Inspection on 16/12/08 for Cedar Lodge

This inspection was carried out on 16th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cedar Lodge Main Street Offenham Evesham Worcestershire WR11 8RL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Emily White     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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 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 32 Information about the care home Name of care home: Address: Cedar Lodge Main Street Offenham Evesham Worcestershire WR11 8RL 01386446871 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : iansomauroo@hotmail.com A & I Care Home Ltd care home 13 Number of places (if applicable): Under 65 Over 65 13 13 13 mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 0 0 0 The registered person may provide the following category of service only: Care Home Only - Code PC To service users of the following gender: Either To service users of the following categories: Mental Disorder over 65 years of age (MD)(E) 13 Physical Disability over 65 years of age (PD)(E) 13 Old age not falling within any other category (OP) 13 the maximum number of service users be be accommodated is 13. Date of last inspection Brief description of the care home Cedar Lodge provides accommodation and personal care for thirteen older people who may have a physical disability. The home is situated in a small village outside Evesham town and is on a local bus route. It is an adapted country house and has two floors accessible by stair lift. Handrails are appropriately fitted. There are six bedrooms upstairs, five of which have ensuite facilities, and one has its own toilet and washbasin Care Homes for Older People Page 4 of 32 Brief description of the care home nearby. There are seven bedrooms downstairs, six of which have ensuite facilities and one has its own toilet nearby. There are communal bathrooms on both floors, each with a hoist and one also has a shower. There are separate communal dining and lounge areas and a conservatory looking out onto an attractive garden. Mr Ian Somauroo took over the ownership and management of Cedar Lodge in 2008. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before we visited Cedar Lodge we looked at eleven surveys sent to us from people who use the service and nine surveys from staff. The surveys were sent to us shortly after the new manager took over. We also looked at the Annual Quality Assurance Assessment sent to us by the manager. This tells us what the service has been doing well and its plans for improvement in the future. We visited Cedar Lodge on a week day. The deputy manager and staff were there to help us. We met people who use the service, and some showed us their rooms. We observed daily life at the home and looked at records such as care plans. We met the manager at the end of our visit and had some time to talk to him. Care Homes for Older People Page 6 of 32 Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 32 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 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is able to meet peoples needs and shows this by providing good information to people and making sure they have a detailed assessment of their needs before they more to the service. Evidence: During our visit we spoke to some people who had recently moved to Cedar Lodge and looked at the statement of purpose and service guide, which are very detailed. The service guide includes information on how to make a complaint and all the information required by the National Minimum Standards. A brochure is given out to interested people when the make an enquiry. People who live at Cedar Lodge have a document holder in peoples rooms with the guide and other information. One person we spoke to said she does not know what information is in her room but said she had enough information before she moved in, and her son came to visit for her while she was in hospital. Care Homes for Older People Page 10 of 32 Evidence: The Annual Quality Assurance Assessment tells us that everyone has an updated contract with the terms and conditions and fees of the service. We looked at several care files which showed a contract had been provided. Just after the new manager took over we received 11 surveys from people using the service, who all say they received a contract and they had enough information before moving in. the Annual Quality Assurance Assessment also tells us that everyone considering moving in can visit the home as many times as they need. The service carries out an assessment before someone new moves to the house to make sure they can meet the persons needs. One person has moved in since the new manager took over the service. We looked in detail at their assessment, which includes information on personal care, mobility, falls, diet, continence, medication and mental well being. The assessment covers all the areas required in the National Minimum Standards, however the amount of space does not allow for much detail, for example about leisure and social interests. One assessment we saw for someone who moved to the home for dietary reasons had appetite good and likes mostly everything in their assessment. We would expect more detail about someones needs to ensure that the service can meet their needs before they move in. The service does not provide intermediate care at present. Care Homes for Older People Page 11 of 32 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. People have detailed care plans and their privacy and dignity is respected. When peoples health needs deteriorate or change, staff are not always properly supported to meet those peoples needs. Evidence: During our visit we looked in detail at the experiences of three people who use the service, which included meeting them if possible, looking at all their care records and other records used by the service. All the care files we looked at had new care plans written by the new manager. The care files contain Essential Information which includes the persons personal details, allergies, next of kin, advocate, GP and social worker. Everyone also has a Personal Profile which includes information about their personal relationships and family history, personality, an advance decision in event of mental incapacity, action to be taken in