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Inspection on 15/12/08 for Autumn Grange Care Home

Also see our care home review for Autumn Grange Care Home for more information

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Autumn Grange Care Home 19-29 Herbert Road Sherwood Rise Nottingham NG5 1BS     The quality rating for this care home is:   zero star poor 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: Karmon Hawley     Date: 1 6 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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 35 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 35 Information about the care home Name of care home: Address: Autumn Grange Care Home 19-29 Herbert Road Sherwood Rise Nottingham NG5 1BS 01158417475 01159620061 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Sherwood Rise Ltd care home 76 Number of places (if applicable): Under 65 Over 65 51 25 dementia old age, not falling within any other category Additional conditions: 0 0 Registered Manager must be full time and have full time supernumery hours of work That the identified bedroom to be only used for residents who by virtue of their needs are unable to use an ensuite facility. Three Senior Carers to be in charge, one on each unit (three in total) from 08:0020:00 for 76 service users at least 7 (seven) care assistants must be provided from 08:0020:00 Date of last inspection Brief description of the care home The home is located in a quiet residential area of Nottingham (Sherwood Rise) with access to local amenities. The city centre of Nottingham is about 1 mile away and there is a direct bus route to and from the city centre with a bus stop about 300m metres from the care home. A park and ride service is available, about 500 metres from the care home. The home is split into three units, two of which provide up to fifty-one (51) places for people who may have a Dementia related illness (residential, Care Homes for Older People Page 4 of 35 Brief description of the care home non-nursing). The other unit provides personal care (residential care, non-nursing) for up to twenty-five (25) older people. There is a choice of lounges and combined dining room areas. The building is wheelchair accessible with adaptations and equipment appropriate to the needs of the service users. The garden area to the front of the premises has an enclosed safe garden to enable residents to access it safely. Parking is limited at the front of the building but there is more space available at the rear of the building itself as well on the road parking. The current basic weekly fees for the service is £329. The most recent inspection report can be found in the entrance hall. Care Homes for Older People Page 5 of 35 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: zero star poor 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 focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people living at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. Two regulatory inspectors conducted the unannounced visit over 2 days, including the lunchtime periods. A review of all the information we have received about the home from the provider and the general public since the last inspection was considered in planning this visit and Care Homes for Older People Page 6 of 35 this helped decide what areas were looked at. The main method of inspection we use is called case tracking which involves selecting the care plans of 6 people and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. The registered provider, acting manager, members of staff and people who use the service were spoken with as part of this visit. Two hours were spent carrying out a specialist observational technique called SOFI (specialist observational framework inspection). During this time we observed the care given to a small group of people who have dementia. All observations were followed up by discussions with staff and examination of records. As we were unable to effectively understand and communicate with some of the people living at the home, some judgements in this report are drawn from our observation of staff and resident interactions. Documents were read as part of this visit and medication was inspected to form an opinion about the health and safety of residents at the home. A partial tour of the building was undertaken, all communal areas were seen and a sample of bedrooms to make sure that the environment is safe and homely. What the care home does well: What has improved since the last inspection? What they could do better: Plans of care must be person centred and reflect peoples personal choices and preferences. This will ensure that people receive their care and support in their preferred way. Plans of care must be in place for peoples highlighted needs. This will ensure that peoples needs are fully met. Plans of care must be reviewed on a regular basis or when changes occur in a persons condition. This will ensure that people receive care and specialist support according to their needs. All staff must be fully aware of peoples plans of care and support people using the service accordingly. This will ensure that peoples needs are fully met. Risk assessments must be in place for all highlighted risks. This will ensure that risks are reduced and managed as far as reasonably practicable and people using the service remain safe. Poor working practices must be investigated and eradicated. This will ensure that people are protected from abuse. Staff working with a POVA 1st (a check to see if a person has been placed on a register of people that have abused vulnerable people in the past) in place must be supervised Care Homes for Older People Page 8 of 35 by another member of staff who has a satisfactory criminal record bureau check in place whilst waiting for theirs to be returned. This will ensure that people using the service are protected from unsuitable people caring for them. ufficient numbers of staff must be available to support people using the service at all times during the day. This will ensure that people receive support and assistance when they need this. The manager must make an application to the Commission for Social Care Inspection to become the registered manager. This will ensure that people live in a care home that is well run and managed. Further developments in quality assurance systems must take place. This will ensure that people receive good quality care and they are supported to have a say in how the care home is run and managed. 