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Inspection on 08/12/08 for Deerwood Grange Nursing Home

Also see our care home review for Deerwood Grange Nursing Home for more information

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Relatives spoken to made positive comments about the home and the care that their relatives receive. Relatives said the staff are very good and they have no complaints. Health professionals are involved in the care of individuals and people have regular health check ups. This helps to ensure their health needs are met. People are supported to keep in touch with their family and friends so they can maintain relationships that are important to them. Relatives said that they can visit at any time and are always made welcome. Staff were observed to ask relatives if they wanted to assist their relative with eating so helping them to continue to be involved in their care. The presentation, quality and taste of the food are good making the meal times more appetising and enjoyable for the people living there. The home is generally well maintained, decorated and clean so it is a safe and comfortable place to live. Staff have infection control training, which ensures that good hygiene standards are maintained and the risk of people living there getting an infection is reduced. Staff keep good records about people`s medication so to ensure that people receive the correct levels of their medicine to meet their health needs.

What has improved since the last inspection?

Care plans had improved so that they included more information about the choices and preferences of the people living there so staff know how to support them to meet their individual needs. Evidence that satisfactory pre employment checks are completed on all staff before they start working at the home was available so that the people living there are protected from harm. Action was taken to ensure that the risks of there being a fire are minimised as much as possible. The statement of purpose and service users guide included the relevant and required information. This ensures that prospective service users have all the information they need to make a choice about whether or not they want to live there. Preadmission assessments included enough detail so that the home can be sure that the person`s needs can be met there. The complaints log recorded the outcome of complaints made to show that people`s views are being listened to and action is taken to resolve any complaints.Staff are aware of the different types of abuse and how to report it. This will help to make sure that all the people living there are protected from harm.

What the care home could do better:

There should be more improvements to care plans so that they describe how all the care needs of the people living there are to be met. This will ensure that staff know how to support each person to meet their needs. All the people who live there should be weighed regularly to reduce the risks of them being malnourished. The medication policy should be updated to include all areas of how to ensure that people`s medication is safely stored and given to them when needed. Staff must communicate with the people living there so helping to respect their privacy and dignity and ensure their well being. People should be supported in the right way at mealtimes so helping them to be as independent as possible. Clearer records of food eaten by each person should be kept to ensure they have a varied, nutritious diet and the foods they like to ensure their health and well being. Further redecoration should be done to make sure the home is safe and comfortable for the people living there. All staff should have the training and support they need so they know how to support the people living there to meet their needs and ensure their well being. A representative of the provider should visit every month to make sure the home is meeting the standards. From this an action plan should be written to improve the home for the people living there. There must be regular fire drills so the people living there and staff can practice what to do if there is a fire. People must be moved safely to avoid risk of injury to them and to staff.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Deerwood Grange Nursing Home 22 Wentworth Road Four Oaks Sutton Coldfield West Midlands B74 2SD     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: Sarah Bennett     Date: 0 8 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 30 Information about the care home Name of care home: Address: Deerwood Grange Nursing Home 22 Wentworth Road Four Oaks Sutton Coldfield West Midlands B74 2SD 01213550060 F/P01213550060 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Carol Mann Type of registration: Number of places registered: BAMH (MIND) care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 23 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 23 Mental disorder, excluding learning disability or dementia (MD) 23 Date of last inspection Brief description of the care home Deerwood Grange is a large detached adapted nursing home in the Four Oaks conservation area of Birmingham. The home is approached from a driveway, and is set back from the main road. To the rear of the building are large gardens, which are utilised by the people living there in good weather. The building work to extend the home has provided most people with single bedrooms apart from one that is shared. Care Homes for Older People Page 4 of 30 Over 65 0 0 23 23 Brief description of the care home There are two large lounge areas, and a large dining room. The extension has also provided a new laundry, a disabled toilet and down stairs shower room. The upstairs bathroom has been converted into a new shower room. There is a new staircase to access the first floor of the extension, access to the first floor using the passenger lift is via the original building. The home provides nursing care to people over the age of sixty-five with a diagnosis of dementia and/or mental health issues. The home is staffed 24 hours a day and there is always a qualified nurse on duty. Care Homes for Older People Page 5 of 30 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 for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The visit was carried out over one day by two inspectors. The home did not know we were going to visit. This was the homes key inspection for the inspection year 2008 to 2009. The last key inspection was in March 2008. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Care Homes for Older People Page 6 of 30 Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and the manager completed a questionnaire about the home the Annual Quality Assurance Assessment. This gives their view about how the home is meeting the needs of the people who live there. Four people who live in the home were case tracked. This involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. The people who live at the home, their relatives, the manager and the staff on duty were spoken to. Due to the needs of the people living many were unable to verbally communicate their views about the home. Time was spent observing care practices, interactions and support from staff using the Short Observational Framework for Inspection tool. A partial tour of the premises took place. Care, staff and health and safety records were looked at. The service users guide stated that the fees charged to live there range from 479 to 614 pounds per week. A copy of the last inspection report is available on request from the manager or staff. Due to the needs of the people living there this is not displayed in the home. What the care home does well: What has improved since the last inspection? Care plans had improved so that they included more information about the choices and preferences of the people living there so staff know how to support them to meet their individual needs. Evidence that satisfactory pre employment checks are completed on all staff before they start working at the home was available so that the people living there are protected from harm. Action was taken to ensure that the risks of there being a fire are minimised as much as possible. The statement of purpose and service users guide included the relevant and required information. This ensures that prospective service users have all the information they need to make a choice about whether or not they want to live there. Preadmission assessments included enough detail so that the home can be sure that the person’s needs can be met there. The complaints log recorded the outcome of complaints made to show that people’s views are being listened to and action is taken to resolve any complaints. Care Homes for Older People Page 8 of 30 Staff are aware of the different types of abuse and how to report it. This will help to make sure that all the people living there are protected from harm. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 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 30 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. Arrangements are in place so that people can be confident their needs will be met on admission. Evidence: Since the last inspection the welcome pack had been updated so that people have the information they need about the home. It was printed on yellow paper with black print in a size large enough so that it was more accessible to people who have dementia. The fees charged to live there were stated. The statement of purpose included all the information that prospective service users would need so they can make a choice as to whether or not they want to live there and the home can meet their needs. The AQAA stated that an assessment is completed before a person moves into the home to ensure that their needs can be met there. The records of one person who had recently moved in were looked at. These included a detailed assessment that was completed before the person moved in. From the assessment their care plan was developed so Care Homes for Older People Page 11 of 30 Evidence: that staff would know how to suport them. The home does not provide intermediate care. Therefore, standard 6 that relates to this was not assessed at this inspection. Care Homes for Older People Page 12 of 30 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. Arrangements are not always sufficient to ensure that individuals health needs are met, which could impact on their well being. Evidence: The records of four of the people who live there were looked at. These included an individual care plan that detailed how staff are to support the individual to meet their needs. These had improved since the last inspection in that they included more detail. They also included how staff were to support the person to meet their social, leisure, religious and cultural needs. Each person had a life history document that they and their family had helped to complete. This gave staff more information so they can understand more about the person so helping to know how to support them. One persons records stated that they had epilepsy but there was not a care plan for this so that staff knew how to support them.Care plans had been reviewed each month and updated where needed so that staff know how to meet the current needs of the person. Care plans included individual risk assessments. These stated how staff were to Care Homes for Older People Page 13 of 30 Evidence: support the individual to take risks where these were of benefit to the person but helping them to be as safe as possible. Some risk assessments needed more detail to ensure the person, other