Inspection on 29/10/08 for Austenwood Nursing Home

This inspection was carried out on 29th October 2008.

CSCI found this care home to be providing an Good 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

Austenwood Nursing Home 12/11/07

Austenwood Nursing Home 22/11/06

Austenwood Nursing Home 14/03/06

Austenwood Nursing Home 03/01/06

Austenwood Nursing Home 25/05/04

Austenwood Nursing Home 17/03/04

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 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Austenwood Nursing Home 29 North Park Gerrards Cross Bucks SL9 8JA     The quality rating for this care home is:   two star good 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: Jane Handscombe     Date: 2 9 1 0 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. 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 31 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 31 Information about the care home Name of care home: Address: Austenwood Nursing Home 29 North Park Gerrards Cross Bucks SL9 8JA 01753890134 01753893535 j.gittens@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Westview Limited The registered provider is responsible for running the service Name of registered manager (if applicable): Name of registered manager (if applicable) Mrs Jeanette Gittens Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 29 The registered person may provide the following category of service; Care home with nursing (N) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Austenwood Nursing Home is situated a short distance from the town centre of Gerrards Cross, which provides a variety of shops and local amenities. The town is served by buses and Chiltern Line trains. The premises consist of an older two-storey building and a more recent ground floor extension. The home has gardens to the rear Care Homes for Older People Page 4 of 31 care home 29 Over 65 29 0 Brief description of the care home and a large enclosed courtyard garden. There is parking for several cars. The home is registered to provide care with nursing for up to 29 older people, who can be accommodated in one of 19 single or 5 shared rooms. Of these rooms, 11 possess ensuite facilities. The home has 4 bathrooms for communal use, all of which enable disabled bathing. In addition to the en-suite facilities there are a further 4 toilets, situated at convenient positions around the home. Toilets and bathrooms contain grab rails. The homes communal areas comprise of a large lounge, which opens out onto the courtyard, and a well-presented dining room, which can seat all residents at one time. Both floors of the homes main house are accessible by a passenger lift. A registered nurse is on duty 24 hours a day, and is supported by a team of carers, housekeeping, administrative and catering staff. All residents are registered with a general practitioner (GP) and access to other healthcare professionals is either by direct contact or through GP referral. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection, which took place over one day. The visit took place on the 29th October 2008. The purpose of the visit was to see how the home is meeting the National Minimum Standards. Results of this inspection report are derived from feedback gained from surveys sent out to people using the service and to healthcare professionals and staff working in the home. Discussions were held with service users and with staff during the inspection, viewing client’s records held within the service, examining policies and procedures, staff personnel files and general observation throughout the day. We also take into account information provided to us within the AQAA, an annual quality assurance document sent to the home from the Commission for Social Care Inspection and completed by the manager and any other information that CSCI has received about the service is taken into account in order to Care Homes for Older People Page 6 of 31 gain an understanding of how the service meet the service users’ needs, and how this impacts upon their lives. We looked at how well the home was meeting the key standards set by the government and have in this report made judgements about the standard of the service. Fees range from 560 pounds to 750 pounds per week. Our thanks and appreciation goes all those who gave their time during the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: Update the information within the residents guide, provided to current and prospective users of the service, to include all the items listed under schedule 2 of the care home reguations. Ensure that peoples prescribed medication is administered and recorded appropriately, using appropriate codes where medication has not administered to evidence the reason Care Homes for Older People Page 8 of 31 for non administration. Ensure to notify the Commission of any incidences which adversally affects the well being or safety of any person who uses the service. Ensure that nurses and care staff receive formal supervision at least six times a year, are provided with an annual appraisal of their work and appropriate documentation to evidence these are held within staff personnel files. It would be good practice to contact some independent advocacy services to obtain some information on the service they offer and provide information and contact details to those using the service. 