Inspection on 22/10/08 for Charnwood House

This inspection was carried out on 22nd October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Charnwood House 26/09/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Charnwood House 49 Barnwood Road Gloucester GL2 0SD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Wendy Kirby     Date: 2 2 1 0 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: Charnwood House 49 Barnwood Road Gloucester GL2 0SD 01452523478 01452523478 mel_holland123@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Apsley Park Ltd Name of registered manager (if applicable) Melanie Katherine Holland 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: The maximum number of service users who can be accommodated is 35. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home This care home is registered to provide predominantly nursing care to 35 elderly people. There is a qualified nurse on duty at all times. Accommodation is over three floors and there is a shaft lift and stair lifts to help with access. The home provides a mixture of single and double bedrooms. There are two communal lounge areas, a conservatory and dining area, all with access to enclosed gardens and paved courtyards. The home has been extensively extended and is set back from the main road. There are gardens to the front of the house and some off road parking is available. The care home is situated on a road leading to Gloucester City. It is Care Homes for Older People Page 4 of 32 care home 35 Over 65 35 0 Brief description of the care home therefore on a well serviced bus route. It is close to a doctors surgery, local chemist, public house, petrol station and local shops are approximately five minutes away by car. Gloucester railway station is accessible by bus. It costs between 550 pounds and 650 pounds for self funding people to stay at the home dependent on their needs. Costs for people funded by social services are determined between the funding authority and the home. There is a notice on the main notice board informing visitors that the last inspection report produced by the Commission for Social Care Inspection (CSCI) is available on request. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced Key Inspection which included a visit to the home. The visit was completed by one inspector and lasted approximately nine hours. Prior to the inspection we (The Commission) looked at various pieces of information to gather evidence in preparation for our visit, which included the following: The previous inspection report. The homes inspection record, which gives us an account of any information we have received about the home since the last inspection. Care Homes for Older People Page 6 of 32 The Annual Quality Assurance Assessment, known as an AQAA. The home is requested annually to complete and return this assessment to us by a specified time. We received the AQAA on time, which contained information about what the home considers it does well and what plans they have for further improvements in the coming year. We sent surveys Have Your Say to people who live in the home and twenty-two were completed and returned. Comments received form the surveys will be referred to throughout this report. We also received eight completed surveys from staff and four from health professionals who regularly visit the home. Details from these will also be used in this report. During our visit we spoke with some of the people who live in the home, visitors, the registered provider, the manager and other staff members who were on duty. We also looked at how effectively staff engage with people in the home and how they were interacting and communicating with each other. We looked at four individual care files, which included, pre-admission assessments, care plans and risk assessments. We also looked at a number of records and files relating to the day-to-day running and management of the home. We spent time in all communal areas of the home and some of the bedrooms. We finished the inspection with a feedback meeting between the registered provider and the manager who demonstrated a very caring, committed attitude to their roles and responsibilities in ensuring they provide quality of care to the people who use the service. We would like to thank everyone who took part in the inspection, their enthusiasm and support was greatly appreciated. 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. People looking for somewhere to live receive adequate information so that they can decide if this is the right home for them. Peoples needs are assessed prior to admission to determine the suitability of placement. They can be confident that staff will have the resources and skills to meet their assessed needs. Evidence: The homes statement of purpose contains the information that people need to help them make a decision about where they want to live. This information is also available on CD and audiotape to assist people with sight and hearing impairment. People are encouraged to visit the home as many times as they want and perhaps stay for lunch, dependent on their wishes. Our surveys confirmed that people felt they had received enough information about the home before moving in. Comments included, Care Homes for Older People Page 10 of 32 Evidence: My sister arranged for me to look around the home before I made my decision, My children brought me to see the home and I was happy to move here and I had plenty of information and the home was recommended to me by friend who already lived in the home. We were told that some people have initially moved into a double room when single rooms have not been available on the understanding that they will be offered a single room when one becomes available. Some people said that they were told after admission that they would have to accept a shared room on a permanent basis. We spoke with the manager about this who assured us that people are offered single room accommodation when it becomes available and that unfortunately some people may not be able to afford the extra funding required for a single room. It was agreed that prospective clients need clarification prior to admission that single rooms will be made available but at an additional cost. We looked at the pre-admission assessments, which were comprehensive covering all activities of daily living, a full health screen and personal history background. The information gathered pre-admission should provide a sound benchmark of the persons ability, state of health prior to admission and subsequent needs when they move into the home. People wishing to live in the home, family and carers are involved in the pre-admission assessment wherever possible and all information is used to determine the suitability of the placement. Where possible the manager also obtains comprehensive assessments and care plans from other health and social care professionals involved, for example, social workers and hospital staff. The manager clearly demonstrated the importance of thorough pre-admission assessments in order to ensure that the home can meet individual needs. The manager told us that on occasions when there may be some doubt as to whether the home could meet someones needs the pre-admission assessment is completed by the manager and a trained nurse. