Inspection on 17/09/08 for Conewood Manor Nursing Home

This inspection was carried out on 17th September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Conewood Manor Nursing Home 60 Dunmow Road Bishops Stortford Hertfordshire CM23 5HL     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: Jane Greaves     Date: 1 7 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Conewood Manor Nursing Home 60 Dunmow Road Bishops Stortford Hertfordshire CM23 5HL 01279657933 01279657934 jackie@hollycaregroup.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Jaqueline Lepley Type of registration: Number of places registered: Conewood Manor (Registration) Ltd care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 42 The registered person may provide the following categories of service only: Care Home with nursing - Code N to service users of the following gender: either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other categories - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Conewood Manor Nursing Home is registered to provide nursing and personal care to 42 people. The home is situated within easy reach of Bishops Stortford town centre. The established accommodation is arranged over three floors accessed by stairs and a passenger lift. There is a communal dining room on the basement floor and a Care Homes for Older People Page 4 of 30 Over 65 0 42 42 0 Brief description of the care home communal lounge on each of the other floors. Bishop Stortford has excellent road, rail and air links and there is ample parking to the front of the home. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key site visit. At this visit we considered how well the home meets the needs of the people living there and how staff and management support people to have a lifestyle that is acceptable to them. The site visit took place over a period of eight hours. A tour of the premises was undertaken, care records, staff records, medication records and other documentation were selected and various elements of these assessed. Time was spent talking to, observing and interacting with people living at the home, and talking to staff. Care Homes for Older People Page 6 of 30 Prior to the site visit the manager had completed and sent in to the Commission for Social Care Inspection the homes Annual Quality Assurance Assessment (AQAA). This is a self assessment document required by law and tells us how the service feels they are meeting the needs of the individuals living at the home and how they can evidence this. Before the site visit a selection of surveys with addressed return envelopes had been sent to the home for distribution to residents, relatives, involved professionals and staff. The views expressed by visitors to the home during the site visit and in survey responses have been incorporated into this report. Feedback on findings was provided to the manager throughout the inspection. The opportunity for discussion or clarification was given. The fees charged for care and accommodation at Conewood Manor range from 441.28 pounds to 600 pounds per week. Fees do not include personal items such as hairdressing (5 pounds to 22 pounds), chiropody (12 pounds), newspapers and toiletries. The home is registered to accommodate 42 people however due to extensive buidling works, including the replacement of the roof of the main part of the house there were 22 people living there at the time of this visit. We would like to thank the manager, staff team, residents, relatives and visiting professionals for their help throughout the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 30 Care Homes for Older People Page 9 of 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wanting to move into the home cannot be sure that the services the home offers are what they want, but the robust assessment process ensures that having made the decision to move into the home their needs can be met. Evidence: People considering making Conewood Manor their home had access to information via the organisations web site and a Statement of Purpose that set out the services and facilities provided at the home. This document was still being developed at this visit. The document provided for the purpose of this inspection process did not indicate how many staff members were employed and what roles, qualifications or experience they had nor did it give information about the size of any of the private or communal rooms. The Statement of Purpose stated that the service provided a small residents shop, the responsibility of the activities co-ordinator, selling a small selection of sweets, toiletries and greetings cards. The registered manager told us that the service Care Homes for Older People Page 11 of 30 Evidence: did not operate a shop, as it was preferred that people had the opportunity to visit the local town to make their purchases. We looked at admission paperwork for three people recently admitted to the home. The registered manager told us that two peoples contracts were with family members to be signed at this time, the contract for one of these three people was available on the file at the home. The registered manager told us that people were encouraged to visit the home with their families or representatives first to make sure it was the right environment for them before the admission process started in earnest. A comprehensive assessment of needs and preferences was then made either at the persons own home or hospital. The assessment covered such areas as personal care and well being, mobility and falls, diet and nutrition, social interests and hobbies, religious and cultural needs and activities of daily living. Family members spoken with during the inspection process confirmed they had been involved with their relatives pre admission assessments. The managers AQAA stated Only when the assessor is happy that the individuals needs can be met will an offer of accommodation be made. We looked at staff training records to determine whether the staff team had the skills and experience to care for the people living at Conewood Manor. Records showed us that 13 of the 27 people employed to work at the home had received training in caring for people with dementia, safeguarding vulnerable adults, fire awareness, and confidentiality. The registered