Inspection on 05/11/08 for Alice Grange Care Home

This inspection was carried out on 5th November 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Alice Grange Care Home St Isidores Way Ropes Drive Keasgrave Ipswich Suffolk IP5 2GA     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: Francesca Halliday     Date: 0 5 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 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Alice Grange Care Home Ropes Drive St Isidores Way Keasgrave Ipswich Suffolk IP5 2GA 01473611967 01473610519 catherine.condon@barchester.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Catherine Condon Type of registration: Number of places registered: Barchester Healthcare Homes Limited care home 84 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 84 The registered person may provide the following categories of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Physical Disability Code PD Date of last inspection 84 0 84 Over 65 0 84 0 Care Homes for Older People Page 4 of 30 Brief description of the care home Alice Grange is a purpose built nursing home on three floors, that can accommodate up to 84 people who need nursing or personal care. The home has a 10 bedded unit for younger people with a physical disability, a 19 bedded unit for older people, a 38 bedded unit for dementia care and a 17 bedded assisted living unit for people who are independent but may need occasional support. The home offers respite care and short breaks. Each unit has communal lounge and dining areas and all the bedrooms have an en-suite toilet, basin and shower. Each floor has assisted baths and two floors also have assisted showers. The first and second floors can be accessed by both stairs and a passenger lift. The home is within walking distance of local shops. There are bus stops outside the home and the town of Ipswich is approximately five miles away. The weekly fees at the time of inspection in November 2008 were from £850 for nursing care, from £950 for dementia care, from £1000 for younger physically disabled and the supportive living rooms were from £700 to £1000. Charges for personal care were dependent on the needs of the individual resident. Respite care was charged at £135 per day. There were additional charges for hairdressing, chiropody, toiletries and newspapers (although the home ordered two daily newspapers for each floor). Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 key inspection was carried out on 5th November 2008. The term resident is used throughout this report to describe people living in the home and the term we refers to the Commission for Social Care Inspection. All the key national minimum standards (NMS) for older people were assessed during the inspection. The report has been written using evidence accumulated since the home was first registered in May 2008, as well as using evidence accumulated during the site visit. We also looked at the annual quality assurance assessment (AQAA) completed by the manager. The report includes views and comments from two relatives spoken with during the inspection and one member of staff we spoke to after the inspection. Time was spent talking to the registered manager and four of the staff. We also had chats of various lengths with seven residents. We sent surveys out prior to the inspection, however, only one staff Care Homes for Older People Page 6 of 30 survey had been received by the time this report was completed. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be confident that they will receive an assessment of their needs before making a decision about admission to the home. Evidence: The home had a range of information for prospective residents, their relatives and their representatives. The manager said that she would remove the reference to the home admitting residents with a mental illness from the statement of purpose as this was incorrect. Prospective residents were invited to visit and spend some time in the home prior to making a decision about accepting a placement. The home had a home service advisor who dealt with all enquiries and answered any questions about the care, the services and the contract. They showed prospective residents and relatives round the home. A welcome guide with information about the home was placed in each residents room Care Homes for Older People Page 10 of 30 Evidence: on admission. A trial period of four weeks was offered before residents made a decision about permanent placement in the home. The home services advisor saw new residents at regular intervals in the first ten days following admission to ensure that they had settled in and to pick up any queries and concerns. They had also organised a meeting about financial planning and power of attorney for residents and their representatives. A resident told us that they found the home service advisor very supportive when they moved into the home. The manager carried out the pre-admission assessments for all prospective residents. We looked at the assessments for three residents and they were seen to be of a good standard and provided staff with clear information about residents needs. However, the assessment tool used did not provide a sufficiently detailed mental health assessment for residents with dementia, as only memory was assessed. This could potentially result in residents being admitted inappropriately to the home. Emergency admissions were rarely accepted and only when the manager had sufficient information from different sources to enable them to assess whether the home could meet the needs of the potential resident. Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents consider that they receive good care but limited care documentation does not encourage consistency of care practises. Some improvements in medicines management are needed to improve the safety for residents. Evidence: Residents and relatives we spoke with said that they were very happy with the standards of care in the home and the support they received from staff. One relative told us Im very happy with the standard of care, staff are very gentle. Residents told us that staff treated them with respect and a relative told us, Staff shut doors when carrying out care and treat residents with respect and courtesy. We observed that staff had a respectful, caring and supportive manner with residents. All bedroom doors had knockers and letterboxes like a front door, this emphasised the fact that residents rooms were their private spaces. We looked at the care documentation for three residents. The standard of the documentation was very variable. Some of the care plans seen had elements Care Homes for Older People Page 12 of 30 Evidence: describing the residents interests, wishes, preferred routines and abilities. However, in a few instances care plans had been written when there was no identified need or problem and in other instances there was no care plan when the needs had been identified in the assessments, daily records or in our discussions with residents or staff. One residents care plan for personal hygiene stated that the resident was unable to fully carry out their own personal care but did not state exactly what they could do for themselves or what assistance they needed. This lack of detail could result in care being provided in an inconsistent manner. Some care plans had not been updated following changes in residents condition and did not reflect their current condition and care needs. The evaluations were also of a variable standard. Some had information on the residents condition and how they were responding to care, others had statements such as no change to care plan and others gave instructions to carers rather than evaluating care and care needs. The manager told us that the companys clinical development nurse was monitoring the standard of care documentation and had identified the staff who needed additional training and support. Care plan training was due to take place shortly after the inspection. We saw a very good prompt sheet for nursing and care staff to use, that encouraged them to write more detailed and care plans tailored to the individual resident. There was some evidence in the daily progress records of staff observing and recording the psychological health of residents with dementia. However, the home was not using a tool for systematically monitoring residents psychological health over a period of time, for example monitoring changes in condition or challenging behaviour, reaction to medication or gathering evidence of the need for reassessment. The home had a range of risk assessments for residents, which included assessing their risk of falling, of malnutrition and of developing pressure sores. The assessments were generally well completed but in some instances needed to be linked more closely with the care plans, in order to demonstrate the support the residents needed to reduce the identified risk. The daily care records we sampled were generally of a good standard and contained details of the residents health, the care provided and how they had spent their day. Residents had been weighed on a regular basis and there was evidence that action was taken if any weight loss was identified. This included adding additional calories to the residents usual meals, obtaining extra supplements via the GP and if necessary making a referral to a dietitian. Staff, residents and relatives all told us that the GPs who visited the home were very supportive. There were records of GPs visits with information on any changes made to residents treatment or care. The manager said that optical checks were being arranged for all residents and she said that she would try to arrange for residents to also have dental checkups. Two chiropodists visited the home and some residents had retained their own chiropodists. There was evidence Care Homes for Older People Page 13 of 30 Evidence: that some residents who had been admitted to the home had been rehabilitated, for example one resident had who had used a wheelchair most of the time on admission was now more mobile and only rarely used the wheelchair. There were good systems for checking receipt of medicines, with two nurses carrying out the checks. There was evidence that alternative preparations of medicines had been requested when residents could not swallow tablets, in order to ensure that they could still take their medication. The medicine administration records (MAR) were generally well completed. Some good records were seen that gave clear reasons, on the reverse of the MAR, about why a resident had not received their prescribed medicines. However, a few gaps were noted and at times more detail was needed, when using codes, to establish why medicines had not been given. Medicines with a limited shelf life on opening had been dated on first use. The temperature of the clinical rooms and the medicines fridges were being checked daily. Action was being taken to repair the air conditioners as the clinical room temperatures had been above the safe temperature for storage of medicines. Residents who were prescribed sedatives and anti-psychotic medication on an as required basis did not have care plans to provide guidance to staff on their use and the actions to take before giving the medication. There was evidence from the records that staff were not always administering as required medicines in a consistent manner. We noted that two residents did not receive their prescribed medication due to it being unavailable, for nine days in one instance and four and a half days in another instance. The manager said that there had been problems with both the surgery and pharmacist and that new systems were being put in place to double check that the surgery and pharmacy had received the faxes and prescriptions. The controlled drugs (CD) balances were checked and seen to be correct but one CD had not been entered in the CD register. The manager said that all nurses received an assessment of competence before administering medicines in the home and one of the nurses we spoke with confirmed this. Care Homes for Older People Page 14 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are offered a varied and nutritious diet but would benefit from further development of activities in the home. Evidence: The post of activity coordinator had been vacant for four weeks and the post was being advertised. A member of staff had not been identified to cover the role but the manager said that they would try to do this following the inspection. We saw assessments of residents interests, hobbies and abilities in