Inspection on 18/02/09 for Country Court

This inspection was carried out on 18th February 2009.

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

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

Other inspections for this house

Country Court 12/05/09

Country Court 16/11/06

Country Court 06/02/06

Country Court 17/10/05

Country Court 10/02/05

Country Court 29/10/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Country Court Southcoates Lane Hull East Yorkshire HU9 3TQ     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: Beverly Hill     Date: 1 8 0 2 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: Country Court Southcoates Lane Hull East Yorkshire HU9 3TQ 01482702750 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : countrycourt2005@yahoo.co.uk Pearl Dusk Limited care home 34 Number of places (if applicable): Under 65 Over 65 34 34 dementia old age, not falling within any other category Additional conditions: 0 0 Exception statement - permitted to provide care for one named person under pensionable age. Date of last inspection Brief description of the care home Country Court is purpose built building, which provides care for up to thirty-four older people, who may also have dementia. The home is situated to the East of the city of Hull, with shops, health facilities, community services and public transport all easily accessible. All accommodation is on the ground floor with all rooms providing single accommodation. Nine rooms have en-suite facilities. The home has three bathrooms and one shower room. There is a large lounge, a dining room and a small conservatory. A additional quiet lounge also has a small conservatory attached. An inner courtyard is available and accessible for residents to use should they wish to sit outdoors. A small car park is available at the front of the home. Care Homes for Older People Page 4 of 32 Brief description of the care home According to information in the homes Annual Quality Assurance Assessment document, the weekly fees are 348.50 pounds to 391.50 pounds. There is no top-up fee. Optional extras include chiropody, hairdressing, newspapers and toiletries. 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating form this service is 1 star. This means that the people that use this service experience adequate quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key unannounced inspection on 16th November 2006 and Annual Service Review on 12th December 2007. It includes information gathered during a site visit to the home, which took approximately nine hours. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Country Court. We also had discussions with a proprietor, the registered manager and staff members. Information was also obtained from surveys received Care Homes for Older People Page 6 of 32 from residents and care staff. Comments from the discussions and surveys have been used in the report. We looked at assessments of need made before people were admitted to the home and the homes care plans to see how those needs were met whilst they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff recruitment, induction, training and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out staffs understanding of how to maintain privacy, dignity, independence and choice. The home had returned their Annual Quality Assurance Assessment (AQAA) within the agreed timescales. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. We would like to thank the people that live in Country Court, the staff team, and management for their hospitality during the visit and also thank the people who completed surveys and had discussions with us. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward as recommendations, but only when it is considered that people who use the service are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: Staff formulate care plans for people that detail their assessed needs but they could make these even more individual to reflect wishes and preferences in the way they want to be cared for. Care needs to be made when writing daily reports so that descriptions of particular behaviours are made rather than subjective comments. Some residents have behaviours that are challenging to others. These should be clearly Care Homes for Older People Page 8 of 32 identified in plans with guidance for staff so there is a consistent approach to managing them. There are also some areas of risk management that need improving so care is not missed. Bed rails risk assessments need to be more comprehensive and checks need to be made on the rails themselves. Some areas of medication had significant shortfalls, mainly in the recording, and for one resident in the administration, of controlled drugs. Staff need to follow medication policies and procedures more thoroughly. The home was clean and tidy but there were lots of notices around directing staff and reminding them to do things. This detracted from the homeliness of the home and they could be placed in the staff room. Mandatory training was organised but there was little training in conditions affecting older people. Training in areas such as dementia care, diabetes, strokes and Parkinsons disease would ensure staff had a more comprehensive range of skills and knowledge in caring for older people. Staff recruitment lacked specific checks necessary for safe working practices. The manager had lots of experience and was progressing with her Registered Managers Award. This had been ongoing for some time and should be completed as soon as possible. Although the home had a quality assurance system some sections needed closer attention to ensure a robust system of self audit was in place. This was particularly important in the areas of recruitment, medication and accident auditing. 