Inspection on 13/01/09 for Cookham Riverside Nursing Home

This inspection was carried out on 13th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cookham Riverside Nursing Home 23/02/07

Cookham Riverside Nursing Home 05/01/06

Cookham Riverside Nursing Home 16/08/05

Cookham Riverside Nursing Home 09/12/04

Cookham Riverside Nursing Home 29/06/04

Cookham Riverside Nursing Home 16/03/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cookham Riverside Nursing Home Berries Road Cookham Berkshire SL6 9SD     The quality rating for this care home is:   two star good 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: Helen Dickens     Date: 1 3 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 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 32 Information about the care home Name of care home: Address: Cookham Riverside Nursing Home Berries Road Cookham Berkshire SL6 9SD 01628810557 01628521239 cookhamriverside@talktalkbusiness.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hamilton House Medical Ltd The registered provider is responsible for running the service Name of registered manager (if applicable): Name of registered manager (if applicable) Mary Taylor Clay 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: 35 The registered person may provide the following category/ies of service only: Care home with nursing - 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 category - OP Date of last inspection Brief description of the care home Cookham Riverside is, as its name suggests, situated on the river in the Thames village of Cookham. The home provides nursing care for up to 35 older people. It was purpose built in the 1970s and lies towards the end of a private road just off Cookham High Street. Many rooms within the home overlook the River Thames, thus enabling Care Homes for Older People Page 4 of 32 care home 35 Over 65 35 0 Brief description of the care home residents to enjoy the pleasant river views. To the front of the property is a car park and to the rear a terraced area, with well maintained lawns and gardens stretching down to the river. The gardens have level walkways, and the terraces have seating and tables for the use of residents and visitors. Cookham has public transport, shops and amenities within walking distance of the home; the larger town of Maidenhead is approximately three miles away. The cost of this service ranges from #825 to #1150 per week. This excludes hairdressing, chiropody and newspapers Care Homes for Older People Page 5 of 32 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was unannounced and took place over 7.5 hours. The inspection was carried out by Mrs. Helen Dickens, and the Registered Manager Mrs. Mary Clay represented the establishment. The owner, Mr. David Edmondson, also joined the inspection briefly during the afternoon. A partial tour of the premises took place and a number of files and documents, including three residents care plans, two staff training and recruitment files, quality assurance information, and the annual quality assurance assessment (AQAA), were examined as part of the inspection process. A number of surveys returned from residents, staff and health professionals involved with this home, were also used in writing this report. The inspector saw most residents who were in the home on the day Care Homes for Older People Page 6 of 32 of the inspection and spoke briefly with some in the dining room at lunchtime. Four residents were later spoken with in more detail. The current fees at this home range from 770.00 to 1050.00 per person per week. The inspector would like to thank the residents and staff for their time, assistance and hospitality. 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 Care Homes for Older People Page 8 of 32 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 32 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 32 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. Residents needs are assessed and they are assured these can be met prior to them moving into the home. Evidence: The AQAA completed by the manager prior to the inspection states that comprehensive pre-admission assessments are carried out, including the use of the Department of Health (DoH) validated tool (FACE) and the abbreviated mental test. Three residents files were sampled, looking at their assessments and their care plans. These included a long standing resident, a recently admitted resident, and a resident who had high levels of nursing care needs. The long standing residents file contained only relevant parts of the original assessments on the current working file as the original assessments were now kept elsewhere. The file also contained a print out from the doctors surgery including the residents past medical history and medication Care Homes for Older People Page 11 of 32 Evidence: requirements. The two newer residents files had an admissions checklist and copies of assessments from other professionals, as well as the print out from doctors surgery on past medical history and medication, treatments etc. The home uses the FACE overview assessment which is a comprehensive assessment tool recommended by the DoH. The two sampled were well completed, dated and signed. Baseline assessments of weight, blood pressure, temperature etc had been taken and noted, and risk assessments had been drawn up in relation to the dependency levels of each resident, the risk of pressure sores, and their nutritional needs. The falls risk assessments on residents files also used a DoH recommended tool and contained a clear assessment of the risk of them falling, and any preventative action needed. The AQAA noted that currently 17 residents have some form of dementia. This was discussed with the registered manager and later with the owner who joined the inspection briefly during the afternoon. Whilst they did not think their service needed to consider