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Because they are consulted about their health and personal care needs people can be sure their views and expectations will be considered. The health and personal care that people receive is based on individual needs. Safe systems of practice are in place in receiving, storing, administering, and disposing of drugs which will help protect the health and wellbeing of people living in the home. People can be confident that staff have a good awareness of their needs and that they will be treated with dignity and respect. Evidence: From the pre-admission assessments the staff are able to develop a set of care plans based on identified needs. During the first months trial period the plans are reviewed weekly and developed accordingly. Care plans were completed with regards to health and social needs including, Care Homes for Older People Page 12 of 32 Evidence: psychological, emotional, and cultural needs which demonstrates that the home takes a holistic approach to the provision of care. All plans were detailed and person centered including personal preferences, likes and dislikes. One plan told us that a person in the home had specific requests when settling down for the night, which included a cup of tea at 9pm, a blanket must be provided for the persons knees and shoulders and the call bell must be attached to the persons teddy bear. This is very good practice and clearly demonstrates that people are involved in deciding how they want to be looked after and cared for. All care records showed consistency in assessing, planning and evaluating care as required. The home conducts regular care review meetings for people, which includes the involvement of family members and key worker wherever possible. This allows the opportunity to discuss and evaluate care plans and any issues or concerns people may have. Twenty people told us that they receive the care and support they need comments included, My every wish is catered for thank you and I always receive the care I need where necessary. Records of the GP visits and the outcomes were documented. Specialist referrals and visits from other professionals including District Nurses, Chiropractors, Dentists and Opticians were also seen. Health care professionals including GPs and staff from the Community Support Team told us, The home always makes appropriate requests for GP visits, The home has built up good relationships with the Support Team and regularly contact us for advice and assessments. People said they always felt that they received the medical support they needed, comments included, Oh yes I can always see the doctor, he is only two doors away and They will always call the doctor when I ask them. Health Care needs are monitored and documented in the care files. Nutritional assessments are completed on admission and reviewed monthly, people are weighed as part of the review. Care plans are written for people who are nutritionally at risk, these include personalised information such as likes and dislikes. Specialist health care support is sought and referrals are made to Community Dieticians and the Speech and Language Therapists at the local hospital. The speech and language therapist told us, Staff awareness of problems associated with people who have swallowing difficulties has greatly improved and appropriate referrals are made. All of the recommendations we make to the home with regards to implementation of care are carried out by all staff consistently. The home also seeks guidance and expertise of the community Tissue Viability Nurse (TVN). The home now has a lead nurse who attends monthly community TVN Care Homes for Older People Page 13 of 32 Evidence: meetings; wound care training is accessed through the local Primary Care Trust (PCT) and other community resources. Wound management care plans were clear and detailed, each wound was marked on a body map and pictures of the wounds are taken on a regular basis to assist with identifying any improvements or deterioration. A written evaluation is recorded following any redressing of a wound. We spoke with some staff who demonstrated good relationships with individuals and were knowledgeable about the care needs of those living in the home. Staff agreed that they had up to date information about individuals needs, they confirmed that care plans were reviewed at least monthly unless there were any other significant changes, staff were also updated at the handover session before each shift, although one staff member said that handover doesnt always happen on the afternoon shift. Policies and procedures for receiving, storing, administering and disposing of medications were examined and discussed with the manager. All systems in place are effective and well managed. The home operates a monitored dosage system for the administration of medication, which is supplied at regular intervals by the local pharmacist. Six monthly medication reviews are completed by GPs. Since the last inspection and subsequent requirements the home has improved its policies and practices around some areas of medication. Two trained nurses now sign for any verbal changes in medication made by the GP over the phone. The CSCI Pharmacist Inspector has supported the home to introduce a new protocol for drugs that are given to people on an as needed basis. Guidelines are kept with the medication charts for those people who require insulin in case of an emergency. Fridge temperatures are recorded daily. The administration charts were legible