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Inspection on 16/12/08 for Carshalton Nursing Home

Also see our care home review for Carshalton Nursing Home for more information

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

As an older home this building would not meet current standards however it aims to provide a homely environment for the people who live there. People told us that they feel as if they are living in a family and one relative chose the home because of this. Most of the staff have worked in the home for some time and they know the residents and their families well. For people who may be confused this is particularly important and those who could talk with us said that staff are "lovely, very kind and helpful". Visitors told us that they are always made to feel welcome and they are always kept informed of any changes in the health of their relatives. People say that they enjoy their meals in the home and that they are always able to have a choice. There are extra cups of tea and snacks available to them if they want them.

What has improved since the last inspection?

We could see that staff have been working to improve residents care plans to make sure that they identify all of the support that they need and that any changing needs are addressed. Some of them are beginning to contain information about social needs and preferences and some life history work has been undertaken although more work is still needed with these. This information is particularly valuable when residents have dementia as it gives staff an insight into their past lives and allows them to understand their current behaviour and provide activities which suit them. The redecoration programme in the home is continuing and new carpets and chairs have been provided. Heat reflecting panels and air conditioning have been put in place to try and maintain an ambient heat in the lounge.

What the care home could do better:

The overall rating for the home has been affected by shortfalls in the management and administration outcome areas. The Annual Quality Assurance Assessment document that the service has returned is the one intended for services that support younger adults rather than older people. This means that it has not always addressed the relevant key standards. We have read the homes Statement of Purpose and Service User Guide and find that it does not reflect the care and services being provided. This is especially true of daily life in the home. The documents describe a wide range of organised activities, trips and outings that are not actually happening. This could be very misleading for anyone choosing a placement for themselves or their relatives. On the day of the inspection we saw that some people are brought into the lounge in the morning and apart from being taken to the toilet occasionally they do not move from their chairs. Their only stimulation is the television which is on constantly. Little importance has been placed on equality and diversity issues in the home. We noted that there are some people living there who come from different culturalbackgrounds but no particular activities are arranged for them. It may be that they would enjoy different meals however this has not been explored in any detail. No residents in the home are having their spiritual needs addressed, we were told that nobody wants any visits from any church representatives. However there are limited opportunities available for people to express their opinions. We were told that residents meetings rarely happen and it is unlikely that many of them would be able to complete a quality assurance questionnaire. The home still has no manager. A suitably experienced and competent person to be in daily charge of the home is essential to provide leadership and continuity for staff and residents, to supervise staff and identify training needs and to promote equality and diversity within the home. Currently, trained nurses are attempting to manage the home in addition to undertaking their own roles. We also considered that staffing levels in the home were inadequate to meet the needs of residents especially in the afternoon. Staff are having to care for people who are very frail and may exhibit quite challenging behaviour. In the evening they have to cook or heat and serve the supper and are also expected to organise activities. On the day of the inspection visit two people were extremely unwell and they were unable to support them or their families as they should have been able to. We have issued some requirements for the Providers to address these issues.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Carshalton Nursing Home 28 Salisbury Road Carshalton Surrey SM5 3HD     The quality rating for this care home is:   zero star poor 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: Alison Ford     Date: 1 6 1 2 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 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: Carshalton Nursing Home 28 Salisbury Road Carshalton Surrey SM5 3HD 02086692592 02086699558 sweethomes@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Sweet Homes Ltd Type of registration: Number of places registered: care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 33 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 33) Dementia - Code DE(E) (of the following age range: 65 years and older) (maximum number of places: 10) Date of last inspection Brief description of the care home Carshalton Nursing Home is registered to provide care for up to thirty-three older people who may have dementia. As an existing care home some of the facilities would not meet the requirements of a newly registered home. A large proportion of the accommodation is provided in shared rooms, without en-suite facilities and they are Care Homes for Older People Page 4 of 29 Over 65 10 33 0 0 Brief description of the care home smaller than would now be acceptable. There is only one lounge/dining