Inspection on 18/03/09 for Dewi-Sant

This inspection was carried out on 18th March 2009.

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.

Other inspections for this house

Dewi-Sant 23/07/10

Dewi-Sant 07/05/10

Dewi-Sant 13/12/06

Dewi-Sant 15/12/05

Dewi-Sant 07/06/05

Dewi-Sant 25/11/04

Dewi-Sant 29/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Dewi-Sant 32 Eggbuckland Road Mannamead Plymouth Devon PL3 5HG     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: Antonia Reynolds     Date: 2 0 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Dewi-Sant 32 Eggbuckland Road Mannamead Plymouth Devon PL3 5HG 01752664923 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mannarest Limited 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 who can be accommodated is 34 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) Date of last inspection Brief description of the care home Dewi Sant is a care home providing accommodation and personal care for a maximum of thirty-four older people, some of whom may have dementia. It is privately owned by Mannarest Limited. In March 2009 the fee levels ranged from 340 pounds to 430 34 0 Over 65 0 34 Care Homes for Older People Page 4 of 33 Brief description of the care home pounds per week but vary depending on the individual needs of each person. The home is a large, three-storey, detached building, converted into a care home approximately forty years ago and located in the residential area of Mannamead. The home is within walking distance of shops in Mutley Plain and close to bus services into central Plymouth and the railway station. All the bedrooms are single and none of them have en-suite facilities. There are eighteen bedrooms on the ground floor, eleven on the 1st floor and four on the 2nd floor. The top two floors can be reached using the stairs or the stair lifts on each flight. Communal rooms are on the ground floor and consist of two lounge rooms, a dining room and a conservatory with doors out onto a patio. Because of the layout of the home it is not suitable for people who use wheelchairs. The home has limited parking space at the back of the house but unlimited on street parking is available at the front. Information about the home, including copies of inspection reports, can be obtained from the Registered Manager, Mrs Preston. Care Homes for Older People Page 5 of 33 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 inspection consisted of an unannounced visit to the home by one inspector between 9.15am and 2.45pm on Wednesday, 18th March 2009 and a further visit between 1.45pm and 3.45pm on Friday, 20th March 2009. The inspector was accompanied by an Expert by Experience. We last inspected this service on the 13th December 2006. Throughout this report, the term we will be used as the report is written on behalf of the Commission for Social Care Inspection. An Annual Quality Assurance Assessment (AQAA) was completed by the home prior to the inspection. The AQAA is a self-assessment that focusses on how well outcomes are met for the people who live in the home. A tour of the premises took place and records relating to care, staff and the home were inspected. Care Homes for Older People Page 6 of 33 Twelve people living in the home were spoken with during the visit and seven surveys were returned from them, although some of these had been completed by relatives. Four visitors were spoken with and two surveys were received from relatives. Three staff members were spoken with and four surveys were received from staff. One survey was received from a healthcare professional. The Registered Manager was available for consultation and discussion during the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: Before someone comes to live at Dewi Sant an assessment of their health and social care needs is carried out to ensure that the home is suitable, that any required equipment is available, and that the staff team are experienced, skilled and competent to meet the persons needs. However these assessments need to be documented and include all aspects of personal, health, psychological and social care needs to ensure that peoples needs are fully identified. Once a person moves into a care home, or before, a care and support plan has to be developed with that person and/or relatives and representatives to agree on what care the person needs and how the staff team should support them. The care plans in the home need to include all aspects of peoples care needs and how the staff should meet those needs. The plans should include risk assessments for those people deemed to be at risk of falling, night-time routines, communication needs and details of peoples social activities, interests, hobbies and aspirations. Care plans should be signed by people who live in the home and/or relatives/representatives to show that they have been involved in drawing up the plan and are aware of the content. The use of the word problem in the care planning system should be changed to terminology that has more positive connotations. This is so that anyone reading the care plan does not see someones care needs being portrayed as problems. Whilst the people in the home said they liked the food, they should be made aware that they can have a cooked breakfast and a hot alternative to the main lunchtime meal each day. If someone is on a soft diet or needs their food liquidised, meals should still be presented in a manner which is Care Homes for Older People Page 8 of 33 attractive and appealing in terms of texture, flavour and appearance, in order to maintain appetite and nutrition. The medication administration records in the home should be signed on every occasion when medication is administered to the people who live there. This is so that there is an accurate record of when medication is administered to ensure that people are given the correct medication. Medication brought in and taken out of the home by relatives should be clearly recorded so that there is an accurate audit trail of medicines in and out of the home. A robust recruitment procedure is necessary as the first step towards keeping the people who live in the home safe from harm and it has not been followed recently. Therefore before appointing a new member of staff all the required checks and references need to be obtained. These include a check against the Protection