Inspection on 17/09/08 for Derwent House

This inspection was carried out on 17th September 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Derwent House 30/09/09

Derwent House 10/10/07

Derwent House 01/09/06

Derwent House 06/12/05

Derwent House 16/05/05

Derwent House 05/10/04

Derwent House 21/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 01/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Derwent House Ulverston Road Newbold Chesterfield Derbyshire S41 8EW     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: Jill Wells     Date: 1 7 0 9 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 32 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 32 Information about the care home Name of care home: Address: Derwent House Ulverston Road Newbold Chesterfield Derbyshire S41 8EW 01246 340230 01246 347517 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Derbyshire County Council Mrs Janet Elizabeth Greenfield care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP 0 Over 65 40 Date of last inspection Brief description of the care home Derwent House is located on the north-west outskirts of Chesterfield in a busy residential area, close to local shops and amenities and on a direct bus route to Chesterfield town centre. The home is registered to provider personal care and support for up to forty people, having all single room accommodation, provided over three floors. Wheelchair access is provided throughout the building, which is suitably adapted to assist those people who may have mobility problems, including a passenger lift and emergency call system throughout. There is a range of communal lounge and dining Care Homes for Older People Page 4 of 32 rooms, including quiet areas and a smoking area. Assisted bathroom and toilet facilities are located on each floor. Grounds and gardens are well maintained and include an internal courtyard/garden area with seating for people. People are provided with care and support from a team of care and hotel services staff led by a registered manager, who also has deputy and external management support via Derbyshire County Council. The home provides both short-term respite and long term care provision. A copy of the homes service guide and the last inspection report is available at the home. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for the service is one star. This means the people who use the service experience adequate quality outcomes. The inspection visit was unannounced and took place over 8 hours. The charges for short term care are 102.90 increasing to 336.42 if someone has savings of 22,250 or over. The full cost of a placement is 392.18. There were 35 people living at the home on the day of the inspection. 8 residents, 5 staff, 3 visitors,and the deputy managers were spoken with during the visit. Some residents were unable to contribute directly to the inspection process because of Care Homes for Older People Page 6 of 32 communication difficulties, but they were observed during the visit to see how well their needs were met by staff. We also looked at all the information that we have received, or asked for, since the last key inspection on the 10th October 2007. This included: · The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. · What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. The previous key inspection report Completed surveys from people living at the home, staff, relatives and professionals that visit. Records were examined, including care records, staff records, maintenance, and health and safety records. A tour of the building was carried out. What the care home does well: What has improved since the last inspection? What they could do better: They were a number of people living at the home with high dependency needs. The service manager responsible for the service had agreed that as a temporary measure the manager would not be admitting other people due to this. They had also agreed some additional staffing at busy times, but the staffing levels still may not always meet peoples needs. Recent meetings had highlighted that staff morale was quite low due to this. One staff member said, we havent got time to sit and chat with residents. A night staff worker had expressed concerns in a recent team meeting about pressures on night staff and being unable to to do hourly checks on people that needed this. Although personal service plans were available for each person, these were brief and were not person centred to assist staff with their work. Staff spoken with said that although these were available, they often did not have time to read them. One person who had a moderate level of confusion had attended for day care during the day of the inspection. There was very little information available about them, and staff were only aware of what the person had told them. Up to date training records were not available, which made it difficult to assess whether everyone had received mandatory training and other relevant training. Several records that were needed for the inspection visit were not accessible by the deputy managers on duty. These were only accessible to the manager who provided information after the inspection visit. Care Homes for Older People Page 8 of 32 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. Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are fully assessed prior to admission but staff are not always aware of this information. Information was available about the home so that people could make an informed choice about whether to live there. Evidence: There was a statement of purpose and service user guide available at the home. These had been placed in each persons bedroom so that people had information about the service. They had recently been revised and now provided up to date information concerning fees. The service user guide still had the CSCI address and telephone number in place which would not enable people to contact CSCI if they need to. Care Homes for Older People Page 11 of 32 3 out of 4 peoples files that were seen had an assessment in place ensuring that the service could meet each persons needs before they were admitted. However one person that was at the home on the day of the inspection visit for day-care had no assessment and staff had no details about this person. This was not the first time the person had visited. The manager later contacted us to say that this was in place but staff had not seen it. Each file had a copy of an individual placement agreement, however there was not a date that the agreement started from on any of them. The statement of purpose says that they offer trial visits to prospective service users and avoid unplanned admissions except in cases of emergency. People spoken with confirmed that they had all visited the home, some for short-term care before they decided to live at the home. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although staff work generally in a person centred way when supporting people, care planning records did not support them to do this. Medication systems had not put people at risk, however some errors could potentially be unsafe for people living at the home. Evidence: Each person had a care plan written by the Social Services care manager and a personal service plan written by staff at the home. These plans were to assist staff to provide all aspects of each persons health, personal and social care needs. The personal service plans were not always sufficiently detailed. For example one stated under the information concerning the need for personal care, a little help sometimes. There was no indication of the persons own abilities, what type of help was likely to be required, and what may trigger this help. Another plan said, care staff to provide assistance when required. This was not person centred care planning. Care Homes for Older People Page 13 of 32 Care staff wrote detailed monthly reviews for each person. Some information that was seen on the reviews should have triggered a revised personal service plan and risk assessment for example one persons July report said that they had significantly deteriorated and now had very poor mobility. However personal service plans and personal handling risk assessments had not been revised. There were relevant risk assessments in place, including personal handling, falls and nutritional risk assessments. Weight was being regularly monitored. One persons record that was seen showed that they had lost significant weight and were now provided with food supplements. Daily logs were being written for each person although these were very brief, which had been highlighted by the service manager for the home. Staff explained that records of bathing were included in these daily logs. There was no record of one person being offered or supported to have a bath and a second persons records showed that they were last supported to bathe over two weeks ago. Staff were not recording if any person had refused the offer of assistance with bathing. It was unclear whether this was lack of bathing or lack of recording. Discussions with the relevant people still did not make this clear. One staff member that was spoken with said that the provision of moving and handling equipment could be improved as there was only one stand aid between three floors of the home. The manager later confirmed that a second stand aid had been ordered. Records of GP visits were recorded, however these were on the computer system and were not printed out for care staff to have access to. This would make writing monthly reports difficult for care staff and did not provide a full picture of the person s care. Staff spoken with said that they did not always have time to read peoples files. This was highlighted by the fact that no one had gone to check the persons file that was admitted for day-care as they were not aware that there was no documentation. Staff spoken with had very little knowledge about this person, who had significant confusion. One staff member was observed transporting a person in their wheel chair without using foot rests. The staff member explained that the person did not like to use foot rests, but they were then observed easily persuading the person to use them. This persons plan of care or personal handling plan did not state any issues concerning use of foot rests. Staff were observed treating people with respect. Staff spoken with could give good examples of how they respected peoples privacy. Everyone living at the home that was spoken with confirmed that all staff treated them how they wished to be treated. One person said, staff are very respectful. The student social worker on placement at the home said that she had always observed staff treating residents with respect. A member of staff said, I try not to do things my way but their way. Care Homes for Older People Page 14 of 32 There were no one living at the home that administered their own medication. People signed to say that they wanted staff at the home to administer their medication. The medication administration records were seen. These were in reasonable order apart from some occasional gaps that had been highlighted by the manager. Some medication that had been prescribed stated, only when required but there was no record either on the medication records or care plans when the medication was likely to be required. One person that had been admitted for short-term care had their medication in a strip but not in a box with the pharmacy label attached, therefore there was no information as to how