Inspection on 17/11/08 for Brigshaw House

This inspection was carried out on 17th November 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brigshaw House 27/05/08

Brigshaw House 24/07/07

Brigshaw House 21/11/06

Brigshaw House 04/10/05

Brigshaw House 20/05/05

Brigshaw House 05/10/04

Brigshaw House 18/05/04

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Snydale Care Home

Larchfield Manor

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Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Brigshaw House 2 Brigshaw Lane Allerton Bywater Castleford West Yorkshire WF10 2HN     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: Dawn Navesey     Date: 1 7 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Brigshaw House 2 Brigshaw Lane Allerton Bywater Castleford West Yorkshire WF10 2HN 01132868421 F/P01132868421 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Cymar Care Homes Limited care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Brigshaw House provides a service for up to twenty one older people, some of whom may have dementia, but do not require nursing care. The home is situated in Allerton Bywater, a former mining village midway between Leeds and Castleford and is close to local amenities and public transport. The building comprises of an older house with the addition of purpose built accommodation. There are seventeen single and two double bedrooms, good dining facilities and spacious sitting areas. There is car parking space at the front of the home and at the back there are extensive and well kept gardens, which are quiet and private. Copies of previous inspection reports are available in the front entrance of the home. In November 2008 the manager said that the fees ranged from 388 pounds per week to 410 pounds per week. More up to date information can be obtained from the home. 21 0 Over 65 0 21 Care Homes for Older People Page 4 of 35 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 the people who use this service experience adequate quality outcomes. The Commission for Social Care Inspection (CSCI) inspects services at a frequency determined by how the service has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.csci.org.uk One inspector who was at the home from 10:30am until 7:00pm on 17 November 2008 carried out this unannounced visit. Care Homes for Older People Page 5 of 35 The purpose of the inspection was to make sure the home was providing a good standard of care for the people who use the service. Before the inspection, evidence about the home was reviewed. This included looking at any reported incidents, accidents or complaints. This information was used to plan the visit. The acting manager of the home was asked to completed an Annual Quality Assurance Assessment (AQAA) before the visit to provide additional information. This was not returned to us despite reminders given and had not been done at the time we visited the service. We also carried out a further random inspection in September 2008 where we saw some progress in addressing identified shortfalls. What we saw at this visit confirmed these improvements too. We looked at a number of documents during the visit and visited areas of the home used by the people who live there. We spent a good proportion of time talking with the people at the home, staff and the new manager. Comments made to us during the day appear in the body of the report. We also sent survey forms to people who live at the home, staff and health professionals who visit the home. One of these had been returned at the time of writing the report. Feedback at the end of the visit was given to the manager. The last key inspection of this home was 27th May 2008. What the care home does well: What has improved since the last inspection? The homes statement of purpose has been updated with information about the home and the specialist care the home offers for people with dementia. More staff have now completed training in dementia care. This means they have skills to meet the specialist needs of people with dementia. Care Homes for Older People Page 7 of 35 Some progress has been made with the quality and standard of the care plans and risk assessments of people who use the service. Some of these are clear, person centred and give staff specific instruction on peoples care and support needs. Any handwritten entries on the MAR (Medication Administration Sheets) sheets have now been signed by two people to reduce the risk of errors occurring. People who live at the home said there had been a little more to do recently. Comments included: A bit more going off lately We have played bingo and the big card game. Staffing levels have been reviewed and increased to make sure there are enough staff on duty to provide activity or just sit and chat with people. Staff said this was now better and they felt they had more time recently to organise and join in with activity. Staff have also recently completed a training course on providing activity for people with dementia and memory loss. They said they enjoyed this and learnt a lot. Comments included: Made me realise how important just chatting to people is Reminiscence is very important, good to get people talking about things they remember from the past We used drawing to help people remember things Activity with a bit of exercise involved is good for people, like the giant dice Since our last visit to the home, a residents/relatives meeting has been held. People who live at the home made suggestions for activities and changes they would like to see in the home. Staff have completed training