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Inspection on 04/02/09 for Brownscombe House Nursing And Residential Home

Also see our care home review for Brownscombe House Nursing And Residential Home for more information

This inspection was carried out on 4th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Visitors are welcomed to the home to maintain contact with their friends and family. Residnts confirmed that the home provides a healthy and balanced diet. The home maintains and promotes good working partnerships with health care professionals. Residents live in a well maintained environment which is homely and comfortable.

What has improved since the last inspection?

The admission and assessment procedures continue to be reviewed in order to ensure that peoples care and support needs are appropriately identified prior to moving into the home. A planned review of all residents care plans and risk assessments has been implemented to ensure that peoples needs are identified and met. Medication procedures have been reviewed and all registered nurses have received medication training to ensure the safety and well being of residents receving prescribed medicines. There is a raised awareness of peoples rights to protection, dignity, respect, choice, lifestyle preference and ethnic and cultural identity. The daily recording procedures have been reviewed to enable the care staff to have more accountability and involvement in report writing as they are the primary care givers. People are consulted about their choice of social activities and the programme of activities provided by the home is available for people to see. People are more fully protected by the homes complaints and safeguarding adults procedures. The planned redecoration programme which has included the purchase of new bedroom furnishings has been completed to benefit the comfort and safety of all people in the home. Plans have also been discussed for the improvement of some bedroom facilities which would include en-suite facilities for the comfort and benefit of residents. The control of infection in the home has significantly improved to ensure peoples safety, health and welfare is promoted. Recruitment practices to ensure the safety and protection of residents in the home have been improved. Substances which are hazardous are stored in compliance with the control of substances hazardous to health COSHH legislation in order to ensure the safety andwelfare of residents. Records of food temperatures and storage of food has improved in order to ensure residents health and safety. Unannounced visits by senior management in order to form an opinion of the standard of care provided by the home home have significantly improved and the written report is thorough in reporting the detailing the conduct of the home. Arrangements have been made for the robust management of staff including supervision in order to ensure staff are well supported and work as a cohesive team. All events which affect the well being and welfare of residents are reported to the commission without delay. The overall management of the home has significantly improved which has had a positive effect in improving the quality of peoples daily lives and the care and support they receive.

What the care home could do better:

The care planning, risk assessment and medication processes in the home have been improved to benefit residents yet need to be further strengthenned to ensure that residents needs are consistently met. All mandatory training must be updated in order to ensure that the homes staff are suitably trained and competent in their duties.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Brownscombe House Nursing And Residential Home Hindhead Road Haslemere Surrey GU27 3PL     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: Suzanne Magnier     Date: 0 4 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Brownscombe House Nursing And Residential Home Hindhead Road Haslemere Surrey GU27 3PL 01428643528 01428643616 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr L K Hasham care home 36 Number of places (if applicable): Under 65 Over 65 3 36 1 dementia old age, not falling within any other category sensory impairment Additional conditions: 0 0 0 One (1) named service user within the category SI/E (Sensory Impairment - over 65 years of age) may be accommodated. One (1) named service user within the category SI/E (Sensory Impairment - over 65 years of age) may be accommodated. Up to 25 beds may be used for the provision of nursing care for elderly people from the age of 60 years Date of last inspection Brief description of the care home Brownscombe House is a care home registered to provide nursing care for up to 36 older people, over 60 years of age. The home is owned and run by Care Homes of Distinction who also run similar establishments in Surrey. Brownscombe House is a large building in Haslemere that provides accommodation over three floors, which can be accessed by a lift. There is ample parking available to Care Homes for Older People Page 4 of 29 Brief description of the care home the front of the house. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The last inspection on this service was completed on the 18th August 2008. This inspection of the care home was an Announced Key Inspection in order that the senior management team would be present to represent the service. Ms S Magnier Regulation Inspector carried out the inspection and arrived at the service at 08.00 and was in the home for nine and a half hours. It was a thorough look at how well the service was meeting the key National Minimum Standards for Care Homes for Older People and has in this report made judgements about the standard of the service. For the purpose of the report the individuals using the service are referred to as residents. Care Homes for Older People Page 6 of 29 The CSCI Inspecting for Better Lives involves an Annual Quality Assurance Assessment to be completed by the service, which includes information from a variety of sources. This document was received following the previous inspection in August 2008 and reference to the AQAA was made whilst undertaking the key inspection and developing the report. The