people living there and staff were safe. For example one record stated the person can be violent and aggressive but it stated there were no risks so no assessment was completed. There are potential risks if a person can be violent and aggressive and these should be assessed so that staff know how to manage this behaviour and reduce risks. Records showed that people were generally weighed regularly and if they refused this this was recorded. One person had been weighed until June this year, then it stated that they were too frail. They had lost 6 kilogrammes in the first six months of the year. Where people are too frail to be weighed the circumference of their arm should be measured. This can indicate weight loss, which could be an indicator of an underlying health need. The manager said this should have been done but there was no record that it had been. this could put the person at risk of malnutrition. The manager said they had recently purchased a nuritional screening tool that they were going to train staff in using which will help in ensuring that people are adequately nourished. Records showed that other health professionals are involved in the care of individuals. One person was unwell, staff were observed to respond quickly so that the person was made comfortable. The manager called the GP immediately for advice and passed this onto staff so they knew what to do to support the person. A local pharmacist supplies the medication to the home. Medication is stored in locked cabinets so that people are not at risk of getting medication that is not prescribed for them. The medication administration records of four people were looked at. These had been signed appropriately indicating that medication had been given as prescribed. A few weeks before it was reported to us that some medication had gone missing. The manager investigated this appropriately and the outcome of this was recorded. Action is being taken to reduce the risk of this happening again. One of these actions was that the medication policy developed by the organisation did not include what to do if medication goes missing. The manager has asked for this to be updated so that all staff can be aware of this helping to ensure that peoples medication is safe. Some medication is stored in a locked fridge. Staff test the temperature of this regularly to make sure that medication is stored at the right temperature so it is effective in meeting peoples health needs. Records showed that it was at the right temperature. Eyedrops were stored in the fridge for some people. These had not been dated when they were opened to ensure they are not used when they are no longer effective. The people living there were well dressed in individual styles that reflected their gender and personality. Attention had been paid to individuals personal care ensuring they were clean so raising their self esteem. Care plans stated how staff are to ensure that they respect the privacy and dignity of Care Homes for Older People Page 14 of 30 Evidence: the people who live there. Two staff on separate ocassions entered a persons bedroom without knocking on the door but just walked in using the key to unlock it. Despite care plans stating that staff are to treat each person as an adult staff were heard saying to people on a few ocassions that they were a good girl. This does not show that staff respect the privacy and dignity of the people living there. Care plans stated whether the person had the mental capacity to make decisions or whether they needed support from others in doing this. Care Homes for Older People Page 15 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all the people who live there are supported to experience a meaningful lifestyle of their choice, which could affect their well being. Evidence: Since the last inspection care plans have been written so that staff know how each person wants to spend their lesiure time and what activities they like doing. There are two activity workers employed so that people can have staff spend time with them doing activities. One activity worker was on duty during the day. They spent time with people talking to them, playing games and encouraging them to mobilise around the home. Records showed that people are supported to go out for walks to the local park and to have a drink and snack while they are out. The AQAA stated that all religious beliefs are respected. Records sampled showed that a church service is regularly held in the home that people can attend if they want to. We used the Short Observational Framework for Inspection tool during the morning. This involved observing for two hours five of the people who were sitting in the lounge and recording how often staff, other people, visitors and any animals interacted with the individual. Where interactions were noted from staff it was recorded whether these were good or poor and what affect these had on the persons well being. Eleven of the Care Homes for Older People Page 16 of 30 Evidence: interactions were assessed as being poor. On one occasion staff sat next to one person, the person looked at the staff, staff looked at the person but made no attempt to acknowledge or communicate with them. On another occasion staff were assisting people to have a drink while holding a conversation between themselves so ignoring the person they were assisting. In the two hours it was observed that there were very little interactions from staff with the people living there. It was noted for one person with whom staff interacted for up to half an hour of the two hours that their state of being was positive for only a very small amount of time. Staff were observed talking to each other while the people living there were trying to get their attention. Little interaction was observed between staff and the people