Inspection on 16/09/08 for Amphion View Limited

This inspection was carried out on 16th September 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Amphion View Limited 27/07/09

Extracts from inspection reports are licensed from CQC, this page was updated on 04/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Amphion View Limited 17/19 Avenue Road Wheatley Doncaster DN2 4AQ     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: Beverly Hill     Date: 1 6 0 9 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 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 33 Information about the care home Name of care home: Address: Amphion View Limited 17/19 Avenue Road Wheatley Doncaster DN2 4AQ 01302595959 Telephone number: Fax number: Email address: Provider web address: mue@amphion.co.uk Name of registered provider(s): Name of registered manager (if applicable) Muriel Broadhurst Type of registration: Number of places registered: Amphion View Limited care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 14 The registered person may provide the following category of service only: Care Home only Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Dementia - Code DE, maximum number of places 14 Date of last inspection Brief description of the care home Amphion View is a newly registered service that is able to provide care and support to a maximum of fourteen people who may have dementia care needs.The home is situated in a residential avenue in Doncaster and is close to local shops and amenities. Bus services to the city centre are a short walk away. The home has fourteen single bedrooms, all of which are ensuite and located over two floors accessed by a passenger lift. Communal rooms consist of one lounge and a large dining room with comfortable seating at one end overlooking the garden. The garden is accessed via patio doors and has a paved area with garden furniture and a large lawn. The home Care Homes for Older People Page 4 of 33 Over 65 0 14 Brief description of the care home has two bathrooms, one of which has a hoist to assist people in and out of the bath. The other has an unassisted bath and is for more ambulant people. The proprietors have plans to renovate this bathroom into a walk-in shower room. There is parking for a few cars in the driveway and in the avenue in front of the building. According to information received from the home the weekly fees are £426.55p. Additional charges are made for hairdressing, chiropody, clothing and toiletries. Information about the home and services can be located in the statement of purpose and welcome pack provided to prospective residents and available from the manager on request. This is the homes first inspection and the report, when completed, will be on display in the home. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since registration of the home in May 2008, including information gathered during a site visit to the home, which took approximately eight and a half hours. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Amphion View. We also had discussions with the general manager, the registered manager, the activity coordinator and care staff members. Information was also obtained from surveys received from people living the home, and one completed by a relative. Comments from the surveys have been used Care Homes for Older People Page 6 of 33 in the report. We looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. We would like to thank the people that live in Amphion View, the staff team and management for their hospitality during the visit and also thank the people who completed surveys. What the care home does well: What has improved since the last inspection? What they could do better: The homes statement of purpose and service user guide need some more information to make sure they are clear about the services provided by the home. The care plans and risk assessments produced by staff need to contain full information about peoples needs and how they will be met so that care wont be missed. The way medication is recorded needs to be improved so that all medication is signed into the home and there are clear instructions for staff. The home could employ a cook to prepare the main meal on the premises rather than staff having to collect it from the companys other home. The care staff do prepare breakfasts and the evening meal in the home. The manager and senior care staff in charge of shifts need to undertake more informed training in how to safeguard vulnerable people from abuse and medication training Care Homes for Older People Page 8 of 33 could be more thorough to ensure staff have the required skills to manage it safely. The training plan includes mandatory and some specific training for staff when caring for people with dementia, however it could also be expanded to include other conditions affecting older people. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home only admits people after a full assessment of their needs and provides people with the opportunity to have trial visits. Some gaps in the initial information given to prospective residents means that they may not have full information to make an informed choice about the home. Evidence: The home had developed a statement of purpose and service user guide, the latter in the form of a welcome pack. We examined these as part of the inspection and found that some sections required adjusting to provide commissioners of services and potential residents with more information about the care and support provided in the home. The statement of purpose needs to have the name of the manager, numbers of staff Care Homes for Older People Page 11 of 33 Evidence: employed and relevant qualifications and experience of both. The statement of purpose needs to be more specific about the range of needs the home is able to meet, especially in the level or degree of dementia people may have. The age range of people is mentioned but not that the home is able to provide support to both male and female residents. The criteria for admission section could also be expanded to reflect that people have their needs assessed prior to admission to the home by social services if their placement is funded by the local authority or by senior staff in the home if self-funding their care. The