Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 27/10/08 for Denham Manor Nursing Home

Also see our care home review for Denham Manor Nursing Home for more information

This inspection was carried out on 27th October 2008.

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

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

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

The care needs of potential residents are identified with them, prior to their move to the home, to ensure that they can be met. Residents have contracts, which describe the service that they should expect, and the responsibilities of both parties. Their funding arrangements are clear. The assessment document prompts staff to ask potential residents about their spiritual and cultural needs, which were recorded. Residents` healthcare and medication needs are met. Comments were made in the questionnaires to say that `my mother has never complained, she is always happy` and `all requests are considered`, `every effort is made to fulfill my needs`. There is good support from the local general practice and residents see the doctor or specialist nurse on a regular basis. Resident`s autonomy and lifestyles are respected and there are a wide variety of activities on offer to bring interest and diversion to their day. There is an enthusiastic activities coordinator who has worked with residents to identify their preferences and provides a lively programme of entertainment and outings on an individual and group basis. Residents were appreciative of this and one said `there are interesting activities which stimulate and entertain`. The environment is attractive and welcoming. The gardens are well maintained and there is access and seating areas for people who have disabilities. Residents said that the staff were kind and helpful, although `busy`.

What has improved since the last inspection?

The management of pressure damage has improved since the last inspection and no one had developed a pressure sore since they moved to the home. Medication management has improved and residents` medication is administered safely. There have been improvements to the bathrooms and further improvements to the environment to make the home a welcoming and attractive place for residents and their families. Meal times are better organised and the dining room is an attractive place in which to eat. Staff were observed to help residents discreetly. Recruitment procedures have improved and the necessary checks are undertaken before new staff start work.

What the care home could do better:

The home must ensure that residents who require a special diet for medical reasons receive this and that all staff are knowledgeable about the foods that they can eat safely. The menus should be reviewed with residents to ensure that a higher number of residents are satisfied with their meals and that they are aware that a choice is available.Complaints must be investigated and responded to within the timescales stipulated in the complaints policy. Records of all complaints must be kept at the home. The provider must agree and adhere to a realistic timetable to provide all residents, who require care in bed or support moving, with a height adjustable bed, to reduce the risk of injury to both the resident and care staff. The provider should ensure that the home complies with the requirements of the fire safety authority and that the evacuation procedures are clear to staff and that they have the correct equipment. The provider must ensure that bed bases, mattresses and bed rails are compatible to prevent injury to residents. The manager must register with the Commission for Social Care Inspection.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Denham Manor Nursing Home Halings Lane Denham Bucks UB9 5DQ     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: Chris Sidwell     Date: 0 4 1 1 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. 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 30 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 30 Information about the care home Name of care home: Address: Denham Manor Nursing Home Halings Lane Denham Bucks UB9 5DQ 01895834470 01895832845 denham@caringhomes.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): County & Suburban Care Ltd The registered provider is responsible for running the service Name of registered manager (if applicable): Name of registered manager (if applicable) vacant post Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximm number of service users who can be accommodated is 53 The registered person may provide the following catergories of service only: Care home with Nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) old Age not falling within any other category (OP) Date of last inspection Brief description of the care home Denham Manor is a care home providing nursing and residential care for up to 53 residents. The home is situated in a pleasant, but relatively isolated country lane, on the outskirts of Denham. Public transport and other amenities are not easily accessible. Care Homes for Older People Page 4 of 30 53 0 Over 65 0 53 care home 53 Brief description of the care home The home was registered in 1988 and consists of a two-storey building, with three conservatories. The home has forty single and three shared bedrooms. Some bedrooms have en suite facilities. There is a passenger lift. The home has extensive gardens, which are well maintained. Information about the home in the form of a statement of purpose, a service users guide and brochures can be obtained from the home. Copies of previous inspection reports are also available at the home. 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 inspection was conducted over the course of four days and included a two day unannounced visit to the home. The key standards for older peoples services were assessed. Information received about the home since the last inspection was taken into account in the planning of the visit. The manager completed an annual quality assurance assessment. Questionnaires were sent to the home for distribution to residents and their families. Residents and families were spoken to on the day of the unannounced visit. Discussions took place with the Operations Director, Manager, nursing, care and ancillary staff. Care practice was observed and the care of four residents followed through. A tour of the building and examination of records was also undertaken. The Care Homes for Older People Page 6 of 30 homes approach to equality and diversity was considered throughout. The last inspection of this service was completed on 26th November 2007. What the care home does well: What has improved since the last inspection? What they could do better: The home must ensure that residents who require a special diet for medical reasons receive this and that all staff are knowledgeable about the foods that they can eat safely. The menus should be reviewed with residents to ensure that a higher number of residents are satisfied with their meals and that they are aware that a choice is available. Care Homes for Older People Page 8 of 30 Complaints must be investigated and responded to within the timescales stipulated in the complaints policy. Records of all complaints must be kept at the home. The provider must agree and adhere to a realistic timetable to provide all residents, who require care in bed or support moving, with a height adjustable bed, to reduce the risk of injury to both the resident and care staff. The provider should ensure that the home complies with the requirements of the fire safety authority and that the evacuation procedures are clear to staff and that they have the correct equipment. The provider must ensure that bed bases, mattresses and bed rails are compatible to prevent injury to residents. The manager must register with the Commission for Social Care Inspection. 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. There is information available for prospective residents and their care needs are identified with them, prior to their move to the home, to ensure that they can be met. Residents have contracts, which describe the service that they should expect and the responsibilities of both parties. Evidence: The home has information for residents in the form of a statement of purpose and coloured brochures. An updated statement of purpose was seen in residents rooms. It held information about the home and details of the complaints procedures should any one have concerns. The acting manager said that the statement of purpose was also available on CD Rom. The files of four residents who had moved to the home since the last inspection were examined. All had evidence that the acting manager had visited them prior to their Care Homes for Older People Page 11 of 30 Evidence: move to the home and that their needs had been assessed. There was evidence in the files that care managers assessments have been sought where appropriate. The documentation used to guide the assessment of potential residents who are self funding is comprehensive. Care plans are drawn up following assessment and the family of one resident spoken to confirmed that they had been involved in this. Residents cultural and religious needs are identified and recorded as part of the assessment. The files contained copies of residents contracts and terms and conditions, which were explicit as to their individual funding arrangements. There were also records to show that notice of fee increases is given. The home does not offer intermediate care. 