Inspection on 09/01/09 for Eastrise

This inspection was carried out on 9th 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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Snydale Care Home

Hawkhills

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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: Eastrise 851 - 853 Holderness Road Kingston upon Hull East Yorkshire HU8 9BA     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: Beverly Hill     Date: 0 9 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 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Eastrise 851 - 853 Holderness Road Kingston upon Hull East Yorkshire HU8 9BA 01482794270 01482794270 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Redstacks Residential Home Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 21 Number of places (if applicable): Under 65 Over 65 0 21 dementia old age, not falling within any other category Additional conditions: 21 0 The maximum number of service users who can be accommodated is: 21 The registered person may provide the following category of service only: Care Home only Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP Dementia - Code DE Date of last inspection Brief description of the care home Eastrise was registered with new proprietors in July 2008. The home is situated on a main road, which leads to the centre of Hull. It is close to East Park and other local facilities such as shops, pubs, health services and public transport. Eastrise is registered to provide care and support to twenty-one older people, some of whom may have needs associated with dementia. The home is made up of two houses separated Care Homes for Older People Page 4 of 33 Brief description of the care home by a driveway but connected by a corridor at the rear of the buildings. It has two floors serviced by a passenger lift in one building and a chair lift in the other. Communal areas consist of a main lounge and a dining area near the kitchen in one of the houses, a small conservatory in each house and a further small sitting/dining area in the second house. The home has nine single and six shared bedrooms. Four bedrooms have en-suite facilities. There are three bathrooms, two of which have bath hoists. The new proprietors are planning to convert two of the bathrooms into shower rooms. There is a large garden to the rear of the property and a covered area for people wishing to smoke at one of the rear exits. Visitors can park their cars in the driveway or there is extra parking on the street at the front of the home. Information about the home and its services can be found in the statement of purpose and service user guide. The home also has a pack to give out to prospective residents with additional information. The weekly fee for the home is 350 pounds. The proprietors provide items such as basic toiletries, soap, shaving foam, talc and hair care products. There is additional charges for optional extras such as hairdressing, chiropody, personal toiletries, newspapers and magazines. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating form this service is 1 star. This means that the people that use use this service experience adequate quality outcomes. This inspection report is based on information received by the Commission for Social Care inspection (CSCI) since the last key unannounced inspection on 7th January 2008 including information gathered during a site visit to the home, which took approximately eight and a half hours. The home was registered with new proprietors in July 2008 and prior to this had a quality rating of 1 star. The new proprietors have worked very hard to put in place systems to improve the management of the home and the general environment. The improved quality rating is a reflection or their efforts and commitment in such a short space of time. Care Homes for Older People Page 6 of 33 Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Eastrise. We also had discussions with the proprietors, one of whom is the manager, care staff members and two relatives. Information was also obtained from surveys received from residents, care staff and a visiting health professional. Comments from the surveys have been used in the report. We looked at assessments of need made before people were admitted to the home and the homes care plans to see how those needs were met whilst they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff recruitment, induction, training and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out staffs understanding of how to maintain privacy, dignity and, independence and choice. The proprietors returned their Annual Quality Assurance Assessment (AQAA) within the agreed timescales. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. We would like to thank the people that live in Eastrise, the staff team and management for their hospitality during the visit and also thank the people who completed surveys. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward as recommendations, but only when it is considered that people who use the service are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: Although an improvement was noted, the homes statement of purpose, service user Care Homes for Older People Page 8 of 33 guide and terms and conditions documents needed some minor adjustments and additions to ensure people have full information about the home. A new system of care planning is being introduced. This needs to be done quickly so staff have the information they need to refer to when supporting people. Also risk assessments need to be reviewed when changes occur and the bedrail risk assessment needs to reflect health and safety guidance. The management of medication needs some improvement to make sure that staff record all medication into the home even when people arrive for short stays and they need to follow guidance when handwriting details onto the medication administration record. Choices for people with regards to activities and social stimulation need to be increased to prevent