Inspection on 16/02/09 for Briardene Care Home

This inspection was carried out on 16th February 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Briardene Care Home 30/06/09

Briardene Care Home 03/06/09

Briardene Care Home 01/05/09

Briardene Care Home 16/09/08

Briardene Care Home 11/06/07

Briardene Care Home 08/06/06

Briardene Care Home 06/09/05

Briardene Care Home 14/12/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Briardene Care Home Newbiggin Lane Westerhope Newcastle upon Tyne NE5 1NA     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: Janet Thompson     Date: 1 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for 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: Briardene Care Home Newbiggin Lane Westerhope Newcastle upon Tyne NE5 1NA 01912863212 01912866820 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) : Windmill Hills Ltd care home 59 Number of places (if applicable): Under 65 Over 65 31 28 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 0 1 6 0 9 2 0 0 8 Briardene is a care home with nursing providing care for older people with physical and mental health needs. The home is owned and managed by Windmill Hills Limited that is part of a larger group, which provides care services for a variety of client groups. The home is staffed by registered general nurses supported by care staff. The philosophy of care is to support the residents in their activities of daily living and to provide for their physical and mental health needs. The home is situated in Newbiggin Lane in the west of the city of Newcastle upon Tyne fairly close to local shops and public transport links. The building is comprised of three floors, the top floor being staff accommodation. The lower two floors are resident accommodation with 62 single bedrooms all with en-suite facilities. On each of these floors there are a number of bathrooms, toilets, lounge and dining rooms. The home has a visitor coffee room and hairdressing room. There is also a kitchen and laundry room. To the rear of the home there is a very nice garden and patio area. Fees in the home vary and are available on request from the organisation. Care Homes for Older People Page 4 of 31 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: 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: The quality rating for this service is 1 star. This means people who use the service experience adequate quality outcomes. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations. This will only happen when it is considered that people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This was an unannounced inspection. The manager and operations manager were Care Homes for Older People Page 6 of 31 present at the inspection. The inspection team consisted of two inspectors and a pharmacy inspector. The inspection took a combined time of eighteen hours to complete. Before the visit we looked at information we had received since the last visit, including how the service dealt with any complaints and concerns. We checked if there had been any changes to how the home was run and asked the provider for their view of how well they care for people. We also sought the views of people who use the service. This was given to us in the form of questionnaires. A the time of writing this report we had received eleven questionnaires from residents and relatives. During the visit we talked with people who use the service, staff and the manager. We looked at information about people and checked how well their needs are met. We also looked at other records the home is required to keep. We checked that staff had the knowledge, skills and training to meet the needs of the people they care for and we looked around the building to make sure it was clean, safe and comfortable. Feedback was given to the manager and operations manager at the end of the visit. What the care home does well: What has improved since the last inspection? What they could do better: The care plans did not properly reflect peoples current needs. Information in the daily records indicated changes in peoples health that had not been followed up on the plan. The plans did not reflect the social and emotional needs of people and were not person centered. Records of food and fluid did not show the actual amounts of food taken and these were not properly filled in. Social care was not good. There are activities on offer but we saw little evidence of good social interactions. Staff cared for people in a task orientated way and residents told us that some staff seemed disinterested. We noticed that some staff did not engage residents in conversation when they were supervising public areas. We observed the meal being served and tasted the food. The meal was served later than planned on both floors due to a number of reasons. Tables were not set with condiments, though they were offered to some residents with their meal. Drinks were served in coloured plastic beakers that looked a little institutional. Staff helping residents to eat did so standing up rather than sitting in a more discreet way. We thought the meal was adequate but the vegetables were overcooked. Care Homes for Older People Page 8 of 31 The storage cupboards used to store medication were not big enough and the administration records were not always properly filled in. We made a number of requirements and recommendations about medication. Staff recruitment was not thorough enough to protect residents from harm. Some of the files we examined did not contain enough evidence of reference checks, background checks or declarations of offenses. Residents and relatives told us that they understood the complaints procedure but they also said that improvements arising as a result of complaints were not maintained. Staff training in the protection of vulnerable adults had lapsed but was remedied on the day of the inspection. The management of the home was not good enough to raise and maintain standards. Several areas that we highlighted for improvement should have been picked up by the manager. Where improvements have been made in the past these have not always been maintained. There was not enough evidence of consultation with staff or day to day supervision of staff. 