Inspection on 23/01/09 for Ashdale Lodge

This inspection was carried out on 23rd January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashdale Lodge 15/03/07

Ashdale Lodge 14/12/05

Ashdale Lodge 14/07/05

Ashdale Lodge 22/03/05

Ashdale Lodge 25/11/04

Ashdale Lodge 09/03/04

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Snydale Care Home

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Extracts from inspection reports are licensed from CQC, this page was updated on 26/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ashdale Lodge 2 Wheeler Street Anlaby Road Hull East Yorkshire HU3 5QE     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: 2 3 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Ashdale Lodge 2 Wheeler Street Anlaby Road Hull East Yorkshire HU3 5QE 01482352938 01482574929 lynn.buxton@sanctuary/planhousing.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sanctuary Care Ltd Name of registered manager (if applicable) Miss Lynn Buxton Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: To admit one named person under the age of 65, for this condition to expire when the person reaches the age of 65 or moves out of the home. Date of last inspection Brief description of the care home Ashdale Lodge is owned by Sanctuary Care Ltd and is situated about a mile west of Hull City Centre. It is close to a range of shops, pubs, post office, indoor bowling alley, churches and is on major bus routes.The home is registered to provide accommodation and personal care for up to thirty-six people over the age of 65, some of whom may suffer from dementia. Ashdale Lodge is a purpose built home and has thirty single and three shared bedrooms situated over two floors. The upper floor is serviced by a passenger lift and stairs. There is a large dining room and conservatory in the centre of the home overlooking an attractive and well maintained rear garden. The home has Care Homes for Older People Page 4 of 33 care home 36 Over 65 36 36 0 0 Brief description of the care home four lounges and a small seating area on the landing, providing the residents with different places to sit. One of the lounges is used for activities and craft work. The home has four bathrooms and sufficient toilets throughout. There is car parking space to the front of the home. Information about the services the home provides can be found in the statement of purpose and service user guide available in the home. The weekly fees range between 350.50 pounds and 405 pounds. There is a top-up of 25 pounds depending on circumstances. Optional extras are chiropody, hairdressing, newspapers and toiletries. 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 form this service is 1 star. This means that the people that use use this service experience adequate quality outcomes. This inspection report is based on information received by the Commission for Social Care inspection (CSCI) since the last key unannounced inspection on 15th March 2007 and Annual Service Review on 4th April 2008. It includes information gathered during a site visit to the home, which took approximately ten 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 Ashdale Lodge. We also had discussions with the registered manager, care staff members and one relative. Information was also obtained from surveys Care Homes for Older People Page 6 of 33 received from residents, care staff and a visiting health professional. Comments from the discussions and surveys have been used in the report. We looked at assessments of need made before people were admitted to the home and the homes care plans to see how those needs were met whilst they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff recruitment, induction, training 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 staffs understanding of how to maintain privacy, dignity and, independence and choice. The home had returned their Annual Quality Assurance Assessment (AQAA) within the agreed timescales. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. We would like to thank the people that live in Ashdale Lodge, the staff team, and management for their hospitality during the visit and also thank the people who completed surveys. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward as recommendations, but only when it is considered that people who use the service are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? The home did not have many requirements from the last inspection. The homes service user guide has more up to date information, which enables prospective residents to find out about the home and the services it provides. The statement of purpose given to us to examine was the old version and, we accept, although not seen, that the home has updated this document as well. Several of the bedrooms have been redecorated and the home has an ongoing redecoration and refurbishment plan. The home continues to be well maintained and looks clean and fresh. The manager completed a risk assessment when new laminate flooring was introduced in parts of the home. The new flooring has made cleaning the home and managing odours much easier. Staff training has continued to improve and the home has 75 percent of care staff that have gained a national vocational qualification in care at level 2 or 3. This was an excellent achievement. Care Homes for Older People Page 8 of 33 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 Care Homes for Older People Page 9 of 33 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 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 11 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 ensures that people are only admitted after a full assessment