Inspection on 19/11/08 for Arden House Nursing Home

This inspection was carried out on 19th November 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Arden House Nursing Home 29/11/06

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Arden House Nursing Home 31 Upper Highway Hunton Bridge Kings Langley Hertfordshire WD4 8PP     The quality rating for this care home is:   three star excellent 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: Sheila Knopp     Date: 1 9 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 29 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 29 Information about the care home Name of care home: Address: Arden House Nursing Home 31 Upper Highway Hunton Bridge Kings Langley Hertfordshire WD4 8PP 01923262157 01923267137 ardenlgl@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Alexander Lancelot Banson-Idun Type of registration: Number of places registered: Lower Green Limited care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category terminally ill Additional conditions: Date of last inspection Brief description of the care home Arden House is an extended Edwardian House in a residential area of Hunton Bridge that provides accomodation for up to 22 people who require nursing care. The home is slightly set back from the road. A small forecourt provides access to the home with limited off road parking. There is a bus service that stops directly outside the home. Residents are accommodated on the ground and first floor. Lift access is provided to the first floor. There is a single storey extension to the rear of the building. Residents are accommodated in 16 single rooms, two of which have en-suite provision and 2 double rooms. The L-shaped day area is used as a lounge and dining area. Assisted bathing and toilet facilities are provided. Arden House has been a Nursing home for many years but does not fully meet the current enhanced requirements for communal Care Homes for Older People Page 4 of 29 Over 65 22 0 0 2 Brief description of the care home space for homes registered from 1 April 2002. The home changed ownership in 2006. The new proprietor is looking at providing a lounge extension to provide additional communual space. Information about the home in the form of a statement of purpose, service user guide and previous CSCI inspection reports are available on request from the manager. The current fees charged to people who are self funding range from 700 - 750 pounds per week. Different charges are applied to local authorities responsible for funding arrangements. Care Homes for Older People Page 5 of 29 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: three star excellent 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: Our last visit to Arden House to carry out an inspection was on 29/11/06. That inspection told us that the home was providing a good service to the people living there. This meant that we carried out an annual service review on 3/3/08. An annual service review does not involve a visit to the service but is a summary of new information given to us, or collected by us since the last key inspection. A copy of the annual service review report is available on request from the manager or by contacting the Commission. This inspection was carried out by one inspector who spent 5 hours 20 minutes in the home. For the purposes of this report the commission is referred to as we. As well as a visit to the home we sent surveys out to residents, relatives, staff and care Care Homes for Older People Page 6 of 29 managers, who are involved in placing people in the home, so they could give us their views. Four residents, 7 relatives, 3 staff and 2 local authority care managers returned completed surveys to us before the inspection and their views and experiences have been included in this report. During our visit we observed the interaction between residents and staff. We spoke with residents in the public areas of the home and in their own rooms. We interviewed 4 members of staff. To see how the care of residents and the home were being managed we reviewed relevant care, health & safety, training, recruitment and quality assurance records. The manager sent us the Annual Quality Assurance Assessment (AQAA) that managers are required to complete annually. It focuses on how well the service is meeting outcomes for the people who live there and gives us some numerical data. What the care home does well: What has improved since the last inspection? The owners have continued to update the fixtures, fittings, furnishings and fabric of the home to improve the quality of the environment for people who live there. This includes the provision of a walk in shower and electrically operated adjustable beds in each room to maximize peoples independence and comfort. In keeping with offering people choice and dignity it is positive to note that the owners have converted two further shared (companion) rooms into single rooms. People are being offered a wider selection of meals and are also able to view a pictorial menu to assist them with their choice. There has been a focus on introducing a more individual approach to providing people Care Homes for Older People Page 8 of 29 with stimulating activities. There is increasing involvement with the local community, which has enabled residents to attend outside events. The manager has told us that a recent successful recruitment drive and incentives for staff, who cover additional shifts, has reduced the need for agency staff. This means people are supported by people they know and staff are able to work more efficiently. A relative told us that the regular carers were excellent. Another person said the staff are wonderful I cannot praise them enough. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 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 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are fully involved in the decision to move into Arden House and invited to provide information, that enables staff to support each person, according to their individual preferences and care needs. Evidence: To assess whether people are involved in decisions to move into Arden House and that an assessment of their needs is carried out, we reviewed the information we received from surveys and followed through the processes of admitting some to the home. A relative of a new resident told us they were happy and well looked after. A care manager, involved in peoples admission to Arden House, confirmed the manager always went out to assess people before accepting them to see if staff could meet their needs. Care Homes for Older People Page 11 of 29 Evidence: All 4 residents who completed surveys for us said they had received enough information about the home to help them in their decision to move in. One person said their daughter had visited the home and been given a full guided tour. A new resident confirmed that they were receiving the help and support they needed. We were able to see that