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Inspection on 15/09/08 for Beacon Hill Lodge Nursing Home

Also see our care home review for Beacon Hill Lodge Nursing Home for more information

This inspection was carried out on 15th September 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides good and detailed information for prospective residents. A newsletter provides interesting seasonal information for the residents detailing forthcoming events and changes to the home and staff. Comprehensive pre-admission assessments are carried out to determine whether the residents` needs could be met. There is a good rapport between the staff and the residents. It was observed and confirmed by residents that staff are kind, patient and respectful. There is a welcoming atmosphere. Residents said they liked the food, which is of a high standard and with a food variety and choice. On the day of the inspection, there were pancakes for pudding with strawberries and raspberries and homemade cake for tea. The home is kept clean, fresh and odour free. Good and imaginative activities are provided Monday to Friday by an activities person who knows the residents well. Visitors are made welcome in the home and encouraged to join in with activities and special occasions. Staff are provided with comprehensive mandatory and specialist training which include Dementia care and safeguarding vulnerable adults. The company has its own trainer who was present at this inspection. The home promotes Equality and Diversity and the manager was able to give several good examples of how this is put into practice. All activities are equally accessible to all residents. Holy communion service is organised once a month and other religious services can be accessed if required. Residents` personal life choices are encouraged and disabled access provided to all parts of the home. There is no segregation of any group within the home and all residents take their meals in the communal areas if they so wish and are able to.

What has improved since the last inspection?

Care plans have been further improved. Those for residents with dementia and mental health needs are being further updated. Care plans are informed by a range of risk assessments, which are regularly reviewed. Some improvements have been made to the kitchen. Communication with relatives and residents has been strengthened. The manager reported that excellent communication has been forged with the local district nurses team. A wet room has been provided on the top floor. This is a great improvement.

What the care home could do better:

The Company must ensure that there are sufficient numbers of care staff on duty to meet residents` needs in a timely manner. Many residents stay in their rooms due to their dependency as well as by choice. It is imperative that they have regular staff contact to prevent isolation and to receive the care they need. This is further compounded by the lay out of the building with residents being cared for on three floors. Staffing levels were discussed at length with the manager and group manager. Whilst it was said that for the morning shift 5 care workers would be needed, there were 4 care workers on duty. The kitchen was reviewed by the Environmental Health Officer during January 2007 and it was then recommended that it be refurbished. At this inspection it was noted that the kitchen has not been refurbished but some new cupboards have been provided and tiles repaired. Whilst the communal areas and many residents` rooms were well decorated and in a good state of repair, in several rooms it was noted that repairs and maintenance work were outstanding. The hairdressing room would benefit from a clearout, improved ventilation and upgrading to provide a more pleasant environment for the residents. Both sluice rooms would benefit from a clearout of miscellaneous items to ensure effective cleaning.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Beacon Hill Lodge Nursing Home 18 Beacon Hill The Downs Herne Bay Kent CT6 6BA     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: Lisbeth Scoones     Date: 1 5 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 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 28 Information about the care home Name of care home: Address: Beacon Hill Lodge Nursing Home 18 Beacon Hill The Downs Herne Bay Kent CT6 6BA 01227375536 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Unique Help Group Limited Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 30. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Beacon Hill Lodge Nursing Home is a detached Victorian building, which faces the sea front at Herne Bay. It is close to the town centre, with its shops and other amenities. The home was purchased by Nicholas James Care Homes Limited during 2006. The Company owns another four care homes with nursing, in this vicinity. This enables the managers to train together and support each other. The home is registered for a total Care Homes for Older People Page 4 of 28 Over 65 0 30 30 0 Brief description of the care home of thirty beds, most of which are for single use and have en-suite facilities. There has been a change in the registration category in the last year, which now enables the home to take older people who have dementia and nursing needs, as well as older people with nursing. There is no separation of facilities in the home for these different categories of care. There is an understanding with CSCI that the home will consult with residents who do not have dementia on an ongoing basis and will not admit residents with dementia who may have disruptive behaviour. The home has a large lounge and a separate dining room. There is easy access between the ground and first floors via a passenger lift. All rooms have a TV point, nurse