of their needs has been completed and they are confident the persons needs can be met in the home. Evidence: The homes service user guide has more up to date information, which enables prospective residents to find out about the home and the services it provides. The statement of purpose given to us to examine was the old version and, we accept, although not seen, that the home has updated this document as well. We examined three care files in detail, one of which was to assess the admission process for a resident newly admitted to the home. There was evidence that the home completed an assessment of the persons needs prior to admission and also obtained the assessment and care plan produced by the Local Authority responsible for funding Care Homes for Older People Page 12 of 33 Evidence: the persons placement. The homes assessment and care planning documentation has been reviewed recently and new paperwork introduced, which has scope to cover all areas of health, personal, social and psychological needs. In addition it has several areas of risk assessment to focus staff attention on risk and how to minimise it. Care staff are getting used to the new way of working and have started to update existing residents assessed needs using the new format. The admissions process enabled management to decide whether needs could be met in the home. The home needs to formally write to residents or their representative, following the assessment, stating that they are able to meet their identified needs. The home was able to offer trial visits and respite stays to enable people to sample the home prior to a decision about permanent residency. This was confirmed in discussion with a resident admitted for respite care. The manager stated that the first few weeks of admission was seen as a trial period and a decision to stay would be made at the residents review with relatives and the funding authority present. Care Homes for Older People Page 13 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. Shortfalls in care planning, risk assessment and the recording of medication could mean that staff do not have full information about residents needs and care could be missed. Evidence: We examined three care files in detail to check how peoples assessed needs were planned and met. The care files contained a wealth of information for staff to use when planning care. The home started the process of installing new assessment and care plan documentation last August but have not fully implemented it yet. Each care file was a mixture of new documentation and old style care plans. Senior staff advised that they have had to update the care plans in their own time or in exchange for time off in lieu, which impacts on staffing levels. The care plans examined contained basic information about peoples needs and were not individualised sufficiently to give a full picture of how the person preferred to be cared for. For example one person had complex needs and their care plan for personal Care Homes for Older People Page 14 of 33 Evidence: hygiene gave no preferences for choice of clothes, night wear, perfumes, toiletries, whether the person needed to wear their glasses and how oral hygiene needs were met. The care plan to promote their continence was similarly brief with no reference to barrier creams required, incontinence aids and night protection. There were no likes or dislikes, quantities required, type of diet or what action to take if intake was poor, in the nutritional needs care plan. Non of the persons individual care plans referred to how privacy, dignity, choice and independence were to be met for them. There was no care plan regarding their social needs and stimulation, how they communicated their needs, how staff managed the persons memory impairment or how they were moved and handled safely. Other care plans examined were similarly brief. Some residents managed a part of their own medication, such as inhalers. Whilst this is good practice in enabling the person to maintain their independence, they should have a risk assessment, with how staff are to supervise the process, and it should be planned into their care plan. Daily recording indicated that another person had behaviours that could be challenging to staff but they had no behaviour management plan to give staff clear guidance in how to meet their needs in a consistent way. Care plans had not been evaluated since August 2008 and some of the documents from the new system had been installed in the care file but not completed. To improve, the care plans need to contain details of all assessed needs and have clear guidance for staff in how those needs are to be met. Care plans also need to be signed by the resident or their representative to show that they have seen them and agree to the contents. The care files had new risk assessments in place for areas such as nutrition, falls, moving and handling, continence and physical dependency. Some files also had generic risk assessments for the use of hoists and wheelchairs. There was also a risk assessment for bedrails, which was mainly an information sheet detailing that bedrails were in place rather than a thorough risk assessment of the need for bedrails, and whether they were the most appropriate piece of equipment to keep the resident safe. The risk assessments need to be kept under review and information from them used to plan care. There was some evidence that risk assessments had been recently examined by staff but this needs to be at more frequent intervals. Daily recording was basic, did not always follow on issues nor give a full picture of the care provided. Most staff had a standard phrase that stated medication was