Inspection on 14/10/08 for Bay Court Nursing and Residential Home

This inspection was carried out on 14th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bay Court Nursing and... 13/11/07

Bay Court Nursing and... 18/10/06

Bay Court Nursing and... 15/11/05

Bay Court Nursing and... 17/06/05

Bay Court Nursing and... 05/01/05

Bay Court Nursing and... 23/08/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 13/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bay Court Nursing and Residential Home 16-18 West Hill Budleigh Salterton Devon EX9 6BS     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: Vivien Stephens     Date: 1 4 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Bay Court Nursing and Residential Home 16-18 West Hill Budleigh Salterton Devon EX9 6BS 01395442637 Telephone number: Fax number: Email address: Provider web address: matron@baycourt.net Name of registered provider(s): Type of registration: Number of places registered: Court Healthcare Limited care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Notice of Proposal to Grant Registration of staffing/environmental conditions of registration issued 1/3/1999 Date of last inspection Brief description of the care home Bay Court is situated in the centre of Budleigh Salterton in East Devon. The home has level access to the local shops some 200 metres from the home. Bay Court has three communal sitting areas in addition to a dining room. There are 24 bedrooms arranged over three floors. Qualified nursing staff are on duty 24 hours a day. The ethos of the home is to provide a relaxed homely environment in which the staff are able to care for people over the age of 65 years who require either personal or nursing care. At the time of this inspection the cost of care was £506.00 to £690.00 per week. Some of the additional costs that are not covered in the fees include chiropody, hairdressing and personal items such as toiletries and newspapers. Current information about the service, including Commission for Social Care Inspection reports, Statement of Purpose and Service User Guide are available within the entrance hall. 0 Over 65 29 Care Homes for Older People Page 4 of 31 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: Several weeks before this inspection took place we sent an Annual Quality Assurance Assessment form (AQAA) to the home. The completed form gave us useful information about the home and the services they provide. We also sent survey forms to the home and asked them to distribute them to a random sample of people living in the home, to the staff team, and to health and social care professionals who visit the home. We received 10 surveys from people living in the home (some people received help from their friends or family to complete the form), 9 from staff, and 2 from GPs. Their responses have helped us to form the judgements we have reached in this report. This inspection began at 10am and finished at approximately 5pm. On the day there were 23 people living in the home. Care Homes for Older People Page 5 of 31 During this inspection we case tracked four people who live in the home. We did this by reading their care plan files to find out what information the home had gathered about each person before they moved in, and how they used this information to plan the care the person wanted. We then talked to each of the four people, and also talked to the staff team about how they delivered the care to these people. We also looked at the way the home stores and administers each persons medications. We carried out a tour of the home during which we looked at a random sample of bedrooms, the toilets and bathrooms, the kitchen, laundry and the communal areas. We looked at other records the home is required to keep including the accident report book, menus and individual dietary needs, fire log book, and staff employment and training records. What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 7 of 31 Measures have been taken to ensure that every person living in the home has the means to call for assistance whenever needed. In the last year the home has improved the methods that they check people are well nourished. They have purchased a set of sit-on scales and this means that more people can now be weighed regularly. All staff have received good training on the prevention of abuse and protection of vulnerable adults. We saw evidence to show that the home has carried out risk assessments where devices have been put in place to restrict peoples movement. This includes the use of bed rails. Good recording systems have been put in place where money has been handled on behalf of any person living in the home. The staff employment records we saw included evidence of their identity and qualifications. Menus have improved and people have been consulted on the choices and their suggestions have been incorporated into the menus. The home now has regular maintenance and gardening contracts and repairs and routine maintenance is now carried out promptly as and when needed. What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 31 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 31 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 31 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. People can feel confident that they will be given enough time, information and opportunities to visit and get to know the home. Good assessment procedures are followed and this means that the home can be certain they can meet the persons needs before the person decides to move in. Evidence: The home told us in their AQAA that they are prepared to spend a lot of time with people before they move in to make sure they know the home and are certain it is the right place for them. The manager, Sue Stevens, told us that, if possible, they will always visit the person to carry out an assessment and to give them information about the home. She said they gather as much information about the person as possible when making their assessment. They do this by talking to the person and their family (where appropriate), and to any health or social care professionals involved in their care. Where available they will obtain an assessment from a hospital or from social Care Homes for