Inspection on 08/10/08 for Chatham House

This inspection was carried out on 8th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chatham House 28/09/09

Chatham House 29/01/08

Chatham House 31/07/07

Chatham House 13/09/06

Chatham House 15/12/05

Chatham House 24/06/05

Chatham House 01/02/05

Chatham House 06/07/04

Chatham House 11/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Chatham House Chatham House 44/46 Wembdon Rise Bridgwater Somerset TA6 7QZ     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: kathy McCluskey     Date: 0 8 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. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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: Chatham House 44/46 Wembdon Rise Chatham House Bridgwater Somerset TA6 7QZ 01278427758 01278427758 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Jessie Joan Pope Type of registration: Number of places registered: Mrs Jessie Joan Pope care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Chatham House is registered with the Commission for Social Care Inspection to provide personal care for up to 26 people aged 65 years and over. The home is not registered to provide nursing care nor is it registered to provide dementia care or any other specialist care. The registered provider/manager is Mrs Pope. Chatham House is situated in the residential area of Wembdon, 2 miles from Bridgwater town centre. Two large Victorian houses are linked by a modern annexe. There is car parking at the front of the house. To the rear there are extensive gardens with wheelchair access and handrails with a pleasant patio area. Accommodation is on two floors, comprising of 22 single bedrooms and 2 double rooms. There are 19 rooms with en-suite WC facilities, some have a bath/shower facility. TV points are available in each room. There is a passenger lift and two sets of stairs to the first floor, one with stair lifts. The communal rooms comprise of a very large lounge with three distinct seating areas, a smaller Care Homes for Older People Page 4 of 32 0 Over 65 26 Brief description of the care home lounge and an adequately sized dining room. There are three payphones in different locations in the home, plus the use of a mobile phone for incoming calls. There is a call system fitted to all areas of the home. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection was carried out over one day (9.5hrs) by CSCI Regulation inspector Kathy McCluskey and Regulation Manager Jackie Dolan. The inspection commenced at 0730hrs to enable us to meet with night staff and observe the morning routines. At 1100hrs the CSCI Pharmacist Inspector arrived at the home to examine the homes procedures for the management and administration of medication. At the time of the inspection 21 people were living at the home, which included one person who was in hospital. The registered provider/manager and deputy arrived at the home shortly after our Care Homes for Older People Page 6 of 32 arrival and they were present throughout the inspection. We were able to speak with two night carers, four day carers, the cook, two relatives and the majority of people living at the home. As part of this key inspection, the Commission sent comment cards to a number of healthcare professionals. Comment cards were left for all staff and two were given to relatives. At the time of this report,completed comment cards were received from three healthcare professionals. Comments have been included in this report as appropriate. We were given unrestricted access to the home. A selection of bedrooms and communal areas were seen. Records relating to people using the service, staff and health and safety were examined. We would like to thank all concerned for their time and co-operation with the inspection process. We were informed that the homes current fee range is between three hundred and seventy pounds and three hundred and ninety pounds per week. Additional charges include: chiropody,personal toiletries,hairdressing,newspapers,magazines and some personal care products. The following is a summary of the report and should be read in conjunction with the whole of the report. What the care home does well: What has improved since the last inspection? At the last inspection, two requirements were raised relating to the homes care planning procedures and the arrangements for staff supervision. At this inspection we were able to see that clearer instructions had been documented in individual care plans for staff as to how needs should be met. We were able to see that the preferences of the individuals had been recorded and that people and/or their representatives had been involved in the care planning process. At this inspection there was evidence of supervision dates having taken place or having been planned for staff. Staff also confirmed that they received appropriate support. Annual appraisals also take place. We have made some good practice recommendations regarding the records which should be maintained for staff supervision sessions. Appropriate action had been taken to address the four good practice recommendations raised at the last inspection. We found that any hand written entries on peoples medication administration records were now being confirmed by two staff signatures and that all staff involved in the administration of medication had received appropriate training. Care Homes for Older People Page 8 of 32 The home now ensures that emergency lighting is tested each month. 