Inspection on 17/12/08 for Afton Court

This inspection was carried out on 17th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Afton Court 09/06/10

Afton Court 27/01/10

Afton Court 18/12/06

Afton Court 25/01/06

Afton Court 20/04/05

Afton Court 17/01/05

Afton Court 04/08/04

Afton Court 04/03/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Afton Court 66-72 Marshall Avenue Bridlington East Riding Of Yorks YO15 2DS     The quality rating for this care home is:   one star adequate 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: Jean Dobbin     Date: 1 7 1 2 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. 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 34 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 34 Information about the care home Name of care home: Address: Afton Court 66-72 Marshall Avenue Bridlington East Riding Of Yorks YO15 2DS 01262606888 01262677999 aftoncourtltd@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Afton Court Limited Name of registered manager (if applicable) Mrs Samantha Jane Berry-Dagnall Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Afton Court consists of four adapted terraced houses close to the centre of the seaside town of Bridlington. The home is registered to provide personal care and accommodation for up to 41 older people who may also have dementia. It is conveniently located for all local amenities and facilities including public transport. The home can provide on-street parking permits for visitors. Single and shared bedrooms all have en suite facilities of a wash-hand basin and toilet. Some rooms also have a bath or shower. There is also a self-contained ground floor flat suitable for a married couple. A vertical passenger lift provides access to all three floors. There is a choice of lounges and dining areas. A large private and well maintained courtyard provides a safe area for people living there and the outside space is very easy to access. The Statement of Purpose and service user guide, as well as the latest inspection report Care Homes for Older People Page 4 of 34 care home 41 Over 65 41 41 0 0 Brief description of the care home completed by the Commission for Social Care Inspection are made available in the home, for people to read. The weekly fees in December 2008 are between £350 and £425. A one-to-one service is also offered, where staff can provide support for individuals to meet specific needs. This bears a fee. Additional charges are also made for items like hairdressing, chiropody and beautician services, as well as individual items like newspapers and toiletries. Care Homes for Older People Page 5 of 34 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: one star adequate 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: This is what was used to write this report. Information about the home kept by the Commission for Social Care Inspection. Information asked for, before the inspection, which the manager provides. This is called an Annual Quality Assurance Assessment or AQAA. Information from surveys, which were sent to people who live at Afton Court, to staff and to other professional people who visit the home. 10 were sent to people at the home, and all were returned. 5 were sent to health care and social care professionals and 1 was completed and returned. 10 were sent to relatives and 6 were completed Care Homes for Older People Page 6 of 34 and returned 5 were sent to staff at the home and 2 were returned. A visit to the home by one inspector, which lasted about 9 hours from 9 until 6 o clock. This visit included talking to people who live there and their visitors, and to staff and the manager about their work and training they had completed. It also included checking some of the records, policies and procedures that the home has to keep. Some time was also spent watching the general activity to get an idea about what it is like to live at Afton Court. Information about what was found during the inspection was given to the registered manager and the general manager at the end of the visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: The way care plans are written could be more person-centred so that it is clear how one person is very different to the next. They could identify peoples strengths and how they will be supported to maintain some control of their lives. This extra detail would help to ensure they received the same level of support regardless of who is providing Care Homes for Older People Page 8 of 34 it. There could be more consistent management of risk. Those people identified, as at risk could have a detailed care plan in place, saying what care staff need to do to minimise the risk of an individual coming to harm. People who display behaviour that challenges the service could also have a care plan in place to say how that behaviour is to be managed so that the same level of support is provided. Care plans could be reviewed when peoples care needs change so that they provide an accurate and up-to-date record of the care people need. There could be a system where medication records and practises are checked more regularly to make sure medication is being stored correctly and people are receiving their medicines as prescribed. The dining experience, for those people needing more assistance, could be looked at to see if changes would enable those people to be assisted in a more sensitive and respectful manner. The registered person could make sure that incidents at the home, which may be abusive, are shared with the local authority so that they, as the professionals in charge of investigating these allegations, can determine whether more needs to be done to keep individuals safe. The registered person could continue to promote the National Vocational Award Scheme so that 50 of care staff achieve a Level 2 Award in Care. People are more likely to receive safe, consistent care from staff that have a good understanding of their role. The registered person could provide better written evidence to show that recruitment processes within the home are robust as this will help to confirm that people are being protected from harm. The registered person could ensure that the Commission is notified promptly when an individuals health and wellbeing is affected by any event at the home. Law requires this so that these incidents can be monitored. The registered person could seek guidance from a fire safety officer about the need for staff to attend fire safety refresher training, so that they have up to date knowledge of what to do in the event of a fire at the home. The frequency of hot water temperature monitoring in the home could be reviewed. This is so that the registered person can satisfy herself that the risk to people being scalded, from any hot tap that they have access to, is minimised. 