often this medication should have been given. Where the pharmacy instructions stated an optional dose, there was not a record of the dosage that had actually been given. Where medication administration records were handwritten, they were being signed by the person that had handwritten them, which was good practice, however the instructions from the pharmacy labels were not always recorded for example dissolve in water. One handwritten record was checked and the person writing this had written the dosage as 5mg, however the dosage on the pharmacy label was 0.5mg. Although there was no indication of incorrect administration, these handwritten errors did highlight the importance of a second person checking and signing handwritten records for peoples safety. Most people had a photograph attached to their administration records, however one person that had been admitted to the home two weeks ago still had no photograph in place. The deputy manager was observed administering medication and she was following good practice guidelines. There was a safe system for storage, receipt and return of medication. The recording system allowed a good audit trail. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The range of activities and standard of meals offered was good, which met the needs and wishes of people living at the home. Evidence: There were three staff providing activities at the home, which totaled 45 hours per week. However on discussion with two of the staff, they confirmed that there was on average 2-3 hours per day, five days per week actually used for activities. Some of their time was spent supporting care staff, for example in the morning assisting people out of bed. They also took people to hospital and other appointments. They spent some of their time on a one-to-one basis with people that needed to remain in bed. Activities provided included craft making, dominos, flower arranging, chair based exercises, word search, as well as a monthly trip using community transport. There was Holy Communion organised on a monthly basis. People spoken with were generally satisfied with the level of activities. Several people commented about activities provided in the surveys that we sent to them, for example, activities are Care Homes for Older People Page 16 of 32 always encouraged depending on health at the time, always and very enjoyable, always but I dont always want to go. There were several areas around the home that were being used for activities for example there was a lounge area on the second floor that had a reminiscence corner. Staff were helping residents that were interested to make boxes for children in Africa. several people spoken with appreciated this. The various tools for recording activities seemed to duplicate and were unnecessarily complicated. This meant that activity staff spent an unnecessary amount of time recording, and were often behind with this. Although there was a notice board displaying activities, not all activities seemed to be advertised. For example there was a church service advertised, then nothing until a film show four days later. Several visitors were spoken with during the inspection visit. They felt that they could visit at any reasonable time, and were made welcome by staff. The menu on display showed a choice at mealtimes. The cook was spoken with and confirmed that care staff went to each person in the morning to discuss their preferred choice. People spoken with were satisfied with the meals. Comments in our surveys sent to people were mixed. For example one person said,this area could be improved but there is a choice if you do not like anything, another person said,The food could be better, although no specifics were given. At the last inspection it was highlighted that people living at the home did not like to be given the cold meat on Monday from the Sunday dinner as it was difficult to chew. A carer said that this was being looked at, however this was almost a year since it was initially brought up. Minutes of residents meetings highlighted that people were consulted about the meals and encouraged to make suggestions. People spoken with confirmed that they could bring their personal possessions with them. One person said, I brought lots of things with me, it helps me feel like it is home. Care Homes for Older People Page 17 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and are protected from abuse. Evidence: The complaints record was seen. There had been no complaints recorded in the last two years. However it was evident that informal complaints were not being recorded. One person living at the home spoke about a minor complaint that they made. They were happy about the way this had been dealt with. This was not recorded in the complaints record. The residents meeting minutes highlighted several minor complaints for example, the fish had been overcooked on one occasion. This had not been recorded in the complaints book which would highlight that all complaints were taken seriously and looked into at an appropriate level. Everyone spoken with felt able to make a complaint if they needed to. One person said, I would go straight to staff if I had a concern. There had been one safeguarding adults referral made since last inspection visit. The outcome of the investigation by Social Services was that there was no evidence of neglect on the part of Derwent staff or any failure to provide the care required. However a review of practice and lessons learned has been completed by Derwent House Managers. Care Homes for Older People Page 18 of 32 Staff that were spoken with had attended training in safeguarding adults. Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, well-maintained and comfortable environment, which encourages independence. Evidence: Since the last inspection visit new baths were in the process of being placed into the home. These would better meet the needs of people living at the home. The bathrooms were being redecorated after the baths had been fitted. There was a choice of communal areas where people could sit, including several large and small lounge areas and a lounge/dining room. There was also a smoke room, and communal areas on the first and second floor. There was space for people to take visitors if they did not wish to use their own bedroom. The wall over the heater after the first flight of stairs was very dirty and was in need of redecorating. Other areas along the stairs showed bare plaster where repairs had taken place but had not been re decorated. The door lock was broken on the first floor bathroom. There was a strong smell of urine on the ground floor bedroom corridor. Generally the home was well decorated and maintained and had a warm and welcoming feel on entering. Care Homes for Older People Page 20 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The number of care staff on duty may not always meet people’s needs. There was a high number of staff with NVQ Care 2 which would assist them to do their job. Evidence: The information form the annual quality assurance assessment competed by the manager said that Derwent House has well qualified and experienced staff who are trained to meet the needs of residents and the establishment staffing ratio is consistantly maintained. All new staff recieve the required induction training and an ongoing training programme is in place. Information from people living at the home about staffing levels was varied. One person wrote in our survey in answer to the question, are staff available when you need them? yes, but there never seems to be enough for the amount of residents. Other people in our surveys were satisfied with staff availability. Several people living at the home commented that staff were very busy all the time and did not have time to talk, though they were very appreciative of how hard staff worked. A staff member wrote in a survey that,the service could do better by employing more staff. There are too many high dependency residents and too few staff to give good and proper care. Staff spoken with felt that there were insufficient staff working at the home, especially taking into account the high Care Homes for Older People Page 21 of 32 dependency needs of several people living at the home. One staff member said, we cant give people the time and attention that they need, sitting and chatting to people doesnt get done. Another staff member said, it can take 30 minutes with one person who needs hoisting and are doubly incontinent. It feels like a conveyor belt. One staff member said, I love my job, we have a good rapport with residents and staff work together. Information provided by the manager after the inspection visit highlighted that there are very high dependency needs at the home. There are 7-9 people that needed two care staff for all of their moving and handling needs. There are also a high number of people(17) with comprehension problems which means that providing care may often take longer. 29 people were unable to wash and dress/undress themselves. Two people were poorly in bed, and staff were concerned that they were not receiving the attention that they needed. One of these people required turning every 1-2 hours due to their condition. Two staff were needed to do this. This level of dependency meant that communal areas were often left unsupervised. The statement of purpose said that there were 99 hours management/care hours. The manager explained that these were care hours that should be done by the deputy managers, however they were unable to do these due to other management duties and would only undertake care if there was an emergency or were very short staffed. The manager explained that admissions had been cancelled on a temporary basis due to the high dependency levels of people living at the home. There were 35 people living at the home on the day of the inspection visit. The staff rota was checked for the previous seven days prior to the inspection visit. The rotas showed that there were three morning shifts and five afternoon shift where there were only three staff on duty. The service manager responsible for the home had recently obtained agreement to increase staffing levels between 5:30 p.m.-9:30 p.m. to four care staff, however the deputy manager explained that cover had not always been possible. Additional care staff is sometimes available from the Rapid Response team and home help service who are employed to provide care for people residing within the local community. However, their availability is dependent on no community work being required, which is their primary responsibility. Staff said that over recent days they had staff from the community on most days, however there was no record of this, so it was unclear how many additional hours had been provided. The night staff meeting minutes 30/7/08 highlighted concerns from night staff that due to high dependency levels the night shifts were very busy and some people needed up to an hour if they and their bed needed changing, making hourly checks on other people not possible. The report completed by the service manager responsible for the home had recorded in August and September, staffing level problems and poor staff morale due to the workload. Attempts had been made to increase staffing levels at busy times by one, and use other sources of staffing as discussed previously where possible. On the day of the inspection visit there was additional staffing from the Rapid Response service. Care Homes for Older People Page 22 of 32 Information received on the annual