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 9 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 10 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 are provided with the information needed to enable them to make an informed decision about moving to the home. The home ensures that people are appropriately assessed before a placement is offered. Evidence: The home has produced a Statement of Purpose and Service User Guide which provides people with information about the home and services offered. We were advised that there have been no changes to these documents since the last inspection. We were able to see evidence that people are provided with contracts which specify the fees to be charged and the terms and conditions of occupancy. We noted that the registered person had not completed details regarding the room number to be Care Homes for Older People Page 11 of 32 Evidence: occupied. This was addressed at the time of the inspection. We examined a number of care plans and were able to see evidence that people had been appropriately assessed before a placement had been offered. Assessments from other health care professionals were in place as appropriate. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning procedures have improved though further improvements have been recommended to ensure that the effectiveness of any risk assessments are monitored. People have access to a range of health care professionals but the home need to ensure that peoples psychological well-being is monitored and that appropriate action is taken where there are concerns. People spoken with said they were treated with respect but terminology used by staff within care plans need to be reviewed. Evidence: We examined care records relating to four people using the service and noted that there had been improvements in the care planning process. At the last inspection we required that instructions for staff contained more detail to enable staff to meet peoples assessed needs. We also recommended that people and or their representatives were involved in the care planning process. Care plans examined Care Homes for Older People Page 13 of 32 Evidence: contained more information for staff and they also included the preferences of the individuals. Care plans examined had been signed by the individual or their representatives. We were able to see evidence that care plans were being reviewed at least monthly. Staff make regular entries for each individual. On examination we noted that the majority of information recorded contained only basic information regarding a task that had been performed i.e. bathed, shaved. The home need to ensure that a daily entry is made for each person which provides sufficient information regarding the health and well being of the individual. We also found that some of the wording used was inappropriate and was lacking respect. We identified these areas and discussed this in detail with the registered provider/manager at the time of this inspection. We were given assurances that this would be raised with staff at a forthcoming staff meeting. The home are also recording information about people in a day and night diary. As this has implications under the Data Protection Act 1998, a recommendation has been raised under Standard 37. A single recording system would also help to enhance continuity and consistency. Care plans contained basic risk assessments relating to falls, nutrition and moving and handling. The home should ensure that risk assessments contain sufficient information to enable staff to monitor the effectiveness of the risk assessment and to enable any preventative measures to be put in place. One care plan we looked at relating to a person who had a high number of falls did not contain information about what measures had been put in place to reduce the risk of falls or how the effectiveness would be managed. Care plans contained evidence that people have access to appropriate health care professionals. Running records demonstrated that GP input had been sought where there were concerns about an individuals health. Peoples contact with health care professionals are recorded on separate records within the plan of care. Records also demonstrated district nurse input as appropriate. During our case tracking process we noted that one persons mental health had deteriorated and that they were spending long periods alone in their room and had occasionally refused meals. Although details had been recorded in the plan of care and it was apparent that this was not unusual behaviour, it was not clear when the home would seek further input/review or advice from mental health care professionals. This was discussed in detail with the registered provider/manager during the inspection and she stated that she would request an assessment from appropriate healthcare professionals. Records demonstrated that peoples weights are monitored on a monthly basis. Care plans examined showed that the individuals weight had either remained stable or had Care Homes for Older People Page 14 of 32 Evidence: increased. The homes recording system allows for any weight loss or gain to be clearly identified. We sent a number of comment cards to a range of healthcare professionals. Three completed comment cards were received by the Commission. In response to the question, Are individuals health care needs properly monitored and attended to by the care service? One responded Always and one Sometimes. One gave no response. In response to the question, Do the managers and staff have the right skills and experience to support individuals social and health care needs? One responded Sometimes, one Always and one no response. During this inspection we observed staff interacting