of Vulnerable Adults list, a Criminal Records Bureau check and a full employment history. If a person is employed in the home prior to receiving a satisfactory check from the Criminal Records Bureau, this person must be supervised by a designated staff member at times, and must not escort people who live in the home away from the premises. Written references for new staff members should be signed and dated by the person who wrote them so that is is clear who they are from and when they were written. Personnel files for all staff members must be kept in the care home and be available for inspection. This is to ensure that recruitment procedures are robust enough to provide support and protection to the people who live in the home. The number of care staff on duty should be sufficient to meet the needs of the people who live in the home without the Registered Manager being one of that essential number. This is to ensure that the quality of care is not affected should the Registered Manager be called away for any reason. Whilst some staff have received occasional one to one supervision sessions with the manager, these were not happening as regularly as they should and need to include all aspects of practice, the philosophy of care in the home and career development needs. This is so that staff receive the support they need to do their jobs well. Overall, health and safety practices were satisfactory however the home needs to obtain an up-to-date electrical wiring certificate to verify that the electrical system is safe; and obtain advice about the type of lock that should be fitted to bedroom doors where bedrooms are also fire exits to make sure that people can get out of the home if there is a fire. The complaints procedure should be updated with the name of the present Registered Manager so that people know who to go to if they wish to raise a concern or complaint. The home has a quality assurance system in place that asks for feedback from the people who live in the home and relatives or representatives. This system would be more comprehensive if it included an annual internal audit of the facilities and services in the home. The Registered Provider should document the monthly visits and supply a copy of the report to the Registered Manager. This is so that the Registered Manager has clear information about the conduct of the care home and is given structured guidance about any changes that need to be made. Also, if a robust internal auditing system was in place, it would have identified the issues raised in this report. 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. Care Homes for Older People Page 9 of 33 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 33 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 33 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. Pre-admission processes are in place to ensure that peoples needs are properly identified and planned for before they move into the home. Evidence: Information in surveys from people who live in the home confirmed that they were given information about the home, and had opportunities to visit, before they moved in. A relative said she visited several homes and Dewi Sant ... has proved to be the right choice and [my relative] is very happy there. Discussion with the Registered Manager confirmed that, before people come to live in the home, she carries out a thorough inital assessment of their physical, psychological and social care needs to decide whether the home can meet them. The files of three people who had recently been admitted to the home were inspected and these contained pre-admission assessments of their needs. However the information was very brief and did not include all aspects of peoples health and social care needs. Care Homes for Older People Page 12 of 33 Evidence: Surveys from staff members confirmed that they have enough information about peoples needs to provide the care required. The admission process includes visits to the home to meet the other people who live there and staff, so that people have a chance to assess the quality, facilities and suitability of the home. Dewi Sant does not provide intermediate care. Care Homes for Older People Page 13 of 33 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. People who live in the home are treated with respect and personal support is offered in a way that promotes peoples privacy and dignity. There are arrangements in place to ensure that medication is administered in a safe way. Evidence: Those people able to comment, as well as surveys from people who live in the home and their relatives, confirmed that the staff provide personal care in a respectful way that preserves peoples privacy and dignity at all times. Staff were observed knocking on bedroom doors before entering people said that the staff always make sure bedroom, bathroom and toilet doors are closed when personal care is being given. Discussions with people living in the home, as well as the Registered Manager, confirmed that people could have their own telephone in their bedrooms, at their own expense, if they wished to. However the home had a telephone system with portable handsets and people could use this to make and receive private telephone calls. Comments included: I am very well looked after since coming here; Dewi Sant has been a positive move for mum, she always looks nice and personal hygiene is excellent; and the staff are very caring and helpful to my [relative] ... and the staff Care Homes for Older People Page 14 of 33 Evidence: ... understand her moods and behaviour. People who were able to comment, feedback from relatives and staff, as well as information contained in personal files, confirmed that people living in the home have access to health care services such as doctors, district nurses, community psychiatric nurses, dentists, chiropodists, opticians and hospital consultants. Surveys from people who live in the home, as well as from relatives and a healthcare professional, showed that the care people receive from the staff team was very good. Equipment to promote peoples health and well being was provided including equipment for promoting pressure area care and to prevent skin breakdown. The files of three people who lived in the home were inspected and these contained individual care plans with extremely brief information on care needs and how staff