the event of their death, finances, social and leisure interests and hobbies, religion, and medical history up to moving to the service. Everyone has Needs Assessments which are updated monthly, and scored according Care Homes for Older People Page 12 of 32 Evidence: to the persons need, for example whether they can manage alone, supervised, with one carer or two carers. This scoring does not give very much detail about peoples care needs but is supported by the monthly review which covers the same areas, such as personal care, diet and weight, sight, mobility, falls, continence, medications, and mental well being. This provides details such as needs assistance with getting up, getting dressed, getting washed and bathed and combing her hair. There is also a more detailed care plan which provides further detail about peoples care needs. From these records we can see that people are having their care needs reviewed on a monthly basis, however details are not always consistently recorded. One person has had a period of poor health which is well recorded in the daily notes written by staff. Some of this persons earlier reviews record information such as change of behaviour of late culminating in memory loss. However more recent reviews record no change where there is evidence from the daily notes that this person requires more assistance than they did before. This person also requires a soft diet, however their needs assessment records a liquid diet as there is no category for soft diet. The service also carries out nutritional screening, falls assessments, and risk assessments. We saw some risk assessments for falls, bathing and pressure care. There are records of GP and other health professional visits which all tie in with the daily notes and show that health professionals are being contacted in a timely way. The service also monitors peoples blood pressure, their weight, and when they have baths or showers. The care file of a person who has recently moved to the service shows that the reviews have been completed monthly, the care plan has been updated following weight loss, and monthly weight measurements show their weight has since gone up. All the monitoring forms mentioned above are completed, and a fall is recorded in the accident book. We noted that people appear very well cared for, smartly dressed, wearing jewellery and with clean styled hair. We noted that staff spoke to people with respect and with appropriate terms of address. People told us they feel well cared for and their privacy and dignity is respected by all the staff. We received 11 surveys from people using the service three months after the new manager took over. These say that people always receive the care and medical support they need. Comments include We are all looked after by caring staff, cant wish for anything else and I am perfectly happy here and the staff are all pleasant and caring. We also received three surveys from health professionals which tell us that the service seeks advice and acts upon it to improve peoples needs, always respects peoples privacy and dignity, helps people to live the life they choose and responds well to concerns that are raised. Comments include I have been going to Cedar Lodge for two years and have always felt that there is respect for the residents privacy and dignity and From what I have seen the residents are very much treated Care Homes for Older People Page 13 of 32 Evidence: as individuals and given a level of independence where appropriate. While we observed a lot of good practice as described above, we found that where peoples needs have changed or they are more dependent, some aspects of their health care have not been managed so well. For example, one person who has been very dependent for some time does not have a pressure area risk assessment. Aspects of their care plan do not provide enough detail, for example where 1 to 2 carers is recorded we would expect to see more detail about when one carer is enough and when two carers might be needed. We looked in detail at someones records whose health has deteriorated. From August until November the monthly reviews record no change to the persons care plan. However the daily notes show concerns from staff at the deterioration in this persons health and concerns that they frequently fall in the toilet. An updated risk assessment in November records changes to using a commode and how the person is supported on the stairs, however this is not mentioned in the review forms. A series of incidents shortly before our visit gave cause for concern. A person using the service fell, went to hospital with a fractured pelvis and was discharged the same day. The falls risk assessments, bathing and pressure risk assessments are not dated and there is no reference to the persons new needs until three days after their discharge from hospital. During this three day period concerns about the persons care are recorded in the staff daily notes. On the third day after discharge there is a note from the manager in the contact sheets and a letter of permission from the family for the use of bed rails. On the same day the daily notes and accident book record that this person fell from bed, receiving an injury to their hand from the bed rails, resulting in the doctor being called to assess the injury. The bed rails were then removed, having been in place for less than 24 hours. Care records show that a review of the care plan took place after this incident occurred. The review of the care plan states that this person is not safe and there is permission from daughter to have mattress on floor until back to normal. The review does not provide detail on the number of carers that are needed to help this person, how to assist them in getting up, or a risk assessment of safety for using a mattress on the floor. In a situation described as above we would expect a considered plan to be in place following changes to a persons health, to ensure their needs are met and that further risks to their well being are avoided. Daily notes recorded by staff show that outside health professionals have been contacted and have visited regularly, and that care staff are acting appropriately to care for this person and others who use the service. However the above incidents raise concerns that in the absence of an experienced