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. People are properly assessed, taking account of their needs and wishes, so that they can be assured this is a suitable home and receive an individual care service. Evidence: Three pre-admission assessments were seen. They contained enough information to enable staff to assess if they could meet the individual needs before admission. Information from other health professionals and carers was included in the assessment. We spoke to residents about the admission process but they could not remember the details as they had been in the home for some time. Care Homes for Older People Page 11 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal care that is not always well planned but does takes account of their diverse needs. Evidence: Eight care plans were examined and four were case tracked. This means that we spoke to the individual residents or observed their care then matched our observations to what was written in the care plan. The standard of care plans varied and some did not reflect the actual care needs of residents. For example one residents needs had changed after a fall, she now required food supplements due to poor appetite and she had lost weight. This was recorded in the daily record but not reflected in the care plan. One residents plan stated that she needed the assistance of two to stand when in fact she was unable to stand. We also noted that five of the eight residents had lost weight and one persons weight record showed great variations month to month. We asked a carer if the weighing scales were accurate, she responded that she did not use them as she could not add up very well. The scales are relatively simple but a little old fashioned. We raised this with the operations manager who agreed to purchase new Care Homes for Older People Page 12 of 31 Evidence: ones. We also noted that the recording of food and fluid intake was not consistent. The detail of what was offered and actually eaten was not always complete and there were gaps in fluid charts. Records showed that some residents had taken poor diet that day but there was no record to show what had been done about it. Other health professionals contributed to the planning of care. These contributions were clearly recorded. Advice has been sought from the challenging behaviour team for some people on the dementia unit. Charts were in place showing staff what could trigger challenging behaviour and the steps to take to manage this. This advice was not, however, incorporated in to the care plan. Advice was recorded from the Tissue Viability nurse. Records relating to wound care were good, although they are all kept in a separate file, which does not contribute to person centered care. We concluded that most files contained good information, but not all. Care plans are based on a medical model that does not promote person centered planning and were therefore lacking in social care elements. We received questionnaires from relatives and residents that told us they thought the care was good. Residents said they were well looked after and that staff were approachable and helpful. A relative told us that the physical care of residents was good. Another resident said she was very well looked after and cared for. We received eleven questionnaires, none of which contained any negative comments about the physical care of people in the home. When we talked to residents they said they had choices in things like bathing, when to get out of bed and how they spent their day. Residents looked clean and well cared for. Residents told us that care was given in the privacy of their own rooms. One resident said that she found it embarrassing to be bathed by staff but understood that she needed supervision. She told us that staff went out of their way to give her as much privacy as possible whilst remaining in the room for safety. Medicine administration was observed on the first floor and was generally seen to be in accordance with best practice guidance.Time was spent with each person and encouragement given to help them take their medication. Medicines were given directly to service users from the original packaging and there was no evidence of medication being placed in medicine pots for administration at a later time. The treatment rooms used to store medication are inadequate to meet the needs of the home. The rooms are small and congested and some nutritional supplements, laxatives, creams and ointments were stored on open shelving rather than in locked cupboards. Only one drug cupboard is located in each treatment room and consequently medicines for oral use cannot be separated from products for external use. In addition, the room on the ground floor was warm and the temperature records confirmed this was usually twenty five or six degrees centigrade,which is the limit for the maximum recommended temperature for the storage of non- refrigerated medicines. Neither medicines fridge was locked on arrival at the home and temperature records for the first floor fridge were largely incomplete. The controlled drug cupboard does not appear to meet the safe custody regulations because it is fastened to a partition wall and has no steel plate mounted behind it. Care Homes for Older People Page 13 of 31 Evidence: There were no discrepancies between controlled drugs held in the home and the relevant entries in the controlled drug register and on the medication administration record charts and stock is checked regularly. The current medication administration charts on both floors were looked at. On the first floor we noted a small number of gaps in the administration records where medicines had not been given as prescribed. Two medicines had been recorded as out of stock resulting in one service user not receiving painkillers regularly as prescribed for four days and another service user not receiving a once daily medication for two consecutive days.Many handwritten entries on the MAR charts were incomplete and did not always include the quantity of medication received or carried over from the previous month and a witness signature. For example, one entry on an administration record sheet for a controlled drug was not signed, dated ,or witnessed and the quantity of medication received was not recorded on the chart. Medicines with