living there at mealtimes apart from to say that they were having another mouthful of food or their meal was on the table. People are supported to keep in touch with their family and friends so they can maintain relationships that are important to them. Several relatives visited during the day. They said that they can visit at any time they want to. It was observed that staff encouraged relatives to take part in the persons care if they wanted to so they can feel they still have a part to play in caring for their relative. Relatives said that they look after the persons money and when they give money to the staff this is held securely and spent on personal items. Some people had bought personal possessions and furniture with them when they had moved into the home so making their room more homely. It was observed that people could choose when they had their breakfast and what they ate. The main meal of the day was served at lunchtime. There was not a choice of this. The meal was nutritious and included fresh vegetables. Where relatives wanted to they were encouraged to assit the person with their meal. One relative was not given a chair to sit on to assist until the manager came into the dining room about 20 minutes into the meal. So the relative had to stand over the person to assist them. People were given their meal and told it was there but not what it was. Given the needs of the people living there and some people have additional needs of visual impairment it is essential that staff communicate what the meal is. One person was given a lipped plate as stated in their care plan. This is to help them to load the food onto the spoon so they can eat independently. The plate was positioned round the wrong way so that the person could not load their spoon and had to use their fingers. Staff sat to assist people with their meal where needed. One person sat in the dining room for 30 minutes before staff came to assist them with their lunch. Their meal was liquidised as it should be to prevent them from choking. Staff did not explain to them what the meal was. There was little interaction observed between staff and the person while they were being assisted. Mealtimes are an opportunity for the person to experience some social interaction so they are not isolated but this was not evident either at lunchtime or during the evening meal. Staff now record what food people eat and how much. Records showed that generally Care Homes for Older People Page 17 of 30 Evidence: a varied and nutritious diet is offered although some records still stated Meal meaning they had what was provided and how much. This does not help to ensure that each person is receiving the nutrition they need. Care Homes for Older People Page 18 of 30 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. Arrangements are in place to ensure that the views of the people living there are listened to and they can be safeguarded from abuse. Evidence: The complaints procedure included the information that a person would need to make a complaint if they were unhappy. It needed updating with our new address so that people would be able to contact us if they wanted to. Each person had a copy of the complaints rocedure in their welcome pack when they moved into the home. The complaints log showed that the last complaint was made in March this year. The record showed that this had been responded to appropriately and action taken to make the necessary improvements. Thank you cards and compliments had been received from relatives and other professionals and these are kept to show a balance of all comments made about the service. Most of the staff have received training in safeguarding vulnerable adults. The manager said that in the next few weeks all staff would have had this training so they should know how to safeguard the people living there from abuse. The AQAA stated that and training records showed that staff have received training in the Mental Capacity Act so they are aware of the implications of this legislation for the people living there. This Act came into force in April 2007 and requires an assessment of the persons capacity to ensure they are able to make a decision about their heath and welfare. If they are assessed as not being able to an Independent Mental Capacity Care Homes for Older People Page 19 of 30 Evidence: Advocate can be appointed to help them with this so it is in their best interests. Care Homes for Older People Page 20 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further improvemnts are needed so that people live in a homely and comfortable environment that meets their individual needs. Evidence: The AQAA stated that some parts of the home had been redecorated. It was observed that the decoration in some rooms was worn and would benefit from further redecoration. Staff spoken with said the home could benefit from being freshened up. The larger lounge was quite bare with few objects that would make it look more homely. The TV in this room was not that big which could make it difficult for people with impaired vision to see clearly from the other side of the room. The AQAA stated and staff said that they are planning to create a reminscence room in the smaller lounge so that people can be comfortable and spend time remembering the things that are important to them. Since the last inspection signs have been put on the bath and shower room doors so that people know where these are. Signs with the persons name on have also been made for their bedroom door. These are accessible to people who have dementia so that it is easier for them to find their bedroom. People are able to wander freely about the shared areas of the home including the office as this is considered to be part of their home too. The front door of the home is locked not to deprive people of