Inspection on 21/01/09 for Clare Hall Nursing Home

This inspection was carried out on 21st January 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Clare Hall Nursing Home 14/01/08

Clare Hall Nursing Home 31/08/07

Clare Hall Nursing Home 27/09/06

Clare Hall Nursing Home 02/03/06

Clare Hall Nursing Home 29/09/05

Clare Hall Nursing Home 22/03/05

Clare Hall Nursing Home 08/09/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Clare Hall Nursing Home Clare Hall Nursing Home Ston Easton Somerset BA3 4DE     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: Justine Button     Date: 2 1 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 31 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 31 Information about the care home Name of care home: Address: Clare Hall Nursing Home Clare Hall Nursing Home Ston Easton Somerset BA3 4DE 01761241626 01761241727 robins@bupa.com 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) : BUPA Care Homes (CFC Homes) Ltd care home 57 Number of places (if applicable): Under 65 Over 65 57 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is 57 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Clare Hall is registered to provide general nursing and personal care. The home is formed from an older house and a more recent extension. Both areas have been adapted for the client group. It is situated in the village of Ston Easton, 3 miles from Midsomer Norton and 12miles from Bristol and Bath. The home is set in large, wellmaintained gardens, which provide different areas for sitting and walking. The majority of the bedrooms are for single occupancy although there are a small number of double rooms. There are several large areas on the lower floors used as dining and sitting rooms. The office space, kitchens and laundry are also found on the lower floor. The home is owned by Care First Homes, a direct subsidiary of BUPA. Care Homes for Older People Page 4 of 31 Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This Key unannounced inspection was carried out over one day by one inspector. The Manager Mrs Carrie Williamson was available on the day of the inspection. We would like to thank the manager and the duty staff for their time and hospitality shown to us during the visit. The focus of this inspection visit was to inspect relevant key standards under the CSCI Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are:excellent, good, adequate and poor. These judgement descriptors for the seven chapter outcome groups are given in the report. Care Homes for Older People Page 6 of 31 We received the homes Annual Quality Assurance document (AQAA) on time and this had been completed in full. In addition we have recievied a number of surveys from people living at the home. In the surveys received all people described themselves as white heterosexual. All fall into the older peoples category. We have also recieved feedback form a number of health proffessionals over the last few months. The Records examined during the inspection were care and support plans as part of the case tracking process, medication administration records, maintenance records, the homes Statement of Purpose, staffing rosters, menus, the homes complaints file, staff recruitment files, staff training records, quality assurance processes and staff supervision records. The inspector also conducted a tour of the premises. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. The current fees range from 700 pounds to 900 Pounds per week, which does not include hairdressing, toiletries, dental care, optician, physiotherapy, newspapers, transport or chiropody. What the care home does well: What has improved since the last inspection? What they could do better: The home as previously described is situated in two areas, the house and the wing. The house area is currently closed as it does not meet fire regulations. As such admissions to home are reduced. This has caused some anxiety for both people living at the home and staff who perceive the lack of investment as an indicator that the home may close. The management need to ensure that they communicate the future of the home to all parties via staff and residents meetings. The home was not clean, tidy and free from unpleasant odours in all areas. This was Care Homes for Older People Page 8 of 31 evident in the corridors, bathrooms, shower rooms and sluices. Details of the action taken in response to this are detailed in the main body of the report. It could not be confirmed on the day of the inspection that all people living at the home are supported to meet all aspects of their personal hygiene. This included taking regular baths or showers and meeting oral hygiene. Activities and opportunities to under take recreational opportunities are currently reduced although it is envisaged that this will improve in the very near future as a staff member has been seconded to undertake the activities organizer role. Not with standing the improvements noted at this inspection in order for the home to continue to develop and the overall rating of the home to improve the areas identified in this report now need attention from the management team. 