Inspection on 24/02/09 for Chrissian Residential Home Limited

This inspection was carried out on 24th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chrissian Residential Home... 03/11/08

Chrissian Residential Home... 29/08/07

Chrissian Residential Home... 29/08/06

Chrissian Residential Home... 17/12/05

Chrissian Residential Home... 10/06/05

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Claremont House

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Sun Court Nursing Home

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Bilney Hall

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Mabbs Hall Nursing Home

Henrietta House

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Chrissian Residential Home Limited 526-528 Woodbridge Road Ipswich Suffolk IP4 4PN     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: Claire Hutton     Date: 2 4 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: Chrissian Residential Home Limited 526-528 Woodbridge Road Ipswich Suffolk IP4 4PN 01473718652 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : feizal.molabaccus@ntlworld.com Chrissian Residential Home Limited care home 22 Number of places (if applicable): Under 65 Over 65 22 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 0 3 1 1 2 0 0 8 Chrissian House is situated on a main road into Ipswich town centre. The home comprises two buildings joined together at ground and first floor level. One is known as the annex. There is a medium sized garden to the rear of the building, with patio area and a small amount of outdoor furniture and seating. The accommodation was developed in early 2002 to meet the standards at that time. The number of double rooms was reduced, and new rooms were created when the development was completed. The garden has had landscaping, and is attractively maintained. The home caters for those with low and medium needs only. The home has stair lifts to aid those with poor mobility. The home would not accept a resident who was a wheelchair user at the time of admission. Care Homes for Older People Page 4 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: 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: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a key inspection, which focused on the core standards relating to Care Homes for Older people. The inspection was unannounced and the visit was on a weekday, which lasted 7.5 hours. The inspection team was made up of an Inspector and an Expert by Experience. The Expert by Experience was Mrs Violet Shaw and she came came from Help the Aged. As a service user Mrs Violet Shaw has an expert opinion on what it is like to receive services for older people. Her comments are included throughout this report where she is referred to as an Expert by Experience. The Expert by Experience spoke with both the CSCI inspector and the manager to inform Care Homes for Older People Page 5 of 29 them some of her findings before leaving the inspection. We (the CSCI) received a written report. This report has been written using accumulated evidence gathered before and during the inspection, including information obtained from surveys. We received 1 completed Have Your Say surveys from a service users family. We met 3 care staff during this visit and interviewed them. The expert by experience spoke to several residents. The inspection process included visiting all areas of the home, observations of staff and resident interaction, and the examination of a number of documents including residents care plans and associated documents, medication records, the staff rota, records relating to health and safety and records relating to staff recruitment. We also assessed the outcomes for the people using the service against the Key Lines of Regulatory Assessment (KLORA). What the care home does well: What has improved since the last inspection? What they could do better: This report contains areas for development that we would like to monitor, therefore we have requested an improvement plan. This service needs to ensure that it properly assesses peoples needs prior to admission and that it does not admit residents outside of their registered category. At this inspection we found people living at the home outside the registered category. And the home was unable to demonstrate that they were able to meet the needs of people with mental health problems as staff individually and collectively did not have the skills and experience. Staff need to ensure they follow the homes medication procedure and not place residents at risk by secondary dispensing medication. Staff should use the correct codes when recording medication to avoid any misunderstandings. Currently residents are not protected by the homes recruitment procedure as we found Care Homes for Older People Page 7 of 29 one person working at the home with no criminal records bureau check and other staff without completed checks that are defined in the regulations. If the home are to accommodate residents who may become aggressive and staff to deploy physical intervention as a last resort, then guidance must be sought and training provided. This training should be around the Mental Capacity Act, Deprivation of Liberty Safeguards, with training dealing with behavious that challenges with techniques in distraction and deescalation. This will ensure residents rights, safety and well being is maintained. All staff at the home should be trained to meet the aims of the home and the changing needs of residents. This includes training such as manual handling, abuse awareness and risk assessing 1st aid training requirements. Chrissian House is comfortable and clean, but dated and well used. A plan of refurbishment that sets out timescales and areas of priority will show commitment to developing the environment for the benefit of residents. Residents should be given opportunities for stimulation through leisure and recreational activities which suit their needs, preferences and capacities. 