Inspection on 09/09/08 for Ashley Arnewood Manor

This inspection was carried out on 9th September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashley Arnewood Manor 14/09/06

Ashley Arnewood Manor 08/11/05

Ashley Arnewood Manor 05/04/05

Ashley Arnewood Manor 17/12/04

Ashley Arnewood Manor 21/04/04

Ashley Arnewood Manor 16/02/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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: Ashley Arnewood Manor 32 Ashley Road New Milton Hampshire BH25 6BB     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: Janette Everitt     Date: 0 9 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 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 34 Information about the care home Name of care home: Address: Ashley Arnewood Manor 32 Ashley Road New Milton Hampshire BH25 6BB 01425611453 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs S Rawlins Type of registration: Number of places registered: SCOFIL Limited care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 20 The registered person may provide the following category/ies of service only: Care home only - PC 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 - OP Dementia - DE Date of last inspection Brief description of the care home Ashley Arnewood Manor is a privately owned and run care home is set in a residential area close to local amenities and New Milton town centre. The home residential care for up to 20 elderly residents including persons with dementia. Bedrooms are situated on two floors ground and first floors with a chairlift between floors. A variety of aids and adaptations have been provided which enable residents to move about more independently. Eighteen of the bedrooms are single, two of these having an en suite Care Homes for Older People Page 4 of 34 Over 65 0 20 20 0 Brief description of the care home toilet. There are three communal toilets and a bathroom on the ground floor, and three toilets and two bathrooms on the first floor. There is a garden to the rear of the building easily accessed by residents. Care Homes for Older People Page 5 of 34 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 site inspection visit to Ashley Arnwood Manor, which was unannounced, took place on the 9th September 2008 and was undertaken by one inspector with the assistance of the registered manager, Mrs Rawlins. The inspector being a representative of the commission is referred to as we in the main text of the report. The visit to the home formed part of the process of the inspection of the service to measure the service against the key national minimum standards. The manager had returned the Annual Quality Assurance Assessment (AQAA) to the CSCI within the stated timescales and the focus of this visit to the home was to support the information stated in this document and other information received by the CSCI since the last fieldwork visit, which was a key inspection, made to the Care Homes for Older People Page 6 of 34 home in September 2006. The service had an annual review in December 2007 at which time the outcomes for the service users remained good. Documents and records were examined and staff working practices were observed where this was possible without being intrusive. The inspector spoke to most of the residents, staff and visiting relatives in order to obtain their perceptions of the service the home provides. Those spoken to were very happy and complimentary about the care. Surveys had been distributed to service users, staff, GP and other visiting professionals. Five service user survey and five staff surveys were returned to the CSCI. The outcome of the surveys indicated that there was a high level of satisfaction with the service and that generally residents and relatives were pleased with the care the home provides. There were 20 residents, accommodated in the home and we were unable to communicate effectively with a small number of residents to gain their views of the service. There were no residents from an ethnic minority group. The manager told us at the time of this visit that the current fees were between 347 and 538 pounds sterling. These fees do not include hairdressing, newspapers, chiropody and other personal items. What the care home does well: What has improved since the last inspection? What they could do better: Care plans must be more person centred and contain details about the service users needs and how they are to be met. The medication policies and procedures must be reviewed to reflect how the medication is being dispensed. The double dispensing of medications must cease as this is considered to be unsafe practice. The home must formulate an infection control policy to guide staff in the prevention of cross infection. Hand washing facilities should be provided in all toilets and bathrooms by way of a soap dispenser and disposable towels. Care Homes for Older People Page 8 of 34 Mandatory training in regards to Health and Safety must be maintained at appropriate intervals and records of this training must be maintained in the staff members personal file. The manager must plan a programme of supervision for all staff to be undertaken at least 6 times a year. Recruitment is not robust. Two references, a current CRB and POVA check undertaken by the home should be received before employment commences. Accurate and up to date records must be maintained of all training undertaken by staff. 