their needs had been assessed by the manager before offering a place. A further assessment was carried out on admission and a care plan put in place so staff know what they need to do. The assessments are detailed and thorough. People are involved in developing their care plans and invited to sign them. Further reviews are carried out after 6 weeks, with the resident, relatives and funding authority, if involved, so people can give their views and make suggestions for changing the care plan if need be. We confirmed people are issued with contracts which set out their rights and responsibilities with regard to their stay at Arden House. On arrival people are given a welcome pack which provides useful information about what they can expect during their stay including the names of staff, times of meals and visits from hairdressers and chiropodists. Care Homes for Older People Page 12 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that the care they receive will be based on their individual needs and support their dignity. People will be supported to manage their own medicines if they want to and there are safe systems in place for people who need help with this area of their lives. Evidence: To assess whether people are receiving the health and personal care they need we reviewed the surveys we received, observed the care environment and staff interaction with residents, reviewed care records, assessed the medication systems and had discussions with residents and staff. We observed a very high level of personal care and attention to clothing, nail and hair care, that enabled people to maintain their dignity and individual identity. Some one told us their relative was spotlessly clean and fresh when they visited. People spending time in bed because of their frailty, all looked comfortable and well supported Care Homes for Older People Page 13 of 29 Evidence: with drinks and call bells to hand. Aids to independence and prevention of pressure sores are available and in use. Assessments for the safe and appropriate use of items such as bed rails are in place. People told us that Arden House felt like home. A resident said we are very spoilt. Three out of 4 residents who completed surveys told us they always received the care and support they needed. One person said this was usually the case. They all said they always received the medical support they needed. A relative told us the nurses are very efficient and always call the doctor when needed. Five out of 6 relatives who returned surveys (83 ) told us their relatives care needs were always met. One person said this was usually the case. Some one added their relative is very well looked after. Our interviews with staff confirmed their understanding of the key worker, named nurse role in supporting the needs and interests of individual residents. The care plans we looked at were very detailed and individual to the person concerned. They provided confirmation that people are involved in planning and reviewing their care. We saw very good evidence that people admitted with complex problems improve during their stay at the home. The nursing outcomes described in the care plans are linked to current nursing research and staff are provided with clinical training so they keep up to date and practice evidence based nursing. A local authority care manager told us that the care plans they had reviewed showed that peoples needs were monitored. There are good systems in place for ensuring people receive their prescribed medication safely and regular audits are carried out to confirm staff are working to the homes polices and procedures. People are able to manage their own medication and maintain their independence in this area, subject to an assessment of risk and regular reviews. Consent to administer medication is obtained. Staff have a positive approach to promoting the health of the people living at Arden House. Regular assessments of their nutritional status and weight are carried out. Where needed people are given dietary supplements to boost their intake and immune system. Staff made arrangements to give people flu vaccinations, when these were due. We have advised the manager to review the systems in place when people are having their annual flu vaccines to make sure staff can respond to any emergencies that may arise. Care Homes for Older People Page 14 of 29 Care Homes for Older People Page 15 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given opportunities to lead dignified, comfortable and fulfilling lives based on their individual preferences, abilities and choices. People are provided with a choice of meals that they enjoy and maintain their health. Evidence: The managers self assessment (AQAA) tells us of changes that have been made as a result of listening to people living at Arden House and their relatives. This includes providing cups which are easier to pick up and making portable reading lights available. The manger tells us that the involvement of outside entertainers has increased and a library service including talking and large print books has started. In the last 12 months there has been a focus on developing the skills of staff to focus on person centred stimulation for residents and introducing personalized activity folders. Details of the activities and events taking place on a daily basis are displayed for people to see. In addition to the one to one and small group activities, arranged by staff, visiting entertainers and exercise therapists also visit. A relative told us that staff make an effort to stimulate and entertain residents. Another person told us about Care Homes for Older People Page 16 of 29 Evidence: their involvement in the personal profile being compiled for each person and said staff were asking questions about the residents early life and family. They went on to say there are regular singing and dancing shows, memorabilia talks and exhibitions choirs and music shows. People told us the home was very welcoming. We saw that visitors are served with tea and coffee. The manager has also created an area where visitors can make their own tea and coffee during the day. Some one told us they were encouraged to stay for meals with their spouse. The activity program includes opportunities for relatives to join in with events. In response to discussion with relatives, communication books have recently been introduced for each resident, as an aid to communication, for example if toiletries are needed or families and friends want to leave messages for each other. The manager and activity organizer told us that links had been made with local schools and churches to enable residents to attend functions in the community. There are regular opportunities for residents and relatives to give their views on how the home is run. Each person living in the home has a plan of care that takes account of their individual interests, preferences and life history so activities can be matched to their individual needs. A care manager who has supported peoples admission to the home said This care service encouraged the service users I placed with them to live as independently as possible and peoples privacy and dignity were respected. A relative said Arden House is their home. Friends and relatives are encouraged to visit any time of the day and are made to feel very welcome. Another person said there is a lovely family atmosphere. They keep us very well informed of all aspects. People are offered a choice of meals each day. The manager has put together a photographic menu to assist people in making their choices. We could see from our discussions with people that individual arrangements are made for people who need special diets or have particular preferences. One person told us their relatives meal was pureed but is always beautifully presented on their plate. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they will be protected and their individual rights supported because there is an open and inclusive atmosphere in the home and staff work in their best interests. Evidence: In several sections of this report we have identified that the manager and owners have a very open approach to listening to residents, relatives and staff and involving them in the running of the home. This means that the home has not received any complaints and we have not been notified of any concerns between our inspections. Information on how to make a complaint is available in the home and copies are available in each persons room to remind them of their rights. One person told us they have peace of mind after each visit knowing their relative is safe and well cared for. The manager has taken on board the implications of the Mental Capacity Act in making sure people act in the best interests of residents and involve them in decisions about their lives. This has included updating the documents available in each persons care plan and providing staff with training. Staff receive training in protecting people from abuse and understand their responsibilities to report any concerns they have. Staff receive a copy of the General Social Care Council Code of Conduct, which sets out their responsibilities as social care Care Homes for Older People Page 18 of 29 Evidence: workers. The nurses work under the Nursing & Midwifery Council Code of Conduct. People tell us that they are listened to. One person told us that the managers door is always open and he is really helpful. A relative told us that residents are given plenty of opportunities to express their needs and concerns. To increase relative involvement in meetings the manager tells us he provides details of forthcoming meetings with the monthly invoices that are sent out. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, clean home, which is kept under review by the manager and owners, so they can make improvements where they can, within the confines of the building, to benefit the people who live there. People can be confident that there are suitable systems in place to provide them with fresh clean laundry and prevent infections spreading. Evidence: The owners have continued to keep people updated on the planned extension to the lounge, which will improve the space available to residents and their visitors. This is an area that 3 relatives specifically commented on, in their surveys, and want to see taken forward. The October newsletter updates people on the arrangements that need to be in place before the owners proceed with the extension. The owners have also advised residents and relatives of some extensive electrical work, that is due to take place, to upgrade systems in the home following a periodic electrical safety check. The manager confirmed that the fire safety risk assessment and evacuation procedure has been updated following a planned visit by the Hertfordshire Fire Safety Service. We spoke to the member of staff involved in reviewing health & safety in the home Care Homes for Older People Page 20 of 29 Evidence: and heard about the eyes wide open initiative, which encourages people to report problems they see, so they can be addressed at an early stage, and all staff take responsibility for ensuring people are living and working in a safe environment. There have been several developments since our last inspection that improve the quality of life for people living in the home. These include the installation of a walk in shower and provision of electrically operated height adjustable beds in each room. We have advised the manger to include access to the hand operated control in the risk assessments associated with the use of these beds. This is to ensure the continued ability of people who are able to adjust the bed themselves is kept under review and there are clear procedures in place for people who are not able to make decisions for themselves. This is to show they are not subject to restraint because of they cannot change their own position and may not be safe to have access to the control. A relative commenting on the improvements being made to the home also listed the provision of new commodes and wheelchairs. They said the home seems to be improving all the time. All areas of the home we visited were fresh and clean. A relative told us the home was very clean and fresh. People are provided with freshly laundered clothing and bed linen that promotes their dignity. There are good systems in place to reduce the risk of infection. This includes staff, resident and visitor access to liquid soap and paper hand towels. Staff have access to protective clothing and disposable gloves. The manager has completed the Department of Health, Essential Steps infection control audit, to make sure current guidance is being followed. Clear instructions are available to staff. Care Homes for Older People Page 21 of 29 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 a staff team that have been selected for their suitability to work with vulnerable people and receive the training and supervision they need to respond to peoples diverse and changing needs. Evidence: To assess whether residents are supported by competent staff who are suitable to work with vulnerable people and can meet their needs, we reviewed the information we received in our surveys, the managers self assessment and interviews with staff and residents. We also reviewed the recruitment and training records for 4 members of staff. Four relatives who completed surveys specifically raised concerns regarding staff shortages, which resulted in agency staff being used. However the manager, provider and staff now tell us that following a successful recruitment program and some initiatives to reward permanent staff, covering additional shifts, that agency staff are no longer required. The owners have updated people on the current developments in the most recent newsletter available in the home. People commented positively on the approach of staff. One person said the staff are always pleasant and caring. Two other people said