Inspection on 23/09/08 for Autumn House

This inspection was carried out on 23rd September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Autumn House 11/10/07

Autumn House 30/11/06

Autumn House 27/04/06

Autumn House 19/10/05

Autumn House 29/04/05

Autumn House 18/11/04

Autumn House 12/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 05/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Autumn House 21 - 27 Avenue Road Sandown Isle Of Wight PO36 8BN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Janet Ktomi     Date: 2 3 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Autumn House 21 - 27 Avenue Road Sandown Isle Of Wight PO36 8BN 01983402125 Telephone number: Fax number: Email address: Provider web address: office@autumnhousecare.demon.co.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Janice Ioannou Type of registration: Number of places registered: Mrs Janet Holmes care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 44. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) Physical disability (PD). Date of last inspection Brief description of the care home Autumn House is a large period property situated in a busy part of Sandown. The property has been extended in recent years and provides accommodation on the ground and first floors for up to 44 older people and is registered to provide care for up to 31 older people with dementia. The first floor can be accessed via a passenger lift and the addition of ramps, during the extension, has improved access for those Care Homes for Older People Page 4 of 32 44 0 44 Over 65 0 44 0 Brief description of the care home residents who are not fully mobile. There is limited parking in the street and staff park in the courtyard area of the building, which restricts off road parking for visitors. There is a small area of garden to the rear of the property, with a terraced seating area. The home can provide daycare and short stay/respite accommodation. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The home was previously inspected on the 11th October 2007. This report contains information gained prior to and during unannounced visit to the home undertaken on the 23rd September 2008. All core standards and a number of additional standards were assessed. Compliance with requirements made following the previous inspection in October 2007 was also assessed. The visit to the home was undertaken by one inspector and lasted approximately eight hours commencing at 9.45 am and being completed at 5.30 pm. The inspector was able to spend time with the registered manager, provider and staff Care Homes for Older People Page 6 of 32 on duty. The inspector was provided with free access to all areas to all areas of the home, documentation requested, visitors and people who live at the home. Prior to the inspection visit the registered manager had completed the homes Annual Quality Assurance Assessment (AQAA), this was received at the commission following a reminder letter and information from it is included in this report. Information was also gained from the homes service file containing notifications of incidents in the home. Surveys were sent to the home for distribution prior to the inspection visit, however these were returned to the commission as the post office could not deliver them to the service and they were not collected from the post office. Following the inspection visit the inspector telephoned local health and social care professionals who regularly visit the home. What the care home does well: What has improved since the last inspection? The home has undertaken a number of improvements to the environment. All bedroom doors have been fitted with an electronic system that is linked to a key fob that only requires to be placed near the detector to open he door. This system is individualised to each door with staff having a master fob. The manager and care staff stated that this has eliminated the problems of people going into other peoples bedrooms. Doors cannot be locked from the inside, so only prevent people without the correct key fob going into bedrooms. The home has also secured the two flights of stairs such that key coded doors are now fitted to the top and bottom. All doors open automatically in the event of fire alarms sounding. The home has continued to redecorate and refurbish bedrooms and the kitchen has also been modernised and refurbished. The home has purchased two mattress detectors capable of sensing if people are getting out of bed or having seizures. An entrance hall has been created providing a place where information can be available for relatives and has reduced problems for people entering and leaving the home. At the time of the previous inspection in October 2007 the home was introducing a new computerised care planning system. This had not been completely introduced and a requirement was made that peoples care plans must include details/information of how peoples psychological, emotional and social care needs are to be met. Care plans viewed on this visit contained information covering all these areas. The home has changed the way that medication is administered so that the staff member who dispenses the medication also gives it to the person for whom it has been prescribed. This was a requirement from the previous inspection in October 2007 which has been complied with. A recommendation was made following the previous inspection in October 2007 that there are individual protocols for as required medication. These were seen during this Care Homes for Older People Page 8 of 32 inspection visit. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 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 32 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. All people are assessed prior to moving into the home to determine that their individual needs can be fully met. People, or their representatives, are able to visit the home prior to admission to assess the quality, facilities and suitability of the home. Standard 6 is not applicable as the home does not provide intermediate care. Evidence: The registered manager explained the homes admission procedure and the preadmission assessments for two people admitted shortly before the inspection visit were viewed. The inspector discussed admissions with care staff and with relatives of people living at the home who were visiting on the day of the inspection visit. Due to age related memory loss it was not possible to discuss the admission process with the people who live at the home. Care Homes for Older People Page 11 of 32 Evidence: The registered manager stated that if an initial inquiry from either social services or from a persons family indicates that the home would be able to meet the persons needs the manager will arrange to visit the person, either at their home or in hospital. A comprehensive pre-admission assessment is completed including where possible members of the persons family and professionals involved in their care. Care manager assessments and hospital discharge information was also seen in care plans viewed. The person is provided with information about the home and where practicable is invited to visit the home before making a decision as to whether to move in on an initial trial basis. When the person is unable to visit the home a relative is invited to view the available room and facilities at the home. The home has an assessment tool that covers all the relevant areas necessary for the home to decide if it is able to meet a prospective persons needs. The registered manager stated that she will also visit and if necessary reassess people who have been admitted to hospital before they are discharged back to the home to ensure that their needs can continue to be met. Discussions with relatives who were visiting the home at the time of the unannounced inspection visit confirmed that they had received written information about the home and been able to visit the home prior to their relative moving into the home. A copy of the homes service users guide was seen in the entrance hall with other information that may be of interest to relatives. Discussions with care staff confirmed that they felt that they had enough information about new people admitted to the home and that they had the necessary training to meet peoples needs. People living at Autumn House tend to be long term, however the home has one bedroom that is contracted to the local social services to provide respite/short stays. The registered manager stated that the same admission procedures would be used for respite or short stay admissions as for long-term admissions. The home would also consider respite/short stay accommodation for private people if a suitable room were available and the same pre-admission procedures would be followed. The home does not provide dedicated accommodation for intermediate care or specialist facilities for rehabilitation. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health, personal and social care needs are set out in an individual plan of care that states how peoples needs should be met. Medication is correctly stored however records are not fully completed and people have not received all their prescribed medication. People are treated with respect and their dignity maintained. Evidence: Four care plans were viewed, two for people admitted to the home shortly before the inspection visit and the others for people who have been living at the home for a longer time. The inspector discussed with staff, visitors and people who live at the home how care needs are met. Following the inspection visit the inspector telephoned care managers and health professionals who regularly visit the home. At the time of the previous inspection in October 2007 the home was introducing a new computerised care planning system. This had not been completely introduced and a requirement was made that peoples care plans must include details/information of how peoples psychological, emotional and social care needs are to be met. Care plans Care Homes for Older People Page 13 of 32 Evidence: viewed on this visit contained information covering all these areas. People have a detailed plan of care that related to the persons assessment. The care plans are individualised and person centered being written in plain language providing sufficient information as to how needs should be met. Plans are reviewed on an as needed or monthly basis with reminders provided by the computer when reviews are due. Photographs were seen in care plans. Care plans contained relevant risk assessments and management plans including nutrition, falls and any individual risks such as those resulting from memory loss. The home monitors peoples weight on a monthly basis with records seen. The manager stated that new sit on scales had recently been purchased so that all service users could now be weighed. Care staff spoken with said that communication about peoples needs was good. One person who had been admitted five days prior to the inspection visit did not have a care plan. Information about their needs was available to staff via the detailed preservice assessment and staff stated that they were aware of the persons needs. The manager said that she would be completing the full care plan as they had now had the opportunity to complete further assessment of the person. The home must ensure that even if a full care plan is not completed immediately on admission that risk assessments such as for moving and handling are completed. The inspector was able to talk with the relatives of people who live at the home who stated that they felt their relatives always received the care and support they need. They also stated that they were kept informed of any issues or concerns. Health and social care professionals who regularly visit the home were telephoned following the inspection