Inspection on 26/11/08 for Donnington Nursing Home

This inspection was carried out on 26th November 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Donnington Nursing Home 01/12/06

Donnington Nursing Home 13/12/05

Donnington Nursing Home 14/07/05

Donnington Nursing Home 02/11/04

Donnington Nursing Home 03/06/04

Donnington Nursing Home 26/02/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 27/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Donnington Nursing Home Wantage Rd Newbury Berkshire RG14 3BE     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: Helen Dickens     Date: 2 6 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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: Donnington Nursing Home Wantage Rd Newbury Berkshire RG14 3BE 01635521272 01635582210 tayljo@Bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): BUPA Care Homes (CFC Homes) Ltd The registered provider is responsible for running the service Name of registered manager (if applicable) Miss Joanne Kate Taylor Type of registration: Number of places registered: care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Chronically disabled adults under the age of 65 years will not be received except for convalescent or respite care for periods not exceeding three weeks. Date of last inspection Brief description of the care home The Donnington Residential and Nursing Home was originally a large private house built in the late 19th Century that has been extended and converted. The home, which is owned by BUPA, is registered to provide care with nursing for up to 45 older people. The home is located approximately 1.5 miles from Newbury and is in a secluded area away from shops and other facilities. The home enjoys the benefits of an activities organiser who provides a varied programme of in house arts and crafts; exercise Care Homes for Older People Page 4 of 31 Over 65 45 0 Brief description of the care home classes and trips out. The home also has a computer available for the exclusive use of service users. 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 inspection was unannounced and took place over 6 hours. The inspection was carried out by Mrs. Helen Dickens, and the Acting Manager and Chef Manager represented the establishment. The Registered Manager who has been away for 6 months is returning to the service on 1st January 2009. A partial tour of the premises took place and a number of files and documents, including three residents care plans, staff training and recruitment files, quality assurance information, and the annual quality assurance assessment (AQAA), were examined as part of the inspection process. The inspector saw most residents who were in the home on the day of the inspection and went to each table in the dining room at lunchtime. Three residents, and five members of staff were spoken with in Care Homes for Older People Page 6 of 31 more detail. The current fees at this home are range from 800 to 1,000 pounds per person per week. The inspector would like to thank the residents and staff for their time, assistance and hospitality. What the care home does well: Donnington offers a very pleasant and homely environment which is currently undergoing significant refurbishment and redecoration. Residents spoke well of the staff and there is a relaxed and happy atmosphere within the home. Those spoken with were pleased with their rooms, the meals on offer, and the activities. Residents are encouraged to raise any areas of concern and spoke freely with the inspector on some minor matters, confirming that problems reported to staff were taken seriously and dealt with promptly. Care plans are kept in individual residents rooms which fosters a more inclusive care planning process. Residents confirmed they and their families were involved in drawing these up, and reviewing the contents. Two care plans sampled were completed to a very high standard with very detailed information about how residents would like their support to be delivered. Residents are offered many opportunities to exercise choice and control over their daily lives and they are encouraged to be as independent as possible. Arrangements for activities and social opportunities are excellent at Donnington, with a full time and very enthusiastic activities co-ordinator. The activities calendar sampled for December showed that most days there were two or three different activities. In addition to regular activities there was a festive theme covering tree decoration, two pantomimes, carol singing, bell ringers, Christmas baking and craft work, and poetry readings. Meals and mealtimes are very organised at Donnington and the chef manager and staff have been complimented by the Environmental Health Officer for their Exceptionally clean and well run kitchen. The dining areas are very pleasant and those residents needing assistance were observed to be well supported. The menu offers a variety of foods and residents have a choice of cooked breakfast, two hot main courses at lunchtime, and a variety of supper dishes. Residents spoken with confirmed they usually had breakfast served in their bedrooms, and could have any other meals served in their room if they wished. Sufficient domestic staff are employed and this ensures the home is clean and fresh throughout. There is also a full time laundry worker who manages all the residents laundry, as well as the bedlinen which is laundered and ironed on the premises. A full time maintenance worker ensures that day to day repairs are managed, and that health and safety matters are properly monitored. Staff training is well organised with a part time trainer arranging both in house and external staff training, on a rolling programme. The home also exceeds the Standard recommending that in addition to trained nurses, at least half of the care workers have an NVQ qualification in care. In the absence of the manager, who will be returning to the service after Christmas, there was strong evidence of staff working together for the benefit of residents and to maintain the good reputation of the home. All staff spoken with were keen to be Care Homes for Older People Page 8 of 31 involved in the inspection process and to demonstrate how their role contributed to the overall welfare of residents. What has improved since the last inspection? 