relation to activities but there were limited records of how much they were involved in the activities or whether they enjoyed or benefited from them. There was very little evidence of activities in the records we sampled. A member of staff who responded to our survey told us that residents do the same thing every day, eat, sleep and watch TV. They are bored. The manager told us that she was aware of the need to provide additional training for care staff in the range of activities suitable for older people and people with dementia and how they could incorporate more activities and stimulation in their day to day interaction with residents. The home had kitchens on each unit that residents and relatives could use to make Care Homes for Older People Page 15 of 30 Evidence: drinks and snacks. The kitchens could be used as part of life skills rehabilitation and contained some safety features to prevent residents with dementia using the facilities without supervision. The corridors in the dementia units had a number of collections of artifacts on different themes, such as gardens and the beach, for residents to look at and handle. The manager said that residents enjoyed using the items and that staff collected them from their rooms at the end of the day. There were also rummage boxes available with items to stimulate conversation and interaction with residents. Residents with dementia had helped to pot up some of the large planters in the garden. The manager told us that they had entertainers in the home every three weeks. They had a special champagne afternoon tea when they opened the first floor and they held a Halloween party. Residents told us that they thoroughly enjoyed the parties and very much liked some of the entertainments. The home had a minibus and ten of the residents and six of the staff had been to a fish and chips supper at the pub the previous evening. Residents told us they had enjoyed it very much. The home had unrestricted visiting. A relative told us that staff had been very supportive during a residents serious illness. One relative said Staff give good support to families. Theyve looked after us so well. Relatives told us that staff offered them meals if they were staying any period of time. One resident considered that the communication in the home could at times be improved to enable them to keep in touch with their family. They said that they did not have a telephone in their room but that staff did not always let them know when there was a phone call for them. They said that on one occasion their relatives could not get any reply from the front door and so they went away and that on another occasion their relatives were told to wait while they finished their meal but staff did not tell them that they had visitors, so they waited a very long time. Links with the community were being developed. The local primary school children had become involved with the home and were having a competition to name the different units in the home. They were also coming to sing carols at the home at Christmas. The manager told us that local ministers visited residents on request. There were no services currently in the home, however, the local pub opposite the home held a non denominational service once a month that residents could attend if they wished. The manager said that the Woodbridge library had an arts and crafts morning that they hoped some residents would attend. She also said that that arrangements had been made for the local library to visit the home. The British Legion visited the home and they were hoping to take some residents to a remembrance service. Some residents went to a local Headway day centre and some Headway clients were going to visit the home for a music quiz and fish supper. Care Homes for Older People Page 16 of 30 Evidence: A relative told us that staff had helped the resident they visited maintain their independence and said how important this was to them. There was evidence in one of the records seen that staff were encouraging a resident to be fully involved in choices about their care and encouraging them to maintain their independence for as long as possible. All the residents and relatives we spoke with told us that the food was of a good quality and that there were choices available at each mealtime. The menus we looked at showed plenty of choices and there was an alternative menu if residents did not like what was on the main menu. The manager told us that the food was all home made and that they tried to use locally sourced produce. The dining areas were attractively set out and residents were able to choose what they wanted to eat at the point of service as in a restaurant. This was a particularly good approach for residents with dementia who were able to look at the food before making a choice at each mealtime. Residents could choose to have a light breakfast or a full English breakfast if they wished. The home offered a light lunch and the main meal was served in the evening. A choice of wine, sherry and soft drinks was also offered before the evening meal. The manager considered that residents were more awake in the day when they had a light lunch and appeared to sleep better at night after a larger meal. Staff said that the home could cater for a wide range of diets. A relative told us that the chef offered to make any food to tempt a residents appetite when they were having difficulties eating. The manager told us that snacks were available at all times and that the chef ensured that there were plenty of snacks available out of hours, for example sandwiches and home made biscuits. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their concerns will be promptly addressed and that they will be protected from abuse. Evidence: The home had a complaints procedure, which was included in the statement of purpose and was also on display in the entrance hall. The statement of purpose stated that if residents had a visual impairment the complaints procedure could be read to them and an audio version of the complaints policy could be made available on request. The policy needed to be updated with the current address and telephone number of the commission. The home had received two complaints since the home opened. There was evidence that the complaints were fully investigated. One of the responses we saw gave details of the actions taken to address the issues raised and an apology was given. We received two complaints, which were passed to the home and investigated by the manager but neither were substantiated. The standard of investigation and responses we saw was good. One relative we spoke with told us that staff had responded very positively and took prompt action when they raised some concerns. The home had a policy for safeguarding vulnerable adults and protecting them from abuse and a whistle blowing policy (the reporting of suspected abuse or poor care). The manager said that all staff received an introduction to safeguarding in their Care Homes for Older People Page 18 of 30 Evidence: induction and then received the formal training. According to the records fifteen staff required safeguarding training and this had been arranged. We asked a member of staff about the different types of abuse that could occur and the actions to take if abuse was suspected and found that they had a good understanding of safeguarding issues and how to protect vulnerable residents from abuse. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from an attractive and well maintained environment. Evidence: The home was opened in May 2008, the furnishings and fittings were of a high standard and in excellent condition. The manager said that there was air conditioning throughout the communal areas of the home. Each unit had communal lounge and dining areas and all the bedrooms had an en-suite toilet, basin and shower. At the ends of the corridors there were small areas with bay windows where residents could sit and watch what went on in the streets outside. Each floor had assisted baths and two floors also had assisted showers. There was an attractive hairdressing salon with adjustable basins that were suitable for wheelchair users. All beds in the home were electric profiling (adjustable) beds with pressure relieving mattresses. There were life skills kitchens on each floor with safety features that prevented them being used by residents with dementia without supervision. The kitchens had hot water dispensers and juice machines for residents to help themselves. The juice was sugar free and had added vitamins. There was an enclosed garden for residents with dementia. The first floor units (for residents with dementia) had a balcony with a wall a third of the way up and a glazed area above, which made it safe but not enclosed. One resident told us that their en-suite shower room did not have appropriate grab Care Homes for Older People Page 20 of 30 Evidence: rails making it more difficult for them to be independent. The manager said that grab rails were normally put up when permanent residents were admitted. However, a number of residents on respite care would need adaptations such as grab rails to assist them in regaining independence prior to discharge home. Residents told us that the home was kept very clean and on the day of inspection we observed that the home was clean and had no unpleasant odours. The laundry looked well organised. It had a clean and dirty area and a separate entrance and exit. The home had a good system for handling soiled linen that involved minimal handling by staff, to reduce the risk of cross infection. The home provided prospective residents with labels for their clothes so that they could be marked before their admission. Residents we spoke with said that there was a good laundry service. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are cared for by an adequate number of well recruited staff. Evidence: We looked at the staff rotas over a period of four weeks and found the staffing levels were variable. On the day of inspection there were 10 nursing and care staff from 08.00-14.00, 6 nursing and care staff from 14.00-20.00 and 3 nursing and care staff from 20.00-08.00. At the time of inspection the home had 22 residents on two floors of the home. We observed staff supervising residents in the lounges on the day of the inspection. The manager told us that the staffing levels did not go below 6 nursing and care staff in the morning, 5 in the afternoon and 3 at night and that the additional staff on the day of inspection had been due to the fact that training was being carried out. In addition to the nursing and care staff the home had catering, housekeeping, hostess and laundry staff. There was also an administrator and a home services advisor. One relative said that there were occasional times when there were not enough staff when staff called in sick and the home had not been able to get additional staff at short notice. A resident also considered that there was a staff shortage on some days. Another relative told us that they had not been happy when they heard foreign staff talking in their own language at the nurses station. The manager said that this was not acceptable and said that she would talk to staff about it. A relative told us that staff responded reasonably quickly to the call bells. The manager told us that, if necessary, Care Homes for Older People Page 22 of 30 Evidence: they could monitor the time staff took when responding to call bells as the system was linked up to a computer. We looked at three staff files and they demonstrated that a good recruitment process was followed prior to staff commencing employment. There was evidence of checks with the criminal records bureau (CRB) and the protection of vulnerable adults (POVA) list and nurses registration was checked with the nursing and midwifery council (NMC). Two references had been obtained and identification was on file. The manager told us that all care staff were encouraged to start the Barchester national vocational qualification (NVQ) at level 2 as soon as they had completed their initial mandatory training and were encouraged to go on to NVQ level 3. The manager said that the NVQ was accredited with the city and guilds and incorporated the skills for care induction. Seven care staff were due to start NVQ level 2 in care in December 2008 and five of the support staff were starting NVQ level 2 in multi-skilled hospitality in December 2008. Two of the staff we spoke with said that they needed more training and considered that they did not have a full induction when starting at the