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 35 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 35 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. A new admission process will ensure that staff can meet peoples needs before they move into the care home. The service does not offer intermediate care. Evidence: The statement of purpose has been updated to reflect the current management arrangements and the changes to the environment. The service is currently not admitting any new people into the care home until outcomes for people using the service have been improved upon, however there have been no concerns in this outcome area previously. The acting manager has however in anticipation of new people being admitted to the service in the future, devised a new admission process that will ensure that peoples needs are fully assessed to make sure that staff can meet these before a decision to move into the care home is made. Care Homes for Older People Page 11 of 35 Evidence: Intermediate care is not provided at the home and this standard is not applicable. Care Homes for Older People Page 12 of 35 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all peoples care files have plans of care or risk assessments in place that are specific to their needs resulting in their needs not being fully met. People using the service are not protected by the medication practices that take place. Evidence: The Acting manager and staff are currently working towards updating peoples plans of care; therefore plans of care that we examined are in two different formats. Plans of care that have been updated now contain a section that specifically relates to an individuals personal life and their life history. Staff have worked closely with people and their relatives and extensive information and photographs are available within some files. Plans of care are in place for identified needs and these are based upon a persons strengths and remaining abilities so that these can be maintained. They are personalised and reflect individual likes and dislikes in the way they want their care Care Homes for Older People Page 13 of 35 Evidence: needs to be met. The Mental Capacity Act and a persons ability to communicate is also assessed to make sure that peoples rights and choices are upheld Each person now has a key worker who is responsible for the persons plan of care, personal care needs and belonging. Plans of care that have not been updated do not contain specific information in regards to peoples needs. Within one plan where a person has been refusing medication for several weeks, despite staff reviews and concerns, the plan of care had not been updated and advice from a doctor had not been sought to address this issue. There is no risk assessment in terms of refusal of medication, nor is there any action plan which would guide staff as to when they should refer a refusal of medication on to the doctor. Plans of care are not personalised, do not outline personal preferences and are based more on the things that a person cannot do rather than their strengths and remaining abilities. Within a plan of care in regard to dementia care needs and behaviour that is challenging the plan does not outline how staff are to support the person in order for their needs to be met. When carrying out our specialist observation we saw that staff practices are not always the same as the plan of care. For example within one plan it stated that a person needed help and assistance with eating their meal, however on the day of the visit this person was observed to eat their meal unaided. Also within another plan it stated that a person required regular changes of position, and regular snacks and drinks between meals due to weight loss, however this did not take place throughout the observational period. Risk assessments are not in place for all identified risks, where are person had been identified as having behaviour that is challenging, there is no risk assessment in place as to how staff will ensure that this person and others using the service remain safe. Also during the tour of the care home we saw that bed rails are in use with no bumpers on them to protect the person from entrapment or knocks on the rails. There are no risk assessments in place to tell us how people are being protected from this. Within case files examined we saw that people using the service have access to specialist services such as the doctor, district nurse and optician as required, with the exception of the above incident where refusal of medication was not followed up. Care Homes for Older People Page 14 of 35 Evidence: During the tour of the care home we saw that people have access to specialist equipment such as cushions and mattresses as needed for pressure area care. We saw staff carry out good manoeuvres in manual handling and offer people explanations before they assisted anyone to move. Staff spoken with are aware of the need for pressure area care to make sure that a person does not develop