Inspection on 05/11/08 for Buckland Court

This inspection was carried out on 5th November 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Buckland Court 15/11/06

Buckland Court 15/02/06

Buckland Court 23/08/05

Buckland Court 21/02/05

Buckland Court 04/11/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Buckland Court Southmill Road Amesbury Salisbury Wiltshire SP4 7HR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sally Walker     Date: 0 5 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 34 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 34 Information about the care home Name of care home: Address: Buckland Court Southmill Road Amesbury Salisbury Wiltshire SP4 7HR 01980623506 01980626638 manager.bucklandcourt@osjctwilts.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Tania Arnold Type of registration: Number of places registered: The Orders Of St John Care Trust care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: No more than 18 service users aged 65 years and over with dementia may be accommodated in the home at any one time The maximum number of service users who may be accommodated in the home at any one time is 50 Date of last inspection Brief description of the care home Buckland Court is a single storey care home purpose built by the local authority nearly 30 years ago. It is registered to The Orders of St John Care Trust to provide care for a total of 50 older people, 18 of whom may have a dementia. All accommodation is in single rooms with wash hand basins, most rooms being somewhat smaller than standard. There is one room for respite care and a separate day care facility for up to 20 older people. The Orders of St John Care Trust were registered in 1999. Ms Tania Care Homes for Older People Page 4 of 34 Over 65 18 50 0 0 Brief description of the care home Arnold is the registered manager. The staffing rota provided for a care leader and 5 care staff during the morning, a care leader and 4 care staff during the afternoon and evening. At night there are 3 waking night staff. Housekeepers, chefs and kitchen assistants are also employed. The fees for the home were between £370.57 and £486.39. The fee did not cover newspapers, chiropody, hair dressing, toiletries or clothing. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place on 5th November 2008 between 8.55am and 5.40pm. Ms Tania Arnold was present during the inspection. We spoke with people who use the service and staff. We looked at care plans, daily reports, medication, activities, complaints, staff records, the rotas and the arrangements for safeguarding peoples money held in the safe. We also made a tour of the building. We asked Ms Arnold to fill out the AQAA Annual Quality Assurance Assessment. It was filled out in full and returned on time. As part of the inspection process we sent survey forms to the home for people who use the service, staff and healthcare professionals to tell us about the service. Comments Care Homes for Older People Page 6 of 34 can be found in the relevant section of this report. The last Key inspection was on 15th November 2006. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the care home does well: What has improved since the last inspection? What they could do better: The pre-admission format should provide sufficient space for the assessor to expand upon specific individual needs of the person being assessed. Care Homes for Older People Page 8 of 34 Care planning documentation should be reviewed and rationalised, to avoid duplication of information. The nutritional risk assessment outcome number should automatically feed into the pressure damage risk assessment. Confirmation must be sought from the Medicines and Healthcare products Regulatory Agency that the blood glucose device used for more than one person, confirms to the information in the Medical Device Alert 2006, 066. Staff should ensure that meals taken to people in their bedrooms are covered. Consideration should be given to ways of making people aware that there is a complaints procedure. Support staff must be allocated on a Sunday evening so that care staff do not have to serve the evening meal and wash up. The organisation should produce a policy on provision of intimate care by staff of a different gender. This should state boundaries of roles for the protection of staff as well as the people who use the service. 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 34 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 34 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. Peoples needs are fully assessed before decisions are made as to whether the home can meet those assessed needs. The home does not provide intermediate care. Evidence: Some action has been taken to address the requirement we made that pre-admission assessments capture and record all of the assessed needs of people considering using the service. We said that this must include information about those people who may not be able to say what their needs are. We also said that the form should record the source of the information and be signed and dated. The organisations new preadmission format was being used. The assessment is in the format of tick boxes, with little space for the assessor to write. The assessment does seek peoples social history as well as their medical history. If people are unable to express their needs, the assessor will discuss their needs with their families and other supporters. Care Homes for Older People Page 11 of 34 Evidence: Action has been taken to address the requirement we made that if people have a meal out as part of an activity, they do not pay for that part of the meal that they have already paid for as part of the fee. We said that the statement of purpose, service users guide and contract must state those items covered by the fees and those items that people will have to pay for. We saw that the statement of purpose had been updated to include these details. We were told that the activity budget covers meals out. In a survey form one of the people who use the service told us I knew the care was good. My contract is kept with my records. