Inspection on 26/01/09 for Downham Grange

This inspection was carried out on 26th January 2009.

CSCI found this care home to be providing an Adequate 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

Downham Grange 26/02/08

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Downham Grange Clackclose Road Downham Market Norfolk PE38 9PA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elaine Boismier     Date: 2 6 0 1 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 32 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 32 Information about the care home Name of care home: Address: Downham Grange Clackclose Road Downham Market Norfolk PE38 9PA 01366387054 01366385861 helenforsyth@kingsleycarehomes.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Kingsley Care Homes Ltd care home 28 Number of places (if applicable): Under 65 Over 65 28 old age, not falling within any other category Additional conditions: 0 All future Service Users who are offered accommodation in rooms 9,10,11,12 and 13 must be independently mobile. Twenty-eight (28) Older People, not falling into any other category, may be accommodated. Date of last inspection Brief description of the care home Downham Grange, formerly known as Clackclose House, is a registered care home, providing personal care and accommodation for up to twenty-eight older people and is owned by Kingsley Care Homes Limited. The home is located in the market town of Downham Market and is close to shops, pubs, the post office and other local amenities. Downham Grange is a two-storey building and accommodation is provided on the ground and first floors. The home has eight double and twelve single bedrooms, the majority of which have en-suite facilities. There are two passenger lifts. The home has extensive gardens that are well maintained and easily accessible. Curent fees range from £347 to £358 depending on the room. Additional charges are made for items such as hairdressing, private chiropody, newspapers and personal toiletries. Further Care Homes for Older People Page 4 of 32 Brief description of the care home information about the fees can be obtained via the home. A copy of our inspection report is available on request from the home or via our website www.csci.org.uk Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key unannounced inspection took place on the 26th February 2008. We, the Commission for Social Care Inspection (CSCI), carried out this key announced inspection between 9:50 and 15:35, taking just under 6 hours to complete. We had a look around the premises, spoke with some of the people who lived at the home, spoke with the staff, including the Manager, watched the activities, including the staff working, and we examined some of the documentation. Before the inspection we received an Annual Quality Assurance Assessment (AQAA) that was completed by the Manager and we looked at any information that we have received about the home, since our last inspection in 2008. Care Homes for Older People Page 6 of 32 For the purpose of this report people who live at the home are referred to as people, person or resident. What the care home does well: What has improved since the last inspection? What they could do better: A requirements has been made with regards to the safe storage, safe administration of medication and to improve the standard of recording of medication administered or otherwise. A requirement has been made to improve the current recruitment process to ensure people are cared for by suitable staff. There are a number of areas that we are expecting the home to take action on, rather than we make any requirements, on this occasion. These will not appear in the recommendations table but do appear in the main body of this inspection report. Care plans must provide detailed assessments of the person; they must be drawn up in consultation with the person and to be actively reviewed each month or sooner. People must have a nutritional assessment carried out; they must be weighed; suitable weighing equipment must be acquired; records of weights and records of when people decline the offer to be weighed, must be maintained. The dignity of people must be respected at all times. Care Homes for Older People Page 8 of 32 The home must provide a wider range and greater amount of activities for people although we understand this is being considered. Information about what people are to have for their meals could be made more available. The type of clothing protection, worn by some of the residents when eating their meals, could be less institutional. Information for staff of the contact details of any agency involved in safeguarding enquiries and investigations should be made available. The home must be made safer for people to live in: action is in progress with some of these areas although risks remain until this action has been completed. The home should have 50 of care staff who have the National Qualification level 2 in care, or equivalent, although we understand progress is being made with regards to this. The training of staff must improve to include safeguarding and other care areas as identified under Standard 30 of this report. The management systems must improve, including the standard of the quality assurance, staff supervision and the environment of the home (fire alarms, emergency lighting and electrical wiring for example). Unless action is taken by the registered persons the people who live at Downham Grange are at risk to their health, welfare and safety. 