Inspection on 03/12/08 for Anchor Homes - Monarch Court

This inspection was carried out on 3rd 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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: Anchor Homes - Monarch Court 30-50 Cadogan Terrace Hackney London E9 5EJ     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: Robert Cole     Date: 0 3 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. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (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 31 Information about the care home Name of care home: Address: Anchor Homes - Monarch Court 30-50 Cadogan Terrace Hackney London E9 5EJ Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Moise Louis Jennah Type of registration: Number of places registered: Anchor Trust care home 66 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 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 The maximum number of service users who can be accommodated is: 66 Date of last inspection Brief description of the care home Monarch Court is a purpose built home registered to provide nursing care and care and accommodation to people with dementia. The home is located in the London Borough of Hackney, overlooking Victoria Park. The home is close to public transport networks, including bus routes and the London Overground service. The home is built over four Care Homes for Older People Page 4 of 31 Over 65 0 66 0 66 0 66 Brief description of the care home floors, and all floors are accessible via a sevice lift. The home was first registered with the Commission for Social Care Inspection in June 2008. The home is privatley run, and owned by Anchor Homes. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 inspection took place on the 3/12/08 and was unannounced. The inspector had the opportunity of speaking with service users, their relatives, staff from the home, the deputy manager, and the homes manager was present throughout the course of the inspection. The inspector also spoke with two relatives by telephone prior to the date of inspection. The inspection included a tour of the premises, and an examination of documents and other records. In addition, the inspector was able to observe staff as they carried out their duties. Prior to the inspection, the inspector issued surveys to service users, two of which were completed and returned. The home completed an Annual Quality Assurance Assessment prior to the inspection at the request of the CSCI. All of this has Care Homes for Older People Page 6 of 31 formed part of the overall inspection process, and contributed to the judgements made within this report. 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 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It is the view of the inspector that service users are provided with sufficient information about the home to enable them to make an informed choice as to move in or not. This information is provided through written documentation and the opportunity of visiting the home. However, the home must ensure that pre admission assessments are carried out on all service users before they move in to the home. Evidence: The home has a Statement of Purpose in place. This contains the aims and objectives of the home, which include Respect for each individual and his/her background and culture. Help the person as far as possible to continue with their chosen lifestyle. and Provide personal care that is discreet, sensitive and appropriate to the needs of that individual. The Statement also includes details of the facilities and services provided by the home and of the management and staff team. Care Homes for Older People Page 10 of 31 Evidence: The home also has a Service User Guide. This includes details of he complaints procedure and of the homes physical environment. All service users have been provided with a copy of the Guide and of the Statement of Purpose. Written contracts are in place for service users, which include details of fees payable and the services and facilities provided by the home. These have been signed by service users and a representative of the home. The home has an appropriate admissions procedure in place. This states that pre admission assessments will be carried out on any prospective service users, and that they will have the opportunity of visiting the home before making a decision as to move in or not. The inspector spoke with several relatives, who were all able to confirm that they had being able to visit the home before any decision was made about moving in. As part of the case tracking of service users, the inspector checked several pre admission assessments. Those that were in place were of a good standard. They were set out on a standard pro forma, which includes sections on physical and emotional heath, mobility, continence and cultural and religious needs. However, for two service users that were case tracked, there was no evidence that they had had an assessment carried out. The manager informed the inspector they believed that one of these people had indeed had an assessment, but this could not be found during the course of the inspection. The other service user is receiving respite care at the home. The deputy manager informed the inspector that no assessment of their needs had been carried out, as they were not aware that this was required for service users receiving respite care at the time that they moved in. In order to help ensure that the home is a suitable placement, and that the home is in a position to meet the needs of any prospective service users, it is required that a comprehensive pre admission assessment is carried out on all prospective service users before they are admitted to the home. The home does not provide intermediate care. Care Homes for Older People Page 11 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It is the judgement of the inspector that the home is meeting the personal care needs of service users, but that more needs to be done to ensure their health care needs are being met. Medications must be administered and recorded appropriately, and the home must ensure that nursing care is properly attended to. Evidence: Care plans were in place for all service users. Each service user has an allocated nurse and keyworker, and these staff are responsible for drawing up and