Inspection on 11/11/08 for Benslow Nursing Home

This inspection was carried out on 11th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Benslow Nursing Home 29/11/06

Benslow Nursing Home 10/05/06

Benslow Nursing Home 03/11/05

Benslow Nursing Home 10/04/05

Benslow Nursing Home 16/12/04

Benslow Nursing Home 11/05/04

Benslow Nursing Home 27/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Benslow Nursing Home Benslow Rise Hitchin Hertfordshire SG4 9QY     The quality rating for this care home is:   three star excellent 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: Claire Farrier     Date: 1 1 1 1 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 29 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 29 Information about the care home Name of care home: Address: Benslow Nursing Home Benslow Rise Hitchin Hertfordshire SG4 9QY 01462459773 Telephone number: Fax number: Email address: Provider web address: sandra@benslow.co.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Sandra Tyers Type of registration: Number of places registered: Benslow Management Company Limited care home 35 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 who can be accommodated is 35. The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Benslow Nursing Home is a care home providing personal care and nursing care with accommodation for 35 older people, who may also have a diagnosis of dementia. It is owned by Benslow Management Company Limited, which is a private company. It was first registered under the Registered Homes Act (1984) in January 1996. The home is situated in a quiet residential neighbourhood just over a mile from the centre of Care Homes for Older People Page 4 of 29 Over 65 0 35 35 0 Brief description of the care home Hitchin. It consists of a three storey building and the interior is decorated to a high standard. All the homes bedrooms have en-suite facilities. There are three double bedrooms, which may be occupied by choice by a married couple or friends who wish to share. There is a passenger lift between the floors. The home has a garden at the side, accessed through the front door, with lawn and shrubs, a patio and sheltered sitting places. The current charges range from 538.54 to 900 pounds per week. This is variable according to assessed care needs and should always be subject to an individual service contract agreed by the resident or their representative, and the service providers before a resident moves into the home. Ancillary fees payable for services such as hairdressing or chiropody are itemised in the contract. The statement of purpose, service user guide and previous CSCI inspection reports are available at the home. CSCI inspection reports are also available on the CSCI web site. Care Homes for Older People Page 5 of 29 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: three star excellent 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: The last key inspection of Benslow Nursing Home took place between 29th November and 18th December 2006. We carried out an Annual Service Review of the information we had received since the last key inspection in January 2008. A copy of this review is available on request. On this occasion we spent one day at Benslow Nursing Home, and the people who live there and work there did not know that we were coming. The focus of the inspection was to assess all the key standards. Some additional standards were also assessed. An Expert by Experience (EBE) took part in the inspection. The EBE is a person who has experience of care services for older people. The EBE met and talked to the people who live in the home, both in their own rooms and in the lounges. We also talked to some Care Homes for Older People Page 6 of 29 of the staff and we looked around the home. One member of staff completed a Have Your Say survey before the inspection, and we have used the information from this in this report. We looked at some of the records kept in the home and some of the homes policies. We also looked at a sample of care plans so that we could see how people are involved in planning their own care and support. We talked to the manager, and discussed what we had seen during the inspection. The manager sent some information (the Annual Quality Assurance Assessment, or AQAA) about the home to CSCI before the inspection, and her assessment of what the service does in each area. Evidence from the AQAA has been included in this report. What the care home does well: What has improved since the last inspection? What they could do better: We are confident that the improvements that have already taken place in the home will continue. The manager has plans in place to ensure that there is a positive outcome, to continue to provide a good quality of life for the people who live in the home. We have made requirements about recording medication and about the number of staff employed in the home. We found one minor discrepancy in a spot check of the Care Homes for Older People Page 8 of 29 medication records, which indicates a need for a more robust system of audits. Some members of staff are working an excessive number of hours, which may cause them to be too tired to provide a good quality of care for the people who live there, and there is a risk of errors due to poor concentration. More staff have been employed to start in December, and the manager needs to ensure that there are sufficient staff in the home at all times so that people do not work excessive hours. 