and continuity of administration was shown with a signature from the person dispensing. There is an monthly audit of medication systems in the home, which includes, administration of medication, storage and stock control and accurate record keeping. The home promotes privacy and dignity to all people who use the home. Staff attend training on promoting privacy and dignity on induction, which covers the importance of closing doors and pulling curtains when delivering personal care and knocking on peoples doors and waiting for an invitation to enter before going into their rooms. We saw staff knocking on bedroom doors before entering, members of staff spoke respectfully about individuals needs and referred to them in the term of address that they preferred, this information was documented in the care files. Some of the rooms are shared by people living in the home and suitable screening is Care Homes for Older People Page 14 of 32 Evidence: provided by way of curtains to protect peoples privacy. On occasions staff have found it difficult to give personal care and maintain privacy for people in the home, due to lack of space within the screened areas, this is addressed later in the report under section about the environment. All health care professionals who visit the home told us that privacy and dignity is respected comments included, Screens are used in shared rooms and conversations are conducted in private and Staff are always respectful throughout my visits. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a varied activities programme, which is both enjoyable, stimulating and meets individual preferences and expectations. People maintain family contact and staff encourage family and friends to join in with activities and any outings. The home actively promotes individuals to exercise choice and control over the lives they choose to live. People receive a varied and wholesome diet that they are able to influence. Evidence: There is a newly appointed activities coordinator who has settled in well and proving a big hit with many of the people living in the home. We received very positive comments from people who seemed well informed about the plans arranged for each week, each person is given a weekly time table every Tuesday. Although there are group sessions the coordinator also spends individual time with people in the home, one relative told us about the coordinator and said, He is very Care Homes for Older People Page 16 of 32 Evidence: good and will often go to my relatives room and play scrabble or drafts. Other comments from people living in the home included, The activities provide individual and group sessions to meet various needs, I feel he does a very good job and pays good attention to me and I am very happy and look forward to him coming. Following any interaction with people the coordinator documents the session and its value to individuals. Personal profiles are also being completed for everyone living in the home, these were very detailed, interesting and told us a lot about peoples lives prior to moving into the home, their personal preferences and how they choose to live their lives now. Useful information is shared by having notice boards throughout the home, we also saw photographic displays of memorable events which provide topics of conversation and allows for people to reminisce. People in the home are able to choose how they wish to spend their day and there doesnt appear to be any rules in the home, daily routines are flexible. People told us, I make my own decisions and I like to stay in my room, I like to sit on my own and I have my books and newspapers, I dont like too much noise and I choose not to participate in many things in the home, but I am always offered the opportunity. We met the head cook who had worked at the home for nearly thirteen years, she was very happy in her work and demonstrated good awareness of the individual needs and preferences of people in the home. The cook and kitchen assistants meet every three months with the manager and registered provider to discuss coming events, any issues or concerns, training requirements and any improvements needed. Although there is a four week menu plan for people living in the home, everyone is asked daily about what they would like to eat and they dont have to have whats on the menu if they dont like it. The cook told us that the food budget was ample to provide the variety of food required and the excellent standard of produce they access. All food is freshly prepared in the home on a daily basis including, cakes, pastries, bread, soup and fruit salad. The kitchen has recently been redecorated and fully refurbished, it was very clean, spacious and well equipped. Stores showed a good range of foods, including well known brands and plenty of fresh produce. Documentation was provided to show that required temperature checks were being carried out on fridges and freezers and that food was also being probed after being cooked prior to serving. Care Homes for Older People Page 17 of 32 Evidence: The size and layout of the dining room makes it possible for some of the people to enjoy the social advantages of dining together and the conservatory is also used to accommodate people. Staff had used their expertise and knowledge of the individuals, personalities, preferences and ability to eat independently, when seating them for lunch. Some people chose to have their meals in their rooms and we saw trays attractively laid with doilies and condiments. People that required assistance with eating their meals were supported by staff members, this was performed in a respectful, sensitive way, without rushing and staff were sat at the same level. We saw one staff member in particular who described the food on the plate, made polite conversation and offered a drink throughout the meal. We asked people if they liked the meals in the home and in general the results were positive comments included, My relative enjoys most of the meals and is always offered an alternative for things she does not like, Excellent meals and a good variety, Sometimes the portions are larger than required and the plate is cold and I think they do really well. The cook told us, As long as they are happy I am happy. The cook and staff team enjoy having themed events, which are popular with people living in the home and their families and friends, such events have included, Barbecue on Bonfire Night, Hawaiian Day and an Irish day. The food is themed and staff dress up in costumes for the events, they also have entertainers including Morris Dancers and someone playing the Bag Pipes. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good policies and procedures in place to manage complaints and people can be confident that their concerns will be listened to and acted upon. There are good arrangements in place for staff training and awareness of protecting vulnerable adults so that people living in the home are further protected from abuse. Evidence: The complaints policy and procedure is detailed and contains all the required information, this can be found in the service user guide which is given to people on admission, it is also displayed on notice boards throughout the home. Six out of twenty people living in the home stated in our surveys that they did not know how to make a complaint. It was thought that there could be two reasons for this. Some people had been in the home a long time and may had forgotten that they had been given this information and other people rely on their families to discuss issues or concerns on their behalf. The manager agreed that it might be a good idea to discuss the complaints policy and procedure at the meetings that are arranged for people living in the home as a gentle reminder. People told us that they knew who to speak to if they were not happy comments included, All staff are very good and kind, I would speak to my key worker and Care Homes for Older People Page 19 of 32 Evidence: carers and I feel I can talk to anyone. Staff surveys indicate that staff are also fully aware of the homes policy and procedures about complaints and supporting peoples rights. There are policies and procedures as well as a range of guidance information on the topic of protecting vulnerable adults from abuse. The availability of this information should increase staff awareness and their role of protecting people in the home. We were told that the home actively promotes staff training in this area on induction and on an annual basis staff receive an update. A number of staff are also enrolled on the National Vocational Qualification (NVQ) in Care Award and a component of the award addresses issues about protecting vulnerable people. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. When the refurbishment and redecoration of the remaining parts of the home are completed, people will live in a safe, peaceful and well maintained environment. Since the completion of the communal rooms, bathrooms and some of the bedrooms facilities are suitable and well presented for their purpose and meet the needs of people living in the home. Evidence: The inspector had a tour of the home with the manager and examined all areas and most bedrooms. Charnwood House is a large Georgian property with many original characteristic features. Prior to the registration of the new provider the home had become run down and outdated. Since registration the registered provider has continued to make good improvements in the environment by redecoration and refurbishment and investment in this continues. We acknowledge this progress and we are confident that the work will be completed. We feel it would be beneficial to the Commission and to the registered provider that he produces an improvement plan detailing the ongoing refurbishment programme and how this will be implemented. Care Homes for Older People Page 21 of 32 Evidence: The lounge and adjoining dining area has recently been redecorated and new furniture and accessories were provided. People living in the home were involved in choosing colors and divided the space to suit their needs. The dining area looks out onto a new paved area with seating, flowerpots and a water feature, beyond this is a small, well maintained, secluded garden with a variety of trees, shrubs and flower beds. New fencing and gates have also been provided to further ensure peoples privacy and safety when outside. On the other side of the home is an additional living open plan area that also provides access to some bedrooms and a pleasant conservatory. The home does lack space and so this additional area for people to enjoy is at times compromised by hairdressing, equipment and staff lockers. However the registered provider and the manager are continuing to look at how space can be effectively utilised throughout the homes refurbishment process. At the last inspection it was noted that the conservatory got extremely hot in the warm weather and that there was no suitable screening to protect the people from the direct sun. New blinds have now been fitted and people were seen using this area throughout our visit. The conservatory looks out onto a pretty courtyard. Some condemned furniture had been put in this area but we were told this was a very temporary measure until the skip had arrived. Some bedrooms have been decorated and the colors used are tasteful and give warmth to the rooms, people had personalised their rooms with ornaments, furniture and pictures. Many of the rooms are still in need of redecoration and refurbishment and as mentioned previously this will continue. Bedroom furniture has been replaced in the newly decorated rooms providing adequate storage for peoples belongings. Although the rooms are not en suite people have individual commode facilities should they need them and there are toilets situated throughout the home for peoples use, new vanity units have also been fitted in some rooms. We understand that to make the home financially viable the home has to be able to accommodate a certain number of people. There are many shared bedrooms in the home and although the sizes meet the national minimal standards some rooms may not be conducive to provide nursing care whereby a lot of specialised equipment is required and therefore subsequent space is needed. We did receive some comments from surveys about the smallness and lack of natural light in these rooms, some staff also felt that it was difficult to maintain privacy and Care Homes for Older People Page 22 of 32 Evidence: dignity at times partly due to the positioning of the screening. The manager told us that as rooms are refurbished the screened area will be reviewed in order to support carers to be able deliver personal care in a dignified private manner with adequate space. Since the inspection one particularly small