Inspection on 20/01/09 for Avalon Nursing Home

This inspection was carried out on 20th January 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

The Shelley

Thorndene

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Avalon Nursing Home 5 Nevill Avenue Hampden Park Eastbourne East Sussex BN22 9PR     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: Elizabeth Dudley     Date: 2 0 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 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 32 Information about the care home Name of care home: Address: Avalon Nursing Home 5 Nevill Avenue Hampden Park Eastbourne East Sussex BN22 9PR 01323502487 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) : lynnvq@aol.com Elderly Care Home Ltd care home 21 Number of places (if applicable): Under 65 Over 65 21 0 old age, not falling within any other category physical disability Additional conditions: 0 21 The maximum number of service users to be accommodated is 21. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Physical disability (PD). Date of last inspection Brief description of the care home Avalon nursing home is registered with the Commission for Social Care to provide nursing care for up to 21 people over 65 years of age.The home is a detached converted building situated in Hampden Park on the outskirts of Eastbourne. Situated near an attractive park it is within walking distance of the village, with easy access to shops, public transport, GPs and dental surgeries.There are 13 single and four double rooms on two floors, with a large lounge/dining room on the ground floor, with sufficient space for group activities. A small seating near the office looks out onto the internal patio area, that is accessible to wheelchairs through the lounge, and is used by Care Homes for Older People Page 4 of 32 Brief description of the care home residents when the weather permits. Assisted bathrooms and toilets are on each floor and a shaft lift provides residents with access to all parts of the home. The garden to the rear is accessible by steps and the front garden overlooks the main road through the village, with parking spaces for up to 5 cars 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: This key unannounced inspection took place on the 20th January 2009 over a period of five hours and was facilitated by the manager Ms L Tobin. The methodology used to inform the judgements made in this report included examination of documentation, discussions with residents, staff and visitors to the home, a tour of the home, observation of staff interaction with residents and observation of lunches being served. Documentation examined included care plans, medication charts, menus and catering, personnel and training files and health and safety files. Care Homes for Older People Page 6 of 32 Residents and visitors comments included:Lovely home, staff nice. Very happy with the home, the food is very good, the staff very caring and polite, couldnt wish for more. Very nice staff, could do with more of them in the afternoon. I am so pleased that (my relative) is here, it gives me peace of mind, she is very happy. She is well looked after and the food is wonderful. My friend is happy here, its a very caring home, with good food and she has choices, she says its the next best thing to being at home. Staff said that they enjoyed coming to work, there was a very low turnover of staff and generally staffing levels were good. A member of staff said that an extra member of staff in the afternoon would give more time to spend with residents, but they thought that they had sufficient staff to give the care without being too rushed. The home has the same manager and owner as at the last inspection. However due to the changes in the companys registration, this is now classed as a new home by the CSCI and therefore this inspection is classed as the first inspection. Current fees for the home range between Five hundred and seventy five pounds and Eight hundred pounds per week. Extra services, such as chiropody and hairdressing are not included in the fees, and the charges for these are available from the manager. All the residents were seen and spoken with during the day, but seven residents were spoken with in depth in order to gain their views of the home What the care home does well: What has improved since the last inspection? What they could do better: Insufficient time allowed for management does not permit the management to be as effective as it should be, which may eventually impact on residents wellbeing. This was evidence by documentation within the home which did not always show evidence of actions taken. The Statement of Purpose requires review to ensure that staff details reflect the current staffing in the home. There was no evidence to show that all residents have received a copy of the terms and conditions and contracts. There was no evidence of staff supervision and a personnel file belonging to a long term member of staff did not contain all the documents and checks as required by regulation and had not been reviewed. Care Homes for Older People Page 8 of 32 Insufficient training of the manager and senior staff in adult safeguarding could put residents at risk. There were no records available to evidence that hot water temperatures to residents outlets had been monitored. Monitoring done this month showed the temperature to be well below an acceptable standard. The provider has not ensured that documentation relevant to the safety of residents in the home is kept in the home. These include electricity and gas certificates and portable appliance testing. 