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning documentation continues to improve. Generally people have all their care and support needs set out in their care plan. Rationalisation of the plans should avoid some duplication. Healthcare needs are being met. People can administer their own medication following a risk assessment. People make choices about who delivers their intimate personal care. Evidence: The home had implemented the organisations new care planning documentation. It was clear that staff had spent a great deal of time transferring information from the old format. Ms Arnold told us that the home had a care planning champion who was regularly reviewing the format. We saw that there were improvements in the recording with more detail and guidance to staff on how needs are met and monitored. We saw that people were asked at the point of admission about their preference of gender of the care staff providing intimate personal care. People had also signed their care plans. There was information in one care plan detailing how staff should care for the persons medical condition. The guidance to staff about their intervention was very detailed. Care Homes for Older People Page 13 of 34 Evidence: There was nothing in the care plan about whether the person knew they had the condition. We noted that there was much duplication. One example, was a care plan for catheter care duplicated in a separate care plan for continence management. Another example was a care plan for diabetes and another separate one for diet, which had similar information. There was good information about symptoms and when to contact the persons GP. The same person had two different care plans, in relation to their mental health and emotional wellbeing. We said that statements such as offer reassurance on low and anxious days should be clarified so that staff know exactly what they should be doing to support this person. Daily reports were detailed with good descriptions of how people had spent their day, how they were feeling and staff interventions. The descriptions related to guidance on how their care should be met and monitored. It was clear from these records that staff discussed their care with people who use the service. There was also some evidence of support with day to day decision making. In the AQAA Ms Arnold told us that peoples needs are fully respected in matters of religion, culture, race or ethnic origin, sexuality or sexual orientation, political affiliation, marital status or disability. She also said we have introduced a dementia care champion, who is working closely with residents and relatives to further develop life histories. This reassures relatives that we care and recognise that a persons life experience and history, makes them who they are today. One of the people we spoke with told us they are very good if youve got anything wrong with you, they get the doctor out. Action has been taken to address the requirement we made that each person who uses the service has their risk of developing pressure damage assessed. All care plans had risk assessments with regard to peoples risk of developing pressure damage. There were pre-printed generic documents with guidance on how to manage and monitor risks. There was information on encouraging people at risk to keep mobile and other preventative measures. These assessments were regularly reviewed and revised when necessary. Ms Arnold told us that the falls clinic had carried out an audit in the home. Peoples nutritional status was also assessed. The format outcome number did not correlate to the nutritional part of the pressure damage risk assessment. We saw pressure relieving equipment in place. We also saw details of different pressure relieving equipment in peoples care plans. Other risks were identified in peoples care plans, for example, bathing, slipping and tripping, moving and handling and self medication. Care Homes for Older People Page 14 of 34 Evidence: Action has been taken to address the requirement we made that tissue viability training is carried out by a suitably qualified person. The records showed that tissue viability training had taken place since the last inspection two years previously. The Tissue Viability Specialist Nurse had provided a training session the previous day and planned a further session for the remaining care staff. Two of the people who use the service told us that they administered their own medication. They said they had a locked cupboard in their bedrooms to store the medication. Staff would re-order their medication. Another person told us that staff applied their prescribed topical cream at the right time. Another person told us that staff were on time to administer their eye drops. Someone else told us they had a form in their bedroom which staff had to sign when they applied their topical cream. One of the care leaders showed us the arrangements for administration of medication. They told us that new staff would not administer medication until they had completed their probationary period and their competency had been assessed. Continued competency of all staff was monitored by the care leaders. The home operates a monitored dosage system put up by the supplying pharmacist. Administration records were being properly maintained. Information about different medication or allergies was recorded. Medication is generally given at mealtimes by one member of staff. We saw that staff asked people if they needed their prescribed pain killers. We saw that some people had duplicated care plans about their medication. One persons care plan stated administers the majority of medication but there was no detail as to which medications they took. There was another care plan entitled self medication, which stated that they took controlled medication. Again there was no detail as to what this medication was. There was information from their GP agreeing that they could continue to take controlled medication themselves. The community pharmacist had provided training on the side effects of some medication. Action has been taken to address the requirement we made that where a prescriber gives verbal instruction to crush medication and place on food, that either an equivalent liquid or soluble medication is requested or written confirmation