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 34 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 34 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. Service users needs are assessed and information given to them prior to any decision being made about if the home can meet their needs. Evidence: Service users are assessed by the manager or her deputy prior to decisions being made about them being admitted to the home. The manager told us that referrals to the home come from clinical settings, care managers and also families. The assessments are undertaken in whatever environment the potential service user is living. Potential service users contribute to the assessment process and relatives are also involved if appropriate. A sample of pre-admission assessments were viewed. These demonstrated detailed Care Homes for Older People Page 11 of 34 Evidence: information about the person and these were signed by the person or their relative as evidenced their involvement in the process. If a care manager has referred a person to the home, they will also contribute and send a completed care needs assessment to the home. The manager told us that if the potential service user can spend a day at the home prior to making any decisions about moving into the home, and it is at this time that the initial assessment can be undertaken. The manager told us that the home has no set down admission criteria but they will not admit persons with challenging behaviours owing to the layout of the home and the client base in residence. The first floor accommodation has some stairs that are not covered by a stair lift. This must be considered when admitting a person whose mobility is poor and no ground floor room is available. There was evidence in a sample of assessments that relatives have written some social history about the service user, giving details of their likes, dislikes, daily routines and their preferences with what they like to do during the day. Service user surveys returned to CSCI indicated that they considered they had sufficient information about the home before they moved in to make an informed decision. A relative spoken to said he had received sufficient information about the home but that he knew the home well and was very pleased that his wife had been accommodated there. Care Homes for Older People Page 12 of 34 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. Service users have care plans documented, however, these need to be more person centered and reflect individual needs and risks with details of how risks and care is managed. Service users healthcare needs are met. Service users are not fully protected by the home policies and practices for the management of their medication. Service users are treated with respect and their right to privacy is upheld. Evidence: A sample of care plans was viewed by us. The previous inspection identified that care plans needed more detail and specific guidance on how care needs would be met. Although the manager had reviewed the plans and added more detail, the care plans are contained on one piece of paper and do not identify all care needs in detail and how the needs are to be met. The care records contain very sparse information about the capabilities of the service user. The care plans would not give much information to Care Homes for Older People Page 13 of 34 Evidence: care staff that were not familiar with the service users. The system for care planning was discussed with the manager who acknowledges that the care planning system needs to be reviewed and be more person centered with more detail put into the assessments and risk assessment, and care plans written to guide practice and manage any identified risk. The care plans contain a photograph of the service user and the general details of that person. Social histories are obtained if possible but are very basic. Likes and dislikes are documented with medical history, any special needs, allergy, sleep pattern, bowels, mental state and funeral arrangements. Service users have a key worker and the care plans were observed to be reviewed monthly and signed by the designated key worker. The daily reports and records were viewed. These were detailed in how the service user had spent the day and much of the information contained in the daily records could be recorded in the care plans. The care plans did not appear to be working documents and other records such as daily records, communication book and handover reports were used for communication between staff to inform each other how the service users were. Although it is important for continual communication between staff, the foundation of how the service users needs are being met should be detailed in a care plan to ensure consistency of care and to identify changing needs. The records demonstrate that service users receive the health care needs that they are entitled to. All service users are signed up with the local GP who will visit the home if requested. Service users can keep their own doctors if this is agreed with the GP. Records seen and speaking with service users confirmed that they see the GP and other healthcare professionals, when needed. The service users are seen by the chiropodist 6-8 weekly, dentist and opticians as and when needed. The community psychiatric nurse does visits the home if there are any service users who are currently under their care. Service users medication is reviewed by them at least six monthly but the manager told us that she can access this service at any time to request a visit and is well supported by this team. The medication policy and procedures were viewed and observed. The homes medication procedure was observed by us to be dispensed from individual bottles and packets and were being dispensed into medicine pots with lids placed on the top with the service users name on the lid. This was observed to being done for all those receiving medication at lunchtime and the pots were taken out on a tray to be administered to the service users. The senior carer then returned to the office to sign the medication administration records (MAR) sheets. Care Homes for Older People Page 14 of 34 Evidence: This procedure was discussed with both the manager and the deputy manager who coordinates the ordering, receiving and administration of the medicines, and was dispensing the medications. We identified that this method was not good practice and that the Royal Pharmaceutical Society Guidelines states that there is potential for drug error when medicines are prepared in advance into pots, this being termed as double dispensing. The manager was advised where she could obtain the revised Royal Pharmaceutical Society guidelines to the handling of medicines in social care