area and this is in the form of a conservatory, which despite fans, is sometimes uncomfortably hot. There is a shaft lift to ensure accessibility throughout the home and the conservatory overlooks the rear garden. There is limited off-street parking however, the home is in a quiet road and close to public transport links. At the time of this inspection fees range from £525- £850 per week. Any extra charges payable for services such as hairdressing would be discussed prior to admission. A copy of the homes Statement of Purpose, Service User Guide and the latest inspection report can be obtained from the homes Registered Providers or the latter can also be obtained from the Commission For Social Care Inspection from their website. www.csci.org.uk 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: zero star poor 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 report follows an unannounced key inspection visit to the service. The last inspection on this service was completed on 08/01/2008. When writing the report, consideration has also been given to other information that we have gathered throughout the year including notifications of complaints, accidents and incidents that have occurred. We have spoken with residents and their relatives and also to members of staff who work in the home. The home has sent us their Annual Quality Assurance Assessment which tells us what they believe that they are doing well to provide a service for the people that they support and about their plans for the future. Care Homes for Older People Page 6 of 29 We undertook a tour of the premises, looked at a sample of care plans, medication procedures and records and documentation that the home is required to keep as evidence of its commitment to the health and safety of the people who live there. Since the last inspection there has been one complaint made about the service. This was addressed according to the local authority safeguarding policies. During the process several of those people using the service were reviewed by their care managers and The Commission undertook an additional unannounced visit. The concern was largely unsubstantiated, no residents were considered to be at risk and the issues were left to the Registered Providers to resolve according to the homes own procedures. What the care home does well: What has improved since the last inspection? What they could do better: The overall rating for the home has been affected by shortfalls in the management and administration outcome areas. The Annual Quality Assurance Assessment document that the service has returned is the one intended for services that support younger adults rather than older people. This means that it has not always addressed the relevant key standards. We have read the homes Statement of Purpose and Service User Guide and find that it does not reflect the care and services being provided. This is especially true of daily life in the home. The documents describe a wide range of organised activities, trips and outings that are not actually happening. This could be very misleading for anyone choosing a placement for themselves or their relatives. On the day of the inspection we saw that some people are brought into the lounge in the morning and apart from being taken to the toilet occasionally they do not move from their chairs. Their only stimulation is the television which is on constantly. Little importance has been placed on equality and diversity issues in the home. We noted that there are some people living there who come from different cultural Care Homes for Older People Page 8 of 29 backgrounds but no particular activities are arranged for them. It may be that they would enjoy different meals however this has not been explored in any detail. No residents in the home are having their spiritual needs addressed, we were told that nobody wants any visits from any church representatives. However there are limited opportunities available for people to express their opinions. We were told that residents meetings rarely happen and it is unlikely that many of them would be able to complete a quality assurance questionnaire. The home still has no manager. A suitably experienced and competent person to be in daily charge of the home is essential to provide leadership and continuity for staff and residents, to supervise staff and identify training needs and to promote equality and diversity within the home. Currently, trained nurses are attempting to manage the home in addition to undertaking their own roles. We also considered that staffing levels in the home were inadequate to meet the needs of residents especially in the afternoon. Staff are having to care for people who are very frail and may exhibit quite challenging behaviour. In the evening they have to cook or heat and serve the supper and are also expected to organise activities. On the day of the inspection visit two people were extremely unwell and they were unable to support them or their families as they should have been able to. We have issued some requirements for the Providers to address these issues. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. No-one is admitted in to the home without having an assessment undertaken which identifies whether their needs can be met. However, the information that has been made available to help them choose whether the home will be suitable for them is misleading and not reflective of the current situation . Evidence: There is a new Statement of Purpose, Service User Guide, and brochure. The homes providers are required to put these documents in place to give residents and their families all of the information that they might need when deciding if the home will suit them. It also allows us to monitor how well they are delivering the services that they say they will provide. The providers tell us that these documents outline the philosophy of the home and also the daily life there. However, they do not seem to be reflective of the current situation. This is particularly true with regard to the information about the activities that are offered. The information states that activities Care Homes for Older People Page 11 of 29 Evidence: include coffee mornings, keep fit sessions, and outings. Also, that residents pastoral needs will be met. During the inspection we spoke with staff and residents and found out that organised activities are in fact very few and limited to a musical entertainer once a week. Staffing levels restrict the amount of input from care staff and some residents told us that they get very bored during the day and would appreciate something to do. We were also told that representatives from local churches no longer visit the home. We consider that anyone whose decision to live in the home was influenced by the information that they read might be very disappointed when they moved in. The registered providers must consider how they are going to ensure that the home provides the facilities and services that are described in its Statement of Purpose particularly with regard to social activities. The majority of people who live in the home are funded through care management arrangements. We saw that they had a care managers assessment which outlined the support that they would need and they are reviewed on a regular basis. In addition we saw that potential residents are assessed by a senior member of the nursing staff before they are are admitted although the information that they collect is still quite limited. Once the resident has come to live in the home more detailed information is gathered which helps the staff to understand them and decide how they need to be cared for. 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. There is information available to staff to ensure that they are able to deliver appropriate care to residents and any changing needs would be identified and addressed. The quality of care and support that is offered to people at the end of their lives could be improved. Evidence: Residents living in the home looked clean, happy and suitably dressed. They each have an individual care plan which sets out details of all of the support that they need so that everyone knows how they prefer this to be done. These care plans are reviewed regularly so that any changing needs are identified. We looked at three care plans during this inspection and found them to be generally in good order. There was evidence to show that other health care professionals such as General Practitioners visit the home and advice regarding wound care is given by the tissue viability nurse. Care Homes for Older People Page 13 of 29 Evidence: Factors which could lead to residents developing pressure sores are monitored and appropriate equipment is in use where it is needed. People who were being nursed in bed, because they were unwell, looked comfortable and well cared for. We looked at medication records and storage and found them to be well maintained and we judged that residents are receiving their medication as it has been prescribed for them. We did see that where residents are prescribed topical creams it does not always state where this should be applied and the nurse in charge agreed to address this. Also, in line with all other prescribed medicines, when these creams are applied there must always be a signature of the nurse who has administered the cream, rather than just a tick. The majority of the staff who work in this home have been there for some time and know the residents well. People speak very fondly of them and told us that they are kind and caring. As this is a home for elderly frail people with nursing needs, we would expect that staff would be skilled at offering care and support to those who may be nearing the end of their lives. At the time of the inspection there were two resident who were extremely unwell, one of whom was dying. Staffing levels in the home did not allow the care staff to spend as much time with them and their relatives as they would have liked, to help and support them through this time. As well as being reflective of staffing issues we considered that had there been a Registered Manager they would have assessed this particular situation and managed it more appropriately. These issues are highlighted in standards 27 and 31. Care Homes for Older People Page 14 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not providing the lifestyle that is described in its Statement of Purpose and there are limited opportunities for residents to engage in any social activities. Limited consideration has been given to their differing cultural backgrounds. Meals that are served are wholesome and appealing although some consideration needs to be given to making mealtimes more relaxed for those people who need assistance. Evidence: It is acknowledged that people who live in this home are very frail and many of them have advanced stages of dementia. This makes finding ways to interest and stimulate them quite challenging. However, it seems that little is being done to maximise their remaining abilities. The information that is available about the home tells people that there is a varied programme of activities which include coffee mornings,keep fit sessions, sewing and knitting,and outings. At this inspection we could find no evidence of these having taken place and some residents said that they find the days in the home very long and Care Homes for Older People Page 15 of 29 Evidence: they would enjoy some organised activities. During our visit we saw that people are brought in to the lounge in the morning and many of them are not moved from their chairs throughout the day apart from being taken to the toilet occasionally. We were told that an outside entertainer visits the home once a week to organise a musical session and that the Christmas party was going to be held at the weekend. Other than that, the television seems to be the only source of stimulation