limited use once opened were not always labelled with the date of first opening.This means there is a risk that medication may be used beyond the date recommended by the manufacturer and may not be safe to administer. We found a number of discrepancies between the quantities of medicines received, the number of doses recorded and the quantity of medicines remaining. This suggests that people may not always be getting their medicines as prescribed. Medication and administration records on the ground floor were generally well maintained although a number of handwritten entries on record sheets were not fully completed. Eight staff have recently undertaken comprehensive medication training but their competence to handle medicines has not yet been fully documented. The medicines policy covers the main aspects of handling medicines in the home but could be improved to include detailed guidance on the administration process and to more accurately reflect local practices. A medication audit was carried out for the first floor in January but no completed audit was available for the nursing floor. Regular audit of the whole of the medication system helps identify medication problems promptly and helps confirm that staff are closely following the homes medicines policy. We were shown a more comprehensive document which the home proposed to introduce and use on a monthly basis. We case tracked one resident who was receiving end of life care. The plan showed that integrated care pathways were in place, however staff had not received training about this. There were pain monitoring strategies in place and good plans showing the management of pressure points and skin integrity. Care Homes for Older People Page 14 of 31 Care Homes for Older People Page 15 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not fully supported to lead a healthy and fulfilling personal lifestyle that takes account of their wishes and diverse abilities. Evidence: Residents told us that there were activities in the home if they wanted to join in. Three residents we spoke to said they did not want to join in and spent most of their time in their room. They told us this was because they did not feel the activities suited them, or they just preferred their own company. There was an activities schedule in place that showed a reasonable range of activities. In questionnaires residents and relatives told us that suitable activities were only available sometimes. One person said physical care was good, psychological care was not good. We noted on the the dementia unit that there were no social interactions in the morning, residents were wandering the corridors and staff did not interact with them. In the afternoon residents made crispie cakes. On the ground floor residents were playing board games in the morning but after lunch when we visited the lounge we noted that they were sitting in silence mostly asleep. A carer was in this lounge but she had her back to the residents and was not engaging any of them in conversation. This shows that carers perceive activities and socialising to be the role of someone else and they are not caring for the Care Homes for Older People Page 16 of 31 Evidence: person as a whole. There was also the constant piped music which did not interact particularly well with people talking, listening to their own music or watching television. Residents told us they did not often go out of the home on trips because of lack of staff to take them. Relatives also commented on this in their questionnaires. We ate lunch in the home on both floors. We noticed that there was a delay on both floors in serving meals to all people. Some people had finished their meal and others waited thirty five minutes. On the first floor the dining areas are segregated, people who needed the most support had their meal in the small dining room. This meant staff were split between two areas and in some cases the meal became cold. Portions were served in various size to different people taking account of their appetite. The food we ate was adequate. People were given choices of sausage casserole, yorkshire pudding, green beans. potatoes and cauliflower.The alternative was cold meat and chips with a small side salad. We thought the vegetables were overcooked. On the first floor staff did ask if anyone wanted salt, but they put it on the meal, there was no offer of sauces or vinegar and there was no encouragement for self serving to maintain or regain some independence. On the ground floor there were no condiments on the table though salt was offered to those who had chips. Drinks were served in coloured plastic beakers or feeding cups to everyone. There was no assessment made of those people who were able to use glass, or preferred something less institutional. On the first floor assistance was given to people who needed help to eat but the carer stood over the resident instead of sitting next to them. This draws attention to the fact that help is needed and does not protect the dignity of the residents. At the last inspection some residents told us that the tea served was not hot enough. Thermos flasks were purchased to address this. At this inspection residents told us that the situation had improved but was not maintained. On discussion with the chef it was apparent that the thermos was not used for the tea. Residents choice is limited in this instance as they said they often leave the tea and drink juice instead. Care Homes for Older People Page 17 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are not fully protected from harm through thorough policies, procedures and staff training. Evidence: Staff follow the homes policies and procedures relating to the management of complaints and allegations of abuse. Refresher training on the protection of vulnerable adults is about to take place. This is needed by some staff who have not received this training for a number of years. This training was organised immediately at the inspection but should have been identified by the manager before this. Staff spoken to were clear about the whistle blowing policy and protection of adults issues. Residents are told how to complain through the complaints procedure. This was clearly visible within the home. Residents spoken to said they would