Inspection on 23/10/08 for Cornwallis

This inspection was carried out on 23rd October 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cornwallis 11/02/10

Cornwallis 22/10/09

Cornwallis 28/07/09

Cornwallis 02/11/07

Cornwallis 23/05/07

Cornwallis 22/05/06

Cornwallis 24/02/06

Cornwallis 05/09/05

Cornwallis 03/03/05

Cornwallis 20/09/04

Cornwallis 08/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cornwallis Trewidden Road St Ives Cornwall TR26 2BX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Diana Penrose     Date: 2 3 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 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: Cornwallis Trewidden Road St Ives Cornwall TR26 2BX 01736796856 01736797143 cornwalliscare@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Cornwallis Care Services Limited Type of registration: Number of places registered: care home 51 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Cornwallis Nursing Home is a detached property located above the town of St Ives, Cornwall. It is a three-storey dwelling and is situated at the top of a hill. The home offers nursing care for up to fifty-one elderly residents with a dementia or mental health problem. Residents accommodation is spread over three floors. Residents private bedrooms are shared or single, with bedrooms on the first floor having en suite provision. There are two communal lounge/dining areas, plus a conservatory, which has sea views. The upstairs conservatory has been repaired and refurbished and can be used by the residents. All rooms have call bells and assisted bathing facilities are provided. The garden area is accessible to residents. There are opportunities for socialising and visitors are openly encouraged. Information about the home is available in the form of a residents guide, which can be supplied to enquirers on request. A Care Homes for Older People Page 4 of 31 Over 65 51 51 0 0 Brief description of the care home copy of most recent inspection report is available in the home. Fees range from £490 to £695 per week according to the manager, who supplied this information during this inspection. Additional charges are made in respect of private healthcare provision, hairdressing and personal items such as newspapers, confectionary and toiletries. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Two inspectors visited Cornwallis Nursing Home on the 23 October 2008. They spent seven hours at the home. This was an unannounced visit. The purpose of the inspection was to undertake a statutory inspection and to gain an update on the progress and compliance of the requirements identified at the last key inspection on 02 November 2007. All of the key standards were inspected. On the day of inspection 32 people were living in the home, one was receiving respite care. The home also provides day care to one person once a week. The methods used to undertake the inspection were to meet with residents, staff, and the management team to gain their views on the services offered by Cornwallis Nursing Home. Records, policies and procedures were examined and the inspectors toured the building. This Care Homes for Older People Page 6 of 31 report summarises the findings of this inspection and evidence gathered from the inspection record and Annual Quality Assurance Assessment document submitted by the manager. Surveys were sent to the home for distribution to staff and people using the service, very few were returned. There have been further management changes at the home since the last inspection. The registered manager resigned in August 2008 and there have been two different managers since then. The current manager has been in post since 16 October 2008. The registered managers post is to be advertised. The requirements set at the last inspection have been met. Although no requirements have been set in this report breaches to regulations have occurred. Due to the positive response of the management team recommendations have been made at this time. What the care home does well: What has improved since the last inspection? What they could do better: All prospective people wishing to use the service should be appropriately assessed to ensure their needs could be fully met at the home. A recent admission had a suitable assessment but again new paperwork is to be introduced and will need time to become established. Although there has been some improvement in the care planning arrangements more detail is required to ensure staff are fully informed of the care to be provided. The home has used a person centred approach but it does not include peoples wishes, aspirations and goals. Staff feel the plans are long and would not fully inform new staff of the care to be provided. Individualised risk assessments are needed for those Care Homes for Older People Page 8 of 31 requiring restraint such as cot-sides or other special requirements. Staff need to ensure best practice is used as well as focusing on residents safety. The medicines policy has been reviewed and is more directive for staff a few additions to the policy were discussed with the manager. Safety signage should be in use where oxygen is being administered or stored. The wet room facility needs to be completed and the other bathing facilities reviewed to ensure suitability for the elderly frail and to provide a homely feel. Refurbishment plans indicated at the last inspection have not taken place. The home generally needs to be improved and upgraded to provide a cosy homely environment. This was discussed with the management team and an in depth environmental audit should be undertaken with plans for improvement to the decoration, furniture and furnishings. Strong odours were noted around the building, further efforts need to be made