available. As set out in a previous requirement relating to Standard 1, The Registered Providers must consider how they are going to ensure that the home provides the facilities and services that are described in its Statement of Purpose particularly with regard to social activities. Visitors are always welcome in the home and one, that we spoke with, said that they liked the fact that the layout of the home, with everyone in the lounge together, made it feel very homely. There are currently residents in the home who are not English although, little consideration has been given to any ways of reflecting their diversity other than providing rice at mealtimes on occasion. This inspection visit took place just before Christmas however, there was no acknowledgement of the fact that they might have enjoyed other celebrations. We were told that church representatives no longer visit the home because residents do not want them. However, there are limited processes in place to test this view and to try and gain the views of people who use the service and allow them to influence the lifestyle there. It is reccommended that the Registered Providers should consider how they are going to acknowledge the diversity of those people who live in the home and provide a service which reflects their different needs. The lunchtime meal was served during the inspection. It was well presented and people told us that they enjoy the food in the home. There is always a choice and the cook knows what people like or dislike. A hot supper option is also provided in the evening. Meals are served on tables in front of the residents, only two of them sit at the table. We saw that their high dependency means that many of them require assistance and we noted that care staff may have to help more than one person at a time. Care Homes for Older People Page 16 of 29 Evidence: Consideration should be given to managing this situation so that care staff have more time for each person to ensure that their mealtime is a more relaxed experience for them. Care Homes for Older People Page 17 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. There is a complaints procedure in place and any concerns are addressed appropriately. Residents are protected from those people who have been judged as not being suitable to care for them and policies and procedures are in place to make sure that they are protect from abuse. Evidence: There is a complaints procedure in place in the home. This is available in the Statement of Purpose and Service User Guide. A copy of the procedure is in the hall although the book to write in, is held at the nurses station. It is recommended that there should be information added to the notice which tells people where it is kept. There has been one complaint since the last inspection. This was addressed according to the local authority safeguarding procedures and the investigation included an unannounced inspection visit by The Commission. The allegations were largely unfounded and it was not considered that anyone who uses the service was put at any risk. It was left to the Registered Providers to close the complaint in accordance with the homes internal procedures. The staff that we spoke with displayed a good understanding of issues concerned with recognition and reporting of suspected adult abuse and also of the principles of whistle Care Homes for Older People Page 18 of 29 Evidence: blowing. One new member of staff has been employed since the last inspection however their personnel files were not available. The information that is in the AQAA tells us that new staff are not employed without satisfactory clearance from the Criminal Records Bureau and Protection of Vulnerable Adults Registered. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is warm and clean and some redecoration has recently occured. Although it would not comply with new standards and more could be done to improve its overall appearance, people like the homely atmosphere. Evidence: This is an older home and as such would not meet many of the standards that would be expected of a newer facility. There is a lack of communal space with one main area used as a lounge and dining room. The nurses station is situated in the corner of this. Given that the home cares predominantly for people with dementia there is nothing in place to help or stimulate them. Ideally this would include increased signeage, pictures and objects that provide reality orientation. The telephone in the lounge, provided for residents to use, has not worked for some time. Bedrooms are irregularly shaped, which may hinder the use of hoists, and they were originally designated as being for shared occupancy although most of them are currently being used for only one resident. Some redecoration has now taken place and new carpets and chairs have been provided. However, more work could still be done to improve the overall appearance of Care Homes for Older People Page 20 of 29 Evidence: the home. We noted that the rear fire door is still needing to be opened with a key and have reminded the Registered Providers that this is not ideal. At this visit the key was also broken although it did still work. The home has a very homely atmosphere which is due, in part, to the fact that everyone sits together in the lounge. Some of the residents and relatives have told us that they particularly like this feature and one relative said that they had chosen the home because of it. The Annual Quality Assurance Assessment tells us that there is an intention to apply for planning permission to make some changes to improve the home. On the day of the inspection the home was clean and warm and free from malodour. 