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 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 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. The home ensures no resident moves into the home without having his or her needs assessed and been assured that these will be met. Evidence: The AQAA completed by the home prior to this inspection stated that The QUEST programme ensures that we provide resident centred care. The file of the most recent resident was sampled and the QUEST format had been used to document the assessment information. It covers all aspects of daily living and was completed in full. Assessments are carried out by trained staff and specialist assessments from other professionals are also recorded, for example speech and language therapists. Nursing assessments are carried out and copies were kept on file including skin viability (using the Waterlow assessment) and nutrition (using the MUST nutritional assessment tool). A copy of the assessment is kept in each residents bedroom in a folder. Three residents spoken with and specifically asked about their involvement with their Care Homes for Older People Page 11 of 31 Evidence: admission said they had been consulted and involved in their assessment and drawing up their care plan. Two residents said their relatives had also been very involved in the process. Information relating to the home and the service offered (the Statement of Purpose and the Service User Guide) can be found in a folder in each residents room, and displayed in the communal hallway area. Care Homes for Older People Page 12 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. Care plans reflect residents personal and social care needs, and the practice of keeping these plans in each residents room promotes their inclusion in the care planning process. Arrangements for meeting residents health needs, and administering medication are good. Residents are treated with dignity and respect by staff. Evidence: Three care plans were sampled, including two for longer standing residents. These were in the BUPA format and very well done. They had been drawn up using the initial assessment information. Care plans are kept in residents room and those people spoken with confirmed they and their families were involved in drawing these up. Care plans covered all relevant areas and included risk assessments in relation to moving and handling, and mobility. There was a section entitled familys expectations and this covered, for example, who in the family would be the first point of contact, and when they would like to be contacted. The level of detail on how to support residents is excellent. For example one resident who has glasses and a hearing aid had a care plan Care Homes for Older People Page 13 of 31 Evidence: section just on these two issues including assisting the resident to clean their spectacles. The third care plan, for the newest resident, was incomplete. The resident had been at the home for more than a week yet the care planning section gave no instructions to staff on how to support the resident with personal care. The acting manager and staff nurse followed this up immediately. The remainder of the care plan had been completed by the following morning and this was confirmed to CSCI by telephone. This resident was spoken with during the inspection and they said they were happy with the care provided, and raised no concerns about the help they were given by staff. Health needs of each resident are recorded on their care files for example in relation to their nutrition. The home uses the MUST nutritional risk assessment tool which is a well recognised method of assessing the nutritional needs of each person. Residents are weighed regularly and weights noted on their record. Several residents spoken with confirmed they were weighed and one told the inspector their weight had been monitored since they arrived and they had put on weight initially. They thought this was in part due to having a cooked breakfast which they did not have when they lived at home. Daily notes record any health matters and there are separate areas within the care folder for the GP and other visiting professionals to record their visits and advice. Residents confirmed that a doctor is called if needed and one described how the home had followed up to ensure they got the flu jab. Other nursing assessments are carried out, such as skin viability using the Waterlow assessment format. The home monitors any pressure ulcers and the two residents who had these at the time of the inspection, already had them when they were admitted. Records showed that both were improving. Each residents medication is listed in their care folder, together with any allergies. There are opportunities for both mental and physical stimulation including activities such as quizzes and word games, current affairs sessions, and gentle exercises to music The AQAA states that additional services such as chiropody, the optician, and dental services are made available at the home. Medication is administered by trained staff and according to BUPA procedures. A community pharmacist inspects the medication administration arrangements and the last inspection was carried out in March 2008. A detailed report was compiled by the pharmacist looking at administration, stock