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 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. The home ensured that peoples needs were assessed prior to admission. Staff supported people in the decision to look around prior to admission, and to have trial visits to sample the services the home has to offer before deciding on permanent residency. Evidence: We examined four care files during the visit and all contained assessments of need completed by the home prior to the persons admission. The home used a system called, standex, which had pre-admission assessment forms and further assessment forms to be completed after admission. This actually made more work for staff and the one full assessment section could be used prior to admission and further details completed in it later. The assessment documentation covered all aspects of health, personal, social and psychological care needs. Each of the assessments examined detailed the planned admission date. The main, more detailed assessments were Care Homes for Older People Page 11 of 32 Evidence: completed in each case during the first few weeks of admission as more information became available. The home also obtained assessments completed by care management for people funded by the local authority. The assessment process enabled staff to be sure the persons needs could be met in the home. People were able to have trial visits and respite stays when vacancies allowed to enable them to sample the home before a decision about permanent residency was made. People had the initial opportunity to look around the home and some comments from residents were, I came to look around before moving in - I liked what I saw and moved in and my family came to look around for me and chose the home. The home does not provide intermediate care so standard 6 is not applicable. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples general health and personal care needs are planned for and met, however, there are gaps in risk management and clear guidance for staff in how to manage behaviours that are challenging. This could lead to care being missed. There were also gaps in the management of medication, which had led to one person not receiving important medication as prescribed and several recording issues. Evidence: We examined four care files during the day and they contained a wealth of information on which to formulate plans of care. Generally the care plans contained peoples assessed needs and gave guidance to staff on how to meet them. To improve, the plans could be more individualised to include more detail about personal preferences, how the person likes to be supported and what the person is able to do for themselves. Care plans had been signed and dated by the person formulating the plan but there was no evidence that residents had seen and agreed to the contents. Care Homes for Older People Page 13 of 32 Evidence: Daily recording in two of the care files highlighted that the residents had behaviours that could be challenging but there were no plans of care to give staff guidance in how to manage the behaviours in a consistent way. Other recording was inconsistent and in two residents files there were subjective comments from staff. For example, some staff used the term, nasty after an entry about personal care support. It highlighted a lack of understanding regarding dementia care and would be more helpful for staff to record the behaviour and how they have communicated their needs rather than assume the resident is being, nasty towards them. A good behaviour management plan would be able to identify triggers and help staff provide care and support using consistent approaches. Charts to monitor food and fluid, and pressure relief were in place. There were risk assessments for a range of activities and occurrences but some were of minor issues that should be provided for in care plans whereas other more important risks had been omitted. For example, one person had risk assessments for the use of a hearing aid and for wearing glasses but they lacked a risk assessment for behaviours that were challenging for staff and for their nutritional intake. Other risk assessments were for moving and handling, falls, skin tears, wheelchair use and wandering out of the building. The risk assessment used for the management of bed rails was insufficient and written guidance on the safe use of bedrails was provided to the manager and proprietor. It was clear that residents had access to a range of health professionals for treatment and advice. These included GPs, district nurses, chiropodists, opticians, out patient appointments and emergency care practitioners for any falls or incidents in the home requiring emergency treatment. People who were able to weight bear could be weighed in the home but as there were no sitting scales this was limited. This is important and alternative arrangements for monitoring people at risk of fluctuating weight must be put in place if this situation is to continue. One persons file indicated they had lost two and a half stone in two years but they had not been weighed in the last three months due to mobility issues. This must be checked out and was mentioned to the manager. People spoken with were happy with their care and stated they thought their health care needs were met. Five surveys from residents indicated they received the care and support they required, always and five stated this was, usually. Seven stated they received medical support, always, two said, usually and one stated this was, sometimes. People said staff were always willing to help and their privacy and dignity were respected. There were some areas of medication management that required attention - controlled Care Homes for Older People Page 14 of 32 Evidence: drugs (CDs) in particular. One resident was prescribed painkilling patches every 72 hours but on three occasions they had not received these as prescribed. One dose had been missed until the following day and instead of contacting the prescriber for advice, staff had administered the patch and the next dose was administered after 48 hours instead of the prescribed 72 hours. There was also a discrepancy between the actual amount of patches stored in the CD cupboard and the amount recorded in the CD book. When checking the CD book against the medication administration record (MAR) it was clear that a dose had been omitted but signed as being administered on the MAR. It is very important that people receive their medication as prescribed. Medication was stored appropriately although it is recommended that the low dose Oromorph Liquid be stored and recorded as a CD for good practice rather than maintained with mainstream medication. There were several recording issues in the CD book. For example in one instance the name of the medication had been omitted from the top of the page, lots of entries of only one staff signature when there must be two, returns to the pharmacist not signed by them on receipt and an entry that clearly showed staff were not following policies and procedures regarding administration. Other recording and practice issues were that the date on time limited medicines such as eye drops must be written on the bottle, two signatures were required for all handwritten entries onto the medication administration record, and risk assessments and care plans should be in place for residents who are able to, and choose to, selfmedicate all or part of their medication. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensured that people had a good quality of life by providing opportunities for social stimulation, encouraging contact with friends and relatives and by the provision of nutritious meals. Evidence: People spoken with on the day were happy with their home and told us that routines were flexible and visitors encouraged and welcomed. There were plenty of activities arranged and outings to local facilities. In surveys received from residents people confirmed there were activities available and they had a choice whether to participate or not. Comments were, there is always something going on, mam likes to join in, there are lots of things arranged but I choose not to join in, I am very happy here, my visitors can come anytime, I am very contented, I like watching television in my room and my relatives come three or four times a week and Ive been out to Bridlington and East Park. Activities were planned and recorded in individual care files with the staff member involved. These included clothes parties, visiting entertainers, craft work, ball games, skittles, bingo, reminiscence therapy, sing-a-longs, church services and games. In warmer weather the staff ensure that people get out and about and there were records of picnics, visits to the coast and BBQs. The home had also Care Homes for Older People Page 16 of 32 Evidence: put on a, home front day, which consisted of a film, nostalgic sounds, memory lane bingo and a 1940s sing-a-long. There was evidence that people were able to make choices about aspects of their lives, for example bedrooms were very personalised and people had brought in their own small pieces of furniture from home. Some people had their own fridges and telephones in their bedroom and some chose to have a small pet such a budgie. Some people managed a part of their medication such as inhalers and when able, some managed their own finances. People told us there was no set time for rising or retiring. In discussion staff were clear about how they tried to ensure people made choices, we ask them how they like things to be done and we all have our own ways, its about getting to know peoples ways and respecting choice and preference. People were happy with the food provided. Comments were, the food is very good, the foods great, we can have a cup of tea anytime and we are well fed. One persons appetite had waned recently and she told us, the staff went out to get me fish, chips and mushy peas the other night and I really enjoyed it. All ten surveys from residents stated they liked the meals either always or usually. Catering staff had been awarded an, A for safe food management in the Local Authoritys, scores on the doors assessment system and had also gained a, Healthy Heartbeat Award. Menus rotated over a four-week period and alternatives were available to the main meal provided. Catering staff have information on likes and dislikes and special diets are catered for. Care Homes for Older People Page 17 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. The home provided an environment where people felt able to complain and were protected from abuse by staff training and adherance to policies and procedures. Evidence: The home had a complaints policy and procedure that was on display and the manager maintained a folder of complaints reports. When checked these were of a minor nature and were investigated and resolved appropriately. The form used to record complaints and outcomes could detail that the complainant was satisfied via a space for their signature. The Commission had not received any complaints since the last inspection. Staff spoken with knew what to do if people raised any complaints with them and residents were very satisfied with their care. Those spoken with on the day confirmed they felt able to complain. They mentioned staff by name as the people they would go to if unhappy about anything. All ten surveys received from residents indicated they knew how to complain. The home used the multi-agency policy and procedure for safeguarding adults from abuse. Staff were knowledgeable in discussions and were able to tell us exactly what they would do should they witness any incidents that concerned them. According to training information nine staff had completed comprehensive safeguarding training Care Homes for Older People Page 18 of 32 Evidence: with the local authority and others were included in plans to complete the training. Safeguarding adults from abuse is also discussed during the induction process and covered as part of national vocational training. The manager had received training facilitated by the local authority and the proprietors had knowledge of the procedures. It is important that ancillary staff as well as care staff complete safeguarding training. Residents stated they were happy and well cared for, and felt safe in the home. Care Homes for Older People Page 19 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. The home provided a clean and homely environment for people. Evidence: The home was clean and tidy and free from any malodours. Communal areas consisted of a dining room set out with individual tables and chairs, which led into the main lounge. There was a small conservatory attached, sufficient for four to five easy chairs. The conservatory also had two dining tables and chairs which made the room look a little cramped and it was noted during a moving and handling task that staff struggled in the