Inspection on 18/01/08 for Conifers

This inspection was carried out on 18th January 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Conifers 09/01/09

Conifers 13/07/07

Conifers 18/04/06

Conifers 05/10/05

Conifers 09/06/05

Conifers 14/10/04

Conifers 11/05/04

Similar services:

Deepdene Care Centre

Ferndale Residential Care Home

David Gresham House

Elizabeth House

Elvy Court Nursing Home

Fontenay Nursing Home

Clairmont Residential Home

Cornford House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Conifers Seal Square Selsey Chichester West Sussex PO20 0HP Lead Inspector Laurie Stride Unannounced Inspection 18 & 21 January 2008 10:15 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Conifers Address Seal Square Selsey Chichester West Sussex PO20 0HP 01243 602436 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Family Care Private Company Limited Mr Martin Pelling Care Home 20 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (20) of places Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Only service users over the age of 65 years of age may be admitted to the home. The home may accommodate one service user under the age of 65 years. 13th July 2007 Date of last inspection Brief Description of the Service: Conifers is a care home providing personal care and accommodation for up to twenty service users in the category of dementia, over sixty-five years. It is owned by Family Care Private Company Limited and managed by Mr Pelling. The home is located in Selsey and is close to shops and other amenities in this seaside town. It is a detached property with accommodation on three floors with eighteen single rooms and one double room. Several rooms have sea views. There are sitting areas and a dining room. The responsible person on behalf of the company is Mr Samarasekara. The home’s weekly fees range from £400.00 to £470.00. This information was obtained at the time of the inspection visit. Members of the public may wish to obtain more up-to-date information from the care home. Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced visit took place over two days, in order to assess the service against the key national minimum standards and to check compliance with the requirements identified at the previous inspection. During this visit we, the commission, spoke with the home’s management and staff and met some of the people who use the service. The home provides care for people with dementia and we were not able to communicate in depth with any of the individuals who live there, but we did observe staff interacting with people who live in the home in a professional yet friendly manner. We did this by spending time in the lounge with people who use the service, watching the daily routines, how people spend their time and how staff supported their needs. We also saw samples of the home’s records and undertook a tour of the premises, including bedrooms, communal areas, the kitchen, bathrooms and toilets. Additional information we used for this inspection was taken from the previous inspection report and from the homes’ own annual quality assurance assessment (AQAA), which we received from the registered manager in August 2007. What the service does well: What has improved since the last inspection? Care plans now contain greater detail about peoples’ health, personal care and social needs and staff training has improved. The homes’ recruitment procedure is thorough to ensure people are protected. The physical Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 6 environment has been improved significantly and people who use the service also benefit from better planning around social, recreational and occupational activities. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home has good systems in place to ensure that people who use the service have their needs assessed prior to moving into the home. The home does not provide intermediate care and therefore standard 6 is not applicable. EVIDENCE: The previous inspection report identified good outcomes for people who use the service, in relation to receiving information about the service and having their needs assessed prior to admission to the home. During this visit we saw a sample of three pre-admission assessment records. These included initial assessments and reviews carried out by the registered manager and information obtained from the relevant health and social care professionals. The registered manager uses a pro-forma for the home’s assessment procedure, on which the individuals’ details are recorded, such as Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 9 important contact numbers, medical history, the levels of support required and the person’s preferences in relation to receiving assistance. This demonstrates that the home is continuing to provide a good service in relation to preadmission assessments. We spoke to a relative of one person who uses the service. The relative told us that they had been able to visit the home before any decision was made about admission. The relative also said they felt that the person using the service has been more settled since coming to the home. Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 & 10 People who use the service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. The health and personal care needs of people who use the service still need to be detailed more thoroughly in their care plans, to ensure that they and others are not put at risk. The home has good procedures for managing medication and the principles of respect, dignity and privacy are put into practice. EVIDENCE: The previous inspection report identified that the health, personal care and social needs of people who use the service were not sufficiently detailed in their individual care plans, although there was evidence that these needs were being met. A requirement was made in relation to this. The previous report also identified that people who live in the home were treated with dignity and were protected by the home’s medication procedures. During this visit we saw a sample of three care plans that showed improvements have been