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 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides prospective service users with information about the home and its services and undertakes an assessment of needs which allows them to make an informed choice when deciding upon a home suitable to meet their needs.. Evidence: The homes residents guide and statement of purpose, provides both prospective and current users of the service with information about the services that are offered at the home, which can be produced in various formats to suit peoples individual needs. The residents guide needs updating to include all the details listed under schedule 1 of the Care Home Regulations 2001. Prior to being offered a place, the registered manager visits the prospective user of the service to undertake an assessment of needs to ensure that all parties are confident that their needs can be met at Austenwood Nursing Home. Admission only takes place Care Homes for Older People Page 11 of 31 Evidence: if the management and staff are confident that they possess the skills and abilities to meet the needs of the prospective service user. Files viewed during this inspection evidenced that a thorough pre admission assessment of needs is undertaken. Discussions with recently admitted residents and their visiting family members ascertained that discussions had taken place with them and all relevant parties to ensure that all their health, personal and social care needs had been fully assessed. Visits to the home had been arranged wherever possible so that they and/or their representatives could meet with fellow users of the service, meet with staff members and gain a ‘feel’ of the home prior to making a decision as to whether the home was suitable for their needs. The home deals with a number of diverse care needs and there is a commitment to ensure that however diverse peoples needs may be, receive a person-centred package of care, which meets their needs appropriately. The home does not offer intermediate care, therefore standard six does not apply. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All residents have a care plan detailing their needs which is regularly reviewed. The residents are well cared for, and feel that they are treated with dignity and respect, and know that their wishes regarding the end of their life will be carried out. Evidence: Each user of the service has a comprehensive care plan in place detailing their health, social and personal care needs and appropriate risk assessments are in place detailing any risks that may be present along with any actions to be taken to remove or reduce the risks, The home uses a number of clinical tools to identify risks to residents in relation to tissue viability, nutrition, dependency rating, environmental risks, bathing and falls all of which were fully developed. Care plans, treatment plans and appropriate equipment were in place to reduce the risks identified. There was evidence in the files that body maps were used when necessary to evidence resolution of wounds. Likewise, continence and nutritional assessments are also undertaken and monthly weights are recorded. Care Homes for Older People Page 13 of 31 Evidence: A sample of care plans were examined and this was followed up by meeting with the individual service users to confirm that their care needs were being met. On each occasion the care plans gave a good reflection of the person, their care needs and how these would be met. The plans were reviewed on a regular basis, and the daily records reflected the care given as set out in the individual care plans. There was evidence within those files viewed of service user and/or their representatives involvement in the care planning and review process. The home has good working relationships with healthcare professionals and evidence within care plans informs us that the service accesses them when required and records their visits appropriately within the individuals file. All residents are registered with a GP; three practices are used by the home. Dieticians advise is sought, Physiotherapists are usually sought via the PCT on referral but may also be accessed on a private basis and an optician visits the home annually. Residents requiring dentistry normally travel to an NHS dental clinic in Amersham, a wheelchair taxi service is available in Chalfont St Peter if needed. A chiropodist visits the home every six weeks. Five healthcare professionals completed surveys that we sent out prior to this visit and all tell us that peoples health care needs are met at Austenwood, that the home seeks their advice when necessary and acts upon it to manage and improve individuals health care needs and inform us that the home respects individuals privacy and dignity. One GP added that the service provides a friendly, homely environment and feels the home respects peoples individual needs well telling us that he/she is happy with the care of my patients. Another GP informs that the service bends over backwards to keep customers/clients/patients happy (as well as their relatives) which was also expressed by a care manager who tells us they have worked well with very difficult families and have given then a lot of time to listen, guide and share; general communication has been excellent. As part of the inspection process we looked at the medication systems within the home. People who wish to maintain responsibility for their own medication are enabled to do so within a risk management process, although at the time of this visit no service users were self-administering their own medication. Qualified nurses administer all medication; carers are not trained to administer medication. The home does not use a monitored dosage system, rather medicines