Inspection on 26/11/08 for Bournville Grange

This inspection was carried out on 26th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bournville Grange 30/01/07

Bournville Grange 18/11/05

Bournville Grange 14/06/05

Bournville Grange 10/02/05

Bournville Grange 28/07/04

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Maple Lodge

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Ravenhurst

Bank House

Inspirations

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bournville Grange 168 Oak Tree Lane Bournville Birmingham B30 1TX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kulwant Ghuman     Date: 2 6 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. 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 31 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 31 Information about the care home Name of care home: Address: Bournville Grange 168 Oak Tree Lane Bournville Birmingham B30 1TX 01214722213 01214724561 bournvillegrang@aol.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) : Bournville Grange Limited care home 27 Number of places (if applicable): Under 65 Over 65 27 old age, not falling within any other category Additional conditions: 0 Minimum staffing levels for 27 residents are maintained at three care assistants plus a senior carer throughout the waking day. Two waking night care assistants with a nominated person on call. The care manager hours are supernummery to care hours. Ancilillary staff must be provided in addition to care staff. Mrs Brown must provide evidence of successful completion of a management and care qualification at NVQ level 4 or equivalent by April 2006. The category of registration is OP (older people, over 65) and the type of home is care home only. The number of residents shall not exceed 27 To accommodate one named service user within existing numbers under the age of 65 years. Date of last inspection Brief description of the care home Bournville Grange is a large detached property situated in the conservation area of Bournville. The home is within walking distance of local churches, parks and Bournville Village Green, which has a variety of local shops and a post office. Public transport is Care Homes for Older People Page 4 of 31 Brief description of the care home also within a short distance. The home offers accommodation to 27 elderly people over three floors. All but one of the bedrooms are singles and have en-suite facilities. The people living in the home have a choice of 3 lounges and there is one dining room. All are very comfortable and furnished in a homely style. There are three assisted bath/shower rooms and adequate numbers of toilets throughout the home. Aids and adaptations include a ramped entrance and shaft lift, giving easy access to the first and second floors for those who experience difficulties with mobility. The ground floor of the home also houses the main kitchen, laundry and office space. There is parking space at the front of the home and there are extensive, mature and well maintained gardens to the rear. Many of the rooms have a good view of the gardens. There is a patio with an ornamental pond and seating for the people living in the home. The service user guide did not include the fees payable in the home. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection was carried out by one inspector over one day in November 2008. The previous key inspection was carried out on 30th January 2007. An Annual Service Review was carried out on 30th November 2007. This is when we ask the home to send us some information about the home and we gather the views of some of the people who live in the home. We knew that no complaints or adult protections had arisen at the home since the previous key inspection. This review told us that the home was continuing to provide a good service to the people living in the home. Before this inspection we were provided with some information by the home and this gave us some detail about what had been happening at the home since the last Care Homes for Older People Page 6 of 31 inspection. We sent nine surveys to people living in the home, five staff and ten relatives. We received completed surveys from eight surveys of the people living in the home, four staff and 3 representatives of the people living in the home. Whilst at the home we spoke to seven of the people living there, one relative, the manager and a senior care. The proprietor also visited the home during the inspection. Some bedrooms and the communal areas of the home were looked at and we had lunch with the people living there. We looked at the files of four people living in the home to see that they were receiving the care they needed and two staff files to ensure that the appropriate recruitment checks were being undertaken to protect the people living at the home. We also looked at the management of medicines and some health and safety documents. No complaints or adult protection issues had been raised about the home either with the home or with the commission. What the care home does well: What has improved since the last inspection? The home has an ongoing redecoration programme which ensures that the home is always well maintained. New washing machines and tumble dryers have been provided in the laundry. Two lounges have had new carpet and all bedrooms have new furniture. Recently appointed staff have been using the Skills for Care induction programme. There is a board displaying the day and date in the hallway to help orientate the people Care Homes for Older People Page 8 of 31 living in the home. The activities in the home are also identified on a poster in the entrance foyer. Staff have undertaken training ensuring that they have the skills and knowledge to care for the people living in the home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission process ensured that the needs of people moving into the home could be met. People received enough information on which to make a decision about whether the home was suitable for them and contracts were provided. Evidence: We looked at the files of two people who had moved into the home since the last inspection. One