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 31 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 31 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 continues to be able to provide prospective residents and relatives with sufficient information in the format of brochures, the Service User Guide and Statement of Purpose for them to make an informed decision about the home. All prospective residents receive a pre admission assessment by the registered manager to ensure the home can meet the assessed needs identified. Evidence: Surveys were returned to us and these confirmed that they received enough information prior to admission. Residents surveys received stated that all had received a contract and all felt they had received enough information prior to admission, about the home to make an informed Care Homes for Older People Page 11 of 31 Evidence: decision. The home has an updated Statement of Purpose and Service User Guide and the contract examined contained terms and conditions of residency and fee rate. Comments received included; We visited several Nursing Homes before choosing this particular home as we felt that it would suit the personality of our relative. One relative of a person recently admitted to the home commented; Matron and all the other staff could not have been more caring to my relative or me. Any questions I ask are answered pleasantly. On the day of inspection people using the service who were able, confirmed that they had been involved in the decision to move to the home and their relatives had viewed the home prior to admission. We examined records of a pre admission assessment undertaken by the manager and observed that the home had received a copy of the SAP (Single Assessment Process) prior to peoples admission to the home. The assessments were detailed and used to base the persons care plan on. Care Homes for Older People Page 12 of 31 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. The care planning system has improved with the majority of the plans being specific and person centered although this requires some additional development. Evidence was seen of input from the resident and/or their representative in the plan of care. Staff now ensure that people have access to fluids at all times. The frequency and incidents of pressure damage has reduced. Residents are able to have privacy in their own rooms. Personal support was offered in a way to promote the privacy and dignity of residents. People were treated with respect. The management and administration of medication was good. People living at the home may not be offered the opportunity to meet all aspects of their personal hygiene. This may include the opportunity to have a regular bath or shower and to maintain oral hygiene. Care Homes for Older People Page 13 of 31 Evidence: Three people were case tracked during the inspection and their care plans reviewed. Case tracking involves identifying individuals at the beginning of the inspection and comparing the care and support they receive with the needs identified in the care plan. The majority of the plans had been completed with the individual and or their representative. All contained a range of appropriate assessments and associated care plans. The majority of the care plans were clear and detailed. Care plans contained up to date assessments, which included moving and handling, reducing the risk of pressure sores & falls. Likes and dislikes were well documented in the majority of the plans seen. This was not consistently completed in all the plans viewed with some containing more detailed documentation than other. Some plans therefore required continued development to ensure that the plans reflect the way in which the individual would like their care to be delivered (person centered) A number of people at the home are frail and as such staff had introduced charts to record such things as amount of fluids taken and frequency of positional change. The majority of the charts viewed had been accurately completed and demonstrated that staff had delivered appropriate care and support. There was a good range of pressure reliving equipment, hoists were available. Improvements have been noted in the frequency and occurrence of pressure sores and ulcers. This is a significant improvement on previous inspection findings. It was also noted that people in the communal areas and in their rooms had access to fluids at all times. Drinks rounds are conducted throughout the day and no person appeared to be dehydrated. During the case tracking process and the reviewing of the care records it was noted that there was evidence that one individual had not been supported by staff to have a bath or shower for a period of 20 days. In this 20 day period one bath had been offered to the individual which was declined. There was no evidence in the care records that staff were proactive in re offering this and no other records that a bath or shower had been offered and declined. Staff confirmed with us the bathroom that this individual would use. In care homes there is a requirement that the hot water temperatures are monitored to prevent the risk of scalding. The hot water temperatures for the bathroom and shower room near this individuals bedroom were viewed. The hot water temperatures in bathroom again recorded and confirmed the care records and that the last bath had been taken 20 days previously. The records of hot water temperatures in this bathroom showed that a maximum of 12 baths had been undertaken in a three month period. The home is only currently using two bathrooms and one shower room. On the day of the inspection thirty five people Care Homes for Older People Page 14 of 31 Evidence: were living at the home. The hot water records showed that sixteen showers had been completed from ist Jan until the inspection date and three baths (included in the 12 baths as previously stated). This confirms that a total of twenty baths or showers have been completed in a three week period. This equates to a total of six baths or showers a week. Therefore if the recording and documentation are correct an individual living at the home could expect to have a bath or shower once every five weeks People spoken to during the inspection who were able to give an opinion stated that they did receive regular offers of baths or showers however two people stated that