of this unorthodox method of administration must be obtained. Action has been taken to address the good practice recommendation we made that details for administration of specific medication should be recorded in care plans. We Care Homes for Older People Page 15 of 34 Evidence: saw that body maps were on file for specific applications of topical creams. Pre-printed documents were in some peoples care plans for self administration, administration of medication with specific prescribing instructions and medication that is to be taken only when required. We saw details of guidance to staff on what prompted administration of these medications. There was also a generic guidance format for the administration of antibiotics. Action has been taken to address the good practice recommendation we made that the term mental health should be avoided in care plans, as the home is not registered for this category of registration. We noted that some people who had their blood glucose tested had their own prescribed devices. We saw that the home was using one device for a number of other people when testing their blood. We have advised the home to check with the Medicines and Healthcare products Regulatory Agency, to establish whether this device conforms to the information in the Medical Device Alert 2006, 066. Named staff had been trained to monitor blood glucose levels. Those people with a diagnosis of diabetes had care plans identifying parameters for healthy blood glucose levels. There were also details about what should happen if test results were outside those parameters. We were told that the district nurses administered any insulin injections. We saw that staff had taken time to ensure that people are well groomed, had clean teeth and spectacles. In a survey form one of the people who uses the service told us If I need to go to hospital a member of staff will always give me extra support. In a survey form one of the relatives told us Staff here know of his needs and always discus these with me. Staff call the doctor when they feel it necessary to do so and inform me afterwards of the outcome. This gives me total peace of mind knowing my father is so well cared for. Two GPs responded to our surveys. One said They liaise with the surgery very well. Follow advice given. Participates in decision-making. There are times when I feel clients are inappropriately placed - this puts strain on all involved. The staff all seem to be appropriately trained. They delegate appropriately. I think Buckland Court is fantastic. Well run and organised. Good atmosphere and content residents. The other GP said I am very impressed by the individual care residents receive. Also the staff are dedicated, enthusiastic and cheerful. Obviously I visit a variety of care/nursing homes. Buckland Court has consistently been one of the best. Care Homes for Older People Page 16 of 34 Care Homes for Older People Page 17 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People make choices about their daily lives. Some extra staffing hours are provided for activities. People enjoy a range of group activities both at the home and in the locality. People are encouraged to maintain links with family. People enjoy the range and quality of meals provided. Evidence: Action has been taken to address the good practice recommendation we made that consideration should be given to providing extra staffing hours, for what is described in the activity programme. An extra seven hours had been allocated. The person responsible for providing activities keeps a daily log for each person. This details any activities that they have been involved in. They told us that they share a minibus with another home and have at least one trip out each week. People had recently been to a shopping village, to a garden centre and a drive to the local valleys. The activities person told us they regularly held quiz nights with nibbles and sherry. They had organised a fund raising bazaar for the following weekend. Two staff regularly took five people to a club run by Wiltshire Blind Association. Tape recordings of the local newspaper were available to people each week. Care Homes for Older People Page 18 of 34 Evidence: One of the people we spoke with told us there was all sorts of things to go to. Another person told us they were a smoker and explained where the designated smoking room was. They told us that they were offered a wheelchair if they needed to go anywhere in the home and could not face walking the distance. One of the staff told us that they planned to have film nights with a glass of sherry. On the afternoon of the inspection, part of the dining room had been transferred to look like a cafe. People invited their families for a cup of coffee and cake. There were photographs of different events and celebrations posted on notice boards around the home, the most recent being Halloween. The activities person had a range of age appropriate material for activities. Some of these had been purchased and some they had made themselves. They told us they had access to a budget for any activities. The home has a large day service and people from the home can also attend their activity programme. All of the sitting rooms had large televisions so they were visible to most people. One of the people we spoke with told us they went to the quizzes. They told us that competitions were held between the organisations homes. They said that the last competition was held at a home that was two hours away. They said they did not go because they could not cope with the journey. One of the people who we spoke with told us that they always had a very good present at Christmas. They said they were always asked what they would like. They said they enjoyed Christmas at the home. Another person told us they liked pasta dishes, which they had quite often. Someone else told us that their relatives could visit at any time and were always offered refreshments when they were taken to peoples bedrooms. Another person told us that staff respected their privacy when giving personal care, or using their commode. They told us they liked to spend time in their room but would go to the dining room for meals. They said they had a television