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. In general, residents healthcare and medication needs are met. The home must ensure that residents who require a special diet for medical reasons receive this and that all staff are knowledgeable about the foods that they can eat safely. Evidence: The care plans of the four residents whose care was followed through were examined. The content of the care plans had improved since the last inspection. The files were in order and the manager has introduced new documentation to make it easier for staff to identify, plan for and meet residents needs. There was also evidence that care managers assessments had been sought and some care plans were signed by the resident or their family to indicate that they had been involved in the development of the care plan. All entries were signed and dated. Residents had been helped to maintain their personal care needs. One resident said that the carers are very good but very busy, they always help me and I can have a bath when I wish. Of the eight people who returned the questionnaires, one said that Care Homes for Older People Page 13 of 30 Evidence: they always received the care they need and the rest said that they usually did. Comments were made to say that my mother has never complained, she is always happy and all requests are considered, every effort is made to fulfill my needs. All said that they were treated with dignity and respect. There were records in the files to show that residents are assessed as to their risk of developing pressure damage, losing weight or falling. Their moving and handling needs are also assessed. Not all residents who required nursing care in bed had height adjustable beds and a number of divans with longer legs to allow the hoist frame to go underneath were still in use. Of the four residents whose care was tracked all had been weighed and all but one had maintained their weight since moving to the home. The chef was aware of those residents who require high calorie meals. The home uses a recognised risk assessment tool to establish a residents risk of nutritional deficiency and, with the exception of one, these had been completed in full and accurately. The home should ensure that all nurses are able to complete these risk assessments accurately. The chef has a list of residents who require special diets. Two residents were identified as requiring a low sodium diet. The chef was not aware of any special requirements for these residents and there was no information in the care plans regarding dietary needs. There was no guidance available in the kitchen regarding low sodium diets. The staff were however in contact with the hospital dietitian regarding one resident. The nutritional risk assessment was under estimated for one of these residents. These concerns were brought to the attention of the acting manager who agreed to deal with them immediately. The home must ensure that, when a resident requires a diet for medical reasons, the residents care plan is up to date and the chef and care staff have full information about the diet and food that the resident can eat safely. The prevention and management of pressure damage has improved since the last inspection. One resident had moved to the home and had pressure damage which he acquired in hospital. He had been appropriately assessed and his care plan was complete and had been reviewed regularly. He was being cared for on an appropriate pressure relieving mattress and was helped to change his position regularly. His family were happy with the care he was receiving. The care plans of other residents showed that their risk of developing pressure damage had been assessed, updated regularly and the appropriate steps to minimise the risk had been taken. The home has continued slowly with a plan to provide height adjustable beds for all residents who require nursing care although this is not yet complete and has been the subject of previous requirements. A number of divan beds with hard plastic covered matresses are still being used. The provider must agree and adhere to a realistic Care Homes for Older People Page 14 of 30 Evidence: timetable to provide all residents who require care in bed or support moving with a height adjustable bed and matching mattress, to reduce the risk of injury to both the resident and care staff. Residents are registered with a local general practitioner of their choice who visits regularly. There was evidence in the files to show that residents see a chiropodist regularly and have access to an optician. There are medication policies and procedures in place. Storage facilities are satisfactory. Records are kept of medication entering and leaving the home. There were no gaps seen on the medication administration records and hand written entries had been signed by two people. The staff said that no one was self medicating at present, although there were policies and procedures in place to support this, if a resident wished. The staff were aware of what to do if a resident did not wish to take their medication and said that medication was never given covertly. Controlled drugs were stored in a satisfactory manner and all entries to the controlled register were signed. Controlled drugs are checked when they are given to residents and at each shift handover. There was evidence that medication can be obtained promptly if a residents medication is changed following a visit from the doctor. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents autonomy and lifestyles are respected and there is a wide variety of activities on offer to bring interest and diversion to their day. The menus should be reviewed with the residents to ensure that more residents are satisfied with their meals and are aware of and enjoy the choices offered. Evidence: There is an activities organiser in post who arranges a number of activities which residents are assisted to participate in if they wish. A musical afternoon was being held on the day of the unannounced visit. On most days there is a pick and choose afternoon in the lounge when games are played. Coffee mornings, sherry mornings, cream teas and quizzes are featured. The activities organiser said that he also meets with residents on a one to one to basis if they do not wish to participate in communal activities. Funding to support activities is raised through raffles and fetes. Residents also have the opportunity to go out, either as individuals or in groups. Tea dances and musical entertainments are held. A garden fete was held in the summer. The residents spoken to said that they enjoyed the entertainments and that it livened up the day. Comments were made such as the activities provided by Denham Manor entertainment manager are excellent. He was receiving a companys unsung hero Care Homes for Older People Page 16 of 30 Evidence: award for his activity programme on the second day of the inspection and it was clear that his efforts are appreciated by residents. He has maintained the high standards achieved at the last inspection. The residents spoken to said that they had a choice as to how they spent their day and as to when they got up or went to bed. One qualified this by saying that I sometimes get up early, as I know if I say, not yet, I will have to wait a long time. Two visitors were spoken to and both said that they were made welcome at any time and one said that she was often able to have tea with her friend. The service users guide states that visitors are welcome at any time. There is a rotating menu plan, which showed that the menus are varied and that a choice is available. The menu for the day was on display in the main entrance hall and residents had copies on the dining tables. There is a new dining room and conservatory, which is bright and pleasantly decorated. The meal was served from about 1pm by the chef, a registered nurse and several carers. The meal service has improved since the last inspection and the main meal was seen to be an enjoyable and sociable occasion. Food was kept in a hot trolley and adaptations such as plate guards were available for those residents who