Inspection on 12/12/08 for Bilton House

This inspection was carried out on 12th December 2008.

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

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

Other inspections for this house

Bilton House 10/02/09

Bilton House 10/12/07

Bilton House 14/06/07

Bilton House 03/11/06

Bilton House 01/03/06

Bilton House 04/08/05

Bilton House 22/03/05

Bilton House 08/06/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bilton House 5 Bawnmore Road Bilton Rugby Warwickshire CV22 7QH     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: Martin Brown     Date: 1 2 1 2 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Bilton House 5 Bawnmore Road Bilton Rugby Warwickshire CV22 7QH 01788813147 01788811184 care.biltonhouse@btconnet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Rugby Free Church Homes For the Aged care home 33 Number of places (if applicable): Under 65 Over 65 0 33 dementia old age, not falling within any other category Additional conditions: 33 0 Age: Dementia - Code DE age 55 and above. The maximum number of service users who can be accommodated is: 33 The registered person may provide the following category of service only: Care Home Only (Code PC) 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 (OP) 33 Dementia (DE) 33 Date of last inspection Brief description of the care home Bilton House is a residential care home with a Christian ethos and is governed by the Trustees of Bilton House charity. The aim of the charity is to provide a home for the care of older people within the liberal Free Church traditions, and to enable each resident to continue living as independently as possible. The home was established as a residential home for older people in 1946. Bilton House is a large building, which has Care Homes for Older People Page 4 of 29 Brief description of the care home been extended over a number of years and has bedrooms on two floors, which can be accessed by a lift. The property fronts directly onto Bawnmore Road and there is a large visitors car park at the rear of the home, which can be accessed via a side entrance. The home is registered to accept 33 older people 17 of which are for people with a diagnosis of dementia. There is level access to the home for wheelchair users to the front and back of the home. The Clarice Cooper wing accommodates eight residents with a diagnosis of dementia, this is referred to as the specialist dementia care wing and the main building accommodates the additional nine people with a diagnosis of dementia. Most of these residents occupy bedrooms on the ground floor. Both the frail elderly category residents and those with a dementia diagnosis freely intermingle with one another within the home. The Clarice Cooper wing has its own secure gardens and there is also a large well-maintained garden with a footpath, which residents can utilise from the main building. All rooms in the main building have ensuite showers and toilets. The rooms in the Clarice Cooper wing have ensuite toilets. There are 32 rooms in all but the home have used one of the larger bedrooms as a double hence the registration for 33. There are five communal lounges, large corridor areas, with seating, and two dining areas. At the time of the inspection visit the fees are based on dependency levels and are charged in the range £390.00 - £555.00 per week. 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report has been made using evidence that has been accumulated by the Commission for Social Care Inspection. The inspection visit was unannounced and took place on 12th December 2007, between 9.00m and 5.15pm. During that time, many of the people living in Bilton house were spoken with. A number of those living on the Clarice Cooper wing have cognitive impairments but were still able to engage in conversation on topics of interest to them. Staff and management were spoken with, and interactions between staff and residents were observed. The manager was absent owing to illness, but a deputy was available much of the time, as were representatives of the organisation. Three relatives present at the home were also spoken with. One visiting professional was spoken with during the Care Homes for Older People Page 6 of 29 inspection. One relative was spoken to by telephone following the inspection. One outside professional was also spoken with following the inspection. Surveys by the home of relatives and residents also informed the inspection. The Annual Quality Assurance Assessment, completed and returned by the manager earlier in the year, also informed the inspection. Policies and procedures and care records were examined, and four residents were case tracked, that is, their experience of the service provided by the home, was looked at in detail. Staff, management and residents, were welcoming and helpful throughout the inspection. What the care home does well: What has improved since the last inspection? 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 8 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 9 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. Residents can be confident that the home assesses their needs and only accepts them if it is confident it can meet those needs and that they will benefit from the service the home provides. Evidence: The care file for one person admitted to the home within the last twelve months was looked at. This person and a relative were spoken with, and were both happy with the move and how it had progressed. The procedure for moving into the home includes a visit by the manager to the prospective resident to carry out a preadmission assessment, so that the home can be sure individual needs can be met before any decision to move in to the home is made. In many cases, residents have a process of gradual admission by which they have an Care Homes for Older People Page 10 of 29 Evidence: awareness of the home, visit it, express their