double room has been made into a single room, this room now has a good space for sleeping and personal care and a very nice area to use as a living area where one can receive guests. In light of the registered providers continued desire and efforts to improve the environment for the people in the home it was disappointing to see that in the majority of rooms curtains were not hung properly, nearly all of them did not have enough curtain hooks and did not hang effectively when curtains were drawn. The manager made a list during the inspection of the rooms where this was the case and we were told that new hooks would be provided. We also saw that towels and flannels were badly frayed, worn and torn. We were told by the manager and the registered provider that laundry staff should condemn any items that are not fit for use and that they would reiterate this to the staff again as a reminder. We were informed shortly after the inspection that new towels and flannels had since been provided. Bathrooms and toilets had been refurbished and were clean and well equipped. One of the shower seats and two doors in the wet room needed replacement and we were told that this was being addressed. In general it was felt that the overall cleanliness of the home had improved since the last inspection, people living in the home told us, There are no smells like in other homes and My room is always clean and tidy. One person said, Sometimes hair is left on the floor for sometime after the hairdresser has gone and arrangements should be made to hoover this up when the session is over. Care Homes for Older People Page 23 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. The home promotes staffing levels and skill mix of staff in order to help ensure that people needs can be met. The recruitment policies and procedures set up in the home should help ensure that people living in the home are supported and protected. The training provided to staff should help ensure that staff have the skills and resources to meet peoples needs. Evidence: The manager ensures that staffing levels are indicative of the needs and levels of care required and confirmed that levels of staff rise should dependency levels increase. We saw that staffing levels had increased recently due to the deterioration of two people living in the home. Most surveys agreed that staff were always available when they were needed and listen and act upon what the people living in the home say. Comments included, Staff are always available, They see to me whenever I ask but sometimes I have a short wait if they are busy. We spoke with several people who expressed very positive views about staff and the care they receive one person said, I am so lucky to be here Care Homes for Older People Page 24 of 32 Evidence: all of the staff are caring and kind and I am well looked after. We asked staff if they felt that there were enough staff to meet individual needs of people in the home, staff replied, Generally we have enough staff but we tend to use agency on the weekends, staff incentives would encourage people to work weekends and As with most care homes staff come and go and sickness is a big factor, the home always has the correct amount of staff because we use agency. This can affect the continuity in care because they dont know the people living in the home. The manager told us that the home is currently advertising for permanent staff. She takes recruitment seriously and will not fill vacancies unless people are suitable for the roles and responsibilities expected of them. The home does use agency in the absence of permanent staff and although this can be unsettling for both people living in the home and staff the manager is vigilant in maintaining adequate staffing levels. The same agencys are always used to try and maintain some continuity in care. The recruitment records were examined and showed that the home follows good recruitment procedures. Records contained application forms with an employment history, two written references, and a CRB (Criminal Records Bureau) disclosure. This will help ensure that the right people are employed to work at the home and people living in the home will be further protected. There is an induction programme, which covers all mandatory training, including Fire, Manual Handling, Health and Safety and the Protection of Vulnerable adults. The home has a mentor system where all new staff are linked with and shadow a senior staff member during each shift to enable continuity and continued training throughout the induction process. Staff told us that induction in the home is very good comments included, I was very happy with my induction, Induction was very thorough I was not allowed to do any practical work until I had completed all the relevant training. The home provides the staff with training and development opportunities tailored to individual needs. The manager and staff are conscientious about attending training relevant to the care needs of people living in the home. All staff surveys told us that they receive training relevant to their roles and responsibilities in order to understand peoples needs and to keep up to date with current practice. Staff comments included, My manager is constantly bringing new training and initiatives to my attention, The manager is very supportive and encourages and arranges many study days for us to attend. One staff member told us, The manager is very good and she will put us on courses that will benefit us, she will also ask us if we have any specific training we would like to do. Even when we may not understand something or ask her about an individuals needs she will often come in the next day with piles of information for us to Care Homes for Older People Page 25 of 32 Evidence: read. The home continues to support staff in the NVQ in Care Award and five have recently commenced this. We also asked staff if they felt that they had the right support, experience and knowledge to meet the different needs of individuals. Information we received was constructive and demonstrated that staff take their roles and responsibilities seriously. Comments received included, I think you continue to learn on a daily basis I have been working in care for twelve years and I am still learning, I feel I get a lot of support from the manager regarding training and understanding the ever changing needs of people in the home and I feel that I lack