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 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a good standard of information about the home and there are robust systems in place to ensure the home can meet the needs of any person who decides to live at the home. Evidence: Since our last inspection the application to register the Manager was approved, in June 2008. The Statement of Purpose has since been updated to reflect her registration status. The certificate of registration, that was on display, and dated 6th June 2008, was not the current one. In October 2008 we issued a new certificate of registration to reflect the change of name of the home. According to the Manager, this latest certificate was not correct as it omitted her name as the Registered Manager. She said that she has contacted our office and is waiting for a correct certificate to be issued. Care Homes for Older People Page 11 of 32 Evidence: From our discussion with some of the residents and examining their care notes we found evidence that the home carries out assessments of any person wishing to move into the home. The home does not offer intermediate care or day care services. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some of the people are at risk to their health and welfare and safety due to the standards of health and personal care provided. Evidence: Following on from our last inspection a recommendation was made for the implementation of new care plan formats. Examination of three peoples care records, and discussion with the staff and the Manager, indicates that this recommendation is under consideration. Discussion with three people and examination of their care plans indicates that some progress has been made with the care plan documentation although further work needs to be taken to ensure that Standard 7 is fully met. The care plans that we saw had information about the persons needs and preferences such as if and when they liked having a bath and what they liked to eat and drink. Although the home had a visit, in June 2008, from an external consultant, who wrote in their report Care plans do need to include the signature by the resident and or their Care Homes for Older People Page 13 of 32 Evidence: next of kin to indicate that the care plans have been agreed with those concerned our evidence suggests that active consultation does not always take place with the person whilst their care plan is drawn up. One of the three people, we case tracked, confirmed that they had seen their assessment and we saw that they had signed this although the remaining two people had not signed their assessments. Two of the care plans had not been signed by any of the residents and two of these people said that they had not seen their care plan. In addition we were told that staff had not sat with the person to discuss their care needs. Of one of the three peoples care files there were no current care plans on the persons files; these were located, by a member of staff, in a filing cabinet. The member of staff said that the care plans, for this person, had yet to be updated. It was not clear how the care plans were reviewed. The daily record sheets were brief in detail and provided general statements such as the resident was fine. For one person who had been assessed as not wishing to self-medicate they told us that they sometimes applied their own prescribed creams; their care plan had not been updated. In addition a risk assessment had not been carried out, to reflect this change of the the persons self-care practices. Risk assessments were carried out and recorded such as those risk of pressure sores and moving and handling. The general assessments were brief and could have been elaborated more. For example one of the peoples assessments stated that their orientation was poor although there were no further details about how the person presented with such poor orientation and how this might have affected the way they lived from day to day. The Manager stated that she would take action to complete the care planning process, within two weeks of our inspection. We have made no requirement on this occasion as we expect the home to improve the standard of care planning. In July 2008 the registered owner sent out surveys asking residents relatives, for their views about the standards of care provided at the home. We saw some of these surveys and we read, in one of these We are very happy with the care provided. The people we spoke with said I am quite happy here and I cant complain. We saw that the standard of personal care was generally good with people wearing clean clothes and they had clean hair and finger nails. A recommendation was made for care records to be completed following visits by any health care professional. For one persons care records it was clear that this recommendation has been considered although for the remaining two peoples care records this was not clear. The Manager reported that the absence of such records were due to the implementation of the new care planning formats. Care Homes for Older People Page 14 of 32 Evidence: People we spoke with said that they received checks by district nurses, for diabetes (mellitus) and chiropody treatments. At the time of our inspection we saw a district nurse visiting the home and a resident told us that they were visiting the dentist. One of the peoples care records indicated the person had received a check for their eyesight. According to the Manager people are weighed if they agree to this and can stand on the existing weighing scales. We were unable to see any records of peoples weights; there was insufficient information to tell us if any of the people had received a nutritional risk assessment; there was no record of any of the people, who could stand, declining the offer to be weighed. The home does not have suitable equipment to weigh people who are unable to stand on the current scales. We expect the home to take action, rather than we make a requirement on this occasion, to ensure that peoples nutritional status is risk assessed; the