interest for the future, and may attend in the day. Several residents spoken with had moved in this manner. Other than in some cases wishing they could still be living independently, no-one spoken with had any regrets about moving to Bilton House. One person who had moved in within the last six months spoke of how they had known of Bilton House through their church, and had made a positive choice to come here. One person had recently been re-assessed with a view to moving to nursing care, following an increase in care needs to the point where the home could not effectively meet these. The home does not provide intermediate care therefore standard six was not looked at. Care Homes for Older People Page 11 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The good personal care that people living at Bilton House receive is compromised by a lack of attention to medication practice, which has the potential to put individual wellbeing at risk. Evidence: A sample of four care plans were looked at, with a concentration on care plans for people with dementia. These were seen to have relevant details of individual care needs, including life histories, well being indicators, and stress and coping indicators, and dietary needs and wishes. Discussion with staff supporting these persons, and observation of interaction and support, showed care needs being met in ways indicated on care plans. Staff were seen to provide support in warm, reassuring and relevant ways, and in discussion were able to demonstrate their knowledge and awareness of how to manage and diffuse potentially challenging situations. Relatives spoken with were very complimentary concerning the care provided. The atmosphere on the dementia wing was calm, good-natured and relaxed. People Care Homes for Older People Page 12 of 29 Evidence: spoken with here seemed at ease with their surroundings and accepting of each other and staff, who provided support and personal care in a positive, friendly and respectful manner. One person was in their night clothes late in the morning and was reluctant to get dressed. Without at all antagonising them, a staff member was eventually able to help them happily get washed, dressed and return. Care plans are updated regularly, and all those looked at had had a monthly review for the current month. Needs noted in the care plans matched those witnessed as being addressed by individual staff, and all gave a good picture of needs and risks, and how these were best managed. One person had a risk assessment which showed how the risk of leaving the home unaccompanied was managed. Personal histories helped staff where support could be usefully allied to individual wishes and interests through past experiences. Care plans for those with dementia also included a functional behaviour chart, whose undoubted usefulness was severely compromised by it not being dated. Residents were well presented. For example, clothes were clean and well cared for and fingernails were clean and trimmed. Care plans showed details of health contacts as required, with input and support from district nurses as necessary. One visiting professional was spoken with, who confirmed that the home sought outside professional help appropriately, and followed advice and maintained good care practices for vulnerable people. Staff were attentive to health needs, one noting a slightly red eye, enquiring about it, and taking appropriate action. Discussion with staff and management, and examination of records, showed a good awareness of health issues. Staff explained the care for anyone with a pressure sore, confirming the involvement of district nurses in the one current case. A district nurse was in attendance during the inspection. Staff and management advised that at present, no-one uses bed rails. The home operates a keyworker system, whereby each resident has a particular named member of staff for that person. Staff were observed respecting individual dignity, always knocking on doors before entering, and throughout helping and responding to residents in a manner which enhanced, rather detracted from, their dignity. Residents spoken with in the main part of the building were very complimentary about the home, saying that staff were always available if they wanted or needed help. One or two commented that the home could benefit from more staff, particularly at times Care Homes for Older People Page 13 of 29 Evidence: when there was sickness, but all said that help was promptly provided when needed. During the inspection, call bells went off very occasionally, and were always responded to promptly. The administration and recording of medication was examined. Medication Administration Record Sheets for the most part gave brief details of what the medication was for. A discussion was had with management on having such useful details for all medication administered. Staff advised that this was done by the prescribing GP, but agreed to enquire to have this done. It was noted that almost all medication is for pain relief, and for specific physical reasons, with a commendable lack of medications to help calm people, or reduce depressive or behavioural difficulties. Medication in monitored dosage or blister packs was seen to be correctly administered and recorded. A number of medications are unable to be so packaged, and are dispensed direct from their original packaging. These are recorded as a set amount to cover a four week period, with the assumption that they will all be used up at the end of that period. Two samples of medication were counted in Clarice Cooper wing. For one, subtracting the number of tablets recorded as being dispensed from the number started with, there should have been seven remaining, but there were nine left, indicating that, at some point, two had not been given, although all had been signed for. Staff responsible for medication could not account for this. The deputy manager agreed that some system of