on safeguarding adults. All staff were clear on their responsibility to report abuse or allegations of abuse. Staffs comments included: Report to manager Go further afield if necessary Would go to social services if not happy with how management dealt with something I had reported Have been given the number in my induction to ring to tell people like you (CSCI) and social services. Care Homes for Older People Page 8 of 35 We have the whistleblowing policy. There is now clear evidence in the home that CRB (Criminal Record Bureau) checks are carried out before staff start work at the home. This protects peoples interests properly. A new manager has been appointed to manage the home. She said she has an NVQ level 4 in care management and a qualification in supervisory management skills. Staff said they had already received good support from the new manager. People who use the service said the new manager seemed Nice. Some relatives said she had introduced herself to them and was Friendly. A suggestions box has been set up in the homes hallway with a poster inviting people to make suggestions or share their views on the home. What they could do better: Pre-admission assessments must be carried out thoroughly and by people who are trained and skilled to do so. This will make sure that peoples needs are properly identified and are not missed or overlooked. Some care plans still have a number of shortfalls and gaps in them which could lead to peoples needs being missed or overlooked. Work should continue on care plan and risk assessment information to make sure they are clear and give staff specific instructions on how to meet peoples care and support needs. Peoples health care needs must be properly assessed and monitored. Referral to health practitioners must be made promptly when peoples health is seen to be deteriorating. This will make sure their needs are not missed or overlooked. The records for medication returns are not well organised and could lead to errors being made. The way medication is ordered should be reviewed. Sending prescriptions to the pharmacist without having first checked them could lead to errors being made. Activity and occupation has increased slightly for people at the home, they are not feeling as bored as they were. However, staff should be guided and directed to provide a stimulating programme of activities based on peoples needs and choices. This will make sure that peoples social and recreational needs are more fully met. People said they thought the home would benefit from some modernisation and sprucing up. Some serious consideration should be given to refurbishment in the home. This will make it more comfortable for the people who use the service. The bath with the chipped enamel must be repaired or replaced to make sure it is safe and people cannot injure themselves on it. As mentioned above, we did not receive the AQAA from the acting manager of the service. This was despite being reminded of the need to do this and it being the managers responsibility. The acting manager has not been notifying the CSCI of events which affect the welfare Care Homes for Older People Page 9 of 35 of people who use the service. This must be done in future to make sure the health,safety and welfare of people who use the service is protected properly. Work should continue on keeping the homes records in good order. This will help the smooth running of the home. 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 10 of 35 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 11 of 35 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. People who use the service are provided with information needed to help them choose a home that will meet their needs, however pre-admission assessments are not carried out thoroughly and could lead to peoples needs being overlooked. Evidence: The homes statement of purpose has been updated with information about the home and the specialist care the home offers for people with dementia. The new manager wants to look at developing this in alternative formats such as large print, tape and pictorial. This will make the information more accessible to people who use the service. More staff have now completed training in dementia care. This means they have skills to meet the specialist needs of people with dementia. Staff said they had found this training useful. We observed staff demonstrating good practice when trying to reassure people who were agitated or distressed. Care Homes for Older People Page 12 of 35 Evidence: We looked at pre-admission assessment information for some people recently admitted to the home. Improvements must be made to how these are carried out. At our last visit to the home we recommended that pre-amission assessments were to be carried out more thoroughly and health needs followed up with the relevant health professionals. At this visit we found that a person had been admitted to the home for respite care without any formal assessment of their needs. The new manager had identified this and been told that the person had visited the home prior to their admission and information had been handed over verbally. All the staff we spoke to said they had been told verbally of this persons needs. The person also looked well cared for. A basic assessment had been completed on the day of admission but the information was inadequate and vague. For example, will need some help from care does not accurately describe the persons care needs and could lead to needs being missed or overlooked. The new manager agreed that the homes admissions procedures needed to be