administered as per medication administration record. To improve the daily records could provide more detail about how the person has spent their day, what they have expressed, how they appear to be to staff and whether they have participated in Care Homes for Older People Page 15 of 33 Evidence: things. The new documentation also included an assessment tool to be used to determine the level of dementia and possible depression of residents. Staff were unsure of the tool and had not received any training in its implementation. There was evidence that residents had access to health care professionals and in most cases their weight was monitored. One resident was unable to be weighed and staff need to develop other means of monitoring whether or not this remains stable, either by checking limb size or attention to clothes. Residents spoken with told us that care was provided in ways that promoted privacy and dignity and care staff were clear about how they supported people to be independent and maintain their existing skills. Comments from residents were, yes they respect my privacy and dignity, the staff are lovely, they come as quickly as possible and they look after us well. Four surveys were received from residents and all stated they received the care and support they required and medical support, either, always or usually. A health professional stated in a survey, the patients say they are happy and they appear well cared for. Staff in the home also stated that the standard of care was very good and they were proud that no resident had any pressure sores. Medication was stored appropriately and generally signed into the home. However it was noted when checking the controlled drugs register that some pain relief patches for one person had not been signed as received into the home. Another residents controlled drugs entry had not been recorded properly. Staff had scored through the page as if the medication had been returned to the pharmacy but it was still on the premises. The manager needs to discuss how to rectify this with the supporting pharmacist and provide training to staff in how to record effectively. Staff also need to ensure that when handwriting details onto the medication administration record midcycle, the full manufacturers instructions must be inputted and amounts need to be carried forward to the next months page for items written in this way. There was also an issue about collecting tablets, offered but declined by residents, in a denture pot and storing this for up to two months at a time in the medication trolley. Staff told us they then sent them to the pharmacist to be destroyed. The manager needs to discuss this system with the pharmacist and return unused medication on a weekly basis. Care Homes for Older People Page 16 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 residents with a good quality of life by ensuring a range of activities to stimulate them, ensuring they remained in touch with their families and by presenting them with nutritious meals. Evidence: People spoken with and surveys received from them told us that the home had flexible routines and visitors were welcomed at any time. There was an activity coordinator employed and a range of activities was provided for people, information about which was displayed on the notice board. These included visiting entertainers, arts and crafts, board games, reading, gentle exercises, hobbies and discussion group, one to one sessions, quizzes, trips out, pet therapy and seasonal parties. Comments about activities, social stimulation and the general feel about the home were, we have bingo twice a week, they see to the entertainment every week, I like the home and Im faddy, there is an excellent activity programme, very good range of activities arranged by the activity coordinator and I like the home very much. There was evidence that people could make choices about aspects of their lives and Care Homes for Older People Page 17 of 33 Evidence: staff in discussion were clear about how they ensured people made simple choices. In the dining room at lunch people were able to help themselves to cups of tea and we observed two choices at the main meal, with some residents having a third choice. People chose where they wanted to sit, what time they arose and retired to bed, and some people chose to manage their own personal allowance and a part of their medication. People had the choice of remaining in their bedroom or joining others in the lounges and the range of activities offered a choice of participation. People liked the meals prepared and those seen were well presented. Menus rotated over a four-week period and there was plenty of fresh fruit and vegetables on offer. The menu for the day was on display outside the serving hatch opposite the dining room. The latter was set out with individual tables and was light and airy. The mealtime observed was a pleasant, social occasion and staff were on hand to support when required. The home had been awarded an, A from the local authoritys, scores on the doors system of food safety management, which was a good achievement. 