reviewing care plans, along with the service user themselves. Relatives spoken to informed the inspector that staff would go through the care plan with them, and make any alterations, additions etc as necessary. Risk assessments were of a good standard. They included a personal history of the service user, and detailed information on how the home was able to meet their needs. Plans cover needs around nursing care, mobility, personal care and on social and leisure activities. Plans also provide information on meeting needs around equality and Care Homes for Older People Page 12 of 31 Evidence: diversity issues, for example one plan stated X likes staff to read the bible to her, X chooses which gospel to read. Care plans are subject to regular review, at least once a month. Risk assessments are also in place for service users, and as with care plans, these are of a satisfactory standard. Assessments identify any possible risks, and include strategies to manage and reduce those risks. They cover risks around skin care, use of bed rails, mobility and aggressive behaviour, and are subject to regular review. The homes registered to provide nursing care to service users, and as art of the case tracking process the inspector checked records around the nursing care that service users receive. In particular, the inspector looked at records relating to the use of PEG feeding, catheter care, diabetes and pressure sores. Records evidenced that care around peg feeding and the use of catheters is being carried out as appropriate. Clear care plans are in place, and accurate and up to date records of care have being maintained. Staff informed the inspector that two service users had pressure sores at the time of the inspection. For one of these service users, records were up to date to indicate that they were receiving treatment as appropriate. The other service user with a pressure sore had a care plan around managing this which was dated the 14/11/08. This stated that the dressing on the wound should be changed every three to four days. Records indicated that the dressing was changed on the 16/11/08, and then not changed again until the 22/11/08, six days later. Records then indicated that their had been no further change of dressing up to and including the date of the inspection, a full ten days later. This issue was brought to the attention of the deputy manager, who discussed it with the nursing staff. The deputy manager then informed the inspector that it was believed that the dressing had indeed being changed at some point during the past ten days, but that no record had been made of this. Staff informed the inspector that at the time of the inspection two service users had diabetes. The care plan for one of these service users states that their blood sugar levels should be checked two times a day, yet records indicated that since the 14/11/08, it had only been checked once a day on any given day. The care plan for the other service user did not state how often their blood sugar levels were to be checked. The nurse on duty informed the inspector that it should be checked once a day, yet records indicated that it had not been checked on the 25th, 26th, 28th and 30th of November 2008. Further, it was noted that care plans do not make clear what the safe upper and lower blood sugar levels are, and what actions staff should take if levels are too high or too low. Care Homes for Older People Page 13 of 31 Evidence: To help ensure the health, safety and welfare of service users, it is required that all identified nursing care is carried out as appropriate, and comprehensive records are maintained of this care. All service users are registered with a GP. The home had only been open for approximately six months at the time of the inspection, and many of the service users have only moved in to the home in the two months preceding this inspection. The deputy manager informed the inspector that as yet not all service users have been registered with a dentists or an optician, but they were able to demonstrate that appropriate steps are been taken to address this situation. Records are maintained of medical appointments, including details of follow up action required. These records indicated that service users have access to health care professionals as appropriate, including psychiatric nurses, chiropodists and dietitians. The home has a comprehensive medication policy in place. Only nurses in the home have responsibility for administering medications, and they have received training on this subject. Medications are stored within a locked room in the nurses station, within locked cabinets, and a locked designated medication fridge. The nurse informed the inspector that the fridge temperature should be checked daily. However, records indicated that in the twenty days prior to this inspection, they had only been checked six times, the last of which was on the 26/11/08, indicating that they had not been checked at all in the previous seven days. It is required that the temperature is checked and recorded at least daily of all fridges used for the storage of medications. At the time of inspection no service users self medicated. Records are maintained of medications entering the home, and of those that are disposed of. The home maintains Medication Administration Record (MAR) charts. These were found to contain several inconsistencies. For example, one service user has being prescribed MIRTAZAPINE SOLTAB. The label on the medication states to take 45mg at night, but the hand written MAR charts states take 30mg. The medication container was found to contain both 45mg and 30mg tablets, both of which in boxes with labels stating take 45mg. To help ensure the health, safety and welfare of service users, the instructions on MAR charts must be consistent with the instructions on the medication label, and both must be in line with the prescribing directions of the medical practitioner who prescribed the medication. Several service users have been prescribed controlled drugs, and these were found to be stored appropriately. A controlled drugs register is in place. However, this contained several inaccuracies and inconsistencies of itself and in relation to the MAR charts. For example, the controlled drugs register is supposed to be signed by two nurses every Care Homes for