reviewed and that she needed to make sure staff were skilled and trained in carrying out assessments. She showed us an assessment format she was planning to introduce. This looked thorough and would identify peoples needs properly. Care Homes for Older People Page 13 of 35 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. In the main, peoples health and personal care needs are met and the principles of respect, privacy and dignity are put into practice. However, failure to monitor some peoples health needs properly has put people at risk. Medication recording systems have not been properly managed and could have led to errors being made. Evidence: At our last key inspection of the home we said that care plan and risk assessment information must be improved so that staff were given clear and specific instructions on how to meet peoples care needs. It is clear that some progress has been made with this, however there is still work to be done to bring them to a good standard. New care plan documentation has been introduced. Some of this has been completed well and includes some good person centred information. Examples of this include, care plans relating to peoples preferred routines for going to bed, the clothes they like to wear and the way in which they want to be supported with personal care. Staff could also accurately describe the care they give and how they support people with Care Homes for Older People Page 14 of 35 Evidence: their personal care. People who live at the home and their relatives said, We are well looked after, We want for nothing and No problems with the care, it is very good. People look well cared for clean, tidy and well groomed. Attention had been paid to detail. People had clean glasses, women had their nails painted if they wanted and people had their hair styled as they wished. Staff were patient and kind when interacting with people. They were discreet and respectful of peoples dignity when attending to any personal care needs. They gave reassurance and explanations for any tasks that they needed to support people with. This seemed to give people confidence in the staff. Some life history work has been completed for people. Staff said they found this useful to have when working with people who had memory loss. One said, It can be very reassurring for people to talk about the past and acknowledge what they used to do. Some care plans still had a number of shortfalls and gaps in them which could lead to peoples needs being missed or overlooked. A person admitted for respite care had not had any care plans developed, just some basic assessment information completed on their admission. The new manager is planning to introduce a care plan format for people who come for respite care and said she had already started working on this. Other care plans had vague information and did not tell staff how people were affected by their needs. For example, how a persons dementia affected them as an individual or how someone could communicate their needs to people. Some peoples nutritional needs had been assessed but then not properly monitored through the care planning process. For example, someone who had lost a significant amount of weight had not been weighed for 3 months due to their refusal or the scales being broken. Their appetite was declining in this time and documented as such in the daily notes. This person was not referred to a health practitioner until they needed to be admitted to hospital and had become dehydrated. The new manager said she had discussed this on her arrival at the home and staff said they thought the weight loss was due to the persons medical condition. The manager referred this person to the doctor and they are now being monitored properly and food supplements had been prescribed. The manager also agreed that food and fluid intake needed to be recorded for anyone nutritionally at risk and that this would be done for this person. She was also making sure this person was weighed weekly so that their weight could be properly monitored. Care Homes for Older People Page 15 of 35 Evidence: We noticed some improvements at our last visit to the home on risk assessments and risk management plans. However, on this visit, it was clear that improvements still need to be made to make sure risk assessments are carried out thoroughly to make sure people are safe. Some management plans were clear and gave good instructions on how risks were to be managed. However, some management plans had not been put in place even when it was evident that people were at risk. For example, a person at risk from choking had no plans in place to say how this was managed. Staff did however know what to do to minimise this risk and could speak confidently about what they do. Another person was at risk from pressure ulcers but had not been assessed as such. However, pressure relieving equipment was in place and staff could describe how they prevent pressure ulcers from developing. The new manager is currently conducting a full audit of everyones care plans and risk assessments. She has started to put her findings together to discuss with staff and has identified improvements that need to be made. She also showed us a new format she will be introducing. This looked more organised than the current one. The manager has also identified the need to archive some old information from peoples care plans so that only current information is in the file. This will make the care plans more accessible to staff. She said she wants to make sure people who use the service and relatives are fully involved in the care