Inspection on 07/01/09 for Axbridge Court

This inspection was carried out on 7th January 2009.

CSCI found this care home to be providing an Good 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

Axbridge Court 06/09/07

Axbridge Court 07/06/06

Axbridge Court 12/12/05

Axbridge Court 08/09/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Axbridge Court West Street Axbridge Somerset BS26 2AA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Justine Button     Date: 0 7 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 30 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 30 Information about the care home Name of care home: Address: Axbridge Court West Street Axbridge Somerset BS26 2AA 01934733379 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) : axbridge@almondsburycare.com Almondsbury Care Limited care home 36 Number of places (if applicable): Under 65 Over 65 36 old age, not falling within any other category Additional conditions: 0 The home is to be registered for 36 nursing beds. Date of last inspection Brief description of the care home Axbridge Court Nursing Home, formerly the St.Johns Hospital, has been adapted to a two-storey home in the centre of Axbridge, close to the local shops. The home is in shared private grounds and has car parking space. There is a large garden area. The home has a large well appointed communal lounge and dining room. The home has mainly single bedrooms with en-suite facilities. The en-suites enable wheelchair access. There is a passenger lift facility to the first floor. Aids and adaptations have been made to promote mobility in the home. There is a nurse call system through out the home. Health and safety measures include covered radiators and window restrictions. The home is registered to provide nursing care for up to 36 people. Personal care can also be provided within these numbers. The manager is a registered nurse and there is a registered nurse on duty at all times. Axbridge Court was purchased by Almondsbury Care on 23 June 2005. The owners have undertaken a major refurbishment and improvement programme. Care Homes for Older People Page 4 of 30 Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This Key unannounced inspection was carried out over one day by one inspector. The Registered Manager Ms. Crossey was available on the day of the inspection. The inspectors would like to thank the manager and the duty staff for their time and hospitality shown to the inspector during their visit. The home completed an Annual Quality Assurance Assessment, AQAA, prior to the inspection. A number of surveys were sent to the home, of which 8 were completed and returned to the CSCI. People living at the home and relatives completed the surveys enabling us to get a broad view of the home. Comment cards about the service from visiting professionals were also forwarded to the CSCI at the time of the Care Homes for Older People Page 6 of 30 inspection. People who responded to surveys for the CSCI, all described their ethnicity as white/British. Residents are over 65 years of age. The inspector was able to see and observe staff interactions with many residents, meet several relatives, discuss care issues with staff and discuss the management of the home with senior staff. The focus of this inspection visit was to inspect relevant key standards under the CSCI Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are excellent, good, adequate and poor. These judgment descriptors for the seven chapter outcome groups are given in the report. Records examined during the inspection were care and support plans as part of the case tracking process, medication administration records, maintenance records, the homes Statement of Purpose, staffing rosters, menus, the homes complaints file, staff recruitment files, staff training records, quality assurance processes and staff supervision records. The inspector also conducted a tour of the premises. The current fees was quoted as six hundred and eighty five pounds per week. This does not include the registered Nurse Contribution. Additional charges are made for hairdressing, toiletries, dental care, optician, physiotherapy, newspapers, transport or chiropody. What the care home does well: What has improved since the last inspection? At the last inspection it was identified that a range of snacks was not available for people who were at risk of weight loss, had difficulty in swallowing or those that required a high protein diet to help with the healing of wounds. Since the last inspection this issue has been addressed with a range of accessible snacks now being available. In addition the system for monitoring the dietary intake of people who are on specialist diets has been reviewed and improved. Care Homes for Older People Page 8 of 30 A system of staff supervision has now been implemented at the home. This now needs to be increased to ensure that this is completed on a regular basis. 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 30 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 30 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 has developed has a statement of purpose and service user guide, which sets out the aims and objectives of the home and includes all required information. Admissions to the home are not made until a full needs assessment has been undertaken by a member of the senior management team. The prospective residents and their families are fully involved in the assessment and are encouraged to visit the home before making a decision on residency. All residents are provided with a statement of terms and conditions of residency/contract that sets out in plain English what is included in the fee, the role and responsibility of the provider, and rights and obligations of the individual. Evidence: The home produces a statement of purpose and service user guide that is readily Care Homes for Older People Page 11 of 30 Evidence: available to prospective residents, their families and funding