Inspection on 29/01/09 for Churchill House

This inspection was carried out on 29th January 2009.

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

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

Other inspections for this house

Churchill House 23/01/07

Churchill House 06/01/06

Churchill House 26/09/05

Churchill House 14/10/04

Churchill House 17/06/04

Churchill House 14/01/04

Similar services:

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Snydale Care Home

Hawkhills

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Ravensworth Lodge

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: Churchill House 745 Holderness High Road Hull East Yorkshire HU8 9AR     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: Beverly Hill     Date: 2 9 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Churchill House 745 Holderness High Road Hull East Yorkshire HU8 9AR 01482709230 F/P01482709230 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) : Wealdplace Limited care home 25 Number of places (if applicable): Under 65 Over 65 25 25 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 0 Churchill House is positioned on the eastern outskirts of the city of Hull. It is situated on a main road, which enables easy access to public transport, shops and health facilities. Car parking and an external seating area for residents are situated to the rear of the property. The home is registered to provide care and accommodation for up to twenty-five older people who may also have dementia care needs. The home has recently changed ownership and one of the bedrooms has been utilised into an office. This means although the home is still registered for twenty-five people there are only placements for twenty-four. The home is a mixture of an old building and a new extension and facilities are over two floors serviced by a passenger lift. It has mainly single bedrooms with the exception of one shared room. There are two lounges with space for dining tables and chairs in each. Communal rooms are decorated in a homely style and furniture provided is appropriate for residents needs. The home has three bathrooms, one of which has an assisted bath. The new proprietors have plans to convert one of the other bathrooms into a walk-in shower room to enhance bathing Care Homes for Older People Page 4 of 33 Brief description of the care home choice for people. According to information received on the day of the visit the current weekly fees are 350 pounds. The home provides basic toiletries, a daily newspaper, a visiting physiotherapist and reflexologist and also pays for a visiting entertainer. Optional extras include chiropody, hairdressing and personal toiletries. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating form this service is 1 star. This means that the people that use use this service experience adequate quality outcomes. This inspection report is based on information received by the Commission for Social Care inspection (CSCI) since the last key unannounced inspection on 23rd January 2007 and Annual Service Review on 21st December 2007. It includes information gathered during a site visit to the home, which took approximately eight and a half hours. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Churchill House. We also had discussions with the new proprietors, the Care Homes for Older People Page 6 of 33 deputy manager, care staff members, the cook and a reviewing officer from care management. Information was also obtained from surveys received from residents, care staff and a visiting health professional. Comments from the discussions and surveys have been used in the report. We looked at assessments of need made before people were admitted to the home and the homes care plans to see how those needs were met whilst they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff recruitment, induction, training and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out staffs understanding of how to maintain privacy, dignity and, independence and choice. The home had returned their Annual Quality Assurance Assessment (AQAA) within the agreed timescales. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. We would like to thank the people that live in Churchill House, the staff team, and management for their hospitality during the visit and also thank the people who completed surveys and had discussions with us. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward as recommendations, but only when it is considered that people who use the service are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: A new system of initial assessment, care planning and risk assessment is being introduced. This needs to be done quickly so staff have the information they need to refer to when supporting people. The care plans need to include all assessed needs, be evaluated and give clear guidance to staff. People self-medicating a part of their medication should also have this in their care plan. Care Homes for Older People Page 8 of 33 Daily recording of care provided also needs to be more comprehensive and care files could be more organised so information is easily accessible. Written information about residents nutritional needs could also be provided to catering staff. The management of medication needs some improvement to make sure that staff record all medication into the home and they need to follow guidance when handwriting details onto the medication administration record. Staff could also be more proactive in contacting the doctor for advice when people decline medication and when there are not clear instructions provided with the medication. Some activities have been started to occupy people but these are limited and people with dementia care needs should have more tailored stimulation suitable to their needs and abilities. The home needs to improve the way it recruits new staff so that all checks are in place before they start on shift. The staff induction also needs to ensure that skills for care standards are completed if an NVQ qualification has not been obtained previously. A training plan for the coming year should be developed in line