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 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 an environment where people felt able to complain and ensured they were protected by staff training and adherance to policies and procedures. Evidence: The home had a complaints policy and procedure displayed in the entrance. There were two systems in place, one was a book for documenting, concerns and another was a form for more formal, complaints. However, it was difficult to distinguish between the two and one system of recording all concerns and complaints would be an improvement. The home also needs to record whether the complaint was resolved to the complainants satisfaction. Residents spoken with felt able to complain and that issues would be sorted out for them, Id see the manager, she would deal with it and you can go to any of them (staff). In surveys residents stated they knew who to speak to and how to complain. There was an ongoing complaint about laundry that we were made aware of on the day. This was mentioned to the manager to address. Staff members spoken with and surveys received from them indicated they were clear about what to do if someone made a complaint about the services they received. The home uses the multi-agency safeguarding policies and procedures when protecting vulnerable people from abuse. In discussion staff were clear about the different types of abuse and what to do if they suspected anything or if concerns were reported to Care Homes for Older People Page 19 of 33 Evidence: them. All but new staff had completed safeguarding training and the manager had completed a, train the trainer course, which enabled her to cascade the training to other staff. The manager had appropriately used the procedures when alerted to incidents between residents and the local authority completed monitoring visits and held reviews of their care. This led to two residents moving to alternative accommodation. 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. The home was well maintained and was a clean, warm and pleasant environment for people. Evidence: The home was clean and tidy and there were no malodours on the day of the visit. The home is arranged over two floors with a passenger lift and stairs accessing the upper floor. There are two lounges on each floor, all nicely furnished and decorated in a homely style, and a large, light and airy dining room on the ground floor. Other communal areas are a small seating area on the landing and an enclosed garden accessed via the dining room and downstairs lounges. The garden was well tended and had areas for people to sit and walk about. The home had thirty single and three shared bedrooms. There were lockable facilities for people to store personal valuables and bedroom doors had privacy locks. The shared bedrooms had privacy screens. All bedrooms had call bells and the manager confirmed a new nurse call system had recently been installed. Bedrooms seen were personalised to varying degrees dependent on the choice and taste of the resident. People spoken with were happy with their home and their individual bedrooms, there are no smells in the home, those days have long gone, its a lovely and clean home, I like the home very much, I have no complaints at all and Im very happy with Care Homes for Older People Page 21 of 33 Evidence: everything, I have a nice bedroom. The home had four bathrooms and, in addition, individual toilets close to communal areas. As storage space was of a premium, one of the upper floor bathrooms was used as a store room and was locked. The home also had a sluice room on each floor, housing a closed system sluice. The rooms were locked for safety when not in use by staff. The home has a redecoration programme in place for bedrooms, communal areas and corridors. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensured that care staff were well trained in order to support people with their assessed needs. Shortfalls in staffing numbers either perceived or actual is creating difficulties in the caring and administrative role for staff, which is leaving them stressed and rushed. This may mean that important care could be missed. Evidence: Numerous comments from staff in discussions and in surveys commented on the difficulties they had in ensuring that residents needs were met with the numbers of staff available. There were thirty-four residents and on each shift during the day there were three care staff and a senior. This dropped to two care staff at night with an oncall system for emergencies. The size of the building and the two floors to be covered made this a low staffing structure. The senior had duties that took them away from hands-on care first thing in the morning as they were responsible for medication, making appointments and liaison with visiting professionals. This left three care staff to support the residents to wash, dress and prepare for the day. This problem had been raised with senior managers and there had been some attempt to re-organise staff via night staff remaining for an extra hour until 8am and care staff arriving at 06.45. However, as night staff have to write their notes for fifteen of these minutes Care Homes for Older People Page 23 of 33 Evidence: and handover to staff for another fifteen minutes, in essence this equates to just fortyfive minutes when there are extra staff. The senior starts at 06.30 but prepares and serves breakfasts, supports people in the dining room, responds to any emergencies, for example falls or requests from carers to see specific residents, and administers medication, all at the same time. The administration of medication requires complete concentration and seniors multi-tasking during this could cause mistakes to be made. The comments from staff and the shortfall in formulating care plans, in evaluating them, in risk assessments, in basic daily recording and in seniors supervising care staff tells us that staff do not have sufficient time to complete all the tasks required of them and the staffing structure needs to be looked at again. Staff did tell us that the new care planning format is also taking some time to get used to. Comments from staff were, we are always rushed, needs are increasing but staffing are not keeping