with subtitles, had magazines and library books delivered. They told us there were lots of activities and staff always asked them if they wanted to join in. They said they liked the meals, particularly breakfast. They said there were always two choices for lunch, but not when there was a roast. They told us they did not like having a bath but their keyworker gave their feet regular washes. They said their keyworker always asked them if they wanted a bath. The home operates a four week menu. This was displayed in a folder in one of the Care Homes for Older People Page 19 of 34 Evidence: serveries. Ms Arnold showed us the laminated sheets she had prepared to put on each of the dining room tables. The menu for each different meal was written on a blackboard by the servery. Lunch was roast pork with two vegetables and roast potatoes. Alternatives were available and listed as omelette, soup, scrambled or boiled egg, salad and sandwiches. Special diets were available for people who were managing their weight or for those managing diabetes. Fresh fruit was available for people to help themselves. We observed lunch in the dining room. Meals were served table by table. Those people who needed support with eating or to be fed, had good support from staff. They were offered the food at their own pace. Staff also chatted with the person during their meal. We saw two meals being delivered to people in their room without a cover. One of the people we spoke with told us that the meals were quite good for the size of the establishment. In a survey form one of the people who uses the service told us I like to take part in activities, they are fun and enjoyable. I enjoy making things, socialising, having a laugh. Joining the Tuesday Club outings and the day centre. My days go by quickly as I can do lots of things if I choose. I am very happy here. This is my home and where I want to be. The kitchen staff will always make me something else when needed, as I really dont like roast dinners. Care Homes for Older People Page 20 of 34 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. Systems are in place for people and others to make complaints about the service. However some people did not know of the complaints procedure. Complaints are taken seriously. Staff know how to report any concerns about abuse to the local safeguarding adults procedure. Evidence: The organisations complaints procedure was displayed on the notice boards. There was also information about how to access an Independent Mental Capacity Advocate. One of the people we spoke with told us that they did not know about the complaints procedure. They went on to say that they would take their complaints to two staff who they named. They then described two recent events which they had brought to staff and how they had been dealt with to their satisfaction. They described the explanation they had been given for the events. They said if you complain something always gets done. All the other people we spoke with were not aware that the home had a complaints procedure. However they all described taking their concerns either to one of the care leaders, to their keyworker or directly to Ms Arnold. One of the people we spoke with told us that they would go to the head ones if they had any concerns or wanted to make a complaint. Ms Arnold keeps a complaints log showing details of all investigations and outcome Care Homes for Older People Page 21 of 34 Evidence: letters to complainants. This showed us that Ms Arnold takes complaints seriously and takes action to resolve any issues in a timely manner. In the AQAA Ms Arnold told us I continue to have an open door policy so that residents, families, friends and staff can come and speak with me if they wish and foster an environment that welcomes complaints. Action has been taken to address the requirement we made that all staff are aware of the local procedure for reporting allegations of abuse of people who use the service. The organisations e-learning programme has a component on safeguarding adults, which all staff have to complete. The local policy had also been an agenda item at the last staff meeting. People had access to the local advocacy service. In a survey form one of the people who uses the service told us I would talk things over if worried with my power of attorney first, then a member of staff or the manager. Then write if needed. I would speak to the manager or my key carer. In a survey form one of the staff in answer to the question about what they should do if resident, relative, or advocate has concerns, ticked yes and told us although I only know this from common sense, having not been told by anybody at Buckland Court. Care Homes for Older People Page 22 of 34 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. Significant improvements continue to be made to upgrading the environment. Signage helps people to find their way around the building. Systems for dealing with laundry have improved. One staff is responsible for infection control. The laundry would benefit from being added to the cleaning schedule. Evidence: Significant improvements continue to be made to the environment. In the AQAA Ms Arnold told us that people had been involved in choosing colour schemes and fabrics. The toilet areas were being redecorated. Ms Arnold told us that a bathroom with an outdated medic bath that no one liked using was due to be refurbished as a shower room. A sluice area was also to be refurbished. We saw signage with pictures and arrows directing people to various points around the home, for example, toilets and the dining room. Action has been taken to address the requirement we made that staff have an understanding of infection control guidance with regard to soiled laundry. We said that a copy of the latest guidance from the Health Protection Agency to care homes must be obtained. Records showed that staff have regular updated training in infection control. A copy of the guidance was in the managers office. One of the staff had the Care Homes for Older People Page 23 of 34 Evidence: delegated responsibility for infection control. We looked at the laundry area. There were systems in place for dealing with soiled or infected laundry. The