with people in a kind and respectful manner and it appeared that people were being spoken to using their preferred form of address. People looked clean and well attired. People spoken to made the following comments about the staff and of the care they received: I feel very well treated and the staff are lovely, Yes the staff are very kind, I like it here, Couldnt have anybody kinder than they are here, The staff are good but sometimes they say they will come back but they dont always, All the staff are lovely here, The staff are very attentive. We spoke to two relatives during this inspection and no concerns were raised about the care their relative received: I have no concerns about the care, the food is fine and the staff are all really nice. One female living at the home told us that she was asked if she minded if a male carer assisting with her personal care. Two comment cards received made the following comments, staff are unfriendly and do not engage in conversation, Individual is not informed of planned reviews. We looked at the homes procedures for the management and administration of medicines. Medicines were seen to be stored securely and in accordance with the current regulations. Looking at the Medication Administration Record (MAR) charts we found that although all administrations are recorded there were many occasions when the actual quantity administered had not been recorded. This may lead to the person not receiving an appropriate dose. The manager agreed that all staff would be told that the dose must be recorded and it was seen that on previous charts that this had mostly happened. Since the previous inspection many staff have received training on the safe administration of medicines, however we found that there was no formal review of competence in the home. It was agreed that the home would start doing this as part of the staff supervision process. We also saw that the MAR charts were checked for errors during the month, however when we asked for records of these checks we were told that none are made. This means that it is more difficult to monitor ongoing problems. Care Homes for Older People Page 15 of 32 Care Homes for Older People Page 16 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. The home has a programme of activities available for the people living there. People told us that their visitors were made to feel welcome and that they could see their visitors in private. People are able to choose how and where to spend their day. The home offers a wholesome and varied menu where choices are available. Evidence: The home displays a programme of activities which cover a seven day period. Activities on offer include; singing and dancing, weekly trip out, movement to music, board games, manicures and hairdressing. We asked a number of people about life at the home and the activities offered and they made the following comments: I think its lovely here, I can choose what time I get up and go to bed, We went out yesterday to the garden centre, it was lovely, The coach goes out every Tuesday afternoon and we go all over the place such as the Care Homes for Older People Page 17 of 32 Evidence: Quantocks, Weston, Burnham, I can do what I like, There are plenty of activities such as bingo, quizzes, exercises and all sorts of games and skittles. During the morning a selection of newspapers were delivered and many people were observed reading the papers during the morning. The home maintains individual records for each person which records the activity undertaken on a particular day. It has been recommended that the home also makes a note of the outcome for the individual for example did they enjoy the activity, did they find the activity difficult etc. Care plans examined contained detailed information about the individuals social history/interests. People told us that their visitors were made to feel welcome and that they could visit at any time. It was confirmed that people could see their visitors where ever they wished; I can see my family in my room if I want to but I like to go to the little lounge. During this inspection we were able to meet with two visitors. Both told us that they were made to feel welcome and that they were kept well informed. They also told us that they did not have any concerns about the care their relative received. In line with fire regulations, the home requires that all visitors to the home sign in and out. People told us that they could choose how and where to spend their day. During this inspection the majority of people were observed utilising the large lounge area. We saw some people wandering in and out of the garden. Some people told us that they preferred to spend some time in their bedrooms. People told us that they made decisions about when to get up in the morning or go to bed. One person told us that they were an early bird and that they liked to get up early, another told us that they didnt like to get up until 0830. On arrival at the home at 0730am, two people were up and dressed. We met with the night staff who told us that these were the only two people up. The day staff start to assist people after the morning handover at 0800hrs. Staff said that peoples choices were always respected. People were positive about the meals available the home. All meals are cooked at the home by designated catering staff. The home have recently been awarded five stars (excellent) for their food hygiene standards by the environmental health department. People told us that choices were available for breakfast and tea. You can choose from a range of cereals, toast, prunes, grapefruit and