settings. The written procedures did not describe this method of administration of medication but the manager told us that this had always been the method and that the home had done this for many years. The manager agreed to make enquiries about a monitored dose system being supplied and purchasing a medicine trolley to enable staff to dispense the medication and sign the MAR sheet when they have witnessed the service users taking their medication thus ensuring safe practice. The MAR sheets were examined. These are not printed out by the supplying pharmacist but are transcribed by hand on the MAR sheets when the medication is delivered from the pharmacy. The deputy manager transcribes these records and she does this solely without having a second carer to check that what she is transcribing is correct. This was discussed with her and she has agreed to ensure a second person will check what she has written on the MAR sheets is correct and sign as evidence of this being checked. There were no service users choosing to self-administer their own medication. There was no medication being administered covertly at this time but the manager was aware of the process to go through if this became necessary. The AQAA states that more staff have undertaken training for safe handling of medicines. There was no evidence that any staff had undertaken training in the past twelve months but there was evidence of medication training certificates in some staff files prior to this year. The manager told us that only carers with the certified training in safe handling of medicines could administer medication. Those who have received training, this has been undertaken at a college and with subsequent training by the supplying pharmacist. Requirement will be made from the findings of this standard The staff were observed to have good relationships with the residents and were familiar with their preferences of how they liked things done. They were observed to knock on bedroom doors before entering and interacting with residents in a respectful manner. Care Homes for Older People Page 15 of 34 Evidence: It was noted that all bedroom doors have locks fitted and there is an option for residents to have a key to the lock on their bedroom door for privacy and security, if this was appropriate, Service users spoken with and their relatives describe the staff as treating them with dignity and respect and they get all the care and support they need. Care Homes for Older People Page 16 of 34 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 provides a programme of social activities to meet service users needs. Service users are able to exercise choice and make decisions about their lives. Visitors are made welcome to the home and they can see service users in private. Dietary needs are well catered for with a balance and varied selection of food available that meets individual dietary requirements and choices. Evidence: The monthly activities programme was on display titled dates for your diary. This showed something going on every day that service users were free to participate in if they wish. Activities advertised included aromatherapy, gentle exercise, bingo, and visiting musical entertainers. A craft lady attends the home monthly and does pottery with the service users. This has been very popular and many of the examples of the service users work were on display in their rooms. The pottery had been fired and was glazed and looked very attractive. A group of three ladies spoken to were very enthusiastic about this activity and said they really enjoyed doing pottery and to see their work once completed, was very satisfying. Surveys returned from service users indicated that generally there is always some Care Homes for Older People Page 17 of 34 Evidence: activity each day they can participate in. A number of the service users, through frailty of mind, were not able to verbalise their feelings about this but the manager told us that the aromatherapy lady does nails with hand and arm massage and this is very welcomed by some of the ladies who are unable to participate fully in other activities. Social histories are captured as much as possible but unless relatives supply the information there is little social history available to inform the activities programme. The manager told us that the service users are encouraged to participate and continue with hobbies but, that some are very reluctant to join in. The home provides parties at birthdays and festive times of the year, to which family and friends are invited. The manager told us these are well attended and everyone enjoys the gathering. The minister visits the home monthly to offer communion to those who wish to take it. The service users do go out on outings in small groups by taxi. The manager said at the last residents meeting they suggested attending an Old Time Music Hall evening at the village hall. The residents were keen to attend and were willing to contribute towards the cost of the evening. All other entertainment is free. The home does strive to provide appropriate activities for those will mental frailty. The homes visiting book demonstrated that the home does have regular visitors. Service users can see their family and friends in the privacy of their own room or in one of the communal areas. Service user spoken with and from surveys returned to CSCI indicate that service user are able to make choices in their everyday life in respect of what they eat, where they eat their meals, what time they like to go to bed and get up in the morning. Relatives do come to the home and take service users out but the manager told us some service users choose not to go out. There are no service users that are able to go out independently. Service users likes and dislikes are documented in care plans and the manager said the kitchen is aware of service users food preferences. The menu for the month was display and the home has introduced a daily menu board displaying the full menu for the day. Service users are invited to inform a carer or kitchen that they want an alternative meal to the