planning process as they are not at the moment. The new manager is also looking at peoples health care needs to make sure they are properly monitored. She has identified people who may need their needs to be reviewed by health practitioners. For example, a person with diabetes does not currently have their blood sugar or diet monitored by a health practitioner. An appointment has been made to have this reviewed. Another person whose needs seem to be changing is to have their moving and handling needs re-assessed to make sure the current practice is safe. Peoples health care needs must be properly assessed and monitored in the future. Referral to health practitioners must be made promptly when peoples health is seen to be deteriorating. This will make sure their needs are not missed or overlooked. People we spoke to said the staff had, when needed got them medical attention. A relative said, They have always been quick off the mark in getting the doctor and keeping me informed. Records showed that health practitioners such as doctors, district nurses and chiropodists visit people who live at the home. Staff told us they had received some training in meeting peoples health needs. Care Homes for Older People Page 16 of 35 Evidence: Training such as medication administration and dementia. The new manager has identified some further training needs for staff. She is going to access training on skin care and diabetes to make sure staffs skills are up to date. The home uses a monitored dosage, pre-packed system for medication. All staff, who adminster medication have been trained to use the system. It was not clear if a record is kept in the home of medication ordered and if therefore prescriptions are checked before going to the pharmacy. This practice could lead to errors. We checked the MAR (Medication Administration Record) sheets. Medication received in to the home was recorded properly and in the main there were no errors in medication administration. Any handwritten entries on the MAR sheets had been signed by two people to reduce the risk of errors occurring. We looked at the controlled drugs register and found there to be errors in this. One persons medication had not been properly accounted for in the register, however, the MAR sheet showed it had been given. There was also other medication, for people who had moved on from the home or passed away, listed in the controlled drugs register that was not on the premises. The returned medication record did not show whether this medication was returned to the pharmacy. The records for medication returns were not well organised. The new manager agreed to make sure these records were better organised in the future to make sure medication could be properly audited. The manager also agreed to investigate the discrepancies with the controlled drugs register and forward a report to the CSCI within 7 days. Care Homes for Older People Page 17 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall,people who use the service have an increased range of activity and occupation available to them. This means they are not as bored as they have been in the past. Menus in the home provide people with a varied and healthy diet. Evidence: People who live at the home said there had been a little more to do recently. Comments included: A bit more going off lately We have played bingo and the big card game However, relatives visiting the home said they thought there wasnt enough for people to do. One said, On the whole things are alright but there is a lack of activity, not much going on. People said they enjoyed watching the new plasma screen television in the lounge. Some people said they enjoyed the Church of England service that takes place monthly Care Homes for Older People Page 18 of 35 Evidence: in the home. Staff said they had been encouraged to organise more activity recently. On the day of the visit people were watching television during the morning and chatting. Some people looked bored and were falling asleep during this time. The layout of the chairs in the large lounge does not encourage conversation or socialisation. People are sat quite a distance from each other with the chairs placed around the edge of the room. The new manager said she had identified this and would want to make the room more open to socialising for people. A game of giant dice was offerred to people in the afternoon. A number of people took part in this and from the laughter and conversation of people they clearly enjoyed themselves. A list of activities has been drawn up with ideas for staff and people who use the service. Most of these activities have not yet been offerred or organised. The new manager is aware of the need to draw up a programme of regular activity and guide staff to organise this. New activities have been introduced since the new managers arrival. These have included foot spas and pamper sessions. The manager is also encouraging staff to record activity so that she can monitor and evaluate its success. There have been monthly outings to a local methodist church luncheon club. The manager is also looking to book transport for a trip to the Leeds Christmas lights as people who use the service have asked for this. Staffing levels have been reviewed and increased to make sure there are enough staff on duty to provide activity or just sit and chat with people. Staff said this was now better and they felt they had more time recently to organise and join in with activity. We observed staff having a sit down and a chat with people during the day. Staff have also recently completed a training