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 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 9 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to be provided with information about this home, have their needs assessed before they move in and have the opportunity to visit and therefore are more able to make a decision about their choice of home. However, people admitted outside of category e.g people with primary ongoing mental health needs may not have all their needs met. Evidence: At this inspection we requested a copy of the revised information that was made available to people. We were given the same information as our last visit however in addition the terms and conditions of residence along with information on the fees payable had been added. Therefore people who use this service are given sufficient information about the service on offer and what is included in the stated fees. However, upon reading through the information at the inspection we found that the contact date details of the commission and social services were out of date and Care Homes for Older People Page 10 of 29 Evidence: incorrect. The manager agreed to reread the whole document and make updates where necessary. Two new service users had been admitted to the home since our last random inspection therefore, we requested to see the information that the manager had relating to assessment of their care needs. In both cases the manager had received information on assessed needs from a placing authority and had visited the individuals to make an assessment for himself before the residents moved into the home. One individual had been at the home for approximately 24 hours. The care plan developed for this individual was still progressing and information available to staff was satisfactory. Information about the home state that people are encouraged to visit Chrissian care home before deciding to move in and they moved in on the premise of a trial period lasting four six weeks. During inspection we identified 2 people relatively new to the home whos primary care needs were around their mental health and not necessarily around their need for personal care as an older person. This service does not have the category MD (mental disorder) on its registration and therefore should not accept people whos primary care needs is around their mental health needs. This service is not staffed with people who have the collective skill, training and experience to support people with enduring mental health needs. We had a discussion with the manager who believed with the support of the local mental health services the he and the the home were currently able to meet the needs of these individuals. However, we sought assurance from the manager that future people would not be admitted to the home where ongoing identified needs relating to mental health were unlikely to be met. The manager agreed. Care Homes for Older People Page 11 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to have an individual care plan in place good health care pathways. Not all people can be assured that their manual handling care needs can be safely met at all times. The current procedures around medication do not ensure residents are protected sufficiently. Evidence: At the last inspection of this home which was a random inspection on 3rd November 2008 we had concerns around manual handling as currently the home is not protecting residents and staff as well as it could do. We found that 8 staff had not had training. We found that care plans did not contain manual handling risk assessments to instruct staff how to safely move residents. We found that one resident had fallen and the home and staff were unable to get them up from the floor once paramedics had found no injuries. We asked the home to review care needs around manual handling, falls prevention and then provide the appropriate equipment to meet those needs and train the staff in the techniques of moving people. Care Homes for Older People Page 12 of 29 Evidence: At this inspection we found that in relation to one resident we had identified the manager had referred the individual through the GP and had accessed the falls prevention service. Staff had received training on both falls prevention and how to use the new hoist that had been purchased. We saw that the individuals care plan had been altered to reflect the need to use the hoist at specified times. During the inspection we did not see staff using the hoist or see staff moving residents - even though we requested to observe when this occurrence was likely to happen. However we believe on the information we have that in this individual case this resident is being offered satisfactory care with respect to manual handling. We were aware from our last visit to the service that one resident had been assessed by 2 physiotherapists as requiring a stand aid. The stand aid had been delivered and the manager told us that he and staff member were not able to work out how to use the equipment and did not find it useful so sent it back. We looked at this individuals care plan and found that the manager had dated it as being reviewed, but the plan was not updated with information relating to the current manual handling needs and the use of the hoist. We would expect to see staff trained in methods such as assisting people to stand and transfer, able verbally prompt residents to manoeuver themselves and trained to use equipment such as handling belts. This is the type of training that is covered on general manual handling. Staff had not received training in manual handling. We spoke to the manager about this aspect and the need to train staff. Our overall view is therefore some residents have their presenting manual handling care needs assessed, equipment provided and staff trained in specific techniques, but not all people can be assured that their manual handling care needs can be safely met at all times. We examined the care plans of 3 individuals and discussed a further 2 individuals care needs with the manager. We found that there were care plans in place that had evidence of review. The daily notes made by care staff were detailed and informative of the care and support given. The notes also contained information on access to health care. There are good health care pathways in place for people at this home with appropriate access to the GP, District Nurse and Community Psychiatric Nurse. We spoke to staff about how they would ensure the privacy and