one on the menu. Service users have a choice of cooked breakfast but most prefer cereal and toast which is served in the dining room or in their own room if they prefer. Care Homes for Older People Page 18 of 34 Evidence: The residents meeting minutes demonstrated that the menus were discussed and detailed what the service users would like changed. As a result of this the menu has been changed. A designated person undertakes the cooking for each day and a number of the carers and the deputy manager are happy to cook for the day. All those who undertake the cooking have undertaken the Food Handling and Hygiene training. The cook for that day was the deputy manager and she said the home shops locally and all food is bought in fresh. We were present when the lunchtime meal was being served and this was observed to be wholesome and nutritious and well presented. There were no service users needing special diets but the cook said other diets could be catered for if required. Tea, coffee and other beverages were offered throughout the day with biscuits or cake. A relative commented that the home is always clean and the tables for food are beautifully laid and attention is given to detail making it a pleasant place to visit. There are no nutritional risk assessment undertaken but service users are weighed regularly and we saw records of this. The manager said that if there is a notable weight loss or the home is worried about a service users nutritional status, she refers them to the GP. Care Homes for Older People Page 19 of 34 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 had a clear and satisfactory complaints procedure to address the concerns of residents, relatives and representatives. Service users are protected from abuse. Evidence: The home has a complaints procedure, which is also included in the service users guide. The AQAA states that the home has a complaint procedure that is issued to all service users with their contracts. They also have the details of an advocacy service should a resident need this. The AQAA states that there are no complaints recorded, the home has received no complaints since the last inspection. The complaints log was viewed and did not record any complaints. The CSCI has received one complaint in the last year and this was resolved by the manager. Surveys returned and speaking with the service users, said that if they had concerns or wanted to complain they would talk to their carer or the manager. The home has a procedure that operates in tandem with the policy and procedure produced by Hampshire County Council designed to protect vulnerable adults (POVA) from abuse, which was available at the time of this visit. Care Homes for Older People Page 20 of 34 Evidence: The AQAA says that the home has a policy for abuse awareness and staff are encouraged to attend courses on this. There were certificates displayed on the wall that demonstrated a number of staff have received POVA training. There was no evidence of recent training or refresher training, but the manager told us that those carers who are undertaking the NVQ level 2 training,a component of the training is recognising abuse and what to do if it is witnessed. Staff spoken with had an awareness of what they had to do if they had concerns or had witnessed any form of abuse. The staff surveys returned to CSCI also indicated that staff were aware of their duty if any concerns were reported to them. The manager told us that no form of restraint is used currently in the form of bed rails or lap straps and that if this became necessary a risk assessment would be undertaken before they were used. Care Homes for Older People Page 21 of 34 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. Service users live in a homely well-maintained environment, which is clean and hygienic. However, there are identified areas of the home in need of redecoration. Evidence: We looked around the premises. The home is a big old house that is a listed building and as such many of the original features remain. The home has twenty single bedrooms two of which have en-suite facilities. The rooms are decorated to a good standard and have been refurbished with new furniture, curtains, bedding and carpet as they have become vacant. Rooms were observed to be very individual and some service user had chosen to bring items of personal furniture and belongings with them that have made their rooms very personal. One resident commented how she really liked her bedroom. Service users spoken to say they were happy with their environment and one relative said he was very pleased with the pleasant room his wife accommodated. The home has two communal areas. The AQAA states that the dining room is to be redecorated within the next two months. The providers have purchased the next-door premises, which is attached to the old house, and building permission has been sought to extend the home. Owing to this being a listed building there has been a delay in Care Homes for Older People Page 22 of 34 Evidence: work commencing and as a result some of the areas of the existing home, which were planned to be refurbished, has been delayed. This applies to the laundry room, which is in need of redecoration. The furniture in the lounge area was homely and comfortable and new furniture has been purchased in the hallway after re-decoration. The home is surrounded by gardens which service users have access to. The AQAA states that more seating could be made available in the garden area. The manager told us that she and the operational manager have an environmental and maintenance plan and the manager involves the residents in choice of colours and redecoration The minutes of the residents meeting evidenced that residents were asked preferences of what colour the dinning room should be painted and the manager has tried to involve the service users as much as they wish to be. The manager told us that budgets are set and must be accounted for and there sometimes there is a delay in getting things done but the provider is very good and will do what is identified as needing