Inspection on 25/09/08 for Brierfield Residential Home

This inspection was carried out on 25th September 2008.

CSCI found this care home to be providing an Adequate 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

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: Brierfield Residential Home 58 High Road Trimley St Mary Felixstowe Suffolk IP11 0SY     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: Mary Jeffries     Date: 2 5 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 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 33 Information about the care home Name of care home: Address: Brierfield Residential Home 58 High Road Trimley St Mary Felixstowe Suffolk IP11 0SY 01394283422 01394279103 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Emma Catherine Beckett Type of registration: Number of places registered: J&S Healthcare Ltd care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is 18 The registered person may provide the following categories 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: Dementia - Code DE Date of last inspection Brief description of the care home Brierfield is a home providing care for eighteen older people with dementia. The home is on the main road of Trimley St. Mary, which is a small village adjacent to Felixstowe. There are limited local amenities nearby but Felixstowe offers a wider selection of shops and facilities. The home is a converted residential property of two storeys. There are two lounge areas and a large conservatory for communal use. There is a dining room beside the kitchen and a garden area for the residents use. There is a shaft lift to the upper floors. The current fees are £550 per week. Additional items charged Care Homes for Older People Page 4 of 33 Over 65 18 0 Brief description of the care home include hairdressing, chiropody, newspapers, taking to and collecting from appointments, dry cleaning, and any specialist purchases as required and discussed. Care Homes for Older People Page 5 of 33 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 inspection was unannounced and took place over six hours and fifty minutes on a weekday. This was a key inspection covered all of the standards relating to older people, as it was a newly registered home. The report has been written using accumulated evidence gathered prior to and during the inspection. This included a completed Annual Quality Assurance Assessment (AQAA). We received the AQAA after the inspection, so it was not possible to send out surveys prior to inspection. The manager and the deputy manager helped facilitate the inspection, three other members of staff and two relatives contributed. There were no vacancies in the home on the day of the inspection. Three residents Care Homes for Older People Page 6 of 33 were tracked; and a number of others were spoken with and care of residents was observed. A number of records were inspected including those relating to residents care plans, residents finances, complaints, staff personnel and training, medication, quality assurance and polices and procedures. A requirement made at the last inspection when the home was under different ownership was followed up. What the care home does well: What has improved since the last inspection? What they could do better: The Service User Guide requires further information regarding fees, and should also provide information about the door to the home being locked, and arrangements in place to ensure those that are able to can access the outside freely. Those who cannot, would benefit from a secure garden area. There was no program of daily activities available in the home, although care staff did make a point of offering some activities to residents. Although the environment is homely, a number of health and safety and infection control deficiencies were found during the inspection. Some of these were addressed on the day, and the home wrote to us immediately following the inspection to advise of the steps they were taking to address the immediate requirement made concerning fire safety. Whist medication recording was generally good, any changes to medicine administration records must be signed and dated, and the home must review the need for any update training to ensure all staff follow best practices in administering medicine. Training on infection control should also be given to staff. Whilst the reviewing system for residents care plans is good, and routinely involves relatives, the home must ensure that risk assessments are undertaken and/or updated should an event indicate this is required. Care Homes for Older People Page 8 of 33 Two signatures are required to support invoices for any additional expenditures. Whilst the home has some good systems in place, and a good atmosphere, the lack of monitoring in the environment and the lack of an updated risk assessment for one resident who subsequently had a similar accident indicate that sufficient time has not been devoted to management whilst the manager has been spending a proportion of their time working on the floor of the home as a carer. Although regulation 26 monthly provider reports were sent to us after the inspection, these were not available in the home on the day of the inspection or therefore to the manager. This is necessary to support the managers role. 