dignity of residents at the home and they were able to assure us of their practice. One staff member said I always ensure the doors are closed and cover people up if they are on the commode. It is also important to keep matters confidential. The expert by experience told us: The residents appeared to be comfortable and happy. Care Homes for Older People Page 13 of 29 Evidence: We examined the medication arrangements in place at the home. We believe that there are some key improvements that need to be made relating to the procedures around medication at the home to ensure residents are protected sufficiently. There are 2 medication trolleys in use and we saw 2 different staff follow the practice of secondary dispensing medication into labeled pots to be distributed at a later date. This is not what the homes medication policy states they should do and is perhaps done to save time at a later point in the shift. However this is placing residents at unnecessary risk of receiving the wrong medication. We also found in the records kept by staff that they were using the wrong codes for medication when they were not signing to say they had given it. These incorrect records may lead to misunderstandings and should be avoided. Finally we found from looking at records (we had not been notified) that a residents medication had gone missing on 17/02/09. This medication, along with all the other residents medication for the following month had been booked into the home, but had been stored unlocked and accessible to all. We left advice with the manager to report the matter to police and to ensure medication at the home was safe and secure at all times. Since our inspection the manager has told us that a police investigation has started and assured us that medication is kept secure at all times once on the premises. Care Homes for Older People Page 14 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy a varied healthy diet. Residents may not be offered sufficient leisure and recreational activities to suit them. Evidence: Staff and relatives previously surveyed had expressed a view about the lack of activities on offer at the home. In response to our annual service review completed in August 2008 the manager wrote to us to say that we do entertain the residents on a Thursday afternoon. And that he would go on to survey residents and staff about activities/entertainment. This matter was looked at during our random inspection. People we spoke with confirmed that entertainment was provided on a Thursday and this tended to be bingo as it was a favourite of the residents. The manager had conducted a survey at the end of 2008 and was in the process of looking at the results. One very positive development was that a staff member had enrolled upon a course at a local college entitled Promotion of activities in a care setting. We fed back to the manager that we would expect to see activities on offer each day based upon residents preferences. At this key inspection our expert by experience reported On the day of my visit there Care Homes for Older People Page 15 of 29 Evidence: were no activities taking place. Television sets were switched on but no other activity appeared to be planned and no list of planned activities displayed. I spoke with several residents and members of staff and it would appear that no activities other than bingo once a week are taking place. A hairdresser attends the home at least once per week and there is an alternative hairdresser available for appointments. A chiropodist is available to visit for appointments. When asked about a variety of activities, the response generally was we have nothing like that here. The expert by experience believed the Manager appreciated the need for a more structured approach to this problem and was keen to encourage both staff and residents to participate in activities generally. The expert by experience was also told that one member of staff intended to undertake a course involving the promotion of activities mental stimulation in a care setting. We asked the expert by experience to look at matters relating to catering and this is what they reported Three cooks are employed part time, approximately between the hours of 07.30 and 13.00 hours. The cook today was very pleasant and helpful and willing to answer any queries. The kitchen is very old and extremely tired. There is no dishwasher used in the kitchen, all crockery being washed by hand. The area is also used as a short cut from one section of the Home to another, access not being denied to anyone. During discussion with the Manager, it was established that the whole kitchen area is being refurbished this year. The expert by experience went on to tell us The food store is monitored by the Manager who then decides on what is to be ordered and organises the necessary shopping. The majority of fresh fruit is either paid for by the residents and purchased by the staff on their behalf, or brought in by relatives. The fruit is then stored in separate baskets in the kitchen. Generally during the afternoon the staff will cut up or prepare the fruit for the residents. Meals are served in two dining areas. Some of the residents use the larger dining room which seats approximately 14 diners and there is a smaller dining area which could seat 8 to 10 diners. The dining chairs all had arms to assist with standing up or sitting down and, although very sturdy, are in need of refurbishment. The menu for the day was clearly displayed in the dining room. The menu for today was liver and sausages, potatoes, carrots and cabbage. There was an alternative of macaroni cheese. Trifle or yoghurt was served for sweet. The size of the portion for each resident appeared to be well judged and the majority of the residents ate most of the meal. The residents I spoke with had no complaints. In general they thought the food was good, OK but not excellent and I always eat everything. Care Homes for Older People Page 16 of 29 Evidence: The evening meals are generally prepared and served by the care assistants and this is a light meal. Today pancakes were going to be on the menu. The main breakfast each day appeared to be fruit juice, cereal or porridge. The Manager is due to review the menu and at