call alarm and telephone point. The home has parking space for guests at the front of the premises, and on road parking as well. The fee levels range from £396 per week (residential placements), to £700 (for people with high nursing needs) depending on the assessed needs for individual residents. Care Homes for Older People Page 5 of 28 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 inspection was carried out by two inspectors on 15 September 2008. It comprised discussions with the registered manager, group manager, staff on duty and conversations with a number of residents and visiting relatives during the visit. An accompanied tour of the premises was carried out, a lunchtime session observed and documentation examined in respect of care plans and risk assessments, staff rota, menus, staff and training files, training matrix and medication records. Prior to this inspection, an annual service review had been undertaken. The manager and group manager were present throughout the day and a comprehensive feedback was given at the end of the inspection. Key Lines of Regulatory Assessment (KLORA) have informed the judgements made Care Homes for Older People Page 6 of 28 based on records viewed, observations made and written and verbal responses received. KLORA are guidelines that enable The Commission for Social Care Inspection (CSCI) to make an informed decision about each outcome area. The inspection was further informed by an AQAA (annual quality and audit) completed on 30th April 2008 by the manager and by 3 returned comment cards completed by residents or their relatives. Information thus received is incorporated in the report. Since the previous inspection, the manager has become registered with the CSCI. She has brought stability and firm leadership to the home. The manager reported in the AQAA that the home had received 3 complaints, which were investigated and closed. Two referrals had been made to the safeguarding vulnerable adults team and these have been investigated and closed. The previous inspection was carried out on 28/06/07 and an Annual Service Review on 10/06/08. What the care home does well: What has improved since the last inspection? Care plans have been further improved. Those for residents with dementia and mental health needs are being further updated. Care plans are informed by a range of risk assessments, which are regularly reviewed. Some improvements have been made to the kitchen. Communication with relatives and residents has been strengthened. The manager reported that excellent communication has been forged with the local district nurses team. A wet room has been provided on the top floor. This is a great improvement. Care Homes for Older People Page 8 of 28 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 28 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 28 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. Residents are provided with comprehensive information about the services the home provides. Every resident is assessed before a decision is made to admit the resident. Evidence: The home provides good information for prospective residents. The Statement of Purpose is well set out with all the required details (as per Schedule 1 of the Care Homes Regulations) and is regularly updated. The document includes details such as the style of accommodation, activities available, complaints procedure and advocacy services. It clearly states that the home is for older people with nursing needs and for older people with nursing needs and dementia. These are integrated into the life of the home together, with no separation for different categories of residents. The Service Users Guide is in large print, and had been updated to reflect recent changes in Care Homes for Older People Page 11 of 28 Evidence: staffing. The Guide includes the details for what is included in the fees, and what is not included (e.g. dry cleaning, hairdressing, chiropody). A sample contract is included, and a sample resident questionnaire form. All residents (or the person acting on their behalf) are provided with a contract, and a signed copy is retained on file. A completed contract was viewed. A copy of the most recent inspection report is available by the visitors book in the front entrance hall, along with a copy of the service users guide, the complaints procedure, and the homes latest newsletter. There was good evidence that the manager carries out pre-admission assessments to determine if the home can meet the individual needs of each person. These are well completed, with all relevant information, such as medical history, moving and handling needs, nutrition, pressure areas audit, medication, and dependency levels. The manager assesses residents with dementia to ensure they will fit in with other residents. Residents and relatives are encouraged to visit prior to making a decision about moving into the home. As many residents are admitted from hospital, it is often their relatives who make decisions for them. Admissions are for a trial period of 4 weeks, with a review at the end of this time to check the suitability of the placement. Care Homes for Older People Page 12 of 28 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. Every resident has a care plan that sets out in detail the planned care for their medical, personal and social needs. Residents are protected by the homes medication procedures. Residents are treated with kindness, sensitivity and respect throughout their stay. Evidence: A sample of regularly reviewed care plans was viewed. These are very comprehensive documents with clear details about medical and nursing care. Care plans are supported by a range of risk assessments in respect of pressure area damage, moving and handling, nutrition and continence management. Safety issues are risk