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Inspection on 17/10/08 for Derwent Residential Care Home

Also see our care home review for Derwent Residential Care Home for more information

This inspection was carried out on 17th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 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

All residents before coming to live in the home have a pre-admission assessment, to ensure that the home can meet the needs of the resident. Prospective residents and their relatives are invited to visit the home prior to making a decision about the resident moving into the home. Residents care plans reflect the detailed pre-admission assessment, and are regularly reviewed. Each resident is risk assessed to enable the home to reduce the level of risk to a minimum. Residents have a variety of activities offered in house on a daily basis, as well as community activities, which they are able to participate in if they wish to. Visitors are welcomed into the home by the staff at any time. The home has recently had an extension added on and can now offer placements for 34 residents with mild to moderate dementia type illness. The environment of the home is comfortable, homely and bright and airy. There is a specially designed safe and secure garden at the rear of the home which the residents are able to use freely. The home is free from offensive odours and staff are trained in the prevention of cross infection. Residents know that any complaints will be listened to and acted upon appropriately within the timescales set out in the complaints policy and procedure. The recruitment of new staff is rigorous ensuring that staff have the appropriate protection of vulnerable adults and criminal records bureau checks, and references taken up prior to being employed by the registered manager. The registered manager has many years experience of working in residential care and has obtained her registered managers award. She operates an open door style of manager, and is available to both residents, visitors and staff when she is on duty. Health and safety checks are carried out on a regular basis to ensure that residents live in a safe environment. Residents spoke highly of the care they received, and the staff. One residents said the care here is wonderful, I could not wish to be in a better place. Two visitors were full of praise for the home and what it had done for their residents. Staff were happy in their work. One member of staff said - we really work together as a team here.

What has improved since the last inspection?

Some of the staff have received training in safeguarding vulnerable adults the the remaining staff will complete this training by the end of November 2008. Quotes have been obtained to ensure the driveway at the front of the home is made safe, the delay in getting this work done was due to the outside of the building needing to be re-rendered. Now that re-rendering work is complete the driveway will be made safe. Planning is now underway to ensure that all rooms are heated by a main boiler/s and that storage heaters will disposed of. An order has been placed for a new carpet to be laid in the main hallway of the home.Staff training is on going, and the registered manager has further training courses booked to ensure that all staff receive training in first aid, food hygiene and medication. The registered manager is in the process of changing pharmacy supplier, and further staff training will be provided by the new pharmacy supplier. The registered manager has developed a good quality assurance system in the home, which includes surveying all residents, visitors and external stakeholders as well as regular monitoring of all systems used in the home. An annual quality assurance now needs to be developed to show how these checks are improving the quality of care for the residents in the home. The manager has developed a staff supervision matrix, and all staff now receive regular supervision on a two monthly basis. An annual improvement plan has been developed and the registered manager is aware of issues that still need to be addressed. The inspector evidence that the registered provider carried out regular monthly regulation 26 visits to the home and completes a report at the end of each visit.