manager reported that a trainer from the Holly Care group was due to visit the home this month to deliver all outstanding training to the staff team. All staff with the exception of 3 domestic staff had received training in safer moving and handling. All staff had received the organisations basic induction training; the registered manager reported that the whole staff team were due to commence the Skills for Care Induction standards later this month. The Statement of Purpose stated that people considering moving into Conewood Manor and their relatives were invited to visit the home prior to admission and once admitted there was a trial period so that people could be certain their needs were being met before making the decision about permanent residency. Relatives of people living at the home confirmed they had been encouraged to visit as part of the admission process and that they had been made very welcome. Conewood Manor does not offer intermediate care. Care Homes for Older People Page 12 of 30 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. People living at Conewood Manor can be confident that the staff provide appropriate care, although this may not always be documented. Evidence: Each person living at the home had an individual plan of care that had been generated from pre admission assessments undertaken by the management of the home, information received from other agencies, from family members and individuals own opinions choices and preferences. The care plans set out in clear detail the actions needed to be taken by nursing and care staff to meet peoples needs to ensure that all aspects of health, personal and social care were met. We looked at three peoples care plans as part of this inspection site visit. Each one included a photograph of the person, next of kin contact details and a comprehensive personal profile detailing what pastimes people were interested in doing and any personal goals, such as to see the Physiotherapist in order to improve mobility. Risk assessments were in place for areas such as mobility, pressure sores, personal care Care Homes for Older People Page 13 of 30 Evidence: tasks, eating and falls. A record of healthcare professional visits was included in the care plan and evidence that peoples weight was checked and regularly monitored. Each persons care plan included a full list of medication they were prescribed. Daily records were not informative and did not provide us with a clear picture of what personal care and support had provided for people. Daily records are a good source of evidence to show that care is being provided, as detailed in the care plan, however the terms Personal care all OK and All needs attended are not helpful or adequate. One care plan we looked at stated that the person Forgets to drink and therefore suffered frequent urinary tract infections and needed encouragement to take fluids. The daily records contained no reference to how this was being managed. The registered manager acknowledged that the daily records were not appropriately completed and reported that care plans were work in progress. People living at the home told us We get every attention, all the help we want and They look after you very well. Comments received from relatives of people living at Conewood Manor included, I would say I have nothing but praise for the carers and the nursing staff for the way they look after the people living at the home Each person was supported to register with a GP of his or her choice, the manager had secured the services of a GP surgery from a neighbouring village for those people who did not have a preference. There was a fortnightly surgery held at the home at the time of this visit, the manager reported that once more people were accommodated at the home this was to be a weekly surgery. It was reported that medication reviews formed part of this routine visit ensuring that peoples medication regimes were regularly assessed. The registered manager reported that medication supplies had been a shambles until recently when she had secured the services of a new pharmacy supplier on 1st September. There had been problems with re-ordering medication; at this visit some medications were supplied in blister packs and some in boxes causing considerable difficulty in auditing supplies. The new system meant that each persons medication would be supplied in blister packs. Qualified nursing staff gave the medication to the people living at the home. We looked at the storage and the recording of medication. The storage facilities were safe and secure although the temperature of the medication room was high on this day; there were no records to show if this was out of the ordinary. Controlled medications were stored in a locked facility secured to a wall on the basement floor of the home. Medication Administration Records (MARs) did not include photographs of the residents. Review of the completed MARs showed us that procedures for administering medications to be taken when required (PRN), such as paracetamol, were not consistent. Some staff were recording when these medications had been offered and refused and some were only recording when they were given. Care Homes for Older People Page 14 of 30 Evidence: There was one gap in recording noted on the MAR sheets, this meant that without counting the number of tablets left for this individual it would not be possible to be sure if the medication had been given or not. We checked stocks of all the controlled drugs held at the home against the controlled drugs register. Observation on the day of this visit showed us that staff interacted with the people living at the home in a sensitive and caring way that promoted their privacy and dignity. Comments received in surveys returned to us by relatives of people living at the home as part of this inspection process included, My relative has dementia, the staff team seem to know how to look after him/her properly and understand the needs of a dementia patient and They treat all residents with respect. The registered manager reported that she was working towards implementing the Liverpool pathway for preferred place of care and providing tailored and individual care for people who are reaching the end of their lives. Care Homes for Older People Page 15 of 30 