authorities. These documents are clearly written in plain English and a copy is available to all residents when they move into the home. All the people spoken to and in the surveys received said that they had received enough information about the home. Some people said that they had looked around the home before they moved in but others had been unable to visit and their family had chosen the home. The home produces a terms and conditions of residency that includes details of the room to be occupied and what is included in the fee. People said that they had a contract; one person commented that this was easy to follow and understand. A copy of the contract was viewed during the inspection process. The contract specifies that the first four weeks is a trail period. Two weeks before the end of trial period people have the opportunity to meet with manager to discuss if placement suitable. Fees quoted do not include the RNCC.This is a government benefit payed to anybody who receives residential nursing care. Fees are payed one month in advance. Separate fees are charged for newspapers, hairdressing, trips and outings and special requirements which will be confirmed in advance. Transport and escort duties are also charged if additional staff are needed to provide cover. No reduction in fees is made for periods of absence such as a Holiday or hospital admission. Personal possessions are insured up to 500 pounds. Twenty eight days notice is required to terminate the contract. The home has an equal opportunity policy relevant to people living there which acknowledges peoples rights to be seen as individuals and makes clear that the home will make all efforts to meet individuals needs and aspirations. A preadmission assessment is made by one of the senior nursing staff prior to moving into the home to help ensure that the home can meet the needs of the individual thinking of moving into the home. The homes pre admission assessment covers all the topics recommended in the national minimum standards. Care Homes for Older People Page 12 of 30 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. Health care needs are met although care needs are not always clearly documented in the plan of care. The care plans therefore require additional development. Privacy and dignity is maintained medication is on the whole well managed with only some minor shortfalls Evidence: Four people living at the home were case tracked at this inspection. This involved meeting with the individual, examining care and related records and viewing their bedrooms. Additional care plans and bedrooms were viewed and individuals spoken to. Since the last inspection the staff have worked at reviewing and developing the care planning process. This has also been confirmed by other professionals who have been visiting the home. The care planning process although improved does require some additional developments. Care Homes for Older People Page 13 of 30 Evidence: The care plan for one individual who had been admitted to the home over a week before the inspection was viewed. A pre admission assessment had been completed however this had not been dated and signed. Over the first night staff reported that this individual was having difficulty in sleeping and as such it had been identified that they were at high risk of causing injury to themselves and at risk of falling. It had also been noted that the individual did not accept the help of the staff readily. Despite identifying these issues relatively quickly the staff had not developed any care plans in this area for this person. The individual had been admitted to the home with some pressure damage (sometimes called bed sores or pressure sores) A plan was in place for this aspect of the individuals care although no photographs, measurements or tracings had been completed (It was not confirmed if the indivdual would give consent for these to be completed.) This is important as it then clearly demonstrates if the wounds are improving or deteriorating and the staff can then adjust the dressings or treatment accordingly. Nutrition is also important in the healing of any tissue damage. A nutritional assessment had been completed which identified that that the individual was at high risk of poor nutrition. Despite this staff had not yet implement an nutritional care plan so it could not be confirmed how staff were going to monitor the individual to ensure that a diet appropriate for the needs of the individual was provided . It would be expected that for any new admission to the home that initial care plans would be developed within the first few days of admission. The plans should detail the care and support that the individual required. Initially plans would be expected to be reviewed regularly as staff got to know the person better and their needs more throughly and had completed additional assessments. The bedroom for this individual was viewed during the inspection. This showed that appropriate pressure reliving equipment was in place. During the course of the inspection this individual was supported to change position on a regular basis. A change of position is required to help in the prevention and the healing of any pressure damage. The care plan for a second individual was observed. The plan identified that the individual can become anxious at times. The plan was quite clear on how staff should offer reassurance at these times. The nutritional assessment had identified that the individual had a very small appetite and was at high risk in this area. Staff had taken appropriate action with regard to this issue in the fact that the GP had been made aware. Supplementary drinks had been prescribed and a referral to the dietitian was pending. In addition the individual had been placed on the red tray system (see standard 15). A care plan for this area of need however had not been developed. This is important particularly for new staff or relief staff who may not know the individual well and may not know the