Inspection on 18/12/08 for Conifer Lodge

This inspection was carried out on 18th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Conifer Lodge 18/01/07

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 26/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Conifer Lodge 95/99 Pembroke Crescent Hove East Sussex BN3 5DE     The quality rating for this care home is:   three star excellent 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: Jennie Williams     Date: 1 8 1 2 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. 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: Conifer Lodge 95/99 Pembroke Crescent Hove East Sussex BN3 5DE 01273701888 01273245918 mpc@ntlbusiness.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Macleod Pinsent Care Conifer Ltd Name of registered manager (if applicable) Miss Josephine Carina Lowe Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 34 The registered person may provide the following category/ies of service only: Care home only - PC 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 category - OP Date of last inspection Brief description of the care home Conifer Lodge is a care home registered for thirty-four (34) places for people over sixty-five (65) years of age. No nursing care is provided at this home. District nurses will provide nursing input for those residents requiring this. Conifer Lodge is located in a quiet residential area of Hove. The care home is three separate homes that have been joined together for its current use. Residents bedrooms are located over three floors. There are stair lifts located in the home to Care Homes for Older People Page 4 of 31 care home 34 Over 65 34 0 Brief description of the care home assist residents to access all floors. Some bedrooms are accessible by stairs and residents residing in these rooms must be able to mobilise on these independently. There are eighteen (18) rooms for single occupancy and eight (8) double rooms, all provided with en suite facilities. All rooms are currently being used for single occupancy. There are suitable numbers of toilet and bathing facilities located throughout the home to meet the needs of residents. There is a good-sized dining room and lounge room/conservatory and two other private communal areas for residents to use. Residents have access to a garden area at the rear of the home. There are some local amenities in the area and there is nearby access to public transport. There is limited parking available at the home and restricted paid parking in adjacent streets. Weekly fees range from 332 pounds to 653 pounds per week. There are additional fees; hairdressing, chiropody, beautician, newspapers/magazines and personal toiletries (at cost). This information was provided to the CSCI on the 18 December 2008. Prospective residents find out about the home through social services referrals, word of mouth and from themselves/relatives living in the area. 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: three star excellent 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: It should be noted that following CSCI consultation, it was identified that service users prefer to be called people who use services. It was confirmed that the home uses the term residents. For the purpose of this report, people who use the service will be referred to as residents. This unannounced site visit took place on the 18 December 2008 for six and half hours. Evidence obtained at this site visit, previous information regarding this service and information that the CSCI have received since the last inspection forms this key inspection report. An expert by experience accompanied the Inspector for three and a half hours at the home. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service Care Homes for Older People Page 6 of 31 with an inspector to help them get a picture of what it is like to live in or use the service. An annual quality assurance assessment (AQAA) was sent to us by the service, completed by the home on the 09 September 2008. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. The last key inspection was undertaken on the 18 January 2007. An Annual Service Review (ASR) was undertaken on 03 March 2008. Between the expert by experience and the Inspector 14 residents, of either gender, were spoken with. Discussions were had with five staff members throughout the site visit, plus the Registered Manager. Two care plans were viewed along with specific areas of care in a further 12 care plans. Medication procedures were viewed. Procedures and records for handling residents finances were inspected. Four staff files were inspected, along with training records. A tour of the environment was undertaken and some individual rooms were viewed. The quality assurance system, complaint records and quality monitoring checks in place were viewed/discussed. There were twenty-one residents residing at the home on the day of the site visit. What the care home does well: What has improved since the last inspection? Action has been taken to address both requirements made at the last inspection in relation to hot water and guarding radiators to ensure residents live in a safe environment. There is guidance in place within an individuals care plan regarding the level of selfmedication i.e. does the individual or home order repeat prescriptions etc. A new system has been installed for the monitoring of residents during the night. All rooms have a bar code on the back of their room door that staff scan when they are undertaking checks and records any action that may be taken. This scanning generates a print out and the system is also linked to the head office for the group of homes owned by same provider. The AQAA received identified many areas that the home has improved in the last 12 Care Homes for Older People Page 8 of 31 months. Work has been undertaken and is continuing to be done to improve the standards within the environment. Other changes made have been implemented by the service listening to the views of residents such as introducing a suggestion box and converting a communal bathroom into a walk in wet room. A computer has been installed into the small lounge room for residents use. 