room was visibly clean. However we did see a build up of dust on the opening of the washing and drying machines. There was also an unlocked cupboard housing a water hopper which had a build up of dust and builders debris. We advised that these areas must be added to the laundry cleaning schedule. We spoke with two people in the small sitting rooms in one of the units. When we asked them how they would summon staff, we discovered that the call bell was missing from its housing. This was pointed out to one of the staff who immediately replaced it. All of the people we spoke with told us that staff were quick to respond to their call bells. One person told us that the response was quicker during the night. Care Homes for Older People Page 24 of 34 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. The employment of care support staff means that care staff have more time to dedicate to caring and administrative duties. Housekeeping hours are better allocated across the week but care staff still have to serve the Sunday evening meal and wash up. Staff are not protected by a policy on provision of intimate personal care. People are protected by a robust recruitment process. Staff have good access to training provided by the organisation and outside agencies. Evidence: Action has been taken to address the requirement we made that staffing levels are sufficient to meet the needs of the people who use the service. Care support staff have been employed to work during the mornings to serve refreshments and clear tables at meal times. Care staff told us that they could now spend more time with people who use the service and attend to any administrative responsibilities. One staff told us that they were pleased to spend more time reviewing and revising their key peoples care plans. The rota also provided what was described as a middle shift. This means that an extra member of care staff comes in later during the morning until the later afternoon. There was a care leader and five care staff on duty during the morning and a care leader and four care staff for the afternoon and evening. At night there are three waking night staff. Care Homes for Older People Page 25 of 34 Evidence: Some action has been taken to address the requirement we made that housekeeping hours are allocated throughout the week, to ensure that care staff are not taken away from their work with people who use the service. Ms Arnold told us that a head of housekeeping had been employed to over see the cleanliness and infection control practices in the home. We saw that there were housekeeping staff working some afternoons as well as mornings. However at weekends the number of housekeeping staff was reduced to two working in the mornings. Ms Arnold told us that housekeepers worked staggered hours at weekends. We said that the actual hours must be identified on the housekeeping rota. We also saw that there was no one allocated to the kitchen duties on a Sunday evening to prepare the meal or wash up. Care staff confirmed that they did this when we asked them. Some action has been taken to address the requirement we made that a policy is in place about carrying out of intimate personal care by staff of a different gender. We saw that the pre-admission assessment has a tick box where peoples preference can be recorded. There was also information about peoples decision in care plans. However there was no policy available. We said that the organisation should produce a policy on provision of intimate care by staff of a different gender as a matter of good practice. This should state boundaries of roles, for the protection of staff as well as the people who use the service. We talked with some of the ladies who use the service. They said they had been asked about who provided their intimate personal care. We saw in one gentlemans care plan that he had requested male staff to support him with showering. Ms Arnold told us that staff regularly attended training provided by Salisbury District Hospital. She also told us that she was concentrating on providing dementia training for the newer staff. All staff have access to the in house dementia training. The majority of staff have completed this training. Ms Arnold was in the process of making sure staffs training records were on the organisations computer system. There was a hard copy of which training staff were expected to carry out in their different roles. Recent training has included diabetes awareness. One member of staff showed us the paper she had produced on nutrition and health for an internal award. One of the people we spoke with told us about a time when they could not sleep during the night and that night staff had brought them a cup of tea when they rang their call bell. Another person told us that all the staff were very kind. They said staff put their call bell within easy reach after providing support with care. Care Homes for Older People Page 26 of 34 Evidence: One of the newer members of staff told us they had been welcomed into the staff team. They went on to say that all the staff help each other and that it was a great team to work in. They told us they had received an induction into their role. They said they had undertaken training in diabetes, moving and handling and infection control since they started this job. They felt they had access to a good training programme. They told us about their supervision and that regular staff meetings were held. We looked at staffing records. All the information and documents required by regulation were in place. All new staff are inducted into their role. We saw that no one commences work until their suitability to work with vulnerable people is established with the Protection of Vulnerable Adults list. We saw that staff were working in a respectful manner with people who use the service. All personal care was carried out in private. Staff knocked on doors and waited to be invited in. We saw that staff immediately responded to people when needed, either in response to call bells or when asked by people. In a survey form one of the people who use the service told us they always speak to me in a manner to which I understand. In a survey form one of the relatives told us