a sore due to sitting in one place for long periods of time, however during our observational period we saw that one person was left sitting in the same place for the whole two hours and during this time was not offered food or drink. This was discussed with the acting manager following the observation and when we checked this person had then received attention in the mean time. One staff member said that people can see the doctor at any time and one person using the service confirmed this. The service received a pharmacy inspection on 2nd October 2008 where issues of concern had been noted. Four requirements were set along with two good practice recommendations in regards to poor medication practices. During this inspection we looked at the medication practices in all of the units to see if things had improved. Despite staff receiving training in medication practices; on examining these we found that there are a number of gaps in medication administration charts. There are incidents where medication has been signed for but not administered and administered but not signed for as given, which could result in people not getting their medication as prescribed. There is a large amount of unused medication in the treatment room, which the acting manager stated is to be returned to the pharmacy. There are no records documenting the medication stored here to keep an audit trail of unused medication. During the inspection we found that the medication room keys had been left in a cup in unit one, so that anyone could use these and access the treatment room. We informed the acting manager who acted upon this immediately. On examining medication records we saw that on some occasions people due to their dementia care need refuse medication for long periods of time. Within one plan of care only two references have been made in regard to a person refusing medication, despite this being ongoing for several weeks. This concern had not been referred to a doctor to see if an alternative method could be used to ensure that this person received their medication appropriately. Also within another plan in regards to Care Homes for Older People Page 15 of 35 Evidence: challenging behaviour we saw that episodes where medication has not been administered that behaviour is affected. The acting manager stated that there have been problems with the current pharmacy arrangements and showed us evidence that alternative arrangements have been looked into. She said she hoped that this would address some of the issues in regard to record keeping and medication disposal. During the specialist observation we saw that the person administering medication left the medication trolley open and unattended whilst they carried out another task. During the inspection two members of staff made a whistle blowing allegation about poor practices in dealing with medication. This incident was alerted to the Local Authority by the acting manager as soon as possible and is currently being investigated. Due to the what we found and the fact that a requirement set at the previous inspection, in regard to ensuring that arrangements must be made for the safe administration and recording of medication had not been met we issued a Code B (a document that allows us to seize evidence under the Police and Criminal Evidence Act). This allows us to assess any further enforcement action that we may take to ensure compliance. We saw staff treat people using the service with respect and maintain their dignity throughout the inspection. Staff spoken with are able to discuss how they make sure that they do this all the time when supporting people. One person using the service told us, the staff are very kind to me, they always knock on my door before they come in and they are respectful towards me. Care Homes for Older People Page 16 of 35 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 supported to carry out activities of their choosing and maintain contacts with people that are important to them. Evidence: During our specialist observation we saw staff interaction with people using the service was mainly good and that staff are kind and caring with a gentle approach. They spent time interacting with people and dealt with behaviour that is challenging well on all but one occasion. On this occasion a staff member was attempting to use reality reorientation but was unsuccessful. During the observational period people using the service ranged from being in a positive state of well being when interacting with staff and carrying out activities to a withdrawn state when there was limited interaction. The acting manager has increased staffing levels so that there are more staff available to spend time with people using the service. She stated that she did not want a specific activities coordinator but wanted all staff to carry out activities with people as they know them better and will be able to support them according to their needs. Care Homes for Older People Page 17 of 35 Evidence: Staff spoken with said that there is a lot more now for people to do, such as bingo, arts and crafts, dominoes, jigsaws and reminiscence therapy. People using the service told us that the manager had spent time with them asking what sort of things they like doing and what they want to do. There is a monthly church service held at the care home should people wish to attend this. The acting manager also outlined facilities, such as the polish synagogue that are available within the local community for people to attend should they wish. There are no restrictions on visiting so that people can maintain contact with people that are important to them. We saw several visitors come in to the home and spend time with their relatives. Staff spoken with confirmed that people can