at the home would meet those needs. Peoples files contained the names and addresses of their relatives and representatives so that staff knew who to contact should they need to. Each file contained recently reviewed and updated risk assessments relating to falls, skin/pressure area care, moving and handling and nutrition. However the care planning documentation did not contain any information about peoples social and personal histories, or their previous lifestyles, interests and routines. There were no documented risk assessments in place for people identified as being at risk of falling; there was no information regarding peoples night-time routines and no information about peoples communication needs. Also the system being used referred to areas of need as problems. A discussion took place with the Registered Manager about changing the terminology to something more positive so that areas of need are not seen as problems but as identified needs where people may require assistance. By the last day of inspection the Registered Manager had devised a better proforma for care planning to ensure that all aspects of peoples care would be included so that staff knew what care they should be giving. Information about each person living in the home was recorded on a daily basis and it was this information that staff followed to ensure consistent care to the people in the home. Medication was stored securely and most of it was administered from blister packs prepared by a local pharmacist. Records relating to the administration of medication were generally up-to-date although there were a few gaps where there was no signature to say medication had been administered, but the medication was not in the container. Also medication brought in or taken out of the home by relatives was not being clearly recorded so there was no accurate audit trail of medication in and out of the home. The Registered Manager confirmed that staff who were responsible for administering medication have received training from the local pharmacist ensuring they are competent and confident to administer medication in a safe way. Care Homes for Older People Page 15 of 33 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 routines in the home are relaxed, relatives and friends can be confident that they are welcomed, and social activities are arranged. The dietary needs of the people who live in the home are catered for with a balanced and varied selection of food that reflects their tastes and choices. Evidence: The home has an activities programme giving people the opportunity to take part in a variety of activities within the home. In-house activities included bingo, craft sessions, physical exercises, quizzes, large-scale crosswords and visiting musicians and entertainers. Large-scale jigsaw puzzles were available for people with dementia to use. Staff from the local museum visited and facilitated reminiscence groups or discussions, for example, about fashion through the ages. A member of care staff was also the activities organiser but there was no allotted time for the activity duties. This meant that caring duties tended to come first and she could only organise activities when she had time. However discussions with the people who lived in the home, as well as information in surveys from them and their relatives, indicated that people were content with the programme of activities. Comments included: I really enjoy the music men and quizzes; Mum enjoys the different activities going on most days of the week. The music days are especially good and mums quality of life has improved Care Homes for Older People Page 16 of 33 Evidence: because of these; and the residents are always encouraged to interact and join in with all the activities. The Registered Manager said that no trips out of the home had taken place for some time because people did not want to go but they would be arranged if requested. However care staff did escort people individually to the local shops or out for a picnic if they wished to go and many people went out with family members. Peoples religious interests were documented in their personal files and the Registered Manager confirmed that people would be enabled to attend a local church or other place of worship if they wished to go. Family and friends were observed visiting the home and it was evident that they were actively welcomed into the home and may visit whenever they liked. A relative commented that I am always made to feel very welcome here. People who lived in the home were complimentary about the meals provided. People said that a new chef had recently started working in the home and we are trying him out and so far he seems good. Surveys received from peoples relatives included comments such as Mum has a good appetite and enjoys the meals very much. The menus showed that there was one hot main meal at lunchtime and cold alternatives were available. Discussion with the Registered Manager indicated that alternative hot meals would be provided on request but the people living in the home did not seem to be aware of this, neither did they know they could have a cooked breakfast if they wanted one. We tried the main meal at lunchtime and it was well presented, fresh, hot and tasty with good quality meat and we observed that most people ate all the food on their plates. One person was assisted in a discreet manner by a carer alongside and others were given words of encouragement by the staff serving the meal. Lunch was served in two sittings so that staff could pay proper attention to people whilst they were eating their meal and provide assistance if necessary. Special diets, such as diabetic, were catered for and dietary needs were documented in peoples personal files. Discussion with a staff member responsible for catering showed that, if a person needed their food liquidised, she would put all the items together rather than liquidising them separately so that it was easy to differentiate between the food items, for example, meat and vegetables, on the plate. Care Homes for Older People Page 17 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home can be confident that any complaints or concerns will be listened to and acted upon by the home. Evidence: The homes written complaints procedure was displayed in the hallway as well as a copy being given to each person who lives in the