commission have received responses to questionaires sent prior to the inspection some of which have been included within the report. The information contained in this report was gathered from observation by the inspector and speaking with a number of residents and care staff. A full tour of the premises was undertaken and documents sampled during the inspection included some residents care plans, daily records and risk assessments, medication procedures, health and safety records, staff training and recruitment records, and some of the homes policies and procedures. The final part of the inspection was spent giving feedback to the responsible indivdual and senior service representatives about the findings of the visit. One safeguarding vulnerable adult referral remains unconcluded. The homes representaives advised that no complaints have been received by the home and no complainant has contacted the commission regarding the home. From the evidence seen by the inspector it is considered that the home would be more able to fully provide a service to meet the needs of clients who have diverse religious, racial or cultural needs. The commission have noted that all requirements made during the last inspection in August 2008 have been complied with and the homes owners, directors and senior management have worked closely with the commission in order to improve the services to the older people receiving care and accomodation at the home. What the care home does well: What has improved since the last inspection? The admission and assessment procedures continue to be reviewed in order to ensure that peoples care and support needs are appropriately identified prior to moving into the home. A planned review of all residents care plans and risk assessments has been implemented to ensure that peoples needs are identified and met. Medication procedures have been reviewed and all registered nurses have received medication training to ensure the safety and well being of residents receving prescribed medicines. There is a raised awareness of peoples rights to protection, dignity, respect, choice, lifestyle preference and ethnic and cultural identity. The daily recording procedures have been reviewed to enable the care staff to have more accountability and involvement in report writing as they are the primary care givers. People are consulted about their choice of social activities and the programme of activities provided by the home is available for people to see. People are more fully protected by the homes complaints and safeguarding adults procedures. The planned redecoration programme which has included the purchase of new bedroom furnishings has been completed to benefit the comfort and safety of all people in the home. Plans have also been discussed for the improvement of some bedroom facilities which would include en-suite facilities for the comfort and benefit of residents. The control of infection in the home has significantly improved to ensure peoples safety, health and welfare is promoted. Recruitment practices to ensure the safety and protection of residents in the home have been improved. Substances which are hazardous are stored in compliance with the control of substances hazardous to health COSHH legislation in order to ensure the safety and Care Homes for Older People Page 8 of 29 welfare of residents. Records of food temperatures and storage of food has improved in order to ensure residents health and safety. Unannounced visits by senior management in order to form an opinion of the standard of care provided by the home home have significantly improved and the written report is thorough in reporting the detailing the conduct of the home. Arrangements have been made for the robust management of staff including supervision in order to ensure staff are well supported and work as a cohesive team. All events which affect the well being and welfare of residents are reported to the commission without delay. The overall management of the home has significantly improved which has had a positive effect in improving the quality of peoples daily lives and the care and support they receive. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission and assessment procedures ensure that residents needs are appropriately identified prior to moving into the home yet need to be more consistenly implemented. Evidence: An individuals care plan who had been recently admitted to the home was sampled and evidenced that an assessment had been made by a qualified person to ensure that the needs of the resident could be met by the homes staff. Following the previous inspection the homes senior management has been revised and the newly appointed general manager has, through auditing the service,identified and noted that admission assessments and documentation of intial care plans and risk assessement are not always consistently recorded. These shortfalls having been identified will be addressed and kept under review by the homes day to day manager. Care Homes for Older People Page 11 of 29 Evidence: The home continues to offer respite care for individuals. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning, risk assessment and medication processes in the home have been improved to benefit residents yet need to be further strengthenned to ensure that residents needs are consistently met. Residents rights to protection, dignity and respect are promoted at all times. Evidence: Two care care plans were sampled and it was evident that one of the residents had had their care plan developed from the pre assessment documentation which included some of the persons care and support needs. The other care plan was related to an individual who had been a resident in the home for some while. Following the previous inspection the commissions representatives were shown a new person centred style care plan which the owner and director advised would be introduced at the home in order to benefit the residents and staff providing the residents care. This was confirmed during the inspection and the home currently have a system where a kardex record and a person centred care plan are both used to Care Homes for Older People Page 13 of 29 Evidence: record the individuals holistic care and support needs. The