with information gained from staff supervisions and appraisals and knowledge of residents needs. It should include mandatory training with updates, safeguarding of adults from abuse and conditions affecting older people and particular residents in the home. The home has a new system in place to monitor the quality of the service it provides. This includes audits and questionnaires to people and needs to be fully implemented. Care staff do have formal supervision sessions with their manager but the doocumentation is basic and the discussion needs to cover all aspects of care and staff development. The manager needs to make sure they send the Commission any information about incidents that affect the wellbeing of residents. These are called notifications and help us to look for patterns in accidents and incidents in the home so we can check out how they are managed. Staff do complete accident forms but sometimes not as thoroughly as required and the manager should restart to audit them to enable changes in practice if necessary. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensured that assessments of peoples needs, completed by the local authority, were obtained prior to admission to enable staff to determine if needs can be met in the home. New assessment documentation introduced will ensure this assessment process is kept under review. Evidence: We examined four care files during the visit and all had assessments of need completed by the local authority prior to admission. There was no evidence that the manager or deputy manager completed the homes own assessment and it appeared that they relied on the local authority assessment for information. The deputy manager confirmed that people were not admitted until the local authority assessment had been received and this enabled them to determine if needs could be met in the home. The new proprietor will be introducing new assessment paperwork in line with other Care Homes for Older People Page 11 of 33 Evidence: homes in the company. This will enable staff to follow up the local authority assessment with their own documentation and to keep the assessment under review. The home needs to formally write to potential residents following their assessment stating their needs can be met in the home. Staff spoken with were clear about peoples needs and residents told us their needs were met. Residents were able to have trial visits at the home and respite stays were arranged to enable people to sample the home prior to any decision about permanent residency. This was confirmed in a comment from a relative, she had respite at the home before becoming a permanent resident and found the staff and the environment pleasant. The home does not provide intermediate care services so standard 6 does not apply. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Gaps in care planning and risk assessment means that staff may not have the full information required to care for people and important care may be missed. The recording, and in some instances administration, of medication was insufficiently robust to ensure safe practice for residents. Evidence: We examined four care files to check how peoples needs were identified in care plans. The care files contained information about people and a local authority care plan giving basic information, but there was no recognisable plan of care to give guidance to staff on how the persons needs were to be met. A recording sheet had a statement about an area of need, for example, mobility, but not how this was to be managed. The statement was followed by a monthly entry by the manager regarding whether there had been any changes. There was evidence that reviews had taken place with the local authority and family members present. Care Homes for Older People Page 13 of 33 Evidence: There needs to be a full care plan system whereby needs identified at the assessment stage are planned for with clear guidance to staff. Evaluations of the care plan need to take place monthly taking into consideration information written in other parts of the care file and changes in need must be clearly identified. Some areas of risk had been identified, for example skin condition and risk of pressure damage. However the risk management system was basic and needs to link to care planning and review. One care file examined identified the person had some behaviours that could be challenging to others. These need to be clearly identified in a detailed plan that gives staff consistent guidance in how to manage them. Recording of daily care and key worker activity was limited and although staff spoken with were clear about residents needs, the reliance on verbal means to pass on important information was unsafe. The new proprietors had recognised this and had set up a new system to record day and night care. Staff spoken with found this useful in handovers, however, daily recording of care provided needs to be much clearer with follow on from shift to shift of important information. To improve the care files could be more organised with different sections to make access to information easier. There was evidence that residents had access to health care professionals such as GPs, district nurses, community psychiatric nurses, specialist nurses, chiropodists, opticians, out patient appointments and dieticians. Ten surveys were received from residents, some completed with the aid of relatives, and all stated their health and personal care needs were met. Comments were, she has specific needs relating to her condition - the staff rise to the challenge and we are always contacted as appropriate. A health care professional stated in a survey, well run home, staff help residents and follow up any medical treatment I recommend. Residents spoken with confirmed care was provided in ways that respected their privacy and dignity. New medication policies and procedures are being introduced by the new proprietors and the manager and deputy manager are awaiting an update in medication training. The home does not have any residents receiving controlled drugs at present but storage facilities are in place should this situation change. The