What the care home could do better:

The registered manager needs to ensure that each resident is risk assessed in accordance with their daily living activities, this must include self medication, accessing the local community, and the risk of en-suite baths. Where residents participate in communal activities or receive one to one social care from staff this must be recorded within the residents care plans. Mandatory training must be kept as a high priority to ensure that all staff receive training and update their training in moving and handling, fire safety, first aid, food hygiene, infection control and work related issues. The registered manager must ensure that she implements the Skills for Care induction that she has developed, to ensure that all new staff are made aware of the basic standards for care. All opening window must be fitted with window opening restrictors.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Derwent Residential Care Home 38 Sedlescombe Road South St Leonards-on-sea East Sussex TN38 0TB     The quality rating for this care home is:   two star good 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: June Davies     Date: 1 7 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Derwent Residential Care Home 38 Sedlescombe Road South St Leonards-on-sea East Sussex TN38 0TB 01424436044 01424715409 derwent@cedarscaregroup.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Denise King Type of registration: Number of places registered: The Derwent Residential Care Ltd care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 34. The registered person may provide the following category/ies of service only: Care home only - (PC) tos ervice 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 - (OP) Dementia (DE) Date of last inspection Brief description of the care home The Derwent Residential Care Home is a large detached house situated on the outskirts of St Leonards On Sea. It is registered to accommodate thirty-four older people. There is good access to St Leonards where there are a range of shops and services. All bedrooms have en-suite facilities. Communal space includes a dining room, large lounge area and a fully accessible well maintained garden to the rear of the property. Care Homes for Older People Page 4 of 31 Over 65 0 34 34 0 Brief description of the care home The range of fees is #322-#382 per week as of 22/11/06. Additional charges are made for chiropody, hairdressing and other individual requirements. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good 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: This key unannounced inspection was carried out on the 27th October 2008. During this inspection the inspector talked to the registered manager three members of staff, three residents and two visitors. Documents relating to the key standards inspected were also viewed. The inspector carried out a tour of the home and the back garden, and undertook an audit of medication used in the home. A lunch time meal, staff respecting residents rights to privacy and dignity and administration of medication was observed. Information contained within this report was also obtained from the Annual Quality Assessment sent by the registered manager to the Commission. Care Homes for Older People Page 6 of 31 Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Some of the staff have received training in safeguarding vulnerable adults the the remaining staff will complete this training by the end of November 2008. Quotes have been obtained to ensure the driveway at the front of the home is made safe, the delay in getting this work done was due to the outside of the building needing to be re-rendered. Now that re-rendering work is complete the driveway will be made safe. Planning is now underway to ensure that all rooms are heated by a main boiler/s and that storage heaters will disposed of. An order has been placed for a new carpet to be laid in the main hallway of the home. Care Homes for Older People Page 8 of 31 Staff training is on going, and the registered manager has further training courses booked to ensure that all staff receive training in first aid, food hygiene and medication. The registered manager is in the process of changing pharmacy supplier, and further staff training will be provided by the new pharmacy supplier. The registered manager has developed a good quality assurance system in the home, which includes surveying all residents, visitors and external stakeholders as well as regular monitoring of all systems used in the home. An annual quality assurance now needs to be developed to show how these checks are improving the quality of care for the residents in the home. The manager has developed a staff supervision matrix, and all staff now receive regular supervision on a two monthly basis. An annual improvement plan has been developed and the registered manager is aware of issues that still need to be addressed. The inspector evidence that the registered provider carried out regular monthly regulation 26 visits to the home and completes a report at the end of each visit. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Care Homes for Older People Page 10 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents move into the home knowing that their needs can be met. Evidence: The registered manager visits prospective residents either in their own homes or in hospital to complete pre-admission assessments. Prospective residents are also invited to visit the home prior to making a decision to move into Derwent Resident Care Home. If a prospective resident is in hospital, it is often the relatives who visit the care home. Where possible the registered manager also obtains pre-admission assessments and plans of care from the care manager of the funding local authority. The inspector viewed the pre-admission assessments of four residents presently residing in the home and found them to be detailed and informative in regard to the health, personal and social care of the residents. From these pre-admission assessments the registered manager is then able to decide if