plans seen were well written to allow the reader to gain an overview of the persons medical and personal care needs. The care plans have additionally improved to more fully document information about the individuals maintainance of their daily living skills, their likes and dislikes, lifestyle choices for example what time they like to get up and retire at night, their previous occupation, how they like to be addressed, their spiritual, ethnicity and cultural needs and choice regarding gender specific care. The homes management and staff have an action plan to continue to work towards ensuring that all residents care plans accurately reflect the needs of the resident in respect of their health, social and behavioural needs and the care plans will be audited by the homes manager. There was evidence to support that the new management team are working closely with all grades of staff in order to improve staff practice and are continuing to ensure that residents or their representatives, where able, are being consulted about the formation of their care plan. One of the two care plans sampled had been signed by the resident as they were able to do so. The kardex system contained records relating to the assessments of hazards in peoples daily lives which included risk assessments for the individuals nutrition, mobility, use of bed rails, moving and handling, medication, eating and drinking, and receiving personal care. Records were sampled for individuals that were receiving care whilst in bed. It was noted that records were kept of residents fluid intake and output, records documented when the person had been supported to change their position whilst in bed in order to ensure they were kept comfortable and to check their pressure areas. The senior management are undertaking an audit of residents care who are currently being supported in bed to ensure that the reasons for them being supported in this way is clearly documented within the individuals care plan and risk assessments completed to ensure the care represents good practice. It was observed that those residents in their bedrooms had their call bells available to them in order that they could ring for staff assistance if needed. There continues to be documented evidence that appropriate health care appointments including visits by the General Practitioner had been attended and through sampling care plans and observation it was evident that the homes staff are promoting and maintaining good working partnerships with health care professionals. Health care visits to the home include visits from the opticians,continence advisors, dentists and chiropodists to ensure that residents health care needs continue to be met. Care Homes for Older People Page 14 of 29 Evidence: One healthcare professionals written comments received by the commission stated that they felt that the staff had varying skills and it would depend on the staff member as to whether they have the right skills and experience to support a residents social and health care needs. Another survey stated that the staff inform the surgery promptly if they are concerned about any residents and staff are polite and helpful. Following the previous inspection the homes management have reviewed and improved the procedures of recording the care and support provided by staff within the daily records. It was confirmed that the care staff complete the daily records and have been offered more autonomy and accountablity as the primary care givers in this process. The commission have been given assurances that the overall statndard of care plans will be improved by the day to day manager and all staff members, including the registered nurses will be given support and training to improve the current care planning system for the benefit of residents receiving care and support at the home. The home has a medication policy and procedure in place and continues to use a monitored dosage system. The inspector was advised that there had been concerns identified during a recent audit of the homes medication procedures and as a result the homes senior managers had arranged to meet with the homes registered nurses, general practioners and the local pharmacy from whom the homes medications are dispensed in order that the concerns be rectified. Following the inspection the commission were informed that the senior management team had met with the prescribing general practitioner, and practice manager and they have agreed a new working practice regarding some of the medication procedures. A meeting has been arranged with the dispensing Pharmacist regarding the ordering, delivery and disposal of medicines. All registered nurses have been given up to date medication training by the dispensing pharmacist in order to promote safe practice and ensure residents safety and well being. Performance management of the registered nurses has been improved. Throughout the day the inspector observed that residents were addressed in a polite and courteous way by all staff. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples rights of choice about their daily routines and the range of activities offered is promoted. Visitors are welcomed to the home to maintain contact with their family members and friends. The home provides a healthy and balanced diet and improvemnts to the dining experience have been implemented. Evidence: The home has an activities organiser who, with the support of the senior management has revised the daily activities plan which was displayed in the homes main hallway and lounge area in large print so residents and other people in the home could see what social gatherings and meaningful activities were available during the days of the week. Several residents spoken with said they enjoyed the activities and especially the new large screen television. An area within the small lounge had been designated as a library area and it was observed that there were board games, quizzes and magazines available for residents to look at. During the inspection five residents were observed to be taking part in gentle exercises and playing skittles which they all seemed to enjoy. One senior manager advised that the home have started to have informal resident and relatives meetings which