an additional category of registration at the moment, they were asked to look at the latest CSCI Guidance (up-dated on 07/01/09) entitled Care Services for older people with mental health needs or problems and to keep their service under review in this regard. Care Homes for Older People Page 12 of 32 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. Residents are complimentary about the health and personal care they receive at Cookham Riverside, though improvements in care planning documentation are being put in place, by the manager, which should address some of the current shortfalls in recording. Medication arrangements are satisfactory, and residents are treated respectfully by the staff and management. Evidence: In relation to residents care plans, the AQAA stated that named nurses review the care plans, and that the new Berkshire Care Association format has been adopted. Three care plans were sampled, and four residents were spoken with about the care they received. A visiting health professional noted that Staff are helpful, friendly, caring and supportive. The care plans were drawn up using the assessments carried out prior to and during the admission of each resident. The manager made good use of recognised assessment tools including the Waterlow skin viability assessments, the Bartel Care Homes for Older People Page 13 of 32 Evidence: dependency rating tool, and a DoH recommended falls assessment tool. The home uses the well regarded MUST nutritional risk assessment format. Each resident has a named nurse, and each nurse has four residents whose care they manage, including drawing up and reviewing the care plans for those residents. The file sampled for the resident with high nursing needs had good levels of detail about the nursing care interventions needed and how their care was being managed in relation to clinical care. A resident whose file was not part of this sample, but whose nursing needs were fairly complex, was interviewed separately by the inspector, and this resident praised the staff for the care and attention they give, describing them as Wonderful in this respect. Another resident who had been at the home for a year said I cant speak too highly of the care staff and the nurses. The three files sampled were using the homes own old style care planning format and the manager said that though no care plans had yet been transferred over to the new format, the plans to introduce the Berkshire Care Association tool were in place and the project to transfer all plans to this format would be completed within the coming 2 months. The shortfalls in the homes current format including insufficient detail about exactly how each resident would like their personal care delivered, and little documented evidence of involvement from the service user, are likely to be remedied by the introduction of the new format and a Requirement, with a date of two months from the date of this inspection, will be made in this regard. It was also noted that reviews were documented less frequently than on a monthly basis as recommended in Standard 7. The manager said that when the new care planning format is introduced, two senior nurses, (her new assistant and the deputy matron), would have responsibility for monitoring the care plans overall, whilst she herself would retain responsibility for the auditing. She also added that the monthly reviews had probably been carried out, but had not been recorded by staff. Health care arrangements at the home are well managed. The AQAA states that the home accesses appropriate medical attention for residents, and facilitates fortnightly reviews of all residents through a funded contract with a medical centre. It also noted that they have made a number of improvements in the last 12 months including introducing a validated falls risk assessment tool, together with falls prevention strategies, which has reduced the number of falls within the home. The GP from the health centre was making the fortnightly visit on the day of the inspection, and was seen to be speaking with individual residents. Residents who were asked, knew the doctor visited on a regular basis, but also confirmed that if they needed the doctor outside these visiting times, the doctor would be called. One resident said they had been ill recently and, when asked how they had been looked after, they stated the staff were ...brilliant at that. Care Homes for Older People Page 14 of 32 Evidence: Another GP who has patients at this home returned a survey and wrote; Excellent nursing home, .....nursing care standards of the highest level. The visiting podiatrist also returned a survey and noted The residents often tell me they are happy and comfortable, and how kind the staff are. A visiting clinical nurse specialist noted on their survey that The home always follows advice and seeks advice when needed. The file sampled for the person with a high level of nursing needs contained information on arrangements for managing their health care including the medical discharge summary from hospital, assessment by the lead nutrition support dietitian, and swallowing guidelines. Regular reviews of swallowing by the speech and language therapist were documented, including two reviews in the last month. The manager said this resident has improved since arrival and she said their relatives are very pleased with the progress being made. Medication is dispensed by trained nurses at the home and the inspector observed part of lunchtime medication session. The staff have 2 separate trolleys, one for each floor, and these were both brought to the dining room at lunchtime. The trolleys were securely kept and medication was taken directly to individual residents. The home uses blister packs from the local pharmacy, who carry out 6 monthly inspections at the service. On the last visit there were no requirements or recommendations made by the pharmacist. Residents