management of medication needs review to ensure it is completed safely. Some residents were admitted for respite care but their medication had not been signed into the home. There was also evidence that medication supplied other than in the monitored dosage system was not signed in. Some residents had received medication mid-cycle and staff had written the information onto a medication administration record (MAR). However the full written instructions had not been included and the two signatures required were missing. There was evidence that instructions for some Care Homes for Older People Page 14 of 33 Evidence: medication was not being carried out because the resident declined to take the dosage prescribed. Staff need to be proactive about this and contact the prescriber for advice and direction. The dosage may be changed to one that suits the resident. There was also an issue of timings with one particular medication. This was mentioned to the deputy manager to address. Some medication was written on the MAR, as directed. This did not give staff clear directions and needs to be addressed with the prescriber or the pharmacist. Some residents managed a part of their medication in the form of inhalers. Whilst this is good practice in supporting people to maintain their independence, it needs to be risk assessed and clearly documented in care plans with supervision arrangements identified. The room where the medication is stored needs to have a thermometer so the storage temperature can be monitored. It would also be advised that a small medicines fridge be obtained rather than storing medication in the main kitchen fridge. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff provided people with a homely and pleasant environment where they are able to make choices about aspects of their lives and are supported to remain in contact with family and friends. There are gaps in the provision of activities which could mean people, especially those with dementia care needs, are receiving insufficent stimulation. Evidence: Residents told us that routines were flexible and visitors were welcomed at any time and offered refreshments. The atmosphere was relaxed and pleasant and there was good interaction noted between staff and residents and definite signs of wellbeing noted. People told us they were happy in the home and staff treated them well. They had the opportunity to make choices about aspects of their lives such as where to sit, what to eat, the clothes they wanted to wear, visitors they wanted to receive, whether to remain in the bedrooms and whether to participate in activities. Some residents managed a part of their medication and some managed their own finances with assistance from relatives. Some people had their own telephones and fridges in their bedrooms. One resident commented in a survey, I prefer to stay in my room rather Care Homes for Older People Page 16 of 33 Evidence: than join in activities - this is my choice. Staff spoken with were clear about how to maintain independence and how to encourage people to make choices, we make sure people always have choices at mealtimes and we do take some residents to the shops so they choose their own things. The home provided a limited range of activities for people to participate in and the proprietor confirmed this was an area they wanted to improve. They had started fortnightly reflexology and fortnightly physiotherapy (on opposite dates so there was something weekly) and staff provided one to one chats with people and escorted some residents to local shops and cafes. An entertainer visited every two to three months and seasonal parties were arranged. Clergy visited particular residents and newspapers were delivered to the home. One person told us they were an avid reader and relied on family members to bring in books. To improve the home could look at contacting a mobile library to increase choice for the person. Some people were quite able to entertain themselves and clearly preferred to stay in their bedrooms or in the second lounge watching television or listening to music. However, there was no clear structure or plan of activities or any record of the benefits to residents. It was difficult to see how people with dementia were stimulated and the home needs to address this with social needs assessments and clear documentation of how identified needs are to be met. People spoken with liked the meals provided and those seen were well presented. The cook told us that there were alternatives available and staff visited each resident in the morning and afternoon to see what they wanted for lunch and the evening meal. Meals were all prepared on the premises and special diets were catered for. The dietician had been involved for specific residents. Comments about the meals were, the meals are really lovely, nicely dished up on our plates, the meals are very good, they feed me very well and there are two choices and lots to eat - all home cooked and traditional. It may be useful for residents to have access to jugs of water or juice in the lounges so they can help themselves. The home had received an, A in the local authority, scores on the doors assessment system for safe food management, which was an excellent achievement. Care Homes for Older People Page 17 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided an environment where people felt able to complain and were protected from abuse. Evidence: The home had a complaints policy and procedure that was on display. The procedure required some updating to include information about other avenues for complainants if they were not satisfied with any investigation outcome, for example the Local Authority and the Commission. There were two systems in place, a niggles book for minor issues and a complaints form. Both were held in the managers office and it was suggested that these be made accessible and more visible to people. The home had not documented any complaints since the last inspection. The Commission had received one complaint, which was related to contracts and fees. It was referred to the previous proprietor to investigate. There were no records of the