home. However this was out of date as it still referred to the manager who left some years ago. Surveys from people who lived in the home and their relatives confirmed that they know how, and to whom, to make a complaint should they need to. People living in the home, who were able to comment, said they would talk to the staff on duty if they had any concerns, and this was observed during the inspection. Comments included The manager is always available to my family with any concerns we might have and the manager is always happy to help as are all the staff. All the surveys we received from the people in the home and their relatives confirmed that they have no complaints about the home. The Commission for Social Care Inspection received a complaint about the home in 2008 which was passed to the Registered Manager who investigated the issues raised thoroughly. The home keeps a complaints log where all concerns and complaints are recorded as well as the details of any investigation and actions required. The home had a visitors book to record dates, times and names of all visitors to the home. The staff training records in the home showed that all staff were expected to complete in-house training related to the safeguarding of vulnerable adults as well as the Care Homes for Older People Page 18 of 33 Evidence: training provided by the Local Authority. This means they were aware of the local procedures to follow should an incident of abuse or neglect be suspected or alleged. Discussions with the Registered Manager and staff team confirmed that they were knowledgeable about the local processes in place to safeguard vulnerable people. Care Homes for Older People Page 19 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, comfortable and warm and the recent addition of a conservatory provides a better environment for the people who live in the home. Evidence: We looked all round the home and found it was warm, comfortable, clean and free from offensive odours. A relative commented in a survey that the home is very clean and mums room is always immaculate. The Registered Manager said that the home was in the process of a phased internal refurbishment programme but this had been delayed as the roof developed leaks in the winter and had to be replaced. The shared rooms consisted of two large lounge rooms, which have a variety of seating for people to use, and a dining room. One of the lounge rooms had a very large television with the volume turned up high and the other lounge, referred to as the quiet lounge, also had a television but with the volume set at a lower level. Since the last inspection a conservatory has been added at the back of the home, with a patio around it, and several people were sitting and talking in this room. The bedrooms are located on each floor and there are stair lifts to assist people with mobility difficulties. However some of the bedrooms can only be reached by using stairs so the Registered Manager has to ensure that people who use those rooms can manage a few stairs with staff support if necessary. Whilst the home is registered for thirty-four people, only thirty-three single bedrooms were available for use at the time Care Homes for Older People Page 20 of 33 Evidence: of inspection. One bedroom on the 1st floor was no longer being used as a bedroom as it is very small and has a very steep internal fire exit leading from it, therefore the Registered Manager deemed it unsuitable for people to use. Bedrooms were well decorated and contained many personal possessions. The Registered Manager confirmed that most people have keys to their own bedroom doors and the staff have a master key so they can gain access in an emergency. The home had four bathrooms, one with a bath hoist and the others with bath seats, and eight toilets. These were located close to bedrooms and communal areas so people could easily access them. The home was heated with electric storage heaters that had been guarded to reduce the risk of people being burnt. The Registered Manager confirmed that thermostatic valves, to reduce the temperature of hot water so that people are not scalded, are installed on all the baths. Laundry facilities were in an outbuilding in the garden but this did not have impermeable flooring and the wall finishes could not be easily cleaned. The Registered Manager confirmed that the laundry room is included in the present refurbishment programme. Appropriate arrangements for controlling the spread of infection were seen including gloves and aprons being available for staff to use. There were covered systems in place for transferring soiled and potentially infected linens between bedrooms and the laundry. Whilst no-one specifically mentioned the quality of the laundry service, relatives commented that the home is kept very clean and hygiene is always very good and bedding is always clean and fresh. People were observed dressed in clean, ironed clothes. Care Homes for Older People Page 21 of 33 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. Sufficient numbers of caring, well trained, staff support the people who live in the home. Recruitment practices are not sufficiently robust to protect the people who live in the home from risk of harm. Evidence: Information contained in staffing rotas, as well as discussion with the Registered Manager, showed that there were usually five care staff on duty in the mornings and four care staff in the afternoons. They were supported by catering, domestic and maintenance staff. A member of the staff team was also designated to organise activities each day. At night there were two waking staff members and the Registered Manager was on call if needed. Surveys returned from seven people who lived in the home and four staff members said that there were usually enough staff in the home to meet the needs of the people who lived there. One relative commented that there are always several members of staff around, always busy and happy to help. However the Registered Manager was expected to work shifts as part of the care team working directly with the people who lived in the home. This meant that she was not always available during the week to meet with health or social care professionals and, if they turned up and needed to speak with her, the staff team may be left short. Also some management duties, for example, ensuring that all paperwork