Inspection on 21/01/09 for Chapel View Nursing Home

This inspection was carried out on 21st January 2009.

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

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

Other inspections for this house

Chapel View Nursing Home 29/01/08

Chapel View Nursing Home 12/09/06

Chapel View Nursing Home 12/10/05

Chapel View Nursing Home 31/05/05

Chapel View Nursing Home 04/03/05

Chapel View Nursing Home 06/05/04

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Hawkhills

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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: Chapel View Nursing Home Spark Lane Mapplewell Barnsley South Yorkshire S75 6BN     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: Jayne White     Date: 2 1 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 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 33 Information about the care home Name of care home: Address: Chapel View Nursing Home Spark Lane Mapplewell Barnsley South Yorkshire S75 6BN 01226388181 01226380270 chapel.view@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Chapelfield View Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Name of registered manager (if applicable) Mrs Lynda Jackson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Persons accommodated shall be aged 60 years and above. There are 19 beds registered for nursing (N) and 20 for personal care (PC). Date of last inspection Brief description of the care home Chapel View is owned by Four Seasons Healthcare Limited. The home provides nursing and personal care and accommodation to thirty-nine older people. The home occupies a central position in the village of Mapplewell in Barnsley, close to shops, pubs, the post office and other local amenities. The home is a two-storey building. There are thirty-five single bedrooms and two double bedrooms. There is a passenger lift. The home has a garden area that was well maintained and accessible. Care Homes for Older People Page 4 of 33 care home 39 Over 65 39 0 Brief description of the care home A copy of the previous CSCI inspection report was on display and available for anyone visiting or using the home. Information about how to raise any issues of concern or make a complaint was on display in the entrance hall. The manager confirmed that the range of monthly fees from 29th January 2008 were 351.50 per week. Care Homes for Older People Page 5 of 33 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: This was a key inspection and comprised information already received from or about the home and a site visit. We visited the home on 21 January 2009 without giving them any notice between 09:30 and 18:30. The visit also included attendance at an adult safeguarding meeting. Lynda Jackson, the registered manager was present during the majority of the visit. Bernadette Hinchcliffe, area manager was also available for some of the visit. The manager completed an Annual Quality Assurance Assessment before the site visit. This gives the service the opportunity to tell the CSCI how well they think they are meeting the needs of people using the service, what the home was doing well, what had improved since the last inspection on 29 January 2008 and any plans for improving Care Homes for Older People Page 6 of 33 the service in the next 12 months. Various aspects of the service were then checked during the site visit including inspection of parts of the environment, records relating to the running of the home, observing care practices and inspecting a sample of policies and procedures. We also sent out surveys prior to the inspection. Two were received back from people using the service. The majority of people living at the home were seen throughout the visit and several were spoken with about the care they received. The care provided for three people was checked against their records to determine if their individual needs identified in their plan of care were being met. We checked all of the key standards apart from standard 35, service users money and requirements from the last key inspection. All this information and peoples and staffs opinions and comments were considered for inclusion in this report. The inspector wishes to thank people living at the home, the staff and the manager for their assistance and co-operation during the visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: When people are admitted to the service, more detailed information needs to be obtained in the assessment process to ensure that all peoples needs can be met on admission. In addition, increase/improve quality auditing to make sure plans of care are updated as required, to reflect accurately the care that is provided to meet peoples needs. This also applies to actions to be taken from complaints and adult safeguarding Care Homes for Older People Page 8 of 33 investigations, so that emerging themes of complaints dont apply and people are not placed at risk of harm or neglect. Improve medication administration records, so that medication, including dietary supplements are administered to people as prescribed and there is a record of all medication received into the home. In addition, that people look after their own medication when an assessment has been made of their ability to do so. An immediate requirement was left for the service to undertake an audit of all handwritten medication by the end of the next day, so that people were administered medication in accordance with their prescription. To promote respect and dignity for people, people cared for in their own rooms must receive the personal care they need to maintain their health and wellbeing and their surroundings must be kept hygienic, clean and tidy. Individualise care and social activities for people by developing individual activity plans, a wider range of activities and recruiting an activity co-ordinator. The dependency needs of approximately 14 people were very high and increasing the number of staff would mean sufficient numbers of staff were available to fully meet peoples needs at all times. A more thorough recruitment process needs to be evidenced to make sure recruitment procedures fully protect people. An immediate requirement was issued to make sure the service took steps to achieve this immediately. Some staff did not have a programme of training in place that met regulatory requirements and National Minimum Standards including adult safeguarding, a structured induction programme, NVQ Level 2 in Care, safe food handling, fire safety, health and safety and management and control of infection. Review procedures for when peoples money is looked after by the home, so that people who entrust the home with looking after their money, can have access to it at all times. 