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Inspection on 18/02/09 for Brendoncare Chiltern View

Also see our care home review for Brendoncare Chiltern View for more information

This inspection was carried out on 18th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There is information available to residents and their families and their needs and wishes are assessed before they move to the home, to help them decide whether the home can meet their care and support needs. One family member commented `the home were very supportive and answered all our questions and offered details of additional help not particularly requested`. Residents needs are assessed and their cultural and spiritual wishes noted. Residents` health and personal care needs are met in a way which protects their dignity. The home recognises the need for people with dementia to have activity which is tailored to their abilities and is introducing a programme to develop this aspect of care. There is a programme of entertainment and an active League of Friends who support the home. Residents are at liberty to walk around the home which is safe and on one level. Tthere is safe access to the gardens, which residents were seen to use. Meals are good and meet residents` nutritional needs. There is a choice of meals and special diets to meet residents` health and cultural needs are available. There are complaints and safeguarding policies and procedures in place which should protect residents from harm. The home is purpose built, clean and well maintained. It is an accessible, safe and comfortable place for residents to live and is accessible for those with disabilities. There are good staffing levels and families said that staff were welcoming and kind. Staff were observed to treat residents with respect and to be patient and understanding of the difficulties that their memory loss gave them. The home is well managed in the interests of the residents. The quality assurance programme could be strengthened to promote ongoing improvement for residents and to ensure that the deficiencies noted in other sections of this report are addressed.

What has improved since the last inspection?

There have been some improvements in care planning since the last inspection although further improvements are needed if residents needs are to be identified, recorded and met consistently. A training programme has been started to give staff a better understanding of the needs of people with dementia.

What the care home could do better:

Not everyone has a contract or terms and conditions. The organisation must address this to ensure that everyone is fully aware of the terms and conditions of their stay in the home, irrespective of their funding source.There is a need to provide newly prescribed medication more promptly if residents minor illness is to be treated in a timely way. There is a need to ensure that all staff have dementia care training and to ensure that the mandatory training in safe working practices is up to date. There is a need to improve recruitment procedures and to ensure that two references are sought for new employees, one of which should be from the last employer and to ensure that everyone has a current work permit in their file. The manager must register with us. The quality assurance programme could be strengthened to promote ongoing improvement for residents and to ensure that the deficiencies noted in other sections of this report are identified by the home and addressed.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Chiltern View Nursing Home St John`s Drive Stone Aylesbury Bucks HP17 8PP     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: Chris Sidwell     Date: 1 8 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Chiltern View Nursing Home St John`s Drive Stone Aylesbury Bucks HP17 8PP 01296747463 01296747138 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Brendoncare Foundation Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 31 Number of places (if applicable): Under 65 Over 65 0 0 31 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 31 31 0 The maximum number of service users to be accommodated is 31. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Chiltern View Care Home is a purpose built home providing nursing care for up to 31 elderly people with dementia. It is managed by the Brendoncare Foundation, which is a Care Homes for Older People Page 4 of 29 Brief description of the care home charitable foundation. The home is situated in Stone, a village on the outskirts of Aylesbury. There are limited local facilities, although the town of Aylesbury is approximately three miles away. The majority of rooms are single, none are en- suite. There are two shared rooms. The home has been designed to provide a safe environment with room for residents who have dementia to walk freely. It is divided into two units. Gardens are safe and accessible with extensive rural views. Qualified nurses are on duty at all times. Staff training is provided. All residents are registered with a local General Practitioner and have access to the specialist healthcare services provided by the local NHS Trusts. The provider makes information about the service available to potential residents on their website and in the form of a comprehensive brochure available from the home. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The home was last inspected on the 25th February 2008. This inspection was conducted over three days and included a review of the information we hold about the service and an unannounced visit to the home of six hours. The key standards for older peoples services were assessed. Information received about the home since the last inspection was taken into account in the planning of the visit. The manager completed an annual quality assurance assessment. Questionnaires were sent to the home for distribution to residents, families and staff. Residents were spoken to on the day of the unannounced visit. Discussions took place with the manager, nursing, care and ancillary staff. Care Homes for Older People Page 6 of 29 Care practice was observed and the care of a small number of residents was followed through in detail. A tour of the building and examination of records was also undertaken. The homes approach to equality and diversity was considered throughout. What the care home does well: What has improved since the last inspection? What they could do better: Not everyone has a contract or terms and conditions. The organisation must address this to ensure that everyone is fully aware of the terms and conditions of their stay in the home, irrespective of their funding source. Care Homes for Older People Page 8 of 29 There is a need to provide newly prescribed medication more promptly if residents minor illness is to