assessed in respect of the prevention of falls, the need for bed rails and whether the person can use a call bell. Systems are in place to ensure that residents are checked at least hourly. Daily reports are maintained and visits from other health professionals recorded. Care Homes for Older People Page 13 of 28 Evidence: The manager is in the process of extending the care plans for residents with dementia and mental health needs. A sample of this was seen and demonstrated a whole person picture. The manager is proud of staffs achievements in preventing pressure ulcers developing. Where residents need wound care, good documentation is maintained including details of progress and a body map. Nutritional needs are well documented, and weights are recorded weekly or monthly as appropriate. There was evidence of input from different health professionals. Appropriate referrals are made to the dietician, speech therapist, physiotherapist, GP and others. The manager reported that more input has been developed from occupational therapists and physiotherapist and the mental health team. The manager ensures that nurses and care staff are informed of specific needs for newly admitted residents. Additional staff training would be provided. There is tidy and well organised clinical room. Room and fridge temperatures are recorded to ensure that the temperature does not exceed 25 degrees Celsius. The nurses ensure that there is a good stock rotation and that no medication is out of date. Records are maintained of medication entering the home and those disposed off. Medication records (MAR charts) were in order as well as a controlled drug check carried out. Residents said that they are well looked after. On comment cards it was recorded that all the staff are charming and the nursing home is perfect, it is a trying job nursing the elderly. A resident said the staff could not be better. The home has 4 shared and 22 single rooms. Apart from three, all have an en-suite facility. Residents are treated with kindness, dignity and respect. For the purpose of dignity it was recommended that continence products are not left on display but discreetly stored. It was further recommended that in shared rooms arrangements are made that clearly identify which toiletries and towels belong to which resident. The manager said that staff are trained in the care of the dying and that the home has registered with the Gold Standards Framework. Residents have care plans and assessments in respect of death and dying. These form part of the admission process, so that residents can quickly have the opportunity to discuss any particular fears and preferences about staying in the home or admission to hospital and any special religious and funeral arrangements. Care Homes for Older People Page 14 of 28 Care Homes for Older People Page 15 of 28 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 are provided with a range of activities and outings. These are to be further enhanced for the benefit of residents with dementia. Residents are provided with a choice of wholesome and varied meals, which are well prepared and presented. Evidence: A weekly planner on display in the front entrance hall provided an overview of the activities on offer. The inspectors met with the activities co-ordinator who works for two hours every afternoon (Monday to Fridays). She has been working at the home for four years and knows the residents well. She keeps records for each resident of their preferences, their previous hobbies and lifestyle, and the sort of things they like to take part in. She said that she spends the first hour carrying out a group activity and the second hour giving one to one time with residents in their own rooms. A resident discussed his previous job and continued interest in the subject. It was suggested that this interest might be explored and a visit to the previous place of work arranged. The suggestion was taken on board. The home has the use of two minibuses for outings. Care Homes for Older People Page 16 of 28 Evidence: A recent pictorial newsletter (written by one of the staff) was seen. It includes items such as birthdays and details of forthcoming events. It further contained poems and recipies relating to the season. There is a recognition that the residents would benefit from more activities at the weekend. The manager reported in her AQAA that she would like the residents to be able to make more use of the garden. If this were to be adapted for wheelchair users, residents could get involved in the planting and tending to flowerbeds. The home has a welcoming and friendly atmosphere. Visitors confirmed this and said that they are always made welcome and are usually offered a drink. Kitchen staff always present these very nicely with a tray of tea/coffee. Residents are enabled to bring in personal possessions as confirmed during a tour of the home. A property list is retained in care plans for any specific items. Residents said that they are able to go where they wish, or stay in their own rooms. Residents spoke highly of the quality of the food. Residents enjoyed their meal at lunchtime. There was plenty of choice and meals are well cooked and attractively presented. The chef knows the residents and their individual preferences and diets well. On the day of the visit there was pork casserole or pan-fried cod with fresh vegetables and pancakes with strawberries and raspberries. Pureed food was well presented and the chef said that for those residents who are underweight soups and food would be fortified with cream and butter. Soups are usually home made and homemade cakes are offered every day. The home employs two chefs and kitchen assistants during the morning and at suppertime. If a member of care staff were to assist with meal preparation, they would not be on the