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. The home provides sufficient information for prospective residents which enables them to make the decision about whether they wish to live at the home. Not all residents are assessed by the manager prior to admission, and prospective residents do not receive written confirmation about whether the home can meet their needs. Evidence: There is a range of accessible information about the home and the services it provides. This includes a Statement of Purpose and Service User Guide, which are displayed in the home and given to prospective residents, relatives, representatives and other interested parties. All of the residents in the home have a copy of the Service User Guide Care Homes for Older People Page 11 of 32 Evidence: Some amendments are required to both these documents in relation to the staff in the home. The manager says that residents receive a copy of the the homes contract, which includes the Terms and Conditions of Residence, on admission. One copy of this document which had been signed by a resident, was seen. Due to unavailability of any further signed copies, a blank blank copy was examined. These documents contained the information required by the regulations and the National Minimum Standards. The manager states she generally undertakes a preadmission assessment on prospective residents to ensure that the home can meet their needs. However, out of the four residents being case tracked only two had preadmission assessments. The manager stated that this was due to these people being emergency admissions and that full information had been received from their previous homes, and that due to the current employment structure of registered nurses in the home, she was unable at times to go out to assess residents. It is the homes responsibility to ensure that prospective residents are full assessed prior to admission. This allows the manager to be confident that the home has the staff skills and the equipment to meet the persons needs, that the prospective resident is within the homes registration category, and that their admission will not be detrimental to the needs and quality of life of the residents currently in the home. The regulations state that prior to any resident being admitted, the home confirms in writing to the resident or their representative that the home can meet their needs. Residents are admitted for respite or continuing care but not for intermediate care. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Comprehensive care planning ensures that the delivery of care to the residents meets their psychological, physical health and social care needs. Good examples of personlised care planning were seen, and daily records of care given reflect the care which has been assessed as required.This allows residents to be sure that they are receiving the care that they require The standard of medication safeguards the residents. Evidence: During the inspection four care plans were examined. A new care planning format is in place and includes care planning for personal care, continence care, moving and handling, nutrition and wound care. There is a specific night care plan which includes residents preferred times of rising and retiring. A social care plan is included in this system. Care Homes for Older People Page 13 of 32 Evidence: Care plans were individual and good examples of personalised care planning were seen. Daily records of the care given showed that care delivery was in line with the planned care. Care plans had been reviewed on a regular basis but few care plans showed that they had been formed or reviewed in consultation with the resident or their representative. The manager gave assurances that this would commence, where possible, therefore no requirement has been made. The home does not use the Malnutrition Universal Screening tool but weighs residents on regular basis and records their body mass index to assess nutritional status. The moving and handling care plans require more detailed information on the type of moving and handling aids and the sizes of hoist slings required. It is recommended that where residents require an electric pressure releiving mattress, that the correct inflation pressures for that specific resident are recorded in the care plans, with a means of monitoring this on a regular basis. Risk assessments were in place for bed rails and other equipment. Residents appeared well cared for and there was evidence of involvement of other health care professionals, which included physiotherapists, tissue viability specialist nurses, dieticians and General Practitioners. Nursing care charts in residents rooms were up to date and gave information on the nursing and care interventions that had taken place. Residents spoken with said: Its very good here, the care is wonderful, I cant fault it. The staff come quickly if you ring the bell, they get the doctor when you need them and really give us very good care. Very good attentive care, what more can I say. A visitor commented that they were very happy with the home and the care given to their friend Its a very caring place and they communicate with you very well. Staff were observed giving personal care in a manner which respected the residents privacy and dignity and in accordance with residents preferences. Care Homes for Older People Page 14 of 32 Evidence: Medications are administered using a drug trolley and a prepacked medication administration system. A medication round observed was seen to safeguard the residents. Medication policies are in place and have been reviewed recently. They include policies for receipt and disposal of medication and a policy for residents that self medicate, no residents are self medicating at present. All medications had been signed for on administration and controlled drugs were stored and recorded correctly. Some of the medicine charts did not have photographs of the residents but the manager said that this was in the process of being addressed. The manager should ensure a regular audit of medication takes place to ensure that liquid medications are not kept past the optimum time. The clinic room temperatures are not currently being monitored and the room felt hot. It is recommended that this commence, to ensure that it does not reach above 25C which is the optimum temperature to maintain the efficacy of some medications. In view of the clinic room temperatures it is recommended that eye drops are stored in the drug fridge and taken out one hour prior to use. Residents who were nursed in bed appeared comfortable. The home provides end of life care and contacts Macmillan nurses or the hospice for advice as required. The manager is considering training in the use the Liverpool Care Pathway and Gold Standards Framework (nursing tools to ensure that residents reaching the end of their lives receive a recognised standard of care and pain relief) and it is recommended that this is taken forward and put in place. All registered nurses are competent in the use of syringe drivers and other methods of pain relief. Care Homes for Older People Page 15 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. There is scope to provide a greater range of leisure activities which reflect individual residents