their liberty but to keep them safe from harm. Each person has an assessment stating what Care Homes for Older People Page 21 of 30 Evidence: support they need to go out of the home so they can do this safely. The light in one shower room was not working. Staff reported this immediately to maintenance staff so it could be repaired. In this shower room there was a portable fan. There was no socket in the room to plug it in but it could have got wet from the shower being used. Staff said that the shower room is not often used and was used for storage. The manager said that the fan would be disposed of so that people were not at risk of electrocution from using it. Since the last inspection one of the baths had been repaired so that people had more choice as to where they could have a bath. The adapted bath in the first floor bathroom is situated against the wall. This limits the space for staff to assist a person from either side of the bath so that not all people with a mobility impairment would be able to use it. When this bath is replaced the space and location of the bath should be considered. The bedrooms of five of the people who live there were looked at. Only one of these bedrooms contained several possessions making it very personalised. One persons records sampled stated that they like tactile things. Their records also stated that they pulled over furniture in their bedroom often during the night so disturbing other people. There were no tactile objects in their bedroom that might stimulate them and provide an alternative to pulling over furniture. Some of the furniture in bedrooms looked worn. Staff said that it would be better if this was replaced. There is only one shared bedroom and rails had been fitted so that people can have privacy. Staff said that when one person moves from that bedroom another person would not be admitted so that all rooms will be single. The home was clean and free from offensive odours so it was a pleasant to live in. The laundry is sited so that soiled laundry does not have to be taken through areas where food is prepared or stored. Staff have training in infection control so they know how to stop any infections spreading, which could put peoples health at risk. Care Homes for Older People Page 22 of 30 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. The arrangements for staffing, their support and development are variable, which could affect the well being of the people living there. Evidence: The manager said that there were no staff vacancies on days. Two night staff had recently been recruited to fill the vacant posts at night. A team of bank staff have been used to cover the vacancies so to provide consistency for the people who live there. When needed to cover staff sickness three agency staff are used who know the people living there. Staff spoken with said that there were sufficient staff on duty to meet the needs of the people living there particularly during the week when activity workers are also employed. The Deputy Manager who had worked there for 10 years had left the week before. One of the qualified staff was acting in the post until recruitment takes place. As stated earlier in this report observations showed that staff did not always interact with the people living there in a positive way. This needs to be improved to ensure that the needs of the people living there can be met. The AQAA stated that all but one of the care staff has National Vocational Qualification level 2 or above in Health and Social Care. This exceeds the standard that at least 50 per cent of staff have this qualification so they should have the skills and knowledge to meet the needs of the people living there. Care Homes for Older People Page 23 of 30 Evidence: The records of three of the staff who work there were looked at. These included the required recruitment records to ensure that suitable staff are employed to work with the people living there. This included a satisfactory Criminal Records Bureau check being completed before staff start working there. Evidence was seen that the qualified nurses are all currently registered with the Nursing and Midwifery Council indicating that they are fit to practice as a nurse. Staff who had recently started working at the home said they had a good induction and this was sufficient so they knew how to support the people living there. Records showed they had completed their induction. One staff said they had a mentor who helped them to know how to support people who live there. They said that all the staff were supportive if they were unsure of anything. They said they had been booked on other training so they would have the necessary skills and knowledge. The manager said and records showed that since the last inspection as recommended some staff had received training in daibetes. This should be provided for all staff. From sampling one persons records and from observations made it is evident that not all staff have sufficient knowledge to support people who have a visual impairment. The manager said that training in this was difficult to access but they would ensure that staff do have this. Care Homes for Older People Page 24 of 30 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. Arrangements do not always ensure that the health, safety and welfare of the people living there is promoted and protected which could impact on their well being. Evidence: The AQAA stated that the registered manager is a qualified nurse. She has achieved National Vocational Qualification Level 4 in care and the Registered Managers Award. The manager is currently doing the Leading in Dementia Care course at Stirling University. From this the manager is making improvements to signage and the environment so it is more accessible to the people who live there. Staff said that the