Inspection on 12/11/08 for Barford Court

This inspection was carried out on 12th November 2008.

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

Barford Court 15/11/06

Barford Court 10/11/05

Barford Court 02/06/05

Barford Court 08/02/05

Barford Court 01/09/04

Barford Court 25/11/03

Barford Court 06/06/03

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: Barford Court 157 Kingsway Hove East Sussex BN3 4GR     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: Jennie Williams     Date: 1 6 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: Barford Court 157 Kingsway Hove East Sussex BN3 4GR 01273777736 01273777633 barford@rmbi.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Royal Masonic Benevolent Institution Name of registered manager (if applicable) Mrs Susan Hale Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Barford Court is a care home registered to provide accommodation for forty (40) residents in receipt of either nursing care or personal care only. The home is part of the Royal Masonic Benevolent Institution (RMBI). The home is located in Hove and is within walking distance of the seafront and local amenities. The home is a large building and is separated into four units. Car parking is available at the home. There is nearby access to public transport. Residents rooms are located over two floors. Passenger shaft lifts are present within the home to assist residents to access all areas. All rooms are for single occupancy and provided with en suite facilities. There are suitable bathing and toilet facilities located throughout the home to meet the needs of the residents. Care Homes for Older People Page 4 of 30 0 Over 65 40 care home 40 Brief description of the care home There is a large indoor garden/communal sitting area and eight day/quiet rooms throughout the home for residents/relatives to use. There are easily accessible, well maintained gardens to the front and rear of the home. Weekly fees range from 586 to 833 pounds per week. There are additional fees; hairdressing, chiropody and newspapers/magazines. This information was provided to the CSCI on the 16 January 2009. Prospective residents know about the service through social service referrals, word of mouth and living in the area. A copy of the most recent CSCI inspection report is available at the home. 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: 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: It should be noted that following CSCI consultation, it was identified that service users prefer to be called people who use services. It was confirmed that the home uses the term residents. For the purpose of this report, people who use the service will be referred to as residents. The first unannounced site visit took place on the 12 November 2008 for four hours and the second site visit was for six hours, undertaken on the 16 January 2009. There was a suspected outbreak of scabies at the time of the first site visit, so the Inspector viewed records with the Registered Manager and then the service. The inspection was completed when confirmation was received that there was no further outbreak. Evidence obtained at this site visit, previous information regarding this service and Care Homes for Older People Page 6 of 30 information that the CSCI have received since the last inspection forms this key inspection report. An annual quality assurance assessment (AQAA) was sent to us by the service, completed by the home on the 02 September 2008. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. The last key inspection was undertaken on the 15 November 2006. An Annual Service Review (ASR) was undertaken on 18 December 2007. Six residents were spoken with. Discussions were had with three staff members throughout the site visit, plus the Registered Manager. One care plan was viewed along with specific areas of care in a further 11 care plans. Medication procedures were viewed. Procedures and records for handling residents finances were inspected. Six staff files were inspected, along with training records. A tour of the environment was undertaken and some individual rooms were viewed. The quality assurance system, complaint records and quality monitoring checks in place were viewed/discussed. There were 33 residents residing at the home on the day of the second site visit. 13 in receipt of nursing care and 21 in receipt of personal care only. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 30 Clear and up to date information pertaining to individuals are to be maintained and all care provided be accurately recorded to evidence that the home is meeting the needs of residents. Whilst specific requirements previously made in relation to medication have been met, there continues to be shortfalls in the medication procedures. The home must ensure robust procedures are followed for the recording, handling and safe administration of medicines received into the home to ensure residents are safeguarded and health needs are met. The home needs to consider obtaining feedback from health professionals and staff to assist them in the monitoring of their services provided and to continue to ensure the home is run in the best interest of residents. Discussions were had with the Registered Manager on ways the information in the AQAA can be improved the next time it is asked for. Evidence needs to be provided on how they are meeting all key standards and what action has been taken to address any requirements or shortfalls made in the previous inspection report. Any minor shortfalls noted, of which no requirement or recommendation has been made, have been highlighted throughout the report of which was acted upon immediately or the Registered Manager confirmed will be addressed. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre admission process ensures that only those residents whose needs can be met are admitted. Evidence: A new leaflet has been developed by the organisation for the service that contains more detailed information regarding staffing and the structure within the home. This leaflet also provides an explanation on what colours the different uniforms worn by staff mean. The Registered Manager confirmed that there have been no other changes to the Statement of Purpose/Service Users Guide. There was evidence of pre admission assessments in place for two newly admitted residents. There was evidence that the home obtains information about a prospective residents cultural/religious/spiritual needs at the pre admission stage, to ensure they can meet these expectations. One resident had been transferred from another care Care Homes for Older People Page 11 of 30 Evidence: home within the same organisation. The Registered Manager of Barford Court had not undertaken an assessment. All documentation was transferred with the resident and discussions were had over the phone between the homes and the Regional Manager of the organisation was involved in this process. Staff spoken with confirmed that they felt all residents were appropriately placed at the home and that management take appropriate action should someones needs no longer be met at the home. Some residents confirmed that they pre visited the home prior to admissions. One confirmed that they felt the pre admission process went smoothly. One comment received was If you have to go somewhere, this is the ideal place. Another individual came for respite and stated that they thought I dont want to leave here. Everybody made me feel very comfortable and very friendly so I stayed. The AQAA identifies that senior staff have received customer care training to ensure that their approach is always professional, helpful and welcoming. The Registered Manager confirmed that staff found this training interesting. The Registered Manager confirmed that there is no resident at the home from any minor ethnic community, social/cultural or religious groups with any specific needs or preferences. The ASR undertaken identifies that staff have received training in diversity issues. The home does not take emergency admissions. The home does not have dedicated accommodation to provide intermediate care, however respite is available if there is a spare room available. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff practice reflects an understanding of residents personal and healthcare needs, however the documentation in place for some people does not fully reflect the level of care provided and there is a risk that care may not be consistently provided. Following robust medication procedures will better safeguard residents. Evidence: A care plan viewed identified that there is a brief overview of the individuals needs that gives brief information to carers on the individuals preferred daily routines, preferred times for bathing and identifies if they have a preference on the gender of the carer assisting them with personal care etc. A more detailed care plan is then implemented based on the assessed needs of individuals. Whilst there is guidance in place for staff on the assessed needs of individuals, care plans did not always read as being personalised to the individual. Some care plans have pre-populated information on them and staff must ensure that information not relevant to the individual is removed. Care plans are not accurately reflecting the level Care Homes for Older People Page 13 of 30 Evidence: of care provided. Examples noted were that a care plan was in place for someone whose nutritional status is compromised. The care plan identified that the resident should be weighed weekly and record results. Records viewed identified that the individual was being weighed monthly and a registered nurse confirmed that monthly weights are undertaken. Where an individual had been discharged from requiring a physiotherapist input, the notes identified that this individual should continue with their own exercises. There was no information in the care plan identifying this or what exercises have been recommended to follow. A senior carer confirmed that the exercise guidelines are in the individuals room and the resident is self-caring with these needs. Another care plan identified that staff need to document daily intake for an individual. This was not being done. A senior carer confirmed that this resident was not at risk. The Registered Manager amended the care plan at the time of the second site visit. Where a care plan for pain identified to give prescribed analgesia and monitor effectiveness using a pain scale. There were no records of this being maintained. A staff member confirmed that they had administered analgesia at midday and had not returned to see if the pain was controlled. It was confirmed that the resident is able to use their call bell and would call staff again had the pain not been controlled. Daily notes viewed also did not reflect any information regarding pain. Other specific areas of care viewed identified that there are guidelines in place for staff to follow. Staff spoken with confirmed that they find the care plans informative and easy to understand. Of three residents who were asked, two confirmed that they were not familiar with their care plan and another confirmed that they had not seen it recently, however has seen it in the past. Staff confirmed care plans are reviewed with the individual. There was evidence in a care plan viewed that it had been reviewed with friends/relative. The home is implementing an opt out form for people to sign if they choose not to be involved in their care plan reviews, however will be advised of any substantial changes. On viewing daily notes, it was observed that some staff were writing all care given or Appears well, all care needs met etc. Daily records are a good source of evidence to show that care is being provided, as detailed in the care plan, however the term All care given is not helpful or adequate, especially when care plans do not reflect accurately all needs. Daily records when well written, help ensure a consistent approach and good quality of care for residents. It is in the homes interests to be able to show what they have done, along with providing the evidence on which to base the Care Homes for Older People Page 14 of 30 Evidence: monthly review and to record that they are following the assessment of needs. There was evidence that the home seeks advice from other professionals when needed. Evidence seen included visits from a GP, chiropodist and Community Psychiatric Nurse (CPN), hairdresser etc. There was evidence that pressure-relieving equipment is available at the home. Action is needed to ensure that robust medication procedures are followed. The Inspector only viewed medicines within the nursing unit. Medication Administration Records (MAR) charts viewed identified that staff are