they were aware that this was not the case for all people living at the home especially for those who could not request one. In addition concerns raised with us by relatives since that last inspection have in some cases related to a perceived lack of personal hygiene. On the day that we visited the home all people looked clean tidy and well kempt however the management need to ensure that there is a robust system in place which ensures that people living at the home are offered the opportunity to have a bath or shower according to their individual wishes. During the inspection we visited a number of the bedrooms occupied by people living at the home. There was evidence that people had been supported by staff to have a wash in that face cloths and soaps were wet. A number of toothbrushes and toothpastes however were dry and had not been used. The care records for some people where this was the case were viewed. The care records demonstrated that these individuals either had their own teeth or required the use of dentures. As such oral hygiene with the use of toothpaste and tooth brush would be required. It is concluded therefore that not all people living at the home had received support from staff to clean their teeth and to met their oral hygiene needs. Staff demonstrated a good understanding of how to promote privacy and dignity and examples of how they do this were seen. Staff were seen interacting kindly to residents and were seen knocking on doors before entering. People living at the home spoken to during the inspection confirmed that staff treated them with respect and helped to maintain their privacy when delivering personal care. The homes procedures for the management and administration of medication were examined at this inspection. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). The registered nurse on duty administers medicines. Medicines were found to be securely stored. Creams in use, seen in individuals bedrooms, had not in all cases been marked with an expiry date and the MAR chart been signed to confirm that the creams had been applied as per the Prescription. Creams once opened have a limited shelf life. Staff are required to mark creams with a date of opening to ensure that the cream is not used after this date. Care Homes for Older People Page 15 of 31 Evidence: All other medication administration, recording and storage was found to satisfactory. Care Homes for Older People Page 16 of 31 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. Activities are on offer although these may be limited on occasions. Staff at the home need to ensure that the activities on offer are person centered. People living at the home are able to maintain contact with family and friends. The availability of food is good including the availability of snacks and appropriate foods for those on a specialist diet. Evidence: During the inspection the manager explained that the activities organiser was off on long term sick. This was also reported in the homes AQAA. This has impacted on the social and recreational opportunities available for people living at the home. This was confirmed in the surveys received. The surveys stated that people would like an increase in the opportunities available to them. People spoken to during the inspection stated that there was rarely things to do. In one of the care plans viewed documentation stated that one individual had undertaken some flower arranging on the 19/01/09. Prior to this the last documented activity was recorded on the 19/11/08. Care Homes for Older People Page 17 of 31 Evidence: Clearly care staff are primarily there to provide care and could only engage in activities for short periods. It would seem that care staff do not really have enough time to offer person centered choices of activity to a large number of residents with a wide range of needs. One person did say every day is just like any other. It is hoped that in the near future the activities and social opportunities available to people will increase as the manager has informed us that one of the care staff has been seconded in to the role of activities organiser. During the inspection we observed visitor coming and going. People living at the home confirmed that they were able to meet friends and relatives at any time and that staff made people feel welcome. Lunch was observed on the day of the visit. A choice of meal was available. The choices included beef stew or salmon and broccoli bake. Mashed potato and vegetables were also served. The potatoes and vegetables were served in dishes to the table which allows people choice of not only what they would like but also of portion sizes. The tables were nicely set with linen tables cloths and napkins. A choice of juices and water was available. Apple and blackberry pie and crumble was served following the meal. Some people require staff support to eat their meals. This was observed by us. Staff supported people in a dignified and unhurried manner. On the day of the visit there was a range of snacks and drinks available between meals. This included snacks fro those with specialist diets and for people with swallowing difficulties. Such things as yoghurts and fruit was available in addition to cakes and biscuits. One person living at the home however stated that this was not all ways the case and that the youghurtsand fruit were only available because the inspectors were here. It should be noted however that the incidents of weight loss and pressure ulcers at the home has reduced. Interactions between staff and people living at the home were observed to be good with staff acting in a kindly and respectful manner. Care Homes for Older People Page 18 of 31 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. Staff and residents are