Inspection on 04/02/09 for Belmar Nursing Home

This inspection was carried out on 4th February 2009.

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

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

Other inspections for this house

Belmar Nursing Home 08/02/10

Belmar Nursing Home 06/02/08

Belmar Nursing Home 30/05/07

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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 adults (18-65 years) Name: Address: Belmar Nursing Home 25 Clifton Drive Lytham St Annes On Sea Lancashire FY8 5QY     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: Lesley Plant     Date: 0 4 0 2 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 Adults (18-65 years) 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 Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Belmar Nursing Home 25 Clifton Drive Lytham St Annes On Sea Lancashire FY8 5QY 01253739534 01253796447 belmarnh@gmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Belmar Care Home Ltd Name of registered manager (if applicable) Mrs Lynne Millar Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following category of service only: Care home only: Code PC, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Dementia over 65 years of age: Code DE(E) (maximum number of places: 4). Mental disorder, excluding learning disability or dementia: Code MD (maximum number of places: 40). The maximum number of people who can be accommodated is: 44. Date of last inspection Brief description of the care home Belmar Nursing Home is situated in a residential area of Lytham St Annes. The home provides a number of lounge and dining rooms plus a conservatory, which is the designated smoking room. Parking is available at the front of the building and there is a small garden area at the rear. Care Homes for Adults (18-65 years) Page 4 of 32 care home 44 Over 65 4 0 0 40 Brief description of the care home The home is currently registered to provide personal and nursing care to up to 44 people, with 40 places for people with mental health problems and four places for people over 65 with dementia. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection focused on the outcomes for the people living at the home and involved gathering information about the service from a wide range of sources over a period of time. The visit to the home was unannounced and looked at all the key national minimum standards plus the standard relating to supervision arrangements for staff. At the time of the visit there were 36 people resident at the home. The inspector spoke to the registered manager, five care staff, the two nurses on duty and six people living at the home. Information was also gained from the annual quality assurance assessment completed Care Homes for Adults (18-65 years) Page 6 of 32 by the manager. This is a self assessment that focuses on how well positive outcomes are being achieved for people who use the service. It also provided some numerical information. CSCI surveys were received from 13 people living at the home. Records were viewed and a tour of the building took place. Time was also spent observing staff and those living at the home as they went about the days activities. The last key inspection was in February 2008, with a random inspection taking place in August 2008. This random inspection did not look at all areas of service provision but focused on how well the home was meeting the requirements and recommendations made at the key inspection in February. What the care home does well: What has improved since the last inspection? What they could do better: Where possible individuals should be fully involved in the drawing up of their care plan. If restrictions have to be imposed, these should be agreed with the person concerned or their representative. This will help to ensure that any restrictions are in the persons best interests. Staff are not clear about their key worker role and communication between staff also needs to be improved, particularly regarding risk management plans. There needs to be consistency in the support provided, in order to keep people safe. Individual activity plans should continue to be put in place, particularly for people who it is difficult to engage with. This will help to ensure that all those living at the home take part in meaningful activities. Care Homes for Adults (18-65 years) Page 8 of 32 People living at the home require more direct support with personal care and care of their clothing. Staff need guidance in this area and need to develop proactive ways of working. Medication practices are generally good. The recommendations within this report will help to ensure consistency and help to prevent errors being made. Improvements must be made to the management of the home. Lack of a structured induction for new staff, limited staff supervision, poor staff communication and inadequate quality monitoring are all impacting upon the service being provided. There needs to be a stronger management presence and clear leadership for staff. Progress with the environmental improvements is now slow and this must be addressed by the home owner. 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 Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Assessments take place prior to people being admitted to the home, helping to ensure that their needs can be met. Evidence: The home has developed a new brochure, which is soon to be printed. Copies will then be available for anyone interested in moving into the home and also for any interested professionals such as social workers. Qualified and experienced staff carry out the assessment prior to any person moving into the home. This helps to ensure that people are only admitted to the home if their needs can be met. Information from other professionals is also gathered during the assessment period. Risk assessments are then carried out and a care plan put in place. Records were viewed in relation to an individual who had lived at the home for four months. An assessment by the CPA (care programme approach) coordinator was available and also a report by an independent mental capacity advocate, which Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: concluded that a home providing nursing care was required for this person. A copy of the assessment undertaken by staff from the Belmar was also in place. All the information gathered is then used to inform the care plan. A number of people who completed CSCI surveys responded that they did not receive much information before they moved into the home. As most people have lived here for some time, this may have been the case when they moved in. The new brochure will help in this area, providing information to people who are considering moving into the home. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Care plans and risk management plans are in place. However, lack of clarity, the differing views of staff and the ineffective key worker system mean that there are inconsistencies in how support is provided. Evidence: The care planning records for three people living at the home were viewed. Separate care plans are written for each area of need, such as personal hygiene, medication, and continence. The care plans viewed were all being regularly reviewed. For one person there had been a CPA (care programme approach) review and a care plan compiled by the CPA coordinator. Issues identified within the CPA review were then reflected within the care plans drawn up by staff at the home. This shows that everyone involved is aware of the key areas of support. Staff keep good daily records, giving an overview of how people have spent their time and how they have been. Records are completed for the day and nighttime periods. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: Records were in place, signed by some individuals to say that they were in agreement to their care plans and risk assessments. It is understood that some people do not like signing these records even though they may in principle have agreed to the content of the care plan or risk management plan. Where individuals are either unwilling or unable to sign in agreement, the reason should be recorded and agreement gained from the social worker or relative. This is particularly important when restrictions have been imposed. Risk assessments were viewed in relation to smoking, alcohol and vulnerability if away from the home without staff. These too are being reviewed. The records viewed showed that one person had significantly reduced their alcohol intake, which had been excessive. This person was spoken to and appeared pleased with the situation saying; Im happy, everything is ok. I can have three cans a day and that is ok. New recording sheets have been introduced regarding any serious incidents. These allow for a good level of detail and focus on what happened before the incident, how staff responded and what the outcome was. This way of recording allows for any patterns to be identified and for risk management plans to develop which take into account what is likely to help in these situations. One risk management plan gave good practical advice to staff, saying that the person is more likely to respond positively to more mature staff. This kind of detail is useful and helps staff when they are responding to difficult situations. Although risk management plans are in place, some major inconsistencies were found in how these were being put into practice by staff. The risk management plan for one person who is vulnerable if away from the home without staff states that half hour checks of her whereabouts need to be made by staff. The record sheet being used by care staff showed that 2 hourly checks were taking place. There were different views from staff regarding another person who requires staff support when out. The nurse spoken to said that he generally complies with this, whereas the senior care staff on duty responded that he often goes out without staff. A member of care staff spoken to explained this difference of opinion, saying that care staff see what actually happens, as nursing staff are often busy in the office. There is key worker system in place, however this does not seem to be put into practice. Two members of staff spoken to were vague about this role and were each only able to recall one person they were key worker for even though staff have key worker responsibility for several people. There appears to be a lack of communication between different groups of staff and the key worker role is not well established. A strong management input is required, in Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: order that improvements can be made. Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. Activities are provided and people enjoy the meals at the home. Evidence: The people living at the Belmar have very different needs. Some people are able to arrange their own social life and others may have difficulty communicating their preferences. It is acknowledged that for many people with mental health problems, motivation may be low and for some people their medication may also have an effect on their levels of motivation. Activities continue to improve at the home. People were seen to be responding with more purpose, there was a range of different activities taking place and the general atmosphere was more positive. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: A new activities coordinator has just commenced, having previously worked in another post at the home. Activity plans are in place for each person, although these have not yet all been put into action. On the day of this visit, the activity coordinator and another member of staff were carrying out hair and beauty treatments for some of the ladies, who were seen to be enjoying this session. Others at the home were playing cards and snooker with staff. The staffing levels do allow for different activities to take place. Records show that people go out for walks, have lunch out and the cookery sessions are also continuing. Some people have expressed a wish to go to church and this is being arranged. A special valentines night is planned with a singer coming to provide entertainment. Some people have links with the local community mental health team and access activities at this base. The new activities coordinator has met with people to discuss the things they would like to do and has made plans to put these in place. The atmosphere appeared calm, with people engaging positively with staff. More effort now needs to be focused on those who are more difficult to engage in activities and this was discussed with the activities coordinator. Individual plans could include some routine household tasks, such as cleaning their bedroom, or ironing clothing, as well as leisure activities in and out of the home. A strengthened key worker system would help in this area. Visitors are made welcome, as seen during this inspection visit. Staff record on the daily notes if anyone has had a visitor or had contact with their family. The kitchen is in the basement of the building, with meals being brought up to the dining room in heated trolleys and then served by care staff. This means that people are able to see what food choices are available and select what and how much they want to eat. There is a choice of two hot meals at lunch time, with one being a vegetarian option. On the day of this inspection visit people were seen to be enjoying the food and the two people spoken to during lunch both made favourable comments about the meals at the home. At tea time a number of choices are available, plus soup and sandwiches. People are encouraged to eat main meals in the dining room. At the start of the inspection visit some people were eating breakfast, with a few people preferring to eat in one of the lounges. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Pride in appearance and care of clothing is not strongly promoted by staff. Medication is generally well managed, however improvements in this area would provide extra safeguards for people living at the home. Evidence: Care plans address the personal care needs of each person and the amount of support required varies. A number of people require prompting in order to maintain acceptable standards of hygiene and some people resist the support being offered. A daily work allocation record is kept, showing which staff are responsible for tasks such as helping people to bathe, morning drinks and room checks for people who may smoke in their bedroom instead of in the conservatory, which is the designated smoking room. The incidents of people smoking in bedrooms does appear to be reducing as staff are vigilant in carrying out these checks. Several people were seen to be wearing dirty clothing or clothing which required mending or buttons replacing. Whilst acknowledging that some individuals will not agree to staff support in this area, staff could be more proactive. A member of staff Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: approached an individual and pointed out that her coat was dirty, but did not prompt her to change it or provide support to clean it. This resident then responded that there was also had a hole in her pocket and that her purse kept falling out. The member of staff did not offer any response or attempt to rectify this and when prompted was not able to say who would normally carry out sewing repairs or where the sewing kit was kept. Another person was wearing shoes which were incorrectly laced and he had no socks on, saying that he couldnt find any. The staff member with him did not respond to this until asked by the inspector to go and find some socks. Different views from nursing and care staff were given in relation to this person changing their clothes. At the time of the visit his coat was extremely dirty, with care staff saying that he would not take it off for washing, although when requested he did so. When discussed with nursing staff, the response was that this person was generally compliant, which contradicted the view of care staff. Staff need to be more proactive in this area and understand the impact of appearance upon feelings of self worth and confidence. Staff should also be acting as role models in this area and be mindful of their own appearance. Records are kept of health care appointments and show contact with health care professionals such as GPs. Specialist input is provided from community psychiatric nurses and the community mental health team. Weight is monitored and records are kept. Medication is safely stored in two locked medication cabinets kept in the nurses office which is locked when not in use. Only qualified nursing staff administer medication and there is a record of the signatures of these staff. The medication records for three people were viewed and showed that staff are consistent in signing the record when medication is given. However handwritten entries of prescribed medication were not being checked and signed by two staff. One such entry had not been signed at all. Previous inspection reports have recommended that all handwritten entries of prescribed medication should be checked by two people but this is still not being consistently carried out. The double checking of these entries will help to prevent errors being made. Medication, such as liquids, not supplied in blister packs by the pharmacist is being dated when it is first opened. This is good practice and will help in any audit and will also help to prevent any medication being given when it is past the expiry date. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: Some people living at the Belmar have medication prescribed to be given when required. There should be clear written guidance regarding under what circumstances this should be given. This will help to make sure that medication is given consistently and that all those responsible for administering medication are following the same directions. This is particularly important for pain relief medication and for medication prescribed to be given if the person becomes aggressive. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. Arrangements for dealing with complaints are in place. Staff training helps to give staff an understanding of how to manage difficult situations. Evidence: A formal complaints procedure is in place and is available to those living at the home. The majority of people who completed CSCI surveys responded that they know how to raise any concerns. Records are kept of any complaints raised and the outcome of any investigations. The CSCI have received one formal complaint, which was promptly investigated by the area manager of the provider organisation, with one element found to be partially upheld. The manager is aware of safeguarding procedures, with concerns being forwarded to the local social services for consideration under safeguarding procedures. Staff have undertaken breakaway and conflict management training. Several sessions took place, to enable all staff to attend. Risk management strategies regarding difficult behaviour are in place. Records are kept of money held on behalf of people living at the home and these were viewed. Care Homes for Adults (18-65 years) Page 21 of 32 Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, 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. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all parts of the home are maintained to a good standard of decoration and cleanliness. The standard of the environment in some areas needs to be improved, to ensure that all residents are provided with a well maintained, safe, clean and comfortable place to live. Evidence: The refurbishment programme is continuing. The upstairs bedrooms have been greatly improved, with new furniture and carpeting. Following internal building work, some bedrooms now have an en suite facility. Two people resident in the upgraded rooms were spoken with and both were very happy with their bedrooms and new furniture. Although improvements continue to be made, progress in completing the full refurbishment is slow. Damaged radiator covers, dated bathrooms with broken tiles and damaged flooring, and the neglected state of the conservatory all mean that some parts of the home remain poor. Cleanliness of the home is inconsistent. The cleaning schedules, where staff sign to confirm that they have carried out the agreed cleaning duties for each room are not Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: being completed consistently and some areas, such as the bathrooms are hard to clean properly because of the poor state of tiles and flooring. At the time of this visit the chairs in the lounge were dirty and smelly, causing clothing to smell after sitting in them. When pointed out, these were immediately cleaned by the domestic staff. It is understood that the lounge chairs should be cleaned by night staff, but had clearly not been done. The chairs in the lounge not only look dirty but they are also very worn. The manager did explain that new chairs are to be ordered and that material samples were being looked at in order to place this order. The cleaning schedule in the conservatory had not been completed for several days and this room was in need of cleaning. This too was done, when pointed out to staff. This room is the designated smoking area for those living at the home. Although cigarette waste containers are provided, those living at the home do not always use them. Whilst acknowledging that the conservatory is hard to keep clean, this room should be given more attention and it should be cleaned more frequently. New laundry equipment is soon to be purchased and there are plans to re site the laundry to the basement of the home. There are arrangements in place for the disposal of clinical waste. Protective clothing is made available to staff who were observed wearing protective aprons for certain duties. It was confirmed that there is a team of domestic staff at the home, with two cleaners on duty on the day of this visit, and on occasions three cleaning staff on duty. This is a lot of staffing input, which is not reflected in the cleanliness seen during this inspection. The cleaning of the home needs to be closely monitored by the manager and procedures put in place which will mean that all areas are regularly and thoroughly cleaned. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. A well structured induction programme and regular supervisions for staff would help to improve the quality of the service. Qualification training for staff and a good recruitment procedure are good aspects of the staffing at this home. Evidence: At the time of this inspection visit there were 36 people resident at the home, with two nurses, six care staff, (including senior care staff) the manager, a maintenance worker, a cook and two cleaning staff on duty. Rotas show that there are three staff working each night, with one being a qualified nurse. There have been some changes to the staff team, with a member of the team having recently been appointed as activities organiser. Qualification training for care staff is promoted, with 10 of the 14 care staff having achieved NVQ (national vocational qualification) level 2 or above. Some staff who have gained the level 2 award are now working toward level 3. The recruitment records for a new member of staff were viewed. Records included an application form, two references including one from the last employer, a health declaration and a record of the check against the nationally held list of people who Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: have been deemed unsuitable to work with vulnerable people. The full criminal records bureau disclosure had not yet been received. The manager is aware that staff must be closely supervised until this full disclosure is received. The checks that take place help to ensure that only suitable people are employed at the home. A new member of staff was spoken to. This staff member confirmed that this was her first day at work and that a senior care worker was supporting her and was going through an induction to the home. The induction record covered basic, but important information such as fire safety and key procedures. This introduction to the home is important but does not meet nationally agreed induction standards. At the random inspection in August 2008, information was supplied which confirmed that new induction packs were available but were not yet in use with staff and these have still not been implemented. A thorough induction programme in line with nationally agreed standards should be introduced. This will help to make sure that new staff receive appropriate information and training for the work they are to do. Staff training was discussed with the manager and some records of staff attending training sessions were viewed. Training for staff has improved, with a good focus on health and safety related topics. In the last six months training regarding fire safety, moving and handling, abuse, breakaway and conflict management has been arranged for staff. The lack of a staff training matrix, showing all essential training and the dates attended by each member of staff, make it difficult to see where there may be gaps in knowledge and hard to see when refresher training is due. An administrator is soon to take up post, which should improve the general organisation of records, including maintaining an up to date training matrix. Some informal supervision of staff takes place as part of the day to day management of the home. Nursing staff meet with manager on a regular basis to discuss progress with individuals living at the home. Formal supervision of staff is still not taking place regularly. This is an important part of staff development and impacts upon the quality of the service being provided. Each member of the support team should receive formal recorded supervision at least six times a year. This will provide opportunity to discuss work performance, as well as ensure that staff are all working to agreed guidelines in relation to individuals living at the home. The lack of formal supervision for staff has been raised at previous inspections and little progress is being made in this area. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current management arrangements and lack of effective quality monitoring, do not ensure that continual improvements are being made. Evidence: The manager has many years experience, is a qualified Registered Mental Nurse, is registered with CSCI and has gained the Registered Managers Award NVQ (national vocational qualification) level 4, which is the recommended management qualification for anyone managing a care home. Nursing staff and senior care staff also carry out certain management duties at the home. The home is currently without an administrator but an appointment has been made and an administrative worker will soon commence duty. Although the home continues to make improvements in certain areas, overall progress is slow. Strong management is essential to push forward with further changes. It is important that the manager is able to work alongside staff, demonstrate good practice and lead the staff team. There needs to be a strong management presence in the Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: home. The managers office is situated in the basement and the manager does not spend long periods of time in the main parts of the home. The lack of administration staff also means that the manager is not free to spend more time working alongside staff. Nursing staff are based in an office on the ground floor, however they too are occupied with duties such as medication and care plans and do not seem to spend much time working alongside care staff. Quality monitoring needs to be strengthened. In the past, surveys have been sent to relatives but none were returned. Work is being carried out to develop surveys for those living at the home. As yet, these have not been distributed. Regular supervision meetings with staff would help in this area, as would strengthening of the key worker system, both of which would help to promote accountability within the staff team. The area manager continues to make regular visits to the home and carries out certain audits and speaks to staff and the people living there. Staff meetings have been taking place more frequently, an improvement which needs to be maintained. The annual quality assurance assessment completed by the manager of the home contained some useful information, but not in much detail. There were some gaps in the information regarding safety checks at the home, this information was then given when later requested. Health and safety related training for staff has improved. Recent training has included fire safety, moving and handling, abuse and breakaway and conflict management. Some of these programmes were repeated to help to ensure that all staff could attend one of the dates. A high number of care staff have gained an NVQ award and certain health and safety issues are also covered within this training. Fire equipment and electrical equipment at the home is regularly checked. A concern had been raised regarding damaged plasterboard in a storage cupboard where a sign stated that asbestos may be present. The area manager had confirmed that the sign had been placed there by the firm which had carried out the required asbestos survey of the home and that the siting of the notice was agreed practice for parts of buildings where full access and investigation could not take place. There is nothing to suggest that this area poses any risk, however the plasterboard should be repaired, which will help to allay any worries that staff may have. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 24 23 All parts of the home must 30/09/2009 be well maintained and decorated to a reasonable standard. (Previous timescale not met) Quality assurance and quality 30/05/2009 monitoring systems must be established. (Previous timescale not met.) 2 39 24 Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 30 23 A reasonable standard of cleanliness must be maintained. To provide a hygienic environment 01/03/2009 2 37 9 Strong and effective management systems must be in place. To ensure that the home is making continual progress and reaching and maintaining good standards. 30/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 The key worker role should be strengthened, which will help staff to understand and carry out their role and responsibilities. Where possible individuals should be fully involved in the drawing up of their care plan. This will help to ensure that people are getting the support that they want and need. 2 6 Care Homes for Adults (18-65 years) Page 30 of 32 3 6 Where restrictions have to be imposed, these should be agreed with the person concerned or their representative, social worker or relative. This will help to ensure that any restrictions are in the individuals best interests. Agreed risk management plans should be communicated to all staff. This will promote consistency in the support provided and help to keep people safe. Individual activity plans should continue to be put in place, particularly for people who it is difficult to enage with. This will help to ensure that all those living at the home take part in meaningful activities. Those living at the home should receive more support with their personal care and care of their clothing, which will help to give a feeling of self worth. Handwritten entries of prescribed medication should be checked and signed by two staff. This will help to prevent any errors being made. Medication prescribed to be given when required should have clear guidance regarding under what circumstances it is to be administered. This will help to ensure that this medication is given consistently. There should be a training matrix for the staff team. This will help to identify any gaps in essential training. Staff should undergo a structured induction programme in line with nationally agreed standards. This will help to ensure that staff are equipped for the tasks they are to perform. All nursing and care staff should receive regular supervision and records kept. This will provide an opportunity to address and monitor any performance issues which may be impacting on the quality of the service. The damaged plasterboard in the storage cupboard identified at this inspection should be repaired. This will help to allay any concerns regarding potential danger. 4 9 5 14 6 18 7 20 8 20 9 10 35 35 11 36 12 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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