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. Care Homes for Older People Page 9 of 34 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 10 of 34 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 11 of 34 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. The pre-admission assessment ensures that individual care needs can be met at the home and the prospective resident receives information and help, to enable them to choose whether Afton Court is the right place for them. Evidence: Three care records were looked at as part of the inspection process and all showed that an assessment had been completed prior to them moving to the home. These assessments though need to be dated and signed, so it is clear when it was done, and by whom. This assessment process enables the manager of the home to check that all the persons needs could be safely met if they choose to move there. The records also contain detailed assessments from the local authority, if they are funding the placement. One visitor spoken with confirmed that their relatives care needs had been Care Homes for Older People Page 12 of 34 Evidence: discussed with them. They said they had visited the home prior to their relative moving there, but that their relative said the home was good, so was happy to move without visiting. The home provides a brochure to people expressing an interest in moving there. The Statement of Purpose and service user guide are displayed in the home, though the manager may wish to produce the service user guide in an easy read format for those people with impaired understanding. Afton Court does not provide intermediate care, however the home has one bed, which is used for respite care, if needed. Care Homes for Older People Page 13 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst peoples care needs are generally well met the records underpinning that care are lacking in detail and are not being updated properly to reflect peoples changing needs. Risk is not being managed in a consistent way. Evidence: Three care records were looked at in detail as part of this inspection, and several others were looked at briefly. These should describe the care and support that people need to stay as independent as possible, whilst living in a care setting. Each persons care records were put together in a similar way, however they were not easy to follow, for someone unfamiliar with them, and the manager had to explain how they worked. Most contained a photograph of the person. This is good practise, as some people, when asked, may not be able to confirm who they are. People spoken with said they were well cared for and were very complimentary about the staff team. However the records describing this care were not written in enough Care Homes for Older People Page 14 of 34 Evidence: detail. There was some evidence of person centred care identifying how one person was different to another, such as likes to have their breakfast in their room, prior to getting ready for the day. However most information was not written in a way that suggested individuals were receiving very different levels of support in order to maintain life skills or choices in their day-to-day lives. For example needs assistance with bathing does not describe whether a person can manage the task almost independently, can carry out parts with prompting, or is unable to participate at all. This detailed information needs to be written down so that staff provide the same level of support and the individual can maintain some control of their life. The care plans need to show how people are being supported to stay in charge of their own lives as much as possible. If they do not accurately describe the individual care and support people need, then staff are unable to check that they are providing the right care. Care plans should also be written in consultation with the individual, wherever possible. This is so that they have the opportunity to say what matters to them and can sign to say they agree with whats been written down. Records relating to how the home manages risk are also lacking in detail, with little evidence of any assessments. The owner should consider using recognised assessment tools for determining whether someone is at risk of falling, developing a pressure sore or becoming malnourished. This would make sure that people are assessed in the same way, regardless of who is carrying out the assessment. If people are assessed as at risk then they need an individualised care plan, describing what staff will do to minimise that risk. This needs to be reviewed regularly and like all the care records needs to be signed and dated. People who display behaviour that may challenge the service must also have a detailed care plan identifying what sort of things may upset them and how care staff are to manage this behaviour in the safest way. This will promote a consistent response and reassure care staff that they are providing the right support. One person had some history of aggression at a previous care setting, but was assessed as no risk when moving to the home. They