service user guide or welcome pack has information about the proprietors and registered manager but again needs updating with staff qualifications and experience now they are in place. There is a good description of the services provided, which needs expanding to tell people about the accommodation and communal space available, and the number of places provided with any special needs or interests catered for. When the home is more established the service user guide will need to include a range of service user views, which could be taken from a quality audit survey and it should let people know where the latest inspection report can be located. There was evidence the home provided, client agreements to people setting out the terms and conditions of the home. These are comprehensive although an improvement would be to stipulate the room the person is to occupy. There was evidence that all four residents had had their needs assessed prior to admission and the home had obtained assessments completed by care management. This ensured that the home had full information about people prior to admission and helped staff decide if needs could be met in the home. People could also have trial visits and respite stays in order to form an opinion about the home before a final decision about permanent residency was made. The home needs to formally write to people or their representative following the assessment stating their capacity to meet the identified needs. The manager confirmed this was done verbally at present. The home does not provide intermediate care services. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were provided with support in ways that promoted their privacy, dignity and independence. However gaps in care planning, risk assessing and recording means that staff may not have full information about specific tasks and care could be missed. The management of medication was not sufficiently robust to evidence good practice in ensuring all people received the medication as prescribed for them by their physician. Evidence: We examined all four care files during the visit. The way the care plans were written stressed the importance of maintaining independence, privacy and dignity and staff spoken with during the day showed a good understanding of how to promote this. They were observed speaking to people in a pleasant and courteous manner and residents confirmed staff were friendly and helpful. The care files had a précis of information regarding day and night routines, which detailed preferences and was a quick reference for staff. However there were care plan Care Homes for Older People Page 13 of 33 Evidence: issues that required attention. Not all needs identified at the assessment stage had been transferred to the care plan, for example one person had communication needs and emotional needs due to a recent bereavement but these had not been addressed in their care plan. Similarly other people had needs associated with skin integrity, behaviour management and some health issues such as epilepsy and diabetes but again these were not planned for. If staff do not have full information there is a chance that care could be missed. Care plans were not signed by the person formulating them nor by the person they were about. Signing the care plan shows us that people or their representatives have had the plan explained to them and agree with the contents. One of the care plans had been formulated over three weeks after admission. It is important that care plans are produced quickly so that staff have information on how to meet needs. Also care plans need to be evaluated on a monthly basis, taking into account information written in other parts of the care file, to ensure that any changes in needs are identified and addressed. There was evidence that people had access to health care professionals such as GPs, district nurses and chiropodists. The home also monitored and recorded peoples weight and examination of records evidenced this aspect of health was stable for all the residents. The home had completed a risk assessment for one person after they had sustained a fall in the garden, however other important elements of risk management had not been addressed. For example some risks had been identified at the initial assessment stage such as, falls, fragile skin, wandering and leaving the building, behaviours that could be challenging to others, epilepsy and diabetes, but full risk assessments with identified measures to reduce the risks had not been completed. This meant that staff would not have full and up to date information in how to manage the risks. In discussions staff were not fully aware of some of these risks. Daily recording did not give a full picture of the care provided during the day or night and there were times when issues were referred to but not followed through to the next shift. It is important that daily recording improves to evidence that full care is being provided to people. Monitoring charts had been put in place to monitor food and fluid intake, which was good practice to initially check peoples fluid intake after transition to a new environment. However the charts were not completed fully. For example one person was recorded as only having 380mls fluid intake in a 24 hour period and another person had 370mls. These had not been monitored and the low intake had not been investigated. The manager confirmed they thought it was more an Care Homes for Older People Page 14 of 33 Evidence: issue of recording rather than people not having enough to drink. We accepted this as an explanation, as people were observed having frequent fluids throughout the day. In discussion staff told us they had time to read care plans and record care as the home had only four residents at present. It was important they recorded accurate information to monitor the progress of people living in the home. One persons assessment highlighted the need for specific medication but this was not recorded on the medication administration record. The manager agreed to check this out. The home had adequate storage facilities for medication but there were some areas in the management of medication that required attention. 1) Medication not in cassette boxes was not consistently signed as received into the home. 2) Handwritten entries on the medication administration record did not have the full instructions. 