confident that the homes management team would appropriately deal with any complaints or concerns. Policies, procedures and training are available to staff to ensure they have the knowledge to prevent service users from the risk of abuse Evidence: relatives questioned during the visit and surveys, confirmed that people knew how to make a complaint and surveys confirmed that people knew who to speak to if they were unhappy. The complaints procedure is available throughout the home. The homes complaints record was examined and the home has received 3 complaints, which have all been dealt with within an appropriate timescale, and response had been made to each complaint. People using the service told us that they would be comfortable to approach the manager or a member of staff with any worries or concerns. Staff also confirmed that they were happy to approach the management with any concerns and would be confident that they would be dealt with promptly and appropriately. The home has access to an independent advocacy service and all people using the Care Homes for Older People Page 19 of 31 Evidence: service are registered to vote. Staff receive training in abuse awareness as part of their induction and ongoing supervision and all staff spoken with were aware of the whistle-blowing policy. Policies and procedures are available within the home for staff to consult and include information about complaints, challenging behaviour and staff direction regarding wills and bequests. All staff receive a POVA (Protection of Vulnerable Adults) check and a CRB (Criminal Record Bureau) check prior to commencing employment. Care Homes for Older People Page 20 of 31 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. The home is suitable for purpose however requires some updating and refurbishment in some areas. This refurbishment should include the shower room and sluice areas. People are able to personalise their own rooms. The home was not odour free on the day of the inspection. Evidence: During the inspection we were informed by the manager that the house area of the home was currently not in use as it had been identified that this did not comply with the changes to the fire regulations. As such occupancy at the home is reduced. People and staff living at the home are very anxious about this and expressed fears that the home may close. We have not received notification that this is happening and the manager assured us that this was not the case. The management team however need to ensure that this is communicated both to people living at the home and staff as soon as possible. During the inspection it was noted that several areas of the home were on need of Care Homes for Older People Page 21 of 31 Evidence: some attention. The shower room in use in the wing area of the home has mold growing on the ceiling. This is approximately one metere square. In addition widespread mildew was apparent in the grouting and shower cubicle. This does not make this a pleasant environment in which to have a shower and wash. The upper floor sluice area was also in a poor state of repair and looked dirty and smelly. During the morning of the inspection it was noted that some of the corridors had a strong smell of urine. This had reduced by the afternoon however was still apparent. Some of the feedback we have received from relatives and people living at the home confirmed that the home is not as clean and odour free as one would expect. During feedback to the manager, which was given at the end of the inspection, we discussed the issues observed. The manager stated that there are plans for a total refurbishment of the home in 2009. It should be noted however that we were informed that this refurbishment was going to take place in 2008. This did not occur. The manager also stated that she was aware of the urine smell in some areas. The manager stated that they were currently researching cleaning products that would address this concern. At previous inspections it has been identified that not all people who have nursing needs have an adjustable bed. Adjustable beds are required to ensure the health and safety of both people living at the home and staff when assisting people to change position in bed. Due to the reduced occupancy at the home the number of adjustable beds available to people living at the home has increased. On the day of this visit all people case tracked an observed had equipment appropriate to their needs. The environmental health officer visited the home on the 24/10/8. During this visit some recommendations relating to general cleaning and upgrading were made. During our visit it was clear that these recommendations had not been completed by the home. The radiator in the lounge area was not working on there day of the inspection. When the radiator cover was fitted the thermostatic control was fitted under the cover preventing the staff access to alter the temperature of the raditor control. We sampled a few bedrooms and it was evident that people are encouraged to personalise their private space. The home takes appropriate steps to reduce the risk of the spread of infection. Liquid soap and paper hand towels are appropriately sited throughout the home. Staff have access to a good supply of protective clothing. Care Homes for Older People Page 22 of 31 Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels at the home are adequate to meet the assessed needs of people using the service and staff training is well organised and promoted to support people using the service. The home has a comprehensive induction program and well-organised ongoing staff training program. Recruitment practices are robust and protect people using the service. Evidence: Staff rotas were viewed as part of the inspection. These