displayed some difficult behaviour earlier this year, but there is no care plan stating how this behaviour is to be managed, if it were to happen again. There are records of visits from health care professionals and all the surveys state that people always get medical support promptly when needed. A private physiotherapist visits the home each week and they can also provide guidance and support for care staff if necessary. Care Homes for Older People Page 15 of 34 Evidence: Two peoples health care needs have changed recently, but neither of these changes were managed in a timely way. Nor have their care records been updated to reflect their changed needs. The owner is investigating both of these incidents. Medication processes were looked at and some improvements still need to be made. Medicines are securely stored and controlled drugs records were in order. Prescribed medicines are dispensed by the chemist in bubble packs, which are then popped out into medicine pots, for care staff to give to people. Some drugs though are dispensed from their original packets. The quantity of medication from one monthly cycle to the next is not recorded on the new record sheet. This means there is not a complete record of medication within the home and makes it difficult to check if medication is being given correctly. Three medication records were looked at, and a few gaps where signatures were missing, were noted. It wasnt possible to check if these had been given. The manager needs to be regularly checking medicine practises in the home to make sure drugs are being given and signed for correctly. This shortfall was identified at the last inspection two years ago. Three different medicines were being kept in the fridge, but should have been stored at room temperature. Storing drugs incorrectly may affect their effectiveness to treat the medical condition for which they are prescribed. It is good practise for hand written prescriptions on medication records to be dated and a second person should sign the chart too, to confirm they have checked what has been written down. This is a way of minimising possible errors. One person at the home looks after his or her own tablets. Their care record has a risk assessment in place, which has generally been signed by the person every four weeks to confirm their agreement. This though hasnt been reviewed for eight weeks. People though looked well cared for and care staff were observed speaking to people in a kind and gentle manner. There was a happy and friendly feel to the home, where people were included in conversations and their views were listened to. Staff were also observed knocking on doors before entering a washrooms, in case the room was already occupied. Care Homes for Older People Page 16 of 34 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 are supported to lead the life they choose and be involved in activities both in the home and community. People who need a lot of help at mealtimes may not be receiving this support in an unhurried and sensitive manner. Evidence: People living at the home have the opportunity to live interesting and stimulating lives. Several people go out into the nearby town centre independently or with their family. Some people hold a door key to the home, so that they can come and go as they choose. The hairdresser visits twice each week and a beautician also regularly visits to promote peoples well being. An activities person works five afternoons each week and there are regular visits from entertainers, motivational classes and local community groups. One person spoken with said they liked to join in with activities. They said they enjoyed the bingo and were looking forward to the Christmas party, which was planned for the following day. The large screen television was on in the main lounge. The people watching it had decided how loud it was to be, which was not loud. People were observed chatting with each other. One person was knitting dolls clothes. There were newspapers around. Care Homes for Older People Page 17 of 34 Evidence: These all pointed to a normal varied lifestyle. The home has a minibus, so that trips away from the home can be organised. The landscaped courtyard has a fishpond and greenhouse and a hutch where the pet rabbits live. One person was seen helping to keep the area tidy and feeding the rabbits. These outside activities provide people with other interests and responsibilities. People say they are supported to decide how they spend their time. One person said they liked to get down for breakfast about half eight. But if they were poorly theyd have it in bed. Theyre (staff) very good like that. Another person has a great many personal possessions and staff respect and support the individual in their lifestyle choices. Although the homes brochure discourages visitors before ten and over mealtimes one visitor spoken with said they had visited at all sorts of times and always been made to feel welcome. This helps people to keep in touch with family and friends. Residents meetings are held about four times a year and a newsletter is also published quarterly. However some people spoken with, who were very happy at the home, said about the meetings, its not worth your while attending. They said they were unhappy about some of the meals, but felt their views were not being heard. Following the site visit the manager and cook spoke with the people concerned, so that they could discuss what their concerns were. The manager needs to look at whether a residents meeting is the best way of giving people the opportunity of saying what matters to them. Meals are ordered a day in advance. There is a choice of meals, including a vegetarian option, each mealtime. Peoples survey comments about the meals varied, with four of the ten people, saying they only sometimes like the food. However a new cook has been appointed since the surveys were completed. The manager could consider carrying out