they will even do you egg on toast but I like to have my porridge, At tea time we can have what we like, you just tell them but they know I like ham, chips and spaghetti, The food is very good and there is Care Homes for Older People Page 18 of 32 Evidence: plenty to eat. The main meal is enjoyed at lunch time. On the day of this inspection lunch was roast pork with potatoes and a selection of vegetables. People are offered a starter of soup and a dessert. We were informed that people are asked about their lunch preferences during the morning. We looked at the four week menu which is kept in the dining room. The menus appeared wholesome and varied. Following a previous inspection, the home sought the advice and input from a dietician and current menus are a reflection of their recommendations. We examined a number of care plans and the weights for these individuals had either remained stable or had increased. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints procedure which enables people to raise concerns. The home has a range of policies in place to reduce the risk of harm or abuse to people but they need to ensure that all staff are aware of the local policy on safeguarding adults. Evidence: The home displays a satisfactory complaints procedure. We were informed that the home had not received any complaints since the last inspection. We spoke to a number of people using the service during this inspection and all told us that they would feel confident in raising concerns if they had any. The home has policies and procedures in place for staff to reduce the risk of harm or abuse to the people living there. These include a whistle blowing policy and a policy on the acceptance of gifts. Staff do not commence employment until the home have received a satisfactory criminal record and protection of vulnerable adults check. Although the home have an updated copy of Somersets Safeguarding Adults Policy, through discussion with senior staff members and the registered provider/manager, it Care Homes for Older People Page 20 of 32 Evidence: was confirmed that they did not fully understand the procedures to be followed should abuse be suspected. Staff did demonstrate a knowledge of the whistle blowing procedures however it is of concern that the management of the home did not follow correct reporting procedures. An entry in the daily records confirmed that one matter had not been followed up robustly in accordance with safeguarding procedures. The registered person was strongly advised to ensure that both she and staff at the home were made aware of the policy and procedures to be followed. We were able to see evidence that all staff have received training this year from an external training provider on the Protection of Vulnerable Adults. Care Homes for Older People Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in comfortable and homely environment which is fitted with appropriate aids and adaptations to assist mobility. Bedrooms are comfortable and people can personalise their rooms. The standard of cleanliness in the home is good and procedures are in place to reduce the risk of the spread of infection. Evidence: Chatham House consists of two large Victorian properties that have been linked together to provide accommodation for up to 26 people aged 65yrs or over. The home appears well maintained and fixtures and furnishings help to promote a homely feel. A maintenance person is employed. The home has a range of communal space, which includes a very spacious lounge which has patio doors and views over the garden. This lounge is arranged into three distinctive areas. The majority of people were seen to be utilising this area on the day of the inspection. A smaller lounge is also available. There is a good-sized dining room which looks out at the front of the house. The home has interesting and extensive gardens to the rear, which are accessible to wheelchair users. Ramps and grab rails are appropriately sited. Garden furniture is Care Homes for Older People Page 22 of 32 Evidence: available. Car parking is available at the front of the property. Grab rails and ramps are appropriately sited. A nurse call system is installed in all bedrooms and communal areas/facilities. Accommodation is arranged over two floors with a shaft lift and stair lift providing access for those who are unable to manage stairs. There are 22 single bedrooms and 2 doubles. 19 bedrooms have en-suite toilet facilities. Some are fitted with a shower/bath. People told us that they liked living at Chatham House and were satisfied with their bedrooms. A selection of bedrooms were seen at this inspection. All were pleasant and comfortably furnished. Bedroom doors are fitted with a lock, which can be over-ridden by staff in the event of an emergency. The home has an assisted communal bath and level access shower in addition to ensuite facilities. As required, people have their own mobility aids/wheelchairs. The home has one mobile hoist and one stand-aid. All areas of the home seen benefited from natural light. To ensure the health and safety of people at the home, radiators are fitted with a guard, wardrobes secured to the wall and upstairs windows are restricted. Hot water outlets are fitted with thermostats to reduce the risk of scalding. On the day of this inspection the home was clean and free from malodours. Hand washing facilities are appropriately sited in the home. Staff have access to protective clothing. The laundry facilities were not examined at this inspection. 