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 33 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 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to have their needs assessed before they are offered a place at the home, but cannot be assured they will receive all of the information they are entitled to, enable them to make a decision about whether to live at the home. Evidence: We did not see a Service User Guide (SUG) in the room of a resident we met with; the deputy manager advised that the document was not in residents rooms. It was not immediately apparent to us that there was a copy of the SUG elsewhere in the home. The manager directed us to the small bureau upon which the visitors book rests; the document was contained in the drawer. This should be made explicit in a notice or in the SUG, so that relatives may access it without specifically requesting to see the document. The SUG did not include a copy of the latest inspection report, but it refers to the Care Homes for Older People Page 11 of 33 Evidence: availability of this document in the reception area of the home, (it was also in the bureau drawer), as well as in the office. It did not contain a standard form of contact, and it did not include details of the current fees. The manager provided us with a separate sheet of paper that states the fee charged, and the items that will incur additional expenditure. This stated that the current fees are 550 pounds per week, but did not cover all of the information required, for example the arrangement for payment of fees and additional items, and whether a different rate is charged for anyone. The AQAA states that families and residents (if appropriate) are welcomed to come and look round the home prior to admission. A relative spoken with said that they chose the home on the recommendation of a general practitioner, and had not thought it necessary to come and look round. They were aware that they could have done so. Another relative spoken with advised that their relative had visited before they came to live at the home, and didnt need to do so specifically to decide to move in. Three residents records were inspected, one of these had been admitted in the last month. Each contained an assessment of their needs, and care plans explaining how these needs will be met. Risk assessments were completed by senior staff or the homes manager and were detailed and comprehensive. Staff training records were viewed, these evidence that staff are trained appropriately and have sufficient qualifications to meet the needs of service users. Seven members of staff have a certificate in dementia awareness. The home does not offer intermediate care so standard six is not applicable. Care Homes for Older People Page 12 of 33 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. Residents can expect to have their care delivered on the basis of a care plan which is regularly reviewed, and for their family to be invited to participate in that process; they cannot, however, be assured that all risks will be identified and fully assessed or that appropriate preventative measures will be put in place to reduce the likelihood of an accident happening. Evidence: The home was full at the time of the inspection. There was no one on bed rest, and the deputy manager advised that there was no one with any pressure areas. Residents were all well dressed with clean clothing. A relative advised that the laundry worked well. A new computerised care planning system had been introduced. The care plans and associated records, such as the daily statements, relating to three residents were examined. There have been some changes to the care planning format used in the home to improve the accessibility of information to staff, and making them easier to Care Homes for Older People Page 13 of 33 Evidence: review and monitor. All these care plans were clear and easily understood. These were discussed with staff and the manager, who had a good knowledge of residents needs. The care plans include personal care, mobility, nutrition, health needs, social and religious needs and also incorporated any last wishes. There was evidence that residents weight is monitored where appropriate. One of the residents who was tracked had been at the home less than a month, the plans for the other two evidenced monthly updates/ reviews, and six monthly formal reviews to which relatives are invited. Amendments had been made to review forms, so that relatives comments at six monthly reviews are recorded and these are action pointed so that areas of concern from either party are clearly identified and a desired action sought. One of the residents tracked had bedsides in place; the risk assessment was signed by a relative, but was not a developed document, and did not evidence that other possible less restrictive options had been considered. Accident and file records for another resident tracked showed that they had twice, within the space of eight days, tipped over in their wheelchair. The manager was able to advise how they thought the accident had happened, and of instructions given to staff, however there was no written risk assessment undertaken after the first accident, and no evidence that preventative measures had been put in place. During the inspection a number of residents were seen being transported in wheelchairs without footplates. A carer advised some residents did not want to use, or could not use footplates, but there were no specific risk assessments in place to support this practice. There are unnecessary risks involved in using a wheelchair without plates, and a risk assessment must be conducted if this is thought to be appropriate. The residents files seen all had records of the residents GP and other health professionals such as the district nurse, chiropodist, optician and dentist. One relative spoken with explained that they took their relative to appointments, that although the home would do it, they wanted to be involved in this part of their relatives care. Two relatives spoken with advised they thought very highly of the staff, one spoke of the home being very good at keeping their relative warm, clean and fed, but also added, They love (them), the attention they give is second to none. The teatime medication administration was observed and the medicine administration records (MAR sheets) were inspected. The senior had a good manner with the residents, they ensured that they had a drink and were patient. One resident refused, they left them and returned a little later to try again. On each occasion they signed after administering the medication. When removing the tablets from the blister packs into the individual pot, however, they used their fingers to remove the tablet routinely. Care Homes for Older People Page 14 of 33 Evidence: This can contaminate the medication. The medication records included a sheet of specimen signatures. The entries for the last two and a half weeks were inspected, and no gaps were noted in the signature boxes; when a code was used a