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 29 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 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has sufficient information on residents needs and access to appropriate services to enable their needs to be met. Evidence: In September 2008 CSCI agreed to increase the number of people that the home is registered for to 35, and add the category of dementia to the registration. In the registration report we said, The manager is currently working towards completing a BSc in Dementia Studies with Bradford University. All staff have received either basic awareness or level 2 training in Dementia Care. The manager said that staff are keen to work with people who have needs associated with dementia, and to use the training they have received. The manager demonstrated a good understanding of Person Centred Care, and individualised care planning. During this inspection we found that the staff have the experience, training and support to meet the needs of the people who live in the home. The staff who we spoke to confirmed that they have had training Care Homes for Older People Page 11 of 29 Evidence: in dementia care. The Annual Quality Assurance Assessment (AQAA) stated that improvements have been made to the homes assessment process, and more information is now taken before admission to the home. A life history is now more often taken before admission. We looked at the files of two people who moved into the home during the last year. Both files contained assessments with good details of the persons personal and health care needs, which were used to write their care plan. The information included details of each persons personal preferences, for example the time each person likes to get up and have a wash, and what they like to do during the day. We saw completed contracts in the files that we inspected. The contracts contain details of the services that the home provides, and the terms and conditions of the service. Care Homes for Older People Page 12 of 29 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. The people who live in the home are confident that they will receive a good quality of personal care and healthcare. Evidence: Everyone that we spoke to said that the staff treat them well, and we observed a good relationship between the staff and the people who live in the home. The people who completed surveys for the inspection said that the care home gives their relative the care that they expect. Comments from relatives include, The staff at Benslow keep the clients very clean and very well fed, and seem to care about them. They always telephone me if anything medical is wrong and my relative is taken to hospital straight away. They are also very good in any matters and explain what is wrong. We looked in detail at a sample of the care plans and personal files of the people who live in the home. The care plans are generally well written, with good details of each persons personal care needs and healthcare needs. They include assessments for pressure area care and nutritional assessments for each person, and there are good Care Homes for Older People Page 13 of 29 Evidence: systems for monitoring the risks of pressure sores, falls, and poor nutrition. There are good risk assessments that ensure that people can live safely in the home, for example for the use of bed rails, for looking after their own medication, for the risks of bruising from using a wheelchair. The care plans provide clear details of each persons health care needs. The nurses are supported by the community health services. The GP visits regularly every week, and will visit at any time if there is a need. A district nurse and diabetic specialist nurse visited the home during our inspection. They said that they have good liaison with the home, and the homes nurses maintain good records of pressure area care. The staff who we spoke to said that both the nurse and the senior carer give a handover at the beginning of each shift, so they receive good up to date information on each persons health care and personal care needs. The home has sound systems in place for the safe management of medication. We carried out a spot check of a sample of medication records. One persons MAR (medication administration record) chart did not tally with the stock of medicine that was available. It is likely that the count of what was available at the beginning of the month was not accurate. One person has three medicines listed on their MAR chart that are no longer prescribed. We recommend that the pharmacist should be asked to remove these from the pre-printed MAR, so that there is no risk of confusion about the persons prescribed medication. All medicines are stored properly and securely, and controlled drugs are stored and recorded properly. Care Homes for Older People Page 14 of 29 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. The people who live in the home are supported to live full and active lifestyles. Evidence: The manager stated in the Annual Quality Assurance Assessment (AQAA) that the activities organiser has made a difference to the well-being of the people who live in the home. The daily activities are more meaningful to the individuals and help the staff see the benefit of this to the services users. Craft materials have been purchased which people can use to make things to sell at the homes summer and Christmas fairs. The AQAA says that this allows people to feel proud of their achievements. The home has used a government grant to buy a mini bus so that