control and medication records, with only a few suggestions for improvements being made. The acting manager said that the issue raised in relation to the medication fridge not being cold enough has since been remedied. The acting manager carries out a monthly internal audit of medication records to ensure that good standards are maintained. Care Homes for Older People Page 14 of 31 Evidence: Residents raised no negative issues in relation to dignity and respect and those spoken with said that staff treated them well. Staff were seen to knock on doors before entering and to include residents in their conversations rather than staff talking exclusively with each other. Staff training is very well organised and all new staff have an induction which covers treating residents with respect. All new staff also have a course which promotes good customer care. Care plans have a map of life for each resident which is completed with the resident and their family, setting out some brief information about their history, family ties, interests and hobbies, and this enables staff to see residents in a more holistic way. The laundry has a named basket system to ensure all residents get their own clothes back after laundering, and residents were observed to be dressed very individually. It was noticeable that the ladies in particular had very well kept hair and several residents commented on the fact that they had a good hairdresser who comes twice per week. Residents were addressed according to their preferred name and it was noted that this was then translated into their care plans and even onto the kitchen breakfast board where some are referred to by their first name or nickname, and others by Mr. or Mrs. The practice of keeping care plans in residents own rooms fosters an inclusive approach to providing care and shows respect for each resident. One of the newest residents was interviewed during the inspection and they said that Staff are very nice and they do their best. This person said they preferred to eat in their room, and staff respected this choice. Several residents were seen to have large key pad telephones which would enable those with a sight impairment to make calls themselves, rather than rely on staff to dial for them, again protecting their privacy and encouraging independence. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for ensuring residents social, recreational and faith interests are catered for are excellent at Donnington. Community and family involvement is encouraged, and residents are given plenty of opportunities to exercise choice and control over their lives. Residents benefit from having well organised catering arrangements and a nutritious diet. Evidence: Arrangements for activities and socialising at Donnington are excellent. They have a full time activity co-ordinator who was interviewed during the inspection. She is enthusiastic and energetic, and, when she is not around, usually at the weekend, a designated care worker will engage residents in an activity left out by the co-ordinator. There are planned activity sessions over the course of each week and an evaluation form is completed by the co-ordinator about who joined in and to what extent. Residents are each given a copy of the monthly programme of activities and a copy is put on each of three notice boards in the home. The Christmas programme includes Christmas tree dressing, PAT the dog visits, Care Homes for Older People Page 16 of 31 Evidence: current affairs morning, Christmas poetry reading, Christmas card craft, Christmas Fair, hand bell ringers, and a pub lunch. There are visiting entertainers including the local Brownies, and Carol singing by local school children, plus two Pantomimes, one performed as an an annual event by the staff at Donnington, rehearsed and arranged entirely in their own time. On some days there are up to 3 different activities. Residents are encouraged to keep up any hobbies or interests of their own and one resident told the inspector they liked listening to their radio in their room. Residents opinions are sought both during residents meetings, and on a regular basis by the activities co-ordinator who was able to give examples of how residents opinions had shaped the current programme of activities. There are also clubs at Donnington including a Ladies at Lunch Club, and the more recently formed Gentlemans Society Club. The home took part in the BUPA Mediterranean cruise, whereby residents experienced some cultural or informative experience from each country visited. Following on from this idea, the activities coordinator has started her own bus tour from Lands End to John O Groats. Residents have the opportunity to sample different foods or experiences relating to each stop. For the start of the tour in Cornwall she said she persuaded a bus company to bring a low loader bus to the home, and residents sampled Cornish pasties on board. All current residents who specify a faith connection are Christian and there are priests and ministers from the main Christian religions visiting the home, including Catholic, Methodist, and Church of England. There is a mobile library, a monthly visit from a physiotherapist for exercises, and then weekly exercises led by the activity coordinator. Two different activity sessions were observed during the inspection and on both occasions residents were seen to be joining in and enjoying themselves. The more frail residents were supported to take part and the co-ordinator was very knowledgeable on individual residents likes and dislikes in relation to social activities. Residents are encouraged to maintain family and friendship links and relatives are invited to joint resident and relatives meetings twice per year. Residents spoken with talked about their families visiting and when asked, confirmed