care rota. All staff involved with food preparation have been trained in food hygiene. Care Homes for Older People Page 17 of 28 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 know that their complaints would be taken seriously and acted upon. Residents are protected from abuse. Evidence: The manager is keen to ensure that residents and relatives concerns are addressed appropriately and quickly. Residents on comment cards confirmed they would know how to make a complaint. Since the previous inspections, three complaints and two safeguarding vulnerable adults referrals have been made. These were all investigated and have now been closed. The complaints procedure is available in the entrance hall and clearly sets out the route to follow to make a complaint. The manager reported that they have developed a good relationship with the local authority, care managers and the adult protection team. As confirmed on the training matrix and by staff spoken with, the companys trainer said that all staff are provided with training in the protection of vulnerable adults. Such training would include awareness of he Mental Capacity Act. The home has a whistleblowing policy in place. Recruitment practices include waiting for POVA First checks and Criminal Record Bureau checks to be completed prior to confirming employment. Care Homes for Older People Page 18 of 28 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. Residents live in a homely environment, which is pleasantly decorated and furnished. Some bedrooms are in need of attention in respect of minor repairs and redecoration. Residents have sufficient and suitable bathing facilities but locks on bathrooms and toilet doors are of the type that cannot be accessed by staff in an emergency. The home is generally clean and hygienic. Evidence: The inspectors toured all areas of the home. It was redecorated and re-carpeted in 2007 and provides a light and homely environment. Apart from in one room, no offensive odours were noted. The housekeepers work hard to provide good standards of cleanliness. There are three pleasantly furnished communal rooms including a lounge, a large dining room and a quiet room, which may be used by visitors and residents. Since the previous inspection, some internal decorating has been carried out and new chairs, reclining chairs and dining room furniture purchased. Additional profiling beds and profile mattresses have been purchased for residents safety and comfort. Whilst it was said that new bed linen has been purchased, several sheets seen were thin and should be replaced. Care Homes for Older People Page 19 of 28 Evidence: It is a large building, which requires a lot of upkeep. The company has a maintenance team that attends regularly to address maintenance issues. The bathroom on the top floor, which was in a poor condition at the previous inspection, has been changed into a walk-in shower room. The inspectors noted a number of repairs that still need to be carried out such as a loose nurse call panel, holes in a wall, a leaking pipe, various vents in need of cleaning, loosened floor covering in an en-suite and missing tiles. To enhance orientation for confused residents, pictorial signs have been placed on toilet and bathrooms doors. The manager said she would like the residents doors to have name plates with a picture attached that is significant to them. It was noted that bathroom and toilet doors are fitted with a lock that cannot be easily accessed by staff in an emergency. The manager said this would be addressed. The home has sufficient equipment such as hoists, pressure-relieving mattresses, raised toilet seats and grab rails. Wheelchair maintenance is carried out monthly by the maintenance team as well as weekly tyre checks. Hoists are stored in a wide area at the back of the entrance hall. The Environmental Health Officer recommended in January 2007 that the kitchen be refurbished. Whilst some kitchen units and tiles have been replaced, no timescale for this work has been decided. The maintenance team is in charge of the gardens. There is a paved walking area at the rear of the building and an outside table and chairs under a gazebo for people to enjoy good weather. The manager said in her AQAA that she would like more than basic input into the garden. The front of the home has sea views. The laundry service is managed in a separate building at the rear. This area was not visited at this inspection. Designated laundry staff are employed. Whilst the home is in general clean, the sluice rooms are in need of a clearout to allow for effective cleaning and the hairdressing room would benefit from a clearout and upgrade. It was further noted that the outside windows are in need of cleaning. A resident who spends all their time in bed said on a comment card, the home is always fresh and clean apart from the windows. This was discussed during the feedback. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are in need of review to ensure that residents needs can be met at all times. Staff are well trained and competent to do their jobs. Residents are protected by the homes employment procedures. Evidence: The home is staffed with 1 nurse throughout the 24-hour period with 4 care assistants in the mornings and 3 in the afternoons. The nurse manager is on duty until 5.30 pm on weekdays and would assist with nursing duties if needed. Night duties are covered by 1 nurse and 2 carers. On the day of the inspection there was a nurse on duty and 4 care assistants. The companys trainer manager, who is a nurse, was also assisting particularly at meal times. The previous report recommended that staffing levels were reviewed. Several residents at that time had commented that they sometimes had to wait a long time for call bells to be answered. Staff interviewed said