doing as soon as possible. All areas of the home were observed to be very clean and no unpleasant odours were detected. This was supported by the surveys returned from service users The home employs a domestic person five days a week with carers doing domestic duties as needed at weekends. The bathrooms and toilets, although they had soap dispensers in them, had no disposable towels available, only an ordinary towel for everyone to use, including the service users. This was discussed with the manager as to the infection control policy for hand washing. The manager could not access an infection control policy for the home and the training records indicated that the last infection control training was undertaken by some staff via distance learning in 2006. There were no records of any subsequent training of staff in the principles of infection control. Aprons and gloves were available to staff. Care Homes for Older People Page 23 of 34 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. Service users needs are met by the current numbers of staff on duty, however, staffing levels need to be reviewed at busier times of the day. Staff do received training, however, there are aspects of training that are not to an acceptable level to fully protect service users and ensure their needs are met. Recruitment policies and practices do not fully ensure that service users are supported and protected. Evidence: The AQAA reports that the home has good staffing levels of staff with mixed abilities. The improvements the manager would like in the coming year would be to get more staff. Staff rotas were viewed. These indicated that four staff were on duty in the mornings and this included the person who was designated to do the cooking. The care staff on duty also did the laundry. These numbers dropped to 3 in the afternoon with two carers on duty between 1700 and 2000. The two afternoon members of staff serve supper at 1700. This was discussed with the manager as to the numbers of staff being on duty at busier times of the day and that two staff on between 1700 and 2000 did not seem sufficient, taking into account dependency levels of service users and other duties such as clearing up after supper and service users who may want to go to bed. Care Homes for Older People Page 24 of 34 Evidence: The manager told us that this had always been the staffing levels and there had been no reason to change this. We advised that this is monitored. Staff surveys told us that they consider that there is sufficient staff on duty to meet the service users needs. At night there is one awake staff and one asleep staff. The sleep member of staff is available until 2300. It was also noted that at weekends there were three staff on in the mornings and this includes the staff member who would be doing the cooking duties for that day. This was also discussed with the manager who said that in her opinion the current staffing levels were meeting the needs of the service users. Surveys returned to the CSCI from service users indicate that residents say that usually staff are available when you need them. The AQAA states that five of the sixteen staff employed have achieved their NVQ level 2 or above and that two care staff hold a non-British nursing qualification. The AQAA stated that more staff were to commence the NVQ level 2 in early 2008, but that some part-time staff choose not to do this qualification but are valuable care staff. The manager told us that four of the five staff have NVQ level 3 and a further three are currently undertaking the NVQ level 2. The deputy manager is undertaking NVQ level 4. Once achieved this will represent 50 percent of staff having achieved an NVQ qualification. The manager told us that she undertakes the recruitment of staff and they undergo an induction programme based on the Skills for Care Induction programme. The manager told us that new employee have a local induction to the home and are shadowed initially. They will then commence the induction programme, based on the Skills for Care Induction standards approximately six weeks into their employment. The files were viewed for the most recently recruited staff and the records of induction could not be found in the files looked at, one person had not commenced the programme to date. The manager told us that those undertaking the induction programme had their workbooks at home and were therefore not available to view. The manager showed us training matrix that stated the dates for the mandatory training for 2006. There was no evidence of staff undertaken health and safety mandatory training in the previous twelve months. The fire training was being advertised on the notice board for October 2008, this being the first training in twelve months. The manager acknowledged that the training has been put on hold whilst she has been absent from the home and that now she is back she will ensure mandatory training is Care Homes for Older People Page 25 of 34 Evidence: taking place appropriately. The AQAA stated that the manager would like more time for staff support and supervision. This was discussed with the manager who showed us evidence that some appraisals and supervision have taken place but not as often as stated and that the manager reiterated that she needs more management time, and will endeavour in the future to arrange a more structured supervision programme for all staff. Staff spoken to and surveys returned indicate that staff consider they have good training opportunities and are well supported and consider they provide the best quality of care in a safe environment. Another staff member commented that the service users are well cared for by staff who work well together as a team and are like an extended family. We viewed a sample of four staff members personnel files. These were the most recently recruited staff to the home. These evidenced that Criminal Bureau Records (CRB) and Protection of Vulnerable Adults (POVA) checks had been sought. For two of the employees the CRB checks had been recent checks from a previous employer and the manager told us that