were observed to be treated respectfully by staff, who were seen to knock on doors and to give residents choices, for example in relation to meals and drinks. Personal care was delivered behind closed doors and the home has made a number of changes to improve the comfort and dignity of residents, for example by providing new hoists, and they are about to refurbish all the bathrooms and fit over bath ceiling hoists in each one. Residents wore their own clothes and were well groomed. The home encourages people to be as independent as possible and one resident told the inspector that they have their own key to the towpath gate and like to go for walks. Care Homes for Older People Page 15 of 32 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 are offered opportunities to take part in suitable activities, and supported to maintain contact with their family and the wider local community. They are helped to exercise some choice and control over their lives, and are offered a nutritious diet, in pleasant surroundings. Evidence: The AQAA states that the home provides a varied programme of group and one to one activities, entertainment and outings, to meet residents expressed preferences. An activities organiser is employed and was seen to be working in the home on the day of the inspection. A monthly activities programme is produced, and activities for each week are on the board in the hallway. For January, activities included board games, planting hyacinths, knitting, bingo, and music to movement. There was bingo at the home on the afternoon of the inspection, as per the monthly activities plan. Residents also follow their own interests with some residents being keen on jigsaws for which there is an area available in the lounge, and others are learning to use the computer. There are two computers available in the lounge area for residents use, one with an adapted keyboard with large letters for those with a poor sight or impaired Care Homes for Older People Page 16 of 32 Evidence: dexterity, and there is a web cam. Some residents spoken with had a daily paper, and others followed artistic pursuits such as painting and embroidery. The grounds of the home are on the river and the views from the lounge and some residents rooms are very pleasant, with boats and river birds in the distance, and garden birds and squirrels on the terraces around the home. The new call bell system has a wireless option which means residents can summon help anywhere in the home, and even out in the garden, by using the pendant accessories. The activities programme includes walks, and one resident told the inspector she went for regular walks along the towpath. The manager has identified a company with a specially adapted boat on which they can take physically disabled people on river cruises, and she has already booked this for two weekends during the summer. The boat has a lift to enable residents to be taken on board in their wheelchairs, and there are disabled toilet facilities. Residents are encouraged to maintain contact with the local community including outings, for example to the garden centre. Local clergy and church visitors come to the home and some residents attend church services on Sunday. The local Brownies visit Cookham Riverside and the manager showed the inspector four large frescoes the children had created for residents at Christmas which are now hung in the hallway. Those residents spoken with said their visitors were made to feel welcome, and a notice in the hallway was advertising the annual relatives and residents meeting which was to be held later in January. A separate library in the home can be booked for residents who wish to dine privately with their relatives, or for holding birthday parties. It was also noted that where residents rooms did not have much space for spare chairs for visitors, the home had provided comfortable fold-up chairs for residents to keep in their rooms. Residents were encouraged to keep in touch with relatives for example some could use the e-mail and the web camera, or their own landline telephone, and it was noted that some residents had their own mobile telephones. Residents are given opportunities to exercise some choice and control over their lives for example in relation to meals and activities. The manager had carried out annual surveys on food and meals and one of these was sampled by the inspector. The focus had been on likes and dislikes, and residents favourites, and she had collated the responses and produced a master list of favourite foods and preferences for each resident. She said the current menus were based largely on these responses. Residents were seen to come and go within the home, and to eat where they pleased. Some choose to eat in the dining room, some in their rooms, and some in an alcove in Care Homes for Older People Page 17 of 32 Evidence: the reception area where the manager said two or three residents who are friends, preferred to sit together. The manager said residents were encouraged to exercise their right to vote and for those who preferred to go to the polling station in person, the activities organiser arranged their transport. Meals at Cookham Riverside are served in very pleasant dining room which is colour co-ordinated and comfortably furnished. There is always a chef (or the chef manager) on duty each lunchtime and suppertime, and they are supported by a kitchen assistant. Residents can choose to have a cooked breakfast and one person told the inspector how they looked forward to their full English breakfast each morning. Others preferred porridge or cereals and toast, but all spoken with knew they had a choice and what the choices were. There is a choice of two main courses offered at lunchtime (Roast Turkey or haddock on the day of the inspection) with other alternatives for example baked potatoes or omelette offered for those who did not want either of