peoples care records are kept up to date and accurate and that there is suitable equipment to weigh any consenting resident. A recommendation was made for the medication records to be completed. We observed the lunch time medication round and noted that the medication administration records (MARs) were correctly signed after the medication was given to the residents. Variable doses of medication were recorded to say if the person had taken one or two tablets. However there were no signatures in the MARS when prescribed creams and prescribed nutritional supplements had been administered. During the tour of the premises we noted that in three of the peoples rooms prescribed medication was in view. This included ventolin nebules, medication to stop lowering of a persons blood sugar (of which the prescription label was faded and therefore illegible) and prescribed creams. Two of these three rooms were unoccupied, when we visited and the bedroom doors were not locked. For the third person we were informed that they did leave their room (and thereby leaving their medication unattended) and their door was not locked. We saw, later in the day, this person eating their lunch in the main dining room. According to the AQAA and the Manager there are no controlled drugs kept at the home although we understood that should this type of medication be received into the home action would be taken to ensure that this medication would be stored in line with the associated legislation. The two medication trolleys were kept secure when not in use. The rooms where they were kept were warm. One of these rooms we recorded the air temperature to be 27 degrees centigrade and this reading was confirmed by a member of the staff. Such level of temperatures affects the quality of the medication. For the other area there was no thermometer to monitor the air temperature. Care Homes for Older People Page 15 of 32 Evidence: A recommendation was made for the temperatures of the drug fridge to be recorded daily and on the whole, following our examination of these records, this recommendation has been considered. The range of temperatures were within safe limits and did not exceed 5 degrees centigrade. We observed the lunch time medication round and we saw that the staff handled the medication in a hygienic manner and the peoples dignity was respected. However we observed that not always the member of staff witnessed the person taking their medication, although the MARs were signed to indicate that the medication had been taken by the person. One of these people had been coughing before they were given their medication to take and was coughing after their medication was taken. In November 2008 we received required information about a medication error. A member of staff, responsible for administering medication, had delegated this task to another member of staff. The medication was given, in error, to a resident that the medication was not prescribed for. We were informed what action had been taken to reduce such an event occurring again, including refresher training for the staff. We have received no notification since of any such untoward incident occurring in the home. A requirement has been made about the safe storage, safe administration and recording of medication. Two requirements were made following our last inspection and these were associated with privacy, dignity and respect. Discussion with some of the people and observation of the staff working was carried out, to assess if these two requirements had been met. We observed the staff interacting with the people in a respectful manner and knocked on peoples doors before they entered and we saw no person receiving their personal care, in rooms, with the door open. Both of these requirements have been met. We observed how the staff worked during the lunch time and we saw the majority of the staff interacting with the people in a sensitive and caring manner. However we observed that this was not the case for one of the residents, who needed help with their food. The person had their food placed in front of them and this remained so, for 5 minutes before a member of staff assisted the person to eat their food. When the member of staff approached the person and started assisting them with their food, this was done Care Homes for Older People Page 16 of 32 Evidence: so without any explanation or discussion with the person. The member of staff stood over the person, whilst feeding them and took away their empty plate without any explanation; they did not ask the person if they wanted any more to eat or if they had enjoyed their meal. A drink was then placed in front of the person and was told that they must drink more. This was said, not face-to-face to the person, but as the member of the staff was walking away. This episode of care could have been a more positive and dignified experience for the person but the opportunities to do so were missed by the member of staff. We have made no requirement on this occasion as we expect the home to improve this area of care. Care Homes for Older People Page 17 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with opportunities to live an adequate quality of life. Evidence: The three people we spoke with said that there were not a lot of activities taking place in the home although there were games of bingo and exercise games arranged by a visiting company called Sporting Chance. In July 2008 the registered owner sent out surveys asking residents relatives for their views about the standards of care provided at the home. One of the surveys questions was about activities. A range of views were received although in one of these we read that the home could do better with regards to activities. In June 2008 the home was visited by an external