to eliminate these to make it a more pleasant place to live and work in. The fence panels in the garden need to be replaced to make this a secure area for people to utilise. Recruitment of staff must be equal for everyone with all checks undertaken irrespective of whether they have worked at the home before. In house recruitment for promotion must also be robust and include the same process. The policy for managing residents monies needs to further specify what is expected to inform and direct staff and who is responsible for holding keys and so on. The registered managers post is vacant again. The registered provider is trying to recruit a new manager, when a person is appointed they will need to be registered with the Commission for Social Care Inspection. A quality assurance system needs to be developed to ensure continuous review and improvement in all aspects of the home. Meetings need to be regular to enable staff, residents and families to air their views. Staff supervision both formal and practical needs to be evidenced to ensure staff are supported and encouraged to develop their skills. Fly screens need to be fitted to the kitchen windows and external door. We were told at the last inspection that these had been purchased. 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 Care Homes for Older People Page 10 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 11 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is suitable information available to prospective residents for them to choose whether or not to live in the home. There was insufficient assessment information in some files to show that people are fully assessed and the home can meet their needs. Evidence: There is a suitable statement of purpose that has been improved with photographs included since the last inspection. It is available in the home and the manager said it is given to prospective residents families. The managers details now need to be updated as the registered manager has left and there is an acting manager in post. The assessment documentation in use is the same as before but the manager showed us new documentation that she intends to implement. We were told that the manager and a Registered Mental Nurse visit prospective residents to undertake a needs assessment before admission is arranged. Three care files were inspected and only one Care Homes for Older People Page 12 of 31 Evidence: contained a full needs assessment, this was a recent admission the others were 2007. Copies of assessments completed by the healthcare trust or department of adult social care were seen in some files. Care Homes for Older People Page 13 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. All residents have a care plan; these would benefit from being more personalised and detailed to direct staff in the care provision and restraints in use must be risk assessed to safeguard both residents and staff. There is a suitable system in place for dealing with residents medicines and staff do their best to treat residents with privacy and respect to ensure their rights as citizens are maintained. Evidence: Each person accommodated has a written care plan. The format has changed since the last inspection to a style that is meant to be person centred but it does not include peoples wishes, aspirations and goals. Three care plans were looked at in depth and were reasonably well detailed but not very directive to staff on the specific care to be provided. Staff said they are lengthy but they know the residents and how to care for them. They feel that new staff or agency staff would find it hard to access some information. Life histories have been compiled for residents and have improved to contain more Care Homes for Older People Page 14 of 31 Evidence: detailed information and photographs. Risk assessments are included in the care files. One persons file had a care plan in place for the use of cot-sides with a consent form but there was no risk assessment. This issue has been raised with the home on previous occasions and needs to be addressed. A GP visits the home every week and a nurse told us that community specialist nurses are involved when required. This was evidenced in the records. Two members of staff are links for tissue viability and the manager told us she hopes to have links for other subjects in the near future. We were told that the continence assessments have just been completed and there is a system for the ordering of pads for the residents. Staff have received training in respect of the Liverpool Care Pathway and Gold Standard Framework for palliative care provision. Pressure relieving and moving and handling equipment is in use and hospital style beds are available. Individual records regarding wound care are maintained the manager told us there are no residents with pressure sores at the moment. Emergency equipment checks have not been recorded since 19 July 2008 although another monthly record for a suction machine was dated 06 September 2008. Most of the residents were unable to express their views to the inspectors. One residents survey informed us that the person sometimes receives the care and support needed but would like to go out more for a change of environment. Staff were observed to interact well with residents and spent time talking with them and walking around with them. The medicines policy has been improved since the last inspection and is more directive for staff. The inclusion of as required medicine protocols, insulin injection sites, blood sugar monitoring and the washing of the pots were discussed with the manager. An up to date copy of The Royal Pharmaceutical Guidelines for care homes was seen. A monitored dose system is in use and medicines are only administered by registered nurses. The