course on providing activity for people with dementia and memory loss. They said they enjoyed this and learnt a lot. Comments included: Made me realise how important just chatting to people is Reminiscence is very important, good to get people talking about things they remember from the past We used drawing to help people remember things Activity with a bit of exercise involved is good for people, like the giant dice Care Homes for Older People Page 19 of 35 Evidence: Visitors to the home said they were always made to feel welcome and offerred refreshments at their visits. One said, I am treated as part of the team. Another person said they wished there was a small room where people could entertain their visitors and have a bit more privacy. People said the pace of life in the home suited them. They said they can get up and go to bed when they want. They said there is always plenty to eat and they could ask for drinks or snacks whenever they wanted. We saw staff gently encouraging people to be as independent as they could be. Since our last visit to the home, a residents/relatives meeting has been held. People who live at the home made suggestions for activities and changes they would like to see in the home. People said the changes had been acted on. For example, cheese and crackers have been introduced as a supper option, yoghurts are on the menu for desserts and a hands free telephone has been provided making it more accessible for people. The manager said she intends to continue these meetings on a regular basis to encourage peoples involvement in the home. People who use the service were very positive about the food at the home. Their comments included: We are well fed Nice dinners Just the job I like the new suppers, makes a nice change from toast. Menus are varied and arranged based on likes and dislikes of people who live at the home. The new manager has introduced a file for the cook to gather this information on a more formal basis. The manager has also had a meeting with the cook to introduce more choice with the main meal of the day. Staff are sensitive to the needs of people who find it difficult to eat and need help and encouragement with this. Staff sit with people helping them feel comfortable and unhurried which helps people relax and enjoy their meal. We observed the lunch time and evening meals. Food looked appetising and well presented. Care Homes for Older People Page 20 of 35 Care Homes for Older People Page 21 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are now able to express their concerns and are protected from abuse. Evidence: At our last visit to the home we were told that safeguarding training had been arranged for staff. Records showed that this training has now taken place. Staff were now able to say what action they would take if they suspected abuse, witnessed poor practice or had an allegation of abuse made to them. They were also able to describe the different types of abuse. All staff were clear on their responsibility to report abuse or allegations of abuse. Staffs comments included: Report to manager Go further afield if necessary Would go to social services if not happy with how management dealt with something I had reported Have been given the number in my induction to ring to tell people like you (CSCI) and social services. Care Homes for Older People Page 22 of 35 Evidence: We have the whistleblowing policy The new manager is familiar with the local authority safeguarding referral system. This means people are now properly protected. The home has a complaints procedure that is made available to people who use the service. People we spoke to said they would speak to the manager if they had any complaints or concerns. Relatives of people who use the service said they would have no hesitation in bringing forward any niggles or suggestions. They said they felt they would be listened to and taken seriously. We looked at the complaints book. Any complaints received have been recorded and responded to properly. The new manager said she will consider making the complaints procedure more accessible to people who use the service by looking at producing it in different formats. This will include large print, tape and a pictorial version. Care Homes for Older People Page 23 of 35 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. Overall people live in a reasonably comfortable and safe environment. Evidence: People said they were happy with the home and their room. They said: Room is ok for what you need it for Always clean, they work hard People said they thought the home would benefit from some modernisation and sprucing up. The new manager has had a meeting with the director of the home to discuss refurbishment. Many areas of the home are looking tired and worn in terms of the decor and furnishings and should be made more comfortable for people who use the service. Some areas of the home have been re-decorated or carpeted as they were seen as a priority. The new manager has identified the need to develop an on-going programme of repair and renewal in order to keep on top of things. A new system has been set up Care Homes for Older People Page 24 of 35 Evidence: for the handymen, where a book is checked daily for any repairs that need to be done. The home is clean, fresh smelling and warm enough for people. The cleaning staff clearly work hard to keep this up. Relatives of people who use the service commented on the efficiency and hard work of the cleaning staff. Some signage to help people with memory loss has been put up to help people find their way round better. This