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 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 pre admission process ensures that only those residents whose needs can be met are admitted. Evidence: The AQAA identifies that all prospective residents have a thorough and comprehensive pre admission assessment prior to moving into the home. There was evidence of an assessment being undertaken for a newly admitted resident. One pre admission assessment could not be located on the day, however the Registered Manager confirmed that one had been undertaken. Information from other health professionals is obtained wherever possible. The Registered Manager confirmed that they undertake another assessment of an individual if they have spent a period of time in hospital to ensure they can still meet the needs. Prospective residents are encouraged to visit the home prior to moving in and the first Care Homes for Older People Page 11 of 31 Evidence: four weeks are considered a trial period. The expert by experience asked three residents if they had involvement in the decision to live at Conifer Lodge or pre visited the home prior to moving in. One could not remember and one confirmed that their family had sorted it out and was pleased that they had. One resident confirmed that they had been given a months trial and stated I knew within the first week I wanted to stay here. Another resident commented to the Inspector couldnt have made a better choice. Staff spoken with by the Inspector confirmed that they felt all residents were appropriately placed at the home and that management take appropriate action should someones needs no longer be met at the home. A staff member was able to give a recent example where someone needed to be placed elsewhere and explained how they found the experience positive and that the resident and their family were involved in the process of relocation. The Registered Manager confirmed that there is no resident at the home from any minor ethnic community, social/cultural or religious groups with any specific needs or preferences. The ASR undertaken in March 2008 identified that the home plans to implement more pro-active interaction with different cultural and ethnic groups, and various religious observations in their local area, thus providing contacts and a list of leaders of various faiths for the people who use the service. The Registered Manager confirmed that they have some informaiton available at the home and is continuing to collate this information. The home does not have dedicated accommodation to provide intermediate care, however respite care is available if there is a spare place. The Registered Manager confirmed that they take emergency admissions, however ensures that the home undertakes an assessment. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff practice reflects an understanding of residents personal and healthcare needs, however the documentation in place for some people does not fully reflect the level of care provided and there is a risk that care may not be consistently provided. Residents are generally safeguarded by the medication procedures in place. Evidence: The two care plans viewed identified that care plans are in place and provide guidance for staff on how to meet the needs of the residents. There was evidence that these are reviewed on a monthly basis. A monthly summary is done at review and if there are any identified changes, the long-term care plan is amended. A summary is completed that provides a quick overview on the preferred daily routines of individuals. It is recommended that all sections of the care plan be signed at review to evidence that staff are reviewing the whole care plan. A staff member confirmed that the key worker reviews care plans with individuals. Care plans did not read as being personalised to the individual. A lot of residents had Care Homes for Older People Page 13 of 31 Evidence: the same information, identifying that they all had the same needs. The home is aware of this and there are plans in place to implement a new care plan format. The AQAA also identifies that their planned improvements in the next 12 months is to review and update care planning sytems and looking at ways of improving them to ensure that residents receive the best whole-person individualised care, whilst encouraging service users and their relatives to be very much involved in the planning of care. Some specific areas of care viewed were noted not to be reflected in the individuals care plan. Examples of this were if a district nurse was attending for wound care or where a person had a specific religion, there was no information advising staff that this person did not require a specific diet etc. The Registered Manager confirmed that this will be addressed. Staff spoken with confirmed that they found care plans to be user friendly. Clearer information is needed for falls risk assessments. It was not clear that the risk assessment in place related to falls and when asking the Registered Manager and two other care staff, all three had different views as to how the information was used. Staff use a daily diary recording what personal care has been provided and to whom. Information about all residents is recorded on the same page. It was recommended that the home review the procedure for recording this information. Having all information about individuals on the one page does not help promote confidentiality if someone wishes to view any records about an individual. It was confirmed that new forms are being developed for staff to sign on what care they have provided and this will be monitored by the Head of Care. Daily notes were brief with staff writing ...is fine. Daily records are a good source of evidence to show that care is being provided, as detailed in the care plan. Daily records when well written, help ensure a consistent approach and good quality of care for residents. It is in the homes interests to be able to show what they have done, along with providing the evidence on which to base the monthly review and to record that they are following the assessment of needs. There was evidence that records are maintained of all health multidisciplinary visits. It was confirmed that there are policies and procedures in place for all aspects of dealing with medicines and only staff who have been trained administer medication. There were photos on the Medication Administration Records (MAR) charts to assist staff in identifying residents. There are records maintained of all incoming and outgoing medicines at the home. New MAR charts and blister packs were in use so there were limited entries to view. Care Homes for Older People Page 14 of 31 Evidence: There was one incident where staff had not recorded why a medicine had not been administered. No requirement has been made in relation to this as the Registered Manager can identify who was responsible and address it with the individual staff member involved. It was confirmed that the