up, the residents needs have increased and its very stressful, the care officers help but they have their own role, we would like to have more one to one time with residents and the paperwork has really increased from within and from outside agencies. Residents told us that care staff were kind to them, looked after them well and answered buzzers, as quickly as possible. In surveys they said they were available either, always or usually and always listened to them and acted on what they said. The home had a good training plan and staff had the opportunity to participate in appropriate training for their role. The training plan covered mandatory and service specific training and staff commented that training was, first class and we are encouraged and are paid to go on training courses. Care staff felt the home was a good place to work, that morale was high despite staffing levels and they valued their good reputation. Training records confirmed the high priority placed on a trained workforce and out of twenty care staff, fifteen had completed a national vocational qualification in care, which equated to 75 percent of staff trained to this level. This was an excellent achiement and the home has a further four staff progressing through the course. The induction process for new staff consisted of an orientation to the homes way of working, the environment and emergency procedures. Staff also worked alongside more senior staff for a few shifts. There was no record of completion of skills for care induction standards, which seeks to assess competence in various areas and is signed off by senior staff or the manager on completion. Care Homes for Older People Page 24 of 33 Evidence: We examined four new staff members recruitment files. There were some areas to address to ensure the recruitment process was safe. For example it was noted that three of the new staff were employed in the home after the initial povafirst check but prior to the return of the full criminal record bureau check. This was acceptable in exceptional circumstances only and must not be routinely done, and there has to be evidence of stringent supervision. As one of the new staff was a night care worker, and as there were only two night care staff each shift, it could not be guaranteed that the person was supervised in the stringent way required. It was also noted that one care staff had two references from previous colleauges/friends and did not have one fom their previous employer even though it was possible to obtain one from them. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager was supportive and available for residents and staff and people were consulted about the home. Shortfalls in risk management for the use of bedrails and in specific management systems means that there is a risk of injury for some residents and a lack of information or guidance for staff. Evidence: The registered manager had been in post over two years and had completed her Registered Managers Award. She also kept herself up to date with relevant training. Staff spoken with stated she was supportive and had an open-door policy, and surveys received from them stated they met with the manager on a regular basis to discuss progress and issues. Senior management in the company visited the home in accordance with regulation 26 and there was some evidence that staff, especially catering staff, had the opportunity to speak with them. However, staff spoken with on the day and comments in surveys indicated other staff would like the opportunity to meet and discuss important issues, especially about staffing numbers. The regulation Care Homes for Older People Page 26 of 33 Evidence: 26 reports completed by the visiting manager could be more specific in detail regarding the staff spoken with, the issues they raised and what was planned to address them. Formal staff supervision took place but documentation indicated that care staff did not receive the required minimum of six sessions each year. This varied between one and four sessions. It is important that care staff have the opportunity for more frequent sessions. Staff signed a supervision contract and annual appraisals took place. Staff attended a range of meetings for individual staff groups in the home and minutes detailed discussions and the exchange of information. The home had a quality assurance system that consisted of audits and questionnaires to people. The manager completed an annual business plan and had completed a thorough Annual Quality Assurance Assessment (AQAA) required by the Commission. During an audit the manager had identified a staffing issue and had presented her findings to senior managers but it had only been partially addressed. Audits are completed on the environment and other systems in the home. As there have been shortfalls identified in areas such as care planning, risk assessment, medication, recruitment and staff supervision, it would appear more attention is needed in identifying gaps in service. Staff spoken with confirmed they have been trying to update care plans but this has had to be in their own time or in lieu of time off but this stretches staffing even further. Results of audits and evaluation scores from surveys are discussed in staff and residents meetings and displayed on the notice board. The graph format could be made more easily accessible and understandable to residents. The format of the questionnaires to residents and relatives could be reviewed to enable a large print font and a broader range of questions. The views of visiting professionals entering the home could also be sought to extend the range of comments and ideas on how the home is managed. The home has an