is an area that could be further developed to meet the specialist needs of people with dementia and memory loss better. There are enough bathrooms and toilets for people who use the service. The door locks on these are now fixed which makes sure peoples privacy and dignity is protected properly. The bath in one of the upstairs bathrooms has some chipped enamel. This must be replaced or repaired as people could injure themselves on it. The kitchen was clean and proper procedures were being followed to promote safe food hygiene practices. The home has separate laundry facilities to attend to peoples personal clothing. Clinical waste is properly managed and staff wear protective clothing when attending to the personal care needs of people who live at the home. Staff said they had received training in infection control and could talk confidently about the measures in place to prevent the spread of infection. They also spoke of the importance of good practice in washing their hands. Care Homes for Older People Page 25 of 35 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. In the main, staff in the home are trained, skilled and in sufficient numbers to support people who use the service and to support the smooth running of the home. Evidence: Staffing levels have been reviewed and improved since our last visit to the home. Records showed that, in the main, there are now four care staff on the morning shift and two or three on the evening shift. The manager is available Monday - Friday, too. Staff said this was better and they had more time for people through the day. They said they did not feel too rushed and had time to meet peoples needs properly. This should be kept under review to make sure peoples needs are met well at all times. People who use the service and their relatives spoke highly of the staff. They said: Carers, no problem at all, all the girls are lovely Very good, very nice Someone always comes when you want them Always seems to be enough staff around Care Homes for Older People Page 26 of 35 Evidence: Staff are great, always willing to help Staff keep on top of things well People who use the service and staff seem to get on well and have good relationships. We saw good interaction. Staff were thoughtful and sensitive to peoples needs. We looked at the recruitment processes for people working at the home. The files had the relevant information to confirm these recruitment processes were properly managed. This included application forms, references and CRB (criminal records bureau) checks. Staff confirmed their recruitment had been carried out properly. The new manager is currently advertising for an evening kitchen assistant and bank care staff to support the staff team. Staff have recently completed training in moving and handling, safeguarding adults and dementia care. The new manager is now auditing staffs training needs so that future training can be planned and resourced properly. A training plan has been developed and this will eventually show clearly who has done what training and when updates are due. Staff said they were satisfied with their training and felt it equipped them to do their job. Over half the staff team have achieved an NVQ (National Vocational Qualification) level 2 in care. Other staff are currently undertaking this training. At our last visit to the home, we were told that the home is now using Skills for Care common induction standards. The new manager could not find any records relating to this for new staff and staffs files did not show how this had been carried out. Records should be improved in this area. One staff member said the induction had been good and they had worked alongside an experienced member of staff to learn the job. Staff said they felt the atmosphere in the home was much improved lately. They said staff were working well as a team and that people were pulling together. Care Homes for Older People Page 27 of 35 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. Overall, the home is now managed better. The interests of people who use the service are seen as important to the manager and staff and are, in the main, safeguarded and respected. Evidence: We did not receive the AQAA from the acting manager of the service. This was despite being reminded of the need to do this and it being the managers responsibility. The home has a new manager. On the day of our visit, the manager had been in post for one week. She said she has an NVQ level 4 in care management and a qualification in supervisory management skills. She has already agreed, with the director of the home, to complete the registered managers award. She said she had a number of years experience in working with elderly people and has been the registered manager of a home before. The manager said she would be applying to the CSCI for registration for this home. Care Homes for Older People Page 28 of 35 Evidence: People who use the service said the new manager seemed Nice. Some relatives said she had introduced herself to them and was Friendly. Staff said they had already received good support from the new manager. Staff said they felt well supported at the home, in general. They are supervised by a senior member of staff on each shift. Some formal one to one supervision meetings have taken place. Staff said they were looking forward to having more opportunities for this type of supervision so they could discuss their role and how they are getting on. One said that the new manager had spoken to them about this. The manager spoke about the need to put some formal systems in place for peoples