experience on issues about faith, race and ethnicity, however I dont believe that this has an impact on the services I provide at the moment. We know from the homes AQAA and from talking with the manager that training with regards to these areas and equality and diversity is being accessed for staff to attend this year. We spent some time throughout the day observing staff carrying out their duties and assisting people. Staff were respectful, warm in manner, good humoured and sensitive toward people within a relaxed, calm environment. All staff demonstrated a very caring, committed attitude to their roles and responsibilities in ensuring they provide quality of care. Care Homes for Older People Page 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs and best interests are central to the management approach in the home. Staff feel that they receive supervision and support that is appropriate to their roles and responsibilities in the home. The health and safety of people who use this service is protected. Evidence: Throughout our visit the manager demonstrated good, effective leadership and management skills that relate to the aims and purposes of the home. She has worked hard since the last inspection in meeting and maintaining current standards the home has to offer. She shared various new initiatives in order to further develop standards and procedures and she is fully supported and encouraged by the registered provider. Care Homes for Older People Page 27 of 32 Evidence: It was evident the manager and staff are a stable team that supports a commitment to providing quality care for the benefit of the people living in the home. Staff made very positive comments about the manager including, Since the employment of the new manager I feel the home has turned around, it has greatly improved in may ways, she is very much respected by staff and very approachable and The management listens to staff and people living in the home and they are easy to approach. We received a high degree of satisfaction expressed by many of the people who use the service who stated, The staff are kind and respond to my needs, Great home, staff are very very happy and look after all my needs, This is the next best thing to home and Charnwood House has improved over the last eighteen months, including the management, the care and the cleanliness. The home continues to work hard developing formal quality assurance and has recently completed an audit, to assess the satisfaction of people with regards to the service that the home provides by asking them to complete surveys. The results and comments from the surveys were in the process of being collated and documented. The results will enable the home to identify strengths and weaknesses within the service they provide and will form part of their development plan for the coming year. As mentioned previously in the report the home completes an AQAA for CSCI which provides us with information about where the home feels it has improved and their plans to improve in the next twelve months. The areas identified include monitoring staff performance in equality and diversity, staff training and improvements to the environment. People who live in the home, relatives and friends are invited to meetings approximately every three to four months. Attendance varies due to peoples availability, one relative said, If I need to ask anything I would ask the manager when I visit to keep up to date with things going on in the home. The home also produces a useful quarterly newsletter, which contains lots of information including future events, new staff, welcoming new people living in the home, and special anniversaries. The home does not hold any personal money for people living in the home. People manage their own money or rely on support from families, friends and other advocates acting on their behalf. There is an annual appraisal process, which ties in with the supervision arrangements. The management have established a formal recorded supervision procedure for all staff. Care Homes for Older People Page 28 of 32 Evidence: A plan is devised for discussion relating to the residents, work issues, staff issues, personal development and training. Staff felt that the sessions were useful and confirmed that they received them approximately every eight weeks comments included, The supervisions are private and give us opportunity to discuss any problems we may have and We have supervision but I must say the manager is always available to discuss concerns and she gets things sorted. Documentation showed that relevant checks were maintained correctly and at the required intervals including all fire alarms and equipment and emergency lighting. The homes records showed all necessary service contracts were up to date including, gas and electrical services and passenger lifts. The fire logbook evidenced compliance to the weekly, monthly and annual checks alongside records of staff training and drills completed, records showed us that all staff have been present during fire drills as recommended, all night staff undertake this on a three-monthly basis, and day staff six-monthly. The home has a private consultant who takes the lead on Health and Safety in the home. The registered provider, the manager and a nurse have all attended a four week module in Occupational Health and Safety in the workplace since the last inspection. This will further ensure that all people who use the service are protected. Care Homes for Older People Page 29 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 30 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 19 23 An improvement plan must 09/03/2009 be submitted to CSCI detailing the the outstanding refurbishment required in the home with timescales on when this work will be implemented throughout the coming year. This will further ensure that the environment is suitable for the all people using the service in a safe, comfortable, well maintained home. 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 1 It would be could practice to make sure that prospective clients understand that if they move from a double room to a single room additional funding will be required. This information should also be contained within the Statement of Purpose. 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. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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