are supplied in stock containers for each resident, although the manager reported that the service is looking to change over to blister packed medication. All medication was found to be stored appropriately and securely. Medication is generally managed well. Records were kept of medication entering and leaving the home; the home has a contract with PHS for the disposal of surplus stock Care Homes for Older People Page 14 of 31 Evidence: and uses containers of chemicals to ‘denature’ drugs. We chose to view the medication administration records of three service users whose care we were case tracking for the purpose of this inspection. The medication administration charts were generally completed with no gaps although there was one instance in which the service users medication administration record contained gaps indicating that his/her prescribed creams had not been administered for 16 days and therefore were not being administered as prescribed by the GP. A requirement has been within this report to ensure that peoples prescribed medication is administered and recorded appropriately, using appropriate codes where medication has not been administered to evidence the reason for non administration. We undertook an audit of a selection of service users controlled drugs and found them to be stored in an appropriate CD cabinet, all were documented in a CD register and the balance of stock was found to tally with that documented. Two staff signatures were documented against each entry within the CD register and a CD destruction kit was available for use when required. A record of staff signatures, who administer medication, is kept to allow for identification should any errors occur. The manager reports that the arrangements, for the storage of medicines, are checked every six months by the supplying pharmacist and further audits are undertaken by the registered manager on an ad hoc basis. Whilst viewing documentation within the home, it was noted that one error in the administration of prescribed medication had occurred; the service sought appropriate advice and took the appropriate steps to ensure the health, safety and welfare of the service user, however the service did not notify the Commission as is required, for which a requirement has been made within this report under the section headed management and administration. We observed staff members to be very attentive to service users’ needs, they were observed to be very gentle with the residents, were observed to sit with service users and interract with them on a one to one basis and were knowledgable about their individual needs. Residents who are dying are cared for in the home according to their wishes. The care is provided in partnership with GPs and other services as required, these include specialist palliative care services such as Marie Curie nurses and the family and friends of residents may visit whenever they wish. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are able to take part in activities suited to their needs and abilities. One to one sessions are provided for those unable to join in group activities. The home welcomes visitors and encourages people to maintain contact with families, friends and the wider community. The food provided in the home is of good quality, freshly prepared and cooked on the premises, offers choice and meets the dietary needs of those using the service. Evidence: The home employs an activities co-ordinator who ensures there is a varied programme of activities providing a range of stimulating, therapeutic, interesting activities for those who wish to partake and based upon their likes and dislikes. Activities are offered two days a week both in groups and on a one to one basis, according to peoples needs and wishes, which includes quizzes, singalongs with instruments, seated exercise, art and craft and cooking. The weeks activities on offer for those who wish to partake are posted around the home and staff inform service users verbally. Care Homes for Older People Page 16 of 31 Evidence: A number of activities folders were on view containing ideas and examples in which staff and visitors alike can partake in one to one activities with those using the service; these included quizzes, articles for general discussion, topics of interest and poems. Whilst visiting the home, staff were observed to be spending time with service users on a one to one basis. The vicar or curate from the local church visits regularly and the Roman Catholic priest visits on a monthly basis. The church magazine is regularly received into the home and copies are made available for service users to read. There is a prayer group held once a month for people to attend if they wish and the home will assist service users to access the local church facilities if required. A number of outings are provided throughout the year and for those who are unable to leave the home the home endeavours to provide parties and arranges outside entertainers to provide in house entertainment to which family members are welcome to attend. A Halloween party has been arranged for the evening of 31st October and a Christmas party is arranged for 18th December. The home uses a wheelchair taxi service and disabled minibuses to ensure that they can offer outings to people irrespective of their disabilities. One visitor to the home told us of one such outing in which service users spent a day in the summer at Ascot, which was thoroughly enjoyed by all those who partook. The same visitor told us that he was looking forward to accompanying service users