home. They told us that they did not have their formal moving and handling training until they had been in the home for four and five months and had carried out some moving and handling in this period. The manager considered that the head of care, who left Alice Grange in mid September, had not been carrying inductions out according to the homes policies and that full inductions were now being given. She also said that staff were now up to date with the majority of training. Three members of staff had received training in the Mental Capacity Act, nine staff had received dementia care training and three staff had received training in coping with violence and aggression. The manager said that she was aware that more staff needed to have this training but said that all staff on the dementia care unit were receiving dementia care training. The majority of staff had completed or were in the process of completing training in moving and handling, fire safety, food hygiene, infection control and health and safety. A proportion of the training was undertaken as distance learning. Time was allocated for staff to complete the training and the manager was able to monitor individual staff progress through the training. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well managed but increased supervision of staff is needed to improve the outcomes for residents. Evidence: The manager was a registered nurse with previous experience of managing nursing homes. She had completed a diploma in management and had done a five day course in dementia care. The manager said that they were advertising for a deputy/head of care as the post had been vacant since mid September, they were also planning to appoint a head of care for each unit. The inspection highlighted that communication and teamwork needed to be improved and supervision of staff increased. One resident told us that some of the staff would not assist residents with things they considered outside their role, for example they would not change their water jug or remove their tray but would leave them until the next day. They felt that communication between staff could be improved. A member of staff who responded to our survey also considered that communication between staff needed to be considerably improved as it Care Homes for Older People Page 24 of 30 Evidence: was having a knock on effect on the residents. They told us Staff should work as a team and not as individuals. One member of staff said that they did not get a handover when they started one shift and so did not know anything about three new residents, one of whom had an infection. The manager said that there had been problems with supervision but that this had improved since one of the nurses had started covering the post of head of care. The home had a wide range of audits to monitor standards in the home. These included detailed audits on care documentation, medicines, infection control and health and safety. The manager told us that a different topic was chosen each month. Regular Regulation 26 visits had been carried out by the company to monitor standards in the home. The manager analysed all accidents in the home on a monthly basis and the analysis included a detailed section on actions taken by the home to reduce the risk of further accidents occurring. Relatives told us that the home kept them informed if the residents they visited had suffered an accident. The home did not hold any personal money for residents. They kept their own money in a lockable drawer in their rooms. The manager said that families were invoiced on a monthly basis for additional services such as chiropody and hairdressing. There were a range of systems in place for maintenance and servicing to ensure that equipment in the home was safe for residents to use. There were detailed audits of the environment, which included checking the water in outlets used by residents was at a temperature for them to use safely. No obvious hazards were noted during the inspection. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Residents must have up to date care plans that reflect all their current needs, abilities and identified risks and they must be involved in drawing up the care plans wherever possible. In order to give clear guidance for staff on how residents care should be delivered and risks minimised and in order that the plans reflect their individual wishes, interests and priority. 01/01/2009 2 8 12 Residents with dementia 01/01/2009 must have their mental health needs monitored on a regular basis. In order that appropriate and timely support and treatment can be given to them. 3 9 13 Care plans must be developed when residents are prescribed as required 01/01/2009 Care Homes for Older People Page 27 of 30 medication, particularly sedative or anti-psychotic medication. Good systems must be in place for ordering residents medication. Controlled drugs must be recorded in accordance with the Misuse of Drugs Act and associated Regulations. In order to ensure that staff administer residents medicines in a consistent manner and in order to ensure that there are no delays in receipt and that residents receive all their prescribed medication. 4 30 18 The manager must ensure that staff receive moving and handling training prior to carrying out any moving and handling with residents. In order that residents are not put at risk. 5 31 12 The manager must ensure that communication and teamwork are given a high priority. In order to improve outcomes for residents. 01/01/2009 01/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 The mental health aspects of the pre admission assessment should be expanded in order to ensure that the home can meet all the care needs of potential residents. Care Homes for Older People Page 28 of 30 2 12 A member of staff should be identified to coordinate and encourage involvement in activities each day in order to improve residents quality of life. Staff should make every effort to support residents to keep in touch with their relatives and friends. The manager should ensure that there are suitable adaptations such as grab rails in residents en-suite rooms in order to encourage their independence. 3 4 13 19 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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