investigation or outcome held in the home. The new proprietors were unaware of the complaint but there has been no further issues. They are aware that all documents relating to the home must be maintained in the home. Staff spoken with knew what to do if people raised any complaints with them and residents were very satisfied with their care. Those spoken with on the day confirmed they felt able to complain, I would tell any of the staff. They mentioned staff by name Care Homes for Older People Page 18 of 33 Evidence: as the people they would go to if unhappy about anything. All ten surveys received from residents indicated they knew how to complain. One relative wrote, we never have any concerns. The home used the multi-agency policy and procedure for safeguarding adults from abuse. Staff were very knowledgeable in discussions and were able to tell us exactly what they would do should they witness any incidents that concerned them. Records were unclear regarding the amount of training some care staff had received and ancillary staff had not received training. The manager and deputy manager had received training facilitated by the local authority and the proprietors had good knowledge of the procedures. Residents stated they were happy and well cared for, and felt safe in the home. Care Homes for Older People Page 19 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided a clean and pleasant environment for people. Evidence: The home was very clean and tidy with no malodours. It was obvious that domestic staff worked hard to maintain the standards. The home is made up of an old building with a new extension attached. In total the home had two lounges, both with dining tables and chairs insitu. The rooms were decorated in a homely way and furniture was appropriate for residents needs. The hallway, stairs, lounges and dining areas had been recarpeted, and new chairs had been purchased for the lounges in 2008 via a grant from the local authority. The new proprietors were committed to improving the environment and had started a process of redecoration and refurbishment for the bedrooms. Several had been completed to date with new carpets, furniture and fresh looking walls. The shared room had a privacy screen and most rooms had lockable facilities for people to store their valuables. The proprietor confirmed the refurbishment of bedrooms would ensure lockable facilities were available in every bedroom. Those bedrooms seen were personalised to varying degrees. Care Homes for Older People Page 20 of 33 Evidence: The home had three bathrooms, although only one had a bath hoist so tended to be the main one used. After discussion with residents, the new proprietor has plans to convert one of the other bathrooms into a walk-in shower room to make it more accessible to people and increase bathing choices. It was clear from surveys and from discussions on the day that people were very happy with the environment. Comments were, the home is always beautiful and clean in every way, one could wish for no more, the home always smells sweet and fresh, very clean and best of all, no smells, a very good care home, must be one of the best, never had a bad smell in this place yet in six years and homely and friendly with pleasant surroundings. It was noted during the visit that one of the doors leading from the dining area slammed shut each time it was used. This startled the residents and even staff commented on it. As the door was well used it would be appropriate to install a door stop connected to the fire alarm system so it can remain in the open position or alternatively adjust the self-closer so it closes softly. This was mentioned to the new proprietor to address. A downstairs bedroom, which was some distance away from the others had been made into an office for the manager and administrator to use and the managers current office was to be changed into a treatment room for district nurses to see residents in private, and for the storage of the medication. This will improve the environment for residents and staff. Other improvements noted were the purchase of two televisions, one for each lounge, the installation of satelite television to increase the choice of programmes available and two washing machines have been purchased. A dishwasher and bain-marie for the kitchen have been ordered. Communal bathrooms and toilets required paper, hand towels rather than cotton ones to prevent the spread of infection. Some radiators required covers. The new proprietor was aware of this. Care Homes for Older People Page 21 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Support was provided to residents by caring and friendly staff. Gaps in training could mean that staff do not have the required skills to fully meet residents diverse needs. Evidence: The home had sufficient care staff on duty to support the residents. The home is registered for twenty-five people and currently there are seventeen residents with eight vacancies. The new proprietors are taking this opportunity to refurbish the empty bedrooms. They have also utilised one of the bedrooms into an office for the manager and administrator, bringing the number of placements available to twenty-four. Staff told us there were always three carers plus a deputy manager or manager during the day and two carers at night. The managers usually finish their shift at 4 or 5pm. When the home is fully occupied, and depending on the needs of the residents, the staffing levels may have to be adjusted. At present the manager completes some caring tasks when on duty, but this may not always be possible with the amount of managerial tasks to complete. The proprietors will keep a check on the staffing levels as the numbers of residents increase. Care Homes for Older People Page 22 of 33 Evidence: The staff rotas confirmed the numbers. They need to specify in what capacity staff are on duty. Residents spoken with and surveys received from them were very complimentary about the staff. They told us that staff answered call bells quickly and looked after people well. Comments were, they definitely treat me right, they are good to me, I like it here very much, the