The staff are wonderful. I cannot Care Homes for Older People Page 22 of 29 Evidence: praise then enough. They work very hard to a very high standard and we feel the staff are very hard working and welcoming. The recruitment records we reviewed showed us that the manager is receiving the required criminal records bureau check and references before staff are employed. There are good records of the recruitment and interview process to show that the correct procedures have been followed. There is a training plan in place to make sure staff receive the regular training they need to stay up to date. Staff are trained in specific areas, according to their role in the home, to enable them to support the needs of older people. The activity organizer has been having specific training in the providing activities for older people as part of developments in this area. Clinical training for the registered nurses to maintain their practice is supported. A nurse told us about tissue viability (wound care) training. A carer felt they had learnt a lot from recent dementia care training. They felt it enabled them to support relatives more, by being able to explain what was happening to the resident and how they were experiencing the world around them. The manager is working to wards achieving the target of 50 of care staff with qualifications in care at NVQ level 2 and some staff are studying for awards at level 3. The manager has records to show that the personal identity numbers of the registered nurses are kept up to date and they continue to be registered with the Nursing & Midwifery Council. Staff confirmed they are well supported and are able to approach senior staff and the manager. The surveys they completed confirmed that feel part of the family atmosphere described by relatives and take a pride in their work. Staff are able to contribute agenda items to influence the regular staff meetings. In keeping with other areas of communication within the home we were impressed that the owners provided staff with a written response to items discussed at staff meetings. The manager has identified a need to recruit a full time activity organizer to support the current arrangements and development of this area of life in the home. Care Homes for Older People Page 23 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident in the services provided at Arden House because the home is well managed and takes account of their views. There is a genuine commitment to reviewing the quality of the service provided and making sure that the health & safety systems in place to protect people living, working and visiting the home are up to date. Evidence: The manager and owners provide effective leadership and management of the home based on providing good outcomes for the people who live there and involving their relatives. We were impressed with the high level of involvement in the home by the owners who attend regular relative and staff meetings. A relative told us there is a genuine commitment to listening to what people say about the home, ideas are acted upon and Care Homes for Older People Page 24 of 29 Evidence: people provided with feedback. A member of staff told us the manager and owners of our home are very interested in what their staff have to say. There is a detailed quality assurance program in place that provides the manager and owners with a system of continued review and reflection on the standard of service provided. There are well established systems described in other areas of this report for obtaining the views and experiences of people who live, work and visit the home. Residents and their relatives receive feed back from the surveys carried out via meetings or newsletters. The home has a good history of meeting the required standards and this is the second inspection where we have not had to make any legal requirements. The manager who is a registered nurse and experienced manager keeps up to date with current nursing practice to ensure appropriate procedures are followed and any nursing intervention is based on evidence based practice. The self assessment (AQAA) the manager submitted was sent to us on time. The information provides a true reflection of the service and confirms what we found during our visit. It also shows us that the manager works to achieve good outcomes for the people living in the home and is open to new opportunities. People are able to leave small amounts of money with the manager for their day to day use. There are clear systems in place to account for any money deposited and paid out on behalf of residents for example to the hairdresser or chiropodist. There is an annual appraisal system in place to review the work of each member of staff. Staff confirm that they receive regular supervision. The manager has a supervision schedule and says that he links discussions to each persons training and development plan. The training records we saw confirmed that staff receive the health & safety training they need to support safe working practices. These include food hygiene, fire safety, moving and handling and first aid training. Health and safety risk assessments covering the work of the home are in place and kept under review. Records of all accidents are maintained and reviewed by the manager to identify any emerging patterns or risks for individual people. The manager keeps us informed of events in the home, such as accidents and incidents. The range and frequency of notifications have not raised any concerns with us. Care Homes for Older People Page 25 of 29 Evidence: The manager has provided dates of regular servicing of equipment and systems within the home. As stated earlier in this report, as a result of a periodic electrical safety, work is now required to comply with current standards. We understand arrangements have been made to have this work carried out and have asked the manager to notify us on completion. The hot water temperatures are regulated to prevent accidental scalding. The hot water we tested was within the required safety range to prevent this. Staff also record the bathwater temperature each time the bath is used. Windows above ground level are restricted and radiators covered to prevent accidents. Care Homes for Older People Page 26 of 29 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 29 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 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 9 To make sure staff know what to do in the event of somebody developing an allergic reaction to medication or treatment they are being given, the manager should review the procedures for the management of anaphylaxis, staff training to support this and availability of emergency treatment such as adrenaline. Following our inspection the manager confirmed arrangements for staff to receive the training we recommended. Care Homes for Older People Page 28 of 29 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. 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