monitoring arrangements that were in place. The plans that were in place for this individual were ambiguous and did not give clear guidance to staff. For example the individual had frequent Urinary infections. For people with or Care Homes for Older People Page 14 of 30 Evidence: at risk of infections it is important that an adequate amount of fluid is taken each day. The plan for this area of the individuals care was not clear and did not state the amount of fluid the staff should be supporting the individual to have on a daily basis. The likes and dislikes of the individual were not clearly documented. The remaining care plans which were viewed were satisfactory although a more person centered approach needs to be adopted in all of the care plans seen. A person centered approach in the care planning process focuses on strengths and abilities rather than weaknesses and disabilities of the individual, focuses on the perspective of the individual, rather than the staffs perspective and care is planned around the individual and not the home. How the care planning process could be improved in line with a person centered approach was discussed with the manager during the inspection. Despite some shortfalls in the care planning process, the care and support that the individuals received during the inspection remained good. People who were at risk of pressure damage had a regular change of position, fluids were available at all times through out the day. Systems have now been developed to ensure that people who have or are at risk of loosing weight have been developed (see standard 15.) All people seen during the inspection were appeared tidy and well kempt. There was evidence in the care plans that people living at the home have access to health care professionals including GP, dietitian, optician and chiropody. Feedback from people living at the home via direct discussion and from the surveys received confirmed this. All but one person stated that the staff always respected their privacy and dignity. Comments included staff are lovely and very caring, I really appreciate the care and support I receive and could not wish for a better care home in which to live. The remaining person stated that although staff knocked on her door they very often did not wait for a replay prior to entering. Medication was viewed during the inspection. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). The registered nurse on duty administers medicines. The nurse on duty was observed completing a medication round during the inspection. This was completed in line with good practice guidance. Medicines were found to be securely stored on this visit. Creams and lotions stored in peoples bedrooms relate to the individual to whom they are prescribed however not all had a date of opening. This is required to ensure that creams and lotions are not used after the expiry date or shelf life. It was noted during the inspection that the home had a relatively large amount of dressings despite a relatively few people at the home having wounds or pressure damage. The staff need Care Homes for Older People Page 15 of 30 Evidence: to ensure that stock levels at the home remain in acceptable limits. The MAR charts were viewed during the inspection. These were in good order with the exception of medication that had been hand transcribed. ongoing and repeat medication is delivered by the pharmacy with a pre printed MAR on a monthly basis. If medication is prescribed in the interim period eg antibiotics then staff will have to hand write these on the chart. It is good practice that when this occurs that an additional staff member checks that the hand written entry corresponds the instructions on the medicine bottle or box. This reduces the risk of medication errors and helps to prevent the incorrect dose being given. This had not occurred on the hand written entries seen during the inspection this is recommended. Care Homes for Older People Page 16 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home have the opportunity to undertake social and recreational opportunities. This includes the opportunity to access the local community and maintain links with family and friends. People living at the home can exercise choice in respect of personal autonomy and choice. Meal and mealtimes are a pleasant experience. Evidence: The routines of daily life and activities are flexible and varied to suit the individuals expectations and choice. People spoken to during the inspection stated that they have a choice about their routines. Choices were available in meals, what time they got up and went to bed and if and when they joined in the activities that were on offer. This was confirmed in the majority of care plans seen (see health and personal care). The home has recently purchased a wide screen TV in the communal lounge which enables easier watching. A computer system with web cam has also been purchased Care Homes for Older People Page 17 of 30 Evidence: which enables people at the home to maintain links with family and friends who are not able to visits often. Staff are available to support people in using this equipment. The home employs an activities organiser. A photograph album was available in the main entrance hall showing a number of outside trips that have been completed. This included a trip to Bristol Zoo. Entertainers visits the home to provide additional recreational opportunities. There is a weekly activities programme on the wall which included crosswords, creative drawing, bingo, darts and flexercise. People living at the home stated that you were free to join in if you wished but that staff respected your choice if you did not wish to partake in the opportunities available. The activities organiser also spends time on a 1:1 basis for those people who are unable to join in group activities. People spoken to during the inspection and in the surveys received stated that they appreciated the social and recreational opportunities available to