she had commenced their employment because they were recent checks, but she had applied for checks on behalf of the home. One recruitment file held only one reference and the manager had not chased for the other reference. Care Homes for Older People Page 26 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager is qualified, competent and experienced to run the home. Service users monies are maintained appropriately. The home has a quality assurance system in place, but the outcomes from the audits are not identified in a report. The health and safety of the service user and staff are promoted, however, the staff have not consistently received the mandatory health and safety training. Evidence: The manager has been in post for many years and has achieved her Registered Managers Award. She has many years of experience working with the elderly mentally infirm. The manager told us that since the appointment of an operational manager, who is her line manager, she feels much more supported in her role. Service user satisfaction questionnaires are distributed twice yearly. The manager Care Homes for Older People Page 27 of 34 Evidence: looks through the responses but there was no report of any outcomes from this survey. The manager holds regular residents meetings and minutes are recorded and action taken from any issue or suggestion made by the service user. The manager told us that all service users are treated equally and are encouraged to be involved in the way the home is managed. The manager said she is receptive to staff comments and suggestions and staff meetings, which are held four monthly with day staff and five times a year with night staff. The minutes the meetings are recorded. The manager said she also gets feedback from staff at supervision meetings. The manager said that she tours the home three times a week to monitor the cleanliness and any maintenance issues. Cleaning records are kept and night staff have a cleaning regimen to undertake at night. It was observed that a cleaning list was displayed on the wall of the toilets stating when and who monitored the cleanliness in the toilets and bathrooms. We examined a sample of records and receipts of service users own monies. These reconciled with individually stored monies, which were held securely in a locked environment for safekeeping. The fire log was examined and demonstrated that fire checks on the system and equipment were undertaken regularly and at appropriate intervals. Records of the fire training evidenced that the last fire training was September 2006. This was discussed with the manager who told us that she goes through the fire procedures at each staff meeting and records of who attended are listed in the fire log. We viewed the fire risk assessment that was completed in July 2008. A sample of servicing certificates was seen and these were up to date. The accident book was viewed and completed appropriately. The manager analyses the accidents forms to identify any emerging themes. There was little evidence that staff had received mandatory updates in health and safety in the past year. This was discussed with the manager who acknowledged that the training programme had not been maintained and updated, and that budgets have been tight, but that now she was recovered and back to work she would ensure that mandatory training was arranged. There was evidence of fire training having been arranged for the proceeding month for all staff. Cleaning chemicals were seen to be stored appropriately in a locked environment and the Care Homes for Older People Page 28 of 34 Evidence: housekeeper was observed not to leave cleaning materials unattended. Care Homes for Older People Page 29 of 34 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 30 of 34 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 The responsible person must 31/12/2008 ensure that care plans are written with the service user at the center of the plan and to detail actions to take to meet the service users assessed needs. You must do this to ensure that care plans are documented to enable staff to gain information about how the service user needs are to be met and to inform their practices. 2 9 13 Medication must be 30/11/2008 administered directly from the pack into which it is dispensed and not be double dispensed into pots to be administered. Recording on MAR sheets of administered medication must be done following the witnessing of the medication being taken. Care Homes for Older People Page 31 of 34 MAR sheets that are transcribed by the home must be checked by a second person and signed for to ensure medication and dosage is correct. The registered person shall make arrangements for the recording, safe handling, safe keeping, safe administration of medicines received into the home. 3 29 19 The registered person must ensure that all relevent information is recevied, as stated in Schedule 2 of the Care Home Reguations before commencing employment of newly recruited staff. This includes CRB and POVA checks and two written references. You must do this to ensure that service users are protected. 4 30 18 The registered person must ensure that all staff receive training appropriate to the work they are to perform and given suitable assistance and time off for the purpose of this training. Staff must receive a minimum of three paid training days a year to ensure they are competent to do the job for which they are employed. 31/12/2008 31/12/2008 Care Homes for Older People Page 32 of 34 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 26 It is strongly recommended that disposable towels be supplied in all toilet and bathrooms for hand washing purposes to promote infection control. it is recommended that all staff undertake training in the principles of infection control. It is recommended that staffing levels be monitored at busy times of the day, taking into account service users dependancy and staff job roles. 2 3 26 27 Care Homes for Older People Page 33 of 34 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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