the main courses on offer. Residents are asked what they would like for lunch at coffee time each morning. The inspector sampled a teaspoon of each item from the main course and found the food to be both tasty and well presented. The inspector also visited most tables in the dining room at lunchtime, and also spoke individually with four other residents who did not go to the dining room. Comments received were reported back to the manager as she said that few comments had been received on their last food survey. It was recommended that the chef seek comments on the meals directly from residents, perhaps after lunch, as is now common practice in many homes of this standard. Special diets are catered for and some residents files sampled showed specific guidelines were in place for example to prevent choking, or for specialist feeding such as peg feeding. Specialist assessments had been sought (e.g. from the dietitian) and were on file. Each resident has a nutritional risk assessment and those residents files sampled, showed they had all been weighed regularly. Care Homes for Older People Page 18 of 32 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. Residents complaints would be listened to at this home, and they are protected from abuse. Evidence: The home has a complaints procedure in place and the manager said only one complaint has been received in the last 12 months. Records on this were made available to the inspector and the complaint was well documented. The complaint was not upheld and a detailed response had been given by the provider. Residents were observed to speak up and voice any thoughts they had on the home during the inspectors visit. Three residents had returned surveys to CSCI and all three ticked that they would know how to make a complaint, and one added Loud and clear! At the Annual Service Review in June last year, 5 residents returned surveys to CSCI, and they too confirmed they would know how to make a complaint. No complaints have been received by CSCI about this service in the last 12 months. The home has a protection of vulnerable adults policy in place and a copy of the local authority multi agency procedures for safeguarding adults is available at the home. The manager said staff cover this subject in their induction. The manager said all staff have safeguarding training and currently only the few new starters have not yet done this session. It is also covered in NVQ training and over 90 of care workers at this home are NVQ trained. There have been no safeguarding matters reported to CSCI in Care Homes for Older People Page 19 of 32 Evidence: relation to this home since the last inspection. One issue relating to safeguarding and recruitment checks for new staff is dealt with under Standard 29. Care Homes for Older People Page 20 of 32 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. This home offers a bright and comfortable environment, which is clean and pleasant throughout. Evidence: Cookham Riverside Nursing Home offers a very pleasant environment for residents. Furnishings are bright and comfortable and the home offers a range of communal areas for residents to enjoy including a large dining room, and a large lounge with river views, which can be partitioned to provide a second, smaller lounge with a piano and computer facilities. There is a separate library (with a river view) which can also be booked for private lunches and parties. All residents spoken with were complimentary about the environment and liked their rooms. Several told the inspector they thought they had the best room in the home because of the views over the river. Another resident who did not have a river view said she preferred her room as it looked out over a small apparently private garden. Comments included The decor of the whole place is very good. The grounds are tidy and attractive and there is permanent garden furniture on the terrace for residents who wish to sit outside. The proprietor who joined the inspection briefly during the afternoon highlighted a number of improvements including investing in a new water system to avoid the need to store water and thereby eliminate problems they had with the old boiler which has Care Homes for Older People Page 21 of 32 Evidence: now been removed. He also described the installation of the latest call bell equipment which has a wireless facility, enabling residents to summon help in any part of the building, or outside in the garden with the use of a pendant. He is currently replacing all the communal bathrooms and fitting ceiling hoists for the comfort of residents and staff. The manager said the requirements made by the environmental health officer on the most recent visit had now been completed. There are good hand washing facilities at this home including soap and paper towel dispensers at communal basins and in bathrooms. There is also hand gel available. The AQAA states that cleaning standards have improved over the previous 12 months through new routines and staff responsibilities, and that there is improved infection control due to ongoing training and audit. It also notes that the home has had an infection control inspection by a care homes specialist from Berkshire East PCT. On the day of the inspection the home was fresh and clean with no unpleasant odours in any part of the building. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are met by the numbers and skill mix of staff and the home exceeds the recommended number of care staff holding a qualification in care. More work is needed on the recruitment arrangements at this home. Staff training arrangements are well developed but a centralised record of staff training should be available. Evidence: The AQAA states that staff recruitment follows good practice guidance and they provide staff training to meet the requirements and identified needs of individuals. It also says staff rotas demonstrate generous staffing levels and an ideal grade mix. During the inspection it was noted that written staff rotas were in place and additional staff were available at busy times. It was observed for example that there were sufficient staff during the lunch period for those residents who needed support to eat. Additional staff are employed for none care duties such as social activities, kitchen and domestic duties, and there is a handyman. Surveys returned to CSCI confirmed residents received the care and support they needed, and staff listened to them and acted on what they said. Comments from residents during the inspection included Staff are very good;Staff are wonderful; and I cant speak too highly of the care staff. The GP who returned a survey wrote Care Homes for Older People Page 23 of 32 Evidence: Excellent care of their patients, with skilled nursing care. The AQAA states that, in addition to trained nurses at the home, more than 90 per cent of the care staff have at least an NVQ Level 2 qualification in care work. This was confirmed with the manager on the day of the inspection, and she added that all care staff are encouraged to get qualifications; currently all but the two newest members of staff have a care qualification. This exceeds NMS 28 which recommends that at least 50 per cent of care staff should be qualified. Two recruitment files were sampled for recently recruited staff and found to be well kept with individual sections clearly marked. Both had application forms, suitable references, and had completed CRB applications. One, who is a qualified nurse had also had their identification number checked with the Nursing and Midwifery Council. This person had started their induction, and was in the home under supervision, and following a POVAlist check. This check ensures that the person has not been deemed unsuitable to work with vulnerable adults. This is allowed in exceptional circumstances whilst waiting for a full CRB check to be returned. The second person, who was not employed in a care capacity, had not yet had a POVAlist check. The manager said their catering role needed filling as a matter of urgency and, as the person would not have any unsupervised contact with residents, she had decided to go ahead with the appointment. The POVAlist check had been applied for and was expected back within days. The manager pointed out that had she used staff from a catering agency instead, they would not have had POVAlist checks. She was asked to ensure there was a written risk assessment in place, and to familiarize herself with the latest guidance from CSCI on recruitment checks, and in particular the circumstances under which it is permissible to employ staff prior to a full CRB being returned. It was also noted that only a ten year employment history is sought for new staff at the home. The Regulations require a full employment history and the manager was asked to ensure that all staff files contained the necessary information as set down in Schedule 2 of the Care Homes Regulations 2001 as amended. The AQAA states that the home provides staff training to meet the requirements and the identified needs of individuals and the home to ensure best practice.The manager outlined the current training arrangements and it was noted that training is recorded on individual staff files (and certificates are kept), but there is currently no central record of which staff have done which training courses. The manager said the deputy does all the moving and handling training in-house, though the training list was not available as the deputy had left for the day. When asked about the safeguarding adults Care Homes for Older People Page 24 of 32 Evidence: training, the manager was able to demonstrate that all trained staff had attended this course. Over 90 per cent of care staff have NVQ 2 or above so care workers should be competent to do their jobs, but a centralised training record is needed to ensure that all staff have the appropriate training, and that there is a system to highlight when refresher training is due. The manager said staff have a personal development programme, and she demonstrated from supervision notes how training and development are a standard agenda item for all staff supervision sessions, giving examples of training needs that had been identified e.g. person centred care. Care Homes for Older People Page 25 of 32 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. Residents benefit from a well managed home, where their views are sought and taken into account. Arrangements for promoting the health, safety and welfare of people at this home are well developed but more work is needed. Evidence: The AQAA states that the home has an open, positive and inclusive leadership approach. The inspector noted that there were clear lines of accountability within the home. The manager is supported by a deputy matron and the recently recruited assistant matron. The registered nurses support the manager and her deputies, who in turn are supported by care assistants, 90 per cent of whom are qualified in care work. The manager said that she has delegated a number of areas of work and that staff are encouraged to have specialist areas such as continence promotion, infection control, and falls. The manager already has a masters degree in a relevant subject and is currently finishing a Doctorate in clinical leadership. The AQAA states that recent improvements include head office now being located at the home, which means the Care Homes for Older People Page 26 of 32 Evidence: owner and finance manager are more accessible to the manager and staff, residents and relatives. One survey from a health professional commented on the management of the home and noted; The care service will continue to improve under the watchful eye of the manager. She strives to maintain high standards. There are a number of quality assurances processes including regular