Older People Page 14 of 31 Evidence: time controlled drugs are administered, entered in to the register or checked. Yet their were several instances where the register had only been signed by one member of staff. Further, the register stated that one service user has being prescribed FENANYL 75MCG patch, to take one every three days. This was due on the 29/11/08, the MAR chart indicated that this has been administered, where as the controlled drugs register indicated that it had not been administered, an audit of the medication indicated that it indeed had not being administered. Similarly, one service user has being prescribed MORPHINE SULPH 10MG/5ML solution, to take 10ml two times a day. Yet the controlled drugs register indicated that only one dose had being administered on the 25/10/08 and the 27th and 28th of November 2008, but the MAR charts were signed to indicate that two doses had being given. In order to promote the health safety and welfare of service users, the home must ensure that all medications, including controlled drugs, are administered and recorded as appropriate. Through observation and discussion their was evidence that the home seeks to promote the privacy and dignity of service users. For example, staff were observed to knock and wait before entering bedrooms, and systems are in place to ensure that service users always wear their own clothes. All bedrooms have being fitted with a telephone connection point, and service users can have their own telephone with its own number installed in their bedrooms. Comprehensive care plans are in place on end of life care, and service users are supported to make a will if they wish. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It s the inspectors judgement that service users are supported in their daily lives to be involved in meaningful activities. It was further noted that food in the home was of a very good standard. Evidence: The home employs a full time activities coordinator, and there is a designated activities room. In the morning group activities are run, these include newspaper discussions, sensory exercises such as food tasting and aroma activities, quizzes, reminiscence and gentle exercises. The home also has a sensory room. This is not currently in use, the activities coordinator informed the inspector that it was envisaged this would be used more when the home had more service users with dementia. In the afternoons, the activities coordinator spends time with individual service users, especially those who are unable to get out of bed. In good whether group sessions are sometimes held in the park opposite the home, or in its own courtyard. Service users have access to television and music in the home. Children from a near by school have being booked to perform a carol service, and a professional entertainer has been booked to perform old time songs. Care Homes for Older People Page 16 of 31 Evidence: Service users spoken to informed the inspector that they enjoyed the activities on offer, and the inspector witnessed a word and spelling game that service users were actively participating in, and gave the impression that they were enjoying this. The inspector spoke with a relative of a service user, who said that their relative enjoyed and benefited from the activities programme. However, they had concerns about what would happen when the coordinator was away on leave. This issue was discussed with the homes manager, and it is recommended that some arrangements are put in place to ensure that appropriate activities continue to be provided in the absence of the activities coordinator. There was evidence that the home has sought to meet service users needs around equality and diversity issues. For example, representatives from the Seventh Day Evangelists church regularly visit the home. The home had a Vietnamese speaking service user, the home used an interpreter to help communicate with them, and purchased DVDs in Vietnamese for the service user. Staff are only expected to speak in English in front of English speaking service users. Visitors are welcome in the home at any reasonable time, and can see their relatives in private if they so wish. The inspector spoke with relatives, who said they are always made welcome by the staff. The inspector was impressed with the level of choice of menus. The home has a rolling five week menu plan, that was on display within the home. This evidenced that on the day of inspection service users were offered a choice of liver and potatoes, or spaghetti bolgnaise, both of which appeared appetising in appearance. The menu evidenced that service users are offered a varied, balanced and nutritious diet. In addition to the choice on the menu, there is also a list of alternatives that can be requested on any given day. This list included omlettes, poached fish, jacket potatoes with a choice of filling and a choice of salads. The chef team manager was able to demonstrate that all the ingredients where at the home to provide these options. The menu indicated that service users are offered a cooked breakfast if they wish every day. At present, the home has service users from British and Jamaican ethnic backgrounds, and traditional food from both of these cultures was well represented on the menu. Drinks and snacks were provided throughout the day. The kitchen was clean and tidy, and food was stored appropriately. Fresh fruit was available, and fresh produce is routinely used in food preparation. One service user wrote in their survey the home has Freshly cooked food presented well. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It is the inspectors view that the home has taken reasonable steps to help ensure that service users are safe and protected from the risk of abuse. Appropriate procedures are in place, and staff undertaking adult protection training. Evidence: The home has a complaints log in place, although the manager informed the inspector that no complaints have been made since the home opened. The home has a complaints procedure, a copy of this was on display within the home, and all service users are given their own copy. Surveys completed by service users indicated that they had a good understanding of whom they could complain to if they so wished. The procedure includes timescales for responding to any complaints. The complaints log also has a section for compliments, and cards from relatives contained positive feedback about the home. One wrote Your patience, kindness and helpfulness are much appreciated in the care of my mum, but also you made the whole family welcome. The home has a copy of the local authorities adult protection procedures, and also its own policy on safeguarding adults. All but the most recent staff recruits have attended training around adult protection, and this subject is covered in the staff induction process. Staff spoken to demonstrated a good understanding of their roles and Care Homes for Older People Page 18 of 31 Evidence: responsibilities with regard to adult protection. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It is the view of the inspector that the home is able to meet its stated purpose with regard to its physical environment. The home is well maintained, and service users have access to adequate private and communal space. Evidence: The home is purpose built, and was opened in the summer of 2008. It is built over four floors, all of which are accessible via a service lift. At the time of inspection, only the ground and second floor were occupied. The home is located in the London Borough of Hackney, overlooking Victoria Park. It is close to transport networks and other local amenities. It was noted that the home was well maintained, and pleasantly decorated. The AQAA states that the colour schemes have been specifically designed from using the dementia palette. The furniture in the home was domestic in character and well maintained. Communal areas include various lounges, dining areas, quiet rooms, an activities room, a sensory room and a hairdressing room, along with an outside courtyard. Service users were observed to be able to move around communal areas freely. All the bedrooms are single rooms, and all have ensuite facilities. Bedrooms were Care Homes for Older People Page 20 of 31 Evidence: pleasantly decorated, and service users have been able to personalise them to their own tastes, for example with family photographs and personal possessions. Bedrooms contained adequate furniture, including table, chair, wardrobe and chest of draws. Bedding, curtains and carpets were well maintained and domestic in character. Bedrooms contained adequate natural light and ventilation, and were centrally heated. Bedrooms meet National Minimum Standards on size requirements. In addition to the ensuite facilities, communal toilets and bathing facilities were located around the home. These were found to be clean, tidy and free from offensive odour. Bathrooms were fitted with a working lock, which included an emergency override device. The home has taken steps to help prevent the spread of infection. Laundry facilities were appropriate in scale for the size of the home, and hand washing facilities were situated around the home. Protective clothing such as gloves and aprons are available to staff, and COSHH products were stored securely. Various adaptations are in place to help make the home more accessible to service users, thus helping to meet needs around equality and diversity issues. As mentioned, the home has a service lift, and individual service users have hoists. Baths, showers and toilets have been adapted to make them accessible. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It is the view of the inspector that staff in the home have a good understanding of their responsibilities. However, the inspector as serious concerns that staffing and nursing levels are not adequate to met the needs of service users. Evidence: The home provides 24-hour support, including waking night staff and an emergency on-call procedure. The home had a staffing rota, which accurately reflected the staffing situation on the day of inspection. Shortly after arriving at the home for the inspection, the inspector visited the second floor, where four service users were accommodated at the time. The inspector noted that their were no staff present at all on this floor. After approximately ten minutes, the inspector set of the emergency call point alarm system, and approximately two minutes after this a member of the kitchen staff came to investigate the alarm. No care or nursing staff arrived. The inspector brought this matter to the attention of the manager, who arranged for a member of staff to work on the second floor. The staff rota did not specify where staff were supposed to work. The rota indicated that the home operates with only one nurse on duty most of the time, supported by two carers (one carer at night). The nurse has responsibility for Care Homes for Older People Page 22 of 31 Evidence: providing all nursing care and support with medication over the two floors, as well as ensuring that relevant records are kept up to date. The manager of the home informed the inspector that at a recent meeting of the senior staff within the home, it was identified that current staffing levels are not adequate, and that staffing levels needed to be increased. They said that they would be raising this with Anchor, the organisation that runs the home, in the near future. As previously stated within this report, there have been lapses in the provision and recording of the nursing and medication care, and it is possible that this is linked to low staffing levels, and the levels of work that nurses are currently expected to undertake. It was observed that there were insufficient care staff on duty to support service users with meals, and that kitchen staff, domestic staff and the activities coordinator helped out with these duties. Two days prior to this inspection, the inspector was contacted by a service users relative who expressed concerns around staffing levels. They informed the inspector that as the number of service users at the home has grown, staffing levels have not grown to reflect this. In particular, they were concerned that since the second floor had opened, there was not adequate staff cover provided to service users on this floor. A service user wrote in their survey There are times when staff are under pressure due to the volume of help needed. The inspector shares these concerns. It is therefore required that the home undertakes a review of staffing levels, which includes a review of nursing staff levels, to demonstrate how