written explanation was recorded. Two residents had medications added onto the MAR sheet by hand, one had one medication and the other had four medications written in; in neither case were these entries signed. Where any amendments are necessary to MAR sheets the person doing so should clearly sign or initial the entry, to provide accountability and safeguard residents against incorrect medication being given. The manager advised that medication is administered by senior carers, who have all had training from Boots. They provided a schedule of staff training and qualifications, that showed whilst some staff had received training in medication in 2008, two, including the carer who administered medication this occasion had been trained more than three years ago. During the inspection staff were seen to relate very well to residents with dementia, and to treat them sensitively and with respect. Residents care plans included details of death and dying, and the AQAA states that policies on death and dying are in place. Care Homes for Older People Page 15 of 33 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 who use this service can expect their families to be welcome at the home, and to enjoy good home cooked meals, they can expect to be treated as individuals by care staff, but cannot be assured that a regular programme of activities that they can participate in to be available to them. Evidence: There was a pleasant aroma of cooking in the home at lunchtime on the day of the inspection. The main meal was an Irish stew, and two residents spoken with said how much they had enjoyed it. The weeks menu showed a range of home cooked meals was provided, and an alternative was also offered every day. The menu also showed that residents also had the choice of sandwiches or a cooked light meal at teatime. The cook advised that when they make a large meal, they freeze any remaining in individual dishes, so that a range of individual casseroles are usually available as alternatives to the main dish of the day. Residents and relatives spoken with all spoke positively about the food, a relative pointed out that if their relative did not eat much at lunch, they could have a good tea. The other spoken with said that there were always fresh vegetables, and that their relative had put on some weight. Care Homes for Older People Page 16 of 33 Evidence: There was a pleasant atmosphere within the home during the afternoon of the inspection. Staff were observed offering residents the choice of room to spend their time in and settling them comfortably if they required assistance. People sat at various places in the home to eat, some in the two dining rooms, others with table trays. A member of staff advised that it is never the same, it depends on how people feel. A carer was observed feeding one resident, they took their time, and gave the resident plenty of opportunity to taste each mouthful, offering the foods to them gently. Although the food was good and the assistance given with meals was good, the dining tables did not have any place mats, serviettes or flowers; plastic beakers were used for drinking vessels and the stew was served in bowls, and this was not very homely. There was a notice board stating what the main meal was, and also on the same board what staff were on duty. There were no pictures of either, which would make the information more accessible to residents. The notice board did not state the alternatives meals that were available. Providing this information in an accessible way would be beneficial in helping residents make choices and feel in more control in their environment. Residents files seen contained details of the next of kin and contact information.The two relatives present on the afternoon of the inspection confirmed that they always felt very welcome in the home. One attends very regularly, they advised that, there is nothing wrong at all here, I would know. Residents files contained social histories. Some of the life story work covered details of extended family members and their connection with the resident. Staff spoken with about residents needs had a good knowledge of the residents as individuals, their past lives and interests. A carer advised that one person used to paint, and that they now had a drawing pad and pen. Another used to be an entertainer,and gladly met the managers request to sing for the residents.The AQAA noted that the home had not been able to fill the vacancy for an activities coordinator, and that this was much needed as staff do not always have the time to carry out activities. A member of staff spoken with advised that someone attended each week to do gentle exercises with residents, but that there was nothing the carers had to do each day with them. They advised that they spoke with the residents when doing personal care, and that there were games such as bingo available depending on the mood of the residents. One resident was seen playing a game with a carer during the late afternoon.A resident spoken with advised that they attend the monthly Church of England religious services that are held at the home. Residents files contained a daily events log. One of those tracked had only one activity listed apart from family visits in a period of ten days, which was watching football. There was evidence that entertainment from outside the home is occasionally brought in for residents enjoyment. Care Homes for Older People Page 17 of 33 Care Homes for Older People Page 18 of 33 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. Residents can expect to be protected by the homes policies and procedures and to feel able to make a complaint of they need to. Evidence: The homes complaints procedure was displayed in the home, and is also in the Statement of Purpose/Service User Guide. There have been no complaints received by the home or CSCI since the last inspection. Due to the mental frailty of the residents none of them were able to respond to specific questions about complaints but no one looked distressed or anxious about any of the interventions that happened during the day.Two relatives spoken with both advised that they knew how to complain if they needed