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. Residents cannot be sure that there will always be enough staff to meet their needs. Evidence: On the day of the inspection the home was quite busy and we considered that staffing levels were inadequate to meet the needs of the seventeen people who were living there particularly in the afternoon. Two residents were extremely unwell, one nearing the end of their lives. Two others were exhibiting very challenging behaviour. In the afternoon the nurse in charge was supported by only two care staff and the rotas showed that this was the usual situation. In addition to caring for residents, staff have to heat and serve the evening meal and the intention is that they should also organise activities. At lunchtime we had seen that care staff were having to support more than one resident at a time. While it is accepted that there are no statutory staffing levels laid down for care homes we would expect to see that there were enough staff to meet residents needs. The Registered Providers must therfore review staffing levels in the home to ensure that they meet the assessed needs of the people who use the service. At least 50 of care staff have attained an NVQ level 2 qualification and some have Care Homes for Older People Page 22 of 29 Evidence: progressed to level 3. They told us that they have received training this year which was provided in-house and has included fire safety, infection control,moving and handling and first aid. Staff have all been employed by the home for some time and they have previously undertaken training in dementia awareness. They displayed an understanding of issues around adult abuse and knew the procedures to be followed should they wish to raise any concerns. One new member of staff had been employed since the last inspection however, their personnel files were not available to be inspected. The information that is provided by the home tells us that all of the appropriate checks are carried out before anyone begins working in the home. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of a suitable manager has influenced the provision of care in the home which is not always influenced by the needs and preferences of those who use the service. Evidence: The home still has no manager. A reliable and competent manager is essential in providing good quality care, leadership and continuity. Trained nurses are attempting to cover this role in addition to undertaking their own. An experienced manager would have been able to assess the inadequate staffing situation on the day we visited and could have put measures in place to rectify it. They would also be responsible for making sure that staff are appropriately supervised, identify any training needs that they might have and undertaken regular performance monitoring and appraisal. This does not currently happen within the home. An effective manager would also bring an increased focus on equality and diversity issues ensuring that the needs and preferences of people with varying cultural backgrounds are given some consideration. Care Homes for Older People Page 24 of 29 Evidence: The home has returned its Annual Assurance Assessment however, they have completed the document which relates to the provision of care for younger people not for older adults.This means that it has not always addressed the key standards for this type of service. Although it has all been completed we found that it is not always reflective of the current situation within the home and does not provide a reliable picture of the service. Previous inspections noted that there was little in the way of quality assurance monitoring happening in the home. Residents and their families were rarely given the opportunity to comment on, or influence the provision of care in the home. We have been told that a questionnaire is now being distributed to residents and their families twice a year. It is recommended that this should also be distributed to people such as care managers and others who visit the home regularly. The Statement of Purpose and Service User Guide say there are residents meetings however there was no evidence available to show that this is happening. There were also no records available of any visits undertaken to the home by the providers, to monitor the care and services being provided,in line with Regulation 26. Some money is held for residents however the key not available to check accounts. We have not encountered any problems were seen with them in the past. Information given to us by the home says that equipment is being maintained appropriately. Fire alarms are tested on a weekly basis and staff say that have had fire safety training. The last environmental health inspection in April 08 awarded the home 3 stars for its kitchen and catering facilities. Accidents are being recorded appropriately although a new book is needed. Notifications are sent to The Commission when necessary. Care Homes for Older People Page 25 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 26 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 1 4 The registered providers 30/03/2009 must consider how they are going to ensure that the home provides the facilities and services that are described in its Statement of Purpose particularly with regard to social activities. So that the documentation is a true reflection of the daily life in the home. 2 12 12 Activities must be provided, as set out in the homes Statement of Purpose and Service User Guide In order to provide interest and stimulation for residents. 30/03/2009 3 27 18 Staffing level in the home must be reassessed. To ensure that there are always enough staff available to meet the assessed needs of the people who live in the home. 30/01/2009 Care Homes for Older People Page 27 of 29 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 12 It is reccommended that the Registered Providers should consider how they are going to acknowledge the diversity of those people who live in the home and provide a service which reflects their different needs. 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. 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. 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