quality assurance audit completed by the service stated that, the service has robust employment, recruitment and selection procedures and all employees and volunteers have CRB checks. Staff recruitment records were not checked on this occasion as files were not accessible. There were training records available, however these had not been kept up to date. The manager later explained that a new recording system for training was due to be put in place and this was likely to improve the recording of training for staff. Information received from the manager was that 75 of staff have obtained NVQ Care 2 which is above the minimum standard and should be commended. A staff member spoken with said that they were due to start their NVQ3 and any staff member that wanted to do this qualification could do so. Several staff spoken with had not attended training in dementia care. There was a high number of people living in the home that had memory loss and confusion. Several positive comments were received by people about staff. These included, staff are always kind and helpful and, you can have a good laugh with staff . From observations and discussions with staff, it was evident that they were dedicated and committed and tried hard to meet peoples needs. Care Homes for Older People Page 23 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, the home is fairly well managed and run, for the most part in peoples’ best interests. However improvements to recording, access of information for the management team, and provision of one-to-one supervision for staff, particularly when morale is low, would improve the overall quality of the management of the service. Evidence: Information provided by the manager on the annual quality questionnaire assessment was that the management team is made up of qualified and dedicated staff with many years experience in working with older people and equal opportunities are promoted in all aspects of the Home. A second Deputy Manager has now completed Care Homes for Older People Page 24 of 32 her NVQ 4 Registered Managers Award and all managers have attended training to improve their skills and knowledge. The manager is registered with CSCI and is experienced to run the home. Staff and people living at the home that were spoken with were positive about the management approach. One staff member said, the managers will do their up most to help anyone. Staff meetings were regularly held and minutes showed that these gave an opportunity for people to voice concerns and make suggestions. An annual quality assurance survey was completed in 2007. The results were available in March 2008. 80 of residents rated the overall service that they received as either excellent or good.100 of carers and users rated the building cleanliness and comfort as either good or excellent. Over 25 of users rated being treated as an individual to be only fair or poor in a range of measures including; choice about where you sit, frequency of bath times, feeling listened to, having religious needs met and how overall needs were reviewed. Staff spoken with said that residents could sit anywhere in the home. Several people spoken with said that they had a bath once a week and were satisfied with this. The deputy manager was not aware whether the results of this survey were available for people living at the home. There was good progress with regards to timescales to implement requirements identified in the last inspection visit. Particularly concerning new baths, however there had only been a slight improvement in staffing levels. The manager and service manager were working together to try and improve the situation. There was a system for recording service users money, however the receipts completed by managers were not always countersigned, which did not make the system fully safe for all involved. Supervision records were seen from one deputy manager. These showed that the last supervision provided for a staff member was in April 2007 which was inadequate. There was no evidence to show that people were encouraged to have access to their records and information held about them. The accident records were seen and found to be in good order. There was a falls monitoring form completed although it was unclear what was done as a result of the completion of this form. There were monthly reports completed by the service manager responsible for the service. These were detailed and had highlighted some issues that needed addressing e.g. staffing, morale, gaps in medication administration records, and poor quality daily logs. There was a quality audit file, however there were several blanks documents within this including sensory audit, premises audit, security and falls audit. Care Homes for Older People Page 25 of 32 Fire safety checks were being done, however these were not always done as often as the guidance required. There were control of substances hazardous to health (C.O.S.H.H.) assessments, however these were dated July 06 and had not been reviewed. There was a significant amount of information that was not available during the inspection visit. The registered manager provided this information after the visit as some of this was on the managers computer. It was of concern that this information was not accessible for members of the management team and available for an unannounced inspection visit. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 27 18(1) (a) At all times staff must be 31/12/2007 provided in sufficient numbers and skill mix as are appropriate for the health and welfare of people accommodated. Care Homes for Older People Page 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Service user plans of care 18/10/2008 and risk assessments must be reviewed and amended to reflect any changes to the persons needs. This is so that staff have up to date information to assist them to provide a good standard of care. 2 8 12 Staff must ensure the use of 18/10/2008 foot rests on wheel chairs unless there is a risk assessed reason why this is not appropriate. To ensure the safety of people that use wheel chairs. 