the home is able to meet all the assessed needs of service users at all times. Service users spoken to generally expressed satisfaction with the staff, one informed the inspector The staff are very gentle. Through observation there was evidence that staff have built up good relations with service users, and were seen to interact with them in a friendly and respectful manner. There were examples of positive staff interactions seen during the day, for instance support with activities, meals, and general chatting with service users. The AQAA supplied by the home indicated that the home has all necessary employment related policies and procedures in place, including on equal opportunities and recruitment and selection. The inspector checked several staff employment files at random. These were found to contain proof of ID and CRB checks. However, for two staff, there was only evidence of one reference being taken up, and it is required that the home seeks two references for all staff working at the home. Staff undertake a structured induction program on commencing work at the home, this includes service user issues and adult protection. Recent staff training has included dementia, adult protection, dining with dignity, continence management, food hygiene and moving and handling. Over 50 of care staff have achieved an NVQ Level 2 in Care Homes for Older People Page 23 of 31 Evidence: Care or equivalent qualification. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It is the judgement of the inspector that the homes management team are suitably qualified and experienced to carry out their duties. Appropriate health and safety systems are in place, although more attention must be paid to the monitoring of the nursing care and the administration of medications. Evidence: The homes manager has been registered with the CSCI. They are a registered nurse, and have achieved the Registered Managers Award, as well as having a qualification in the care of the elderly. They have over twenty years experience of working in the care setting, including fifteen years in a managerial capacity. The home also employs a full time deputy manager to assist in the running of the home. They are also a registered nurse and have relevant NVQ qualifications. Staff and service users were observed to interact with the homes management team in a relaxed manner. One relative of a service user informed the inspector I can talk to the Care Homes for Older People Page 25 of 31 Evidence: deputy manager about any issues I have. Staff supervisions and meetings contribute to the quality assurance systems in the home, and there was evidence of monthly Regulation 26 visits taking place. The AQAA provided by the home states that the home is subject to Anchor Homes quality management system. The AQAA indicated that the home has all required policies and procedures in place in line with National Minimum Standards. Those checked by the inspector, including admissions, medication and adult protection were found to be of a satisfactory standard. Record keeping in the home does however need to be improved, and requirements have been made around record keeping in relation to the nursing care and administration of medication. Fire exits in the home were clearly signed and free from obstruction. Fire extinguishers were situated around the home and last serviced in April 2008. Fire alarms are tested on a weekly basis, and the home holds regular fire drills. The local fire brigade visited the home on the 17/3/08, and judged that the home has taken appropriate actions to reduce the risk of fire. The home was registered with the CSCI in June of 2008, and as part of that process checks were made around the portable appliances, the electrical installation and the gas safety. Consequently these were not checked during this inspection, but will be subject to inspection at the next key inspection of the home. Hot water temperatures are checked, and COSHH products were found to be stored securely. The home had in date employers liability insurance cover in place. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The registered person must ensure that comprehensive pre admission assessments are carried out on all prospective service users before they move in to the home. So that the home can determine if they are ale to meet all the needs of service users. 31/01/2009 2 8 13 The registered person must ensure that any identified nursing care is carried out and recored as appropriate. To help promote the heath, safety and welfare of service users. 31/12/2008 3 9 13 The registered person must 31/12/2008 ensure that the temperature of any fridge used to store medication is checked and recorded at least once a day. Care Homes for Older People Page 28 of 31 To help promote the health, safety and welfare of service users. 4 9 13 The registered person must 31/12/2008 ensure that the prescribing instructions on medication labels are consistent with the instruct ons on the MAR charts, and that both are in line with the instructions of the medical practitioner who prescribed the medication. To help promote the health, safety and welfare of service users. 5 9 13 The registered person must 31/12/2008 ensure that all prescribed medications, including controlled drugs, are recored and administered as appropriate. To help promote the health, safety and welfare of service users. 6 27 18 The registered person must 31/01/2009 ensure that the home carries out a review of its staffing levels, including the level of nursing staff provided, to determine how the home can meet all the assessed needs of service users at all times. To help ensure that the home is staffed in sufficient numbers to meet the needs of service users. Care Homes for Older People Page 29 of 31 7 29 19 The registered person must ensure that two written references are taken up for all staff employed at the home. To help ensure service service users are supported by appropriate staff. 31/01/2009 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 12 It is recommended that the home make suitable arrangements to ensure that service users continue to have access to appropriate activities within the home when the activities coordinator is away from work. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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