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 33 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 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were assessed prior to their admission to the service. However, the assessment information needs to contain more detail and the information be verified, so that there is an accurate record of their assessed needs, so the home know the support they will need on admission. Evidence: To determine whether the service could meet peoples needs we looked at two peoples files to check admissions were not made until a full needs assessment had been undertaken. We also followed the admission process of another person as a result of a notification to CSCI and subsequent adult safeguarding investigation. We concluded a needs assessment was carried out that the person or a representative had been involved in. Information was also obtained from the hospital and placing social workers, if applicable, although written evidence of this was not always evident. Care Homes for Older People Page 11 of 33 Evidence: When we looked at information in the AQAA and spoke with the manager, admissions to the home only took place if the service were confident the staff had the skills, ability and qualifications to meet the assessed needs of the prospective person. However, in one instance this had not been the case and it was acknowledged by the manager there were learning points. This included confirming information obtained from professionals and people about a persons care needs was correct, which would enable the service to make sure before admission they could meet all aspects of a persons care needs and she intended to address this in future. The information from the needs assessment had been used to put together a plan of care for people. Care Homes for Older People Page 12 of 33 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. On the whole, the health and personal care that people received reflected what assistance they needed. There was a plan of care that the person or their representative had been involved in. The home need to support people better in managing their own medication and manage it more safely if they look after it for them. Overall, people were treated with respect, dignity and privacy. Evidence: When we spoke with people, they said they were usually satisfied with the care they received and always pleased with the medical support they received. They said, whilst we feel that ... may be isolated in her room and lacks mental stimulation the fact she is still with us is testament to the general level of care provided, the care given to my relative is excellent and the staff could not be any more caring, understanding or communicative and (theyre) very good at involving GP and escorting to A & E. We looked at two care plans. We also followed the care plan of another person as the result of a notification to CSCI and a subsequent adult safeguarding investigation. On Care Homes for Older People Page 13 of 33 Evidence: the whole, the plans contained good information, but care needs to be taken that the plan of care is updated as required, to reflect accurately the care that is provided to meet peoples needs. Also, quality auditing needs to increase/improve to make sure staff are acting on everything that has been identified they need to do to meet peoples personal and health care needs. For example, two plans of care identified the people must receive dietary supplements. There was no evidence in records that they were receiving these. In one instance, the plan stated the person must be weighed weekly. The record identified they had only been weighed on admission. A discussion with a member of staff highlighted dietary supplements were added to some foods as a way of increasing their calorific value and making sure people got all the correct nutrients. They stated they werent prescribed for anyone in particular, just what was left. This is not good practice, as dietary supplements are prescribed medication and should be administered as such to the person. In addition, it provides an incorrect picture of a persons wellbeing, if they are maintaining weight through dietary supplements. In another instance, the care plan stated the person would look after their own medication with support by staff. This was not happening. Staff had taken control of the persons medication. There was no indication of the reason for this. In addition, it was the intention that the person returned home, which could mean they were losing vital skills in maintaining their independence to do so. Additionally, a moving and handling risk assessment was incorrect/out of date and staff were not moving the person in accordance with the plan. Records of healthcare visits that were undertaken were maintained and demonstrated people did receive visits from healthcare professionals. People confirmed this when we spoke with them. The records viewed showed that in two instances pressure areas present on admission had healed. Where the other person still had pressure areas the