be treated in a timely way. There is a need to ensure that all staff have dementia care training and to ensure that the mandatory training in safe working practices is up to date. There is a need to improve recruitment procedures and to ensure that two references are sought for new employees, one of which should be from the last employer and to ensure that everyone has a current work permit in their file. The manager must register with us. The quality assurance programme could be strengthened to promote ongoing improvement for residents and to ensure that the deficiencies noted in other sections of this report are identified by the home and addressed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is information available to residents and their families and their needs and wishes are assessed before they move to the home, to help them decide whether the home can meet their care and support needs. Not everyone has a contract or statement of their terms and conditions. The organisation must address this to ensure that everyone is fully aware of the terms and conditions of their stay in the home. Evidence: The home has an updated Statement of Purpose and Service Users guide which gives prospective residents and their families information about the home. They are encouraged to visit the home before deciding to move. All those who returned the questionnaires said that they had received enough information about the home before moving and one commented that the home were very supportive and answered all our Care Homes for Older People Page 11 of 29 Evidence: questions and offered details of additional help not particularly requested. The manager and staff confirmed that they always visit prospective residents at home or in hospital to assess and agree that the home can meet their needs. The care of four residents was looked at in detail and all had been assessed. The assessment documentation was comprehensive and prompted the assessor to consider prospective residents cultural and faith needs. An assessment of the support prospective residents needed in relation to their dementia was also recorded. Four of the nine people who returned the questionnaires said that they had a contract. The manager said that all residents who funded their own care had a contract but was unsure whether all residents whose care was funded by the Primary Care Trust (PCT) or the Local Authority had statements of their terms of conditions. The organisation must ensure that all residents have contracts or statements of terms and conditions if their care is supported by the PCT or Local Authority. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health and personal care needs are met in a way which protects their dignity. There have been some improvements in care planning since the last inspection although further improvements are needed if residents needs are to be identified and met. There is a need to provide newly prescribed medication more promptly if residents intermittent illness is to be treated in a timely way. Evidence: The care of four residents was examined in detail. All had care plans although they varied in detail and as to whether they had been updated on a regular basis. One was dated September 2008 and had not been updated since. Some entries were not signed and dated. There was evidence in one that families had been involved in agreeing the care plan although not in the others. The style of the care plans depended on the person who wrote them. The manager has introduced an approach which focuses on the support people need to compensate for their dementia as well as their physical support needs. This is an example of good practice and his care plans showed a good understanding of the care and support needed by people with dementia. Other care Care Homes for Older People Page 13 of 29 Evidence: plans however focused on residents physical needs and had less information about care needs arising from their dementia. The manager said that he was currently working with staff to develop the new approach. Risk assessments had been completed, including nutritional and falls risk assessments. Residents are weighed regularly and those seen had maintained their weight or action had been taken to address weight loss. Residents had been assessed as to their risk of developing pressure damage and appropriate matresses were in place. No one had a pressure damage at the time of the inspection. There was evidence in the plans that residents health care needs are met. The general practitioner visits regularly and residents are seen by the local community psychiatric nurse when necessary. An optician makes regular visits. One questionnaire respondent felt that dental care could be better. Residents were observed to be well dressed and had been supported to maintain their personal hygiene. The health care professionals who returned the questionnaires said that their advice was always followed. One said patients are respected and well looked after Everyone who returned the questionnaires said that their family member always or usually received the care that they needed. Families spoken to on the day were very happy with care. One said my father is treated as an individual and another I am always made welcome and can come at any time. There are medication policies and procedures in place. Staff were knowledgeable about these. Medication records are kept. The medication administration records were completed correctly. The staff said that medication was not given covertly. There were some instances when medication was handwritten on the medication administration charts and the entry had not been signed. Two members of staff should sign the entry if they transcribe medication needs from a prescription or pharmacist dispensed box to ensure that the transcription is accurate. Controlled drug storage is satisfactory. Four controlled drugs were checked at random and found to be accurate. One entry had not been countersigned. The stock levels were correct and the manager was aware of the issue and staff had been spoken to. There appeared to be some delay in residents receiving antibiotics. Two records were seen where residents were prescribed antibiotics for infection but did not receive them until twenty four hours later. The manager said that the process involved the doctor taking the prescription back to the surgery and for it to be sent to the pharmacist from there and delivered the next day. The manager should work with the practice and the pharmacist to agree how this time lag could be reduced in order to treat residents infections such as urinary and chest infections more quickly. Care Homes for Older People Page 14 of 29 Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home recognises the need for people with dementia to have activity which is tailored