the home can meet the care needs of the prospective resident. Care Homes for Older People Page 12 of 31 Evidence: The home does not offer intermediate care. Care Homes for Older People Page 13 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a consistent care planning system in the home, which adequately provides staff with the information they need to meet residents needs. The systems for medication administration are good to ensure that residents are not placed at risk. Personal support in the home is offered in a way that protects the residents privacy, dignity and independence. Care Homes for Older People Page 14 of 31 Evidence: Four care plans viewed by the inspector showed that each care plan reflected the preadmission assessment. While there were good risk assessments in place they were found to be generic and individual risk assessments are needed when a resident is self-medicating, or is able to go out into the community un-escorted, it was also noted that most of the bedrooms have en-suite baths in situ and these also need to be risk assessed. In each care plan there was good evidence that staff carry out regular monthly nutrition monitoring and also review care plans on a monthly basis. Good evidence on each care plan of visits to and from health care professionals, with the exception of two care plans that did not show regular visits from the chiropodist. The inspector found that the daily records on each care plan were informative in regard to the general care of the residents, but did not reflect what personal hygiene tasks had been carried out. Generally medication is well managed in the home. Monthly administration records are all signed off after medication has been administered. Policies and procedures are in placed for the receipt, recording, storage, administration and return of medication used in the home. The inspector did note that the home does not have a policy and procedure in place for PRN (as required) medication. Controlled drugs are well managed and the controlled drugs register is completed correctly. The inspector does have some concerns in regard as to how controlled drugs are stored in the home at the present time. During the course of the inspection the inspector noted that staff talk to the residents in a kindly manner and respect the privacy and dignity at all times. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have access to a variety of in-house activities and entertainment, and are able to enjoy community activities if they wish to. Service user are helped to exercise choice and control over their lives. The meals in this home are good offering both choice and variety and catering for special diets. Evidence: Each care plan viewed showed that residents are able to make choices in their daily lives in regard to getting up and going to bed, where they would like to eat their meals, and what food they like and do not like. Residents are offered a variety of in-house activities on a daily basis. It was noted that while group activities are recorded onto an activities sheet, care plans do not show what group activities residents have joined in with and one to one time between residents and staff are not recorded. By keeping names collectively on a sheet this contravenes the Date Protection Act 1998. Discussion took place with the registered Care Homes for Older People Page 16 of 31 Evidence: manager regarding the appropriate recording of activities and she stated that she is in the process of developing individual activities sheets for each resident that can be placed in their care plans. One of the carers employed by the home is able to use some of her care hours as an activities co-ordinator. Residents are able to have regular access to the community. At least four residents are able to go to the local shops on their own. On the day of this key inspection a resident went out to the local shops with a relative. Thirteen of the residents have chosen to go to a show at the local theatre in a few weeks time. Money to pay for outings is raised during the course of the year, through fund raising activities arranged by the home and the travelling expenses are paid by the company who owns the home. The local church visits the home on a regular basis to offer Communion to those residents who wish to participate. Other residents whose religious beliefs are not Church of England are able to have lay people of their chosen belief visit them personally in the home. The registered manager told the inspector how she is in the process of finding out what local clubs could be attended by residents in the home. Residents are able to have visitors at any time, and the registered manager said that the home is always busy, with relatives visiting throughout the day. The inspector noted that on the day of this inspection there were many visitors to the home, some who took residents out on a shopping trip, and for a short walk to the local shops, or just visited to sit and chat. Residents are given every opportunity to maintain autonomy in the everyday lives. Where they are no longer able to manage their own financial affairs, the residents have arranged for families to do this on their behalf. From a tour of the home the inspector noted that residents are encouraged to bring personal items into the home with them when they move in. Some residents have telephones in their rooms. One resident has a computer in her bedroom and two other residents have had some of their writings published. On the day of the inspection the inspector observed residents have lunch. It was noted that all residents were able to choose what food they would like. The main menu was Fish, Chips and peas, for those residents who did not like fish there was a choice of corned beef, or egg. Residents are also offered a small glass of sherry with their meals. The menus show that residents are offered a nutritious and balanced diet with a wide variety of choices at all meals. Specialised diets are catered for as an when required. Staff are discreet in offering assistance to those residents who need help when eating. Care Homes