view of the tissue viability nurse was that these were managed in accordance with local protocols and the service was managing them in the circumstances, as well as they could have. The social/activities care plan still needs to contain more detail and be more person centred, so that staff and the service can determine/plan how those needs can be met. When we spoke to people they felt staff treated them with respect. When we observed staff working there was clear and respectful communication between people and staff and staff treated people in a kind manner. On the whole, people were well dressed, with no food spillages on their clothes, tidy hair and clean nails. This indicated respect Care Homes for Older People Page 14 of 33 Evidence: and dignity by staff when caring for people. However, in contrast to this we saw a bedroom area that was not tidy. Dirty continence wear was on the bed and the bed was unmade and stained. This supports findings from a complaint that had been made and is a reflection of the comment made by a relative, mum is totally dependent. We accept that occasionally there will be smells, faeces in nails etc due to her condition and she has been at the home .... and usually looks well. Nursing staff administered medication to people identified as needing nursing care and senior care staff administered medication for those identified as needing personal care. When we spoke to a senior carer about the training they had received they said theyd received training through a college and Boots. They couldnt be clear about whether an assessment of their competency to administer medication had been made, other than by their assessor as part of their NVQ Level 3. In the action plan of a visit made by the regional manager in December 2008 it stated annual medication competency assessments to be undertaken by all staff who administer medication. Medicines were securely stored and additional storage had been provided for the safe storage of medication identified as controlled drugs. We looked at the recording and administration of medication on a sample basis for two people. We concentrated our sample on handwritten entries. For one person, two staff had not countersigned the written entries, which meant there had been no verification that the entry was correct. In two instances the medication to be administered on the medication administration record did not match that on the label of the dispensed medication. To make sure people were receiving the medication theyd been prescribed, an immediate requirement was made for the service to make arrangements for a complete audit of all their handwritten medication entries. In another instance, the amount of medication to be administered had been changed during the month with no record as to the reason for this. On the whole, medication received was clearly recorded on the persons medication administration record and medication administered, signed for. In addition, there was no record of the amount of medication carried forward from one month to another, which made the audit trail of that medication difficult to achieve. Added to this, when the stock of one medication was checked it identified there wasnt a record of all medication that had been received into the home. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. On the whole, people were assisted to make choices and decisions about their daily life, but there was no identified provision for people to take part in social/leisure activities of their choice for a more fulfilling quality of life. People were able to keep in touch with family, friends and representatives. They had nutritious and attractive meals and on the whole these were served at suitable times. Evidence: We saw that some people were able to spend their day as they wished, moving freely around the home and following their preferred routines. For people who were not as independent and their ability to express their choices was limited due to needing assistance with mobility, communication or being cared for in their own room, it was only when staff were undertaking caring tasks with them, that they had any interaction with another person. They spent their time dozing, watching events and staring at the television. This meant these people had no engagement with the world around them for long periods of time. We looked at the surveys returned by people. This told us one person usually felt there were activities arranged by the home they could take part in, another sometimes. Care Homes for Older People Page 16 of 33 Evidence: Their comments included, tends to be left in bed and misses activities such as entertainers - mum needs all cares and cannot walk, talk, dress etc, but can enjoy music and room activity and awaiting an activity co-ordinator, but there has been events organised as usual. The services own customer survey included comments about daily life and social activites and included, not enough fresh air and exercise is given. Stimuli is important to residents and there are staff shortages. Not enough attention is given to the sitting room area to give water, toiletting and communicating with the residents. When we spoke to people and their representatives they said, dont feel isolated (being in their room), enjoy watching TV, they come and check on you every hour and Xmas was lovely - tried to get them all up to open their presents. They had an entertainer and school choir in singing. The AQAA stated the service were planning to individualise care and social activities in the next 12 months. They felt it was something they could do better, by developing individual activity plans, a wider range of activities and recruiting an activity co-ordinator. The comments received by people and our observations highlight that this needs acting on, so that a more fulfilling quality of life is provided for everyone. When we spoke to people they told us their family and