Older People Page 11 of 31 Evidence: services. If the person moves from a residential care home they will request a copy of their current care plan from the home (although Sue Stevens said the homes often refuse to provide this). When people enquire about the possibility of moving in they are given a brochure that gives some useful information. Further information can also be found on the homes web site. Nine out of the ten people who completed a survey form before this inspection told us they received enough information about the home before they moved in. One person told us The family visited several nursing homes and the quality of nursing and care was obvious at Bay Court. We case tracked four people who lived at the home. We looked at the way the home gathered information about each person. We found that the home used a template to guide them to ask the right questions. They had gathered information about all aspects of each persons health and social care needs. This information had been used to help them draw up and agree a plan of the persons care. Care Homes for Older People Page 12 of 31 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. People can feel confident that they will receive care that has been carefully planned and agreed to suit all of their health and personal care needs. Medication storage and administration has been organised to provide a safe, discreet and personalised service. Evidence: When we arrived at the home at 10am we found that almost everyone living at the home were already up and dressed. Two people were still in bed and we talked to one of these people. She told us that she was lovely and comfortable and that she liked to get up slowly in the mornings. The staff arrived to help her to get up at around 11am and she told us this was the time that she preferred to get up. The nurse who was in charge when we arrived told us that most people were usually up by 11am each morning and that the staff arranged their tasks to help people get up when they wanted to get up. Care Homes for Older People Page 13 of 31 Evidence: We looked at the way the home organised and planned the care each person wanted. The home had handwritten care plans that were held in the staff room/office. They also had a folder in each persons room containing a task list that staff were expected to follow. The task lists in each persons bedroom set out briefly each task the staff should carry out throughout the day. The staff were able to read the task lists easily when they went to assist the person. Also, the person was able to read the files themselves and could make sure that the task list was correct. Instructions on skin care, including an administration chart for creams and lotions were included in this file. Specialist beds and mattresses were provided for people who had poor mobility or who had a risk of skin problems. Risk assessments had been carried out for those people who may be at risk of falling out of bed, and bed rails were provided where the risk assessments could demonstrate that this equipment was safe and appropriate. One person who completed a survey form told us they were disappointed that they could only have one bath a week. We talked to the manager, Sue Stevens about this. She told us that people could have a bath more often if they wanted. She said a number of people had either a bath or a shower several times a week. We asked her to check with each person to ensure the care plans and task lists accurately reflected each persons wishes in respect of baths and/or showers. We asked people if they received the medical support they needed. Most people said always. One person said usually and one person said sometimes. We also received completed survey forms from two GPs who confirmed that the care was always good. One GP told us that Bay Court is an excellent well-run nursing home. The care plans we saw covered all aspects of peoples personal and health care needs. Each person had been asked to complete part of the care plan with their views on their increasing dependency and future care. This included their wishes on any possible hospital admissions and on their care wishes for the final stages of their lives. Where appropriate relatives had been asked to provide this information on the persons behalf. The care plans included nutritional needs and we saw records to show that most peoples weight had been checked regularly. The home has purchased some sit on weigh scales in the last year so that more people can be weighed easily. This means that the home has made further improvements to the way they check that people are receiving the right level of nourishment. We saw records in the kitchen to show that the cooks were aware of individual dietary needs. People with swallowing difficulties received visits and advice from a specialist nurse. Care Homes for Older People Page 14 of 31 Evidence: The home told us that one of their priorities was to ensure people felt warm and comfortable. They said the staff were very good at talking to people and finding out what they wanted to wear, helping them to put on make up and jewellery and making sure they were dressed in clean, colour co-ordinated clothing. At the last inspection we recommended that people should be given opportunities to do regular exercises including walking either indoors or outdoors, physiotherapy or fun exercise sessions. At this inspection we could see that there was a small increase in the amount of exercise offered, although outdoor exercise had been limited during the summer due to poor weather. There were no regular planned sessions for those people who needed assistance to walk or for those people who would enjoy group exercise sessions although these activities had been provided at times when staff were available. Several of the staff who completed a survey form said they were often rushed. From our observations of the staff during our inspection, and from talking to people, we found that all of the planned care tasks were carried out and peoples care needs were met. Call bells were answered promptly and routines within the home ran smoothly. We talked to the staff who were on duty on the day of this inspection about this. They told us they would like to spend more time