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. Staffing levels at the home are appropriate to the needs of people currently at the home. Staff recruitment procedures are generally good and procedures are in place to ensure people are protected from the risk of harm or abuse. Staff have been appropriately trained. Evidence: We were informed that staffing levels, for the 20 people currently residing at the home were as follows: Mornings - 4 care staff Afternoon/evening - 3 care staff Nights - 2 waking care staff. Kitchen, domestic and maintenance staff are employed in addition to the care staff. The registered provider/manager stated that a senior member of staff is on duty at all times and is responsible for administering medicines. The inspectors were also informed that the registered person and deputy are on-call out of hours and are often at the home during the evening/night. Duty rotas provided showed that the registered provider/manager and the deputy are on duty in addition to the care hours shown. Care Homes for Older People Page 24 of 32 Evidence: We were able to speak with two night carers and all day carers on duty and no concerns were raised regarding the current staffing levels. There was a staff presence in communal areas throughout the inspection. We examined five staff recruitment files for staff recruited since the last inspection. All contained all required information including evidence of an enhanced criminal record check (CRB) and checks against the protection of vulnerable adults register (POVA). We were able to see that staff had not commenced employment until the full CRB/POVA check had been received. In one file we noted that a gap in employment history had not been explored. The deputy manager informed us that she was aware of the reasons for this but had not documented them. Although two references had been obtained prior to employment commencing, one had not been obtained from the staff members last employer. Good practise recommendations have been raised. The home has an induction programme for staff which follows the Skills for Care Common Induction Standards. We were able to see evidence that the induction programme had been undertaken by the newly appointed staff. We were also able to see evidence that mandatory training had taken place. A clear training matrix is in place which identifies training achievements and dates for updates for all staff. Individual training records are also maintained. Certificated evidence of training achievements was seen in the staff recruitment files. All staff have completed training in the protection of vulnerable adults, 25 of the 28 staff employed have completed first aid training, 24 staff have completed training in dementia care and 14 have received training in diabetes. We were informed that 7 staff have achieved a minimum of an NVQ level 2 qualification in care and that 10 were currently working towards this award. We asked people living at the home about the staff and they made the following comments; They are very kind and I feel well treated. We were able to speak with two relatives during this inspection and both were positive regarding the staff. No concerns were raised by the relatives. Care Homes for Older People Page 25 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. In some respects the home is effectively managed, however knowledge and understanding of safeguarding procedures must be improved. Systems are in place to seek the views of the people living at the home and their representatives. This area could be further improved if the home sought feedback from other stakeholders. The home has systems in place to ensure that staff are appropriately supervised though recording systems could be improved. The home has procedures in place to ensure the health and safety of persons at the home. Evidence: There have been no changes to the ownership or management of the home since Care Homes for Older People Page 26 of 32 Evidence: 1983. Mrs Pope is the registered provider and registered manager. Mrs Pope is supported by her daughter, who is the deputy manager. Mrs Pope is currently working towards the registered managers award. As previously mentioned in this report, the registered provider/manager and senior staff must improve their knowledge of local safeguarding procedures and ensure that these are followed. We spoke to all available staff and all confirmed that they enjoyed working at the home and felt well supported. As part of its quality assurance programme the home sends comment cards to staff, people using the service and relatives. We were able to sample some completed questionnaires which had recently been completed. Comments were noted to be positive. It has been recommended that the home also seeks the views from other stakeholders such as care managers and GPs. We were told that regular meetings take place for staff. We were informed that the last staff meeting was held on 1st and 3rd April 2008 and that another meeting was due to take place. Minutes of the last staff meeting were not available for this inspection. The registered person should ensure that copies are maintained at the home. The registered provider/manager informed us that the home do not manage any monies on behalf of the people living there. We were informed that the home invoices the next of kin for any purchases and that receipts are provided. At the last inspection it was required that the home ensures that systems are in place to ensure that staff are appropriately supervised. At this inspection staff confirmed that they had regular one to one meetings and appraisals. Records were available which confirmed the dates of staff supervisions that had taken place and which had