them from being bored. The numbers of staff on duty were sufficient for the current levels of need of the residents but the rush at lunchtime to support people to the tables meant that the cook was assisting people in the lounge and then going back into the kitchen to finish preparing and serve meals. This is not good practice and more care staff should be available to assist residents at this time. The proprietors described a good recruitment process but they need to make sure they complete all checks when employing workers from the European Union. The manager needs to apply for registration with the Commission as soon as possible. This will give the home some stability. She has already started to provide formal supervision for care staff, which needs to be a minimum of six sessions a year. A training plan for staff needs to be completed to ensure that all mandatory and service specific training is included. New systems have been put in place to monitor the quality of the services the home provides. This needs to be implemented as planned. Care plans need to be held securely when not in use and the manager needs to make sure they send the Commission any information about incidents that affect the wellbeing of residents. These are called notifications and help us to look for patterns in accidents and incidents in the home so we can check out how they are managed. 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 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensured people had detailed information about the services it provided and ensured that people were only admitted after an assessment of their needs has been completed. Evidence: The new proprietors have updated the homes statement of purpose and service user guide. Generally the information gives commissioners of the service and potential residents good information about the home and the services provided. As an improvement, the text could be larger print and both documents need to make it clear that the manager of the home is to be one of the proprietors. Both documents refer to the manager as registered, but to date the manager still has to apply for registration with the Commission. The statement of purpose also needs to clear about the level or degree of dementia care the home is able to provide. Two of the pages need updating regarding the Commissions details but as these will change again in the near future Care Homes for Older People Page 11 of 33 Evidence: the home could wait until these changes are made. The section on complaints management needs to provide information to people regarding the local authority, as it will investigate any complaint into the care received by a person funded by it. The service user guide needs to include a selection of residents views about the service, which can be obtained when the home starts to initiate their quality assurance system. The homes service user agreement was clear about the overall care and services covered by the fee and any optional extras the resident would pay themselves. It included the fee, how this could be paid and by whom. The agreement also covered rights and obligations including notice period required. The agreement needs to identify the room to be occupied by the resident. We examined three care files during the day, two to examine the admission process. Both these files had assessments of need completed by care management, as they funded the placement. The assessments were obtained prior to admission. The home had also completed their own assessment documentation, a tick box multiple choice type form, that covered all areas of need. There was scope to make additional comments on how the persons needs affected their abilities. The assessment process enabled the home to make a decision about whether they were able to meet peoples needs. The proprietors advised that people were able to have trial visits at the home prior to a decision about permanent residency. This was clearly mentioned in the service user guide and the service user agreement refers to the first four weeks as a trial period. The home also accepted people for respite care in order for the person to have a break or to enable their carers a break. This gave people the opportunity to sample the home. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although care staff knew the residents needs and provided care that respected privacy and dignity, gaps in care planning, some risk assessments, daily recording and medication recording, means that care staff may not have full and up to date information. This could mean that important care could be missed. Evidence: The home had fifteen residents, two of whom were in hospital. Three residents care files were examined during the day and each file contained lots of information on which to base plans of care. The care plans in use were in the process of being renewed to bring them into line with other homes in the group. One care file was a mixture of old style and new, which could be confusing for staff but generally the care plans contained all assessed needs. The care plans had not been signed by the resident and in one case not signed by the care staff formulating it. The residents signature, or that of their representative, would indicate that they had seen and contributed to the care plan. Care plans also had not been evaluated consistently. Care Homes for Older People Page 13 of 33 Evidence: Evaluations need to be completed on a monthly basis to ensure the care plan continues to meet the residents needs. The upgrading of care plans needs to be done quickly to ensure care staff have full and up to date information about residents needs. There was evidence that care plans reviews took place with the resident, their family, staff at the home and the local authority present. The home had introduced new documentation for recording but this had not been implemented yet, for example, monthly summary sheets and hospital admission information. Staff did record daily care but there was an inconsistency regarding the follow