friends could visit at any time. When we spoke to family and friends they said, I would like to say that it is a pleasant home with a nice friendly atmosphere and a lot of friendly people, I like coming. I like the staff and everybodies got time of day for you. However, the service need to acknowledge some comments made by family and friends in their own customer survey so that all people feel welcome in the home, by enough seating being readily available for them to sit on. People were rising and having breakfast at various times in the morning. The AQAA told us 14 people needed the assistance of two staff to help with their care and 11 needed assistance at meal times. This dependency is high for 5 staff and a nurse to achieve personal care assistance and the help needed to assist people to eat their breakfast in the morning. However, the manager and staff said that more often than not people have had their breakfast and medication by 10 oclock. Today though staff said breakfast was finished by 10:30am. We saw the nurse still administering medication at 11 oclock, but they did say they were the last two. When we spoke to people they did say they received a drink when they awoke before breakfast. So although improvements had been made so that people got their meal at reasonable times, this needs constantly monitoring to ensure the previous scenario doesnt surface again. When we spoke to people they said they had a good choice of food and the quality of the food served was generally good. Care Homes for Older People Page 17 of 33 Evidence: The dining room was welcoming, being bright and clean. The menu for the day was available on each table, so people knew what the meal would be. When we saw the breakfast, lunch and tea time meals being served, there was no rush to the mealtime and people were given sufficient time to eat. However, the service at breakfast could be more responsive so that some people were not sat waiting enough time for them to comment, they might as well not bother now. Staff were patient and helpful and allowed people time to finish their meal. Care staff were sensitive to the those people who found it difficult to eat their meal themselves and needed assistance. They helped the person at their pace, making them feel comfortable and unhurried. Care Homes for Older People Page 18 of 33 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. There was a complaints procedure that people had access to and felt confident using. However, people may be at risk of harm/neglect through lack of staff training in adult safeguarding, the assessment process and care practices that are not sufficiently monitored and addressed. Evidence: On the whole, people were satisfied with the care they received and felt safe. When we looked at surveys it told us people knew how to complain and they knew who they would speak to if they werent happy. When I spoke with them they said they had no complaints. One commented, nobody can complain about this place. This indicated there was an open culture that allowed people to express their views and concerns in a safe and understanding environment. People could access the complaints procedure because it was displayed in the foyer and clearly described the procedure for people should they have any concerns. It was clearly written, easy to understand and explained what the procedure would be and how long the process would take. The AQAA told us 3 complaints had been made, one which had been upheld. This was confirmed when we looked at the complaints record. The one that had been upheld highlighted that the findings today of a persons room was a similar issue and Care Homes for Older People Page 19 of 33 Evidence: highlighted there may be a lack of action being taken to address emerging themes (see health and personal care). The AQAA confirmed there were policies/procedures/codes of practice in place to protect people from abuse. The AQAA stated the plans for improvement in the next 12 months was to continue with protection of vulnerable adults training. The knowledge of the manager in respect of safeguarding adults was good and the service had the local adult safeguarding policy and procedure for South Yorkshire. However, when we spoke to staff about reporting any allegations there was an inconsistent approach to whistle blowing as one said theyd had training and knew who to report it to, although they did state it would depend on the type of abuse. Another member of staff had not received training, but said they would report any abuse they were aware of or had been reported to them. When we looked at 3 staff records, none of those staff had received adult safeguarding training. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. On the whole, the living environment was clean and provided a well maintained and comfortable environment for people to live and enjoy. Evidence: When we spoke to people they said they were satisfied with their living environment. They said their bedrooms were comfortable and some people had personalised these with pieces of their own furniture and possessions. They said, lovely room. Beds always made, clean and tidy, lovely cleaner, its kept clean and tidy and if I use commode its emptied straight away. They told us there is always hot water and the home was kept warm. The physical environment on the whole, was suitable for the needs of people that lived there. The shared areas provided a choice of communal space. When we looked round the home, the main lounges and dining area presented a pleasant and homely environment for people to live and they were well lit. There were sufficient bathrooms and toilets for people that were appropriately located and easily accessible. There was a mixed response from peoples surveys about whether the home was fesh and clean. One said usually, another sometimes and one commented, can smell of stale urine. When we inspected the environment, on