made to the way that the individuals’ needs are recorded. The registered manager had reviewed the plans, which now contain Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 11 additional information in a section called ‘service user activity of daily living’, including how aspects of personal care and safety are to be addressed. We discussed two of these care plans with the registered manager and advised that specific times need to be given when detailing guidance for staff providing support. This is to ensure that individual needs can be consistently met even if there are staff changes. For example, one individuals’ plan of care regarding sleeping indicated that ‘regular checks’ are needed. This person’s plan in relation to continence also stated that the individual ‘needs to be taken (to the lavatory) at regular intervals’. A similar statement was included in another person’s plan of care for continence, which did contain clear guidance for staff on how to address the individual when giving support for this. The registered manager said he would make these plans more specific. One of the above individuals’ care plans identified that the person might exhibit aggressive behaviour in certain situations, such as when staff provide support with bathing. The plan included information about the person’s needs and abilities in relation to their comprehension and also recorded changes in behaviour, showing that the home is monitoring this person’s needs in this respect. The care plan did not provide an assessment of the risk presented by the aggressive behaviour or guidelines for staff on dealing with the behaviour. The registered manager said he would put a risk assessment and management plan in place. When we visited the home again on 21/01/08, we saw that the registered manager has devised a pro-forma to use when writing up the assessment. A third individual who uses the service had a care plan that showed they are prone to falls and need constant observation. A moving and handling assessment showed that the home had previously tried one specific intervention but this had not been successful. We saw that an additional mattress was placed in this persons’ bedroom, which the registered manager said is put on the floor at night in case the individual falls out of bed. This intervention was not recorded in the person’s care plan and could present a risk to the individual if they got out of bed during the night. We discussed this with the registered manager, who said he would undertake an assessment of the risk associated with using the second mattress and record this in the care plan. Due to the above issues the previous requirement regarding care plans has not been fully met. We discussed this during the visit with both the registered manager and the person responsible for the service, who agreed to address these issues. Records we saw in the home show that people who use the service have access to health and social care professionals such as doctors, district nurse, chiropodist and social workers. Health care appointments and the outcome of these are recorded. The relative of one person who uses the service confirmed Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 12 that the home contacts the relevant healthcare services and arranges visits and appointments as and when necessary for the individual. The relative told us that staff look after people well and that they had “never heard any staff member shout or say don’t” when dealing with people who live in the home. Throughout the visit we observed the manager and staff treating people respectfully and in a friendly manner and saw that individuals’ privacy is upheld. We also looked at the home’s medication procedures. The medication administration records include a photograph of each individual. A sample of these records showed that staff members had signed the record each time a medication had been administered. We spoke to two staff members who both said they had completed training in dealing with medication. Training records held in the home further confirmed this. Staff said that the homes’ procedures are good and include two staff ‘double checking’ when administering medication. They also told us that new staff members spend their first week ‘shadowing’ the senior staff member, who observes them administering medication to ensure they follow the procedures correctly. We saw that medication is stored securely and that since the last inspection the home has obtained a safe for the storage of any controlled drugs. The home does not currently hold any controlled drugs that legally have to be recorded in a separate register. Incoming medications are checked in against the details on the prescription and medication records and signed for by the manager. The disposal of any unused medication is recorded with the pharmacists’ signature. The registered manager said that individuals’ medication is regularly reviewed and this was further confirmed through looking at the care plans of two people who use the service. Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15 People who use the service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who use the service benefit from improvements in structured activities in the home, which will be further enhanced by the deployment of an activities co-ordinator and better record keeping. The home supports people to keep in contact with their relatives. The meals offered are varied and nutritious and promote individual choice. EVIDENCE: The previous inspection report identified that people who use the service did not receive sufficient mental stimulation, social and recreational activities. The home had subsequently sent us an improvement plan, which stated that the service had recruited two specialists to carry out structured activities and social events. The improvement plan also said that individualised activities would now be recorded. The homes’ own annual quality assurance assessment (AQAA), also received by us following the previous inspection, stated that there were plans to improve in this area by training a member of staff in activities specifically for service users with a dementia. The AQAA also said that the home has begun to use outside services, specifically a trained voice therapist. Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 14 During this visit we saw that care plans now contain more detail in a section called ‘working and playing, communication, daily routine and social contacts’. The registered manager has undertaken an assessment of individuals’ known preferences and recorded suggested activities in a file. A record of activities that take place is also kept and we saw entries for this month that included individual drives, passive exercise and voice movement therapy. Some entries did not state what the activity had been and the registered manager said he would ensure that staff completed the records fully. This will also help to monitor that activities selected by and for individuals are consistently offered and reviewed. On the second day of this inspection visit a musician and voice therapist was visiting the home. The minutes of a staff meeting held on 12/12/07 was seen, showing that the management had spoken with the staff team about the importance of maintaining activities on a daily basis and recording these in the folder. The homes’ records showed that in October 2007 a member of staff had been allocated the role of working on activities for people who use the service. This member of staff had since left the service. The registered manager spoke of plans to recruit a replacement staff member to take on this specialist role and told us the home is currently advertising for this. Two members of staff who we spoke to told us that they try to do an activity each day and spend time talking with people who live in the home. One of the staff also told us how the home now uses objects and materials to provide people with tactile stimulation where this is appropriate. This was further confirmed by speaking to the manager and a relative. One of the people who use the service told us that they used to enjoy playing the piano and that the home has provided a keyboard instrument for them to use. On the first day of our visit we spent approximately an hour during the afternoon in the lounge with people who use the service, observing the daily routines, how people spend their time and how staff supported their needs. This took place after lunch and some people were having a nap. We observed signs of positive well-being in those who were awake, people interacting with each other and with staff or simply taking an interest in their surroundings. Staff were giving manicures and chatting to some residents, who responded positively to this and later to singing led by the senior staff member. Just before 3 pm tea and biscuits were served. We saw staff giving assistance to one person drinking their tea, this was done at a pace that suited the individual. During this time we also spoke to the relative of one person who uses the service, who told us that staff frequently have sing-a-long sessions with the residents. We were also told that staff arrange to pick relatives up so that they can visit and relatives are invited to stay for meals. We observed this taking place during the first day of our visit. Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 15 During lunchtime on the first day of the inspection, there was a calm and relaxed atmosphere in the dining room. Staff were available and giving assistance where needed. We saw one member of staff assisting someone to eat and this was done at the individuals’ pace. A relative who was staying for lunch told us that the ‘food is very nice.’ One person who uses the service said they did not want their meal and the senior staff member asked them if they would prefer a sandwich. A notice from the registered manager was in the kitchen, reminding staff to ensure that people who use the service have access to food and drink at any time of day or night. We spoke with the cook who has control of the food budget and we saw that the fridge and larder were well stocked with good quality food. The cook is furthering her knowledge through a nutrition and health training course. We saw records are kept of individuals’ daily dietary intake, which also indicate if someone chooses an alternative to the main meal and what mid-morning snacks and fluids people have. Other records show individual food preferences and if specialist diets are needed. Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home has suitable procedures for dealing with concerns and people who use the service are protected by the home’s policies and procedures. EVIDENCE: The home has a complaints policy and procedure, which is displayed in the home and is also contained in the Service Users’ Guide to the service. The registered manager keeps a record of when a complaint has been made and the details. Some of the previous entries lacked full information about actions the home had taken in response to complaints and the outcome. The registered manager agreed and said he would put in the relevant details. Since the last inspection the home has received one complaint, in November 2007, which also involved the Adult Services who visited the home. We had also been made aware of this matter and it had been recorded in the homes’ complaints book. The registered manager said he had at that time been informed by Adult Services of an allegation and had provided a report to them. He told us that he has to date not been made aware of any outcome of this matter and would contact the relevant department to find out and make a record of it. We spoke to two members of staff who both confirmed they had received training in safeguarding issues, were aware of the home’s policy in this respect and would report any suspected abuse to the manager. The home has an upConifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 17 to-date copy of the local authority safeguarding procedures and we saw records of relevant staff training that took place in September 2007. Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 & 26 People who use the service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who use the service benefit from improvements that have made the home more pleasant and comfortable to live in, while other areas remain under review. There are plans for further refurbishment, which will ensure that the premises remain suitable to meet peoples’ changing needs. EVIDENCE: We undertook a tour of the premises assisted by the registered manager and were later joined by the registered provider. We saw that since the previous inspection visit the home has made a significant number of improvements to the physical environment. These included a number of new commodes and wash-basin units in bedrooms. Two bedrooms have new vinyl flooring and a quotation had been obtained for replacing the carpet with vinyl in another bedroom. The carpet in another bedroom had been cleaned and is to be replaced prior to a new occupant moving in. The manager said that items are replaced as people move. Two of the bedrooms we saw had recently been reConifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 19 decorated and this was happening also in a third room. One individual has moved to a downstairs bedroom while arrangements are being made to fix a leak in their room. Bedroom curtains have been replaced in some rooms where these had not closed properly, thus ensuring people have privacy as identified in the previous report. The registered manager has provided framed photographs of people with their relatives for those who wish to have them. There are laminated pictures on doors with individuals’ names and room numbers to assist people in their orientation. The entrance lobby and inner hallway have been painted. New lounge chairs and dining room furniture have been provided. The manager has put up more pictures in the lounge to make it more homely, these are laminated so that they can be passed around as a talking point. The garden was being maintained in a reasonable condition and the grass had been cut. There were two items of furniture stored to one side of the garden and not in view, awaiting collection. The main bathroom has been re-decorated and is equipped with a new storage cabinet and extractor fan. A spare bathroom is due for refurbishment. A new toilet seat has been fitted where this was a previously identified need and all toilets were checked and found to flush properly. As identified in the previous report, wooden planks have been placed over cisterns to prevent them being removed. We discussed this with the registered manager, who agreed to improve the appearance of these areas, for example by putting shelving there instead. The previous inspection report identified that an alarm-call point in a toilet is situated too high for residents’ to be able to reach it. Call system boxes can be un-mounted and in two of the bedrooms we saw, the occupants had removed the alarm-call box from the wall. We discussed this further with the registered manager, who agreed to record in people’s care plans with regard to their individual capacity to use the system effectively. This will highlight those individuals who are unable to use the alarm-call and ensure the current system is kept under review. The home currently monitors peoples’ whereabouts and the procedure is for staff to use the alarm if necessary. We witnessed a good staff response to the alarm-call system being used in an exercise. The previous requirement has therefore not been repeated. We observed a reasonable level of cleanliness throughout the building. The home has purchased two new sealed bins for the disposal of continence products, replacing the old framed disposal bins, which effectively helps to eliminate odours. This meets a previous recommendation. There are hand gel dispensers throughout the home and in the entrance lobby. Previous reports have identified that there remains an issue with the position of the laundry, but Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 20 a procedure is in place that staff use a side door rather than bringing soiled laundry through the kitchen, to minimise the risk of infection. There are plans for an extensive refurbishment of the property, which when complete will address this issue. Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home employs staff in sufficient numbers and provides them with training to meet the needs of people who use the service. People who live in the home are protected by the homes’ staff recruitment procedures. EVIDENCE: We saw the staff rota, which showed that there are three care staff on each of the morning and late shifts and two care staff awake at night. The home has assessed that these are the required staffing levels to meet the needs of people who use the service. We observed these staffing levels to be in operation at the time of our visit. The home is currently advertising for one full-time staff member and additional bank staff. We observed staff interacting with people who live in the home in a friendly and respectful manner. A relative who was visiting told us that staff ‘are very kind’. The sample of the rota we saw showed that a qualified first aid person is on duty on each shift. Two staff members we spoke to also confirmed this. The homes’ annual quality assurance assessment (AQAA) stated that all staff had satisfactory pre-employment checks. Further evidence of this was seen at the time of our visit through inspecting a sample of three staff members’ recruitment records. These files contained the required information, such as dates of employment and completed job application forms, two written Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 22 references and evidence of satisfactory Protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) checks. This meets a previous requirement and demonstrates that people who use the service are being protected. The home has a training programme and structured induction process and a staff member confirmed that they had completed the induction, including ‘shadowing’ the senior staff member on shift for a week. We saw that a checklist is used to record the induction and we advised the registered manager to check that this process is in line with the Skills for Care Common Induction Standards. Of sixteen care staff, the registered manager reported that four had obtained an NVQ level 2 or above, while another two had qualifications that the manager said was equivalent to NVQ level 3. Five staff including the manager have completed a training course on dementia care and three more staff are currently undertaking this training. The AQAA states this training has been introduced for all staff members and there are plans to develop the training programme. The two staff members we spoke with said they had found the dementia training useful, for example in helping them to understand better some of the individual behaviours of people who use the service. Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 & 38 People who use the service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who use the service benefit from the improvements that have been made in the way that the home is managed. Further attention is needed to ensure that records required for regulation purposes are completed fully and within timescale. EVIDENCE: The registered manager has completed the NVQ level 4 and Registered Manager’s Award. Mr Martin Pelling told us that, since the last inspection visit, the time he allocates to the management aspects of the home has increased significantly. The current rota clearly shows which days the manager is working in a ‘hands-on’ capacity and when he is doing management and administrative duties. The manager informed us that this is soon to change so that he can allocate full-time hours to managing. This will also enable him to Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 24 choose when to work ‘hands-on’ so that he keeps in touch with what is happening in the home. Staff confirmed that the owner and manager are approachable and supportive. The views of relatives and involved professionals are obtained in the homes’ quality questionnaires, which showed overall positive responses, particularly in relation to the care given by staff. The manager collates this information and produces a report. We discussed the homes’ annual development plan with the registered provider/owner, which along with the quality of care has been reviewed since the last inspection, but is still focused on the environment and premises and does not currently reflect the findings of stakeholder consultation and feedback. Both the registered manager and provider said that reports of monthly regulation visits to the home by the provider are written. At the time of our visit copies of up-to-date reports were not available for inspection. This is a requirement. We saw that since the last inspection the registered manager completes a monthly report to the registered provider. Since the last inspection, a good many improvements have been made in the way that the home is managed, so that the standard of the environment has been raised and the social and recreational needs of individuals are being better met. Areas for further improvement that have been identified in this report are in care planning so that any risks are fully identified and minimised; maintaining records of activities which meet individuals assessed needs; improving the appearance of the toilets in the home in order to better promote the dignity of people who use the service; and keeping up-to date records in the home such as quality monitoring reports. The home’s management also need to ensure that the annual quality assurance assessment (AQAA) and any required improvement plans are completed and received by the commission within timescales. Not all sections of the AQAA were completed, for example what the service could do better and how the service has improved, so the assessment lacks detail and does not fully demonstrate a commitment to continuous improvement. This was discussed with the registered manager at the time of our visit and the manager said that he now has more time and is more aware of what is required in the assessment. The registered manager confirmed that the home does not deal with the financial affairs of those who use the service; this is left to the family or advocates of individuals. We saw some records indicating that formal supervision takes place. The registered manager said that he is available in the home to supervise staff on an informal as well as formal basis. The two members of staff we spoke to confirmed that they receive supervision every two months. Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 25 The home keeps records and certificates relating to the servicing of portable electrical appliances, gas heating, fire alarms, fire extinguishers and emergency lighting. Radiator covers have been installed to prevent possible burns to people who use the service. Restrictors have been placed on windows for the safety of individuals and measures have also been taken to prevent possible scalding from hot water. The fire logbook showed that fire alarms and emergency lighting are tested. We saw training records that showed staff training has taken place in moving and handling, first aid, infection control and food hygiene. Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (1) (2) Requirement Care plans must be based on full assessments of individual needs and include specific guidance for staff giving personal care. Care plans must include risk assessment and management strategies to address aggressive behaviour and risk of falls. This is a partially repeated requirement from 13/07/07. The previous timescale of 14/09/07 has not been met. 2. OP33 26 (4) (c) Reports written under this regulation must be kept in the care home available for inspection. 29/02/08 Timescale for action 31/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 28 No. 1. Refer to Standard OP30 Good Practice Recommendations The registered manager should check that the homes’ structured induction is in line with the Skills for Care Common Induction Standards. Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Conifers DS0000046710.V344852.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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