confined space and the residents all had to move their feet as staff pushed the wheelchair past them. The problem may be helped by re-siting the tables length ways against one of the walls to give a wider walkway. This was suggested to the manager to try. In addition the home had a quiet lounge used for activities or for people to see their relatives. Communal rooms were nicely furnished and decorated in a homely style. The home had three bathrooms and one shower room, all appropriate for the residents needs. The home had thirty-four bedrooms, all of which were single occupancy. Nine of the bedrooms had en-suite facilities. Those bedrooms checked were clean and tidy and Care Homes for Older People Page 20 of 32 Evidence: personalised to varying degrees. Residents spoken with and surveys received from them, all indicated they were happy with their home. Comments were, I wouldnt like to be anywhere else, this is my home, I couldnt wish for a better place, the staff are always cleaning and its always clean. It was noted that there was an excessive amount of notices around the home, which were not just for information for the residents but were reminders for staff to do tasks etc. It would make for a more homely appearance if the notices were minimised to essential information on display and staff information placed in the staff office. Care Homes for Older People Page 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were supported by friendly and caring staff but gaps in the recruitment system and training means full knowledge about staff is not known prior to the start of employment and care staff may not be fully equipped with all the skills they require to care for people, especially those with dementia. Evidence: Discussion with staff members and examination of rotas showed that there was five staff on duty during the day and two at night with an on-call system should extra staff be required in emergencies. The manager was supernumerary and the two deputy managers had time built into their week for supervisory duties. Residents spoken with were very complimentary about the staff team, the staff are always there when you need them, the staff look after me very well, I settled straight away - I am very content, the staff are smashing and the staff are very nice. Staff members spoken with stated they tried to spend at least twenty minutes quality time with each resident each shift. They stated how much they enjoyed working at the home and how well the team as a whole got on with each other. In surveys staff also spoke of trying to ensure the home remains a homely and friendly place for residents and their relatives. Care Homes for Older People Page 22 of 32 Evidence: The home had a staff training plan that included mandatory and some service specific training. All care staff had completed moving and handling and first aid and fire safety training was generally up to date. All catering staff had completed basic food hygiene, the staff administering medication had been assessed as competent and nine staff had completed training with the local authority in safeguarding adults from abuse. There were some gaps in infection control and health and safety training. The manager and deputy manager had completed awareness training in mental capacity legislation and deprivation of liberty, which needs to be cascaded to other staff. There was no evidence that staff completed training in the conditions affecting older people, for example, strokes, diabetes, Parkinsons disease and sensory loss, and only two staff had completed dementia care training. Seven out of twenty-six care staff had completed national vocational qualification in care at level 2 or 3, which equates to 21 percent. The home needs to aim for 50 percent. Staff recruitment files were checked for four people recruited since the last inspection. The files showed that application forms were completed and staff went through an interview process. However, the checks required for the recruitment process had not been completed fully. One of the files did not have any references and one file only had one reference. None had povafirst checks against the protection of vulnerable adults register. This is a requirement if starting staff in employment (in exceptional circumstances only) prior to the return of the criminal record bureau check, which had been the case in three of the files examined. Only one staff file had a photograph, which was a passport photo, and only one had completed a health declaration. The homes recruitment process must be improved to ensure full pre-employment checks are made on all staff. This will ensure only appropriate staff care for and support vulnerable people living in the home. Care Homes for Older People Page 23 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. Generally the home is well managed, although to further enhance residents welfare, improvements are needed in some management systems such as recruitment practices, bed rail risk management and medication. Evidence: The registered manager has many years experience of managing a care home and has completed training in mental capacity legislation during the last year. She is supported with particular management tasks, such as recruitment and finances, by the proprietors, who have offices within the building. She is still progressing with her Registered Managers Award. This needs to be completed quickly, as it has been ongoing for some years. Staff and residents spoken with stated they had the opportunity to speak with the manager when they needed to and most residents knew her name. She found time to walk around the home daily making herself available. Comments from staff about the Care Homes for Older People Page 24 of 32 Evidence: manager were, shes brilliant, fair and flexible manager, she sorts out problems and we can go and see the manager anytime to discuss worries or problems. There is good communcation systems between the manager and the staff team and the manager confirmed they often sat in on shift handovers to ensure they were aware of issues and were able to follow them up. Staff stated they felt supported by the manager and received formal supervision every two months. The supervision system was good and