for Older People Page 17 of 31 Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents know their complaints will be listened to and acted on. Staff have good knowledge and understanding of Safeguarding Vulnerable Adults issues which protects the residents from abuse. Evidence: The complaints policy and procedure is displayed prominently in the home, and also included in the service user guide, together with a complaint form. The registered manager has received two small complaints since the last key inspection, the inspector was shown the recording of the complaints, and evidence to show that both complaints were properly investigated and detailed recording of feedback to the complainants. The home has up to date policies and procedures for the safeguarding of vulnerable adults. While the home itself has not had any Safeguarding Adult referrals to Social Services, the registered manager stated that an external safeguarding alert had been raised by her, which is now being dealth with by the local authority care manager. 50 of care staff have received Safeguarding Vulnerable Adults training with further training having been booked in November for the other 50 of staff. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recent investment has significantly improved the appearance of this home creating a comfortable and safe environment for those living there and visiting. Evidence: Derwent Residential Home has recently had a new extension added, the home now provides bedrooms for 34 residents. The home provides its residents with a comfortable, light, airy homely environment in which to live. The back garden of the home has recently been totally re-designed, with decked nonslip ramps and walkways, all of which have handrails on each side. Walkways all interlink with more spacious areas where residents can sit. There is an attractive fenced fish pond, where residents can stand or sit to watch the fish in the centre of the garden is a large tree, where residents can sit in the shade, there are also built up flower containers around the walk ways. The garden is secure and residents are not able to access the front of the home. The communal lounge and dining room are bright and airy, well decorated and furnished with good quality furniture. All bedrooms are fitted with en-suite facilities. Bedrooms in the new extension all have Care Homes for Older People Page 20 of 31 Evidence: patio doors leading to back garden. All bedrooms in the home are large, well decorated, and each bedroom has evidence of residents personal possessions. Communal bathrooms are toilets are all in good decorative condition, and provide residents with a variety of aids to assist with mobility. It was noted that some first floor bedroom window have not been fitted with opening restrictors. At the previous inspection a requirement was made that the front entrance of the home needs to be made safe, this requirement has not yet been met, but the manager was able to evidence that quote have been obtained to ensure that this area is made safe and it is expected that work will be carried out within the next few months. The reason that the front garden has not been attended to within the timescales is that the front of the building needed re-rendering, and therefore it was important that this work was carried out prior to the front garden was laid with a safe surface. A new laundry room has been provided within the new extension, and is provided with an industrial washing machine and tumble drier. The washing machine has a sluicing facility. The laundry room and communal toilets have liquid soap and paper hand towels. Staff are provided with plastic aprons and disposable gloves to prevent the risk of cross infection. There are no offensive odours in the home. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels in the home are good ensuring the residents receive care according to their assessed needs. Over half the staff in the home have achieve an National Vocational Qualification in social care, this ensure that residents have their assessed needs met by qualified staff. The standard of staff recruitment is high ensuring that residents receive care from appropriatgely vetted staff. Many of the staff have received training in mandatory training, further training has been booked to ensure staff have the knowledge and skills to meet residents assessed needs. Evidence: The staff rota truly reflected the number of staff on duty on the day of the inspection. At the present time four care staff are on duty on the a.m. shift, three staff on duty for the p.m. shift and three waking night carers. During day shift the manager or the deputy manager are also on duty. At the present time there are 28 residents in the home. The registered manager said that she continuously keeps staffing hours under Care Homes for Older People Page 22 of 31 Evidence: review to ensure that residents needs can be met. At the time of the inspection 53 of staff have achieved the NVQ level two or above, the home also employs a part time registered nurse. Four more care staff are in the process of completed their NVQ qualification. From viewing four staff personnel files the inspector found that the home operates a stringent recruitment policy all staff had application forms, Protection of Vulnerable Adults and Criminal Records Bureau checks, two written references are obtained. All staff files had different forms of identification and a recent photograph. There was evidence that all staff have received initial induction, and the registered manager was able to show that she has all the paper work together for Skills for Care induction. Each file showed evidence of supervision and forthcoming supervisions. The majority of staff have completed their mandatory training, and the registered manager was able to show the inspector that further mandatory training had been booked to ensure that all staff will now receive mandatory training. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager has a good understanding of what needs to improve in the home. Planning is in place and sets out how this improvement will be resourced and managed. The quality assurance system in the home is good, an annual quality assurance needs to be developed to show that the home is continuously working towards providing a quality service. Residents personal monies are well managed, and kept safely and securely in the home. Staff receive regular supervision ensuring that they have the knowledge to meet residents needs. Health and Safey is generally well managed ensuring that residents live and staff work in a safe environment. Care Homes for Older People Page 24 of 31 Evidence: The registered manager has obtained her Registered Managers Award, and has had many years experience in residential care. She has been in a management position in Derwent Residential Care Home for many years. She operates an open management style and when on duty is available to both residents and staff. The registered manager hours of duty are specified on the duty rota, and when care demands are high due to illness of residents she works hands on. Both residents and staff spoke highly of the manager, saying that she was understanding and approachable. The registered manager has a developed a qood quality assurance system, which includes surveys to residents, relatives and external stakeholders. All the systems used in the home are monitored on a monthly basis by the registered manager. An annual action plan is produced, along with a month by month diary of actions to be carried out. All bedrooms are health and safety and fire risk assessed on a monthly basis. Regulation 26 visits are carried out by the registered provider on a monthly basis. Where the home keeps small amounts of residents personal allowances, these are recorded individually for each resident, a receipt is obtained for any expenditure made on the residents behalf and expenditure is recorded. Residents personal monies are checked on a regular basis. All monies and residents personal accounts are kept safely and securely in the home. All staff receive regular two monthly supervision. Supervision sheets are kept in the staffs personnel file. The manager also has a matrix of when staff supervisions are due. Two members of staff confirmed that they received regular supervision and that they found this to be helpful in carrying out their caring role. As mentioned under Standard 30 in this report the majority of staff have completed health and safety related training in moving and handling, fire safety, first aid, food hygiene and infection control. The registered manager has booked further dates for mandatory training and new staff are enrolled on these courses, together with staff who need to update their training. The home has an up to date health and safety policy and procedure. Risk assessments are carried out for health and safety and fire throughout the building. It was noted during the inspection that not all window are fitted with window opening restrictors, especially on the first and second floors. A requirement is being made to ensure that all windows do have opening restrictors fitted. All doors are fitted with magnetic closures which will activate should there be a fire. Fire points are checked on a weekly basis and hot water temperatures are also checked fregularly and recorded. Care Homes for Older People Page 25 of 31 Evidence: Emergency lighting is checked monthly by an external contractor. The inspector viewed the accident book and found that accidents to residents are well recorded. The manager also checks recorded accidents on a monthly basis, and acts appropriately when a large number of falls are recorded for one resident. The inspector was shown that where one resident is prone to falls this was reported appropriately to the Falls Agency and the residents was supplied with hip protectors, a neck pendant and exit mat. The residents daughter was also involved in this prevention of falls management. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The controlled drugs cabinet, must be securely bolted to the wall, this controlled drugs cabinet must be contained within a suitable medicines cupboard which is also securely fitted to the wall. There must be clear guidelines for staff in regard to PRN (as required) medication is offered to residents and how this is to be recorded after administration. All residents who are self medicating must have an appropriate risk assessment 21/11/2008 Care Homes for Older People Page 28 of 31 in place which clearly describes how this self medication will be monitored. 2 38 12 The registered person shall 19/12/2008 ensure that (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. (c) unnecessary risks to the health or safety of service users are indientified and so far as possbile eliminated. All windows must have window opening restrictors fitted. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 There should be risk assessments in place for individual residents, in regard to there daily living and social lives, for example self medication, going out into the community and baths which are situated within en-suite facilities in bedrooms. It is good practice to record external health care visits for each resident in the home, which should include visits from the chiropodist. It is good practice that activities that residents are involved in including one to one contact with staff are recorded individually for each resident. To keep collective names on records is breaching the Data Protection Act 1998 Mandatory training to continue to ensure that all staff have received health and safety related training in First Aid, Food Hygiene, Fire Safety, Infection Control, Safeguarding Vulnerable Adults and Dementia, and that any staff who will be required to administer medication had received the appropriate training. Induction related to Skills for Care must be started for all Page 29 of 31 2 8 3 12 4 30 5 30 Care Homes for Older People new staff employed in the home, to ensure they have the basic knowledge of care to meet residents needs. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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