them. Lunch was viewed on the day of the inspection. The table were nicely set with linen table cloths, napkins and condiments. On the day of the inspection the lunch consisted of roast lamb, roast potatoes and a range of vegetables. An alternative of faggots were available for people who did not want the lamb. One person who is a vegetarian had vegetable lasagne. A range of fruit juices and or water was available. Staff were observed supporting people who required it in a unhurried and dignified way. Staff sat down to support people. During the meal it was observed that all people were wearing clothes protectors. This practice is rather institutionalized and staff should consider how this impacts on peoples dignity and self esteem. Since the last inspection a red tray system has been introduced. This is for people who have or are at risk of loosing weight and means that staff have to pay special attention to ensuring that the meals are eaten if possible. Staff have to document what everyone with a red tray has eaten. This is then signed off by the Registered Nurse at the end of every shift to ensure that appropriate action is taken if dietary intake poor. Staff feel that this system works well and has reduced the numbers of people experiencing weight loss. Pudding after lunch includes fruit crumble and custard. The chef was observed identifying to staff specialist puddings (ie those that had been fortified) , and those for people who are diabetic. Choice of fruit or yoghurt is always available for those who do not want the main pudding that is offered. Interactions between staff and people living at the home were observed to be good. The menu for the evening meal stated that soup and then cauliflower and broccoli bake or sandwichs followed by fruit flan was planned. Care Homes for Older People Page 18 of 30 Care Homes for Older People Page 19 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel comfortable to raise concerns with a member of staff. Reasonable steps have been taken to protect people from abuse. Evidence: The home has policies and procedures in respect of recognising and reporting abuse, making a complaint and whistle blowing. The majority of staff have now received training in the protection of vulnerable adults and the home has obtained a copy of the Somerset policy and procedure on safeguarding vulnerable adults. People living at the home stated that they would be comfortable to approach a member of staff if there was any aspect of their care that they were unhappy with. Both people who completed a questionnaire said that they knew how to make a complaint and that staff listened and acted on what they said. The whistle blowing procedure is availble for staff and staff spoken with were aware of the ability to take serious concerns outside the home. No complaints have been received by the home since the last inspection. Care Homes for Older People Page 20 of 30 Evidence: Evidence was seen that all new staff are checked against the Protection Of Vulnerable Adults (POVA) register and undergo an enhanced Criminal Records Bureau (CRB) check before they begin work. Care Homes for Older People Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and has undergone significant upgrading and refurbishment. Residents are able to personalise their rooms with their favorite items and have the specialist equipment required to meet their individual needs, however specialist bathing provided may not meet some individual residents assessed needs. Baths in ensuite facilities had been disabled. Residents have a good choice of pleasant communal areas to sit and socialise in. There is a pleasant accessible garden. All parts of the home were clean and pleasant at the time of this inspection. Infection control measures in place were adequate. Evidence: Since purchasing the building in 2006 the home has undergone significant improvement and re-decoration. This work is ongoing but has included the lounge, dining room, halls and corridors, new wet room/shower and refurbishment of the bathrooms, redecoration and re carpeting of many bedrooms and new furniture. These refurbishments have been completed to a high standard and the home provides a Care Homes for Older People Page 22 of 30 Evidence: pleasant environment in which to live. The refurbishment is set to continue over the next 12 months with the remainder of the bedrooms and the kitchen due to be updated. Comments form the feedback forms confirmed that despite the disruption the building works have and continue to cause, people living at the home appreciate the improved environment. Bedrooms are situated on the first and second floor and are accessed by a passenger lift and stairs. There are a number of communal sitting areas throughout the home giving a choice to residents. Corridors are spacious these are fitted with handrails. All bedroom doors have automatic fire door closures. All bedrooms seen were individual and personalised. The grounds are well maintained, which provides a colorful area in the main front garden. Garden areas are mainly accessible for independent wheelchair users and there are tables and chairs in the paved area. There is adequate provision of hoists, which have been serviced regularly. It was found that a number of people living at the home had been assessed as requiring specialist equipment such as pressure mattresses, pressure mats and adjustable beds. These had been provided. During the assessment of the premise it was noted that all residents could access their call bells to summon assistance. The home was very clean and pleasant on the day of the inspection. Infection Control measures were in place and staff were seen using correct techniques. Alcohol hand gel was available throughout the home. All laundry is washed in house and the laundry facilities were adequate for the numbers and needs of the service user group. Care Homes for Older People Page 23 of 30 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. Staffing levels