visit at any time. People using the service told us, my daughter often comes, we tend to sit in the conservatory as it is nice and quiet here, and we can have visitors when we want it is not a problem. Staff are able to discuss the differing needs of people using the service and how they support them to make sure their needs are met. They told us, people have the right to make choices, and we should ask them what they want to do, they can go to their rooms whenever they want and have visitors whenever they want, we know peoples likes and dislikes, they have the right to do as they wish, for instance if they want to stay in bed, they should feel that they can do this, we should not rush them to do things, people should have choices, we should make them feel special, it is their home. We should spend time talking with people and make sure that they feel safe and well cared for, and diversity is all about the persons reality, where they are at, this is where we need to go in order to converse with them and support them to be happy. People using the service told us, I can generally do as I like, I tend to spend a lot of time in the lounge but I am happy doing this, and I can make my own choices, I go to bed when I want and do what I want in the day time. Throughout the visit we saw that people are not restricted in what they do and that staff support people in making choices when needed. The menu that is on offer is of a traditional nature with choices available at each mealtime. The acting manager has implemented a new picture menu so that people can see what food is available at each mealtime and make a choice. Care Homes for Older People Page 18 of 35 Evidence: We saw that people had different meals at both the lunchtime and evening meal. We saw staff assisting people to eat at their own pace without rushing them, however some people had to wait for their meals, which went cold due to staff availability during this time. Staff spoken with are able to discuss the specialist diets that are provided, such as diabetic diets and liquidised diets and the reasons for these. They also confirmed that peoples cultural needs are catered for and there are sometimes different choices such as Afro-Caribbean for those who want it. People using the service told us, the food here is good, we get plenty to eat, I like the food here, we do get choices so there is generally something that everyone likes, and the food is good, it is tasty. Care Homes for Older People Page 19 of 35 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 adequate 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 assured that their complaints will be listened to and acted upon. Although staff have received training in their responsibilities for ensuring that people remain protected from abuse and they can discuss this, people are not fully protected as allegations continue to be made about poor practices occurring within the care home. Evidence: The service has not received any complaints since the previous inspection. A revised complaints procedure is on display in the main entrance and is also within the terms and conditions of admission so that people know how to make a complaint if they need to. Staff spoken with are able to discuss how they would handle a complaint should one be received so that this is resolved. People using the service told us, I am very happy here, the staff are very good, and I dont have any complaints, I like living here. The majority of staff have received training in their roles and responsibilities in protecting people from abuse. Staff spoken with are able to discuss this and how they ensure that people remain safe and protected. Care Homes for Older People Page 20 of 35 Evidence: Despite this there has been seven allegations of abuse occurring in the care home since the previous inspection. Due to this several meetings have taken place with the Local Authority, the Commission for Social Care Inspection and the provider in order to investigate these and improve standards of care for people using the service. Care Homes for Older People Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service live in a comfortable and well maintained environment. Evidence: There is evidence of ongoing maintenance taking place and a new hairdressing and sensory room has been installed. We saw that the acting manager has implemented new cleaning rotas to ensure that a high standard of hygiene is maintained. Staff also complete daily maintenance reports so that any concerns are dealt with quickly. All areas of the care home accessed were clean and tidy. A concern about the availability if gloves and protective clothing had been raised prior to our visit. On visiting the care home we saw that gloves and aprons are readily available and the acting manager told us that she had dealt with this issue. Staff spoken with confirmed that protective clothing is available and we saw staff using this appropriately, One person told us that they had brought in some of their own nik naks to make their room feel more like their own. Care Homes for Older People Page 22 of 35 Care Homes for Older People Page 23 of 35 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. People using the service sometimes have to wait for help and assistance due to insufficent staffing levels at busy periods such as meal times. People using the service are not fully protected by the recruitment procedures in place. Evidence: On arriving at the care home we undertook a tour of the care home to see check how many staff members are on duty. This confirmed that the people on duty are clearly reflected on the duty rota and that there is currently three members of staff on each unit throughout the day. The acting manager has increased the number of staff