3) Codes were used when medication was omitted but the codes were not always defined or the reason explained for the omission. 4) The home needs to keep a thermometer where the medication is stored to be assured it remains at the correct temperature in line with manufacturers instructions. 5) Two people were prescribed ear drops but directions were unclear as to which ear they were to be instilled into. 6) The date of opening for time-limited medication such as ear drops needs to be written on the bottle. 7) One person had prescribed cavilon cream but this was not on the medication administration record. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided flexible routines and enabled people to make choices about aspects of their lives. The home provided meals that met the nutritional needs of people. Evidence: The home had an activity coordinator that they shared with another home in the company and they visited Amphion View approximately 2-3 days a week for half a day at each session. There were a range of activities provided such as, picture cards to stimulate discussions, dominoes, play your cards right, hoopla exercise game, sing-alongs, reminiscence, visits to local shops and pubs, quizzes, painting, hand and nail care, hand massages, birthday and other seasonal parties, watching films together and listening to music. The activity coordinator had completed an information sheet for each resident with their likes and dislikes, whether any mobility or communication issues affected the person and other important information. A list of activities was documented with any comments the person or staff member assisting had made about it. There was a review process built into the documentation. Care Homes for Older People Page 16 of 33 Evidence: The activity coordinator had completed a two-week course with Age Concern and was very enthusiastic about her role. She had a good understanding of the importance of social stimulation and exercise for people with dementia and seemed aware of where to obtain further information. Some people participated in occupational tasks such as washing pots, folding serviettes and making, angel delight. People spoken with stated their visitors could come at anytime and could be seen in private. This was confirmed in discussions with staff, and surveys received from people. We observed visitors coming and going freely. Relatives commented that staff were friendly and kept them informed. People were able to make choices about aspects of their lives. They could choose where to sit and have their meals, the times of rising and retiring, what activities to participate in and whether they preferred to stay in their bedrooms. Staff told us they tried to make sure that people made as many choices as they were able and they had a good understanding of how to promote independence, privacy and dignity. People spoken with enjoyed the meals provided by the home. Breakfast and the evening meal were prepared by care staff on the premises but the main meal of the day at lunchtime, was prepared at the companys sister home a short distance away. This was not ideal as care staff had to collect the meals and at times re-heat them in the microwave. This was as a result of the home not employing catering staff at present due to the current number of residents. This was discussed with the general manager who agreed to bring forward the recruitment of a cook. The home did not have any menus on display so people were unaware of meals available. Staff did state they told people what was on the menu and any alternatives available each morning. They then rang through to the other home to order the meals. As the home had such a small number of residents at present, staff stated they prepared generally what people wanted for the meal in the evening. Special diets could be catered for. The kitchen was in the basement some way from the main part of the home and had quite steep steps leading down to it. As a result it was inaccessible to residents but some activities connected to food preparation could take place in the dining area. The kitchen also had a dumb waiter system of transporting food from the basement to the dining room so staff did not have to carry items up the steep steps. The general manager stated they had plans to relocate the kitchen to a more convenient floor in time. Care Homes for Older People Page 17 of 33 Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided an environment where people felt able to complain and staff had a basic awareness of safeguarding adults from abuse. Further training in this area would enhance staff knowledge and ensure vulnerable people were fully protected. Evidence: The home had a complaints policy and procedure that was displayed in the home. The manager had also set up a file to record any future complaints. There was a form for complainants or staff to use to record issues people were unhappy with. As an improvement the form could indicate whether the complainant was satisfied with the outcome i.e. by signing the form as agreed. To date the home had not received any complaints. People spoken with stated they were happy with their care and felt sure staff would sort out any problems for them. Staff were aware of what to do if people made complaints during their shift. The home had access to the local authority multi-agency policies and procedures in safeguarding vulnerable people from abuse. Staff had received basic training in how to safeguard vulnerable people from abuse via a DVD. In discussions they were able to demonstrate a knowledge of different types of abuse and the importance of making sure people were safe and reporting any issues to their line manager. They appeared Care Homes for Older People Page 19 of 33 Evidence: unsure as to the procedure once the alert had been made and further training in this area would make things clear for them. The general manager, registered manager and seniors in charge of shifts had not completed the local authority training regarding referral and investigation. This would help to consolidate their knowledge and practice in this area. The registered manager did state they were aware alert forms had to be sent through to the local authority. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are provided with a clean and safe environment. Evidence: The home was the first phase in a larger plan that consisted of four individual but joined, houses. Initially Amphion View has been registered to provide accommodation to fourteen residents and consists of two floors, the upper floor accessible by a passenger lift. The houses on either side of the home will be refurbished in later stages. The home was very clean, tidy and well maintained. The home has fourteen single bedrooms, each of which has en suite facilities. The rooms are bright, well decorated and contain appropriate furniture. The bedrooms had privacy locks to the doors and lockable facilities for people to store personal items. Radiators had a low surface temperature to avoid burns. People spoken with liked their bedrooms and had the opportunity to bring in their own personal possessions to make their room look homely. Communal areas consisted of one lounge with sufficient space for eight easy chairs and a dining room set out with four tables and chairs. There was an additional seating area for approximately six easy chairs looking out onto the garden at one end of the dining room. Both areas were clean and warm and the lounge had a television set, Care Homes for Older People Page 21 of 33 Evidence: DVD and music equipment. The garden is accessible from the dining room via a ramp and has been enclosed and made safe. It has handrails onto the patio area and has a large grassed area with garden furniture available. The home has two bathrooms, one of which has a hoist to assist people in and out. The other bathroom is for more ambulant people, however we were advised that the home were considering plans to make this into a walk-in shower room, which would be of more use to people with mobility problems. Corridors were wide enough for wheelchairs and had grab rails to assist people. The home had sufficient moving and handling equipment for the needs of current residents and had access to eight hospital type beds for people that required them. The lounge had two calls bells to enable residents to summon assistance. The home was clean, tidy and well maintained. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by kind and considerate staff however some gaps in service specific training could mean that staff may not have the skills required to meet the diverse needs of people. Good recruitment systems mean the home ensures only appropriate staff work with vulnerable people. Evidence: Discussions with staff indicated that there are two care staff on duty during the day, as well as the registered manager and two care staff at night. As the home has four residents at present this is sufficient to meet their current needs. Care staff are completing domestic and catering tasks at present due to the number of residents but plans are in place to recruit extra staff in these areas when required. The lack of a cook on site and the positioning of the kitchen in the basement, has posed some problems for staff and the monitoring of residents. Care staff prepare breakfast and the evening meal. This means that only one staff member is available to monitor residents at this time. We discussed this with the general manager and they agreed to bring forward the recruitment of catering staff. This showed us the home was prepared to address issues highlighted to them. Care Homes for Older People Page 23 of 33 Evidence: People spoken with and surveys received from them were positive about the care staff team, the staff are very friendly and, yes they do look after us well. Staff also spoke about having a good team and were observed speaking to people in a kind and courteous way. The company has a training officer who is to be responsible for ensuring staff training needs are met and identifying new courses. At present there is a good skill mix of staff and the training plan included mandatory and some service specific training courses. Staff had completed some basic mandatory training via a range of DVDs with questionnaires as part of their induction. These included, basic food hygiene, safeguarding adults from abuse, infection control and first aid. Practical moving and handling had been delivered by the manager, who had completed a train the trainer course, and all staff had received fire awareness training. Staff had also worked through, skills for care induction standards booklets and had these signed off by the manager. The registered manager and general manager had completed a four-day first aid course and senior care staff, the one day appointed person first aid training. This made sure that people in charge of shifts were equipped with first aid knowledge and skills. The registered manager had also arranged basic training in dementia awareness, nutrition for people with dementia and mental capacity legislation. Medication training was not as thorough as required to ensure staff had the appropriate skills to manage medication safely. To improve the overall training plan the home needs to include conditions affecting older people, for example, diabetes, Parkinsons disease, strokes, arthritis and sensory impairments, and issues such as continence promotion, catheter care and the management of pressure areas. Staff in charge of shifts should also complete the local authority training in how to safeguard vulnerable adults from abuse. The home has ten care staff at present and one person had completed a national vocational qualification at level 2 in care. This equated to 10 and the home should aim for 50 of care staff trained to this level or above. The homes recruitment processes are robust. Prior to the start of employment, application forms are completed, references obtained, criminal record bureau checks in place and also checks are made against the protection of vulnerable adults register. Staff files need to have photographs of them in situ. Care Homes for Older People Page 24 of 33 Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well managed and was a safe place for people to live in and staff to work in. Evidence: The registered manager is a Registered General Nurse and has completed registration with the Commission. She has completed a four-day first aid course and undertaken training in mental