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. Residents can expect to receive a balanced and varied diet and a developing leisure activity programme to meet their individual needs. Evidence: Activity records showed us that there were varied activities taking place in the home even though there did not appear to be a specific programme of activities. These included: Hand and arm massage; Taking people into the garden; Exercises; Hang Man; Singing; Word games and quizzes; Trips into town, to the local pubs, cafes and into the town park; Dominoes Card Games; Art; Indoor skittles; Manicures; and Bingo. We noted two dates on notice board for entertainment coming into the home; one of these was a clothing party. The managers AQAA informed us of plans to offer more varied social activities such as outings to places of local interest and developing local community contacts. There was a record of activities maintained separately from the care plans with a list of peoples activity preferences. These activities recorded did not relate to individuals preferences included in the original pre-admission assessment. People told us Nothing to do, we go into a little group and chat My visitors try to come every Saturday I do the word search and I like to watch television, especially Care Homes for Older People Page 16 of 30 Evidence: football and cricket. Family members responding in surveys told us, I understand that an activities co-ordinator is employed on a part time basis by the home. However much of her time was taken up with general caring duties and The only concern I have had is the lack of stimulation. I have however been told that in addition to the therapist who is at the home 3 days per week. A trained activities co-ordinator is soon to start. Copies of staff rotas provided as part of this inspection process showed us that there were two activity co-ordinators employed to work at Conewood Manor however it was not always clear if they were working to cover care shifts or purely to provide stimulation for the people living at the home. Family members spoken with as part of this inspection process said they were encouraged to visit their relatives at any time and were always made welcome. The registered manager reported there had been some advocacy involvement to support one person living at the home around their financial affairs and that she would make information about advocacy services available for all residents and representatives. We viewed menus for 4 weeks and noted that people are offered a varied and balanced diet. We took lunch with the residents in the dining room. They appeared to enjoy their meal and we noted that assistance was provided where needed in a sensitive and relaxed manner. The manager offered people the use of an apron at lunch; no-one was given one unless they asked for it. People told us Everyday day we have to wait such a long time for our dinner after staff have brought us down here Chef is brilliant, everything is home made and she always uses fresh vegetables. She is the best English chef that I have ever met! Nothing wrong with the food my dear, just the waiting I always wonder why they have us sitting here this long. This is due to the fact that the dining room was on the basement floor of the building and people needed to take the passenger lift, which could take 3 ambulant people or one wheelchair user at a time. The process of assisting 17 residents into the dining room started at 12:20 hours and the meal was served at 13:05 hours. The menus showed us that choices were offered at each lunchtime and supper time, people we spoke with were not clear if they were offered choices of meals and on this day it appeared that each person had the same meal. Care Homes for Older People Page 17 of 30 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. People living at Conewood Manor can expect to have any concern or complaint dealt with appropriately and to be protected by the homes safeguarding adults from harm procedures. Evidence: We were provided with a copy of the complaints policy and the procedure for people to follow if they wished to voice a complaint about the care or facilities provided at Conewood Manor. The policy was clear and straightforward leaving the reader in no doubt what response they should receive and in what timescales however the copy provided for inspection purposes bore the name of another home within the Holly Care Group and not Conewood Manor. There were no complaints registered at the home since it started to operate in March 2008. There was no evidence of perceived minor complaints in order to identify trends and patterns in the service delivery. Where staff were dealing with things pro actively and not bringing minor matters to the managers attention there could be no improvement being made to processes and systems that would prevent any further occurrences. Training records showed us that all staff had received some safeguarding training as part of their initial induction training and that 13 of the 27 people employed to work at Care Homes for Older People Page 18 of 30 Evidence: the home had been provided with a training session dedicated to adult safeguarding. The registered manager and deputy are trainers in adult safeguarding and were able to demonstrate that this training for the remainder of the team was scheduled. We saw letters and cards of compliment regarding the care and support provided for the people living at the home. The managers AQAA showed us that the service intends to arrange regular residents and relatives meetings to encourage communication and include all parties in the running of the home. Care Homes for Older People Page 19 of 30 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. People living at Conewood Manor are benefitting from the on going refurbishment of their surroundings. Evidence: Conewood Manor was located on the outskirts of Bishops Stortford, close to public transport links. The building was old and in need of some refurbishment so as to provide suitable dining, communal and personal space for residents. The registered manager reported that the organisation recognised the environment is generally tired and in need of refurbishment, much of this work had been delayed due to the emergency repairs necessary to the roof. It