through of issues to the next shift so it was difficult to track whether issues had been resolved. Some staff were more thorough than others in documenting the care that had been delivered. There were fluid and food monitoring charts in place which needed the amounts to be detailed with more precision if the information was to benefit the dieticians request for monitoring. The homes daily diary had space for night staff to enter checks at night so day staff were aware of any issues. They felt this system worked well and assisted in the handover of information. We observed a staff handover from one shift to the next and each resident was discussed and information passed on. The care files had a generic risk assessment in place completed prior to the new proprietors taking over the home. This included areas such as, falls, carpet hazards, footwear, bathing, sitting, and wandering at night. There was also a range of individual risk assessments, some completed by health professionals. The home completed nutritional screening and there was evidence of dietician involvement. Some of the risk assessments needed updating as the residents needs had recently changed, for example nutritional and pressure relieving needs had increased for one person, another had risks associated with their mental health and a third had bed rails in place but the risk assessment did not follow health and safety guidelines. The review of the care files should address these shortfalls. There was evidence that residents had access to health care professionals such as, district nurses, dieticians, GPs, consultants, chiropodists and opticians. People spoken with were happy with their care and felt their needs were met in the home. They confirmed that care staff supported them in a pleasant and caring way, and were respectful of their privacy and dignity. Six surveys were received from residents and all stated they received the care and support they required either, always or usually. Two relatives spoken with and, a survey received from one relative, all commented positively on the care provided, the home has improved a lot in the last year, she seems more relaxed, settled and happy, she is smart and tidy and her clothes are always clean. Care Homes for Older People Page 14 of 33 Evidence: One visiting professional did comment that some shared rooms did not have privacy screens. This was checked during the day. All shared rooms occupied by two people had privacy screens. Some of the shared rooms only have one occupant at present. The proprietors are in the process of fitting ceiling track dividers in some of the rooms. The home generally stored and recorded medication as per policies and procedures. Two residents had medication that had not been signed into the home. One was for a resident admitted for respite care and family had completed a monitored dosage system to be used during their stay. However the medication was not labelled and staff could not be sure that the medication in the box was that prescribed by the GP. There needs to be a system in place that in such cases medication is received into the home in its original container so staff are aware of what they are administering. Staff had also hand written medication onto the medication administration record (MAR) but had not ensured that this was checked and signed by a second staff member and that it included the full manufacturers instructions. Staff also need to make sure that written instructions to changes in dosage for anti-coagulant medication is placed securely with the MAR. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have good contact with family and friends, however, social and occupational stimulation needs to be planned for in an individualised way and carried out consistently to enhance peoples wellbeing and quality of life. The home provides well-balanced meals to meet peoples nutritional needs. Evidence: Residents spoken with told us that routines were flexible and they could make choices about aspects of their lives. One person said, I used to get up early but I get up much later now, today it was 10 oclock. Another person told us that art classes had been arranged for him but sometimes he decided not to go. People were able to eat their meals in various areas and could sit and chat to each other in the lounge, sitting room and two small conservatories. Most people spent their day in communal areas rather than in their own bedrooms. Staff spoken with were clear about how they would support people to make choices and maintain their independence, we would ask people what they wanted, when people are getting ready in the morning we can start them off and come back in a few Care Homes for Older People Page 16 of 33 Evidence: minutes and we encourage residents to do as much as they can for themselves. To improve, staff could develop this further for people with dementia care needs, for example providing more visual choices at mealtimes and providing more social stimulation for people. Two relatives spoken with told us they felt welcomed and could visit at any time. Refreshments were offered to them. In discussion staff confirmed this and stated that visitors tended to avoid mealtimes, which enabled them to concentrate on the residents. The home offers limited activities and occupational stimulation for people at present, as time and effort has been directed at improving staffing and the environment. Personal profiles were completed on admission, which gave some indication of previous interests and hobbies. The proprietors recognise that this is an area they need to focus on and plan for. They have, however, arranged for a reflexologist to visit fortnightly for foot massages, which we saw during the visit and was much enjoyed by a resident, and a physiotherapist fornightly to provide exercises. Staff also spend time having one-to-one chats with people, games, sing-a-longs and reminiscence discussions. Some residents were able to access local shops independently and some preferred to be escorted by staff. Some residents