manager the service may not be able to support people whose needs suddenly change. During our visit staff raised a number of concerns, including that they were surprised there was no care plan Care Homes for Older People Page 14 of 32 Evidence: immediately after the person had been discharged from hospital, they are concerned about nursing someone from the floor and using a hoist, who to turn to if the person deteriorates, and the lack of staff handover time between shifts. While there is a system for recording over a 24 hour period, this is sometimes left blank and some staff report concerns that information may be missed. While staff told us the manager is very approachable for advice over the phone, they also said they are worried that there is no one in authority at the home for staff to go to for decisions, particularly relating to nursing care. During our visit we also looked at the way peoples medications are managed. Although current medications are not recorded in peoples care plans, they are recorded in the administration records alongside photographs of people. The administration records show that all medications are being administered as prescribed. The service uses a monitored dosage system where tablets are provided by the pharmacy in individual packets. The deputy manager carries out a weekly drug audit on all loose medications, which show that there have not been any errors. The Annual Quality Assurance Assessment tells us that medications are an area the service plans to look at. While people do appear to be receiving their medications, we found that some areas of recording could be improved, for example, medications with dosages that change regularly, such as Warfarin, are being recorded in the daily notes or the 24 hour contact sheet. It would be better practice to record in one place so changes to dosages are not missed. We found one person has not been taking their medications since becoming unwell, which has not been recorded in their care plan. It would also be good practice for current medications to be recorded in the persons care plan so that staff are fully informed and up to date. Care Homes for Older People Page 15 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to take part in social activities and make choices about their lifestyle. Meals are varied. Where improvements can be made the service recognises them and acts on them. Evidence: During our visit we spoke to several people using the service about their daily life and social activities. We looked at some records and spoke to staff about any changes that have taken place since the new manager started. Peoples care plans provide a lot of detail about their likes and dislikes, and are written in a way that supports their individual personalities and backgrounds. For example, one persons interests are recorded as talking, scrabble, television, photos, and drives in the car. The care plan says needs to be entertained by staff on and off during the day especially when she wants to discuss the past. Other comments from other peoples care plans include loves the view from the window and enjoys watching the world go by, likes to take communion every so often, key worker to spend quality time. Peoples key workers names are not recorded in their plan, but are in a plastic folder in their rooms. When asked, people did not know who their key worker is. It would be good practice for this system to be explained to people when they move to the house and to be regularly Care Homes for Older People Page 16 of 32 Evidence: reminded throughout their stay. One staff member is paid for four hours per week over two days to spend on activities with people using the service. These activities include scrabble, quizzes, bingo, music, going out for walks, visits to the village hall. This staff member tells us she tries to spend some individual time with people as well as group activities. She has recently asked everyone using the service what they would like in terms of activities at the home. This good practice could be improved on by recording peoples individual preferences and what activities they have taken part in. The deputy manager completes a monthly audit of what activities have taken place at the home over the previous month, which include crosswords, magnifying strange objects, quizzes, a garden party, nails, music for health, discussions, videos, music and balloons, memory games, walks, and individual outings. Recording peoples individual activities would help to ensure people are not becoming isolated and that they have a chance to take part in activities of their choosing. We observed good staff interactions and a homely feel, with people in the lounge reading papers, books, and listening to music. Some people were in their own rooms watching television which they say is their choice. Staff say the television is not usually on in the lounge unless there is something on that lots of people want to watch. We received eleven surveys from people using the service, seven people said there are always activities at the home to take part in, and four said there are usually or sometimes activities. Comments include, activities are available if one wishes to join in, I do quizzes, bingo, walks, and watch television and activities are somewhat limited and do not always take account of individual disabilities. The service should consider having clearer information for people using the service about what activities are on for the day, including television programmes, so that people can choose where they spend their time during the day. The Annual Quality Assurance Assessment tells us that there are plans for improvement to organise more outings and invite more entertainers to come in to the house. During our visit an outside entertainer was carol singing in the lounge during the afternoon. The monthly audits show us that there are visits from outside entertainments once a month on average, which include music, songs, and exercise. The manager tells us that the house car is now available for the deputy to take people out on trips to garden centres and other places of interest. Peoples families are very involved as people wish, and people are able to receive visitors in private when they like. It is clear that the service supports peoples independence and choice. The Annual