to, and that the manager and deputy were approachable. The home has a policy for the protection of vulnerable adults and a whistle-blowing policy. Staff are required to read and sign the whistle blowing policy as part of their induction to the home. A member of staff spoken with advised that they knew that the details of how to make a safeguarding referral were in the home, and they had spoken about it in staff meetings, but that they had not had training on making referrals. They advised that they would immediately go to the manager if there was any suspicion of abuse, and were able to speak knowledgeably about different types of abuse. Evidence of in house safeguarding training was seen, and the manager was aware of the agreed local referral routes. Care Homes for Older People Page 19 of 33 Evidence: The AQAA stated that the mental capacity of all residents had been assessed. Residents records supported this, and the manager demonstrated a good understanding of the differing abilities of individual residents to make informed decisions. Care Homes for Older People Page 20 of 33 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. People who use this home can expect to live in a comfortable environment but cannot be assured that the health and safety and infection control practices in place will fully protect them at all times. Evidence: The ground floor has 3 lounge areas and 2 dining areas. The ground floor is of open plan design to allow freedom of access of the residents to utilise the space. There are 16 bedrooms of which 2 are shared and 2 have en suite facilities. The home had created a memory wall, showing historical events in recent history. The communal rooms were comfortably furnished with a selection of armchairs of varying heights. Some residents were using specialised reclining chairs and footrests for comfort. There were a number of hoists and slings to move people with limited mobility. The doors and corridors of the home were wheelchair accessible and there were grab rails fitted for the stairs. As noted in the health and personal care section of this report wheel chairs stored for occasional use did not have any footplates fitted; a pooled supply should have plates fitted. The dining rooms had been recently decorated. The managers office was accessible to all residents; it was held open with a door guard alarm.Residents therefore have direct access to the manager, and one was seen speaking informally with them in the office during the inspection. All rooms are Care Homes for Older People Page 21 of 33 Evidence: provided with call systems, including communal areas, bathrooms and bedrooms. The residents bedrooms had pictures on the doors to help residents identify them, and two those seen were fresh and clean. One bedroom door was found to be wedged open; this poses a fire risk and was pointed out to the manager who immediately removed it. The kitchen was found to be clean and orderly. A copy of an environmental health report of a visit undertaken in June 2008 was seen. Two requirements and been made, and both had been addressed. A written procedure for freezing small portions of food was in place and the cook advised that a requirement that Milton used for storing cloths was changed regularly had been met, they advised that if the fluid discolours it requires changing. The environmental health report also stated that the cat, residents, and other carer staff should not be allowed access to the kitchen. The cat was hanging about the threshold to the kitchen as we met with the cook. When asked how they stopped the cat coming through the kitchen, the cook advised that it was with some difficulty; the cat flap was built into the kitchen external door. There were no unpleasant smells in the home on the day of the inspection, and the home was generally clean, but two lavatories inspected required flushing.There are adequate toilet and bathing facilities. All bathrooms are provided with hand wash gel and disposable towels. However, there were three bars of used soap, a pile of material towels and a bottle of shampoo in the bathroom near the entrance to the home; the soap and towels pose an unnecessary risk of infection spreading and the bottle of shampoo is a potential hazard for a person with dementia. These were moved when pointed out. Commode pans being cleaned on the afternoon of the inspection were not being cleaned in accordance with the infection control policy, and a disinfectant was found decanted into an unmarked bottle and stored in an unlocked cupboard. All of these practices pose unnecessary risks to residents health and safety. A carer washing commode pans in the sluice room explained the procedure they used, but did not mention the use of disinfectant in the process. They were asked whether disinfectant available; they could only find an unmarked bottle of a substance in the sluice room cupboard but did not know what it was. It is not good practice to decant hazardous substances. The manager later identified the substance as a sanitizer, labeled the bottle and removed it from the unlockable cupboard. The COSHH (Control of Substances Hazardous to Health) product sheet for the disinfectant was available, it described the substance as an irritant, and stated that medical advice should be sought if swallowed. The carer cleaning the commode pan advised that they would dry the commode with a cloth, and were able to show that there was a supply of cloths for this purpose, along with gloves and aprons, stored in the room. A dirty marked cloth was hung over the tap for the sluice sink. The member of staff said that they would Care Homes for Older People Page 22 of 33 Evidence: not use this, but could not explain why it was there. A copy of the homes infection control policy was provided. It clearly states that commodes should be routinely sprayed with sanitizer. The AQAA states that infection control training is included in induction; only one carer has separate infection control entered on their record of training, and this was in 2003. The entrance to the home is through the veranda. This door was locked on the day of the inspection, and the member of staff who opened it used a