capacity legislation and dementia awareness to keep her skills up to date. Staff spoken with described the manager as, approachable and brilliant and one person stated, you can go to her with problems and she will sort them out. There was certainly a relaxed atmosphere in the home and good interaction was noted between the manager, staff and residents. Meetings took place and staff and residents were able to voice their opinions about the Care Homes for Older People Page 26 of 33 Evidence: way the home is managed. The company has a quality assurance system in place that consists of audits and questionnaires. Audits covered areas such as catering, housekeeping, care and administration. There was also a spot-check system of audits to obtain the views of residents and visitors on staff kindness and whether staff are wearing identity badges plus checks of equipment in the home, care plans, other documentation and medication. Questionnaires had been formulated for residents and visitors for a range of issues, for example, meals, laundry experience, activities, staffing and complaints management. It is recommended that the views of visiting professionals such as district nurses, community psychiatric nurses, GPs and care management teams are obtained at intervals to give a wider range of information about the services provided by the home. The general manager advised that an annual report on the services provided would be completed and this would include the outcome of quality monitoring. As with the other home in the company this would be made available for people to read. The registered manager had completed a staff supervision plan and had started the process so that staff were on target to receive the required six, formal, one to one sessions per year. Supervision covered a review of job descriptions, general issues, manager feedback, support required, training and a review of targets previously set. The registered manager showed us appraisal documentation which was to be used on an annual basis for staff and advised that care staff were to have observations as part of the supervision process. The financial viability of the home was assessed during the process of its registration and was not assessed any further during this visit. The residents families mainly manage finances but there is scope for the home to manage a small amount of personal allowance for people if they choose. The registered manager described how the system worked. Individual records were maintained and receipts kept when staff assisted people with their shopping. The home was a safe environment for people. For example, equipment was new and contracts were in place for servicing at appropriate intervals. Fire equipment and alarms were checked and fire drills held so staff could familiarize themselves with emergency procedures. Any maintenance tasks were quickly identified and on the whole addressed straight away. The door to the lounge was sticking with the new carpet and did not close straight away when the fire alarm was activated. This had been highlighted but not addressed yet. It was mentioned to the manager rectify quickly. Care Homes for Older People Page 27 of 33 Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must address all 30/11/2008 assessed needs with clear tasks for staff. They must be evaluated for changes in need and agreed by the resident or their representative. This will ensure staff have clear and up to date information about people and how to meet their needs so care wont be missed. 2 8 13 People must have risk 30/10/2008 assessments with clear steps on how to minimise the risks of particular issues such as, falls, nutrition, behaviours that are challenging and specific health conditions. This will help to plan care more effectively and minimise risks for residents associated with specific activities. Care Homes for Older People Page 30 of 33 3 9 13 Adequate arrangements must be put in place for accurate recording of all medicines received and administered. This will ensure people receive the medication prescribed for them. 31/10/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The homes statement of purpose and service user guide should contain full information about the services provided especially in relation to dementia care. This will ensure that potential residents can make an informed choice about the home and be sure needs can be met. Monitoring charts, obviously put in place for a reason, should be completed accurately. The temperature of all medication storage areas should be regularly monitored. This makes sure that medicines are being stored at the temperature recommended by the manufacturers. Handwritten entries and changes to MAR charts should be accurately recorded and detailed. This makes sure that the correct information is recorded so a person receives their medication as prescribed. The main meal of the day should be prepared on the premises to prevent the need for staff collecting it from another home and at times re-heating it in microwaves. Breakfast and the evening meal is already prepared at the home. Menus should be displayed to give people information about the meals provided each day. The general manager, registered manager and senior staff in charge of shifts should complete safeguarding training with the local authority to enhance the in-house training regarding referral and investigation procedures. The home should aim to have 50 of care staff trained to NVQ Level 2. 2 3 7 9 4 9 5 15 6 7 15 18 8 28 Care Homes for Older People Page 31 of 33 9 10 29 30 Recruitment files should contain staff photographs. The homes training plan should include conditions affecting older people so staff have a full range of skills to meet the needs of people in the home. Medication training should be thorough to ensure staff have accurate and up to date information about the management of medication. The views of professional visitors to the home such as GPs, district nurses, community psychiatric nurses and care management should be obtained as part of the quality monitoring system. 11 30 12 33 Care Homes for Older People Page 32 of 33 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 © (2008) 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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