available on each unit to assist in personal care and activities. She is also trying to break the cycle of staff undertaking long shifts so that they do not become tired and standards of care do not reduce due to this. Staff spoken with said that the staff team work well together and always help each other if needed. They stated that they felt sufficient members of staff are generally available but they do become very busy at certain times of the day. During our specialist observation we saw that people had to wait to be assisted with Care Homes for Older People Page 24 of 35 Evidence: their meal at lunchtime. Due to the amount of people that needed assistance and the availability of staff, some people sat with their lunch in front of them going cold whilst waiting for help. We saw staff standing whilst they assisted people to eat and one member of staff helping two people at once. To ensure that new staff are aware of their roles and responsibilities when they first commence working at the care home they undertake an induction. There is evidence of staff undertaking inductions within staff files examined. One new member of staff spoken with confirmed that they had undertaken an induction when they first started and they said that this had been helpful in giving them time to get to know people. So that staff have the necessary knowledge and skills to care for people using the service, the majority of them have completed the National Vocational Qualification level 2 (a nationally recognised work and theory based qualification). Those who have not completed this training have now registered to start it or have started working towards it. All members of staff spoken with confirmed that they have completed this training and one person told us that it had helped them to understand peoples needs better. Staff files examined contain all the necessary documentation such as references and a criminal record bureau check (a check to see if an individual has a police caution or conviction) required by law to make sure that people are protected from unsuitable people being employed. Three members of staff are currently working with only a POVA 1st (a check to see if a person has been referred to a list that contains the names people that have abused vulnerable people in the past) in place whilst waiting for their criminal record bureau check to come back. There is no evidence to show that they are being supervised by staff who have a criminal record bureau check in place to make sure that people are protected. The administrator told us that these people are being supervised, however could not evidence this. There is no evidence on the staff duty rota to demonstrate that these people are working under supervision. Staff spoken with could not confirm that staff are being supervised whilst they are waiting for their criminal record bureau check to come back. They did however confirm that they have a criminal record bureau check themselves in place. We left an immediate requirement form that states evidence that these people are Care Homes for Older People Page 25 of 35 Evidence: working under supervision must be presented to show us that people are protected from unsuitable being employed. The staff training matrix examined shows that all members of staff are doing dementia care training and several staff members have undertaken courses in first aid, manual handling, health and safety and food hygiene. The training matrix demonstrates that further training has been arranged for other staff in compulsory areas such as manual handling, health and safety and fire. Staff files evidences that this training is taking place and staff spoken with told us, I have done dementia care training, food hygiene, manual handling and first aid, I am happy with the training that I am getting, and I feel supported in my development, I have done in house training and I am working towards my NVQ (National Vocational Qualification) level 3. One person using the service told us that they feel that staff are well trained as they look after them very well. Care Homes for Older People Page 26 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At present people using the service only have a limited say in how the care home is run and managed as the new management structure is still in its infancy. Peoples personal allowances are secure and protected. Evidence: The acting manager has been in post for six weeks. She has previous managerial experience in a clinical area and has also worked at the care home in the past. She is able to outline the way in which she intends to manage the care home to raise standards for people living there. Staff spoken with stated that many improvements have been made within the last six weeks and that they feel more comfortable about how the care home is running. I was initially horrified at how things used to run, but things have much improved since Paulette has started, she has sorted things out, it is more organised on the unit, Care Homes for Older People Page 27 of 35 Evidence: Paulette is doing checks on the quality, it is making things better, there is more of a management structure, which is better as there are clear lines of accountability, and everything is much better now with the new manager, she sat down and showed me how to do care plans, it is a better atmosphere and people are happier now they are doing more. Two people using the service also told us that they felt things are a bit better now and they had more things to do. There has not been any further development in regard to the quality assurance systems as the acting manager has been concentrating on improving the care plans. However she has arranged for meetings to take place with people using the service and relatives so that