not maintaining an accurate audit trail of medicines. There was evidence that the number of tablets remaining in the blister packs did not always match what was identified on the MAR charts. Staff are not always signing accurately when they have administered a medicine. For one MAR chart viewed, it was unclear by viewing staff signatures if a medicine had been administered of refused by the individual. The registered nurse assisting the Inspector was also unable to clarify some shortfalls in the MAR charts. Residents are provided with an opportunity to self-medicate if they choose and a risk assessment identifies that it is safe for them to do so. There were accurate records being maintained of controlled drugs. It was identified at the last inspection that the GP prescription orders are done for three months at a time, two months being kept safely in the home until needed. This practice posed a risk of misuse of these printed prescriptions. There was also the matter of medicine prescription available for medicines not required. It is confirmed that the supplying pharmacist now collects these repeat prescriptions from the surgery and only medicines required are ordered. The Registered Manager stated that they will be moving away from stockpiling medicines and have commenced installing individual medicine cupboards in the bedrooms, so that all medicines pertaining to an individual is kept within their rooms. It was confirmed that monthly checks are done on the MAR charts and any shortfalls noted are addressed with individual staff. Due to the number of shortfalls the Inspector noted on one unit, it is recommended that the Registered Manager review this timescale. Since the last inspection was undertaken, we have received notifications about incidents relating to medicines kept or administered within the home. Two were in relation to missing prescriptions or tablets. Within the last year we have received Care Homes for Older People Page 15 of 30 Evidence: notifications about medication errors where two residents well being were affected due to these errors. Residents spoken to confirmed that they felt their privacy and dignity are respected and that staff knock on doors prior to entering their room. Staff were observed to have a professional rapport with residents and were heard calling them by their preferred term. 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. Residents lifestyle within the home is their own choice and residents are provided with sufficient stimulation to fulfil their interests and needs. Residents choice and preferences are catered for with meals. Evidence: Residents spoken with confirmed that they are able to generally choose their own routines within the home and that there are enough activities provided should they choose to be involved. Staff also confirmed that they felt there were enough activities provided for residents. Some residents commented that they would like to go out and about in the community more and for the garden to be used better. The Registered Manager confirmed that providing more outings had already been identified through their own quality assurance system and they have commenced obtaining programmes for theatres etc. It was confirmed that residents, when given a choice, refuse to join in outings or use the garden. There is an activities person employed at the home, who works 36 hours per week and Care Homes for Older People Page 17 of 30 Evidence: there is a dedicated activities budget at the home. Outside entertainers also visit the home. There is a schedule available at the home advising residents what activities are being provided. The Registered Manager confirmed that residents appeared to really enjoy Tai Chi and this has now been arranged for once a week. Three residents spoken with confirmed that there were no visiting restrictions. Visitors were observed to be able to freely visit their friend/relative in private. Residents spoken with confirmed that they are offered a choice at meal times and were overall complimentary about the food provided at the home. Comments received ranged from varies, some days good, some days not so good to very good. There is a menu placed on the table identifying what food is being provided. Staff also spoke positively about the food provided at the home. It was confirmed that the home received four scores on the door from the last environmental health visit. Care Homes for Older People Page 18 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. Residents feel comfortable to complain, reassuring them that they are being listened to and that action will be taken, if necessary. Residents are safeguarded by the procedures in place for Safeguarding Adults. Evidence: There is a complaints procedure available at the home and residents spoken with confirmed that they would feel comfortable raising any concerns and knew who to speak to. One resident commented can talk to staff easily. A resident confirmed that they also reflect any changes they would like in the survey they complete as part of the homes quality monitoring. The AQAA identifies that there have been three complaints raised with the home in the last 12 months, of which one was upheld. Records are maintained of all complaints and action is taken wherever needed. Copies of correspondence are kept. Concerns expressed to the CSCI were forwarded to the registered provider to investigate. Information returned identified that a representative from other RMBI homes carried out a thorough investigation. The conclusion was unsubstantiated although recommendations for further training and supervision of staff were made. One complaint was dealt with through the Safeguarding Adults team that was Care Homes for Older People Page 19 of 30 Evidence: concluded as unsubstantiated. Staff confirmed that they know what to do should someone wish to raise a complaint. The Registered Manager confirmed that she will be attending Safeguarding Adults training with the local authority and that annual training is provided to staff. Staff spoken with confirmed that they are familiar with the procedures to follow in the event of an allegation of abuse being made. It was confirmed that the home has information available to staff regarding the Mental Capacity Act and will be arranging training for all staff to attend. Care Homes for Older People Page 20 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean and homely environment and are provided with comfortable indoor and outdoor communal facilities. Evidence: The home is located in a residential area of Hove and is within walking distance to the seafront and local amenities. There is also a small shop opened at the home one morning a week that sells sweets and toiletries etc. This enables residents to purchase items themselves if they are unable to access local shops. The home is spread over a large area, separated into four units and rooms are located over two floors. There is a passenger shaft lift available to enable residents to access all areas of the home. There are well-maintained gardens to the front and rear of the home that residents have access to. There is an enclosed fishpond within the grounds. There is suitable communal space for residents living at the home. There are small sitting areas throughout the home and a large indoor garden/communal area for residents use. Some residents expressed that they wished the garden was put to better use. They were happy to discuss this with the staff themselves. All rooms are for single occupancy. Rooms that were viewed were of a good standard and were observed to be personalised to reflect the individuals choice and personality. Care Homes for Older People Page 21 of 30 Evidence: Of the residents that were asked, all confirmed that they found their rooms to be comfortable. Staff spoken with confirmed that they are provided with enough equipment within the home to carry out their duties. The home has installed 12 ceiling hoists, which staff commented favourably about. The home is working towards installing ceiling hoists in all nursing rooms. There are suitable numbers of bathing facilities throughout the home to meet the needs of residents. It was confirmed that one bath is not well used and there are plans to replace this and update the facilities. The AQAA identifies that their plans for improvement in the next 12 months is to continue to decorate and refurbish bedrooms as they become vacant and make decisions regarding types of new washing machines and driers to be purchased in the future. They are in the process of changing the processes for laundry within the service. The Registered Manager confirmed that they will implement another programme when the budget has been allocated to them from head office. There is a small kitchen area located on each unit that is used to make refreshments and serve meals that have been prepared by the main kitchen. A couple of residents informed the Inspector that they found the lighting in places to be dull and not bright enough for them to read by. They had not informed the home of this. A staff member was informed of this, with the residents present, for the home to address. The AQAA identifies that all staff have received training on the prevention of infection and management of infection control. The home proposes to introduce infection control trolleys for use within the home. There is alcohol gel located at the entrances to the home and throughout the home for people to use to assist in infection control. The home was clean and free from offensive odours on the day of the inspection. There are sluice facilities provided at the home. At the first site visit, there was a suspected outbreak of scabies. Due to the size of the home and the number of people to be treated and laundry of bed linen to be done, the home demonstrated that the treatment programme was well planned and organised. Care Homes for Older People Page 22 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. Residents needs are being met with the skill mix of staff on duty. Robust recruitment procedures ensure residents are safeguarded. Evidence: Staff spoken with stated they were kept busy, however felt that there were sufficient numbers of staff on duty to meet the needs of the residents. A staff member commented that some days there is a floating member of staff that assists between the units where needed, and feels that this position should be in place everyday. This is for the home to decide if this additional post is required daily. Residents spoken with were complimentary about the staff working at the home and comments received ranged from alright, excellent and generally very good. Some residents felt that there were not always enough staff on duty. Some stated that they sometimes have to wait for a long time for assistance, whilst others confirmed that staff were always around when they needed assistance. The Registered Manager confirmed that they have recently increased staffing levels. No requirement or recommendation has been made in relation to staffing levels, however management must ensure they keep the dependency levels of residents under review and take into account the layout of the home when planning staffing levels. A staff member commented that they felt there was good teamwork within the home. Care Homes for Older People Page 23 of 30 Evidence: It was confirmed that there is always a registered nurse on duty, assisted by eight carers in the morning, seven carers in the afternoons and four carers at night. Management support is in addition to these staffing numbers. There are 28 permanent carers employed at the home, of which 17 have National Vocation Qualification (NVQ) level 2 or above and a further two are working towards these qualifications. The AQAA identified that 16 nursing shifts and 193 care shifts have been covered by temporary staff or staff from and agency in the past three months. The Registered Manager, at the site visit, confirmed that there are currently no staff vacancies and the use of temporary or agency staff has decreased. The AQAA identifies that all people who have started work in the home in the last 12 months have had satisfactory pre-employment checks. Staff files were viewed at the first site visit. Some information was not available to view. All documentation was seen to be in place by the second visit, to evidence that good recruitment practices are in place. Application forms are completed; references obtained and enhanced Criminal Record Bureau (CRB) checks are returned prior to anyone commencing employment, including a Protection of Vulnerable Adults (POVA) check. The home ensures the all registered nurses have current registration with the Nursing and Midwifery Council (NMC). There was evidence that new staff undertake an in