complain if they needed to but none of them had any current complaints. One resident said she had made a complaint and things had improved but slowly things deteriorate. Most of the comments in questionnaires said that people feel happy to complain and that they were confident action would be taken. Three people said improvements are not maintained. CSCI received a complaint about the home before the inspection. This remained unresolved. The operations manager discussed the elements of the complaint with the inspector. She agreed that improvements need to be made in the management systems, especially in areas of day to day monitoring of staff. This is something that we will continue to monitor. Care Homes for Older People Page 18 of 31 Evidence: Care Homes for Older People Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe comfortable home that is generally pleasant and clean. Evidence: Generally the home was clean and tidy. There were no odours. The decoration was homely and provided residents with a comfortable environment. The dementia care unit has little in the way of prompts or signage to help those with memory loss find their way around and encourage them to retain a degree of independence. For example, doors are not different, there are no pictures of events or food, directions to lounges, or well picked out grab rails. The lounges are impersonal and have standard furniture and the main interest is the television in the corner. Chairs are placed around the walls which makes any group conversation difficult. Also one lounge is rectangular and the television is in the corner which obscures the view for some. Murals of flowers are painted on the corridor walls and these should be removed as they could increase some peoples confusion. Items are being displayed on the corridor walls to encourage people to touch and provide items of interest. There are also pictures of royal events in the 1930s and pictures depicting farming in the past. The operations manager is going to provide further items of interest such as rummage boxes and other memorabilia to stimulate peoples interest and conversation. On the day of the inspection she arrived at the home with some of these Care Homes for Older People Page 20 of 31 Evidence: items. There is a sensory room with but we were told this was not well used and there may be plans to change the room into a kitchen area so that people could relearn skills such as baking. Bedrooms are all en-suite. They were nicely decorated and furnished and there was evidence that some rooms have been recarpeted. All of the rooms seen had jugs of juice and plastic beakers, so the people could have a drink whenever they wished. We spoke to five residents on the ground floor. They all said they were happy with their bedroom and had everything they needed to stay comfortable. The rooms were clean and smelled fresh. The laundry area was clean and tidy. Facilities are available for washing soiled or infected linen. Staff have received training in infection control and more is planned. Staff were seen to practice good techniques for controlling infection. Care Homes for Older People Page 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are not fully supported or protected through staff numbers, skill and ability. Evidence: The home was adequately staffed on the day of inspection. Generally staff work on the ground or first floors. There is a key worker system in place where carers are given specific responsibility for the care of specific residents. We observed that staff worked to complete tasks and get through the routines of the day. This does not promote person centered or holistic care. In questionnaires residents and relatives said staff were friendly and helpful. Three questionnaires commented that some staff were not as good as others and even seemed disinterested. We noted that there was not a lot of vocational training. Staff had not received training in dementia care or end of life care. There was a training overview matrix allowing the manager to see at a glance which staff needed to be updated in training. Statutory training was generally up to date. Each staff member also has an individual training and development file. Four staff recruitment files were examined. These were for one new carer, one nurse and two long term employed carers, one of who had been promoted to senior. Thorough background checks had not been carried out on all staff before employment. One file showed that a staff member had not declared offenses on an application form Care Homes for Older People Page 22 of 31 Evidence: that later were revealed in a criminal records check. This person was councelled and retained but it was not clear on the interview form what criteria had been used in the decision to retain. Another staff member did declare a number of offenses, again it was not clear why the manager had decided to employ her. The nurse had only provided one current reference, the other reference was a character reference from six years ago. The fourth file contained good information. The inadequate checks on staff prior to employment could mean that residents and other staff are vulnerable to abuse. Care Homes for Older People Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are not fully protected through reflective management which account of the diverse needs of the service. Evidence: The home has an experienced registered manager. She has been assessed as having the competency and skills to run the home. There have been recent complaints from a relative indicating that the management of the home is not positive or inclusive. The provider has investigated these complaints and taken some action to resolve them. There have been some requirements made about issues which are affected by the management of the home. There was not enough evidence that there is a clear sense of direction and leadership. This would be demonstrated through better day to day monitoring of staff, thorough recruitment checks and a consistent maintenance of good standards. The home does operate a quality assurance system. Residents, their relatives and Care Homes for Older People Page 24 of 31 Evidence: professionals are consulted about the service provided. There was not enough evidence that the service