another survey about the food at the home, to check whether peoples views have changed since the new cook started. The breakfast, which includes the option of a cooked meal, is served during the morning, as people are ready for it. The lunch is served in two sittings, with more independent people eating first, to promote a relaxed and social occasion. Kitchen staff serve the meals, and those looked at were all similar sized. The owner could look at whether some people could serve themselves at their table, so that they could choose how much vegetables, or gravy they wanted. This would provide people with more choice and independence. Care Homes for Older People Page 18 of 34 Evidence: The second sitting is for people who need assistance. This experience was not so positive. Although all the available care staff were helping, the number of people requiring help meant that staff could not spend time with just one person. One carer was heard to say Ill do these two here, if youll do those two there. Staff couldnt sit with one person, but were supervising four people at the table, meaning they were having to move around, serve and remove plates, help an individual, clean someones mouth or hands, then back to give someone another mouthful. One person had their meal in front of them for about ten minutes, before a carer noticed that they hadnt eaten anything. The present system is not satisfactory. The manager needs to re-look at the dining experience for those people needing more assistance so that they can be assisted in a respectful manner, by staff who are sat with them, giving them their full attention and making sure that they receive a meal that is freshly served and, if appropriate, hot. Care Homes for Older People Page 19 of 34 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 at Afton Court and their families can be sure that complaints are taken seriously and staff are alert to any signs of abuse. Evidence: The complaints process is displayed in the entrance area and is explained in information given to people and their families when they choose to move there. Everyone spoken with and the survey responses all stated that they would tell someone if they were unhappy about the service, and were confident that the owner would sort it out. One person said they would tell the manager if someone was horrid to me and they see the manager in the home a lot. Staff attend training in safeguarding adults as part of their induction training when they start working at the home, and the owner says that more training is planned for early 2009. One member of staff spoken with was very clear about the need to promptly report any incident that may be abusive, as it was important that people needed to be kept safe. They also said they would report something, even if the person had asked them not to. This is good practise and shows that staff know that they cant keep this sort of information secret. One persons records though identified three incidents where there had been disagreements between two people at the home, and these were discussed with the Care Homes for Older People Page 20 of 34 Evidence: owner. She said minor disagreements between some people happened quite often because of their dementia and these were managed within the home. Another person said, when asked, that they didnt feel safe. They said they were scared of one person and had been called a name that they had found particularly upsetting. This too was discussed with the owner. These sort of incidents need to be discussed with the local authority, who are the lead agency in deciding the best way of managing them. These national and local guidelines are in place to help to keep people safe and by not sharing this information the home manager is not doing all she could be doing to keep people safe. Following the site visit the owner spoke with the local authority to get more guidance about what sort of incidents can be managed in house and which incidents need to be referred to the local authority. Care Homes for Older People Page 21 of 34 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. Afton Court is a comfortable and warm home, which is still being refurbished to improve it more for the people living there. Evidence: Afton Court is an adapted property of four terraced houses close to the centre of Bridlington. It has an attractive well-maintained, safe courtyard area, with a raised water feature and fishpond, a greenhouse and a variety of seating areas and planters. This space has disabled access from several parts of the home. There are a number of different communal rooms so that people can choose where to sit, and with whom. There is also a large conservatory and separate dining room, and a new salon for the hairdresser and beautician has just been created, which will also be equipped as a sensory room. Almost all the bedrooms are on the first or second floors reached by a vertical passenger lift and there are several staircases. Bedrooms are almost all for single use, and all have en suite toilet and hand basin. As rooms are being refurbished wherever possible a shower is being added. Those looked at contained personal items, which make the room more like home and a telephone was seen in one room. However the homes policy is to keep all bedrooms locked, although some people confirmed that Care Homes for Older People Page 22 of 34 Evidence: they have their own room key. The manager explained that most people couldnt go to their room independently as they need supervision in the lift. This does mean though that most people are always reliant on a carer to let them in to their own room. The home has a public telephone booth, but this too is kept locked, with people having to ask a carer before they can use the room. The manager could look and see if there is a better way of allowing people to use these facilities independently. Other accommodation includes a self-contained flat, as well as two en-suite