on a Christmas shopping trip in Uxbridge arranged for December. The home is situated approximately half a mile from Gerrards Cross, which offers local amenities and access can be arranged with a local wheelchair taxi service for those who require. Feedback from users of the service who completed our comment cards were mixed in relation to the provision of activities; we asked if there are activities arranged by the home that they can partake in, four answered always, one answered usually and the three remaining comment cards were completed by family members one of who answered never (named person) is confined to bed , another tells us there is always entertainment and events planned. The activities lady is very good but most of these are beyond people like my mother, although best efforts are made. People who use the service are provided with good quality food, which is freshly cooked on the premises and are offered a choice. Special diets are available to meet residents’ health and cultural needs and the chef always endeavours to take individual tastes into account. Breakfast is served between 8:00 am and 9:15 am, lunch is at 12:45 pm, and the evening meal is served at 6:00 pm. Most residents have their Care Homes for Older People Page 17 of 31 Evidence: meals in the dining room although some prefer to have meals in the lounge or in the privacy of their own bedroom. Assistance is given to those who require. Breakfast is usually cereal, porridge or toast with a cooked breakfast offered twice a week and on one day at the weekend, although they are made available daily if required. Drinks are provided as required and fresh fruit is provided on a daily basis. Morning coffee and afternoon tea are served with biscuits. Relatives are welcome to take an active part in continuing to provide support to their relatives at mealtimes, if they so wish and a number were seen to be enjoying doing so during this visit. Family and friends feel welcome and know they can visit the home at any time. Visitors comments about the home include marvellous atmosphere here, its very nice, very homely, I like everything Ive seen…the staff are very nice and they work well as a team. All those spoken to were complimentary about the provision of care. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure, which is accessible to service users, family members and visitors to the home. Policies and procedures are in place to safeguard service users from abuse. Evidence: Information about the complaints procedure is displayed on the wall in the entrance hall setting out the process to be followed should a resident or visitor be dissatisfied with any aspect of the service. Discussions with service users, family members and visitors to the home, informed us that they were aware of how to make a complaint if the need arose. They said that they were confident that any complaint made would be taken seriously and acted upon appropriately. There have been two complaints received into the service during the last 12 months, one of which was dealt with in line with the services documented policy and another which was ongoing at the time of our visit and has involved liaison with relevant agencies in the community and with CSCI. The commission has not received any complaints in relation to the service during this period. The home has safeguarding systems in place to protect service users; the safeguarding of vulnerable adults is taken seriously, any allegations are dealt with appropriately and in line with the local multi agency procedures and staff members Care Homes for Older People Page 19 of 31 Evidence: receive training at induction and regularly thereafter to enable them to recognize and respond to any incidences or allegations of abuse. A copy of the Buckinghamshire local interagency policy and procedure for safeguarding adults is available in the home. Staff are provided with and understand their responsibility to use the homes whistle blowing policy if the need should arise. The service itself has not had any safeguarding referrals or investigations during the last 12 months, and we at the Commission have not been alerted to any such referrals or investigations. Discussions with staff evidenced their understanding of the importance of protecting residents from abuse and exploitation at all times and understood the implications of the homes the ‘whistleblowing’ policy. We discussed advocacy input within the home and the manager tells us that if a person were to require the services of an advocate, access to such a service would be sought. It would be good practice to contact some independent advocacy services to obtain some information on the service they offer and provide information and contact details to those using the service. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides comfortable surroundings, which are equipped to meet the residents differing needs. Evidence: The home is located in a quiet residential area, within access to Gerrards Cross town centre and station. Gerrards Cross is accessible by train (Chiltern Line) and by buses serving Slough, Uxbridge, High Wycombe and Beaconsfield. There is some parking to the front of the home and in the road. Information on local taxi numbers and a bus timetable is made available for visitors. The premises consist of a pleasantly proportioned large two-storey Edwardian building, with the addition of a more recent ground floor extension, which provides accommodation for 29 residents; 24 bedrooms, five of which offer shared accommodation. There is a garden to the rear of the property and a large enclosed courtyard, which is attractively decorated with baskets and tubs of flowers during the summer months, along with tables and chairs for residents and their visitors to enjoy. The entrance hall leads to the administration office and then through a set of doors to the living room. Both the living room and dining room have easy access to the courtyard. The majority of bedrooms and services are on the ground floor and there is a passenger lift allowing for access between the two floors. There are 19 single Care Homes for Older People Page 21 of 31 Evidence: bedrooms and five double bedrooms, all of which have hand wash basins and approximately 70 have the addition of private toilets. All shared bedrooms have curtains and screens to provide for privacy. Accommodation for each resident is furnished and equipped to ensure them the right to comfort and privacy. The manager informed the inspector that the home always encourages residents to bring small items of furniture and memorabilia to personalise their rooms to their own liking, which was evident on touring the home. Residents and their family members spoken to on the day informed the inspector that they were very happy with their rooms and found them to suit their needs. The home has sufficient toilet, washing and bathing facilities, all of which were accessible and clearly marked. The home provides grab rails in corridors, bathrooms, shower room and toilets and hoists and assisted toilets and baths are available to meet the residents’ needs. The communal WCs and bathrooms are equipped with hoists, Arjo/Parker baths and grab rails to assist service users with maintaining and promoting independence. Grab rails, hoists and a passenger lift are in place and a call system is fitted in the building, which enables residents to call staff in the case of an emergency. The homes laundry facilities are, located well away from areas of food preparation and contained the appropriate washing machines with the specified programming to meet disinfections standards. There are infection control policies and procedures in place and the staff were observed to be washing their hands and wearing appropriate protective clothing. Likewise, visitors to the home are provided with alcohol hand rub to use when visiting and leaving the home. Visitors seen during this visit were all observed to use the rub without any necessary prompting from staff. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is staffed in accordance with the needs of the service users and staff receive the appropriate training to meet their needs appropriately. A thorough recruitment procedure is followed to ensure, as far as is possible, the health, safety and well being of the residents in their care. Evidence: The home has a good recruitment procedure to ensure that suitable staff are employed to look after their vulnerable clients. Application forms are completed, references are collected and face-to-face interviews are undertaken. Relevant POVA (protection of vulnerable adults) and CRB (criminal records bureau) checks are undertaken to ensure the persons suitability with working with vulnerable people. Three staff files were sampled for inspection, which contained all the relevant pre-employment checks, references and their relevant qualifications. All newly appointed members of staff undergo induction training upon appointment to their posts, and are provided with mandatory training, offered ongoing training and encouraged to undertake the National Vocational Qualification (NVQ) in Care, which equips them to meet the assessed needs of the residents within the home and allow for personal development. The inspector was informed that of the 16 permanent care staff twelve have obtained their NVQ qualifications at level 2 or above in care with a Care Homes for Older People Page 23 of 31 Evidence: further two care staff are working towards their NVQ Level 3 in Care. The home is part of a ‘cluster’ of 6 homes that share their expertise, skills, knowledge and training. The home offers itself as a venue for training events held by Buckinghamshire County Council training department and the homes staff visit other homes to participate in other training events. Staff meetings have slipped although there was evidence that this was being attended to and one was booked for the day after this visit. The staffing levels on the day of inspection were sufficient to meet the needs of those using the service. The manager inform us that the staffing levels are as follows: One registered nurse and six care staff in the morning from 08:00 to 14:00, one registered nurse and four care staff in the afternoon and evening from 14:00 to 20:00, and one registered nurse and two care staff at night 20:00 to 08:00. These figures exclude the registered manager. In addition to nurses and care staff the home also employs an administrator, chef (one full-time and one at weekends), kitchen assistants, a parttime activities co-ordinator, a laundry assistant, domestic staff and a handyman. Agency staff are occasionally used and the home receives summary information on staff supplied. This includes personal details, information on training and CRB disclosures. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Austenwood Nursing Home is a well managed home, run in the best interests of the residents, using the service and safeguards are in place to protect their health, safety and welfare. Staff files do not evidence that they are provided with regular formal supervision from their line manager or have their standard of work appraised on an annual basis. Evidence: The registered manager is experienced, knowledgeable, and is competent to manage the home. She completed the AQAA document accurately and is aware of what needs to be done to improve the home. She displays a good sound knowledge of matters related to the management and running of the care home for older people and clear lines of accountability are in place. Residents and members of staff reported that the manager runs the home in an open, positive, inclusive way and they would have no worries approaching her if they had any concerns and were confident that they would Care Homes for Older People Page 25 of 31 Evidence: be listened to and dealt with appropriately, as did the feedback from surveys sent out prior to the inspection. The home has a health and safety policy statement and provides training for staff on safety topics such as moving and handling residents and fire safety training. We discussed health and safety issues and saw appropriate maintenance records relating to maintaining a safe environment for residents. Regular safety checks are undertaken relating to fire safety and infectious diseases and regular servicing and maintenance of equipment, all of which were seen to be documented appropriately The home does not act as agent or manage monies on behalf of residents. The home engages regularly with users of the service to gain feedback on various aspects of the service it provides; this is undertaken on both an informal and formal basis through feedback and questionnaires on various aspects of the service and the care provided. It is recommended that the annual questionnaire allows for family members, GP’s, social workers and any other health professionals involved with the home to take part, to provide for a more rounded view of the service. Whilst viewing a sample of three staff personnel files, it was apparent that there were some shortfalls around providing staff with formal supervision, at the required level of six per year, which the manager agreed has slipped, although assured us that staff are provided with supervision on an informal basis regularly and will ensure to record formal supervisions appropriately. One file viewed highlighted that the member of staff had started work at the home in January 2008, although no formal supervision had been recorded. A further file viewed documented that supervision had been provided in August 2008 but prior to this, the last supervision documented was 13 months previously. The third file viewed was one relating to a newly appointed member of staff, which did contain evidence of some supervision in relation to moving and handling and general care at the end of their second week. A requirement has been made to ensure that nurses and care staff receive formal supervision at least six times a year, are provided with an annual appraisal of their work and appropriate documentation to evidence these are held within staff personnel files. The home deals with a number of diverse care needs and always ensures to offer a personalised service to meet the needs of their clients. There is a commitment to ensure that all clients, however diverse their needs may be, receive a person-centred package of care, which meets their needs appropriately. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 The registered person must 31/12/2008 update the information within the residents guide which is provided to current and prospective users of the service to include all the items listed under schedule 2 of the care home reguations Regulation 4(1)c of the Care Homes Regulations 2001 requires that: The registered person shall compile in relation to the care home a written statement (in these Regulations referred to as the statement of purpose) which shall consist of a statement as to the matters listed in Schedule 1. 2 9 13 Ensure that peoples prescribed medication is administered and recorded appropriately, using appropriate codes where medication has not 31/12/2008 Care Homes for Older People Page 28 of 31 administered to evidence the reason for non administration Regulation 13(2) of The Care Home Regulations 2001 requires that the Registered person shall make arrangements for the recording, handling, safekeeping, safe administraion and disposal of medicines received into the care home. 3 36 18 Ensure that nurses and care 31/01/2009 staff receive formal supervision at least six times a year, are provided with an annual appraisal of their work and appropriate documentation to evidence these are held within staff personnel files Regulation 18(2) of the Care Homes Regulations 2001 requires that: The registered person shall ensure that persons working at the care home are appropriately supervised. 4 37 37 Ensure to notify the Commission of any incidences which adversally affects the well being or safety of any person who uses the service. Regulation 37(1)e of the Care Home Regulations 2001 requires that the Registered person shall give notice to the commission without delay of the 31/12/2008 Care Homes for Older People Page 29 of 31 occurrence of: e) any event in the care home which adversely affects the well being or safety of any service user 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 17 It would be good practice to contact some independent advocacy services to obtain some information on the service they offer and provide information and contact details to those using the service. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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