appear appropriate to the needs of people currently at the home but the hours staff work needs to be kept under review. The home promotes NVQ training for staff and ensures that all staff received training appropriate to their role. The home follows robust procedures for staff recruitment. Evidence: On the day of the inspection twenty five people were living at the home. The duty sheets for 8th December 2008 until 4th January 2009 were reviewed. These demonstrated that there is a registered Nurse on duty at all times. In addition there are six care staff on duty in the mornings, although this occasionally rose to seven and occasionally dipped to five. There are five care staff on duty in the afternoons and evenings. Two care staff and the registered nurse are available over night. In addition to the care staff the home employs a number of other staff including kitchen staff, cleaners, activities organiser, administrator and laundry staff. Since the last inspection the home the deputy manager has left employment at the home. Adverts for this post are to be released in the near future. Care Homes for Older People Page 24 of 30 Evidence: The staff recruitment files were viewed for three staff. These showed that all three staff had signed a contract to work forty eight hours per week. All staff have opted out of the working time directive. This is above the usual full time hours one would expect to see (usually the average full time hours is around 37 hours per week). In addition the duty sheets showed that some staff worked over their contracted hours with one person working 78 hours in a week period. The manager explained to us that this situation was a one off and had been a result of staff shortages at the time. The management need to ensure that staff working such long hours do not impact on the care and support provided at the home. In addition the management need to consider the health and safety aspect of working excessively long periods with out significant time off to recover. Staff spoken with during the inspection confirmed that they had been provided with the training needed to care for people at the home including NVQ. Staff indicated that they felt confident in their skills and they stated that they were never asked to undertake a task that they did not feel trained to carry out. Staff confirmed that, apart from mandatory training, they had received very good training. Staff stated that Training is excellent, not just mandatory training but other training is encouraged with all levels of staff, we have very regular training. Also staff members identified training as something that the home does well. The homes procedures for staff recruitment were examined. Records relating to three staff recently employed were viewed and there was evidence that the home was following robust recruitment procedures which also included appropriate checks with the Criminal Records Bureau (CRB) and Protection of Vulnerable Adults list (POVA). We were able to see evidence that newly appointed staff follow an appropriate induction programme. Care Homes for Older People Page 25 of 30 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 home is well managed in an open management style. The home is run with the service users best interests safeguarded by policy, practice and procedures. Attention to the health and safety of service users and staff is of a good standard. A system of staff supervision is in place. Health and safety is well managed. Evidence: The manager Mrs Crossey has been employed at the home for just over 24 months. During this time significant improvements have been made due to a stable management structure. The management style of the home is appreciated by staff and people living at the home. All but one person was very complementary about her open management style. Staff described Ms Crossey as firm but fair. Ms Crossey undertakes quality assurance assessment of the home; surveys have been made to assess satisfaction. Regular staff meetings are held. Minutes of these were seen. Care Homes for Older People Page 26 of 30 Evidence: All records seen were stored appropriately and safely. This included the system for holding personal monies for people living at the home. Accident forms are completed and these are audited on a monthly basis. Staff supervision is ongoing and all staff receives regular supervision on a rolling programme. Annual appraisals are conducted for all staff. Servicing and maintenance records were sampled these were found to be in good order. COSHH (Control of Substances Hazardous to Health) advisory sheets are held at the home. Care Homes for Older People Page 27 of 30 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 28 of 30 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 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 7 Staff must ensure that care plans are developed as soon as practically possible after admission. The plans should reflect the initial care needs of the individual and be reviewed regularly if needs change or become apparent. It is recommended that home continue to develop the care planning process in line with a person centered approach. It is recommended that all creams and lotions have a date of opening and are signed when applied on the mediaction administration record. It is recommended that all mediaction that is hand transcribed onto the medication adminstration record is checked by a second person and that this person signs to confirm that this has been completed. Consideration should be given to the widespread use of clothes protectors and how this impacts on the dignity and self esteem of people living at the home. It is recommended that the number if hours that staff work is kept under review to ensure that the hours worked does not impact on the quality of care provided. 2 7 3 9 4 9 5 15 6 27 Care Homes for Older People Page 29 of 30 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. 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