values the individual and is managed to promote diversity. This has been commented on in other sections of this report. We looked at the results of the most recent quality assurance surveys and found that most gave positive comments about staff, the environment and the care. Residents and relatives meetings have been held but not on a regular basis, the manager said there was a lack of interest. There is a comments and suggestions book by the entrance, this contained references to individual residents and we advised that it was removed. A more comprehensive audit has recently been introduced, it covers all areas of management of the home and should help to improve standards. Staff supervision records showed that staff are formally supervised on a regular basis. Staff do attend meetings but there has not been a meeting since September 2008. Servicing and maintenance agreements are in place for facilities and equipment. Risks in the environment and tasks, including safe working practices are assessed and reviewed. All fire safety checks; tests and instructions to staff are conducted at the required frequency and recorded. There were no obvious trip hazards in the home. Fire exits were clear of obstruction and all hazardous fluids locked away. Accidents are recorded and an analysis takes place monthly, this looks for trends in people, places and time. Care Homes for Older People Page 25 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 29 19 Ensure staff are sufficiently 01/12/2008 screened and checked before recruitment. Residents are protected from harm by secure staff screening. Care Homes for Older People Page 26 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 7 15 Ensure that care plans give consistent information. Ensure all plans reflect the actual needs of residents and are person centered. Ensure food, fluid and weight records are properly completed. This will ensure that all residents care needs are properly identified. 01/04/2009 2 9 13 All medication must be 01/05/2009 administered as prescribed and a supply must always be available to support this. All medicines must be stored safely and securely and at the temperature recommended by the manufacturer. Best practice guidance and the providers medication policy must be followed when recording all medicines. The controlled drug cupboard should be relocated and fastened to a Care Homes for Older People Page 27 of 31 solid wall. All staff who administer medicines must be formally assessed as competent to do so and a record made of their assessment. This will ensure that people receive their medication correctly and the treatment of their condition is not affected. This makes sure that medicines are not tampered with and remain safe to use. This will help make sure that peoples health and welfare are protected from the risk of medication errors and omissions. 3 15 16 Ensure that residents have 01/04/2009 access to nutritious food that is well presented and served at a temperature that suits them. Residents health and social needs are met at mealtimes. 4 16 22 Ensure that all complaints are taken seriously and acted upon over a period of time. This ensures that all improvements made are sustained. 5 18 13 Ensure all staff receive regular training in adult protection. 01/05/2009 01/04/2009 Care Homes for Older People Page 28 of 31 This helps to safeguard residents from abuse. 6 29 19 Provide evidence that staff have been thoroughly screened prior to employment. Where staff are employed there must be evidence as to how that decision has been reached. This help to protect residents from abuse. 7 31 13 Provide an action plan 01/04/2009 indicating the measures put in place to improve the management of the home. Provide confirmation of the supervisory arrangements in place for the manager, include targets of performance to be reached. Better management of the home will improve standards of care and living for all residents. 01/04/2009 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 7 Purchase new weighing scales and ensure staff know how to use them. Conduct a review of residents weight and address and unexplained weight loss. A system should be in place to record all medication kept in the home and any carried over from the previous month. This helps confirm medication is being given as prescribed and assists in checking stock levels. Medicine fridges should be locked when not in use and the 2 9 Care Homes for Older People Page 29 of 31 key kept with the person in charge of the unit. The medication storage should be relocated to ensure that medicines are stored safely and securely. Staff should sign and date any handwritten entries and changes on MAR sheets and record the amount of medication received. The entry should be checked and countersigned by a second person. This makes sure that the correct information is recorded so that the person receives their medication as prescribed. The medicines policy should be updated in line with current best practice guidance so that staff understand how to handle and administer medicines safely and copies should be kept in treatment rooms. Fridge temperatures should be checked daily, preferably using a maximum/minimum thermometer, to confirm that medicines are being stored within the appropriate temperature range recommended by the manufacturer and so are safe to use. The date of first opening should be written on the containers of all medicines with limited use once opened. 3 4 11 12 Train staff in the use of the integrated care pathways. Ensure staff provide adequate social care to residents. Improve the social care provision. Ensure care is person centered. Demonstrate how residents are supported to establish and maintain good community links. Ensure that staff behave in a way that maximises residents capacity for autonomy and choice. Ensure that the dementia unit is adapted to maximise residents independence and minimise confusion. Provide staff with training relevant to their job. Increase promotion of residents and relatives meetings. Demonstrate how people have been encouraged to attend these. Carry out regular meetings and consultation with staff. 5 6 7 8 9 13 14 22 30 32 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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