accessed a local social club over the Christmas period and enjoyed the entertainment on offer. The proprietor spoke about plans for the garden area as one resident likes to sweep up the patio and tend the flower beds/vegetable patch in warmer weather. He is investigating whether it is possible to keep a few chickens for the resident to look after. The home has produced menus over a four week period. Residents spoken with enjoyed the meals on offer and said they had plenty to eat, and six surveys received from them stated they liked the meals either, always or usually. Diabetic diets were catered for and care staff advised catering staff of dietary needs and preferences. Dietician advice was sought when required. To improve further residents should have access to water and juice in the lounge and sitting room to enable them to help themselves and the range of desserts on offer could be broadened. Care Homes for Older People Page 17 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides an environment were people feel able to complain in the knowledge that it will be dealt with. It also ensures that residents are protected from abuse by staff training and knowledge of local policies and procedures. Evidence: The home had a formal complaints policy and procedure that was displayed in the home. The procedure detailed who to speak to and timescales for resolution. To improve, the procedure could include information about the local authority, as care management teams were responsible for investigating complaints for the people they funded in the home. There had not been any complaints since the new proprietors took over managing the home. We spoke to the proprietors during the day and they stated this was due to the fact they maintained a daily presence in the home and any minor issue could be dealt with straight away. Staff spoken with told us they received very few complaints now and there was a complaints form near the door for people to complete if required. They told us it was nice to get compliments from relatives about the changes in the home. Residents stated they knew who to speak to and confirmed that if they had any issues these would be dealt with, I dont have any complaints and the boss would sort Care Homes for Older People Page 18 of 33 Evidence: them out. The surveys received from residents and a relative all indicated they knew who to speak to if they were unhappy about something. Two relatives spoken with on the day confirmed the new proprietors were responsive when asked to do things, they are here all the time, I would see the person in charge to sort it out and I would go to Jeff (proprietor) but I have no complaints. The home uses the multi-agency safeguarding adults policy and procedure for safeguarding vulnerable adults from abuse. Staff had received training and those spoken with were clear about what to do should they witness anything that concerns them. The proprietors are experienced home managers and are aware of the safeguarding of adults referral and investigation procedures. Care Homes for Older People Page 19 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The new owners are progressing well with their refurbishment and redecoration plan and are improving the environment for the residents. Evidence: There continues to be improvements made to the environment and the new proprietors have formulated a monthly refurbishment plan that they are working through. They have converted a bathroom into a much needed laundry room and used the previous small laundry room as a clothes drying room. Three new washing machines have been purchased. They have installed a new fire alarm system, replaced large and small electrical items and completed external work to the building. The home has one large lounge, which has been fitted with new curtains and blinds, and a small sitting room. Residents have several places to sit and have their meals in the home. There is a dining area near the kitchen sufficient for two tables and chairs, two small conservatories set up with a table and chairs in each and the small sitting room also has a table and chairs. Currently a corridor joins the two houses at the rear of the building but the proprietors have plans to have one large conservatory joining the home in the middle at ground level and an upper floor corridor joining the building at the front. This will make access from house to house easier for both residents and staff. Care Homes for Older People Page 20 of 33 Evidence: The home has nine single and six shared bedrooms. Four bedrooms have been fully decorated and refurbished, one just needs a new carpet. The home is registered for twenty-one people but the proprietors are only using four of the bedrooms as shared rooms at present, and are considering limiting the numbers of residents to eighteen to ensure they have more space. The new proprietors clearly have the residents at the focus of the refurbishment plan and are committed to improving the environment for them. Residents and relatives spoken with had been told about the plans and they commented that improvements had been made to the home, they are making lots of changes, my bedroom has been done out, Im pleased with it, the home has improved a lot in the last year, its cleaner and tidier, her bedroom is nice and clean, the odour is a lot better than it used to be, the new owners are doing more with the home, decorating rooms and they plan to have an extension and his room is always spotless. The home was clean and tidy on the day. Staff told us that they feel the home is a much nicer place to work and has improved for the residents, more effective products are used for cleaning, the new laundry room has helped, the new owners are hands on and the home is more organised. Care Homes for Older People Page 21 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that residents are supported by competent care staff, that have access to training. Further service specific training will consolidate their knowledge and provide them with enhanced skills