Quality Assurance Assessment tells us that people get up when they like and they start the day by having breakfast in their rooms, they can stay in bed or in their dressing gowns until they are ready to get up. People we met during our visit say they are able Care Homes for Older People Page 17 of 32 Evidence: to do as they wish during the day. A few people regularly go for walks to the village shops without support, they tell us it keeps them fit and they like to chat to people they meet in the village. We asked people using the service about meals and mealtimes, and generally the comments are very positive, including I have always found the meals excellent and meals are well cooked and presented. Three people suggested some areas for improvement, including there is too much meat and should be more vegetarian options, I would like more fresh fruit available and there is a lack of fresh produce and portions are smaller than I am used to. Discussions with people using the service and staff show that some changes have been made so that the food is less rich and there is less waste. Staff say that there has been a period of change with the food orders but the manager listens when particular orders are made, and the deputy has access to petty cash if extras are needed. We looked in the fridges and larder which are well stocked with no value items, however we noted that more fresh produce, particularly fruit, could be available. The menus look varied and interesting with fish and meat. There is one choice for lunch but people can have alternatives if they dont like it. Everyones likes, dislikes and allergies are recorded in the kitchen so that the cook makes sure everyone likes what is on offer. People also have morning coffee and biscuits, afternoon tea with homemade cakes every day, and at tea people can have whatever they like for example beans on toast, sandwiches, and sardines. One person using the service has very specific dietary needs which are being met by the service. We spoke to this person who told us the food is excellent and their needs are being met. Care Homes for Older People Page 18 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service and their representatives know how to complain if they need to. When peoples health needs deteriorate or change, them service does not always act in a way that protects people from harm. Evidence: We talked to staff and people using the service about peoples safety and complaints, we looked at records and spoke to the manager about how complaints and protection are managed. The Annual Quality Assurance Assessment tells us that the service has recently reviewed its Complaints Policy and also has a new set of standards in the form of a Residents Charter, Expectation and Rights. These are on display in the home. We noted that the address of CSCI is incorrect in the policy in peoples files and provided the deputy manager with the correct address. The service has a record book for complaints which shows that one complaint has been received and was responded to according to the procedure. The deputy manager carries out a monthly audit of complaints to make sure complaints are managed and monitored. Everyone we spoke to who uses the service says they know how to complain and they trust the staff and managers. We received eleven surveys from people using the service who all say they know who to speak to if they are not happy, and they know how to make a complaint. The Annual Quality Assurance Assessment also tells us that the service plans to display posters against abuse and the right of the individuals to complain, and to Care Homes for Older People Page 19 of 32 Evidence: provide information stored in plastic sleeves for residents to read at their leisure. During our visit we noted that this had been done. Staff files show us that staff are recruited following the required security checks. We spoke to several staff who were all aware of issues relating to safeguarding, definitions of abuse and whistle blowing. We received nine staff surveys which all say that they know what to do if concerns are raised about the service. The service is aware that it has inherited out of date training from the previous management, and the training matrix set up by the deputy manager identifies training for all staff during 2009. When we asked people using the service about their safety, comments included, if I was in any trouble I could speak to the staff and it would be private, I have never heard a cross word. While it is clear that there is good practice in this area, some of the concerns raised in the section under health and personal care affect how people using the service may be protected at certain times, including when they are experiencing poor health. Where physical interventions or other restrictive measures are used, such as bed rails or a mattress on the floor, a suitably qualified, competent and trained individual should assess for the need for specific equipment. There should be effective risk management strategies in place beforehand, relevant records should be maintained and the decisions should be documented. These situations should be kept under regular review to ensure the service is acting in the best way to prevent people from harm. Care Homes for Older People Page 20 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a house that is clean, comfortable and well maintained. Evidence: The Annual Quality Assurance Assessment tells us that the service keeps the home clean, warm, comfortable and hygienic, and maintains the garden to a very high standard. The conservatory is very inviting and the residents love lounging in it and they take their visitors out to it. It also says they encourage people to bring some personal items from home to make their room as homely as possible. During our visit we looked around the house and some people showed us their rooms. There is a homely atmosphere, with good quality furniture and decoration. Peoples rooms are very personalised as they like them. There is a garden with conservatory and we saw photographs of people outside in the summer. We observed that people feel comfortable to come and go from rooms in the house and make use of the lounge area which is comfortable and inviting. We received eleven surveys which told us that people always find the