rooms, with an attached small conservatory, which are used as private living areas. There are adequate numbers of bathrooms though the manager could consider the use of pictorial signs, which may help to promote peoples independence. Two sinks looked at on the ground floor did not have any soap, though this was corrected when pointed out. There needs to be systems in place where routine checks identify when things need to be topped up or replaced so that these basic items dont run out. The owner makes sure that appropriate aids are available and used to make sure that people living and working in the home are protected against infection. One member of staff confirmed that these items were always readily available. Care Homes for Older People Page 23 of 34 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. There are sufficient staff who are well trained and supported properly to meet the present number of people living there. Recruitment processes need to be more robust to show that people are being kept safe. Evidence: People spoken with provided very positive comments about the staff team. These included I am very happy with the care. Staff are kind and considerate. And Ive been well looked after. Theres enough staff and they know what they are doing. Comments from relatives in their surveys were equally positive, including All the staff are very pleasant and helpful. And staff seem to interact well with the residents. All in all, very satisfactory. The owner has a general manager who is in charge of the day-to-day running of the home as well as a care manager, who works more closely with the care staff to ensure peoples care needs are being met. The staffing rotas confirmed that five care staff work the morning shift, three in the evening and three through the night. These numbers are for 33 people currently living at Afton Court. Apart from during the lunchtime period the staff seemed to have the time to talk with people and their behaviours towards them were friendly and respectful. Care Homes for Older People Page 24 of 34 Evidence: There are seventeen care staff and eight have, or are working towards, a National Vocational Qualification Level 2 in Care. Some staff hold a higher qualification than Level 2. People are more likely to receive safe, consistent care from staff that have a good understanding of their role and the owner should continue to support and encourage people to achieve this award. Two recruitment files were looked at. Whilst all checks had otherwise been completed, one persons application form did not provide a full employment history. There was no written evidence to show that the person had been asked about these gaps although the owner knew the reason for one of them. They had started working at the home after a PoVAFirst check had been completed, but before the full police check was available to look at. A PoVAFirst check confirms that a person is not barred from working in a care setting because of a previous offence but the check is not as comprehensive as the full police check. Whilst waiting for the full police check the owner must make sure the persons work is always supervised, ideally by the same named person, and the owner needs to be able to evidence that supervision. Robust recruitment processes are needed to protect vulnerable people from individuals who should not be working in a care setting. New staff follow an induction programme when they start working at the home. One carer confirmed this process and said they attended training in health and safety, abuse awareness and first aid soon after starting to work at the home. More training about the specialist needs of people with dementia is planned for 2009 but records showing the training provided in 2008 were not available to look at. Staff receive regular supervision so that their work and training needs can be discussed. Regular staff meetings also take place. Records for both were seen. Care Homes for Older People Page 25 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the home is generally run in the best interests of the people living there, checks are not being carried out often enough to make sure peoples health and welfare are always being protected. Evidence: The owner is the registered manager, who has worked in social care for more than ten years. She has completed extra qualifications to help her in her role and is currently studying for a dementia care qualification at degree level. She showed in discussion that she had a good understanding of the needs of older people and those with a diagnosis of dementia but was also open to comments about how the service could still be improved. People spoken with said they saw the manager regularly around the home and said she was easy to talk with. However they may have also been referring to the general manager. The home has been awarded the Quality Development Scheme (QDS) by the local Care Homes for Older People Page 26 of 34 Evidence: authority. This is a local scheme introduced to promote quality care in care homes. The home has also achieved the Investors in People Award. Day to day running of the home is the responsibility of a general manager, who is also a registered nurse. Some regular checks are carried out to confirm the home is running well. However some shortfalls, particularly around meeting health and personal care needs identified in this visit, suggest that a more robust system of checks is needed so that the registered manager can be sure that record keeping is satisfactory and care needs are being well met. The home uses surveys to ask people interested in how the home runs, about their views of the service. The owner recognises that it is important to consult with people, although says that the response rate is often disappointing. She has set up a Family Forum, meeting quarterly, to see if this encourages more people to get involved. The newsletter, published quarterly helps to keep people in touch