consultant who wrote in their report Little was observed in the way of activities. According to the Manager it is the expectation that the standard of activities will improve with the future increase of staff numbers. People were seen receiving their guests and the visitors record indicated that people can receive their guests during most times of the day. Peoples rooms were individually complemented with personal possessions, ornaments Care Homes for Older People Page 18 of 32 Evidence: and pictures, including family photographs. Choices of cold drinks were offered at lunch time to include lemon or alternatively orange squash. We heard a range of views about the standard of the food from It could be better to I get enough of it (the food) The main course was shepherds pie with cauliflower, carrots and gravy followed by jam sponge and custard. We compared the menus and discussed with the Manager that the contents of the menu did not reflect what was being served: the cauliflower had replaced the green beans and the dessert had replaced the peach and pear crumble and custard or cream. The alternative hot option, as detailed on the days menu, was cheese and potato pie although this was not available. A member of the staff told us that they knew what the residents preferred. We heard a member of the staff ask one of the residents if they would prefer an omlette. One person told us that there was certain food they did not like (and this was recorded in their care records) and an alternative menu was offered to them, when such (disliked) food was being served. According to the Manager should a person request a cooked breakfast this option is available although this is not included in the menus. Although the residents were unable to tell us what was for dessert we were informed by a member of staff that it was jam sponge and custard. According to the Manager the menu is on display in the dining area. We discussed an improved way to ensure that the residents could see the menus more easily and to offer them a more informed choice of what they would like to eat, or what was available. People, who needed their clothes protecting when eating, wore plastic aprons, as worn by care staff. This type of protection was discussed with the Manager and our views were shared as to how such institutional practice could be improved upon, with the use of more suitable protection. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are listened to and are generally safe from abuse. Evidence: The people we spoke with told us what they would do if they had a complaint about the home and the staff told us what they would do if they had received a complaint or concern about the home. The record of complaints was seen and although there was no date of when a complaint was received the written response was of a sensitive and listening manner. The AQAA told us that, within the last 12 months, the home has received two complaints, both of which were resolved within the 28-day required period and both of these complaints were proven. According to the AQAA, and confirmed by the Manager, the home has been subject to a protection of vulnerable adults (POVA) (now called safeguarding) investigation. The home took appropriate action to protect any of the residents from the risk of abuse. We asked some of the staff what they would do if they encountered any incident of abuse. Their responses needed some prompting before they provided us with a satisfactory responses. This indicates that the staff need to attend up to date training (see Standard 30 of this report) and information of contact numbers of agencies involved in safeguarding alerts and enquiries. Care Homes for Older People Page 20 of 32 Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and homely place that could be more comfortable and safer to live in. Evidence: We looked around the premises and spoke with the Manager and with the staff. The home had a generally warm and welcoming feel to it as we entered the main reception hall. During the tour of the premises we noted that some of the rooms had been redecorated and refurnished and one of the rooms was in the process of being redecorated. A requirement has been met as we found no fire door wedged open by means not approved by the fire safety officer (FSO) and the majority of the doors had been fitted with door guards. A report of a service inspection, carried out in May 2008, told us Our engineer did not proceed with electrical testing as the visual inspection revealed significant defects. According to the Manager the registered owner has been comparing costs to carry out work to make the home safer, with regards to the supply of electric, although we do not know what further action has been taken. Care Homes for Older People Page 22 of 32 Evidence: A recommendation was made, and has been considered, for bedrooms not to be used to store equipment: we found no equipment stored in peoples bedrooms. A requirement was made for hot water to be delivered within safe levels. Records of hot water temperatures were seen and it was noted that hot water is accessed via bedroom sinks and baths and the majority of the records indicated that the hot water is above 43 degrees centigrade and up to 60 degrees centigrade. We asked a member of the staff to tell us how they would check the temperature of hot water run in one of the baths, before any person had a bath. The information provided by the member of staff, including the techniques of using the Hot Spot tester, was satisfactory. According to the member of staff all but one of the current residents require the assistance from the staff to have a bath. We consider, generally, this requirement has been met. A number of the bedroom windows, with particular regard to those on the first floor, had only