home fresh and clean. Comments from people we met say that the house is always clean and homely. We observed that bathrooms and toilets are clean and gloves, aprons and hand wash is available in all rooms. The service is aware that it has inherited out of date training for staff in key areas such as control of infection, and the deputy manager has written Care Homes for Older People Page 21 of 32 Evidence: a training plan to ensure this is updated for all staff in 2009. Care Homes for Older People Page 22 of 32 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. Peoples needs are met by well qualified staff who understand their jobs well. Staff are recruited with the right checks so that people using the service are kept safe. Evidence: We received eleven surveys from people using the service who all say that the staff always listen and act on what they say, and the staff are always available when they are needed. Most of the staff team have stayed at the service when the new manager started, which has provided good continuity for people using the service. Since the new management started, there have been some changes to staffing. The deputy manager tells us there are always two care staff and one or two domestics during the day, and one waking night staff and a sleeping night staff who may be the manager who has a flat at the premises. The rota confirms that this is usually the case, however during our visit the deputy manager was covering a shift for a staff member who was off sick. Staff tell us that there used to be three staff in the morning which has been reduced to two. Staff say this makes the mornings more difficult especially with people who are more highly dependent. Although this is a small home there are two people with a high level of need who require two people to support them. We were told by the deputy manager that it is the policy of the house to have two care staff to carry out Care Homes for Older People Page 23 of 32 Evidence: medications administration, although the registered manager has subsequently told us this is not the case, it is the duty of the keyholder. Although two domestic staff are employed, this is for cleaning and care staff are now doing the laundry which they did not do before the new management started. They say this also takes a lot of their time which they used to spend with people using the service. As mentioned elsewhere in the report, there are plans for people using the service to have trips out in the car, which will be planned so that there are always two care staff on duty. It is difficult to see how all of these arrangements can be met with two care staff working. People using the service tell us that they do not have to wait long for attention from staff, however the service should consider flexibility in staffing arrangements at peak times and when there are people who have high levels of need. We checked three staff files which showed us that all the correct background checks, and references have been sought before staff are employed. This is to ensure the safety of people using the service. The Annual Quality Assurance Assessment tells us that 65 of staff have either NVQ Level 2 or 3. Looking at staff files shows that most staff have NVQ 2 or are booked to do this qualification, and one staff member has NVQ 3. It is clear from observations and speaking to staff that they are well qualified, dedicated to their jobs and care about the people using the service. Staff speak and behave in a way that supports people as individuals. People using the service make comments such as staff are all helpful and pleasant, we are treated like family, very helpful, they have your interests at heart, and I dont think you could find anywhere better. We looked at training files as this is an area that the service has identified for improvement. All staff training is out of date from the previous management, and the deputy manager has written a training plan to make sure all staff will have most of their training by the end of March 2009 and the rest by the end of the year. The mandatory training includes dementia, depression, abuse, fire safety, moving and handling, food hygiene, health and safety, medications, which is above the requirements of the minimum standards. We checked the file of a new staff member who has had a full induction which meets the care industry standards. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of regular and experienced management support has affected the way the service makes important decisions relating to health care and management of risks. This has affected staff and in turn has affected the quality of support provided to people using the service. Evidence: During our visit we were helped by the senior carer who has taken on the role of deputy manager since October 2008. She has a lot of experience in care work, has NVQ level 2 and experience in working with rotas, payroll and time sheets from a previous role. She has taken on these tasks at the home and also has responsibility for the training plan, medications and other audits that the service carries out. The deputy manager says that she is supported in these tasks by the manager who is usually present two days per week. We spoke to the deputy manager and four staff that we met during the course of our Care Homes for Older People Page 25 of 32 Evidence: visit. Staff commented that when the new manager took over, there was a lot of support for staff, the managers presence was very strong and a lot of time was spent updating policies and procedures. Staff feel that procedures are very clear now. Staff say that the manager is very responsive when they ask for things. However everyone we spoke to said that in the past few months the manager has not been present at the home. They say that during most weekends and some days in the week there are no senior staff present. This has combined with changes to staffing and higher dependency of some people using the service. Staff say that in the absence of an experienced manager the lines of responsibility are not as clear. We saw supervision records for some staff which shows that supervisions have been set up. However three staff members say they have not had supervision since the new manager took over. The manager and deputy have been sharing the supervision tasks. There