to their lifestyle and abilities and is introducing a programme to develop this aspect of care. Meals are good and meet residents nutritional needs. Evidence: An activities organiser has been appointed since the last inspection. She is an experienced care home activities coordinator. The manager has introduced a new approach which identifies the ability of residents to engage in activity and at what level. The approach recognises that people will be able to engage in tasks at different levels and endeavours to provide a framework to help carers encourage residents to participate in daily tasks to the level of their ability. The approach also focuses on helping to maintain peoples ability as far as is possible. The activities coordinator is also involved in this and the manager said that he was working with the carers and the nursing staff improve their knowledge as to how everyday activity can be built into service users lives. This is a new programme which has to be embedded into the homes culture before it can be evaluated. The staff were observed to be speaking to residents gently and to be treating them with respect. There is a programme of communal activities such as visiting entertainers, armchair exercises for those who are Care Homes for Older People Page 16 of 29 Evidence: able and reminiscence sessions. There was little to do in the main lounges however and most residents were observed to be sitting for long periods. Staff were observed to be sitting alongside residents at quieter times and perhaps looking at a book or newspaper. Relatives spoken to said that they were welcome at any time. There is a League of Friends which supports the home and families and raises money towards activities and other purchases for residents. Meal times are staggered to ensure that there are enough staff to help residents. There is a varied menu and those who returned questionnaires said that their family member enjoyed the meals. There is a choice of main meal and supper. There is an attractive dining room and staff were seen to be showing residents the choices available to help them choose. Mealtimes were seen to be a sociable occasion. Staff were observed to be sitting alongside residents and to be helping them sensitively. The chef was aware of those who needed a special diet and of those who were at risk of weight loss. High calorie meals are provided. The chef also said that he would be able to provide special menus to meet people cultural wishes if necessary. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are complaints and safeguarding policies and procedures in place which should protect residents from harm. Evidence: There are complaints and safeguarding policies and procedures in place. The manager said in the annual quality assurance survey that the home had received two complaints since the last inspection and one had been dealt with in the timescales stipulated by the policy. The manager had received one verbal complaint about late delivery of medication. Everyone who returned the questionnaires said that they knew how to make a complaint. One respondent commented. The home is very open. Any concerns that I have are dealt with immediately. There are safeguarding policies and procedures in place. The manager said that he had made three safeguarding referrals to the local authority since the last inspection, which had all been investigated appropriately. The training matrix shows that most staff have had safeguarding training but not all and not all have had an update in the last year. The staff spoken to were aware of what constitutes abuse of an older person and said that they would have no hesitation in reporting any concerns to the manager or the operations manager who visits the home periodically. The restraint policy and procedure is being revised. This should be completed and the role of reclining chairs in the home made explicit. Care Homes for Older People Page 18 of 29 Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is purpose built, clean and well maintained. It is an accessible, safe and comfortable place for residents to live and is accessible for those with disabilities. Evidence: The home is purpose built and on one level. It is set in attractive, safe gardens with views over the Aylesbury Vale. It was clean and tidy on the day of the unannounced visit. There were no offensive odours. The majority of rooms are single. Residents may personalise their rooms although most were quite plain. There is generous communal space and residents have a choice as to where to sit. They have free movement around the home which is safe and easy access to the gardens which are secure. There is a separate dining room. The tables were well laid and lunch was seen to be a pleasant time for residents. The home is almost too tidy and there was little tactile or visual stimulus for residents. There is an ongoing redecoration and maintenance plan. There are infection control policies and procedures in place and practice has improved since the last inspection. Staff were observed to wash their hands frequently. They are provided with protective aprons and gloves. Service users rooms have soap and paper towels for staff and alcohol hand gel is available to help minimise the risk of infection. The laundry is well organised and the laundry assistant takes pride in ensuring residents clothes are well maintained. The washing machines have sluicing Care Homes for Older People Page 20 of 29 Evidence: programmes for soiled laundry. Foot operated pedal bins have been provided for clinical waste and the manager said that residents did not now share hoist slings. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good levels of staffing and families feel that residents needs are met in a timely way. The training programme must be completed to ensure that all staff have had training in dementia care. Recruitment procedures must be strengthened to ensure that residents are protected from unsuitable carers. Evidence: A staff rota is kept and showed that there are two qualified nurses and seven care staff on duty on each morning, two qualified nurses and five care staff in the afternoon and one qualified nurse and four care staff at night. Residents and families who returned the questionnaires said that their needs were met in a timely way. All residents, who were getting up, were up by mid morning on the day of the unannounced visit. The annual quality assurance questionnaire showed that agency staff had to be used to maintain these staffing levels although the manager said that he used regular agency and bank staff to maintain continuity for residents. In addition to the nursing and care staff employed to cover the 24- hour rota there are additional staff providing housekeeping, maintenance and catering support to residents. Residents