had proved to be very beneficial to all parties. A Christmas Care Homes for Older People Page 16 of 29 Evidence: gathering and fundraising event had been held at the home which was a huge success and the staff are organising a farm visit in the summer months which some residents spoke to the inspector about. There was evidence that a mobile library visits the home and that residents spiritual needs are addressed by the opportunity to take part in a communion service held at the home. The managers advised that other demoninational services would be sought if a resident requested this. Several residents family and friends visited during the inspection and it was observed that residents could enjoy their company in the lounge or in the privacy of their own rooms. It was observed that residnts visitors had open and professional working relations with staff and managers in the home during the inspection. It was observed that staff were at hand to talk with residents and that the interaction with residents had improved and was genuine to reflect good personal and professional relationships. Some residents were seen to move freely around the home and the atmosphere in the home was was quiet and relaxed. There was evidence to support that residents receive visits by a hairdresser and several residents said they enjoyed having thier hair dressed as it made them feel better. The home is planning to have a separate hairdressing room, which will be equipped to offer comfort and safety to residents. There has been a great improvement in the presentation of the conservatory dining room which residents said it made them feel like they were eating in a restaurant. Each of the small tables had been set with coloured tablecloths and matching napkins. Condiments and crockery were available and the days menu was on each table in large print which the inspector observed was a talking point for residents. The meal served looked tastefully presented and residents stated that the food was good and they enjoyed their meals. The midday meal was observed by the inspector and the new day to day manager and it was observed that some residents who required more support were not attended to by staff for example supporting people to sit up safetly in their wheelchairs and not offered support with cutlery. These observations were noted by the manager who took swift action during and following the meal time to ensure the safety and well being of residents and met with staff to discuss how improvements could be made. Following the inspection the homes senior managers have informed the commission that a risk assessment has been completed regarding the dining room and the layout of the dining room has been altered to enable more accessible entry of the portable hoist should a resident require intervention. The residents seating arrangements have been re assessed and staff are working together in the dining area. People who require Care Homes for Older People Page 17 of 29 Evidence: assistance or support with their meals are being accomodated to have their meals prior to the main serving in order that they can have individual support from staff. Residents who were not able to support themselves with meals had meals in their bedrooms with the support from staff. All residents looked well groomed and wore protective clothing at the meal time. Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are protected by the homes complaints and safeguarding adults procedures. Evidence: The home has an established complaints procedure. The senior managers confirmed that no complaints had been received by the home. Residents told the inspector that they would talk to staff or their family members if they had any concerns or were unhappy about the home. The security of the home has improved with the installation of a video intercom system which ensures residents safety and security of vetting people visiting the home. Four staff training records evidenced that staff had attended safeguarding vulnerable adults training. The home has a whistle blowing procedure in order that staff are aware of their duty of care to report any safeguarding incidents. Staff files sampled evidenced that Criminal Record Bureaux checks and Protection of Vulnerable Adult checks are carried out on all new staff. The home has a copy of the Surrey County Council Multi-agency Procedures for Safeguarding Vulnerable Adults 2008. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes furnishings are of a high standard. The physical layout of the home meets the current residents mobility needs. The control of the spread of infection in the home is robust and the home was clean throughout. Evidence: A senior manager escorted the inspector of a tour of the premises. The planned redecoration programme had been completed which included decoration of hallways, communal areas and some bedrooms and bathrooms. The home continues to provide pleasant surroundings for the residents with suitable furniture and soft furnishings throughout the home for residents to use. It was observed that new furnishings including profiling beds and bedroom furnishings had been purchased by the home. The home was clean throughout. Significant improvements have been made with the purchase of equipment to improve the arrangements of control of infection in the home to ensure the safety and welfare of all people in the home. Sluice areas in the home were viewed as clean and orderly. Staff were observed to wear protective clothing, including aprons and gloves and hand washing facilities were available throughout the home. The home continues to have a planned installation for electronic door closures Care Homes for Older People Page 20 of 29 Evidence: throughout the home but were unsure as to the dates of installation. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are in sufficient numbers to support the people who use the service. A system for the induction, and development of staff is being strengthenned to ensure residents needs are appropriatly met. Safe recruitment and vetting of staff protect the welfare and safety of residents. Evidence: The homes management have identified that there are shortfalls within the staff group and following the employment of the new general manager and day to day manager of the home an action plan has been developed to support all grades of staff in their roles and responsibilities in the home. Several staff on duty during the inspection had been working at the home from a local agency as the current staffing levels are not a full compliment. The senior managers advised that they are actively recruiting all grades of staff which includes volunteers and bank staff. Staff spoken with said they felt there were enough staff and during the day of the inspection the staff were not rushing about and the pace of the home was relaxed. Written comments received by the commission from staff about their views of the home stated we provided a good service to residents, we could improve on client Care Homes for Older People Page 22 of 29 Evidence: entertainment and add an extra cleaner. We help and assist individuals personal needs. The service could provide more training opportunities for staff to give them more knowledge in coping with the increasing number of service users with Dementia. The home provides a nice warm friendly environment for the service users and staff and caters very well to their needs. Discussion with the senior managers about the current staffing of the home identified that the new managers were aware that there needed to be increased close working with all grades of staff to build a cohesive team, improve communication and confidence of staff and conduct weekly team meetings. It was evident during the inspection that the day to day managers ethos was to work closely with staff and mentor good practice. Following the inspection the commission were supplied with an action plan which detailed the ongoing support and supervision plan for staff which would also include identification of training needs. Four staff files were sampled files and evidenced that the homes management have improved the vetting practices concerning the recruitment of staff in order to ensure the safety and protection of residents in the home. The managers reaffirmed that the home is committed to the ongoing training and development of staff yet two staff files detailed that the staff had not received basic food hygiene training and there was no evidence at the time of the inspection that the courses had been booked for the staff to attend. It has been required that all staff must receive statutory training in order to ensure they have the skills and are suitably trained and competent in their duties. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home has been strengthenned and the home is run in the best interests of the residents. The views and opinions of all people associated with the home are taken into account. Peoples general safety and welfare is promoted. Evidence: As previously documented the management of the home has been reviewed and the inspection was undertaken with three senior managers. There has been a significant improvement in the management of the home and all the previous requirements made by the CSCI have been met in order to promote the safety and welfare of all people in the home. A day to day manager has been appointed and the CSCI were advised that a managers appilcation to register with the commission will be submitted in due course. Care Homes for Older People Page 24 of 29 Evidence: The senior managers, had since the previous inspection, held an open day for residents and their relatives, family and friends which was an opportunity for the visitors to the home to raise any questions, concerns and suggestions about the home to the senior managers. One manager told the inspector that this event had been very helpful and the feedback constructive. It was confirmed that relatives meetings would continue to be held and will a positive part of the quality assurance system of the home. One written comment received by the commission from a resident stated this is a very nice home to live in. Clean, cosy and very friendly. There has been significant improvement in the management of health and safety in the home. All hazardous substances were stored in compliance with the control of substances hazardous to health COSHH legislation in order to ensure the safety and welfare of residents. The homes fridge, freezer and pantry were well stocked. Fresh fruit and vegetables were available for residents. Records of food temperatures, storage of food in the fridge and pantry was in compliance with food hygiene standards to ensure residents health and safety. The homes fire procedures sampled confirmed that records were kept of weekly fire tests and equipment checks. A recent Regulation 26 record of an unannounced visit by the newly appointed general manager was sampled and it was noted that the record was thorough in assessing the quality of the service and any shortfall identified would be noted by the owners and director in order that appropriate action would be taken to rectify the shortfalls. No residents monies are kept by the home on behalf of the resident and residents are encouraged to keep their own money. Residents are invoiced for the services of the hairdresser and aromatherapist. A certificate of Insurance was sampled and was confirmed as a current document. Following the previous inspection the home have identified that the recording of accident and incident records needed to be strengthenned and it has been noted that the CSCI are more reliably informed of events which affect the well being and welfare of residents. As recorded throughout the report there has been a significant improvement in the management of the home which has had a positive affect in improving the quality of peoples daily lives and the care and support they receive. Care Homes for Older People Page 25 of 29 Evidence: Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 The care planning, risk 25/05/2009 assessment and medication processes in the home need to be further strengthenned. To ensure that residents needs are consistently met. 2 30 18 Arrangements must be made that all staff receive statutory training. In order to ensure they have the skills and are suitably trained and competent in their duties. 27/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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