persons file showed that they had had a pre-admission assessment and an assessment on the day that they moved into the home. The file of the other person indicated that the person was assessed and admitted on the same day. The manager told us that this was not the case but no evidence could be found of the actual day they visited the home. There was evidence that this persons family had visited the home before the day of the admission. The pre-admission assessment collected information about peoples mobility needs, if Care Homes for Older People Page 11 of 31 Evidence: they needed help with eating, dressing and washing and toileting needs. It was also noted if they preferred a male or female carer to assist with personal care. The admission assessment recorded further areas such as communication, mental state, sleeping patterns and so on. Both of the files contained assessments that had been carried by social workers or hospital staff. One of the files included a third party funding agreement with the local authority. We were told that the other person was funding their own care and the contract had been sent to the relatives. Service user guides were available in bedrooms and the manager was currently replacing them with the new updated version. The updated version did not include the fees that could be charged in the home although we were told that individuals were given the price when they enquired or visited the home. It was recommended that information was made available to enable people to make a fully informed decision about whether the home was suitable for them or not. Completed surveys returned to use told us that people received sufficient information about the home and that they received a contract. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were care plans and risk assessments in place ensuring that the needs of the people living in the home were met safely by the staff. The health needs of the people living in the home were met through liaison with the different health professionals. The management of medicines in the home needed to be improved to ensure that the people living in the home received their medicines as prescribed. The privacy and dignity of the people living in the home were generally well met. People at the end of their lives and their families were treated with care, sensitivity and respect. Evidence: We looked at the files of four people living in the home. Two were for people who had moved into the home since the last key inspection and two were for people who had lived there longer. All the files seen had care plans in place. The care plans were quite well detailed and included information about what the individuals needs were, what tasks they could carry out themselves and what assisstance they needed. For example, one stated the Care Homes for Older People Page 13 of 31 Evidence: individual was able to walk with the use of two walking sticks and was able to use the lift independently. Another entry stated likes assistance from female carer to wash back, bottom and under arms. Does rest themselves. Washes in their en-suite and showers every other day. Hair is washed by hair dresser weekly. There were some areas where care plans needed to be updated. For example, we were told by kitchen staff that a person no longer liked bread so now generally didnt have sandwiches at tea time. This information had not been included in the care plan which stated no known likes and dislikes. There were regular monthly evaluations of the care plans. Surveys completed by staff told us that they felt that they received sufficient information to care for the people living in the home. This information was available in the care plans and updated on a regular basis during handovers at the end of shift. The files included risk assessments in respect of tissue viability, nutritional screening and moving and handling. There were specific risk assessments for falling, and the management of specific needs such as swollen legs. One person was having regular falls in the bedroom and although there was a falls risk assessment in place and the individual had been attending the falls clinic the risk assessment needed to be further developed to show what steps were to be taken to manage the risk. The health care needs of the people living in the home were being met by arranging visits from the GP, attending hospital, dentist, chiropodist and optical appointments as needed. There was good close working with the GPs and district nurses and the staff had been working closely with the medical professionals to ensure that one person was able to stay in the home and their end of life needs were being met with sensitivity and respect. The home used a monthly monitored dosage system for the management of medicines. There was a list of people who were able to administer medicines and all those administering medicines had undertaken training in the safe handling of medicines. The home had started to carry out audits of the medicines following the last key inspection however, there was no evidence available on the day of this inspection that Care Homes for Older People Page 14 of 31 Evidence: showed that any audits had been carried out between November 2007 and November 2008. We were told that they were carried but that the sheets had been mislaid. It was recommended that the audits were recorded in a book and any actions that were needed could also be recorded in this book. This would then show what issues had been identified and how they were being addressed. An audit of the Medication Administration Records (MAR) showed that there were a number of gaps on them. Cross referencing of these gaps with the medicines remaining in the blister packs suggested that in the majority of cases the medicines had been given but they had not been signed as having been given. However, there were instances where it could not be determined that the people living in the home were always getting the medicines as they had been prescribed. For example, on one occasion one person had not received their medication for epilepsy as required. Another had not received aspirin and