was reported that in the 6 months the service has been operating there had been many issues that had needed to be dealt with immediately such as replacing the boilers, the heating system failing, and leaking pipes causing a flood in the basement floor of the home. The managers AQAA told us that in the last 6 months the majority of the bedrooms had been redecorated and refurnished and a large number of bedrooms have had the flooring replaced. The AQAA told us that plans for the next 12 months include refurbishment of the communal lounge and dining areas. The registration report for Conewood Manor stated that certain works had to take Care Homes for Older People Page 20 of 30 Evidence: place before the home could admit residents. All this work had been completed by this visit with the exception of a wheelchair ramp being fitted to the two steps on the first floor leading to two bedrooms. This had been done however the ramp was found to be far too steep. These rooms had been taken out of commission until a wheelchair lift could be installed. We noted an aroma in the entrance hall on arrival. The registered manager told us that this was because the original carpet remained in the hallway. This was due to be replaced throughout with impervious flooring after consulting the Department of Health infection control guidelines. The manager reported difficulty in keeping the balance between requirement for infection control and maintaining a homely environment. We undertook a complete tour of the premises. There was a light airy dining room on the basement floor of the home, the furniture was tired and in need of replacement. The registered manager reported the existing 6 large tables were to be replaced by smaller tables to seat four people each. As the dining area was in the basement it was not easily accessible for people with reduced mobility. There was an activities room on basement floor that was not in use at this visit as vital maintenance work was taking place. It was noted that radiators were covered with safety guards so people were protected from risk of burns. Hoists, wheelchairs and sit on weighing machines were stored under the stairs in the entrance hall, this did not help to create a homely environment for people to live in. The communal lounge had been redecorated with new curtains fitted and new chairs. There was room for 13 chairs in the downstairs lounge, there was a further communal lounge situated on the first floor however this floor was temporarily out of commission due to the roof refurbishment. We noted that due to the layout of the building the communal lounge was situated away from areas where staff would pass by meaning there was a risk of people becoming isolated in this room unless a conscious effort is made to ensure a staff presence. Toilet and bathroom facilities were available close to communal lounges and dining areas. Some were not very easy to access because they were sited in corners where other doors opened up in front of them. This meant one door had to be closed before the toilet door could be opened and this was observed to cause difficulty for those people unsteady on their feet. Most of the beds had been replaced with modern profiling beds and individual rooms Care Homes for Older People Page 21 of 30 Evidence: were to be redecorated, refurnished and re-floored as they became allocated taking into account the needs and wishes of the new occupants. In the corridor in the extension wing there was a trolley full of soiled laundry, a trolley of clean bedding and towels, a yellow bag of soiled incontinence pads tied to a grab rail, a wheelchair, a hoist, slings hung on the wall and a grey plastic box with a note for visitors to check the contents for missing pieces of laundry. This was not hygienic; it looked untidy and detracted from any domestic and homely atmosphere that the staff and management team tried to provide for the people living there. The subject had been debated at the previous staff meeting and had been left for people to go away, give it some thought to bring up ideas at the next meeting. There was a fence panel missing from garden meaning the grounds were not secure. Residents told us The rooms are lovely, everybody is kind and friendly. Family members we spoke to were aware of the refurbishment plans for the building and were looking forward to the works being completed. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Conewood Manor can be confident they are being cared for by competent staff but may be at risk due to inadequate recruitment practice. Evidence: At the point of this inspection visit there were 12 care/nursing staff employed to care for the people living at Conewood Manor. There was a recruitment drive under way so that new staff could be employed as the numbers of people living at the home increased once the roofing work was completed. It was reported that there was some limited use of agency care staff at weekends however this should ease once the recruitment process was completed. We noted that the service was struggling to provide full staff complement on this day and staff told us that this sometimes limited the amount of 1:1 time available to spend with individual residents. Staff told us via surveys There is enough staff and will shortly be more as well. The trouble is if someone calls in sick we have no bank staff at the moment to cover and we dont want to use agency because they have no clue about our residents. Staff surveys included the comment, I had 1 week of induction and they want all carers to do NVQ minimum of level 2 which I have already started. Staff training records showed us that 3 staff members had achieved a minimum of NVQ level 2 qualification in care and four more had commenced working towards this qualification. Care Homes for Older People Page 23 of 30 Evidence: We looked at three recruitment files to confirm that practice promoted and protected the health, safety and well being of the people living at the home. All three files included an enhanced Criminal Record Bureau check, evidence to confirm that staff were checked against the Protection of Vulnerable Adults register before being employed and two satisfactory references for each person. One file did not include a photograph of the person and the application