supervision. The manager also said she was generally looking at needs of the service and will be organising a meeting with staff to discuss proposed changes and improvements she wants to make. An annual questionnaire has in the past been sent to people who use the service and to relatives. There were no current questionnaires to look at. A suggestions box has been set up in the homes hallway with a poster inviting people to make suggestions. Meetings for relatives and people who live at the home are also to continue, giving people an opportunity to express their views. The new manager said she would be arranging for surveys to be sent to people who use the service, their relatives and health professionals such as visiting district nurses. She said these would then be analysed to see where improvements to the service could be made. The new manager said her induction was going well and that she had received Brilliant support, all been really good. She said she was expecting on-going support in her role and would be expecting monitoring visits from the provider now that the provider was not acting as manager . Some records in the home have improved. The director, when acting as manager had made a start on archiving old records and putting new records in order to make them more accessible to staff. The new manager has identified the need for further improvements to records, especially those relating to health and safety, medication (As mentioned in the health and personal care section of this report) and staff training. (As mentioned in the Staffing section of this report). The new manager had updated the environmental risk assessment file to include more up to date information on safe working practice. She told us of her plans to make sure staff are familiar with this. Care Homes for Older People Page 29 of 35 Evidence: Accident records are completed and the manager is putting a system in place to make sure these are analysed each month so that she can pick up any patterns, trends or ways of avoiding future accidents. However, the acting manager has not been notifying the CSCI of events which affect the welfare of people who use the service. This must be done in future to make sure the health, safety and welfare of people who use the service is protected properly. Weekly health and safety checks are carried out in the home. These include fire alarms, call bells, water temperatures, cleaning and maintainence. The manager has introduced a more detailed checklist for these and is making sure they are properly documented. The health and safety file showed that checks on electrical and gas safety were up to date. The home holds small amounts of money on behalf of people who use the service. Any money handed over or any financial transactions are witnessed by two people. The new manager said the system in place was safely managed but she wanted to introduce more frequent checks on receipts to improve the system. Care Homes for Older People Page 30 of 35 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 31 of 35 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 3 14 Pre-admission assessments must be carried out thoroughly and by people who are trained and skilled to do so. This will make sure that peoples needs are properly identified and are not missed or overlooked. 31/12/2008 2 8 13 Referrals to health care practitioners must be made promptly for people whose health is at risk. This will make sure peoples needs are properly met and they are properly supported with their medical needs. 31/12/2009 3 8 12 Peoples health care needs must be assessed and monitored. This will make sure that peoples needs are properly and fully met. 31/12/2009 4 9 12 Records for the return of medication no longer 24/11/2008 Care Homes for Older People Page 32 of 35 required in the home must be improved. An investigation into discrepancies with the documentation of controlled drugs must be completed. This will make sure that medication can be properly audited and any errors can be identified more easily. 5 19 23 The bath with the chipped enamel must be repaired or replaced. This will make sure it is safe and people cannot injure themselves on it. 31/01/2009 6 37 38 The CSCI must be notified of 24/11/2008 any deaths, illness, accidents or other events which affect the welfare of people who use the service. This will make sure that the health, safety and welfare of people who use the service are protected properly. 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 Work should continue on care plan and risk assessment information to make sure they are clear and give staff specific instructions on how to meet peoples care and support needs. This will make sure that peoples needs are not missed or overlooked. 2 9 The way medication is ordered should be reviewed. Sending prescriptions to the pharmacist without having first Page 33 of 35 Care Homes for Older People checked them could lead to errors being made. 3 12 The programme of activity that has been developed should be delivered to people to make sure their social and recreational needs are met. Serious consideration should be given to refurbishment in the home. This will make it more comfortable for the people who use the service. Staffs training records should be kept up to date so that it is clear who has done what training and when any updates are due. Work should continue on keeping the homes records in good order. This will help the smooth running of the home. 4 19 5 30 6 37 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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