staff are very friendly, they are very kind, staff treat us well and support in a nice way, the carers are all so very helpful, they always do as we ask and the staff do very well, I am quite happy and content. The home did not have a training plan but there was evidence that some training had taken place and the amount of care staff that had completed a National Vocational Qualification (NVQ) in care at level 2 was very high at 85 percent. All staff had completed mental capacity legislation awareness training and fire training was arranged for February. Four staff were booked on medication training with three staff having completed the course so far. Various mandatory courses had been completed in the past, however some were out of date and there was little evidence of first aid, infection control and health and safety training. To improve, an audit of staff training needs must be completed and a plan devised from information gained in staff supervision and appraisals. Training should include dementia awareness and conditions affecting older people such as diabetes, strokes, sensory loss and Parkinsons disease. As some residents had these identified conditions it was important staff had the skills to care for them fully. Staff induction was an orientation to the homes way of working and shadowing more experienced staff. Any new staff would also need to complete skills for care induction standards if they had not already achieved an NVQ level 2 in care. The manager needs to obtain information about the common induction standards in readiness for new staff. The new proprietors had a good staff recruitment system, although the one staff member recruited since the last inspection only had one reference in place. The deputy manager explained this was because she had previously worked at the home and was well known to management and the staff team. All other checks had been completed. It is still important to have two references in place or the manager to document why they have recruited on only one, and to sign this off as acceptable. To improve a photograph of staff needs to be in records and information about the interview process would demonstrate that a thorough interview, and recruitment and selection process had taken place. Care Homes for Older People Page 23 of 33 Care Homes for Older People Page 24 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There has been some slippage in implementing management systems in the home, which has been the result of minimal support and guidance from previous proprietors. A change in ownership and fully supportive, hands on, new proprietors should address shortfalls mentioned in the report and provide a more inclusive environment for residents and staff. Evidence: The registered manager was not present on the day but we were able to speak to the deputy manager and the new proprietor. The new proprietors were described as, hands on and always available should they be needed for advice and support. Comments from staff were, the new employers are working well and we are looking forward to the future, I think things will carry on improving now we have new owners, they are brilliant, a big improvement, we see them often, almost daily and they chat to residents and staff and they care about the staff and know our names. This way of working is a big improvement for staff and as a result they felt much more Care Homes for Older People Page 25 of 33 Evidence: supported and guided. The registered manager and deputy manager had been left to manager with minimal support from the previous proprietor and often worked as carers on shift and caterers at the weekend. As a result some management systems have slipped. Staff told us they were very supportive to them and always available. Staff supervision in the form of one to one discussions with the manager took place, but there was little evidence of what was discussed in the notes of the meetings. The staff supervision should cover the philosophy of the home, care practices in general and staff development. The documentation needs to be clearly dated. The new proprietors have initiated their own quality assurance system in line with other homes in the company. Surveys were sent to residents last November regarding their views on activities and catering. The results were analysed and changes have been made to the menus and some activities arranged such as physiotherapy and reflexology. The proprietors recognised the area of activities and stimulation required more input but this was a good start. They are planning more questionnaires to relatives, staff and visiting professionals to gain a range of views, and also audits of systems in the home to provide checks on the quality of service provision. When fully operational the quality assurance system should address the shortfalls identified throughout the report. The new proprietor had also completed his annual quality assurance assessment required by the Commission within the agreed timescales. It showed us they were aware of some of the issues we have identified during the inspection visit and the plans they have to address them. We discussed how residents finances were managed and the new proprietors had implemented the same system as is in operation at other homes in the company. Money was stored securely with restricted access and individual records maintained. Receipts were issued for deposits and withdrawals. Some residents managed their own personal allowance and others had assistance from family members. Lockable facilities were available for people on request in order for them to store their valuables in. Generally the environment was a safe place for people to live in and staff to work in. Equipment in the home was maintained and serviced at appropriate intervals. However staff did require training in health and safety, infection control and first aid. Fire training was booked and moving and handling training had taken place in the past but updates were required. The fire safety record book was disorganised and was difficult to audit clearly what checks had taken place. It was established that some weekly checks had been carried on