medicine administration and disposal records were satisfactory. One as required medicine was written on the chart with a regular prescription, it is advised that these be written separately for clarity and auditing purposes. There is a photograph of each resident with their medicine records for identification purposes. All hand written orders on the medicine charts were witnessed and two signatures recorded. There was no sharing of medicines. The home had one person needing prescribed oxygen and a portable system was used, signage needs to be provided on his door as a safety precaution. There is an approved list of homely remedies which needs to be Care Homes for Older People Page 15 of 31 Evidence: signed by a GP. The storage of medicines is satisfactory, there were no controlled drugs in use at the time of the inspection. There is a medicines fridge and the temperature is monitored daily, it was within the safe limits. Care staff receive some medicines training during induction to the home and we were told that staff trained to NVQ level 3 have received medicines training. The pharmacist is available for advice and updating as necessary. Most residents spend their time in one of the two lounges, they can move between the two lounges if they wish. Residents can spend time in their bedrooms but this tends to be when they are unwell. Some residents can lock their bedroom doors. Staff were observed knocking on doors before entering and residents privacy was maintained. Staff were observed to be respectful of individual residents. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines, opportunities for stimulation and activities are non institutional but the more structured activities need to develop to benefit people further. They can have their own belongings with them and if able choose how they spend their time, contact with family and friends is encouraged. They benefit from the nutritious food provided and assistance is given appropriately. Evidence: A person has been employed for 15 hours per week to co-ordinate activities since September 2008 and is developing a system. She said she is finding out about individuals interests and maintains a file of activities and attendance. Information is transferred from this into peoples care files. During this inspection music and movement was taking place and nail painting for three people. Other activities on offer include playing cards, painting, making collages and singing. A fete took place in the summer and a choir is booked for the end of November 2008 along with other events for Christmas. The manager said they are hoping to get a minibus to take people out. One residents survey indicated that suitable activities are not available and that going out would be very beneficial. Care Homes for Older People Page 17 of 31 Evidence: The visitors book shows that some residents have regular visitors. We were told that visitors could meet with residents either in one of the lounges or in their bedroom. People were still getting up late in the morning, which implies that daily routines are flexible. There are choices on the menu. It was evident residents are able to bring personal possessions into the home, for example, people had some small items of furniture, photographs and other belongings in their bedrooms. The daily records indicate that some people choose how to spend their time and that independence is encouraged. The menu is set but we were told that alternatives are available; sheets were seen of what people order for lunch. Peoples likes ad dislikes are recorded in the kitchen. There was a stock of fresh vegetables in the fridge and the chef said that homemade cakes are on offer. He said that the menus and providers of food for the home are being reviewed and improved. Lunch was served in the two lounges and people were encouraged to have their meal at the table but some had a small table at their armchair. People appeared to enjoy the meal and assistance provided by staff was good. The meals on offer are written on white boards in the lounges. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has suitable complaints and adult protection policies and most staff have received training to ensure that resident are safeguarded. Evidence: There is a suitable complaints policy in the home that is available to staff and is included in the statement of purpose. There have been no complaints since the last inspection. Thank you letters and cards are held. There is an appropriate adult protection policy and the home has a copy of the local authority procedures. Some staff have undertaken the No Secrets training provided by the Cornwall County Council and some have attended internal training. The records show that 21out of 34 staff have attended abuse training. Some staff confirmed that they have attended the training. Practice in the use of bed rails, mattresses on the floor, recliner chairs and so on is aimed at the safety of the resident primarily. However any kind of restraint must be fully risk assessed and documented to avoid its use if possible. (see standard 7) There have been no safeguarding issues since the last inspection. Care Homes for Older People Page 19 of 31 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and warm but there are unpleasant odours around the building and most of it is in need of redecoration and refurbishment to make it a homely pleasant place to live in. A more varied colour scheme would enhance the appearance and benefit residents with dementia and improvements must be made to ensure there are appropriate bathing and toilet facilities for people who are frail and disabled. Evidence: The building was inspected and found to be clean and warm. We noted strong odours in some areas of the building and were told