their families were made welcome at Donnington. Several described how their families had brought in items to help them personalise their rooms, and one resident had a very decorative selection of mobiles and wind chimes brought in by their family. Residents care plans included a specific section on family involvement. Connections with the local community are noted above under activities and in the coming month these would include visiting faith groups, local schools coming in to chat with residents and to Care Homes for Older People Page 17 of 31 Evidence: entertain, the Brownies are carol singing, and there are some joint social events planned with other local BUPA homes. PAT the dog visits are made to this home, and residents also have the opportunity to go out, for example in December there are visits to the garden centre, a pub lunch and a pantomime. Residents are given good opportunities to exercise choice and control over their daily lives at Donnington. For example in relation to meals where residents choose their lunchtime and supper options after breakfast, by filling in a menu options card. Another way that a home can ensure residents exercise choice and control over their lives is to ensure care plans clearly state how residents say they would like to be supported. At Donnington care plans were very detailed on all aspects of support, especially residents personal care, and these are kept in their bedrooms. Meals and mealtimes are very well done at this home and the chef manager and staff have been complimented by the Environmental Health Officer. On the last visit from the EHO the report stated that Donnington had an Exceptionally clean and well run kitchen. Excellent in all aspects of cleaning, preparation, cooking, storage and stock rotation. BUPA uses the Menu Master system to ensure meals are nutritionally balanced. When asked about how the home ensures residents get sufficient fruit and vegetables for example, the chef pointed to the breakfast board where fresh fruit, fruit juices and fruit smoothies are offered, and to the lunch menus where there are always two vegetables and sometimes a fruit pudding. Supper always involves a fresh fruit option. Salads are available for lunch or supper as an alternative to the hot meals, and can be served with baked potato, omelette, or cold meat. Residents spoken with confirmed they had a choice of meals and that they were able to discuss menus at residents meetings. It was noticeable how residents spoke freely to the inspector during the lunch period and several mentioned small issues they had raised, which had now been rectified by the chef. The chef manager said she always responds personally to residents who have any problems with the meals at Donnington. It was later suggested by the inspector (to the acting manager) that the chef might consider visiting the dining room as a matter of routine after lunch on some days to ensure any comments are received directly to her, and to enable her to get feedback directly from residents. Those with special dietary needs are well catered for at Donnington. Those who need a soft or pureed diet are, in the main, given the same food as other residents. The chef described how each food item is pureed separately to maintain the colour and appearance, and is then served with a small scoop to ensure the food items on each Care Homes for Older People Page 18 of 31 Evidence: plate have some shape and remain attractive. Residents who need assistance are brought down to the dining room first and staff are made available to ensure they have the support they need. All residents have a nutritional risk assessment carried out on admission and they are weighed regularly. Food is available in the evening and at night from the Nite Bite menu. On the day of the inspection there was a roast pork lunch with all the trimmings, or a fish pie. The vegetables were leek and broccoli, and there was jelly and ice cream for sweet. The inspector sampled a teaspoon of each item on the main course plate and found the food to be both tasty and well presented. Some comments received in the dining room (including the lunch plates not being warm enough) were passed on to the acting manager for attention. Care Homes for Older People Page 19 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 that any complaints will be taken seriously, and they are protected from abuse. Evidence: The BUPA complaints procedure is in place, though no complaints have been received in the last 12 months at the home. CSCI has not received any complaints about this home since the last inspection. Residents all have a copy of the procedure in their rooms and there is a copy in the communal areas of the home. Residents are encouraged to give feedback in a variety of ways including residents meetings and annual surveys. The homes ethos and management empowers residents to speak up if they have any concerns or problems and this was evident when the inspector visited the communal areas such as the dining room. Residents were freely making comments on relevant issues, good and not so good, to the inspector and gave examples of issues they had raised in the past, that had been satisfactorily dealt with. All staff do a customer service training course when they first start work. The training co-ordinator was interviewed during the inspection and she highlighted the training arrangements for ensuring that residents are protected from abuse. She teaches this course in house and a training pack was sampled, and showed clear reference to local procedures and the local authority arrangements. One staff member who was later asked about training, immediately got out her own training handout and Care Homes for Older People Page 20 of 31 Evidence: showed the inspector the answer to a specific question on the safeguarding