all the staff appear professional, helpful and friendly. In a survey form one of the staff told us I have only worked here for (given time) and have been made very welcome by staff and residents. Another staff said there are regular courses to coincide with changing laws and policies in relation to the care setting. In answer to the question about whether there was sufficient staff on duty they told us usually. Although every home has occasions of being short staffed due to sickness which cannot be helped. It is also very good at keeping manual handling up to date. Care Homes for Older People Page 27 of 34 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. Ms Arnold is clear about how she intends to develop the home. She keeps herself up to date with current good practice with regular training and seminars. Ms Arnold is well known to the people who use the service. The home is run in the best interests of people who use the service. Staff are regularly supervised. Any money that the home holds for people is well managed. Systems are in place to ensure that peoples health and safety is monitored. Evidence: Ms Arnold was registered as manager on 7th March 2008. In the AQAA she told us I have over twenty years experience in the Care Sector and over five years experience in leading staff. Ms Arnold told us that she would complete the Registered Managers award at the end of the month. She told us that she had recently undertaken training in end of life and advanced directives, supervisory management, health and safety, first aid, safeguarding adults, fire prevention and the Mental Capacity Act 2005. Ms Arnold told us that once she had completed the Registered Managers Award, she Care Homes for Older People Page 28 of 34 Evidence: hoped to do more advanced dementia training. In the AQAA Ms Arnold told us that as a relatively new manager I have worked hard to improve my knowledge and skills to enable me to lead and support the team. She also told us about her plans for improving the service, developing the staff and the environment. Ms Arnold was well known to all of the people that we spoke with. The organisation had carried out a quality assurance audit of the home in June 2008. An action plan had been sent to the home. This is monitored by the manager and the line manager. As part of this audit questionnaires had been sent to people who use the service and their families. One of the people we spoke with told us that a member of staff had recently asked them to fill out a form asking what they thought about the cleaning of their room. People who use the service told us about the regular Residents meetings that they attended. They said they discussed a variety of different subjects including the meals and activities. We saw the minutes of the meetings displayed on the notice boards. A Residents meeting was being held that afternoon. In the AQAA Ms Arnold told us that the meetings were attended by a different member of staff each time. She also said that the keyworker system would enable some people to express views privately rather than in a group. Ms Arnold also had a suggestion box for anonymous comments. Staff we spoke with told us they received regular supervision. We found evidence of this in staff files. One staff told us they had a performance review twice a year. The administrator showed us the arrangements for people to hold small amounts of cash in the homes safe. Records, receipts and balances are kept for all transactions. The administrator and the manager regularly audit the arrangements. One staff told us that they had received recent training in Control of Substances Hazardous to Health. Staff receive regular updated training in health and safety matters, including first aid, infection control, moving and handling and fire safety. We saw staff carrying out appropriate moving and handling of those people who needed support. Equipment was used when needed. Risk assessments were carried out of the environment and any tasks that staff were involved in. These were regularly audited. Care Homes for Older People Page 29 of 34 Care Homes for Older People Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 18 13(6) The person registered must ensure that a policy is in place with regard to the carrying out of intimate personal care by staff of a different gender to the resident. 31/01/2007 2 27 18(1)(a) The person registered must 31/01/2007 ensure that housekeeping hours are allocated throughout the week to ensure that care staff are not taken away from their work with residents. Care Homes for Older People Page 31 of 34 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 23 Regular cleaning of the laundry must be added to the cleaning schedule. To ensure cleaning to infection control standards. 30/01/2009 2 8 13 Confirmation must be sought from the Medicines and Healthcare products Regulatory Agency that the blood glucose device used for more than one person, confirms to the information in the Medical Device Alert 2006 066. So that people who have diabetes are protected from risk of cross infection. 30/01/2009 3 27 18 Support staff must be 30/01/2009 allocated on a Sunday evening so that care staff do not have to serve the evening meal and wash up. Care Homes for Older People Page 32 of 34 So that care staff are not taken away from supporting and meeting the needs of people who use the service. 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 3 The pre-admission assessment format should avoid a tick list and include more space for the assessor to write the individual needs of different people being assessed. Care planning documentation should be reviewed and rationalised to avoid duplication of information. There should be a policy on the provision of intimate personal care by staff of a different gender to the person. This should include boundaries of roles. The nutritional risk assessment outcome number should automatically feed into the pressure damage risk assessment. Staff should ensure that meals taken to people in their bedrooms are covered. Consideration should be given to ways of making people aware that there is a complaints procedure. 2 3 7 8 4 8 5 6 15 16 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!