was a staff meeting in September 2008, and another one due in December 2008. We were told that a family member of a person using the service felt the standards of the service had slipped, but did not wish this to be treated as a complaint. We saw evidence of this in records relating to staff meetings. Some staff told us they feel the standards have slipped as the lack of direct management has allowed this to happen. As mentioned earlier in this report, some incidents relating to the health and well being of people using the service have been affected by the absence of an experienced manager to make important decisions relating to health care and management of risks. In addition, we, CSCI, have not been notified of incidents concerning one person using the service, which is in breach of the Care Homes Regulations 2001. While the deputy manager has excellent skills in care work and administration, she does not have the enough experience to manage the service. For example, she told us that she does not have any knowledge of the National Minimum Standards or the Care Homes Regulations 2001. The absence of an experienced care home manager is having an impact on the service provided. One person using the service told us the new managers are thoughtful but I think they have to find their way. We discussed all of the concerns raised in the report with the manager who was able to explain his absence and explained that his intention is to be the full time manager of the service from January 2009. He explained that he intends to fully support the deputy manager in any training and support needed. While this is reassuring we are concerned that we had not been notified of the managers plans during a period of uncertainty and that they appear not to have been communicated to the staff. During our visit we saw some good management practice in that all policies and procedures are up to date. The deputy manager carries out monthly audits for areas Care Homes for Older People Page 26 of 32 Evidence: such as health and safety, activities, and accidents. Medications audits are weekly, and six monthly surveys of people using the service and their families are carried out. These will be used to make improvements to the service. We noted that peoples money is kept safe and there is a secure system for recording all transactions, with a monthly audit taken of this. During our visits the two bath lifts and hoists were serviced. The service carries out health and safety risk assessments which are updated annually, and there are audits for all health and safety topics. We saw that all fire exit checks, fridge temperatures, meat, bath temperatures, and stair lift checks are all done by staff and recorded appropriately, and accident books are all complete and up to date. As mentioned above, the service is required to notify us when there is an incident affecting the health and well being of people using the service, which had not been done at the time of our visit. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 2 (b), (c) The service must make sure that the records used for care planning are up to date and provide meaningful instructions for staff. This is so that people have their care needs met by staff who are fully aware of any changes. 16/02/2009 2 7 13 (4) (c) The service must 16/02/2009 provide assessments of risk where peoples health may be affected, for example where reduced mobility affects pressure areas, where there is risk of falls or where restraint is needed. This is so the service can show how it has reached a decision about a persons care and show that this is the best course of action for that persons health and well being. Care Homes for Older People Page 29 of 32 3 18 13 (6), (7), (8). The service must make sure that where restrictive measures are used, people are prevented from harm and the circumstances are recorded. This is to ensure that people using the service are protected from harm and that decisions about their care are made in their best interests. 16/02/2009 4 31 12 1 (a) The manager must 16/02/2009 ensure that there are clear lines of accountability and that sufficent time is spent by experienced management staff to provide provision for the health and welfare of people using the service. People using the service must be supported by staff able to make decisions supporting their health and welfare. 5 36 18 (2) The manager must ensure that staff receive regular and appropriate supervision. This will will enable staff to carry out their jobs to meet the needs of people using the service. 16/02/2009 6 38 37 1 (e) The manager must 16/02/2009 ensure the health safety and welfare of people using the service. This includes notifying the Commission of any event which adversely affects the well being or Care Homes for Older People Page 30 of 32 safety of any person using the service. This will ensure that actions taken for the health, safety and well being of people using the service is properly monitored. 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 It would be good practice for the service to consider providing more detail in their assessments. This will make sure they know they can meet peoples specific needs before the person moves to the service. It would be good practice for the role of key workers to be explained to people when they move to the house and to be regularly reminded throughout their stay. Recording peoples individual activities would help to ensure people are not becoming isolated and that they have a chance to take part in activities of their choosing. The service should consider having clearer information for people using the service about what activities are on for the day, including television programmes, so that people can choose where they spend their time during the day. The service should make sure that the quality and quantity of fresh produce is not overlooked during the changes being made under the new management. The service should consider flexibility in staffing arrangements at peak times and when there are people who have high levels of need using the service. This will make sure everyone receives the service they need. 2 12 3 12 4 14 5 15 6 27 Care Homes for Older People Page 31 of 32 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. 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