key, which was required. It was established that some, but not all, staff have a key to this door on their person; a key is kept in the office. We were advised that the door through the veranda is not the main fire door, and were shown a door which the manager advised was the main fire exit, which could be opened from immediately with a push bar. Signage in the home, however, identified the front door as a fire exit, and it was the closest exit to the designated congregating area as defined in the homes fire risk assessment. It must be possible for the door to be opened immediately in the event of a fire. The homes garden is not secure. The manager advised that residents are risk assessed to establish whether they can go out side unaccompanied without risk of wandering off. This should be stated in the Statement of Purpose. Care Homes for Older People Page 23 of 33 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. Residents can expect staff to be cared for by staff who relate well to them but cannot be assured that they have received all of the training updates they need to be able to carry out their duties in such a way as to minimise all risks to their health. Evidence: The early shift runs until three pm, and on the day of the inspection there was a deputy manager and three care staff covering this shift. The deputy confirmed that whilst she was the most senior person on duty, she was working on the floor that morning. Details in the AQAA of the care hours worked in the previous week, were fifty less that in the previous years AQAA, when overall dependency needs of the residents were shown to be higher. The AQAA stated stated that staffing levels had been maintained, by much of the managers time being used to cover care duties, and in particular night shifts. The deputy manager advised that she, as well as the manager, was working some night shifts, it had been necessary for her to. The manager confirmed information stated in the AQAA, that these difficulties arose because of difficulties recruiting staff.The deputy manager advised that there were usually four staff on duty, and that they never go below three in the day time. There are always two waking night staff. They advised that they were usually the most senior person on duty, but that sometimes the manager was in as well. The rota confirmed this. As noted under the daily life and social activity section of this report, these staff were also Care Homes for Older People Page 24 of 33 Evidence: covering the activities, without the input from an activities organiser. Staff said there were enough of them to meet the present residents needs. The AQAA stated that seventy hours a week of support provided by ancillary staff such as cooks and cleaners was provided, this had remained at a constant level from the previous year. The personal files of two recently appointed staff were seen. They contained satisfactory CRB checks and the proof of identity needed and the required 2 written references. They had all had an induction on commencing in post that covered fire awareness, health and safety, infection control, moving and handling, food hygiene and first aid. The AQAA states that 12 staff have NVQ2 or above, and that seven staff have completed a dementia awareness course. We have previously seen evidence of the homes training on caring for people with dementia and POVA. The homes training schedule showed that two staff had achieved their NVQ in 2008. Moving and handling training is provided by the manager and certificates to evidence participation are issued. Updates in manual handling had been provided, most recently in November 2007. As noted in the health and personal care section, staff may not have had recent update training in medication administration or training in infection control, and two staff demon stated that they were not following proper procedures in these area which puts residents at some risk. Residents and relatives spoken to thought highly of the staff. One resident who had moved from another care home said, The girls here are very, very, very very good. Another who had lived at the home for many years advised, I like it here, the girls are very jolly. During the inspection they were observed to be relating well to residents. Care Homes for Older People Page 25 of 33 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. Whilst relatives speak positively about the manager, and the home has developed care planning and some aspects of the environment, residents cannot be assured that the home will be have adequate quality control in place, or will be managed by someone who has adequate time to concentrate on management tasks so that they can be assured that all risks to residents are identified and minimised. Evidence: The home changed ownership in April 2008. The manager remained in post, having been registered with us since January 2006. They had maintained their training, and there was evidence on file of a fire safety manager course dated December 2007. The manager demonstrated a good understanding of the needs of people with dementia and relatives described the manager as approachable. There was evidence in the home that appropriate managerial action had been taken in response to a staff conduct matter. As noted in the staffing section of this report the manager had been spending significant amounts of time covering staffing duties. Given the health and safety and Care Homes for Older People Page 26 of 33 Evidence: infection control matters that have either been made as requirements or were pointed out and addressed on the day, this is not appropriate, as the home needs more effective monitoring. The AQAA was not received by us on the date requested. A reminder letter was sent and the home met the revised date. It was clear and complete. Residents views on the home are solicited by questionnaires that are sent out with six monthly reviews. Regulation 26 reports of monthly unannounced visits by the owner were not available in the home for inspection. The deputy advised that the owner attended regularly, usually twice a week and that they knew what days they were attending. Copies of regulation 26 reports were forwarded