administrator for the management of residents finances held for safekeeping. There is restricted access to the safe and personal allowance, which raised questions about how residents were able to access their funds at weekends when both the manager and administrator were not on duty. However, this is resolved by prior planning and shift leaders having access to another lockable facility. Individual records are maintained and two signatures required for all transactions. Receipts for deposits and expenditure are obtained and held with the records. The home has a, residents fund, which is managed appropriately for the benefit of the residents. Appropriate staff ensured that equipment was serviced and maintained and fire alarm Care Homes for Older People Page 27 of 33 Evidence: checks and drills were carried out. Staff had completed training in moving and handling people safely, basic food hygiene, infection control and health and safety. Seven staff had gained a four-day first aid certificate and others had completed a one day course. Generally the home was a safe place for residents to live in and staff to work in. However, there was one safety issue noted on the day that required immediate attention. Some residents required bedrails to prevent them from rolling out of bed. None of the residents had a thorough risk assessment in place that took into consideration health and safety executive (HSE) guidelines on bedrail safety. One resident was recorded as exiting the bed whilst the rails were in place, and there was not a safe combination of bed, mattress and bedrails. Alternative arrangements must be in place. The home was issued with an immediate requirement notice to complete a risk assessment for the resident and take steps to ensure their safety. A follow-up phone call during the writing of this report assured us that the manager had dealt with the situation appropriately. 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 People must have care plans 30/04/2009 that reflect all their assessed needs, are individualised, give clear guidance to staff, are updated when needs changed and be signed by the resident or their representative to show they agree to the contents. This will ensure that care staff have full information and prevent care from being missed. 2 9 13 All medication received into 28/02/2009 the home must be signed in. This is to enable an audit trail of medication. 3 27 18 There must be sufficient 28/02/2009 staff on duty in the home to provide unrushed care to residents, safe practices and adequate administrative tasks. This will ensure important care will not be missed. Care Homes for Older People Page 30 of 33 4 29 19 Full checks, for example references, must be in place prior to the start of staffs employment and if they are to commence after a povafirst but prior to the return of the full criminal record bureau check, stringent supervision must be in place. Staff files need to have photographs in place. This will ensure that only appropriate people are employed to work with vulnerable adults. 28/02/2009 5 38 13 Any resident occupying a bed with bedrails must have a risk assessment in place with clear guidance to staff on how to minimise any risks. This will ensure that unnecessary risks are eliminated and peoples needs more fully assessed. 28/02/2009 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 7 Care plans should be evaluated monthly and updated when required, taking into consideration information written in other parts of the care file. New care plan documentation should be implemented quickly to avoid confusion for staff and to provide clear guidance in how they are to meet needs. Risk assessments for self medication need to be in place and all risk assessments should be reviewed monthly, or Page 31 of 33 2 7 3 8 Care Homes for Older People more often as required, in line with the homes new documentation. 4 5 9 9 Handwritten entries onto the MAR should have the full manufacturers instructions and have two staff signatures. The manager needs to discuss with the local pharmacist how to rectify the error in the controlled drugs book and needs to ensure that care staff are aware of how to record receipts of, and returns of, controlled drugs properly and consistently. A safer system of storing and returning declined medication needs to be in place to avoid stockpiling them. The manager should check this out with the pharmacist. When recording any concerns or complaints staff should indicate whether the complainant is satisfied with the outcome of any investigation. The two current systems in place could be streamlined into one to prevent any confusion for staff or complainants. Senior staff should be able to concentrate on the administration of medication as a single task and not as part of multiple tasks in the morning. The regulation 26 reports completed by the visiting manager could be more specific in detail regarding the staff spoken with, the issues they raised and what was planned to address them. The homes quality assurance system could be improved to enable a broader range of questions in surveys, an enlarged font for residents questionnaires, additional surveys to visiting professionals, improved auditing systems and easier access to results of audits and questionnaires. Care staff should receive a minimum of six formal supervision sessions per year. This will ensure that they feel supported and are able to discuss issues that concern them and training and development opportunities. 6 9 7 16 8 27 9 33 10 33 11 36 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 © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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