that ideally there should be 5 care Care Homes for Older People Page 21 of 28 Evidence: staff on duty in the morning. The inspectors observed that some residents were still in their rooms and not up at 11.30. This is of concern as many of the residents are highly dependent. These residents should be attended to by the staff on a regular basis. One resident was clearly restless and confused. Staff look after residents whose rooms are spread out over three floors and many residents prefer to stay in their rooms. The manager said that additional staff are being recruited. In the meantime however it does not appear that agency staff are employed for the morning shift. A resident on a comment card wrote, All the staff are charming but overworked. A member of staff said: We struggle. Another: We need more staff especially in the morning. The care staff are assisted by a good team of ancillary staff. This includes a chef, two domestic staff from Monday to Friday and one domestic staff at weekends. An activities co-ordinator is employed for two hours from Monday to Friday afternoons. Laundry staff are employed during the week but not at weekends. The home currently has 28 residents and especially in the morning the staffing levels are insufficient. The home promotes NVQ training for care staff and eight members of staff have completed NVQ level 2 or 3 with 2 working towards NVQ level 2. Recruitment files were viewed for three staff. The files were in good order and well maintained. Two written references are requested. However, for one employee the references obtained were different from those supplied. The home must ensure that it records why changes are made and further that all sections of all forms are completed. Staff files include a photograph of the staff member, full employment history, proof of identity, POVA First and CRB checks. Nurses PIN numbers are checked. Staff are provided with a contract. They do not get paid for their breaks. The manager has implemented a staff training matrix which shows that staff have completed mandatory training and there is ongoing training scheduled for updates. The Company training manager is responsible for Skills for Care induction training. She is a POVA trainer (Protection of Vulnerable Adults) and provides all mandatory training except fire safety awareness. The mandatory training includes infection control. Many staff have completed a Certificate in dementia. Training in the Mental Capacity Act is provided. Nurses are encouraged to develop their own skills and abilities. Additional training is accessed through the PCT in respect of flu vaccines, venapuncture and continence management. Care Homes for Older People Page 22 of 28 Care Homes for Older People Page 23 of 28 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 by a competent well-qualified manager. Due to reported low staffing levels in the morning, the home is not always run in the best interests of the residents. Residents financial interests are safeguarded. Staff are appropriately supervised. Residents health, safety and well being is promoted and protected. Evidence: Since the previous inspection, the manager has been registered with the CSCI. She is working towards the Registered Managers Award (RMA). She has been in post since January 2007 and provides stability to the home and clear leadership for other staff. Care Homes for Older People Page 24 of 28 Evidence: She is a level 1 nurse with previous experience of caring for older people. The manager is responsible for some of the administration. She regularly works hands on to keep in touch with the residents and to support the staff. She keeps herself updated and attends local nurses forum. She is a good communicator and it is evident that she is liked by residents and staff. The manager is supported by her deputy, other nurses and the companys group manager. She said, We have a happy team who all get on well and support each other. Good quality monitoring systems are in place, including a questionnaire for residents and relatives. The results would be put on display for residents and relatives to see. Residents meetings and staff meeting are held. Regular audits are carried out of different aspects of the home such as care planning, medication, pressure ulcers, falls and accidents, complaints and nutrition. Policies and procedures are reviewed. Monthly visits are carried out by senior management. With the current shortage of staff in the mornings identified in standard 7, it cannot be guaranteed that the home is always run in the best interests of the residents. At the previous inspection it was recorded that residents money is not managed by the home except for a few pocket monies. These are stored individually, and records are retained for all transactions. Staff files contained records for staff supervision, which has been implemented for all staff. This is carried out on a one to one basis every two months, providing staff with individual opportunities to discuss progress, training and developments in the home. The manager ensures that all health and safety guidelines are adhered to, that staff are trained and suitable risk assessments are in place. She reported in the AQAA that all maintenance and service records are up to date. The insurance certificate is on display and is in date. Care Homes for Older People Page 25 of 28 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 26 of 28 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 27 18 That at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users Insufficient numbers of staff on duty in the morning 28/10/2008 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 Care Homes for Older People Page 27 of 28 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. 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