the whole, it was clean, but Care Homes for Older People Page 21 of 33 Evidence: there was an odour on entering the home in the morning and during the morning in one of the lounges. The service need to monitor this. The AQAA highlighted improvements that were planned in the next 12 months and included, upgrading bathing facilities, redecorating communal areas in 2009 and continue with planned programme of replacement for bedroom furniture. Care Homes for Older People Page 22 of 33 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. Increasing the number of staff would mean sufficient numbers of staff were available to fully meet peoples needs at all times. There was a high staff turnover and recruitment procedures did not demonstrate all checks had been done to make sure staff were suitable to care for people. On the whole, peoples needs were met, but some staff hadnt received relevant training. Evidence: Generally, when we spoke to people they had confidence in the staff that cared for them and that on the whole staff were available when they needed them and they listened and acted on what they said. Their comments included, usually act on families comments, manager is always keen to hear what I have to say, I am aware that they are busy at times and tend to visit out of hours so management often not present. The AQAA told us the dependency needs of 14 of the 30 people living at Chapel View were very high. These people needed full assistance with all aspects of personal care and required nursing input. The staff on duty, to their credit worked hard and were patient and showed empathy to people. They had good relationships with the people that lived there, however, there were occasions when people had to wait for assistance to go to the toilet because of the assistance they needed and the number of staff Care Homes for Older People Page 23 of 33 Evidence: available. We also saw one person being asked by staff to sit down and remain in the dining room both at the breakfast and tea meal. Their purpose was clear - so the person was safe until a carer was available to supervise in the lounge. However, this demonstrates staffing levels are insufficient to support people and support them in their choices of daily routine, when they would like. In addition, the managers understanding of minimum staffing requirements were calculated using the number of people and not their dependency. This had been highlighted at previous inspections. The AQAA told us training opportunities were provided that tried to deliver a programme that met statutory requirements and National Minimum Standards. It stated staff were trained to a minimum of Skills for Care Induction Standards, 33 of staff held NVQ Level 2 in Care, 50 of catering staff and 10 of care staff had received training in safe food handling and 20 staff were trained in the prevention and management of infection control. The number of staff trained to NVQ Level 2 in Care had decreased from 80 at the last inspection, but this was probably the result of 75 of staff leaving. We looked at 3 staff training records to confirm information in the AQAA. However, this told us none of the staff had completed a Skills for Care Induction and the only other certificated training they had received since starting employment was moving and handling. There was no evidence that supervision had been held for these staff to identify a programme of training to ensure they were up to date with current practice and relevant training. The AQAA stated there was a recruitment policy in place and that everyone who had commenced employment in the last twelve months had satisfactory pre employment checks, including ensuring a CRB and POVA first check was undertaken prior to commencement of employment. However, this was not what we found when we looked at three staff files and information provided by an agency for another member of staff that was working. No evidence could be provided that the member of staff from the agency had a current satisfactory CRB. In addition, evidence that a permanent member of staff had a current CRB or POVA first check could not be provided. An immediate requirement was made for these staff not to work on shift until at least a satisfactory POVA first check was received, to ensure people living at the service were sufficiently protected by the services recruitment procedures. The files did contain an application form, declaration of health and identification, but all the files did not contain the employees full employment history with written verification in gaps of employment. All of the files had verification of two written references before they commenced employment. Care Homes for Older People Page 24 of 33 Care Homes for Older People Page 25 of 33 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 management and administration of the home was based on openess and respect. Quality assurance systems were in place to promote the health, safety and welfare of people and staff, but these need to improve to make sure staff receive relevant training to keep people safe. People were not able to access money held on their behalf by the service at all times. Evidence: On the whole, people expressed satisfaction with the service they received. The manager is a qualified nurse and very experienced in the care of older people. Information from surveys and discussions with people and their representatives comfirmed they were all happy to approach the manager at any time for advice, guidance or to look at any issues. They all said that they were confident she would respond to them appropriately and swiftly. Her direction and leadership promoted a relaxed and friendly atmosphere. Care Homes for Older People Page 26 of 33 Evidence: All sections of the AQAA were completed and the information gave a reasonable picture of the current situation within the service, including identifying improvements, so that the