needed them to promote their independence. Carers were observed to help residents discretely. The meal on the day was stew with dumplings although the dumplings were small and not light enough to float. Cauliflower and green beans were served although these were a overcooked and the cauliflower was very soft and the beans had lost their colour. Residents views about the food varied. Of the eight who returned the questionnaires,one said that she always enjoyed the food, five that they usually enjoyed it and two that they only sometimes enjoyed it. Comments were also mixed, one residents saying that the food was well presented and appetising and another saying that it was generally adequate but not appetising. One resident said that she appreciated being able to choose whether to eat in their room or the dining room and that she thoroughly enjoyed breakfast and lunch but was less keen on supper, as not very fond of soup and sandwiches. The menu showed that an alternative was available at supper. On the day of the inspection it was fish fingers and beans. The menus should be reviewed with the residents to ensure that more residents are satisfied with their meals and are aware of and enjoy the choices offered. Care Homes for Older People Page 17 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are complaints and safeguarding policies and procedures in place and residents feel that they are listened to and their concerns are addressed. Record keeping must be improved to demonstrate that all complaints and concerns are investigated in a timely way, even when a person other than the home manager investigates the complaint. Evidence: There are complaints policies and procedures in place. A complaints log is kept in the home. This showed that twelve complaints, including verbal concerns, had been made since May 2008 and had been dealt with by the manager. They had been dealt with promptly and records were kept as to the actions taken in response to the concerns. Five of the residents who returned questionnaires said that always knew who to speak to if they were unhappy and three said that they usually knew who to speak to. One resident commented that staff are always willing to listen. One serious concern had been received which was being investigated by a senior manager of the company. There was no evidence in the home to show that this had been responded to within the timescales stipulated by the companys policy or of any action taken as a result. This must be addressed. It was a recommendation of the previous inspection that complaints are responded to promptly and that accurate records are kept in the home. Although there has been an improvement in the way Care Homes for Older People Page 18 of 30 Evidence: that complaints are managed locally, the records in the home do not give confidence that complaints, that are not dealt with by the home manager, are responded to in a timely way. The home had a copy of the local multi-agency strategy for the Protection of Vulnerable Adults and the training records showed that staff are having training in the topic. The Commission for Social Care Inspection (CSCI) has not received any complaints about care since the last inspection and has not been notified of any allegations made to the local authority under the multi agency safeguarding procedures. Care Homes for Older People Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in an attractive home, which is subject to ongoing improvements to improve the communal areas and residents rooms. There is a need to ensure that height adjustable beds are available for residents who need nursing care in order that their care needs can be met safely and that the requirements of the Fire Authority and the Environmental Health Authority are met in full, to ensure residents are safe. Evidence: The home is an older, elegant building, which is situated in attractive, well-maintained gardens. People with disabilities can access outside sitting areas. The rooms vary in size and there has been significant investment in improving the communal areas in the home. Two new conservatories and a new dining room have been built. The bathrooms have been improved since the last inspection and the refurbishments to the bathrooms on the top floor have been completed. There is still limited space in one bathroom, which contains the Parker bath, for a hoist, which limits the use that can be made of that bathroom. Residents rooms very in size. They are encouraged to bring personal items and many had chosen to do so. Their rooms reflect their diverse lives and interests and were homely. The manager said that rooms are decorated when they become vacant. The Care Homes for Older People Page 20 of 30 Evidence: colours are neutral. A requirement was made at the last inspection that all residents who require nursing care have a height adjustable bed. A survey undertaken for the inspector on the day of the unannounced visit showed that of the forty-five residents who needed nursing care, nieteen had hospital style height adjustable beds, nine had profiling beds and fourteen had divan beds. The home has not yet met the standard that all residents who require nursing care have height adjustable beds to reduce the risk to them, or staff, of injury arising from their care. The home was last inspected by the Fire and Safety Authority on the 18th June 2008 and a number of deficiences were noted by the fire safety officer. These had not been addressed by the time of the unannounced visit to the home. The organisation must ensure that the homes fire evacuation policies and procedures comply with the requirements of the Fire and Safety Authority. This is discussed in the management section of this report The home was inspected by the envirnmental health officer on the 13th July 2006 when verbal advice was given to complete the safer food handling pack issued to the home, provide sanitised wipes for the food probe and a dedicated cling film dispenser for raw meats. This had not yet been complied with in full. There are control of infection policies and procedures in place and the manager stated that these have been updated since the Department of Health issued updated guidance to care homes in June 2006. There is liquid soap and hand towels in resident rooms and evidence that alcohol hand rub is available. Staff were observed to wash their hands and there were notices reminding them of the importance of doing so. A requirement was made at the last inspection that residents do not share hoist slings, as this is contrary to the latest guidance from the Department of Health, which was issued in June 2006. The manager said that she had a enough slings to comply with this and was in the process of ensuring these are kept in residents rooms. One standaid sling was noted to be frayed and in poor condition. The manager said that she would deal with this immediately. Care Homes for Older People Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff to meet residents needs in a timely way. The training programmes should be reviewed to ensure that all care staff undertake a comprehensive induction programme and to train more staff to reach the National Vocational Qualifications in Care at level 2 or above, if all staff are to have the skills and knowledge that they need to meet the needs of frail older people. Evidence: The home is on three floors. There are two qualified nurses on duty throughout the day and one at night, supported by six carers between 8.am and 2pm, four between 2pm and 8pm and three between 8 pm and 8am. The