documentation confirmed clear records were maintained. The home had a quality assurance system in place that consisted of weekly and monthly systems checks, and questionnaires to residents, relatives and staff. Any shortfalls from the audits and questionnaires are collated and dealt with, and the deputy manager has overall responsibility for seeing the system through. Newsletters are produced to keep people informed of events and staff and residents committee meetings are held at various intervals in the year. It is recommended that bed rail checks, accident auditing and staff recruitment audits are built into the system and the views of professional visitors obtained. Closer attention should be paid to the auditing of medication in view of inspection findings. The residents families tended to manage finances but a small amount of personal allowance was held in the home for most people. Individual records were maintained and receipts obtained for purchases. Expenditure tended to be for hairdressing, chiropody, local shopping and the tuck shop available in the home and managed by staff. Some residents manage their own personal allowance and have lockable facilities in their bedrooms to keep personal items safe. Fund raising was carried out throughout the year to top up the, residents fund, which enabled expenditure on entertainment, outings, cards and flowers for people, and nail products for manicures etc. Generally the home was a safe place for people to live in and staff to work in. Equipment was maintained and serviced, and fire alarm checks and drills were completed. Risk assessments were completed, although the bed rail risk assessment was not thorough and did not fully reflect health and safety guidance. This was discussed with the manager and proprietor and information on bed rail safety left with them. A visual check on the bed rails needs to be completed at each use and a maintenance check needs to be built into the environmental audit system. The laundry room needs to be locked when not in use and hot water signs need to be displayed for staff in both the laundry and the sluice room. Care Homes for Older People Page 25 of 32 Care Homes for Older People Page 26 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 27 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 8 13 Risk assessments must fully 30/04/2009 reflect the identified risk and behaviour management plans must be in place to manage any behaviours that can be challenging to the resident or to others. This will ensure that staff are aware of how to minimise risks and have clear guidance in how to support people in a consistent way. 2 9 13 Staff must ensure that resdents receive medication as prescribed. This is to ensure the health and welbeing of residents and to ensure the prescribers instructions are followed. 31/03/2009 3 29 19 Full staff employment checks, including povafirst checks and two written references must be in place 31/03/2009 Care Homes for Older People Page 28 of 32 prior to the start of staff working in the home. This will help to ensure only appropriate people are employed to work with vulnerable adults and help to safeguard them from abuse. 4 30 18 Staff must be trained to 30/09/2009 meet the increasing needs of residents in the home in areas such as dementia care and conditions affecting older people. This will ensure that staff have the skills and knowledge to care and support people with a range of needs. 5 38 13 Risk assessments for the 31/03/2009 use of bed rails must be completed thoroughly in line with health and safety guidelines. This will ensure the actual need for a bed rail has been assessed and ensure the correct match between the resident, bed, mattress and bed rail. This will help to avoid any unsafe fittings and prevent accidents. 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 personalised more thoroughly. This Page 29 of 32 Care Homes for Older People will ensure staff have full knowledge of peoples wishes and preferences. 2 8 Staff should find alternative means of monitoring fluctuations in residents weight if sitting scales are not available and they are unable to use standing scales. The date of opening time-limited medication should be clearly marked on the item. Staff should ensure there are two signatures when transcribing information onto the medication administration record. This is to aid a checking system and to avoid mistakes. Care staff should improve the recording of medication in the controlled drugs book and follow medication policies and procedures more fully. Oromorph liquid should be stored and recorded as a controlled drug for good practice. The homes complaint form should detail complainant satisfaction to evidence that complaints have been fully resolved. Ancillary staff should also complete safeguarding of adults training to ensure they have appropriate knowledge of how to make alerts if they witness anything that concerns them. It is recommended that the dining tables in the conservatory be re-positioned to allow for a wider walkway when using wheelchairs. It is recommended that the excessive amount of notices in the communal areas and bedrooms be reviewed so as not to detract from the homely environment. The home should continue to work towards 50 percent of care staff trained to NVQ level 2 or 3 in care. The registered manager should complete her Registered Managers Award quickly to fulfill the training requirements of managers highlighted in standard 31 of the care homes regulations. Closer attention should be paid to auditing systems such as recruitment and medication in view of inspection findings. This will enable the home to identify shortfalls quickly and ensure safe practice. Professional visitors to the home should be included in any questionnaires This will enable a more complete range of views regarding the services the home provides. Bed rail maintenance checks and auditing of accidents should be completed to ensure any issues can be identified Page 30 of 32 3 4 9 9 5 9 6 7 9 16 8 18 9 19 10 19 11 12 28 31 13 33 14 33 15 38 Care Homes for Older People quickly and referred to the appropriate professionals. 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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