been planned. Although detailed appraisals were available, the home are not recording the topics and outcomes discussed for each supervision session. It has been recommended that appropriate records are maintained and that a copy is given to the staff member. As mentioned in Standard 7 of this report we found that the home were maintaining a day and night diary in which they were recording information about people living in the home. This was being used in addition to individual daily records. Because this has implications with regard to the Data Protection Act, it has been recommended that the home only record information about people living at the home on their individual daily records, which would then be stored within their plan of care. The homes records were examined relating to health and safety. A tour of the Care Homes for Older People Page 27 of 32 Evidence: premises was also carried out. FIRE SAFTY - Records demonstrated that in-house weekly checks were made on the homes fire alarm systems. Emergency lighting is tested monthly. Annual servicing by an external contractor last took place on 01/02/08. Staff training records indicated that all staff had received up to date training in fire safety. ELECTRICAL SAFETY - Annual servicing on the homes portable appliances was found to be up to date. This was last recorded as August 2008. The home has an up to date electrical hard wiring certificate. GAS SAFETY - The home has an up to date annual gas safety certificate dated 02/09/08. EQUIPMENT SERVICING - We were able to see evidence that six monthly servicing on the homes passenger lift and hoists were up to date. Servicing was carried out by an external company, in accordance with LOLER regulations, on 29/08/08 and 12/08/08 respectively. ACCIDENTS - The home maintains appropriate records for accidents. We were able to see that accidents are analysed on a regular basis so that any traits can be identified. Records include details of any actions taken to reduce reoccurrence. The Commission receive notifications about any significant event in the home in accordance with Regulation 37 of the Care Homes Regulations 2001. HOT WATER OUTLETS - We were informed that all bath hot water outlets had been fitted with a thermostatic control. Warning signage was in place over wash hand basins. Records were available to confirm that monthly checks are made on all hot water outlets to ensure that temperatures do not exceed safe upper limits. STAFF TRAINING - As previously mentioned in this report, records indicated that mandatory training for staff was up to date. This included moving and handlin, fire and food hygiene. Care Homes for Older People Page 28 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 29 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 8 13 The registered person must ensure that the advice and input is sought from appropriate health care professionals where there are concerns or a deterioration in an individuals mental or psychological well-being To ensure that peoples psychological needs are monitored and met. 10/11/2008 2 9 13 The actual dose 10/01/2009 administered for medicines prescribed with a variable dose must be recorded. Also inforamtion must be available to guide staff on how to determine what dose should be given. To ensure that people receive an appropriate dose for their needs Recommendations Care Homes for Older People Page 30 of 32 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 7 The registered person should ensure that risk assessments contain sufficient information about the risk identified, what measures have been put in place to reduce any risk and how the effectiveness of the risk assessment will be monitored. The registered person should ensure that daily entries are recorded for each individual which contain sufficient information regarding the well-being of the individual. It is recommended that all staff administering medicines have regular competency checks to identify any non compliance with policies and procedures and protect people. The registered person should raise staff awareness regarding the appropriateness of wording used when recording information about people using the service. The registered person should ensure that individual activity records contain information about the outcome of the activity. It is strongly recommended that the registered person ensures that they, and all staff are aware of the local procedures for safeguarding adults. The registered person should aim for 50 of the care staff employed having achieved a minimum of an NVQ level 2 in care. It is strongly recommended that the registered person ensures that references are obtained from a prospective employees last employer. It is also recommended that the reasons for any gaps in an applicants employment history are documented. As part of its quality assurance programme, the home should also seek the views of other stakeholders such as care managers, health care professionals and GPs. The registered person should ensure that records are maintained for each staff supervision session and that a copy is made available to the employee. All records pertaining to people using the service should be maintained in accordance with the Data Protection Act 1998. This refers to daily entries made for each individual. The home should not use the day and night diaries to record information about people at the home. 2 7 3 9 4 10 5 12 6 18 7 28 8 29 9 33 10 36 11 37 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 © (2008) 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. 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