daily stock control/audit would immediately identify any error and enable it to be swiftly rectified, but agreed that the current system did not enable any error in nonblistered medication to even be noticed until the end of the month, or until a random audit was done. Another non-blistered medication was looked at on this unit, and was seen to be accurate. A topical cream had been recorded as N for not needed for two days. Staff advised that the cream could not be found, but it was then found in the room of the resident. The staff agreed it was not acceptable to record as not needed, when in fact there was another reason, which should have been noted. Staff advised that this lady had been applying the cream herself, which she was able to do, but this was not recorded, nor risk assessed. The lady when asked, said she had put on the cream herself, but was now happier for the staff to do it. A sample of medications were looked at on the main unit. There were some stocks of paracetomel, which were administered as needed. Most of these were given rarely, Care Homes for Older People Page 14 of 29 Evidence: and again, without a system of daily stock control/audit, it was difficult to ascertain the accuracy of records. A pharmacy advisor who visited the following day and who was spoken to after the inspection, advised the home to get such medications administered under the homely remedies policy. This would avoid an excess of such tablets being stored. She had also noted some tubes of medication with no dates as to when they had been opened, so it would be unclear when their usefulness had expired. Her overall view of medication in the home was that policies and procedures were in place, but were not being properly followed by staff. She advised that the home would be offered refresher training for all staff. The manager was spoken with following the inspection, and advised that a daily counting of all non-blistered medication had been implemented, that all staff would undertake refresher training, and that a staff meeting was being called for all staff involved in medication administration to emphasise the importance of accurate administration and recording. Care Homes for Older People Page 15 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. Residents enjoy a variety of activities in accordance with their needs and wishes, are supported in the maintaining of contacts with friends and relatives, and enjoy a balanced diet in pleasant surroundings. They are supported in exercising choice and control in their daily lives. Evidence: The home continues to provide a variety of activities, with the help of an activity organiser, and volunteers. In the morning, several people were busy enjoying creating Christmas cards. Residents spoken with said there were frequent activities for those who wished to take part in them. With Christmas being near, there was evidence of several carol services and carol singing taking place at various times. Later in the day, people in the lounge were seen enjoying reading various puzzles, or conversation. Televisions were in communal areas, but were only seen on in individual rooms. On Clarice Cooper wing, a radio, rather than a television, was on, thus providing background music, without potentially distracting or confusing images. The Annual Quality Assurance Assessment completed by the manager, acknowledged a need for more individual activities to be provided for residents here. It was good to see staff Care Homes for Older People Page 16 of 29 Evidence: paying individual attention to residents, and some residents stimulating others positively in conversation. Later in the afternoon, one staff member started a simple but effective throwing activity with a beach ball, which caused much hilarity, stimulation, exercise and engagement for all those in this lounge. All residents spoken with said they were content with the level of activities available at the home. Friends and relatives are welcome, and are able to support individuals in activities, particularly those involving going out anywhere. Visitors dropping in throughout the day were evident. Relatives spoken with during the inspection were very complimentary about the service, and the welcome they received. One relative said that they dropped in whenever they felt like it, and that this was never a problem. Plenty of magazines were freely available for residents to browse. It was good to see residents, including those on Clarice Cooper wing, getting their daily newspapers promptly in the morning, and taking an active interest in them. Residents were seen to do as they wished, either joining in activities, or spending time in their rooms. Choice was seen to be respected in all areas, including Clarice Cooper wing. A meal was taken with residents. This was tasty and well-presented, and everyone was presented with a choice. Mealtime was a quiet relaxed affair, with residents being attended by staff and supported where needed. Survey results, and comments by staff and management, acknowledged that there had been problems with meals, and the home had taken action to improve this. Everyone was complimentary about the new chef and the cooking. The chef showed a good awareness of dietary needs, which were dealt with in an unfussy way. Rather, for example, than highlight the needs of people with diabetes, the chef endeavoured to ensure that all meals were healthy and sugar free without compromising on taste, whilst still being aware of how individual needs must be catered for. All residents spoken with said the food was always good, and that they were offered plenty of drinks and snacks throughout the day. Fruit and snacks were in evidence in communal areas. Staff on the Clarice Cooper wing were observed to regularly encourage drinks and small snacks where necessary. Breakfast there was observed being served in ways that met needs and wishes, again, with staff supporting residents as needed. 