training. The trainer has a copy of the multi-agency procedures from the local authority and it was suggested she might obtain the leaflets that go with the procedures as these could be given out to staff as a quick reference guide. The course is taught as part of a rolling programme to ensure all staff have either had the full training or a refresher course each year. BUPA has its own safeguarding policy, and this is given to staff, together with the whistleblowing policy, which reminds staff about their duty to report any instances they become aware of, and what their rights are as an existing member of staff. One safeguarding incident has been raised at the home since the last inspection and the home worked with the relevant authorities to ensure the proper procedures were followed. This has now been satisfactorily concluded. Care Homes for Older People Page 21 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. Donnington provides a homely and comfortable environment which is clean and hygienic throughout. Evidence: Donnington offers a very homely environment which is well maintained and decorated. They have just started a major refurbishment programme which will ensure the inside of the home is decorated and furnished to a high standard. Residents bedrooms visited were found to be personalised and comfortable. Communal areas are also well furnished and pleasant. There is a full time maintenance worker employed to ensure the home is well looked after. The grounds are tidy and attractive. The previous Requirement on refurbishing bathrooms has been met. Donnington was described as excellent by the local environmental health department during the last visit to the kitchen, and the home has just won the BUPA fire awareness competition for fire safety procedures. The laundry was visited during the inspection and found to be clean and tidy, with good arrangements in place for managing the laundry. All sheets are washed and ironed in house, as are residents clothes. There is a full time member of staff looking after the laundry and she also carries out minor repairs for residents. The facilities in the laundry include commercial washers and driers, and a sluicing facility. There are Care Homes for Older People Page 22 of 31 Evidence: domestic and housekeeping staff at the home and the home is kept clean and fresh with no offensive odours in any part of the building. The acting manager said the home had just undergone an infection control audit, and the staff have training in this subject every two years. During the visit to the laundry some risk assessments were sampled and these did not cover the fact that the laundry door is not locked. The acting manager said this posed no risk to residents as the laundry and kitchen area are not accessible to residents, as a keypad on a linking door is only used by staff. The acting manager was asked to include this issue in the laundry risk assessment. Whilst the staff maintained there were no liquids or cleaning materials left in the laundry, on the day of the inspection there was a small bottle of floor cleaner left out which the acting manager and maintenance worker moved as soon as it was discovered. One bathroom had clean towels stored on open shelves. As there was a toilet in this bathroom, it was suggested that more suitable arrangements should be made. The acting manager said she would have these moved to the linen store along the corridor. Care Homes for Older People Page 23 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. Residents needs are met by the numbers and skill mix of staff, and Donnington exceeds the recommended percentage of care staff with a qualification in care. Recruitment arrangements are well organised but more work must be done to ensure all the required information is sought in regard to new workers. Training arrangements ensure staff are well trained and competent to do their jobs. Evidence: Staffing numbers and the skill mix of staff meet residents needs. There is a written rota in place, and more staff available at busy times. There were observed to be sufficient staff at lunchtime when several residents needed support to eat. Waking staff are on duty at night and the acting manager said she and a manager from another home make an unannounced visit on one night every month to monitor the standard of care at night. Housekeeping staff are maintaining the home in a clean and hygienic state, and there were no unpleasant odours in any part of the home. The inspector was told that staff are sometimes too busy to answer the call bells. The acting manager checked the print out from the call bell system for the last 2 weeks and, whilst on one single occasion there was a wait of 9 minutes, the average wait was 2-3 minutes. She said she would remind staff about the importance of answering the bells promptly. Care Homes for Older People Page 24 of 31 Evidence: Recruitment files at this home are well kept with clear dividers and all the documentation was easy to find. The BUPA checklist appears at the front of each file enabling the manager to tick off when all the relevant information had been returned. Two recent staff files were checked. Both had had POVAfirst checks, (to ensure they had not been deemed unsuitable to work with vulnerable adults) and one had also had their CRB returned. References had been taken up and identification checked. Interview notes had been kept, as well as records of each workers induction and their initial training. However, not all the information required by the Regulations had been followed up. Neither staff member had a full employment history, though one had only a short gap of 11 months. The BUPA checklist at the front of each folder does not have full employment history as an item to check which might help overcome this mistake in the future. There