some, but not all window restrictors on them. The Manager stated that action would be taken within 5 days of our inspection, to supply such restrictors to the bedroom windows. We were unable to open some other bedroom windows, due to the poor condition of the wood or they had become fixed with dried paint. One bedroom window, that was partially open, had cotton wool wedged between the window and the window frame, to reduce the draught coming in from the outside. The lighting of the home was of variable strengths with some areas being bright whereas other areas being dimly lit. One of the people said they had to strain their eyes to read. Rather than we make a requirement on this occasion we expect the home to improve the ventilation and lighting of the home for it to become safer and more comfortable for people to live in. The home was clean and we found no offensive odours. The laundry area was away from the kitchen area. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are at some risk to their health and safety due to the current standards of staff training and staff recruitment procedures. Evidence: At the time of our inspection there were 19 people living at the home and, on duty there were 3 members of care staff, the Manager supported by her deputy manager, a voluntary worker (work experience student) a cook and a cleaner. The staff we spoke with said that there was enough staff on duty and we heard call bells responded to in a timely manner. The busy lunch time period was calmly run. Within the relatives surveys, of July 2008, we read Staff are always cheerful and friendly and people we spoke with said that the staff were Very good. The AQAA told us that of the 19 care staff, 5 of these had the National Qualification in Care (NVQ) level 2; that is 26.3 . We requested up to date information, from the Manager and currently the home has 14 members of care staff of which 5 have this NVQ certification; that is 35.7 . According to the Manager other members of care staff are progressing to achieve this qualification, by April 2009. An examination of two staff files was carried out and evidence suggests that the recruitment process could be better. Both of the files had a clear photograph of the Care Homes for Older People Page 24 of 32 Evidence: person and a POVA 1st had been obtained before the person started working at the home. Both files contained two written references although three of the four references were provided by friends and therefore there is a risk of subjectivity. Both files had an application form. One of these noted that the person had no previous employment although one of the references was supplied by a previous employer. For the second application form there was an unexplained gap in the persons employment history between February 2004 and 2005 (no month, for 2005, was recorded). The same gap in employment history was also detailed on the persons curriculum vita. Within the persons interview notes there was no written explanation of the persons gap in employment history and there was no other reference to this elsewhere within the file. The Manager acknowledged this omission of recording. Furthermore there was no proof of identification of the person, in either of the two files, such as a copy of a passport, driving license or birth certificate, although the Manager stated that these had been obtained for criminal record bureau (CRB) checks and these had been submitted to the registered owners head office, but not returned. Applications for CRBs had been made within line of the POVA 1st requests. A requirement has been made about staff information being obtained and kept on file. Some of the staff told us that they have attended training in infection control and we saw a certificate that confirmed a member of the staff had attended training in care of a person with diabetes (mellitus). Examination of the two most recently recruited staff files files and discussion with the Manager, indicated that the home has adopted the Common Core Foundation Induction training and evidence of this was in one of the two files that we examined. Our findings, such as with medication and care planning and dignity indicates that the staff may need further training to keep them up to date with current practice and the Manager considered that the training of the staff needed to improve. We have made no requirement, on this occasion, as we expect this to be managed by the home. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current management systems of the home place people at some risk to their health, welfare and safety. Evidence: The Registered Manager started working at Downham Grange in March 2008 and we approved her application, to be the Registered Manager of the home, in June 2008. She has previous experience as a Registered Manager and has attained her Registered Managers Award. She has the City and Guilds Advanced Management in care and is an NVQ assessor. She runs the home with the support of a deputy manager. We have received information as required under Regulation 37 of the Care Homes Regulations 2001. In light of the number of areas we have identified, in this report, we consider that this Standard has not been fully met. We examined the last two regulation 26 visit reports, made by a visiting represenative of the registered owner, and these provided details such as of discussion with the Care Homes for Older People Page 26 of 32 Evidence: some of the residents and reviews of documentation. The copies of these reports were those for 28th March 2008 and 25th June 2008. According to the Manager there have been subsequent visits but no report was available in the home. Surveys, from the registered owner, asking relatives their views had been sent out, in July 2008 although none have