for another person they were not always receiving two tablets as required. For another person, the number of tablets remaining in the box, the number of tablets having been signed as given and the numbers received into the home did not tally indicating that on two occasions either more than the required medication had been given or medication had been lost. There were several people who had creams in their bedrooms. The staff were not completing the charts on a regular basis so it could not be determined that the creams were being applied as required. One person stated that they applied there own cream however there was no self administration risk assessment or compliance checks in place. Some of these issues had been identified at the last key inspection and although they may have been originally addressed the issues were identified at this inspection again. There were copies of the prescriptions and photographs of the individuals on the file of MAR charts to ensure that the right person received the correct medicines and that the correct medicines were received from the pharmacist. The amounts of medicines received at the home were recorded on the MAR charts however, it was not always recorded who had checked the medicines into the home. The controlled medicines were not checked at this inspection however, there was quite close liaison with medical staff for some medicines that were being given to one of the individuals and the dosage was varied as required following consultation with the doctors. All bedroom doors had suitable locks on them and all bedrooms had a piece of lockable furniture in them where people could lock away private items. One person spoken to Care Homes for Older People Page 15 of 31 Evidence: said they did not know that they had said they didnt want a key to their room but would like one. The manager provided one during the day. It was noted that one of the bathroom doors did not have a lock on it and therefore the privacy and dignity of individuals could not be guaranteed. There was one shared bedroom in the home. Although there was a privacy curtain in place it did not provide full privacy. We were told that although this issue had been raised at the last inspection the two people had shared for a long time and rarely used the curtain. Nevertheless, it was important that steps were taken to ensure that full privacy was available in the room if needed. The manager had put plans in place to address these issues. It was evident that the staff were very caring and all efforts were being made to ensure that people who were towards the end of their lives received care that was based on advice of medical professionals. There was regular, ongoing liaison with them and any friends and relatives to ensure that they were kept up to date with the individuals condition. Some of the comments made by people living in the home included: The staff are very kind and helpful. Staff will help me with things I cannot do myself. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience 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 had control of their lives and they could have visits from their friends and relatives. There was a variety of meals available and people told us that they generally enjoyed the food. Evidence: There were no rigid rules or routines in the home. People were able to get up and retire to bed when they wanted. They were able to return to their bedrooms throughout the day. There were a number of different lounges where they could sit. On the day of this inspection people were seen to play some games. People were seen to be reading a newspaper or magazine. Some were watching the television and some were chatting to each other. Some of the people living in the home were aware that an entertainer was coming the next day and were looking forward to this. One person told us that they had been to the cinema the previous day with a member of staff and had enjoyed themselves very much. Care Homes for Older People Page 17 of 31 Evidence: Care plans included some information about the social needs of the people living in the home. The records of the activities in the home showed that some people attended the church services and progressive mobility sessions that were held regularly in the home. There were also bingo sessions, films, firework displays and birthday celebrations held in the home. There were people who came into the home with clothes to sell and some of the people living in the home appeared to have enjoyed this and bought several items. Families were able to come and go at all reasonable times of the day. One person told us that it was nice that visitors could come and sit in their bedroom and that they could have some privacy. There were lots of very good interactions seen between the staff and the people living in the home during the inspection. People living in the home popped into the office throughout the day to speak to staff and the owner of the home when he came in. At the time of the inspectors arrival the people were having breakfast. People were seen to be having a variety of things to eat including cereals, toast, egg on toast and egg sandwiches. The inspector was able to join the people living in the home for lunch. There was roast lamb or salmon as a choice. Both choices had been taken up by the people living in the home and the majority seemed to enjoy lunch. There was a choice of bakewell tart, ice cream or pineapple and melon available for pudding. One of the people living in the home told us that there were suitable items for them to eat as they were on a gluten free diet. The member of staff in the kitchen was aware of who was on a special diet. The food choice record showed one person on a gluten free diet and on a diabetic diet. We were told that there were two people on a diabetic diet and one person did not like sandwiches and preferred to have salads. This information needed to be available in the kitchen so that all staff were aware of particular diets and preferences. There were records for the choices made by the people living in the home for lunch and tea time. There was a four week rolling menu however, we were told that this was not being strictly followed as some of the meals were no longer very popular and a new menu was being set up. Care Homes for Older People Page 18 of 31 Evidence: Surveys completed by people living in the home told us that people were generally happy with the food at the home but two people commented that they did not like the lunchtime meals. Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home were safe and were aware of how to raise any areas of concern they might have. Evidence: There had been no complaints or adult protection issues raised with us about the home and none had been raised at the home. There were appropriate procedures in place for people to raise any concerns they might have. Completed surveys told us that the people living in the home knew who to turn to if they were unhappy about anything. It was recommended that the home sets up a grumbles book to ensure that minor issues were recorded and it could be shown that all issues were followed up. Staff had received adult protection training and the recruitment process ensured that the people living in the home were safeguarded by ensuring that only suitable individuals were employed. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises were well maintained and provided a homely and comfortable environment for the people living in the home. Prompt actions were taken to ensure that the issues raised during the inspection were dealt with. Evidence: During the inspection we toured the building and looked at some bedrooms, the kitchen, laundry and communal areas of the home. The home was homely and comfortable and furniture and furnishings were of a good quality. The bedrooms seen were found to be clean, comfortable and decorated to a good standard. Furniture was of a good standard and the people living in the home were able to bring small items of furniture in to personalise their bedrooms. The people spoken to were happy with their bedrooms. There was only one shared room and all the bedrooms had their own en-suite facilities. There were a variety of en-suite facilities. Some included a shower whilst others did not. There was a choice of bath or shower for the people living in the home and there were Care Homes for Older People Page 21 of 31 Evidence: a number of communal toilets throughout the home. Although hot water outlet temperatures had been regulated it was found that the hot water regulator on the walk in shower could be overridden. This posed the potential for someone to be scalded whilst in the shower. All rooms had an emergency call alarm system available, there were hand rails, hoists, assisted bathing facilities and a passenger lift for people unable to use the stairs. The lift connected all three floors of the home. There was ramped access into the garden. There was a safe system in place for the handling of soiled laundry including the use of red alginate bags that could be put into the washing machine. The kitchen was found to be clean however all the meats in the freezer had not been dated when they had come into the home. The manager must ensure that meats that arrive when the cook is not in the building are dated by the staff putting the meats into the freezer. The freezer needed to be cleaned as there was a lot of food debris on the bottom shelf. Items of food such as rice and flour must be stored in lidded containers once the packets have been opened to prevent infestations. Care staff had discarded gloves in the kitchen bin. Staff must discard used gloves in clinical waste bins and not take them into the kitchen due to the high risk of cross infections. The home was generally clean and fresh however there was an odour in one bedroom and one of the lounges. The completed surveys said that the home was usually fresh however we were told that there was sometimes an odour in the home. This issue was discussed with the manager who felt that this was not the case and the home made attempts to manage odours throughout by replacing carpets on a regular basis and the use of specific sprays in the home. The manager needed to monitor this situation. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were adequate numbers of staff on duty with the appropriate skills and knowledge to care for the people living in the home. The recruitment procedures were robust and safeguarded the people living in the home. Evidence: The staffing rotas were looked at and they showed that there were appropriate levels of staff to meet the needs of the people living in the home. There were two waking night staff on duty. There was always a senior member of staff available for advice either on shift or on call. The home also employed a cook and domestic staff in addition to care staff. The managers hours were in addition to the care staff. The recruitment files for two staff were looked at and it was found that all the appropriate checks had been undertaken before people were employed ensuring that the people living in the home were safeguarded. The skills for care induction training had been introduced in the home however, these were not always being completed within twelve weeks of employment. There was a cross section of staff employed representing the local community in terms of culture and gender. Care Homes for Older People Page 23 of 31 Evidence: There was a training matrix in place and this showed that 75 of the care staff had achieved NVQ level 2 or above and the others were in the process of achieving this. The matrix also showed that most of the staff had undertaken all the required training to ensure that they were able to care for the people living in the home safely however four staff had not undertaken fire safety training within the past 12 months. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff, visitors to the home and the people living there were safeguarded by the homes policies and procedures. The manager was proactive and ensured that issues were addressed promptly. Evidence: The manager of the home had many years experience in the care of older people. She had completed the Registered Managers Award but had not yet completed NVQ level 4 in care. She demonstrated a good knowledge of the needs of the people in her care and of issues affecting the management of a care home. The proprietor of the home visited the home regularly as did the service manager. The home had recently purchased a quality assurance system but had not yet started to use it. However, the home had sent out questionnaires to relatives recently and there was evidence to show that issues raised had been responded to. There was an ongoing refurbishment and redecoration plan. Care Homes for Older People Page 25 of 31 Evidence: We were told that the home does not hold any monies for the people living in the home. Any expenditures, for example, hair dressing and chiropody are paid for by the company and invoices are sent to the appropriate people. The recorded supervisions levels on the two staff files looked at showed that staff were not receiving a minimum of six sessions a year. The manager told us that there were regular discussions with staff but these were not recorded. The homes records were well organised and information was easy to access. Issues that were raised regarding record keeping in the home were that the night staff were not adequately recording accidents in the daily reports and that the accident records did not have the correct dates on them sometimes. This was arising because accidents occurring after twelve oclock were dated with the previous days date. The AQAA told us that the equipment in the home was regularly serviced. It was evident from the AQAA that the electrical wiring in the home was in need of updating in September 2008. At the time of this inspection it was evident that the manager had made some attempts to get this done but the contractors had failed to attend the appointments made. It was important for the manager to contact contractors in advance of the expiry dates to ensure that equipment was serviced before the expiry dates. All the other equipment had been serviced appropriately. The only health and safety issues raised during this inspection were in relation to the ability of the restriction on the hot water temperature of the shower to be overridden and the management of medicines in the home. The fire records were not checked during this inspection. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 The falls risk assessments should clearly show what actions are being taken to safeguard the individuals who are at risk of falling. This will ensure that people at risk of injury from falling are protected. 31/01/2009 2 9 13 The manager must ensure that there are no unexplained gaps on the medication records. This will ensure that the people living in the home receive their medication as prescribed. 31/01/2009 3 9 13 The manager must ensure that there is a robust medication system in place. This will ensure that the people living in the home receive their medicines as prescribed. 31/01/2009 Care Homes for Older People Page 28 of 31 4 9 13 The manager must ensure 31/01/2009 that there is a record for the receipt of medicines into the home This will ensure that there is an audit trail for all medicines in the home. 5 25 13 The water temperature in the shower on the first floor must be restricted to 43 degrees. This will ensure that the people living in the home are safeguarded from scalding. 18/01/2009 6 26 13 Any opened packets of food must transferred to a lidded containers. This reduce the risk of infestations. 18/01/2009 7 26 13 The freezer must be cleaned 18/01/2009 of food debris. This will prevent the contamination of new foods. 8 38 23 The manager must ensure that evidence that the electrical hardwiring checks has been undertaken is forwarded to the commission. This will ensure that the home is safe. 18/01/2009 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. Care Homes for Older People Page 29 of 31 No. Refer to Standard Good Practice Recommendations 1 1 The manager must ensure that the range of fees charged at the home were included in the service user guide. This would enable people to have all the information they needed when deciding which home would best suit their needs. The manager must ensure that cream charts are completed when applied. This will ensure that the needs of the people living in the home are met. The manager must ensure that self administration assessments and compliance checks are put in place for people administering their own creams and inhalers. This will ensure that their abilities are monitored. A record of specific diets and likes and dislikes should be available in the kitchen for staff who may be dealing with food. This will ensure that the specific needs of all the people living in the home are met. The manager should set up a grumbles book where minor issues raised can be recorded. This will show that the people living in the home are listened to and appropriate actions taken where needed. The manager should take further steps to manage the odour identified in one of the bedrooms. This will ensure a pleasant environment for the person in that room. Staff must not put disposable gloves in the kitchen bin. This will ensure that there is no cross infections from the gloves to food. Staff who have not had fire training within the past 12 months should do so. This will ensure all staff are aware of the risks of fire and what to do in an emergency. Staff should complete their Skills for Care induction training within 12 weeks of starting. The manager can then sign them off as being safe to work unsupervised and ensure that the people living in the home are cared for by people with the necessary skills and knowledge. All supervision sessions should be recorded. This will ensure that the staff and manager can check that any actions to be taken can be followed through. The manager must ensure that daily records and accident records are accurate. This will ensure that people are responsible for incidents that occur during their shift. 2 9 3 9 4 15 5 16 6 26 7 26 8 30 9 30 10 36 11 37 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (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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