that carpets have been cleaned but not effectively so new carpets are to be ordered. Most of the bedrooms are in need of decoration, new furniture and new carpets. Several lack any personalisation. We were told at the last inspection that a refurbishment programme was underway to make rooms more individualised and to move away from all white paint, this has not happened. Many of the bathrooms, toilet facilities and corridors are still painted white. It is important, both therapeutically and aesthetically, if there is more variation in the colour scheme. The operations director said at the last inspection that they had researched appropriate colour schemes for people with dementia. Some doors have been painted with brighter colours to enable identification of bathrooms and toilets for example. Care Homes for Older People Page 21 of 31 Evidence: The reception area is tidy and the conservatory is comfortable and available to residents, there needs to be a door handle on the door so that people can identify how to get in. The two large lounge / dining areas are reasonably well furbished. The staff office area in the corner of the garden lounge has peoples files on display on shelves. We were told that these are to be moved and locked away which must be done urgently for confidentiality of records. The manager said she is moving back into the small office off of this lounge and the facilities manager will use the front office. The door in the sea view lounge leading to concrete steps and an external fire door should be risk assessed to ensure that people are not at risk of accidents or absconding. This was discussed with the manager and the facilities manager. Toilet and bathroom facilities still need improvement. Currently assisted bath facilities are very limited. There is a bath chair on several of the baths but baths are domestic in type, and not appropriate for those who are very frail or have a physical disability. The registered provider must provide more appropriate bathroom facilities particularly considering the type of residents the home accommodates. We were told that the wet room facility has not been completed as the work undertaken was unsuitable and new contractors are to be employed. The fences in the garden are missing which makes the garden insecure. There are bushes on the other side and a building site so this area is unsafe for people to use. We discussed issues with the manager and recommend that a full environmental audit be undertaken for all rooms and the grounds and an action plan, with timescales, put in place. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient qualified, competent staff to meet the residents needs. Recruitment procedures are generally robust and staff training has improved to give staff the knowledge and skills to enhance their roles. Evidence: The registered manager has left since the last inspection and there have been several staffing changes in the home. An RGN is now acting manager working alongside a facilities manager responsible for the housekeeping, catering and maintenance aspects of the home Induction training is in line with the skills for care standards. The person responsible for training has gone, a new maintenance man is due to commence work when the CRB check is back, a new chef has been employed and there is a new administrator in post. Agency staff have been employed when required. Five care staff and an RGN were seen on duty on the floor during this inspection (The manager was supposed to be working on the floor). Staff told us there are usually enough staff around but staff surveys say that staffing levels are often poor especially at weekends and at night. Residents surveys say that staff are available when needed. Care staff work 12hour shifts, i.e. 0800 to 2000 and 2000 to 0800. The manager told us that by day there are usually 5 or 6 carers and 2 nurses and by night there are Care Homes for Older People Page 23 of 31 Evidence: usually 2 or 3 carers and 1 nurse. The recruitment system is non discriminatory and based on equal opportunities. Five staff files were inspected and were generally satisfactory with a completed application form that includes work history and medical declaration, two written references and a copy of a Criminal Records Bureau check (CRB) / Protection of Vulnerable Adults check (POVA) disclosure. However when staff have been promoted there is no evidence of an application for the post that an interview has taken place or that a repeat CRB and POVA check has been carried out. One member of staff was promoted but has returned to a job in a lower position than previously. There was no evidence of protection of the previous post or that this was by choice. Photographs were missing on four files. One application form showed a gap in employment but there was no evidence that the reasons had been discussed. Two peoples files showed they had resigned from the home but were now working in the home. There was no evidence that they had applied for a job, were interviewed or that references and relevant checks had been carried out. The induction training programme is in line with the skills for care standards and some evidence of induction was seen in the staff files. One member of staff told us there was no induction or fire training but their previous employer had provided moving and handling training. We were told that care staff have the opportunity to complete a National Vocational Qualification (NVQ) in care. The AQAA states that 50 of care staff are qualified to at least NVQ level 2 in care and there was evidence in the files to show that people have NVQ qualifications or are working towards them. Training records were examined and found overall to be good. A large amount of staff training has been delivered internally and there is a training file that shows who has attended individual sessions. All staff have attended moving and handling, fire, infection control, health and safety, food hygiene and hazardous substances training in 2008. Twenty-one staff out of thirty-four have completed abuse and dementia training and twenty-three have done challenging behaviour training. Staff surveys say that using the Mulberry House system all the time is not as good as having training with a trainer. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements for home have lacked stability for some considerable time; a registered manager is required for the improvement and continuity of systems and to provide leadership for the staff. Better systems have been put in place, or are being developed, so residents can have a good quality of life and be assured that they live in, and staff work in, a safe environment. Evidence: The registered manager resigned in August 2008 and the post is to be advertised. A nurse has been acting manager since 16 October 2008. She is a Registered General Nurse with some experience of working with people with dementia and some management experience. A facilities manager has been employed and is responsible for housekeeping, catering and maintenance. There is a quality assurance policy in place, which needs to be updated. There is no formal quality assurance system in place but the manager said she would be Care Homes for Older People Page 25 of 31 Evidence: implementing one. Staff meeting minutes were seen in a file, the last trained staff meeting was seven months ago and the last carers meeting a few weeks ago. No resident / family meetings have been held since the last inspection. It is recommended again that an annual development plan be produced. The operations director compiles reports in line with regulation 26 but the last one in the file was dated April 2008, the last one received by the Commission was dated September 2008. These reports should be undertaken monthly with a report kept in the home and a copy sent to the Commission. The home provided an Annual Quality Assurance Assessment (AQAA) prior to this inspection although it lacked detail the information provided was supported by evidence seen in the home. We were told that none of the people using the service control their own money, a member of their family or a representative deals with it. The home holds personal money for some people so that they have access to cash to buy personal items. It is held in separate pockets in the safe, the monies checked were correct with the records. There is an audit sheet for each person and two people sign the transactions. A receipt is kept for all purchases and numbered for audit purposes. There is a policy in place for the safeguarding of peoples money and it needs reviewing to detail what the home actually does not what it should do. It also needs to be updated as to who holds the safe keys and the out of hours arrangements. There was evidence in one staff file that an appraisal took place earlier this year. Supervision records were not seen for any of the staff whose files were examined. This was discussed with the manager who will implement a suitable system to support and develop the staff. There is evidence that appropriate health and safety precautions are in place. The accident records were inspected and the number of falls have increased since August 2008. This is mainly due to one person falling and the manager said they are addressing this. The monthly accident audit book has not been updated since June 2008, the manager was advised to continue the audits. Machinery and equipment service checks are undertaken regularly with certificates kept. We were told that the small appliance testing was in progress. At the last inspection we were told that fly screens have been purchased for the kitchen, they have not yet been fitted, net curtaining has been attached to one window. Statutory training for staff has been brought up to date since the last inspection. Care Homes for Older People Page 26 of 31 Care Homes for Older People Page 27 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 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 Care plans should be further reviewed to ensure they are person centred but also give good direction to staff on the specific care to be provided. Risk assessments should be carried out and included in the care files for people using any form of restraint, this will help to ensure that people are safeguarded. The door in the sea view lounge leading to concrete steps and an external fire door should be risk assessed to ensure that people are not at risk of accidents or absconding. The registered provider should undertake a thorough environmental audit of the home and grounds with an action plan developed for improvements to commence. This will ensure that the home is a more pleasant place to live and work in. The registered provider should ensure that the wet room facility is completed and that other bathing and showering facilities, are reviewed and upgraded where necessary. This will ensure the needs of elderly frail people are met A suitable manager should be employed and registered with the Commission to ensure the improvement and continuity of systems and provide leadership for the staff. An annual development plan should be developed to Page 29 of 31 2 7 3 19 4 19 5 21 6 31 7 33 Care Homes for Older People indicate what the home intends to improve over the next year 8 36 The registered person should ensure that care staff receive formal staff supervision at least six times a year- as outlined in National Minimum Standard 36 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. 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