visit. They stated that they felt that staff had knowledge about the people who live there and that peoples health needs were met. The external professionals also felt that the home consulted them when necessary and followed the advice and guidance given. Care plans contained individual manual handling assessments. Manual handling equipment was viewed in the home and care staff stated that they had received manual handling training and this was recorded on the homes training matrix. The manager stated that she intends to complete a manual handling train the trainer course. Visitors and health professionals stated that they felt that staff always treated people who live at the home with dignity and respect. Although it was not possible to have an in depth conversation with the people who live at the home, those able responded that Care Homes for Older People Page 14 of 32 Evidence: the staff were nice and observations of staff interactions indicated that people are treated with respect and their right to dignity maintained. Privacy and dignity are included in the homes induction training. With the exception of one room that may be uses as a twin room if specifically required all bedrooms are for single occupation providing privacy for personal care. All bedroom doors are lockable with an individual electronic key fob opening system. The manager and care staff stated that since this has been introduced that the issues of people going into other peoples bedrooms has been eliminated. Since the previous inspection there has been a safeguarding investigation completed by the local social services department. As a result the home now has a link community psychiatric nurse, community matron and care manager who visit the home weekly and have monthly meetings with the registered manager. The registered manager stated that this means she can discuss any health or social concerns with the external professionals ensuring that issues can be quickly resolved. Discussions with the external professionals indicated that the home does discuss issues with them. Care staff confirmed that they had sufficient time to meet peoples needs and discussions indicated that they had a good understanding of individual peoples needs and how these should be met. Care staff have received training to meet the specific needs of people. Following the previous inspection a requirement was made that the home must change the way that medication is administered by the care staff as the practice in place constituted secondary dispensing. The inspector observed part of the teatime medication round and discussed the procedures with the manager. The home has changed the procedures so that staff who dispense the medication also give it to the service user. This requirement has therefore been met. At the time of the inspection visit nobody was self administering his or her medication. Care staff confirmed that they have undertaken medication training. All medication was seen to be stored securely either in a locked medication trolley secured to a wall or in a locked cupboard. The home has the necessary storage and recording books for controlled medications. With the exception of liquids the local pharmacist dispenses most medication into blister packs. The home uses medication administration record sheets supplied by the pharmacist. Initially the inspector looked at the record sheets for people whose care plans had been viewed but as there were gaps in these, all medication administration sheets were viewed and more were also seen to contain gaps where it was not possible to determine if medication had been given or not. Three people were receiving Care Homes for Older People Page 15 of 32 Evidence: antibiotics and none had received these as prescribed by the Doctor. One person had not received any of their seven am antibiotics for the previous four days; the others had missed several doses throughout the short courses prescribed. The provider and registered manager were present when the inspector viewed the medication records and they stated that action would be taken. The provider and registered manager were also present when the inspector viewed the medication trolley. This contained several small plastic pots containing tablets and with slips of paper with a name on them. It was later identified that these were the afternoon antibiotics that were due to be given at 3pm. Three unidentified tablets were found laying in the bottom of the part of the trolley where medication is stored. The medication trolley must be kept clean. A recommendation was made following the previous inspection in October 2007 that there are individual protocols for as required medication. These were seen during the inspection visit. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The routines for daily living and activities made available are flexible and varied to suit peoples individual needs. Family and friends are able to visit. People receive a balanced diet in pleasing surroundings at times convenient to them. Evidence: The inspector spent time talking with people in the homes lounges, observed part of the lunchtime and teatime meals and met with relatives. Information about social activities was also viewed in care plans and the activities book. Care staff and the cook also discused activities and meals. The routines for daily living and activities made available are flexible and varied to suit peoples individual needs. People living in the home are able to spend their time in the home where they wish, people were seen sitting in all of the homes three lounges. One person was observed informing staff that he wanted to watch a film on television at 1.30pm. At 1.25 pm the staff member returned and assisted the person to return to their bedroom to watch the requested film on television. People were also seen moving around the home as they wished. The home has a small pleasant courtyard style rear garden