they may discuss any issues they may have. She has also moved her office into the main entrance so that she is readily accessible to people who may need her. In the mean time there are questionnaires located in the main entrance should people choose to fill these in. People are able to money kept in the care home safe should they wish and they are able to access this when they need to. Concerns had been expressed prior to this visit, that money was being taken out of peoples personal accounts for toiletries that they had not had. We examined four personal allowances and all corresponded with the accounting sheet and receipts are available for all transactions. The practice of the care home supplying toiletries and charging for these has ceased and alternative arrangements have been arranged to suit individuals. Staff spoken with said that people are able to access their money as they wish, however they are not responsible for handling money as this is done by the administrator. One person spoken with told us that they had money kept in the safe and that they felt that it is kept safe for them. The acting manager has devised a new supervision policy that incorporates staffs expectations of their current roles and the development that they need. There is evidence in staff files to show that these have now begun to take place. Staff spoken with confirmed that they have now started having supervisions and that these Care Homes for Older People Page 28 of 35 Evidence: are proving helpful in their development. We examined the hoist and electrical certificates which show us that these have been serviced and passed as safe to use. During the tour of the care home we did not see any obvious hazards with the exception of the bed rails in use. Staff spoken with are able to discuss health and safety issues such as infection control and keeping people safe. Care Homes for Older People Page 29 of 35 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 35 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 1 29 18 Staff working with a POVA 1st in place must be supervised by another member of staff who has a satisfactory criminal record bureau check in place whilst waiting for theirs to be returned. This will ensure that people using the service are protected from unsuitable people caring for them. 13/01/2009 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 13 Risk assessments must be in 28/02/2009 place for all highlighted risks. This will ensure that risks are reduced and managed as far as reasonably practicable and people using the service remain safe. 2 7 12 All staff must be fully aware 28/02/2009 of peoples plans of care and support people using the service accordingly. This will ensure that peoples needs are fully met. Care Homes for Older People Page 31 of 35 3 7 15 Plans of care must be reviewed on a regular basis or when changes occur in a persons condition. This will ensure that people receive care and specialist support according to their needs. 28/02/2009 4 7 15 Plans of care must be in place for peoples highlighted needs. This will ensure that peoples needs are fully met. 28/02/2009 5 7 12 You must ensure that plans 30/03/2009 of care are person centred and reflect peoples personal choices and preferences. This will ensure that people receive their care and support in their preferred way. 6 9 13 Medicines requiring refrigeration must be stored within the correct temperature range. This must be demonstrated by daily records. Medicines must be stored in accordance with manufacturers instructions, to ensure their efficacy and safety. 30/01/2009 7 9 13 Controlled drugs must be stored and recorded in accordance with the Misuse of Drug Regulations. Legal requirements must be met for security reasons. 30/01/2009 Care Homes for Older People Page 32 of 35 8 9 13 Risk assessments must be 30/01/2009 carried out when enabling people to look after and take thier own medicines. These assessmnets must be reviewed regualry. The health and welbeing of people living in the home must be protected. 9 9 13 Medicines must be given in line with prescribed instructions. This must be demonstrated by record keeping practices. The health and well being of people living in the home must be protected. 30/01/2009 10 18 13 You must ensure that poor working practices are investigated and eradicated. This will ensure that people are protected from abuse. 10/02/2009 11 27 19 You must ensure that sufficient numbers of staff are available to support people using the service at all times during the day. This will ensure that people receive support and assistance when they need this. 20/02/2009 12 31 8 The manager must make an application to the Commission for Social Care Inspection to become the registered manager. 12/03/2009 Care Homes for Older People Page 33 of 35 This will ensure that people live in a care home that is well run and managed. 13 33 24 You must make further developments in quality assurance systems. This will ensure that people receive good quality care and they are supported to have a say in how the care home is run and managed. 12/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 The registered provider should ensure that the maximum and minimum temperatures of medicine fridges are recorded daily to show that medicines are stored at the correct temperature at all times. The registered provider should risk assess the storage facilities for medicines to ensure that medicines are securely stored. The registered provider should review arrangements for the disposal of unwanted waste medicines. To ensure that medicines are disposed of promptly. 2 9 3 9 Care Homes for Older People Page 34 of 35 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). 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