supplying pharmacist undertakes an audit at the home every three months. The last report dated 04.12.08 stated very good standards. It is recommended that clearer guidelines be in place for those that have prescribed creams. As a good practice recommendation, two staff who have been trained in medicines should double sign any handwritten prescriptions. One hand written prescription was not signed at all. There were accurate records being maintained of controlled drugs. The home has been advised that they will need to purchase a controlled drugs cabinet to install to ensure compliance with the current legislative guidelines on the correct storage of controlled drugs. It is recommended for ease of use that the controlled drugs book index is kept up to date. Residents are provided with an opportunity to self-medicate if they wish and a risk assessment identifies that it is safe for them to do so. For a resident who self medicates, a risk assessment was observed to be in place and this is reviewed monthly. Staff undertake weekly checks of the individuals medicines, in agreement with the resident, to ensure they are managing their medicines effectively. One resident used to self-medicate, however on return from a period in hospital it was confirmed that they did not wish to self-administer anymore. There was no recorded evidence available to identify that the resident had been involved in this decision. The Head of Care assured the Inspector that they would address this. All residents that the expert by experience spoke to reported that the staff were always courteous, polite and respected their dignity and privacy. Staff were observed to have a professional rapport with residents and were heard to be addressing residents by their preferred name. The Registered Manager confirmed that head office of the organisation has devised care plans for the end of life and the home is currently implementing these. It was confirmed that residents, family and other relevant representatives are involved in this process. Care Homes for Older People Page 15 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents lifestyle within the home is their own choice and residents are provided with sufficient stimulation to fulfil their interests and needs. Residents choice and preferences are catered for with meals. Evidence: The expert by experience was able to speak freely with 13 residents, either as a group or individually and her findings were as follows. Everyone I spoke to felt they had lots of choice regarding what time they got up, went to bed and how they wanted to spend their time. A couple of residents preferred to spend more time in their own rooms rather than in the communal areas, but were completely happy to do so and didnt feel pressured to do otherwise. I was informed that I can come and go as I please and they cater for everything I want. It was also evident by the residents responses that they have easy access to other services such as chiropody, hairdressing etc. I asked residents if pets were allowed, they felt that although pets werent allowed to live at the home, they could certainly visit. In response to the draft report, the registered providers confirmed that small pets i.e. birds and fish are permitted into the home with prior agreement from management. Care Homes for Older People Page 16 of 31 Evidence: Individuals are responsible for all aspects of caring for their pet. One resident informed me that they were religious and had previously enjoyed regular church attendance. I asked them if this was ever available to them or whether anyone came to the home in relation to this. This was not the case but the resident was happy and content in now listening to a certain radio station to fulfil this need. Written confirmation was provided following the site visit that religious representatives visit the home and the home will assist any resident who wishes to access church services in the community. Residents spoke of visitors being welcome to call at any time and they werent aware of any restrictions relating to this. When I asked about activities and social occasions this was commented on very positively and many of the residents informed me about a range of interests that were catered for including bingo, sing a longs, quizzes, music hour, trips out to various places i.e. cinema, etc indeed there were also many photographs illustrating many of these activities. I was informed by residents that whilst many of these sessions were provided by external persons, the staff with time permitting, also engaged in arranging activities. I joined the residents for lunch, which was gammon, potato and vegetables followed by a wide range of desserts to choose from. Many of the residents commented that they had enjoyed their lunch. Those who needed some assistance were catered for and it all felt very relaxed and unhurried including those who needed a little longer to eat their meal. The table was well presented with tablecloths and napkins. The residents enjoyed a pre lunch sherry, which also created an opportunity for the residents to gather and chat in readiness for their meal. They were also able to confirm that should they require refreshments at any other time of the day, other than allocated times, this is available to them. On the whole most of the residents were happy with the food and the choices offered. I asked one resident as to whether fresh fruit was available, however they were not aware that it was and they opted for tinned fruit as this was their preference in any case. The AQAA identifies that nutritional screening is undertaken on everyone admitted to the service and 100 of the staff have received training in malnutrition care and assistance with eating. It was confirmed that food diaries are maintained for residents Care Homes for Older People Page 17 of 31 Evidence: if concerns are identified. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are dealt with appropriately, reassuring those involved that they are being listened to and that action will be taken, if necessary. Safeguarding Adults procedures ensure residents are safeguarded. Evidence: The AQAA identifies that there has been one complaint raised with the home that was dealt with within 28 days and was found to be upheld. Records are maintained of complaints and copies of any correspondence are kept. Records maintained identified that complaints are dealt with in an unbiased manner and action is taken to address the issues. Residents the expert by experience spoke with felt happy in raising concerns they had with staff and especially with the manager should they need to do so. Staff spoken with confirmed that they knew what action to take should a resident raise any concerns with them. Staff spoken with confirmed that they are familiar with the procedures to follow in the event of an allegation of abuse being made. They attend regular Safeguarding Adults training and procedures for whistle blowing are also incorporated into this training. A scenario was discussed with a staff member who evidenced that they knew the procedures to follow. A staff member confirmed that they would be happy to whistle Care Homes for Older People Page 19 of 31 Evidence: blow within the service. There has been one Safeguarding Adults alert raised in the last 12 months. The home cooperated with the local authority with any investigations. This was related to a staff member using a residents private phone for personal use. This was upheld and the home repaid the resident for any expenses incurred. The home was advised by the Safeguarding Adults team to deal with this through their disciplinary procedures. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean and homely environment and are provided with comfortable indoor and outdoor communal facilities. Evidence: Rooms are located over three floors and there are stair lifts available to assist residents to access all areas of the home. The Registered Manager confirmed that two new stair lifts have been installed to replace old ones. Some bedrooms have five steps that residents must be able to mobilise to reach these. There are grab rails placed throughout the home in areas where residents may require some assistance with mobilisation. The Registered Manager confirmed that there has been no major changes to the environment since that last inspection. There is an ongoing written maintenance programme in place. The AQAA identifies areas within the home that have been refurbished/redecorated and they propose to continue with these improvements in the next 12 months. The home now recycles wherever possible. The home has purchased an inflatable chair to assist in raising residents from the floor in the event of a fall, as discussed with them at the last inspection. Care Homes for Older People Page 21 of 31 Evidence: There is an assisted bath currently out of use and there are plans to convert this area into a wet room. It was confirmed that there are still enough assisted bathing facilities to meet the needs of residents. There is a separate lounge room that is being used as a designated smoking room. It was confirmed that all furniture in this area is made from fire retardant material. The expert by experience spent time with some residents within their own rooms and made the following observations. All the rooms I saw were clean, tidy, warm and very much reflected the residents individuality with their rooms containing many personal possessions, their own furniture and decorated to their taste. Each resident I saw also had a telephone, which they used as required. Without exception everyone I spoke to was extremely happy with the comfort of their room and the facilities available to them within the home including a library, television lounge and garden, which is all easily accessible on the ground floor. The home was observed to be clean throughout and there were no offensive odours noted. Staff spoken with confirmed that there was a sufficient supply of equipment at the home. This included hoists, manual handling equipment and protective clothing. The AQAA identifies that 100 of staff have received training and there is an action plan in place to deliver best practice in prevention and control of infection. All laundry is done in house and a new industrial washing machine and tumble dryer have been installed. There was a hand towel noted to be in the staff toilet, along with paper towelling. The Registered Manager was advised that hand towels in communal areas do not promote infection control. It was confirmed that this will be removed. Care Homes for Older People Page 22 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are being met with the skill mix of staff on duty. Robust recruitment procedures ensure residents are safeguarded. Evidence: The AQAA identified that 31 care shifts had been covered by temporary staff or staff from an agency within the last three months. A staff member confirmed that the same agency staff were used where possible to ensure continuity of care was promoted. It was confirmed at inspection that there had been a high use of agency due to staff illness. One staff member confirmed that there are enough staff on duty and agency is used wherever needed. There are waking staff on duty at night. On speaking with residents, the expert by experience was informed that the only issue for residents relating to staff was when on occasion agency staff were on duty as this created a lack of continuity and attention to detail. Every resident the expert by experience spoke to praised the established staff very highly indeed. This included a range of personal care needs i.e. being tended to if they were ill, showering, having creams applied, feeling looked after and supported during appointments etc. Unless short staffed, the residents felt their needs were attended to promptly and that nothing was too much trouble. The expert by experience observed Care Homes for Older People Page 23 of 31 Evidence: caring and warmth in the staffs interactions with residents, chatting whilst assisting and acting promptly on a request that was made. Residents made further comments to the expert by experience regarding how they view living here I feel happy and well looked after and the staff are marvellous, I couldnt have made a better choice. One resident commented that when there was a shortage of staff, it makes things uncomfortable. No requirement or recommendation has been made in relation to staffing numbers as it was confirmed that the home is currently recruiting for additional staff. It was confirmed that there are currently 16 carers employed at the home of which nine have National Vocation Qualification (NVQ) level 2 or above. Two of these staff members have NVQ level 3 and another is currently undertaking NVQ level 3 studies. The AQAA identifies that all people who have started work in the home in the last 12 months have had satisfactory pre-employment checks. Staff files viewed at inspection evidenced this. Application forms had been completed, references obtained and Protection of Vulnerable Adults (POVA) and Criminal Record Bureau (CRB) checks were in place. Where information had been provided to the