in caring for older people. The homes recruitment process regarding workers from the European Union needs review to be sufficiently robust to ensure all checks are in place and certificates up to date. This will help to ensure only appropriate people are allowed to work with vulnerable adults. Evidence: The home had fifteen residents although two were in hospital awaiting discharge. Rotas indicated there were two care staff on duty during the day as well as the two proprietors, one of which was the manager. In addition, there was a cook for breakfast preparation and the main meal, a housekeeper and an administrator. There were two carers at night with an on call system for the proprietors. As some of the residents had low level needs this was sufficient staff on duty. There has been some staff turnover since the new proprietors took over to ensure that a committed team is in place. Staff spoken with confirmed that some staff had left and some were dismissed for poor performance and time keeping. Those remaining were Care Homes for Older People Page 22 of 33 Evidence: very happy with the home, we have a good staff team now, we generally get on well, the staff are a lot happier and I enjoy working here now. Residents and relatives spoken with were also complimentary about the staff and the care provided, the staff are nice, they look after us, the girls are great, you can have a laugh with them, the staff are very good and I get on with the staff well and know their first names, they look after people well. All six surveys stated that staff listened and acted on what the resident said, always. During the lunchtime period we observed catering staff assisting with moving and handling residents and then enter the kitchen to serve meals. They also assisted a resident to stand using an inappropriate technique and when checked they had not received any moving and handling training. Catering staff should maintain good kitchen hygiene measures when serving food and management need to ensure sufficient care staff are present during busy times. It is acknowledged that the manager was covering a shift for a staff member who was sick and the second proprietor was involved with the inspection during the day and this could have affected the usual routine. Prior to the new proprietors taking over staff had received various training courses in mandatory areas such as safeguarding adults from abuse, medication, first aid, moving and handling, and fire safety in order to meet specific requirements issued by the Commission. Some senior care staff have also completed training in diabetes awareness and dementia care. The new proprietors have started formal staff supervisions to look at any further training that is needed and to produce an annual plan that covers mandatory refresher training and other service specific courses. They stated in discussion that training will be sourced mainly from the local authority and they want to concentrate on mental capacity legislation and conditions affecting older people. Most staff had completed dementia care training but needed to have some check on how their knowledge was to be consolidated. A training log indicated that two staff had completed catheter care training, care of the dying and infection control and five, including a cook, had completed nutrition for older people. The two cooks had also completed food safety management. A health professional stated in a survey that some staff showed more skills than others especially in catheter care and diabetes management but overall staff sought advice from district nurses and showed enthusiasm for their role. The home has twelve care staff and seven had completed a national vocational qualification (NVQ) in care at level 2. This equates to 56 percent and is a very good achievement. Four additional care staff were progressing through the course at this level and all senior care staff were enrolled on the course at level 3. Care Homes for Older People Page 23 of 33 Evidence: Staff induction consists of an orientation into the homes way of working and the home will access skills for care modular induction programme with the local authority for all new care staff. The new proprietors had only recruited one person since they took over. They were due to interview a person for a position of carer during the day of the inspection. The proprietors discussed their recruitment process, which included full checks and an interview prior to starting work. The process of checks for European Union workers must be improved to ensure workers have up to date registration certificates. Care Homes for Older People Page 24 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been noted in all areas of management in the home and new systems have been developed. The implementation of the new systems will further enhance the residents wellbeing and safety. Evidence: The new proprietors took over the management of the home in July 2008 and have continued to make improvements in all areas of the home. One of the proprietors is the manager and is to progress with an application for registration with the Commission. She has twenty years experience in the care sector and has been the registered manager of another home in the company. She has completed her Registered Managers Award. Both the proprietors are very committed to the home and staff described how they both work with the care staff and domestic staff in a, hands on capacity. Staff, residents and relatives spoken with were very positive about the change in ownership Care Homes for Older People Page 25 of 33 Evidence: and management that has taken place. Comments were, the new owners are getting things done, they are fantastic, I was going to leave but things are moving now and its much better, Yvette and Jeff (proprietors) are very hands on, you can go to them with any problems, the way they are with the residents is fantastic, the home runs smoothly now, everything is to hand and the residents are happier. The proprietors confirmed that they have released their