the moment, it would appear that the main meals are basic meat and vegetables. Fish is cooked once each week but pasta, savoury rice or curries did not appear to be a regular or popular choice. It was very quiet in the dining room, no quiet background music and no conversation between the residents. When asked whether there were any residents who needed to have special diets or food, I was informed that none of the residents had any sensitivity or allergies to any ingredients. Several residents required their food cut up for them but no meals were liquidised. On my arrival the Manager informed me that lunch had been ordered for me, which was very thoughtful and when I mentioned that I did not eat either liver or sausages, I was offered several other choices. I chose a cheese salad. When this was served to me, it was crisp, fresh, plentiful and very nicely presented. A good colourful salad selection. Staff were visible and available throughout the meal and assisted whenever required. Any help or request was carried out calmly, efficiently and happily. One care assistant, several times, reminded the residents to drink their water. We also had feedback from a relative who said Chrissian has a lovely homely feel. Excellent home cooked meals and a very friendly atmosphere. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Chrissian has a clear policy and procedure in place for dealing with complaints and views listened to. However lack of training for staff may compromise protection of residents. Evidence: The service has a complaints procedure in place and this is widely known. It is displayed within the home, staff spoken with were clear that if anyone had concerns they would pass the matter on to the manager to address. A relative told us that if needed they knew how to complain and that the homes manager is always in attendance and very approachable. We were able to examine the records relating to complaints and found that the manager kept good records and had addressed concerns in a timely manner to the satisfaction of the complainant. We have not received any complaints directly or been notified of any safeguarding matters. However, before this key inspection we received an anonymous letter of concern from a staff member relating to manual handling and saying that the home could not meet the needs of all the residents. We looked at these concerns as part of this inspection and have reported within the relevant sections of this report on matters. Care Homes for Older People Page 18 of 29 Evidence: In respect of safeguarding vulnerable adults the service subscribed to the local procedure and the manager was knowledgeable about this. He stated that all staff were trained and that he used a video in training developed by Suffolk Social Services. Staff spoken with were clear that if they had any concerns they would immediately report matters. However one staff member said they had not received training in abuse awareness. We have been notified by the manager that on 2 occasions he has had 2 residents become verbally aggressive and that he has had to physically remove them from communal areas. We are clear that physical intervention should only be used as a last resort and in accordance with Department of health guidance. No staff at this home have been appropriately trained in this area. Therefore in order to protect residents who currently use this service guidance and training should be sought. Please also read the section on staff recruitment relating to criminal record bureau checks for staff. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Chrissian House is comforatble and clean but is dated and well used. The environment does pose challenges to older frail residents. Evidence: Chrissian house is 2 converted town houses in Ipswich and as the result poses challenges in mobilising older people upstairs. The home have installed chair lifts on the stairs to help residents reach the first floor safely. The environment is comfortable and clean but is dated and well used. We visited all areas of the home. The expert by experience reported I visited several bedrooms of the residents one of which had not been cleaned. This may well be that it was fairly early in the morning and may well have been last on the cleaners round. Many pieces of furniture in the bedrooms needed updating, as do a lot of the furniture throughout the Home. Some of the bedrooms are doubles, with a curtain to provide some privacy. There is no shower facility in any of the bathrooms. There are seats in the baths which can be raised to assist getting in and out of the bath. Whilst being shown around the Home I noticed that several items of laundry were draped across handrails. When this was pointed out to staff the items were immediatly removed and we were told that was unusual to see. The expert by experience went on to report Double doors lead from the larger lounge area into the conservatory. This is a pleasant seating area with views out to the rear Care Homes for Older People Page 20 of 29 Evidence: garden. At present it is a multi function room. Today it was being used as a hairdressing station and the ironing machine is at present housed in one corner. We are aware that there are plans to refurbish the main kitchen and the manger told us that the local environmental health officer had been consulted. This is a positive move and will greatly enhance the home. The Statement of Purpose says The home maintains a rolling program of re-decoration and refurbishment throughout. We discussed with the manager about developing a plan that would identify what areas of the home needed refurbishment, the timescale and the priorty of these areas. We believe that whilst not detrimental to the residents the environment could and should be enhanced to offer a better quality. 