quality of life for people is improved. The service had quality assurance systems in place, including giving the people and their representatives using the service the opportunity to give their opinion of the care provided. The latest quality assurance audit dated December 2008 showed the overall customer rating as 12 very good, 51 good, 21 fair and 3 poor. The area manager continued to carry out monitoring visits and complete regulation 26 reports. The reports identify her findings of the visit, who she spoke to and identified what action the service needed to take to improve. Monies held by the home on behalf of people were unable to be inspected as no access could be gained because the administrator had gone off duty. This standard had been met at the previous inspection and a review of evidence before this visit identified this had not changed and therefore a further visit was not made to check them. However, it must be noted this highlights people cannot access their own records or money whenever they may wish. The AQAA stated maintenance of equipment was in place for premises electrical circuits, portable electrical equipment, hoists, fire detection and alarms, fire fighting equipment, emergency lighting, emergency call equipment and gas appliances. Discussions with staff and their training records highlighted not all staff had received statutory training in health and safety and fire safety, however, evidence suggests this had not yet resulted in placing people at risk. Fire exits had been kept clear, which should make it easy for people and staff to leave the building in the event of a fire. Care Homes for Older People Page 27 of 33 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 33 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 1 9 13 All handwritten entries on medication administration records must be checked against the actual prescription. To make sure people are receiving the medication they have been prescribed. 05/02/2009 2 29 19 Staff without evidence of a 10/02/2009 full CRB that is satisfactory or a satisfactory POVA first check must not work on shift until at least a POVA first check is in place. Supervision arrangements must then be in place until a full satisfactory CRB is in place. So that the recruitment process is sufficient to protect people. 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 9 12 Regulation 12 (1) (a) People must be able to manage their own medication when and if it is safe to do so after assessment. 21/02/2009 Care Homes for Older People Page 29 of 33 To maintain peoples independence and promote control over their lives 2 9 13 Regulation 13 (2) 21/02/2009 Medication administration records must be an accurate record of medication prescribed for people. They must demonstrate a record of all medication received into the home. In addition, there must be a record of why there has been a change in prescribed medication during the month and who has authorised the change. So that people are protected by the homes policies and procedures for dealing with medicines. 3 9 13 Regulation 13 (2) A record must be made when people receive dietary supplements that they have been prescribed. So a record is maintained to confirm they are receiving the medication they are prescribed to maintain their health. 4 9 13 Regulation 13 (2) Dietary supplements prescribed for people must not be added to all peoples food to increase the calorific value. 21/02/2009 21/02/2009 Care Homes for Older People Page 30 of 33 So that people do not receive medication they are not prescribed. 5 10 12 Regulation 12 (1) (a) 21/02/2009 Systems must be in place so that people cared for in their own rooms receive the personal care they need to maintain their health and wellbeing and that their surroundings are kept hygienic, clean and tidy. To promote respect and dignity for people. 6 18 13 Regulation 13 (6) Staff must be trained in adult safeguarding. To prevent people from being placed at risk of harm or abuse. 21/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 To make sure all peoples needs can be met on admission, the assessment information needs to contain more detail and information provided by professionals and the person verified. This includes obtaining a written summary assessment from those professionals. This also links to standard 12. To identify, demonstrate and plan for the level of social stimulation people need and that this is agreed and provided, care plans should contain more detailed information regarding the social care needs of people and be more person centred. Quality auditing of care plans should increase/improve to make sure staff are acting on everything that has been identified they need to do to meet peoples personal and Page 31 of 33 2 7 3 7 Care Homes for Older People health care needs. 4 9 So that people receiving medication are not placed at risk of harm, staff should receive an assessment of their competence to administer medication. At all times suitably qualified, competent and experienced people should be working in such numbers that are appropriate for the ealth and welfare of people living there. This also links to standard 30 and standard 38. So that people can be confident in the skills of staff that care for them staff should be trained in aspects of care they provide including having a structured induction programme, NVQ Level 2 in Care, safe food handling, fire safety, health and safety and management and control of infection. So that people are protected by the homes recruitment procedure staff should not commence work until a full employment history is obtained with written explanations of any gaps in employment. So people have access to their own financial records and money at all times, systems within the home should be addressed to facilitate this. 5 27 6 28 7 29 8 35 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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