with each person while they were providing care, and they would like more time to stop and talk to them rather than feeling they had to rush to the next person. We watched as the senior nurse who was in charge of the home when we arrived gave out the morning medications to three people. She followed a safe procedure, checking the medications against the administration records before dispensing them. She watched as each person took the medicines before she signed the records to show they had been administered. Each person had a lockable secure cupboard in their room that held all of their current medication. The staff told us they found that this method of storage had resulted in a safer, more personal and more discreet way of helping people with their medication. Any medicines that required refrigeration and all controlled medicines were stored securely elsewhere in the home. The records we saw had been well maintained. The amounts carried forward each month were recorded and this provided a good accounting system to ensure the correct amounts were held. Care Homes for Older People Page 15 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. While there have been some improvements in the level of stimulation, activities and exercise, these have been limited and some people continue to feel the home does not offer enough opportunities and support to enable them to lead interesting and varied lives. People receive a nutritious and balanced diet that has been planned to meet individual tastes and dietary needs. Evidence: At the last inspection we found that the home did not provide enough activities for people. After the inspection the home employed an activities organiser but unfortunately the person resigned after a few weeks and the home has not been able to recruit another person to this post. Instead they have given a member of staff a few extra hours each week specifically for this task. They have also had a volunteer during the summer months who has helped to provide some activities. Many people who completed a survey form before this inspection once again told us that the home did not provide enough opportunities for people to join regular group Care Homes for Older People Page 16 of 31 Evidence: activities. Comments included, Very few activities. Some types of physio could be helpful - easy exercises. My mother is in her room at all times due to her sight and hearing although I do take her out with the help of into the garden weather permitting. It is extremely hard to cover everyones needs but personally I would like there to be more activities. I am filling this in with my mother. There seems to be no activities at all. Most homes have a mini bus and take the residents shopping or to garden centres. She cannot use her hands and no activities have been offered her at all. More mental stimulation would be appreciated. The home is very close to the centre of the town and those people with good mobility were able to go to the shops, church or social events. Some people went out regularly with families or friends. We heard that families and friends were encouraged to visit and always made to feel welcome and involved. The home had recently introduced a system of recording the activities each person had participated in. From these records we saw that the level of activities had increased in the last few months and that most people had several opportunities to go out, to join in a group activity in the home, or to have individual time for such things as manicures each week. However, the activities had been ad hoc and many people (including families and friends) did not know that activities were being provided. We talked to the manager about ways they could improve their publicity about forthcoming events (for example, by providing a monthly calendar of regular planned activities or a newsletter). The records we saw showed that recent activities provided included quizzes, games, religious services, and visiting clothing suppliers. The manager told us that one of the barriers they have experienced had been a lack of alternative space where people could join activity sessions without disturbing other people. The home is planning to provide a new extension in the coming months that will provide a new additional lounge/dining room and they hope this wil give them space to enable more activities to be provided. All of the people who completed a survey form, and those we talked to said the food was good. Comments include The food is wonderful! and My mother needs her food cut up - the care taken with the Sunday roast dinner enabled mother to enjoy the separate tastes. There were printed daily menus on display in the dining room and we saw records that showed that staff went around to each person every day to ask them what they wanted to eat. If people did not like the main meal on offer a suitable alternatives was agreed with them. There was a record in the kitchen of each persons individual dietary preferences and needs. Care Homes for Older People Page 17 of 31 Evidence: The home told us that since the last inspection they had carried out a survey asking the people living in the home for their comments and the cooks had used this information to adjust the menus. Care Homes for Older People Page 18 of 31 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 are protected from the risk of harm or abuse by well trained staff and good procedures. Evidence: The home has a clearly written complaints procedure that has been given to everyone living in the home. People who completed a survey form before this inspection told us they knew how to make a complaint. One person told us I complained about the state of the garden and it has been remedied. The home has kept a record of complaints and grumbles they have received. We looked at this record and found there were some minor day-to-day grumbles recorded since the last inspection and the records. These included such problems as missing socks. The records demonstrated they had listened, found out what was the cause of the problem, and, where possible, taken action to address them. We also saw letters of thanks from grateful relatives complimenting the home for the good standard of care they had provided. In the last year one complaint has been received by the home, social services and the Commission. This has been investigated through the Safeguarding Adults multi-agency procedures. No evidence was found to show that the home was at fault. Care Homes for Older People Page 19 of 31 Evidence: Since the last inspection the staff team have received a good standard of training on the prevention of abuse and how to safeguard vulnerable people. The records we saw showed that the home had followed good procedures when recruiting new staff to ensure people living in the home were safe from harm. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that has generally been well maintained, and is clean, warm, comfortable and safe. Plans to enlarge the home in the near future are expected to improve the facilities and make the home an even better place to live. Evidence: During our visit we looked at all of the communal areas including bathrooms and toilets, and we also looked in a random selection of bedrooms. Our overall impression was that the house and garden looked bright, comfortable and welcoming. Contract gardeners have been employed recently to tidy the garden. They also had a contract for the regular maintenance of the house. The home told us in their AQAA that they have recently replaced some old vanity units in bedrooms with new hand basins that enabled people to sit closer to the basin so that they could wash themselves rather than relying on staff to help them. They also told us that the laundry was being repainted and repaired. We saw records to show that all equipment in the home was regularly checked and serviced. The house has been adapted to provide ramps, lift, and grab rails to help people move around easily. Plans were on display in the entrance hallway showing a new extension that is due to Care Homes for Older People Page 21 of 31 Evidence: be built in the near future. This extension will provide new bedrooms, bathroom with specialist hoisting equipment, a second lift, new kitchen, and an additional lounge/dining room. Most people who completed a survey form told us the home was always fresh and clean. However, one person told us The lavatories are not very clean and do not smell nice. We looked at the bathrooms and toilets and saw that the toilets had been cleaned and there were no unpleasant odours. However, the decoration of some of the toilet cubicles appeared old and tired with chipped paintwork and worn fittings. In some instances the worn fittings looked stained, giving an unclean impression. We talked to the manager Sue Stevens about what we found. She told us that within the proposed programme of new building works she expected many areas would be brought up to a higher standard. She also gave assurances that she would ensure that the redecoration and repainting of toilets would be given a high priority. All of the cleaning staff have received training on infection control. We received two other comments about the environment and these were, Size of the day room needs to be addressed although hopefully the new extension will address this, and (in response to What could the home do better) Decor. Better equipment, beds, nursing aids etc. Since the last inspection the home has increased the number of cleaning staff employed. On the day of this inspection 2 cleaning staff were on duty. The bedrooms we saw were bright, warm and comfortable. People had been encouraged to bring pictures, furniture and personal items with them to make their rooms feel homely. At the last inspection we found that the home did not have enough specialist nursing style beds for those people who needed a high level of care including assistance to move. Before this inspection the home told us in their AQAA that they had just purchased a new variable height electric bed, and they planned to purchase more in the near future. The laundry was tidy and clean. We talked to the staff about how they made sure that clothing was returned to the correct person and we heard that they have good systems in place to minimise the risk of items going missing. Care Homes for Older People Page 22 of 31 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. People receive care from a dedicated and well trained staff team. While there are enough staff to meet peoples main care needs at times there are insufficient staff to give people the quality of care the staff feel they need. The home has followed good recruitment and induction procedures to ensure people are in safe hands. Evidence: On the day of our inspection there were 23 people living in the home. When we arrived we found the following staff were on duty - 1 Deputy Manager, 1 Senior Nurse, 2 permanently employed care assistants and 1 care assistant employed by an agency, 1 cook, 2 cleaners. Later in the morning the manager also arrived (she had been at a meeting). Some of the staff who completed a survey form before this inspection told us they felt they were often rushed and under-staffed. Comments from staff included. We feel we should be able to give more quality time to the residents. Instead it is very hard work and a struggle to get everyone up by lunchtime. I think sometimes it would be better to have extra staff on to fully meet the individual needs of the residents. When we Care Homes for Older People Page 23 of 31 Evidence: had a few empty rooms we could enjoy our work more. We werent so rushed. Now all our rooms are occupied and the work is very hard. We never have any time to give the residents. They need activities, but we just dont have the time. Always very short of staff. On the day of this inspection we found that, although the staff were busy, all routine tasks were carried out in a timely manner. We found that call bells were answered promptly and staff appeared cheerful and relaxed. We talked to the manager and staff about the reasons why the staff felt the staffing levels were too low. We found that there was a close working relationship among the staff team and staff worked together to get the main care tasks completed. However they felt they did not have enough time to provide the quality of care and services they felt people needed, including time to sit and chat, to take people out, or to provide regular activities. Sue