more outings are possible. One relative who completed a survey for the inspection said, I think there could be more activities for the residents. Too much time spent with nothing to do. This home gives my relative a safe and happy environment. Of course they would rather be in their own home but more activities would improve their quality of life. But another said, Since the manageress took over things at Benslow have improved a lot. She has introduced a lot of activity to the home like games etc, sing along songs, bingo, day trips etc. There was nothing like this when my relative went into the home. Its nice to see the residents enjoying themselves. I feel the home is always improving, Care Homes for Older People Page 15 of 29 Evidence: like the garden. She always thinks of other ideas in what can be done for the residents. The Expert by Experience (EBE) talked to some of the residents both in the lounges and in their own rooms. She reported, There are two lounges and people can choose where they would like to be. The smaller of the two is a quiet space. There is no television in here but residents can listen to music if they wish. In the larger lounge there is a television and as our visit coincided with Remembrance Day people were enjoying the Service from the Cenotaph and several were very moved by it. I was able to chat with several residents and they all wanted to talk about wartime memories and about the Service they had just watched. It was interesting just listening to their experiences. We discussed the activities that were on offer. All the people I spoke to joined in with some of the activities. The activity co-ordinator arranged activities for both mornings and afternoons. These ranged from craft, music, keep fit, games, quizzes, visiting groups etc. They were happy with the choices they had. The manager is aware that there could be further improvements, particularly for people who dont join in group activities. The AQAA stated that there are plans for a monthly evaluation and care plan of each persons needs, to ensure their well-being. We joined some of the residents during the afternoon who were very busy making craft items for the Christmas sale. It was a very sociable activity, and they supported each other in their efforts. The activities co-ordinator is in the process of completing a life history book for each resident, with their personal history and memories and details of their likes and dislikes. These will be used to create a person centred activity plan, including what each person likes to do and what time they wish to do it. This will involve all the care staff, not just the activities co-ordinator. The manager stated in the AQAA that further training is in process for the care staff which will develop their role, and redefine the key worker role. The AQAA stated that this has already had some impact on the enthusiasm of the staff team. There is a four weekly rotating menu. The chef asks each person every day what they would like to eat, and if they dont like the menu choices they can ask for an alternative, such as omelette or soup. On the day that we visited the home the dining room was in use for training for the staff, and all the residents were served lunch in their rooms or in the lounges. The EBE said, Several of the people I spoke to mentioned that they were asked if they minded their dining room being used for this purpose, and went on to say that they didnt but did miss meeting with their friends for their mealtime. Mealtimes are obviously an important social occasion for them and not just a time to eat. As some were eating lunch in their rooms instead of the dining room I was asked by some how their friends were and given a couple of messages to pass on. All said they were happy with the choice of food and if they didnt like the choice on the menu were always offered an alternative. I was informed by two people Care Homes for Older People Page 16 of 29 Evidence: that you can have a cup of tea any time, one lady saying I just ring the buzzer and ask, if they arent too busy I get it almost straight away. If they are busy they will say, Just give me fifteen minutes or half an hour, but it always comes. I like a nice cup of tea. Care Homes for Older People Page 17 of 29 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. The people who live in the home are confident that their concerns are listened to, and that they are safeguarded from the risks of abuse. Evidence: The home has a satisfactory complaints procedure. No complaints have been recorded in the home in the last twelve months. The Annual Quality Assurance Assessment (AQAA) stated, All staff are trained to understand the importance of listening to the service users and relatives in any area of concern or complaint, any issues raised are brought to the managers attention and prompt action is taken. The Expert by Experience (EBE) talked to some of the residents both in the lounges and in their own rooms. She reported, When I asked if they were able to voice any concerns they might have and were they listened to three people said they were very happy there and didnt have any concerns. Two people said they would happily talk to the manager or any of the staff that they knew well and trusted and were quite confident they would be listened to. The policy for safeguarding the people who live in the home contains satisfactory procedures for the staff to follow on reporting any suspected abuse, and Hertfordshire County Council (HCC) joint agency procedures for reporting