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. People can be assured that staffing levels are sufficent to meet the needs of the residents. However, staff recruitment practices and gaps in training are currently placing residents at potential risk. Evidence: At our random inspection of this service we found the home provided 3 staff on duty at all times during the day. There was a cook on duty each day who prepares and cooks breakfast and lunch. In an afternoon a carer prepared the evening meal at which time the manager was available for care duties. The home also employed a cleaner 5 mornings a week. At night there were 2 care staff, with a person on call. Everyone we spoke with during our visit said the staffing levels were OK and about enough. At this time we believe staffing levels were acceptable and did not find anything to lead us to believe otherwise. At this inspection we looked at the staff roster and found that staffing levels had remained consistent. The expert by experience reported The staff are very pleasant, anxious to please, always smiling and talk to the residents in a courteous manner. We looked at the recruitment records for 3 staff and found that some checks had been completed, but as a whole these lacked consistency and were not as thorough as Care Homes for Older People Page 22 of 29 Evidence: should be. One person did not have proof of identity or a full employment history that verified why the person had ceased working with vulnerable adults. This same person did not have a criminal records bureau check completed and was working at the home. One person did have 2 references, but not a reference from their previous employer. The third member of staff did not have a full employment history and reasons for ceasing work with vulnerable adults. The lack of robust checks may place residents at risk from unsuitable people being employed at the home. In relation to staff training we received a letter from the home stating that a reputable local firm had provided hoist training to all staff over 2 sessions held at the home. Staff had also received training from Suffolk Primary Care Trust on falls prevention and osteoporosis. Staff were very pleased to have received this training and spoke positively about this. Two staff spoken with confirmed they had either acquired NVQ 2 in Care or were about to complete the training. One staff member spoken with said they would like to receive 1st aid training. In previous section of the report we have recommended that staff receive manual handling training to complement their hoist training. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Chrissian is adequately managed, but the interests and welfare of residents are not actively promoted. Evidence: The manager of this service is suitably qualified and experienced and was registered with us in October 2007. Staff spoken with said they found the manager very approachable and felt that he addressed any matters they raised with him. The expert by experience reported The Manager was extremely helpful, open to any comment and made us very welcome. On arrival at Chrissian, I was able to enter the main door and wander into the hallway, without having to ring a bell. The Manager said he would give consideration to this security aspect and pass his suggestions to the owners. In relation to quality assurance the manager was in the process of evaluating a recent survey of residents and relatives that he had recently conducted. He had received 15 surveys and expected more to be returned. He had sought views on the welcome Care Homes for Older People Page 24 of 29 Evidence: people received, the food, the accommodation, the care and staff attitude. We await the outcome and a copy of this report in due course. The manager confirmed that the home do not enter into any financial matters relating to residents. In relation to staff supervision staff confirmed they do receive supervision and appraisals. We were able to see records of this on staff files. Staff spoke of having observations on their practice from the manager and they attended a staff meeting the previous week. With regard to records being appropriately maintained, we have mentioned the need to develop care plan review recording for some residents, the need to develop staff recruitment records and the need to accurately maintain medication records. In relation to safe working practices we have already mentioned the need to develop staff training. With regard equipment and environment we spot checked hoists and found them to have been serviced, radiators were covered to protect residents, windows were restricted to protect residents and hot water in 2 baths was tested and found to be within safe limits. 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 19 A thorough recruitment procedure in line with regualtion must be completed for all staff. This will ensure residents are protected. 24/06/2009 2 4 14 This service must not admit residents outside of the registered category. The home is unable to demonstrate that they are able to meet their needs as staff individually and collectively do not have the skills and experience to meet the needs of people with mental health problems. 23/06/2009 3 9 13 Medication must not be secondary dispensed. Staff must follow the home medication procedure. 23/06/2009 4 18 12 If the home are to 24/06/2009 accommodate residents who may become aggressive and Page 27 of 29 Care Homes for Older People staff to deploy physical intervention as a last resort, then guidance must be sought and training provided. This should be in the form of Mental Capacity Act training, Deprivation of Liberty Safeguards and managing challenging behaviour. This will ensure the rights, safety and well being of residents is protected. 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 2 9 12 Staff should use the correct codes when recording medication to avoid any misunderstandings. Residents should be given opportunities for stimulation through leisure and recreational activities which suit their needs, preferences and capacities. All staff should have training on abuse awareness in order to fully protect residents. A plan of refurbishment should be developed that sets out timescales and areas of priority. This will show committment to developing the environment for the benefit of residents. All staff at the home should be trained to meet the aims of the home and the changing needs of residents. This includes training such as manual handling, abuse awareness and dealing with aggression. 3 4 18 19 5 38 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. 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