demonstrates that currently adequate numbers of staff are available to meet the needs of the people living at the home. The home however has reduced occupancy due to the closure of the house area of the home. The management need to ensure that as the level of dependency at the home increase that they keep the staffing levels under review and increase these if necessary. . As part of the ongoing review and improvements at the home staff training has been reviewed and up dated training provided to staff. Some deficits in the training matrix were seen however training had been organised to complete this. Care Homes for Older People Page 24 of 31 Evidence: Staff spoken with during the inspection confirmed that they had been provided with the training needed to care for people at the home including NVQ. Staff indicated that they felt confident in their skills and they stated that they were never asked to undertake a task that they didnt feel trained to carry out. Staff confirmed that, they recieved all mandatory training. Staff recruirment records were viwed duringthe inspection. These showed that the home follwos robust recruitment in line with good practise guidelines Care Homes for Older People Page 25 of 31 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. The home does not currently have a manager registered with the CSCI. Staff are appropriately supervised and feel well supported. The homes procedures for ensuring the health and safety of persons at the home are generally good. Evidence: The manager Mrs Williamson has been employed by the home since August 2008. To date no application to become registered with us has been received. The home has not had registered manager since 2007. Managers are required to become registered with us to ensure that they have the skills and abilities to run the home and to ensure that people who live at the home are safeguarded. We wrote to BUPA in September 2008 telling them that Mrs Williamson needed to registered with us as a matter of urgency. An application was then received however this was incomplete and was returned in Care Homes for Older People Page 26 of 31 Evidence: order that this could be amended. The amended version has not yet been returned to us. Since taking over as manager in August 2008 the standards of care and support at the home has improved. People living at th home stated they felt that given more time that these improvements would continue. People sated that they felt more secure now that the home had a manager and that they would feel able to raise any concerns to the management. Staff also stated that they had seen improvements at the home and felt more supported by the reintroduction of such systems as supervision. All stated that Mrs Williamson was fair and approachable. Despite the improvements seen and voiced by people living at the home and staff the management team need to continue to develop the service (taking into account the requirements and recommendations made in this report) to ensure that at the next inspection the quality rating at the home improves. All records seen were stored appropriately and safely. Accident forms are completed and these are audited on a monthly basis. These were reviewed during the inspection with no patterns seen. A system of staff supervision has continued to be developed and is being rolled out to all staff. Servicing and maintenance records were sampled these were found to be in good order. COSHH (Control of Substances Hazardous to Health) advisory sheets are held at the home. The minutes of meeting were viewed during the inspection. The last staff meeting was held on the 13/10/08 and the last meeting for people living at the home was conducted on the 19/08/08. Given the concerns raised with us with regard to the perceived lack of investment and rumors that the home will close these meetings should be again held. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 9 13(2) It is required that medication 15/03/2008 is stored at a temperature in line with the manufactures guidelines. This requirement is outstanding from the last inspection. Previous timescale 17/10/07 Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 The staff at the home shall ensure that all aspects of individuals personal hygiene needs are met. This should include the opportunity for regular baths and/or showers and the maintenance of oral hygiene. This should be completed consideration to peoples individual preferences and in line with the plan of care. To ensure that people have the opportunity to maintain their standard of personal hygiene. 18/03/2009 2 26 23 The management need to ensure that the home is clean and free from offensive odours. To ensure that the home remains a pleasant place for people to live. 19/03/2009 Care Homes for Older People Page 29 of 31 3 26 23 The shower room should be 19/03/2009 refurbished and decorated to ensure an adequate standard of cleanliness is maintained to ensure the home provides a clean environment that is pleasant for people to use. 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 9 That all creams and lotions are marked with an opening date and any creams applied are signed for on the medication administration record. It is recommended that the management at the home review the availability and choices of activities on offer to ensure that they meet the needs of the people living at the home. It is recommended that the thermostatic valve on the radiator in lounge be freed to ensure that the ambient temperature of the lounge can be controlled. It is recommended that the recommendations made by the Environmental Health officer are actioned 2 12 3 25 4 26 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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