with the home and residents meetings also provide an opportunity for discussion. The owner needs to also record comments made in conversation, as this may help to identify similar themes, which can then be looked into. People look after their own finances with support from their relatives or advocates. The home does not hold any personal monies on their behalf. All care services are required to notify the Commission of all incidents, which adversely affects the wellbeing or safety of an individual living at the home. This is to comply with the law, so that these incidents can be monitored if necessary. The Commission has received hardly any notifications in the past year and a look at the accident records confirmed that there have been several occasions when this should have been done. This requirement was discussed with both the owner and general manager. There are a range of health and safety policies and procedures in place. The home has made proper provision to ensure that there are generally safe working practises by providing staff training in first aid, food hygiene, infection control and safe moving and handling techniques. A number of safety certificates were checked and found to be satisfactory. These help to show that peoples health and safety is being protected. Staff attend fire safety training when they first start working at the home. And fire safety checks are carried out regularly. Records show that there have been a number of planned and unplanned fire drills in the past year. However staff do not attend regular fire safety refresher training. The owner must get advice from the fire safety officer about the need for refresher training so that she can be satisfied that staff are very clear about their roles in the event of a fire at the home. Care Homes for Older People Page 27 of 34 Evidence: Hazardous products are stored appropriately and records are maintained as required. Currently only the hot water temperature from bath taps is being monitored to make sure the water is not too hot. The owner needs to be satisfied that none of the hot taps, to which people living there have access, pose a risk of scalding. This is so that she can show peoples health and safety is being protected. Care Homes for Older People Page 28 of 34 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 29 of 34 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 7 15 Peoples care plans must be reviewed and updated whenever their care needs change. This is so that the care plans provide an accurate record of peoples needs and can be referred to, to check that the care provided is the right care. 31/01/2009 2 8 13 People must be assessed as 28/02/2009 to whether they are at risk of harm. If the assessment demonstrates risk, then they need a detailed individualised care plan describing the care and support needed to minimise that risk, whilst recognising peoples rights to take reasonable risks as part of day-to-day living. These systems contribute towards keeping people safe. Care Homes for Older People Page 30 of 34 3 9 13 There must be regular checks of medication practises to make sure medicines are both stored and signed for correctly. This will help to show that the management of medication is robust and people are receiving their medication correctly. 31/01/2009 4 18 13 Events where one person may have been harmed by the behaviour of a second person must be shared with the local authority in line with national and local safeguarding guidelines. This is so that people can be protected from harm. 31/01/2009 5 29 19 The registered person must 31/01/2009 evidence that gaps in the employment history on a persons job application form have been explored with them. She must also ensure that if staff start working at the home before their police check is available to look at then they should work with the same named senior person on every shift until the police check is back. Good recruitment practises contribute to keeping people safe. 6 37 37 The registered person must promptly notify the Commission of any event in the home, which affects the 31/01/2009 Care Homes for Older People Page 31 of 34 health or well being of somebody living there. This is to comply with the law and so that these events can be monitored. 7 38 23 The registered person must 31/01/2009 seek advice from the fire safety officer as to whether staff should attend refresher fire safety training and if so then how often this should be provided. This will contribute to protecting people from harm. 8 38 13 All hot water to which 31/01/2009 people living there have access to, should be monitored so that the registered person is satisfied that the risk of people being scalded by water that is too hot, is minimised. This will contribute to protecting people from harm. 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 7 The care records should be written in more detail, clearly identifying peoples strengths and the help they need to stay in control of their lives as much as possible. These need to be dated and signed. This will help to make sure people receive individualised, consistent care. Hand written entries to medication records should be dated and signed and a second person should sign to say the 2 9 Care Homes for Older People Page 32 of 34 entry is correct. This would help to minimise the risk of errors. 3 15 The dining experience for those people needing a lot of help should be looked at, to see if other ways of working would provide a more relaxing and respectful way of supporting people. Staff assisting people should be sat with them. The home should continue to encourage and support staff to achieve a National Vocational Qualification so that half the care staff have this qualification. This extra training will add to their understanding of their role. 4 28 Care Homes for Older People Page 33 of 34 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. 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