and documentation is kept up to date, have lapsed. A relative commented: I am aware that the manager is part of the working team on the floor which I dont feel is best practice. Care Homes for Older People Page 22 of 33 Evidence: People who lived in the home and their relatives, as well as information in surveys, indicated that the staff were respectful, polite and caring. Comments included: The staff are always happy to help mum and me and answer any questions I have relating to mums care and health; the staff are marvellous, very good and very caring; and all the staff are very caring and understand everyones needs; they are always cheerful which makes a good atmosphere. Information from staff confirmed that there is a low turnover of staff and we are always on courses so we know what our job is all about. Most staff files were not available in the home for inspection. We examined one file and parts of another file. These showed that the required checks and references were not obtained before people started working in the home. The one file that could be inspected showed that the person was employed for over two months before a check was received from the Criminal Records Bureau and there was no evidence that a check against the Protection of Vulnerable Adults list had been obtained. Whilst there were two written references, these were not signed or dated, so it was unclear who had written them and when they had been received, and a full employment history had not been obtained. Obtaining this information is important to make sure that staff are suitable to care for the people who live in the home. The Registered Manager confirmed that all new staff are expected to complete a structured induction programme within the first few weeks of appointment. Discussions with staff members, as well as information contained in surveys, confirmed that the induction training was comprehensive and covered everything they needed to know to do their job. Staff spoken to said they worked well as a team and that Dewi Sant was a good place to work. In particular they praised the training available to them and the support they receive, from both peers and management, to do their job. One staff member commented that the manager says you need to learn all the time demonstrating a management commitment to ongoing training for staff. Staff training records showed that most of the care staff (twenty out of twenty two) have obtained qualifications in caring for older people, namely National Vocational Qualifications (NVQ) at level 2 or 3, and one person was in the process of obtaining a level 2 NVQ. All care staff were expected to participate in a course about how to provide care for people with dementia. In addition staff were expected to complete training in moving and handling, emergency first aid, health and safety, food hygiene, infection control and safeguarding vulnerable adults. These records also showed that staff had opportunities to participate in more specialised training such as palliative care, anxiety and depression and communicating with families. Surveys from four staff Care Homes for Older People Page 23 of 33 Evidence: members confirmed that they have good training opportunities and consider that they have enough training to do their jobs well. A relative, in a survey, commented that the staff seem very well trained and feedback from a healthcare professional said that the staff are well trained, friendly and approachable. Care Homes for Older People Page 24 of 33 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. People living in the home can be confident that it is generally well managed. The health, safety and welfare of the people living in the home are promoted and protected. Evidence: The Registered Manager, Mrs Preston, has been managing Dewi Sant for a few years. She has attained qualifications in care and management, namely a level 4 National Vocational Qualification and the Registered Managers Award. She has also undertaken a specialist course about working with people with dementia. She undertakes periodic training to update her knowledge, skills and competence, for example, knowledge of the Mental Capacity Act and how that may affect people who live in the home, and the importance of nutrition for people with dementia. Mrs Preston operates an open door policy and feedback from people who lived in the home, their relatives and staff indicated that she is very supportive and always available to discuss any issues or concerns with them. Comments included: Jennie the manager is always happy to help; the manager is always available to my family with any concerns we might Care Homes for Older People Page 25 of 33 Evidence: have; I have found that Dewi Sant is more than meeting [my relatives] needs and cant fault it. Jennie Preston runs it very well ... They provide an excellent service and I have daily meetings with my manager to discuss any points which need to be brought to my attention. Also the manager has regular staff and residents meetings. Discussion with the Registered Manager, as well as documentation and surveys from staff, showed that the staff have regular staff meetings and 1:1 supervision meetings, although these were not happening very often. Training records showed that care staff were expected to complete training in emergency first aid, food safety/hygiene, moving and handling, infection control and health and safety. Discussions with the Registered Manager, as well as documentation, confirmed that the financial affairs of the people who lived in the home were managed by themselves, their families or representatives. The home did administer spending money on behalf of some people who lived in the home and records relating to the money of three people were checked and found to be correct. The fire safety equipment records showed that checks and tests of the fire safety equipment were carried out regularly and a local contractor services the fire alarm system and fire extinguishers at least annually. Information contained in the staff training records showed that staff had received training in fire safety awareness and/or had attended a fire drill. Newly appointed staff had received training in fire safety procedures on the first day of employment as part of the induction process. Whilst looking around the home we found that one of the bedrooms (Room 33) was