past and present interests, and are in line with the abilities and wishes of the residents in the home. Routines of the home are sufficiently flexible to ensure that the daily life is in line with individual residents wishes and preferences and enable residents to have choice around the activities of daily living. A varied and nutritious menu is provided with fresh produce provided for the residents. Residents have a choice of menu at all meals and snacks and beverages are available at any time. Evidence: A member of care staff provides some leisure activities for the residents in the home, which include board games, bingo, some one to one conversation and a few outings. There is no transport to enable residents to go out in a group, and therefore most outings are with individual residents and include trips to the local shops or park for coffee. Care Homes for Older People Page 16 of 32 Evidence: The home also looks to bring in entertainers such as theatre groups, a magician, and musical entertainers at various times during the year. Motivational activities which include exercises are provided by an outside agency. Records are kept of which residents participate in activities and each resident has a social care plan and many residents have a life history provided. There is scope to expand activities and to encourage residents to continue with their past interests and a need to place more emphasis on this important part of holistic care. Residents spoken with said that they can Usually find something to do to pass the time. and Staff will always chat to you. Many of the residents usually go into the lounge, but on this particular day residents were confined to their rooms due to carpet cleaning and were mainly watching television, although there were several visitors in the home. Whilst there was good interaction seen between staff and residents, staff stated that they Usually talked with residents whilst doing personal care, as there was not always time to do this at other times of day. All of the residents spoken with said that daily routines in the home were sufficiently flexible to enable them to make choices in the activities of daily living. They said that there was no pressure to get up in the morning or go to bed at a specific time. Visitors are welcomed from late morning onwards and residents are able to keep in contact with families by the use of a telephone in the hall way which gives them free UK calls. Ministers of religion visit the home with the Church of England minister providing a service fortnightly. A nutritious and varied menu is provided, this is a four week rolling menu therefore providing variety and choice. All meals offered a choice of meals and it was evident that residents were not constrained to the choices on the menu. At lunchtime on the day of the inspection the cook had prepared alternative meals as well as those on the menu. Care Homes for Older People Page 17 of 32 Evidence: Supper menus were varied and well balanced. All residents, without exception, said that they enjoyed the food offered. They described it as: Lovely. Can have what you fancy. Really well cooked and looks nice on the plate. Always plenty to eat. Fresh fruit, vegetables and meat are provided and cakes and desserts are home made. The majority of the breakfasts are done by the day staff with the night staff only providing breakfast to those residents who request their breakfast early. A cooked breakfast is available for those residents who wish to have one. The kitchen was clean, and the documentation required by the Environmental Health Authority was in place and up to date. All of the catering staff have the food hygiene certificate but only one of the care staff has this. The manager must ensure that any care staff providing food have a course in safe food handling. The cook has no specific training relating to nutrition in the older person but the dietician has visited and given advice. Residents said that snacks and beverages were always available: You only have to ask, any time of day or night. My visitors can have a cup of tea when they come. Night care plans showed the specific times that individuals wished to have their night drinks and whether they wanted an early morning cup of tea, This is an example of good practice and shows personalised care. Care Homes for Older People Page 18 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. Residents are confident that any complaints they may have will be addressed in a fair and confidential manner. Lack of knowledge of correct safeguarding reporting procedures and protocols, by both management and staff, may put residents at risk Evidence: The home has a robust complaints procedure which is included in the Statement of Purpose and Service Users Guide. Residents were aware of how to make a formal complaints although most said that they would go straight to the manager if they had any complaints and that they were confident that matters would be addressed in a fair and transparent manner. The home has not had any complaints in the past year, but it is recommended that the manager commences records of minor concerns and how these are addressed. Whilst the staff receive training in adult safeguarding from a trainer who comes into the home, the training course on adult safeguarding was not correct on the issue of current reporting practices. Therefore the manager and staff were unaware of the steps to be taken to correctly address and report adult safeguarding, although these procedures have been in place for two years. Safeguarding policies within the home Care Homes for Older People Page 19 of 32 Evidence: also need amending to reflect the correct method of doing this. Following discussion the manager has agreed to attend safeguarding training with the local authority and to obtain the published guidelines Multi agency guidelines, the national guidance for safeguarding reporting, from the local authority. Care Homes for Older People Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides a pleasant and clean home for residents. Whilst currently the failure to provide hot water to the residents rooms has resulted in water at too low a temperature for residents comfort, failure to risk assess alternative measures used has put residents at risk. Lack of ongoing monitoring of water temperatures in residents rooms could put residents at risk. Evidence: The home provides communal space consisting of a lounge/ dining area, outdoor courtyard with seating for residents and a rear garden. Residents rooms which consist of thirteen single and four double rooms are on two floors which are served by a shaft lift. The rooms are comfortable and residents are encouraged to bring in personal possessions to make their rooms homely, and to give them the comfort of having their own possessions around them. All rooms have a lockable drawer. The ground floor rooms are arranged around the courtyard with some of them giving views to the garden. Care Homes for Older People Page 21 of 32 Evidence: Upstairs windows have restricted openings and the temperature of the hot water to residents outlets are controlled by thermo regulatory valves. There was no evidence that the temperature of the hot water delivered to residents washbasins had been monitored until January 2009. These recent temperatures showed the water being delivered to be at the very low temperature of C which is unsuitable for residents comfort. The manager said that she was aware of the problem and it is being addressed. With the temperatures of the water having been so low, staff have been using water from a hot water urn to wash residents. There were no risk assessments in place to cover the use of this. The manager gave assurances that a risk assessment would be put in place and therefore an immediate requirement was not made. The temperature of the hot water outlet on the residents baths had been monitored and recorded before each resident is bathed. The records showed that this was ongoing and that these temperatures were within recommended parameters. The manager and provider must ensure the safety of the residents; therefore a requirement has been made for the provider to contact the Health and Safety Executive for their advice on the monitoring of temperatures of hot water outlets. The home provides three assisted bathrooms, and three of the residents rooms have an en suite bathroom which consist of a washbasin and w.c. There was evidence of adequate aids to enable residents to maximise their independence, including full body hoists, moving and handling aids and variable height beds. Many staff have received training in infection control and staff were wearing gloves and aprons when delivering personal care and using alcohol hand gel. Liquid soap and disposable towels were present in residents rooms and in all bathrooms. Care Homes for Older People Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are generally sufficient staff to meet the needs of the residents in the home but staff have insufficient time to address social needs. Whilst current recruitment procedures are robust, failure to check records of existing staff could put residents at risk. Evidence: An examination of duty rota, discussions with the staff and the residents showed that there are sufficient staff on duty during the mornings to meet the care needs of the residents given the current numbers and needs of the residents in the home. However staff appeared very busy in the afternoon, residents said that staff generally had little time to spend with them apart from when care was being given. As activities take place in some mornings, staff should have time to spend with residents in the afternoons. One resident said The staff are very nice people, and they answer our bells as quickly as they can, but sometimes they are very busy; and its not too long before what you require becomes whats necessary, if you understand me. Its the afternoon that seems to be a bit hurried for them. Care Homes for Older People Page 23 of 32 Evidence: Another resident said I dont see the staff too much, when they get me up and put me to bed, or if I have to ring my bell, they are really busy. The provider should ensure that the dependency and social needs of the residents is taken into consideration when setting out the staffing numbers. Concern was raised with the manager over the amount of time set aside for management, the manager works in the home from 8am-5pm weekdays and is the only registered nurse on duty during this time. There is an expectation that she can fulfil both management duties and full time nursing duties within the home when in reality nursing duties will take up the whole of the time. There were several issues around documentation, training, resident assessment and staff supervision and having to take work home, which indicated that insufficient time is available for management. The issue of taking work home also raises concerns regarding confidentiality. The CSCI would expect that in a nursing home of this size, and given the dependency of the residents and number of staff employed, that the manager is employed for management duties only with supporting registered nurses on duty on all shifts. The nationally recognised Skills for Care Induction course is not used in the home. Staff receive an induction course local to the home unless they are studying for the National Vocational Qualification in Care, in which case, they also commence Skills for Care. Subsequent to the inspection the provider stated that New staff do an (name of training consortium) induction which is linked to the NVQ and the Skills for Care. However this was not evident at the inspection with evidence provided at the inspection that current staff were undertaking the homes own induction course. Over 50 of the staff have the National Vocational Qualification Level 2 in care. Staff training takes place by in house training with a training consortium. This is mainly in the form of distance learning with staff using books to inform them and being tested on their knowledge. On examination of the training records they showed that the adult safeguarding training did not address the reporting protocols and gave no information to senior staff over both the stages and levels of adult safeguarding, this is essential knowledge for Care Homes for Older People Page 24 of 32 Evidence: senior staff in a care home. Other training is provided by this consortium, including infection control, food hygiene, and dementia training. The content of these courses was not examined during the inspection. Moving and handling training is provided by a local physiotherapist, who is a moving and handling trainer, and the fire training by a fire company. All staff had participated in mandatory training, but some staff require some training in safe food handling if they are providing food to residents. Three staff personnel records were examined . One member of staff who commenced work in 2003 had no up to date Criminal Records Bureau check or Protection of Vulnerable Adults relating to this home. The manager gave assurances that this would be addressed and that she would check all personnel files. This will be checked at the next inspection. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current management of the home ensures that residents receive a good standard of care and the ethos and atmosphere in the home results in good outcomes for residents Insufficient time allowed for management does not permit the management to be as effective as it should be, which may eventually impact on residents wellbeing Evidence: The manager has been in post as manager for two years although she previously worked in the home. She is a registered nurse (level 1) She is not currently registered with the CSCI but informed the inspector that she will be applying for this. She has not yet completed the Registered Managers Award having ceased her studying for this qualification due to external factors beyond her control, but is recommencing this in the next few months. The provider is reminded that it is a legal requirement for the person in charge of a Care Homes for Older People Page 26 of 32 Evidence: registered service to be registered with the CSCI. Insufficient time is available for the manager to manage the home in an effective manner. She showed great awareness of the necessity to put systems in place but was unable to do so due to time constraints. Outcomes regarding the nursing and the care of the residents were very good. Residents and visitors saying Its a lovely home.I am really happy here and couldnt wish for more. I cannot fault the care and attention my (resident)receives. I love working here. It has a nice feel good atmosphere, exactly what a nursing home should be. Management is very approachable. The home has introduced a quality monitoring system which consists of sending surveys to residents and relatives. This could be extended to encompass other stakeholders such as health and social care professionals and staff. Results from surveys are collated and used to inform changes in the home. Residents and relatives have the opportunity to make their views known at meetings arranged by the home. The manager tries to arrange these at regular intervals. Staff meetings are held bimonthly and the minutes of these were seen. Policies and procedures have been reviewed in the past year. Amendments will be necessary to the adult safeguarding policy once the manager has attended the relevant training. The home would benefit from a quality auditing system of documentation and records. The home does not deal with or hold any residents money. Regulation 26 visits, (monthly visits and subsequent reports on these visits by the provider which are required by regulation) had taken place on regular basis, and reports were seen in the home. Whilst staff said that they had regular supervision, no records to evidence this were available in the home. The manager must ensure that evidence of supervision is available. Not all records relating to the staff were up to date or available. Some of the records relating to servicing of utilities and equipment were not available. No current record of portable appliance testing, current landlords gas certificate or electrical wiring certificate were available in the home, so it was not possible to determine whether Care Homes for Older People Page 27 of 32 Evidence: these were up to date. Subsequent to the inspection the provider stated that The Portable Appliance Testing certificate, five year electrical certificate and current gas certificate were in the home. However during the inspection neither the manager nor the inspector were able to find these. As detailed in a previous section in the report, there was no evidence of regular monitoring of hot water to residents outlets, and a requirement has been made. During the tour of the home the laundry door was seen open on three occasions, whilst the manager has ensured that there are no chemicals or risk to infection left in bathrooms and other areas of the home, the laundry contains chemicals and electrical appliances which could put residents at risk. The manager must ensure that staff keep the laundry door closed. There is a regular programme of mandatory training including moving and handling, fire training. All staff have the attended these sessions. 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 3 14 The registered person shall not provide accommodation for a person unless the the needs of the service user have been assessed by a fully qualified person. The registered person shall confirm in writing to the service user whether the home is suitable for the purpose of meeting the service users needs. To ensure that the service user is within the homes registration category, that the home can provide staff with sufficient skills and experience to meet these needs and to ensure that the home has the appropriate equipment to meet the needs of the service user. 02/03/2009 2 18 13 That the manager attends suitable training in Adult safeguarding to enable her to be aware of the correct reporting procedures 03/03/2009 Care Homes for Older People Page 30 of 32 required to safeguard the service users. Specific reporting procedures and protocols have been put in place in local authorities to ensure that service users are sufficiently protected from abuse. 3 25 13 The provider to ensure that the delivery of hot water is at a temperature within the recommended parameters and that the health and safety executive are contacted for their requirements over the periodic monitoring of this. Risk assessments must be put in place when water is used from an unregulated source. To ensure the safety of service users and their freedom from the risk of scalding 24/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 16 36 That the manager keeps a record of minor complaints and the issues taken to address these. That all records relating to staff supervision are kept in a confidential manner within the home. This will ensure that the manager is able to monitor that staff are receiving regular supervision as directed by the National Minimum Standards. 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 © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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