3 9 13 Medication must not be 18/10/2008 removed from the original box that has the pharmacy label attached other than for administration purposes. Care Homes for Older People Page 28 of 32 To ensure that the original pharmacy label can be checked and followed for safety. 4 27 18 At all times staff must be 17/10/2008 provided in sufficient numbers, taking into account the dependency levels of people living at the home. (This was a previous requirement, as there has been some improvement the timescale has been extended. To ensure that people living at the home have their needs met at all times. 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 2 1 The service user guide should be amended to include the up to date address and telephone number of the Commission for Social Care Inspection so that people can contact us if they need to. The individual placement agreement should have a date in place of when the agreement/placement started so that clear information is available. Staff should be aware of the details of a persons full needs assessment so that they are aware of each persons needs and to ensure that these needs can be met. Records of bathing offered or provided should be clearly recorded in order to assess whether an individual is receiving adequate support with bathing to meet their individual needs. Personal care plans should be person centred to ensure that they reflect individuals personal abilities, specific needs and wishes, so that staff are supported to provide individualised care. 3 2 4 3 5 7 6 7 Care Homes for Older People Page 29 of 32 7 8 Staff should be aware of the content of individuals assessments, social histories, care plans and risk assessments, including new people, to assist them to provide person centred and individualised care. Records of GP visits should be available to care staff to ensure that that have full information about each persons health care needs. When medication information states, when required there should be an indication for staff as to when this medication is likely to be required to assist staff to provide medication at appropriate times. When medication information states an optional dose, staff should record the does actually administered to ensure a safe system. There should be a photograph in place for each person staying at the home, including new people and people staying for short-term care to ensure easy identification and safe administration of medication. Hand written medication administration records should be checked and countersigned by a second person and the handwritten information should include instructions as stated on the pharmacy label to reduce the potential for error. Consideration should be given to displaying the activities planned for each day so that people can decide whether they wish to take part. The activities recording system should be reviewed to ensure that it is in sufficient detail to evidence that a good range of activities are offered to people, but does not duplicate or cause unnecessary burden on staff undertaking activities. Informal complaints should be recorded to provide evidence that all complaints are taken seriously and looked into at the appropriate level. Re-decoration of the dirty wall on the stairs and bare plaster around windows on stairways should take place to improve the environment. Action should be taken to ensure that all parts of the home are free from offensive odours to ensure that people live in a comfortable environment. There should be clear, up to date records of staff training so that the manager and other interested parties can easily assess if all relevant training has been provided. All staff should receive training in dementia care awareness Page 30 of 32 8 8 9 9 10 9 11 9 12 9 13 12 14 12 15 16 16 19 17 26 18 30 19 30 Care Homes for Older People to assist them with their job. 20 33 The results of the quality assurance survey should be available for people living at the home and visitors, and include the action plan so that people can be assured that consultation takes place and is responded to. The recording system for managing peoples money should ensure that people involved are protected, which includes two signatures when accepting or providing money. Care staff should receive formal supervision at least six times per year to ensure that they are adequately supervised and provided with the support that they need. All members of the management team should have access to relevant records to ensure that the inspector can undertake their regulatory role during an unannounced inspection visit. Managers and staff should actively encourage people living at the home to access their records and information held about them. Discussions concerning their rights about this should be recorded. The control of substances hazardous to health (C.O.S.H.H.) assessments should be reviewed to ensure compliance with the relevant legislation and for safety of people using these substances. A clear analysis of accidents should be regularly undertaken that includes an action plan of the findings of this analysis to help to minimise the risk of accidents, including falls. Fire checks should be undertaken in line with the homes written guidance to ensure that there is a safe fire safety system. 21 35 22 36 23 37 24 37 25 38 26 38 27 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (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. 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