also a fire exit but the lock on the door was not connected to the fire alarm system so would not automatically open if the fire alarm was activated. The home was heated with electric storage heaters that had been guarded to reduce the risk of people being burnt. The Registered Manager confirmed that thermostatic valves, to reduce the temperature of hot water so that people are not scalded, were installed on all the baths. The Registered Manager also confirmed that procedures were in place to reduce the risk of legionella occurring. The home had an electrical wiring certificate dated 25th May 2005 which said it should be re-examined in three years. However there was no evidence to show that the electrical wiring had been checked in 2008. Documentation showed that all portable electrical appliances in the home had been checked for safety in January 2009. Servicing records showed that the hoists and stair lifts had been serviced recently. The home had a quality assurance system in place and questionnaires were distributed to people living in the home on a regular basis. The results were collated and any Care Homes for Older People Page 26 of 33 Evidence: points for improvement noted and acted upon. However the Registered Provider was not documenting the required monthly visits and no annual internal audit of the services and facilities in the home had been carried out. Care Homes for Older People Page 27 of 33 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 28 of 33 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 29 19 No person must be 30/06/2009 employed in the care home before all the required checks and references have been received and are satisfactory. These include a check against the Protection of Vulnerable Adults list, a Criminal Records Bureau check and a full employment history. If a person is employed in the home prior to receiving a satisfactory check from the Criminal Records Bureau, this person must be supervised by a designated staff member at times, and must not escort people who live in the home away from the premises. This is to ensure that suitable people are employed and protect the people who live in the home from risk of harm. Care Homes for Older People Page 29 of 33 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 2 29 17 Personnel files for all staff members must be kept in the care home and be available for inspection. This is to ensure that suitable people are employed and protect the people who live in the home from risk of harm. 30/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 All the information obtained during pre-admission assessments should be documented to ensure that peoples needs are fully identified. This should include all aspects of personal, health, psychological and social care needs. Care planning documentation should be improved so that it includes all aspects of peoples care needs and how the staff should meet those needs. The plans should include risk assessments for those people deemed to be at risk of falling, night-time routines, communication needs and details of peoples social activities, interests, hobbies and aspirations. Care plans should be signed by people who live in the home and/or relatives/representatives to show that they have been involved in drawing up the plan and are aware of the content. The use of the word problem in the care planning system should be changed to terminology that has more positive connotations. This is so that anyone reading the care plan does not see someones care needs being portrayed as problems. The medication administration record should be signed on every occasion when medication is administered to the people who live in the home. This is so that there is an accurate record of when medication is administered to ensure that people are given the correct medication. Medication brought in and taken out of the home by Page 30 of 33 2 7 3 9 Care Homes for Older People 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 relatives should be clearly recorded so that there is an accurate audit trail of medicines in and out of the home. 4 15 The people living in the home should be made aware that they can have a cooked breakfast and a hot alternative to the main lunchtime meal each day. Liquified meals should be presented in a manner which is attractive and appealing in terms of texture, flavour, and appearance, in order to maintain appetite and nutrition. The complaints procedure should be updated with the name of the present Registered Manager. This is so that people know who to go to if they wish to raise a concern or complaint. The number of care staff on duty should be sufficient to meet the needs of the people who live in the home without the Registered Manager being one of that essential number. This is to ensure that the quality of care is not affected should the Registered Manager be called away for any reason. Written references for new staff members should be signed and dated by the person who wrote them so that is is clear who they are from and when they were written. The quality assurance system should be developed to include an annual internal audit of the facilities and services in the home to ensure that the aims, objectives and statement of purpose are being met. The Registered Provider should document the monthly visits and supply a copy of the report to the Registered Manager. This is so that the Registered Manager has clear information about the conduct of the care home and is given structured guidance about any changes that need to be made. All staff should receive formal supervision at least six times a year to include all aspects of practice, the philosophy of care in the home and career development needs. This is so that staff receive the support they need to do their jobs well. The electrical wiring system in the home should be checked by a competent person to make sure it is safe. Advice should be sought from a fire safety consultant to decide on the type of lock that should be fitted to bedroom Page 31 of 33 5 16 6 27 7 29 8 33 9 33 10 36 11 12 38 38 Care Homes for Older People 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 doors where bedrooms are also fire exits. This is to make sure that people can get out of the home if there is a fire. Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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