manager is supportive. The manager said that every three years the organisation has a Quality Review and this was completed recently. The report of this was not yet available. Visits from a representative of the provider had not taken place at least once a month although these had been more regular recently. A representative should visit at least monthly and write a report of their visit. They should look at how the home is meeting the Care Homes for Older People Page 25 of 30 Evidence: National Minimum Standards and what it is like to live there. From this an action plan should be developed on how to improve the service for the people who live there. Staff records sampled showed that two of the three staff had formal supervision with the manager in October. There were no records of the other member of staff having supervision. The manager said that staff have supervision about every six weeks. She also does some clinical group supervision sessions with staff looking at how to meet the needs of individuals who live there and reflecting on the practice of staff. Staff said that they receive regular supervision and support and new staff have a mentor who supports them in their role. An Environmental Health Officer visited recently and the home was awarded a 4H status for hygiene practices. The Officer said that a high standard of cleanliness was noted. Fire records showed that the risk assessment had been reviewed since the last inspection. This detailed the actions to be taken to minimise the risks of there being a fire. An engineer regularly services the fire equipment so it is well maintained. Records showed that staff regularly test the fire equipment to make sure it is working. The last fire drill was in February this year. These should be at least every six months so that staff and the people living there can practice what to do if there is a fire. Previous records of fire drills included an audit of the drill so that any areas for improvement could be made. The last fire drill was not audited and there was not a record of how long it took to evacuate the building and who was involved in it. Records showed that equipment in the home is regularly serviced so it is well maintained and safe to use. Records showed that staff test the water temperatures regularly to make sure they are not too hot and people are not at risk of being scalded. Some people living there need assistance from staff to move around. Staff were observed throughout the day assisting people to move from their chairs to their wheelchairs and vice versa. Sometimes staff did not use the brakes on wheelchairs, which could put people at risk of injury as the wheelchair may move while the person is being transferred. Handling belts were provided, which support the person while being moved and reduce the risk of injury to them and to staff. These were not always used so that the risk of injury was increased. Care Homes for Older People Page 26 of 30 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 30 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 12 12 Staff must spend time interacting and communicating with the people who live there. To ensure the health and well being of the people who live there. 31/01/2009 2 38 13 The people living there must 10/01/2009 be moved safely. So reducing the risks of injury to them and the staff assisting them. 3 38 13 There must be regular fire drills. So that staff and the people living there can practice what they would do if there was a fire so reducing the risks to their safety. 10/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 30 1 7 Care plans and risk assessments should include all the needs of the individual so that staff know how to support them to meet these. All the people living there should be weighed regularly to ensure that if they are at risk of being malnourished action can be taken to ensure their well being. The medication policy should be updated to include all areas of how to ensure that peoples medication is safely stored and administered. Eyedrops should be dated when they are opened to ensure that they are not use past the date which they are effective, which could affect peoples well being. All staff should respect the privacy and dignity of the people who live there. Staff should support people appropriately at mealtimes so they can maintain as much of their independence as possible. Food records should clearly state what the person has eaten so it is clear whether or not they are receiving a nutritious diet. Alternatives to the main meal should be provided so that people have more choice and control over their lives. Some areas of the home should be redecorated to make it more homely and comfortable to live in. When the bath in the first floor bathroom is replaced the location and space should be considered so that all people can use this bath safely with assistance from staff as needed. All bedrooms should be personalised to reflect the tastes and interests of the individual. Furniture should be replaced where needed so that bedrooms are more comfortable. All staff should have training in how to support people who have a visual impairment to meet their needs. All staff should have training in diabetes so they know how to meet the needs of the people living there. A representative of the provider should visit the home every month and write a report of that visit. They should look at how the home is meeting the National Minimum Standards and what it is like to live there. From this improvements can be made to the service. 2 8 3 9 4 9 5 6 10 15 7 15 8 9 10 15 19 22 11 24 12 13 14 30 30 33 Care Homes for Older People Page 29 of 30 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 © (2008) 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. 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