home from the CRB, there was evidence that the home had discussed this with the individual involved. On receipt of a reference, the home rings the referee to verify the authenticity of the written reference. Evidence within staff files identified that no care staff commenced employment prior to an enhanced CRB having been received. One ancillary staff member commenced on a POVA First check, however did not provide personal care to residents and was supervised until the CRB was returned. A training matrix is kept at the home and identifies when training is due to be updated. A staff member spoken with confirmed they are up to date with all mandatory training and stated there were too many training opportunities within the service. Another staff member commented that can always ask if I want more. The Registered Manager confirmed that in house training is provided to staff in manual handling etc until they are able to be booked onto an external course. The expert by experience observed a poor manual handling practice, whereby a member of staff lifted a resident from under her arm from a fairly low level to a standing position. This was reported back to the Registered Manager who explained that this is not how staff have been trained in assisting residents to stand. On this occasion the resident appeared not to have suffered any ill effects, however the expert by experience felt reassured that the manager would act upon the information and remind staff of the correct method for this procedure. It was confirmed that all new staff complete the Common Induction Standards as set Care Homes for Older People Page 24 of 31 Evidence: by Skills for Care. There was evidence in a new staff file that induction had been undertaken. A member of staff reported to the expert by experience that their induction was a positive experience that equipped them for the job i.e. undertaking a range of training and shadowing an existing member of staff. 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 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 benefit from a well managed home and the quality assurance system ensures the home is run in the best interest of residents. Evidence: The Registered Manager is registered with the CSCI and has over 25 years of experience working in the care industry in a variety of roles and settings. She has completed the Registered Manager Award course. Staff spoken with confirmed that they find management supportive and approachable. A comment received in relation to the Area Manager and Registered Manager was best one so far. It was confirmed that there are structured out of hours procedures to follow for management support when the Registered Manager or other seniors are not on duty. The expert by experience spoke with two members of staff who felt under pressure with staff shortages but other than this they felt they enjoyed their work and had access to management to discuss any concerns they may have. Care Homes for Older People Page 26 of 31 Evidence: The home previously had a Quality assurance supervisor role within the home, however at this site visit this role was currently vacant. The Registered Manager confirmed that surveys are provided to staff, residents and representatives/visitors on a six monthly basis. Health professionals are asked to complete a survey when they are visiting the home and ensure these are done at least annually. The Registered Manager confirmed that results are analysed when surveys are returned and some information is used in the Service Users Guide. The Registered Manager proposed to display the results on a notice board within the home, ensuring this is accessible to all people who have an interest within the service. It was confirmed that action is taken wherever possible if any shortfalls are noted within the surveys. The Registered Manager confirmed that she has a quality-monitoring programme in place and records when various areas are checked. A new Head of Care post has been filled where some areas to oversee are delegated to this role. Staff and resident meetings are held. The residents informed the expert by experience that there are opportunities to attend residents meetings with staff and they are given advance notice of when these are forthcoming. There is a suggestion box located at the home, however the Registered Manager confirmed that this is not used by anyone. The Registered Manager was open and honest with the Inspector and confirmed that the Registered Provider had not been undertaking their monthly visits of the service for the last couple of months due to issues arising in other homes owned by them, however had been done regularly previous to this. No requirement has been made in relation to this, however action must be taken to ensure these reports are provided to the Registered Manager on a monthly basis. No one involved with the service is an appointee for any resident. Personal allowances are kept securely at the home for those wishing to make use of this facility. Records viewed and monies counted evidenced that accurate records are maintained of all financial transactions and receipts are kept wherever possible. A limited number of staff have access to residents monies as an extra safeguard. The AQAA identifies that any equipment, as applicable, has been serviced or tested as recommended by the manufacturer or other regulatory body. The AQAA identifies that they have written assessments on hazardous substances and there are policies and procedures available at the home that have recently been reviewed or is currently under review. Staff confirmed that they are provided with regular fire training and participate in fire drills. It was confirmed that a fire officers last visit was undertaken on the 13.10.08 and it was confirmed any recommendations made have been Care Homes for Older People Page 27 of 31 Evidence: actioned. Care Homes for Older People Page 28 of 31 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 29 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 9 13 That a controlled drugs cabinet is purchased and installed correctly. This is to ensure compliance with current legislation. 01/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 To ensure daily notes are clearly recorded as evidence to show that care is being provided, as detailed in the care plan. That hand written prescriptions are double signed by staff who have undertaken medication training to further safeguard service users and colleagues. 2 9 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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