manager said that she kept the staffing levels under review and had been given authority to raise these if the dependency of the residents increased. Residents said that staff were usually available when they needed them. The annual quality assurance assessment showed that eight care staff hold the National Vocational Qualification in Care at level 2. The home does not yet meet the standard that 50 per cent of care staff hold this qualification. The homes training matrix showed that staff have training in safe working practice and that there is a plan to ensure that all staff have regular updates, although this has not yet been completed for this year. The manager said that in addition to training in safe working practices Care Homes for Older People Page 22 of 30 Evidence: some staff have also had dementia care, tissue viability and diabetes training. The recruitment files of four staff members who have been recruited since the last inspection were examined. All contained application forms, evidence of the staff member identity and a photograph. Interview records had been kept and gaps in employment history explored. A Criminal Records Bureau disclosure and two references had been received before the staff member commenced work. There was evidence in the files that the inhouse induction programme had been completed although not that the more comprehensive skills for care induction programme had been started. Care Homes for Older People Page 23 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. The management arrangements in the home have lacked continuity over the last three years and this has affected the consistency with which ongoing improvements are made in the home for the benefit of residents. There has been an improvement in the equipment and facilities available to meet residents needs safely, however the incompatible equipment still in use in the home poses a potential risk to residents which must be addressed. The requirements of the fire safety authority must be met, for residents to live in a safe environment. Evidence: The manager who was in post at the last inspection resigned in April 2008. The head care has acted as manager since that time and was appointed to the managers post in September 2008. Unfortunately she has been away for periods for understandable reasons, when interim arrangements have been put in place. These comprised the new head of care managing the residents care , supported by peripatetic managers and managers from other homes on a rotational basis. None of the previous managers of Care Homes for Older People Page 24 of 30 Evidence: the home have registered with the Commission for Social Care Inspection and it appears from our records that whilst the home has always had a manager or acting manager in place none have remained in post long enough to register with us since the home was acquired by Caring Homes Limited in 2005. This must be addressed as it a legal requirement for providers of services to appoint a manager who registers with us. Caring Homes Ltd has a quality assurance system in place and regularly audits the service. Weekly reports and clinical governance updates are sent to the head office and action plans are developed to address the issues. A monthly management report is also submitted. An operational manager visits the service regularly and a record of her visits is kept within the home. The home does not manage any residents money on their behalf. There is a procedure for the safekeeping of small amounts of money on behalf of residents. Each resident has a transaction sheet and receipts are given for money deposited and expenditure incurred on behalf of residents. The records relating to this were checked and correct. There are health and safety procedures in place and risk assessments have been undertaken. COSHH data sheets are available for hazardous substances. Regular health and safety meetings are held which staff attend and can raise any issues of concern. Training records showed that staff had had training in safe working practices. There have been ongoing issues regarding fire safety in the home. Correspondence was seen at the inspection from the Buckinghamshire Fire and Rescue Service which indicated that the home had not met their standards regarding fire evacuation procedures. The homes fire evacuation procedure was displayed in the entrance hall of the home and referred to residents being evacuated horizontally to a safe area. However some equipment to do this was only being delivered on the day of the unannounced visit to the home and some was still on order. The maintenance man said that this was being dealt with by the organisations head office. Not all correspondence relating to this issues appeared to be held at the home. Staff were unclear as to whether residents should stay in their rooms, with the fire doors closed, or be helped to an adjacent safe area. The lack of clarity around fire evacuation procedures must be addressed urgently and the provider must comply with the requirements of the Fire Authority. A number of different types of bed and bed rails are in use in the home. There were risk assessments in the residents files. However one room was seen where a divan base had a hospital type mattress which was too long for the bed and hung over the foot. This would have been a hazard had anyone sat on the end on the end of the bed. There were bed rails in place but the mattress was slightly narrower than the bed Care Homes for Older People Page 25 of 30 Evidence: base. This posed a risk of entrapment. The use of bed rails must be reviewed to ensure that the base of the bed, the mattress and the bed rails are compatible and that the combination does not pose a hazard to residents. Guidance on the safe use of bed rails is available from the Medicines and Healthcare Regulatory Agency and is on their website www.mhra.gov.uk. 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 8 12 The home must ensure that 27/02/2009 residents who require a special diet for medical reasons receive this and that all staff are knowledgeable about the foods that they can eat safely. To ensure that their health is optimised and that they do not come to any harm eating foods which may harm them. 2 16 22 The homes complaints 30/01/2009 records must be kept up to date and complaints must be responded to within 28 days. To ensure residents receive a timely response and feel that there concerns are listened to. 3 38 13 The use of bed rails must be 30/01/2009 reviewed to ensure that the base of the bed, the mattress and the bed rails are compatable and that the Page 28 of 30 Care Homes for Older People combination does not pose a hazard to residents. To ensure residents are not placed at risk of entrapment by incompatable equipment. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 15 The menus should be reviewed with the residents to ensure that more residents are satisfied with their meals and are aware of and enjoy the choices offered. Height adjustable beds should be provided for all residents who require nursing care. The manager must register with the Commission for Social Care Inspection. The organisation should ensure that home complies with the requirements of the fire safety authority and that staff have a good understanding of the fire evacuation policies and procedures, and have the necessary equipment available. 2 3 4 24 31 38 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 © (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. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!