and investigating allegations is in the home. The homes policy is not sufficiently clear on the procedures that the manager should follow. It refers only to possible abuses by staff members, Care Homes for Older People Page 18 of 29 Evidence: and does not mention other professionals, visitors, friends and families of the residents. It mentions that the allegation should be reported to the local authority safeguarding team where the alleged offence is of a serious nature. But the HCC procedures expect all allegations to be reported to them, and all allegations must also be reported to CSCI. However we have no concerns that the manager would not take the proper actions. There have been no safeguarding concerns in the past twelve months, but in the past appropriate referrals and investigations have been carried out. The AQAA states that training in safeguarding is continuing. All the staff we spoke to during the inspection were aware of their responsibilities for whistle blowing, and knew what to do if they have any concerns. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home and gardens provide a comfortable, attractive and safe environment for the people who live there. Evidence: Benslow Nursing Home is a three storey detached Victorian building, situated in a quiet residential neighbourhood just over a mile from the centre of Hitchin. Since the last inspection the garden has been developed, and now provides an accessible space for the people in the home to enjoy, with raised flower beds and sheltered seating areas. The corridors on each floor each have a corner that has been adapted in different ways to provide interest for the people who live there. Two of these corners are seating areas, decorated and furnished in a domestic style that many would remember, including a working old fashioned radio, and floral wallpaper. The third corner has been set up as an indoor garden with a variety of indoor plants that have different appearances and textures. There are large print colour co-ordinated signs throughout the home to assist people to find there way, for example green signs for toilet, white for lounge and blue for bedroom. In the large lounge there is a shelf with hats, scarves and dolls for people to pick up and use. There is a variety of pictures and old newspaper cuttings on the corridor walls. However many of these have been placed above the eye level of most people, and need to be arranged so that everyone can see them easily. Care Homes for Older People Page 20 of 29 Evidence: The building appeared to be clean and well maintained, and appropriate procedures are in place for the control of hygiene. The Annual Quality Assurance Assessment (AQAA) stated that there is an action plan in place for the prevention and control of infection, which includes developing an audit sheet for infection control. All the staff have had training in prevention of infection. Alcohol hand rub is available for the staff to use when they assist people with their personal care in the bedrooms, and liquid soap and paper towels are available in the bathrooms and toilets. Care Homes for Older People Page 21 of 29 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. The staff have good training and support to enable them to meet the needs of the people who live in the home. However some people work excessive hours, and this may affect the quality of their work and leave the people who live in the home at risk. Evidence: Only one member of staff returned a survey to us for this inspection. This survey expressed concerns about several areas of staff support and training. Unfortunately the survey was anonymous, and we were not able to speak to the member of staff to clarify their concerns in more detail. During the inspection we looked at staff rotas and training records, and we spoke to a group of staff, some new and some experienced, who were on a training course in the home. We also spoke more briefly to individual staff who we met during the inspection. We saw no evidence to support the concerns expressed in the survey. There is a good level of staffing, with two nurses and six care assistants during the day, and one nurse and two care assistants at night. However the staff rotas for the current week and the previous week showed that on four days there were only five care assistants on the early shift and four on the late shift. The manager said that several staff have left recently, and five new staff are currently in trining and will start work in December. Some staff work very long hours. One nurse worked 61 hours the Care Homes for Older People Page 22 of 29 Evidence: previous week, and was scheduled for 60.5 hours this week. One care assistant worked 76 hours the previous week and was scheduled for 73 hours this week. The manager said that one nurse is on annual leave, so the additional nursing hours are temporary. The carer is working additional hours to cover for a care assistant on maternity leave, and this is not a short term measure. These long hours are contrary to the Working Time Directive, which safeguards staff from the risk of losing concentration by working too long. The exceptionally long hours worked in Benslow means that staff may be too tired to provide a good quality of care for the people who live there, and there is a risk of errors due to poor concentration. The company provides a comprehensive training programme that covers all the statutory training, and the training matrix that was seen showed that everyone has attended essential health