Stevens told us that she had been actively trying to employ an activities organiser. We also heard that the home has always filled vacant shifts by using an agency, although she recognised that this was not ideal. We saw records to show that the home was in the process of recruiting more care staff. We looked at the recruitment files of three staff recruited since the last inspection. We saw that the home had followed good recruitment procedures including a completed application form, at least 2 satisfactory references, and a criminal records bureau (CRB) and protection of vulnerable adults (POVA) check before they had started work. The manager told us that the home had good staff retention, with only 1 care assistant leaving in the last year. A few members of staff were about to retire, including the manager. The records also showed that the staff had undertaken a thorough induction training at the start of their employment. We saw records that showed the home had regularly checked the pin numbers of the trained nursing staff to ensure they have kept up their registration. We heard that the level of training provided to staff had increased in the last year. The home has joined a local care training consortium and through this they have been able to access a good range of high quality training. Training records have been maintained for each member of staff. The training provided to staff in the last year and sessions booked in the near future include the protection of vulnerable adults (POVA), dressings and wounds, first aid, manual handling, fire safety, tissue viability, and infection control. One member of staff commented about the training, Staff training has been good and we have managed to have relevant extra training sessions to meet the needs of our residents, ie, we had a motor neurone disease information session. We have also all Care Homes for Older People Page 24 of 31 Evidence: completed the safeguarding adults training which was a useful session. Senior staff deliver some in house training. Care Homes for Older People Page 25 of 31 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. The health, safety and welfare of people and staff are protected by good procedures and recording methods. Evidence: The manager, Sue Stevens, was due to retire one week after the day of this inspection. She has managed the home for a number of years. A new manager had been recruited and she was due to start work the day after this inspection, giving several days for Sue Stevens to handover to the new manager. We heard that the staff do not receive regular supervisions or appraisals. Comments from staff included There are no regular appraisals or supervisions. We may have a trained nurse meeting once or twice a year. We hope that the new manager will address this by setting up regular supervision sessions and staff group meetings. When we talked to staff we heard that a staff meeting had been held recently and they found it was useful but would like meetings to be held more regularly. Care Homes for Older People Page 26 of 31 Evidence: We heard that, since the last inspection, the home has introduced a staff suggestion file where staff can raise any suggestions or comments. The home told us in their AQAA that they asked the people living in the home and their relatives on their preferred way of giving their views about the home and the services. They said they would prefer to do this verbally rather than by filling in a questionnaire. The home decided to give one member of staff the responsibility for gathering information on the quality of the services by going around and talking to each person, asking questions using a standard list of questions. We saw some of the completed questionnaires during this inspection. The home has also used surveys to find out peoples views on the meals and we heard that they have used the comments they received to adjust the menus. We heard that when the owners visit the home they have not completed their own monthly inspection report. This is required under the Care Homes Regulations and is an important part of a good quality assurance system. Sue Stevens said she would talk to the owners about this task. We looked at the way the home stores and records cash and valuables on behalf of those people who have decided they did not want to hold the cash themselves. We saw that all transactions were well recorded, receipts kept where possible, and there were good procedures in place to regularly check the balances and make certain the balances were correct. The records we saw during our visit showed that the home has good procedures in place to make sure the home is safe and the staff are following safe working practices. This included a range of training on health and safety topics, the provision of protective clothing and equipment, and regular maintenance and check on all equipment. We checked the fire log book and accident records and found these had been well maintained. Care Homes for Older People Page 27 of 31 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 31 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 31 26 The registered provider must visit the home at least once a month and prepare a written report on the conduct of the home. The report must be available for inspection if requested by the Commission. . 01/12/2008 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 The home should ask each person how often they want to receive a bath or a shower and agree with them what days and times the staff will offer to assist them with a bath or shower. This should be clearly documented in the care plan. The level of regular planned activities should be improved to meet the social needs as identified in individual care plans. The home should consider repainting bathrooms and toilets and replacing worn fittings where necessary. The home should review the staffing levels to ensure there are sufficient staff to provide activities and ensure the Page 29 of 31 2 12 3 4 19 27 Care Homes for Older People social needs of people living in the home are met. 5 36 Staff should receive regular supervision and appraisals. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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