explained the person was doing their Skills for Care Induction for the first few days during which time the check arrived, but care is needed to ensure that safe recruitment processes are followed. The staff we spoke with told us, I had to wait for my Criminal Records Bureau check to come back before I started work. It seems the situation may have been a one off. Care Homes for Older People Page 25 of 31 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 service is well managed and runs in the best interests of the people living there. Evidence: The owners told us in their Annual Quality Assurance Assessment that the home has two registered managers who have both achieved their Registered Managers Award. This exceeds the National Minimum Standard. People we spoke with told us, the manager is very good and runs the home well, another said, the manager is a nice chap. Staff told us, the managers are really good to work for. The home runs well, they really care about the residents. The managers supervise everyone and seniors do the day to day supervision. The owners told us in their Annual Quality Assurance Assessment that all of the Health and Safety testing and servicing has been completed as required this year. Staff have received statutory training and safe practices were seen. Staff told us, they are really Care Homes for Older People Page 26 of 31 Evidence: good on Health and Safety. If you are concerned about anything you can go and chat to them and they will sort it out. I think we really care for people here. Care Homes for Older People Page 27 of 31 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 28 of 31 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 8 13 Care plans and risk assessments must be in place to guide staff if people are likely to respond in an aggressive way. To offer clear guidance to staff about how to support people and manage the behaviour consistently so people and the staff are safe from harm. 08/01/2009 2 29 19 People must not start 31/12/2008 working at the home until you have received a POVA First check. Once this is received they may only work whilst directly supervised until the CRB check comes through. To ensure that potential staff are suitable to work with vulnerable people. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards Care Homes for Older People Page 29 of 31 and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 The care plans should contain more specific guidance about how staff should support people with their needs so these can be met in a consistent way. Care plans should record the strengths and abilities of people living at the service rather than focussing on their needs so that staff can support them to retain these and promote their independence. Staff should be made aware of the signs of hyper and hypoglycaemia so they can take prompt and appropriate action to ensure the health and wellbeing of people living at the service. There should be a record of stocks of boxed medication which are to be carried forward to another month to enable appropriate auditing and to prevent the misappropriation of medication. The practice of the staff member who administered medication in an unsafe way should be assessed with a view to assessing whether they remain competent to administer medication or need more training or support. Review the decision to use bed rails with consideration for the Mental Capacity Act 2005 and the incoming Deprivation of Liberty Safeguards to ensure that capacity to consent or refuse has been considered along with peoples best interests. Niggles, as well as formal complaints should be recorded to make sure the service is responsive to the concerns of the people who live there. 2 7 3 8 4 9 5 9 6 14 7 16 Care Homes for Older People Page 30 of 31 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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!