and families were complementary about the staff team commenting that the carers are marvellous, do their job well and they are pretty good, have hard job and a lot to do. The home does not yet meet the requirement that fifty per cent of staff hold the Care Homes for Older People Page 22 of 29 Evidence: National Vocational Qualifications in Care at level 2. The manager said that he was currently recruiting to the programme. The training matrix showed that most staff have had mandatory training in safe working practices and that staff undertake an induction programme on appointment to the home. The training statistics seen did not show that staff had undertaken any training relating to equality and diversity issues. The manager has instigated a programme of dementia care training. He is experienced in the field and has developed the programme himself. A number of staff have completed the initial modules but not all. The manager said that he was building completion of the programme into staff supervision. Requirements have been made at previous inspections that staff of this specialist dementia care home have training in dementia care to ensure that their practice is current and meets peoples complex and diverse needs. Although a start has been made to deliver a training programme this is not yet complete. A further requirement will be made and action may be taken if this requirement is not met in a timely way. The recruitment files of four recently recruited members of staff were selected at random and reviewed. All applicants had submitted an application form, which showed their work history. Interview records had been kept. Evidence of identity had been obtained and Criminal Records Bureau disclosures had been sought before the staff member commenced work. Two references had not been sought for all staff and in two cases references were not sought from the last employer. Two of the files checked at random did not contain the staff members work permit. One was faxed from Head Office during the visit. The administrator said that she knew that one work permit was missing and had asked the staff member for it. The recruitment procedures must be strengthened to ensure that two references are sought for all staff and that one of these is from the last employer. The organisation should also ensure that evidence of the staff members right to work in the United Kingdom is sought and kept on file. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed in the interests of the residents. The quality assurance programme could be strengthened to promote ongoing improvement for residents and to ensure that the deficiencies noted in other sections of this report are addressed. Evidence: The manager is experienced and has been managing the home since October 2008. He is a qualified mental health and general nurse. He hold a MSc in Gerontology and a Certificate in Education. He has not yet obtained the national Vocational Qualification in Management at level 4. He was observed to have an open door policy. Families, residents and staff were seen to speak to him frequently and in a relaxed manor throughout the unannounced visit. Residents, families and staff said that he was approachable and dealt with issues promptly. There are clear lines of accountability within the home and with the organisations senior management team. The organisation has a quality assurance programme and a clinical governance Care Homes for Older People Page 24 of 29 Evidence: structure to monitor and improve the standard of care offered. Evidence, however, was not seen on this occasion of regular audit of care plans, medication management or training compliance. Recruitment files had not been audited recently. The incidence of pressure damage and falls are monitored and other incidents are reported to the clinical governance group for review. The manager holds regular staff and family meetings to ascertain their views. The organisation has not undertaken any satisfaction surveys with families or other stakeholders. Recognised tools, such as dementia care mapping, to monitor and improve the quality of care in dementia care homes, where people may not be able to speak for themselves, are not being used. The quality assurance programmes could be developed further. A senior manager visits the home regularly and records of their visits are kept at the home. The home has addressed the requirements of the previous report. There are health and safety policies and procedures in place. Regular health and safety meetings are held and minutes kept. Most staff have had mandatory training in safe working practices. The maintenance team undertake regular checks of fire procedures and hot water temperatures. All residents have height adjustable beds with integral bedrails. Risk assessments and regular checks of these are undertaken. The annual quality assurance questionnaire sent by the manager showed that the maintenance of services and equipment was up to date up to date. The records verified this. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 5 The organisation must ensure that everyone has a contract or statement of their terms and conditions irrespective of their funding source. To ensure clarity for service users and their families. 29/05/2009 2 7 15 Residents care plans must be kept up to date and contain information relevant to their care. To ensure that their needs are met. 31/05/2009 3 9 13 Prescribed medication must be obtained and started in a timely way. To ensure residents healthcare needs are met 31/05/2009 4 28 19 Two references must be sought for all prospective staff, one of which must be from the last employer. 31/05/2009 Care Homes for Older People Page 27 of 29 To protect residents from unsuitable staff 5 29 19 The organisation must ensure that staff have the appropriate work permit to work in the UK. To meet their legal responsibilities 6 30 18 All staff must have training in dementia care. This is a specialist home and staff must have the skills and knowledge to meet the needs of people with complex dementia. 7 31 8 The organisation must ensure that the manager applies to registers with us To meet their legal responsibilities. 30/04/2009 30/06/2009 31/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 18 The review of the restraint policy must be completed and the appropriate use of reclining chairs be made explicit in the home. The quality assurance procedures should be strengthened to ensure that deficiencies in care planning, recruitment and other aspects of the homes management are identified and addressed. Consideration should be given to using one of the recognised tools used to monitor and improve the care of people with dementia. 2 33 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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