form did not include a full employment history. Dates for periods of employment need to be more specific to ensure that any gaps in employment can be explored during the recruitment process. The managers AQAA informed us that plans for the next 12 months included To continue to imptove record keeping in respect of training files and recruitment. A Physiotherapist employed by the Holly Care Group provided moving and handling training for the staff team. Records showed us that 24 of the 27 staff working at Conewood Manor had received this training. Records showed us that the whole staff team had received induction training. As some staff were employed to work at the home before people had been admitted and before the home was physically ready, the initial 1 week induction had been held at a hotel. An induction programme in line with Skills for Care was due to commence in October 2008 for the whole staff team. There were gaps in the training provision for Health and Safety, Adult safeguarding, and Fire Safety. The registered manager was aware of this shortfall and was able to demonstrate that this training was scheduled. Staff told us, There is a good attitude to residents here, we are all living life together The team spirit is good here, the manager involves us in decision making, this makes you feel appreciated. Surveys received from residents and their families included the comments, The staff at Conewood are very friendly, efficient and very approachable, Conewood has a particularly relaxed and happy atmosphere, which is mostly created by the friendly staff, and I believe that is what makes it very good and The staff are very proactive. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well managed home run in their best interests. Evidence: The manager had 7 years experience managing care homes, was a registered nurse and had achieved the NVQ level 4 qualification in management. The manager was registered with us. It was evident through observation on this day, talking to residents, visitors, staff and professionals involved with the service that the management ethos of Conewood Manor was warm, open, inclusive and transparent. The organisation had an established Quality Assurance system in place, this service had only been operating for 175 days at the time of this visit and the process had not yet been put into motion. The manager reported that surveys for residents, families, staff and external stakeholders were due to be distributed imminently and a summary Care Homes for Older People Page 25 of 30 Evidence: of the response together with actions to be taken to address any identified shortfalls would be sent to the commission upon completion. We noted the insurance certificate displayed on the wall of the communal hallway confirming that the registered persons liabilities to people using the service, employees and third party persons were appropriately covered. The registered manager maintained some personal monies on behalf of some of the people living at the home. Each person had a record sheet showing money in and out and there were receipts for all monies spent cross-referenced with the record sheet. Money was stored in a locked drawer in the office in separate plastic wallets for each person. The manager reported plans to get a small safe installed. The registered manager reported that to date each staff member has had one supervision session however, there were no records available to confirm this because they had not yet been written up from note form. The manager planned to hold 4 individual supervision sessions and 2 group sessions per year. The first supervisions were undertaken by the registered manager however, the deputy had been trained for the task and will undertake supervisions for the care staff team and the manager will undertake the supervisions for the nursing staff. Records as required by regulation were accessible and made available for inspection. Some records in respect of staff recruitment, staff supervision and daily care provision were not maintained in a satisfactory manner. The home employed a maintenance person who carried out routine checks and maintenance in respect of the safe working of fire safety, gas, electrical and mechanical systems and equipment used at the home. Records maintained for the checks carried out were assessed. These were well maintained and kept up to date. During this inspection site visit it was discovered that a resident had unlocked a wooden gate at the top of a flight of stairs, and locking it behind them had continued down to the basement floor. This meant they could potentially be at risk from burns, scalds, sharp knives, and cleaning products on this floor. The management and staff team reported this was the first time any resident had accessed the stairway and immediately put strategies in place to reduce the risks. Care Homes for Older People Page 26 of 30 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 27 of 30 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 1 4 You must ensure that the information included within the statement of purpose accurately reflects the services, facilities and staff provision at the home. This is so people can make an informed decision about where to live 31/10/2008 2 7 15 You must ensure that daily records and associated documents include detailed information. This is so that staff can offer residents consistent person centred care and assistance. 31/10/2008 3 18 13 You must provide the staff team with training in Adult Safeguarding This is to prevent people being harmed or suffering abuse or being placed at risk of harm or abuse. 31/10/2008 Care Homes for Older People Page 28 of 30 4 19 23 You must ensure that all parts of the care home are kept in a good state of repair, clean and reasonably decorated This is to ensure that people have a clean, pleasant and safe environement to live in 01/04/2009 5 30 18 You must ensure that at all times suitably qualified, competent and experienced persons are working at the care home. this is to make sure people are kept safe from harm and receive the care they need to meet their assessed needs. 01/12/2008 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 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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