general surveys for residents. There are also specialist surveys such as the meals survey, which the manager said is now in its third year. Some internal auditing is carried out, for example the AQAA states that ongoing training and audit has improved infection control within the home. The owner continues to carry out planned refurbishment within the premises and recently this has included the new call bell system, replacing bedroom sinks and taps, replacing a manual hoist with an electric one, and redecorating some residents rooms. The views of families and friends are sought and the home holds an annual residents and relatives meeting. The AQAA also notes that feedback is sought from external health and social care professionals. The inspector highlighted that there needs to be arrangements in place for auditing of care plans (as discussed under Standard 7) and the manager said there are plans to do this once the new Berkshire Care Association format has been introduced. The manager was asked about how the home supports residents to manage their finances and she said that the home no longer gets involved with this. She said that current residents either manage their own money, or they have a relative or other person who supports them to do this. Health and safety arrangements at this home include having relevant policies and procedures in place. The AQAA lists the following relevant policies and procedures which it states were all up-dated in December 2008: accidents; communicable diseases and infection control; dealing with violence and aggression; Whistle blowing; fire safety; health and safety; and moving and handling. The AQAA also notes under maintenance of equipment that the following are serviced or tested including the lift, gas appliances, fire detection equipment, and fire fighting equipment. Training is given to staff in related topics. Risk assessments are also in place, where the home has identified potential risks, for example all residents have a nutritional risk assessment, as well as risk assessments relating to falls, skin viability, and dependency levels. Other risk assessments are carried out as necessary, for example in relation to the use of cot sides. Reports from external professionals have included the pharmacists inspection report, Care Homes for Older People Page 27 of 32 Evidence: where no shortfalls were noted, and the environmental health officers (EHO) inspection report. This visit from the EHO did result in some requirements being made but the manager said these have now all been actioned. Arrangements for the prevention of legionella include annual samples being sent off for testing, and a number of monitoring procedures including testing water temperatures. The owner joined the inspection during discussion of water safety, and he said a risk assessment had been carried out in relation to water and legionella. He was asked to ensure that the risk assessment and arrangements for the prevention of legionella were in line with guidance issued by the Health and Safety Executive in relation to prevention of legionella in care homes. Further discussion followed on water temperatures and the owner stated that thermostats are not automatically fitted to all taps in the home, though some had been fitted in residents rooms following risk assessments relating to individual residents. He said the baths were all fitted with thermostats. One risk assessment was seen on a residents file but this had not been reviewed for some years. Following a telephone discussion between the inspector and a Regulation Manager, it was agreed that the owner would review the current system and ensure that all residents had an up to date risk assessment, and that any actions highlighted by the risk assessments would be taken. The owner offered to ensure that all communal water outlets to which residents had access would have thermostats fitted within the following week, and outlets accessible to residents in their bedrooms, would have thermostats fitted on a rolling programme, prioritising the work according to the outcome of the up-dated risk assessments. Care Homes for Older People Page 28 of 32 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 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The current care planning arrangements must be reviewed to ensure that all residents have a detailed plan about their care needs and how they would like their support to be delivered. Care plans should be reviewed on a monthly basis in accordance with current good practice and NMS 7. For the benefit and welfare of service users. 13/03/2009 2 29 19 Staff files must contain all 13/02/2009 the information listed under Schedule 2, of the Care Homes Regulations 2001 (as amended) including a full employment history. For the safety and welfare of service users. 3 38 13 The system to prevent 27/01/2009 scalding from hot water must be reviewed to ensure that all residents have an up Page 30 of 32 Care Homes for Older People to date risk assessment, and that any actions then deemed necessary, are carried out without delay. For the safety and welfare of residents. 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 15 It is recommended that the chef seek feedback directly from residents about their meals, and that any comments are used to assist the home to continue to offer a pleasant mealtime experience. Those with responsibility for the homes recruitment procedures should make themselves familiar with the latest CSCI guidance on recruitment checks, and in particular, the decision to use staff prior to receiving a full CRB check. The arrangements for the prevention of legionella within the home should be reviewed to ensure they fit with the Health and Safety Executive Guidelines on the prevention of legionella in care homes. 2 29 3 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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