which has been provided with a solid shelter for people who smoke. The rear Care Homes for Older People Page 17 of 32 Evidence: garden has level access. Care plans contained individual information such as times people like to get up and go to bed. Most of the people living at Autumn House have age related memory loss and care plans contained life history information and recorded peoples likes and dislikes. People confirmed to the inspector that they are given choice over their meals and the inspector was shown the menu choice forms completed for the day of the unannounced visit. People were seen eating different meals. Bedrooms seen contained personal items brought into the home. Care plans and assessments include information about leisure activities, hobbies and interests, catering and religious needs. The inspector viewed the activities records of both group and individual activities and observed activities during the day of the unannounced inspection visit. The home has visiting entertainers/activity providers and one was occurring on the afternoon of the inspection. A care worker assisted with this and later informed the inspector that it had given her some ideas for 1-1 activities that she could do. Care staff confirmed that they had time for activities. A notice board outside the small dining room adjacent to the lift contained a rundown of forthcoming activities and events. The home has an alternative therapy suite and provides massage/aromatherapy and Reiki to service users at no additional charge. Information about religious needs is included in care plans and the registered manager stated that she has contact details and would arrange visits from appropriate ministers/clergy if this were requested/identified as a need. The inspector was able to meet several visitors who stated that they are able to visit at any time. The home does not have a private room for visitors however the home does have a dining room that is not used outside of meal times which could offer a degree of privacy for visitors. Peoples choice about receiving visitors is respected and one care plan contained a note that service user had requested not to receive visits from a particular relative. The home has two separate dining rooms. Most people were seen to have chosen to have their lunchtime meal at the dining tables. Relatives stated that the food always looked good and people living at the home able to respond informed the inspector that they had enjoyed their lunch. The inspector was present for the main lunchtime meal and lighter teatime meal. People were see to be eating the meal and most of the plates emptied. Care staff were seen assisting one person in a non obtrusive manner. Equipment to promote independence such as lipped plates and adapted cutlery. Drinks and snacks are also available throughout the day with people confirming this as well as Care Homes for Older People Page 18 of 32 Evidence: the inspector observing people being given morning and afternoon hot drinks, fresh fruit and biscuits. The need for special diets or supplements is recorded pre-admission. The pre-admission form included information about peoples food likes and dislikes. The cook was aware of the dietary needs of people. Discussions with the cook and food supplies seen indicated that where possible fresh vegetables are used and fruit is available. The cook stated that meals are liquidized for some people and that all parts of the meal (meat, potatoes and vegetables) are all liquidised together. This practice is generally no longer considered acceptable as people are unable to enjoy a range of tastes. Liquidised meals should be prepared such that individual items are identifiable. Care staff stated that people are provided with a supper at about 7pm and those who are still up in the lounge are provided with a hot drink and biscuit at 9pm. Care Homes for Older People Page 19 of 32 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 and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. People are protected from abuse, however the home has not followed procedures for reporting incidents that may occur in the home. Evidence: The home has a clear complaints policy and procedure and a copy is in the service users guide and further information on display in the homes entrance hallway. Discussions with staff confirmed they were aware of what to do if a person or their relative complained or raised an issue. The manager identified in the homes AQAA that the home had received no complaints in the past year. Relatives spoken with stated that they did not have any concerns but if they did they would raise this with the manager. The inspector was shown the complaints record which showed that no complaints had been received since before the previous inspection. The registered manager stated that should a complaint be received she would follow the complaints policy and procedure and that the provider would be kept informed. The home has a policy and procedure relating to safeguarding adults and ensuring that people are not at risk of abuse. Care staff have safeguarding adults training as part of their induction. Discussions with care staff indicated they had an understanding of safeguarding and what they should do if they suspected abuse may have occurred. Care Homes for Older People Page 20 of 32 Evidence: Since the previous inspection there has been a safeguarding investigation undertaken by the local social services department and the home had taken measures to address issues identified. Whilst viewing the handover book the inspector noted that there had been an incident between two of the people who live at the home. This was discussed with the manager who stated that the home investigates incidents and follows these up with the external professionals who visit the home on a regular basis. The correct procedure is that the home should report incidents between people who live at the home to the commission and the social services duty team as safeguarding referrals. Following the inspection the inspector discussed this with the external professionals and identified that they were aware of other incidents between people who live at the home but that these had not been reported as per the correct procedures. Whilst there is no suggestion that the home is hiding incidents, in one instance paramedics were called to attend and external health professionals were aware of the incidents, the home must follow the correct reporting procedures. The homes policies and procedures in respect of peoples personal finances and recruitment should ensure that people are not at risk of abuse. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, safe, well maintained home that meets their individual and collective needs. Evidence: The inspector viewed the home with the registered manager and provider towards the start of the inspection visit and viewed records related to services such as gas and electric and fire safety equipment. The inspector also discussed the homes environment with care staff. The home is four older houses that have been linked and extended to provide the current home. All bedrooms are for single use although one could be used as a twin room if specifically requested. Some rooms have en suite facilities others are equipped with a wash basin. Bedrooms seen are well maintained and the home has a program of redecoration and replacement of carpets and soft furnishings. Bedrooms had personal items belonging to the person whose room it is. Since the previous inspection the home has fitted electronic locks operated by key fobs to all bedroom doors. The registered manager and care staff stated that this has eliminated problems of people entering another persons bedroom. Bedroom doors cannot be locked to prevent people exiting their bedrooms. Care Homes for Older People Page 22 of 32 Evidence: The home has also eliminated the risks posed by the homes two flights of stairs by placing doors at the bottom and top of stair cases which are operated by number codes. In the event of the fire alarms sounding all doors (including bedrooms and stairs) unlock automatically. Care staff stated that the securing of the staircases has greatly reduced risks and they are no longer spending time monitoring people on stairs or going into other peoples bedrooms. The home has a shaft lift and all parts of the home are accessible to people with mobility needs. The home has modernised and upgraded the kitchen. The home has three lounges and two dining rooms. People were observed moving freely about the home with corridors being fitted with grab rails to aid mobility. The home also has an alternative therapy suite. The home was clean and tidy throughout and there were no unpleasant odours. At the time of the visit the home was comfortably warm throughout. The visitors and people who live at the home confirmed that the home is always warm and clean. The home employs housekeeping staff. The home has the necessary moving and handling equipment and baths are fitted with hoists. The laundry was visited and is appropriate and fit for purpose with machines capable of washing to disinfection standards. Members of staff spoken with confirmed that they had access to all the necessary equipment to prevent cross infection such as disposable gloves and aprons, supplies of which were seen during the visit to the home. Substances hazardous to health (COSHH) were stored securely. Certificates seen confirmed that the homes services such as gas and electric have been checked and serviced as appropriate. Portable electrical appliances are regularly checked. Care Homes for Older People Page 23 of 32 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 employs appropriate numbers of care staff to ensure that the needs of people living at the home are met. Staff receive the necessary training. Evidence: All comments from people who live at the home, visitors and professionals were positive about care staff. Duty rotas were seen during the visit to the home. The home provides additional staff at busier times with one person commencing work at 6am and another remaining on duty until 11pm to support the two awake and one sleep-in night staff. The home also employs a cook, kitchen assistant, housekeepers, laundry and maintenance staff. During the inspectors visit staff on duty corresponded to those on the duty rota. Care staff stated that they generally have sufficient time to meet peoples needs and throughout the inspection care staff appeared to have time to meet peoples needs. Visitors felt there were generally sufficient staff to meet peoples needs. The registered manager provided training and qualification information during the inspection and on the AQAA. The home employs twenty-three care staff of whom six have an NVQ level 3 and two staff with an NVQ level 2. Two additional staff are undertaking NVQ level 2. Four care staff are due to start their NVQ level 3 in January Care Homes for Older People Page 24 of 32 Evidence: 2009 and two are doing NVQ level 4. On the afternoon of the unannounced inspection all care staff on duty had either NVQ level 2 or 3. Care staff stated that they felt they had the necessary skills to meet peoples needs and were not expected to undertake activities for which they had not been trained. Care staff stated that they have lots of training. The inspector viewed the training matrix which records training staff have undertaken and allows monitoring of when updates are due. The home has purchased a training system and supplements this with other courses when a need is identified. The registered manager stated that she intends to undertake the train the trainer course for manual handling. An in house induction is used for all new staff and supports the more detailed skills for care induction workbooks they complete during their first six weeks of employment at the home. The manager discussed the homes recruitment procedures and staff files viewed followed this process, however all staff currently employed at the hone have done so for in excess of a year so there were no new recruitment files to view on this inspection. There were no issues or concerns re the homes recruitment processes or records noted in the previous report. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager was registered in August 2008 and is aware of the qualifications she must obtain. Peoples financial interests are safeguarded. Most records are well maintained with the exception of medication record sheets. The health, safety and welfare of people and staff are promoted, however the home must ensure that all incidents are notified to the commission and social services and that medication is administered as prescribed. Evidence: Mrs Janice Ioannou was registered by the commission as the homes registered manager in August 2008. The registered manager is aware of the need to achieve an NVQ level 4 in care and a Registered Managers Award. The manager has registered for the Registered Managers Award and commenced the first unit however the training company is not able to continue to provide the course and the provider and manager are trying to identify their options in respect of the manager obtaining the necessary qualifications. A requirement is therefore not made in respect of the managers Care Homes for Older People Page 26 of 32 Evidence: qualification as the home is attempting to address this issue. Care staff and visitors were clear that they felt able to discuss any issue/concerns with the manager or provider who is often at the home. Following the previous inspection two requirements were made and these have been complied with, as has the one recommendation. The manager has undertaken formal quality assurance work including questionnaires to people who live at the home, relatives and external professionals in August 2008. Questionnaires are available for people at the homes entrance hall. The registered manager showed the inspector completed surveys, most were very positive and the manager described the action she has taken to address any issues identified. The homes registered manager completed the AQAA that was received following a reminder letter. The inspector discussed the AQAA with the registered manager and identified areas where additional information could have been provided. The home does not become the appointee for people who live at the home. Any additional expenses such as for hairdressing or chiropody are invoiced to the person responsible for paying the persons bill. A relative showed the inspector an invoice they had received. The invoice clearly showed what extra services were being charged for. Although care staff stated that they could discuss any issues with the manager or provider there is not at present a formal process of supervision every two months. The manager has undertaken appraisals on all staff and the inspector viewed minutes of team meetings that are held on a regular basis. The manager also showed the inspector some supervision she had undertaken due to specific issues that needed raising with individual care staff. The manager must ensure that care staff receive formal recorded supervision at least six times per year. Various records were viewed during the inspectors visit. All records were appropriately stored with access only available to people who should have access. As previously described the medication administration records had not been fully completed with a number of gaps where it was not clear that medication has been administered as prescribed. The home has taken steps to address safety issues such as having secure doors fitted to the staircases and the provision of mattress movement detectors. The home is well maintained and clean, with staff having relevant training to meet peoples needs. The home undertakes weekly checks of the fire detection equipment. Portable Electrical Appliance Tests (PAT), electrical wiring and gas certificates were seen. The local Care Homes for Older People Page 27 of 32 Evidence: environmental health department has awarded the home four stars (maximum being five stars) for food hygiene. The manager stated that she undertakes a monthly audit of the accidents in the home. The home has not been informing the commission of all incidents within the home that have an adverse effect on people living at the home. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 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 9 13 The registered person must ensure that all medication is administered as prescribed. Medication administration record sheets must be fully completed with no gaps. If people do not receive medication as prescribed by the Doctor then the medication will not be effective, and their health will not improve or they will become ill. The registered person must ensure that safeguarding reporting procedures are followed in all instances. Reporting all safeguarding instances to the commission and social services duty team will ensure that there is a full and thorough investigation by external professionals. 01/11/2008 2 18 6 01/11/2008 3 38 37 The registered person must ensure that notifications are 01/11/2008 Care Homes for Older People Page 30 of 32 made to the commission of any event in the care home which adversely affects the well-being or safety of any service user. Regulation 37 requires the registered person to give notice to the commission of a range of occurrences in the care home. This enables the commission to ensure that the home is managing such occurrences and monitor incidents. 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 36 Staff should receive regular formal recorded supervision six times a year. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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