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. People living in the home are protected from abuse by the procedures and practices of the home, and can be confident that concerns raised will be listened to and acted upon. Evidence: The complaints log was looked at. There was one complaint, from the previous year, concerning one person living at the home being found in a nearby street. The care plan for this person has clear risk managements in place following this to minimise the chance of this recurring, whilst still offering opportunities for being out and about safely. Issues such as laundry and food had previously been raised and addressed in surveys and meetings. One resident commented on residents meetings taking place, where they could raise issues of concern. People living in the home, and their relatives, were quite relaxed about raising issues of concern, all within the context of overall satisfaction. Surveys showed that food had been a concern much earlier in the year, but that this had now been addressed. From talking to a wide variety of relatives and residents, it was clear that people were ready to raise issues of concern if they had them. Staff spoken with showed a good awareness of abuse issues, and of what to do if Care Homes for Older People Page 18 of 29 Evidence: abuse of any sort was suspected or reported. Staff also showed a good awareness of the rights of residents in respect of decision-making, reflecting awareness of the Mental Capacity Act. Body charts were in place where people were at risk of bruising or tissue injuries, and staff were aware of logging bruises and raising 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. Residents benefit from a homely, clean and well-maintained environment, which they value. Evidence: The home was clean and well-maintained during this unannounced inspection, with no unpleasant odours. Domestic staff were busy throughout the day, in a sensitive, unobtrusive, but thorough and efficient manner. Several bedrooms were seen. All were pleasant, well furnished and personalised. All residents spoken with said they were pleased with their rooms. Many of the rooms look directly out of the very attractive and well-maintained gardens. The main building is very grand with high ceilings and much wood panelling, but it also had a homely feel, and residents obviously felt quite at home. The Clarice Cooper wing is a newer extension to meet the needs of those with advanced dementia, and provides a smaller, more intimate area where a smaller group of people were supported in comfortable surroundings. Items such as wheel chairs were stored appropriately in designated areas. There are two lifts for the use of residents on the first floor. This floor, like the rest of the home, was well-maintained and clean. Christmas decorations were tastefully in evidence. Care Homes for Older People Page 20 of 29 Evidence: Management advised that an extension is planned, along with refurbishment to the kitchen. This was awaited keenly by the chef. Bathrooms and toilets were suitable, clean and well-maintained. One, which had recently been refurbished after the need for its renovation was noted at the previous inspection. This is now rather clinical with white walls. The deputy agreed that this bathroom might benefit from being softened to make it more homely and inviting. There are staff toilets, as well as residents toilets. Staff spoken with could see no valid reason for the distinction, and thought this might usefully be removed. Toilets used by those living in the home were as clean and well-maintained as staff toilets. All doors to the bedrooms had small hand-written name plates on. Some bedroom doors had larger notices on where this was judged to be beneficial. Staff advised that this was in accordance with the wishes of residents. The laundry was seen to be operating effectively and in a clean, hygienic and ordered manner. The system for managing soiled laundry was satisfactorily explained. The issue of missing laundry had been raised at a residents meeting, and was also mentioned by some relatives and residents in surveys done by the home. One relative spoken with said that it had been a problem on some occasions. One person living in the home commented that laundry sometimes get lost. The impression gained from talking with staff, residents and relatives was that the laundry system worked well when the designated laundry person was there, and there were only problems when that person was on holiday, or off sick. There were suggestions that employing an assistant for such occasions would solve the problem. 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. Residents benefit from the attentions of sufficient numbers of staff, who support and maintain their dignity and well-being. Any issues regarding recruitment of staff must be clearly recorded in order for people using the service to be confident that all staff are properly recruited. More training for those with responsibility for administering and recording medication would further ensure the well-being of all those who live in the home. Evidence: There were sufficient staff on duty to meet the needs of the residents, with several residents spoken with commenting that staff are always available to help if needed. There are call bells for use, but these were heard very infrequently during the inspection. One resident commented: that the home could benefit from more staff, adding that she understood they had their quota, and that : staff are pretty good at answering calls. Staff were seen to be attentive of residents needs throughout the inspection and particularly where residents have dementia, were seen to re-assure and check their well-being. One domestic staff member commented that everyone works as a team. Care Homes for Older People Page 22 of 29 Evidence: Staff spoken with all showed familiarity with and a good knowledge of individual needs, with most staff spoken with