on equipment and the alarm system, however there was no evidence that staff had Care Homes for Older People Page 26 of 33 Evidence: taken part in any fire drills to practice their response in emergencies. Accidents were recorded but at times the information was incomplete and did not state whether the resident required any treatment from professionals. Also the home did not notify the Commission of incidents affecting the wellbeing of residents as required by legislation. It is important we receive this information so we can track patterns and check with the home how staff are managing the issues. Care Homes for Older People Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 7 15 Each resident must have a 30/04/2009 care plan in place that meets their identified needs and gives clear guidance to staff in how to support people. Care plans must be evaluated and updated when needs change. This will ensure that important care will not be missed. 2 8 13 A thorough risk assessment and risk management system must be in place to help staff identify risk and take steps to minimise it. This will help staff to support people safely whilst ensuring they help to maintain their independence. 28/02/2009 3 9 13 All medication must be signed into the home and advice must be sought from the prescriber when people decline to take the full 28/02/2009 Care Homes for Older People Page 29 of 33 dosage of medication prescribed. This will enable medication to be clearly audited and also ensure the prescriber is aware when people decline medication so they can look at alternative arrangements. 4 12 16 Each resident must have their social needs assessed and planned for. Particular attention to be paid to people with dementia care needs. A structure of activities needs to be in place to provide social stimulation. This will assist staff in tailoring activities to meet residents needs, prevent boredom and help to prevent a deterioration in residents cognitive abilities. 5 30 18 The home must ensure that staff have the required skills to meet the range of residents needs identified. This will ensure care will not be missed and give staff the confidence to care for people with a range of needs. 6 38 37 The home must notify the Commission of any accident or incident occurring in the home that affects the wellbeing of the residents. 28/02/2009 30/06/2009 30/04/2009 Care Homes for Older People Page 30 of 33 This will enable us to look for patterns and follow up with the home how staff are managing the incidents. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 The home should formally write to prospective residents following assessment stating their capacity to meet the assessed needs. The homes own new assessment documentation should be used for any new admission to enable the information gathered during the local authority assessment be kept under review. Daily recording should be more comprehensive and cover the support provided and the welbeing of the resident. Those residents self-medicating a part of their medication should have risk assessments in place and information, including supervsion arrangements, clearly detailed in the care plans A thermometer should be placed in the room where medication is stored to enable staff to be sure medication is stored at the cotrrect temperature. The home should also consider installing a medication fridge rather than keeping medication in the main kitchen fridge. When handwriting entries onto the MAR, staff should write the full instructions and ensure two signatures as a means of double checking the instructions. Staff should check out with the prescriber or pharmacist the exact directions for medications marked, as directed on the MAR and ensure these are clearly documented. This will ensure staff know what is to be administered. Written information about residents nutritional needs, and preferences gathered at the assessment stage, should be provided to catering staff to keep on file. At present the cook had a wealth of knowledge stored in her head which would be lost were she to be absent from the home. The complaints policy and procedure should contain information about other avenues to pursue complaints. This Page 31 of 33 2 3 3 4 7 9 5 9 6 9 7 9 8 15 9 16 Care Homes for Older People will enable any complainant, unhappy with the outcome of any investigation conducted by the home, to take the matter further. 10 11 18 26 The home should ensure ancillary staff have the opportunity to participate in safeguarding of adults training. Communal bathrooms and toilets required paper hand towels, rather than cotton ones, to prevent the spread of infection. If the manager is to employ staff with only one reference because the staff has previously worked at the home they must demonstrate this in documentation and sign off the recruitment as accepted. The home should have a training plan in place that covers mandatory training, updates required, dementia care awareness and conditions affecting older people. The registered manager needs to allow sufficient management time to complete tasks associated with the running of the home. It is acknowledged that support and guidance is now available from the new proprietors. The quality assurance system should be implemented fully to allow for full consultation with people and provide a check on the quality of the services provided. Staff supervision should clearly indicate what has been discussed and cover the philosophy of the home, areas of care practice and staff development. Documentation should be dated. The home should reorganise the fire safety record book into a more organised system as it was difficult to audit when checks had taken place, and restart fire drills for staff to gain practice to how to manage emergency situations. The recording of accidents in the home should have more comprehensive details about the outcome for the resident and whether treatment was required. The auditing of accidents should restart to provide vital information on the management of them. 12 29 13 30 14 31 15 33 16 36 17 38 18 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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