and safety training and training in prevention of abuse during the last year. The staff who we spoke to said that the support and training they receive is very good. They work very well as a team that includes nurses, care assistants and domestic staff. One person said that Benslow is a very happy place to work, and I would not want to work anywhere else. All the staff, including domestic and catering staff, are encouraged to undertake NVQ qualifications, and there is an expectation that new staff will register for the qualification. More than 50 of the care staff have a qualification at NVQ level 2 or above. The home has robust policies and procedures for recruitment. We did not look at any staff files on this occasion. The company carried out a full audit of staff files a month before this inspection, which included checks that all contained a satisfactory CRB (Criminal Record Bureau) disclosure, confirmation of immigration status and current work permit where needed, regular supervision and appraisals, and health checks to show that they are fit to work in the home. The summary of this audit was that all the staff files are in good order. Care Homes for Older People Page 23 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager of the home leads a team of staff who all place the welfare of the residents as their highest priority. The views of the residents and other involved people are actively sought in order to ensure that a good quality of care is provided. Evidence: In the Annual Quality Assurance Assessment (AQAA) the manager stated, I feel that the home is well run, I have been the Manager here for almost four years now, this has led to a sense of stability and familiarity for the service users, and I operate an open and inclusive home. I have many years experience in the care sector at management level. I have a strong staff team and over the years they have shown their skills and knowledge to take on more responsibility. We have staff, service user and relatives meetings and satisfaction questionnaires are distributed to gain peoples views. I operate an open door policy. We have various audits that are completed on a monthly basis to enable me to monitor record keeping and systems are working effectively. The audits completed by our head office show a good result. The manager Care Homes for Older People Page 24 of 29 Evidence: is currently completing a BSc in Dementia Studies with Bradford University, and she has made changes in the environment and the practices in the home to meet the needs of people with dementia. (See Environment, Health and Personal Care, and Daily Life and Social Activities.) The staff who we spoke to said that she provides them with good support, and she is always available if they wish to speak to her. One of the relatives who completed a survey said, I think if I had any concerns about my relatives care I talk to the manager of the home and these are put right straight away. Its nice to know you can talk to them or any of the staff about it. The manager is aware of areas that still need improvement. She has clearly stated in the AQAA what the plans are for these, and we have referred to them in other areas of this report. The manager is not a registered nurse, but the deputy manager is. The deputy manager has responsibility for ensuring that the nurses employed in the home follow correct procedures for nursing care and for administering and recording medication. There are regular meetings with the residents and their relatives. The views of residents and relatives are also obtained from annual surveys. Changes that have been made as a result include suggestions for outings, including one to Duxford RAF museum, to meet the interests of some of the men in the home, and suggestions for changes to the menu. Systems for managing the residents finances are transparent and backed up with signatures and invoices. Money is stored safely and adequate records are maintained in order to protect the people who live in the home from financial abuse. The home maintains appropriate records for the health and safety of the residents and staff in the home, and staff follow the homes policies and procedures. These include monitoring water temperatures and ensuring that there are regular fire drills. Care Homes for Older People Page 25 of 29 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 29 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 9 13 Measures must be put in place to ensure that medication is audited effectively, and that any errors in medication are noted and rectified without delay. This will make sure that everyone has the medication that they need in a safe and effective way. 11/01/2009 2 27 18 The registered person must 11/02/2009 ensure that sufficient staff are employed in the home in order to comply with the Working Time Regulations. The staffing rotas show that some staff work very long hours. People who work excessively long hours may be too tired to provide a good quality of care for the people who live there, and there is a risk of errors due to poor concentration. Care Homes for Older People Page 27 of 29 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 18 The procedures for prevention of abuse should be amended to make reference to the HCC procedures. The procedures should provide the staff with accurate information so that any allegations of abuse are reported and investigated appropriately. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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