all having worked at the home for a number of years. A sample of two recruitment files were looked at. These were for the most recently recruited staff. The files showed satisfactory recruitment processes, with references, Criminal Records Bureau checks and application forms all in evidence. However, one reference seen was for a short employment period, and was not particularly favourable. I was advised that the manager had followed this up with the person concerned, but the outcome of this was not recorded. The other reference recorded was very positive. The staffing matrix, and discussion with individual staff, showed ongoing training taking place, with over half the staff team either having National Vocational Qualification level two or currently undertaking it, with other staff taking level three. Gaps were noted on the training matrix in some areas. While everyone had had Manual Handling training, a number had not had infection control training and Fire Safety, and a number had not had dementia training, and some had not had training regarding abuse. Staff commented favourably on training, saying that the service was supportive on this. Some staff spoke enthusiastically of further planned dementia training. Those administering medication have received training in this area, but shortcomings have been noted in medication recording elsewhere in this report, indicating that refresher training is required. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a home that is run in their best interests, and is generally mindful of the need to safeguard their health and safety. Shortcomings identified in the previous inspection concerning medication administration and recording still persist, and compromises the otherwise good running of this home. Evidence: One staff commented on how helpful the organisation were in providing knowledge and training and general support. An examination of surveys and minutes of residents meetings showed that the home takes on board comment from those who use the service. One relative commented on how obliging the service was, and how, upon being asked for items for the bedroom, they responded swiftly with what was needed. The home has continued with the system for supporting residents finances that had Care Homes for Older People Page 24 of 29 Evidence: been put in place twelve months ago. The home does not keep any cash on behalf of residents as there had been concern over keeping large amounts of cash and/or having bank accounts for residents. Instead, expenditure of residents is paid by the home and a log kept, with receipts wherever possible, and an accumulated bill sent to whoever is responsible for each residents finances on a monthly basis. The treasurer advised that this system has been successful, with a favourable response from relatives and residents. He noted that the only concern had been from one or two people who preferred not to be in debt to the home, even for a short period. A sample of recordings for individual finances showed them to be clearly recorded. The most recent inspection for Food Hygiene from the local authority awarded the home a Gold star Records showed regular safety checks for gas, electricity, and legionella. Following a requirement in the previous inspection regarding hot water temperatures, the home has employed outside contractors to check temperatures of all hot water outlets. These are checked three monthly, with the home taking action necessary on any anomalies identified. A discussion was had with management about the need for the service to have its own, more regular checks, rather than waiting for a consultant to check to show up any problems. Management agreed to put this in place. Fire records showed that equipment and alarm checks were regular. Staff showed a good awareness of procedures in the event of alarms sounding, and of the needs of residents in such circumstances. Fire doors are in place as required, allowing residents bedroom doors to remain open safely where they wish them to be. 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 Any self administration of medicine must be supported by a risk assessment, so that the service can be confident that this is being done in accordance with the prescription. This is to ensure those living in the home and requiring medication can be fully confident it is dispensed and recorded accurately. 18/01/2009 2 9 13 Staff should ensure that where a medication is not taken, they fully record the reason on the Medication Administration Record Sheets using overleaf to further explain if necessary. This is to ensure those living in the home and requiring medication can be fully confident it is dispensed and recorded accurately. 18/01/2009 Care Homes for Older People Page 27 of 29 3 29 19 The service must record any clarification sought regarding employment checks such as references. This is to ensure that all staff are suitable to work in the home 18/02/2009 4 30 18 All Staff responsible for medication administration are to undertake refresher training on medication administration and recording. This is to ensure that all those in the home recieving medication can be confident it is being administered competently. 18/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 9 30 Any element of care plans, such as functional behaviour charts, should be dated and authored. The service should ensure that all mandatory training, as well as training related to specific needs, is undertaken speedily by all staff, and that refresher training is available . The service should ensure that hot water checks are done regularly, rather than rely on quarterly checks by an outside contractor, so that all those living in the home can be more confident that hot water is at safe temperatures at all times. 3 38 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. 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. 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