to us after the inspection. The deputy was also asked about relatives, residents and staff meetings, and advised us that these did not take place. The manager advised that the home does not take responsibility for residents finances. Additional services such as hairdressing and chiropody are billed separately, based on records of additional goods and services residents have received. The home maintains a shop book for purchases made from the home, and keeps lists of residents seen by the hairdresser and chiropodist. The list of residents seen by the hairdresser was not signed, and the list of these who had received chiropody were signed by the chiropodist, only. These must be signed by the person delivering the service and by a member of staff to evidence that the service has been delivered. All the records were securely kept in the office or the newly installed portacabin in the garden. Files were ordered and accessible. The homes Certificate of Registration was on display. The home had a fire risk assessment dated June 2008 in place. As noted in the environment section of this report, the arrangements for emergency evacuation requires all to congregate in an area next to an exit that is locked with a key. The fire risk assessment did not include a vertical evacuation plan, it noted that the home does not have adequate equipment to evacuate residents down a flight of stairs, and states that an evacuate or similar is to be purchased. The home had purchased two sledges, but the plan had not been revised. A member of staff who was asked about the procedures advised that they only had horizontal evacuation plans in place. The manager confirmed that this was the case. As mentioned in the environment sections of the report, a wedged was removed from a propped open bedroom door on the day. The home held information to show that water supplies and had been tested for Legionella in August 2007. Care Homes for Older People Page 27 of 33 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 28 of 33 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 1 7 13 Risk assessments must be in 14/01/2009 place for each resident who uses a wheelchair without footplates in place. Wheelchairs should not routinely be used without footplates, as their is a risk of residents feet and legs being injured whilst they are in transit. 2 7 13 A written risk assessment 14/01/2009 must be in place for a resident who has tipped over back wards twice in their wheelchair. You must establish if the chair can be safely used, and what if any measures are needed to reduce the risk of further similar incidents. 3 30 18 Staff should receive training in infection control. This is to minimise the risk of the spread on infection in the home. 31/01/2009 4 38 23 The emergency fire 14/01/2009 evacuation plan must include a plan for vertical evacuation. This is so that, should, in the event of a fire, the horizontal plan not be sufficient to safeguard residents, a procedure is in place to evacuate the building. Care Homes for Older People Page 29 of 33 5 38 23 The fire exit identified in the 14/01/2009 emergency evacuation procedure must be unrestricted in the event of a fire. This is to ensure that residents and staff can safely and immediately exit the building in the event of a fire. 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 1 5 The Service User Guide must 28/02/2009 contain all of the information required by regulation and also state clearly if the door to the outside is locked, what the arrangements are for enabling residents who are able to do so to access the outdoors safely. A copy must be given to the relatives of all current residents relatives. This is so that prospective residents and their Representatives have all of the information they are entitled to to make an informed decision about whether to chose the home. 2 9 13 Medication must not be 31/01/2009 handled, and any changes to the Medicine administration records must be signed and dated. Care Homes for Older People Page 30 of 33 This is to prevent contamination of medication and to reduce the risk of residents being given incorrect medication. 3 12 16 A suitable programme of daily activities must be in place. This is so that residents are given opportunities through recreational activities that stimulate them. 4 26 13 Good infection control practices must be maintained at all times. This is to reduce the risk of the spread of infection 5 31 12 Sufficient time must be provided by the Registered Manager on management tasks. This is to ensure that the home can be properly managed at all times to promote and make proper provisions for the health and welfare of service users. 6 33 26 Monthly regulation 26 visits 30/12/2008 must be undertaken in line with the regulation and must be unannounced. The reports must be available in the home for the manager to see and for inspection. This is to ensure that the running of the home is appropriately monitored. 07/02/2009 31/01/2009 28/02/2009 Care Homes for Older People Page 31 of 33 7 34 35 Two signatures are required to evidence that additional goods and services have been provided and received. This is to safeguard vulnerable peoples finances. 31/01/2009 8 38 23 Fire risk assessment must be include matters addressed and to contain a vertical evacuation plan. This is to ensure that vulnerable people can be properly safeguarded in the event of a fire. 30/12/2008 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 19 22 A secure garden area which residents with dementia can access should be available. The signage in the home, including daily menus and staff on duty should be reviewed with the needs and abilities of the service user group in mind. Advice should be taken from environmental heath about the suitability of the location of the cat flap, and the home should inform us of the outcome of this consultation and the action taken. The competence of staff handling medication should be monitored on a regular basis and additional training given where a need is identified. 3 26 4 30 Care Homes for Older People Page 32 of 33 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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