been sent to any of the residents. The Manager stated that this is to be considered. The AQAA was completed in an adequate manner although it did not tell us what action had been taken to meet the requirements and if any of the recommendations had been considered. Reference to some of the Standards, Standard 7 for example, was missing. A more robust quality assurance system should have noted some of our findings, such as those described in Standards 19 and 25, and how these issues were to be addressed, rather than a reliance on our inspection findings. A recommendation was made for good records to be kept for peoples money or valuables. We saw the records for peoples personal monies and we found these to be satisfactory. Two residents monies were counted and the amounts reconciled with the record of balances. A requirement was made for the staff to receive supervision. Discussion with the Manager and the staff indicates that action has been taken to improve the supervision of the staff although progress needs to continue to meet this Standard. One of the three members of staff told us that they had received 1:1 supervision and a record of this was made. The remaining two members of staff said that they had not received such supervision. Of the two staff files, that we saw, one person had their induction programme that might be considered as a form of supervision although the other staff file had no evidence that they had received any formal supervision; this person started working at the home in May 2008. Although this requirement has been met in part only we will not carry this forward, as we expect the home to continue with any progress made. A recommendation was made for the policies and procedures to be reviewed. The AQAA notes that the homes policies and procedures have been reviewed in March 2008. From this information provided the recommendation has been considered. (We did not examine any of the policies and procedures on this occasion). A recommendation was made for an audit to be carried out of any accidents in the home. We saw that such audits had been carried out. Care Homes for Older People Page 27 of 32 Evidence: A certificate of names of the staff who attended fire training, on the 21st April 2008, was on display. One of the three staff we spoke with said that they had received training in fire safety although the other two members of staff said that they had not attended such training, including during their induction training. The Manager stated that arrangements for moving and handling training are in place and this was confirmed by a member of the care staff who had not received such training since they started working at the home in June 2008. In August 2008 the home had an emergency situation that required the (successful) evacuation of the home and the fire service to attend the home. We found no records of other fire drill training and the staff we spoke with said that they had received no such training. According to fire service records, for February 2008 and October 2008 there remain issues with the fire alarms and emergency lights, both of which need attention. Following our inspection, of the 26th January 2009, we have spoken with the fire safety officer (FSO). We understand that the home has been served with a deficiency notice, in December 2008, with particular regard to the fire alarms and the emergency lights. We also understand the FSO was satisfied with the training of the staff, in fire safety when they last visited the home, on the 11th December 2008. According to the AQAA and the Manager, 100 of the kitchen staff have attended training in safe food handling. Although a recommendation was made for any staff who handled food, to attend this training, we have found evidence, from observing the serving of the food at lunch time and asking one of the staff about their training in safe food handling, that this recommendation has not been considered in full: this member of staff had not attended such training but was noted to be serving the food to the residents, during lunchtime. Fire alarms and emergency lights are tested each week and records of these were satisfactory. We were unable to find evidence that portable appliance tests (PAT) were in date as there were no records on site and we found some of the portable equipment without PAT stickers. One that we found, of a persons television, was dated February 2002. According to the Manager arrangements are in place for PATS to be carried out, in February 2009. A requirement was made for the mobile hoists and bath hoists be made safer. Discussion with the Manager and examination of the associated service checks indicates that this requirement has been met. Care Homes for Older People Page 28 of 32 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 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The storage of medication must be safer and also stored at temperatures as defined by the manufacturer. The records of any medication given or refused, must be accurately recorded To protect residents from harm by taking medication that they are not prescribed; to protect residents from receiving medication that has deteriorated; to ensure medication is given as directed by the prescriber. 10/03/2009 2 29 19 Full and satisfactory 15/03/2009 information, to include proof of identification and written explanations of any gaps in employment history, must be obtained and kept on file. To ensure that people who live at the home are protected from the risk of harm by unsuitable staff. Care Homes for Older People Page 30 of 32 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 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (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. 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