were issues with the references that had been taken up and this was discussed with the acting manager. A Requirement is being made to check that all staff files have all the information Required by the Regulations, and a copy of the latest Schedule 2 from the Regulations was given to the acting manager to photocopy. Training arrangements are well developed at Donnington as they have their own training co-ordinator, a qualified nurse, who works 12 hours per week. All staff have their own BUPA professional development folder, and records and certificates of all training attended is kept. There is a good rolling programme of mandatory training including safeguarding adults, infection control, fire, food handling (for all those involved with food), and health and safety. Induction courses for new staff now follow the Skills for Care format and the trainer could demonstrate that a random selection of new staff were in the process of completing their induction. Training and supervision for housekeeping and kitchen staff is managed by the chef manager. The home has a dedicated training room containing training records and resources, and a training matrix which shows which staff have completed each training course, and when refresher courses are due. Care Homes for Older People Page 25 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. Residents live in a well managed home, which is run in their best interests. Financial policies and procedures protect their financial interests. Health and safety arrangements promote the safety and welfare of residents and staff. Evidence: The registered manager has been away from the service for some months and returns in January 2009. In her absence the home has been supported by an acting manager (who is the registered manager from another BUPA service nearby) on a part time basis. There was strong evidence of staff working together for the benefit of residents and to maintain the good reputation of the home. All staff spoken with were keen to be involved in the inspection process and to demonstrate how their role contributed to the overall welfare of residents, this included the trainer, chef manager, activities coordinator, the laundry worker, and the maintenance man who were all interviewed during the inspection. Two staff nurses also assisted the inspector. There were clear lines of accountability within the home and the Requirements and Recommendations Care Homes for Older People Page 26 of 31 Evidence: made at the last inspection had all been met. The acting manager took full responsibility for the few shortfalls found during the inspection. Quality assurance processes are well developed and follow the BUPA policy including monthly visits on behalf of the provider, residents meetings, annual surveys given to residents and other stakeholders, and regular care plan reviews. There are also a variety of audits including on care plans, medication, health and safety, pressure ulcers, and unannounced monitoring visits to the home at night by the acting manager. The home uses the BUPA early warning audit tool which covers issues such as finance, health and safety, complaints and recruitment. There is an annual development plan and a planned refurbishment currently being carried out at the home. Residents finances are safeguarded and any involvement from staff is according to policies and procedures set down by BUPA, and financial records are kept. Some residents opt to let the home assist them with money for day to day expenses, and this money is kept in a bank account with interest shared between the residents. Two records were checked and receipts were seen in relation to hairdressing, outings and clothes. A report is printed off with an up to date record of how much each resident has left. There was evidence of payments being made on behalf of residents, for example to the hairdresser. There are comprehensive measures in place in regard to health and safety at Donnington and all staff are trained in relevant topics including fire training for staff. The home have just won an award for their fire safety awareness (in competition with over 300 homes) and will be buying a Wii sports console for residents with the prize money. There are quarterly health and safety meetings, and the maintenance man was extremely knowledgeable on the procedures in place to protect the home from legionella and described in detail the ongoing monitoring arrangements. Other health and safety measures were observed including decorative covers on all the radiators to prevent residents being burned, cones and notices where the refurbishment work had started, and lockable doors and storage for cleaning materials and for areas of the home which may be hazardous to residents. There were risk assessments on individuals files, for example in relation to nutrition, skin viability and moving and handling, and more generic risk assessments relating to hazards within the home such as using equipment or machinery. The acting manager agreed to add to the laundry risk assessment to cover the issue regarding the unlocked door. The small bottle of floor cleaner left in the laundry was immediately removed, though the acting manager said that the keypad entry system Care Homes for Older People Page 27 of 31 Evidence: to that part of the building meant residents would not have been put at risk. Care Homes for Older People Page 28 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 29 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 29 19 Staff files must be checked 01/01/2009 to ensure that all the information required by Regulation 19, and set down in Schedule 2, is on record for each staff member. For the safety and welfare of service users. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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