house induction and Common Induction Standards as set by Skills for Care. The Registered Manager confirmed that a new computer system has been installed that identifies when staff are due for appraisals, supervision or training updates. Staff spoken with confirmed that they are kept up to date with mandatory training and they are provided with enough training opportunities. A registered nurse confirmed that nurses received additional training relevant to their roles. There was evidence of training provided within the staff files. One staff member confirmed that they are provided with dementia training, however feels that they could undertake more training in this area. They are aware that management is addressing this. Care Homes for Older People Page 24 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 generally run in the best interest of residents. Residents financial interests are safeguarded. The health, safety and welfare of residents and staff are promoted and protected so far as is reasonably practicable. Evidence: The registered manager is registered with the CSCI and has the relevant skills and experience to manage the home. She has had over 20 years of care experience in a variety of roles and settings. She has current registration with the Nursing and Midwifery Council. A deputy manager is employed to assist her in the running of the service. The Registered Manager keeps herself up to date with current guidelines from information provided by the head office of the organisation, attending training sessions and attending various multidisciplinary meetings where guest speakers are often invited. Management of all departments within the service hold a weekly meeting where Care Homes for Older People Page 25 of 30 Evidence: information is shared and support each other wherever needed. A staff member confirmed that these meetings help to improve the communication within the service. Staff spoken with were complimentary about the management of the service and felt that there are clear roles and responsibilities within the service. The Registered Manager confirmed that there are procedures within the home to monitor the running of the service. Some areas for monitoring have been delegated to the deputy manager and maintenance person. Examples are care planning and health and safety checks. Staff meetings are held at least every three months or earlier if needed and resident meetings are held every two months. The Registered Manager confirms that she visits residents every morning when she delivers their newspapers to keep in touch with them. The head office of the organisation undertake annual surveys for residents and their relatives/representatives. These were being done again at the time of this inspection. Residents confirmed that they had recently completed surveys. The Registered Manager confirmed that there is currently no process in place to obtain feedback from health professionals and staff feedback is obtained when they have appraisals undertaken. It was discussed with the Registered Manager that it will assist in their quality monitoring of the service they are providing to obtain professional feedback and provide staff with an opportunity to anonymously provide feedback. She will raise this with their head office. The home needs to consider ways to make results from their quality monitoring surveys available to people who have an interest within the service. There is a suggestion box located at the home. Someone within the organisation undertakes monthly visits and a report is provided to the Registered Manager. On receiving surveys, head office of the organisation analyses responses and sends a report to the home. The home then has to produce an action plan to address any areas where it has been identified as needing improvements. The AQAA identifies changes they have made as a result of listening to people who use their service. Examples of this are inviting residents to take an active part in decision making with regards to activities provided and changing their call bell system to a bleep call system to reduce noise pollution. Discussions were had with the Registered Manager on ways in which the information within the AQAA can be improved next time it is asked for. Evidence was not provided to demonstrate how they are meeting all key standards, did not address how previous Care Homes for Older People Page 26 of 30 Evidence: requirements or recommendations had been addressed and the brief summary was very brief. The home is not an appointee for any residents. Personal allowance is held for individuals securely at the home if residents choose to use this service. Residents whose personal allowance is held at the home are aware that their money is only accessible during office hours. There is a no interest bearing account for residents to ensure that excess money is not held at the home. Records are maintained of residents personal allowance on a password-protected computer. There are receipts kept of financial transactions. There are checks in place, internal and external to the home, to ensure robust financial systems are in place. The AQAA identifies that any equipment, as applicable, has been serviced or tested as recommended by the manufacturer or other regulatory body. The AQAA identifies that they have written assessments on hazardous substances and there are policies and procedures available at the home that have recently been reviewed or is currently under review. It was confirmed that staff are provided with regular fire training and participate in fire drills. It was confirmed that a new fire risk assessment was currently being undertaken. 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 1 7 15 That clear care plans and 06/03/2009 information pertaining to individuals to be maintained, up to date and all care provided be accurately recorded. To evidence that the home is meeting the needs of service users and care provided is person centred. 2 9 13 That robust procedures are followed for the recording, handling and safe administration of medicines received into the home. To ensure service users and staff are safeguarded and health needs are met. 27/02/2009 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 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. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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