mobile number to relatives so they can be contacted should they have any concerns. The new systems put in place are just starting to be implemented. The quality assurance system is to run from January to December and consists of internal audits and questionnaires for residents, relatives, staff and professional visitors, in line with other homes in the company. There is a process for looking at shortfalls and producing action plans to address them. Accidents need to be included in the audits to check that all measures have been taken place to minimise them. The results of monthly audits and questionnaires are timed to feed into staff and residents meetings so issues can be discussed. The system when up and running should allow for good consultation and information sharing. Consultation about smoking arrangements has led to the proprietors making a covered shelter outdoors for the few residents who wish to smoke. The staff supervision system has started and one to one discussions cover role and responsibilities, communication, training needs, decision making and any residents issues. Staff confirmed in discussions and surveys that they had received an initial supervision session and had time to sit and discuss things with their manager. The proprietors also complete spot checks, for example at night and early in the morning to ensure staff adhere to good working practices and respect residents preferences for rising and retiring. Families mainly manage residents finances but the home appropriately manages any personal allowance held for safekeeping. Monies are secured and individual records maintained. Receipts are in place for monies in and out of the home. People can access their money when required. Generally the records required for the running of the home were in place, although some required updating, such as care plans and risk assessments, and some required more information such as daily recording, monitoring charts and accident recordings. Care files needed to be secured when not in use in line with data protection legislation and the manager needs to send information to the Commission regarding any incidents that affect the welfare of any resident. This helps us to look for patterns, for example in accidents and discuss how the home is to manage them. Care Homes for Older People Page 26 of 33 Evidence: Generally the home was a safe place to live in and to work in. The fire alarm system has been replaced and every call bell is in working order. Moving and handling equipment is serviced and the new proprietors have replaced several items of electrical equipment. Staff have completed training in fire safety, moving and handling and first aid. Training in infection control and health and safety needs to be sourced. Fire alarm checks and drills need to restart. Care Homes for Older People Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The care plans must be evaluated monthly and reflect changes in need. They must be signed by the resident or their representative and by staff formulating them. This will ensure the care plans continue to meet residents needs and will also evidence that residents have been involved in the formulation and review of them. 31/03/2009 2 8 13 Risk assessments must be in 31/01/2009 place for all areas identified as at risk and must be evaluated and updated when needs change. This will ensure that changes in needs and risk are continually monitored and planned for. 3 9 13 All medication admitted into the home must be signed in and when care staff hand 31/01/2009 Care Homes for Older People Page 29 of 33 write details onto the MAR they must have this countersigned by a second person. This will ensure clear records of all medication in the home and countersigning will help to prevent mistakes. 4 29 19 Staff members from the European Union must have an up to date accession state worker registration scheme certificate with current employers details on. The manager must take advice and address the identified shortfall. This will ensure that the home complete all checks and only appropriate people work with vulnerable adults. 31/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The statement of purpose and service user guide could be in larger print format and make it clear that the manager is one of the proprietors. The statement of purpose could also be clearer about the level of dementia care needs the home is able to support. The new format of care plans should be introduced quickly to avoid confusion for staff with two types of care plan in operation. Care staff should ensure daily recording is improved with regards to food and fluid charts and daily care delivered. This will help to provide more precise information for health professionals and evidence a follow-on system for important issues. Page 30 of 33 2 7 3 7 Care Homes for Older People 4 5 9 12 Written information regarding the changes in dose for anticoaglulant medication should be kept with the MAR. Staff should broaden the range of social and occupational stimulation on offer to keep people occupied in meaningful ways, prevent boredom and enhance the quality of their lives. Staff should ensure that people are able to make more choices about aspects of their lives by providing them with more activities/occupations to participate in, more social stimulation and outside interests, and a broader range of desserts at mealtimes. Staff should ensure residents have access to water and juice in the lounge and sitting areas to enable them to help themselves. All staff employed in the home should be able to converse with residents and be able to understand verbal requests from them. The manager should investigate means of improving English language skills for a designated staff member. The manager should review the system of catering staff in and out the kitchen moving and handling residents, whilst also serving meals. This will help to maintain good kitchen hygiene and infection control measures. The manager should have their hours clearly detailed on the staff rota. A training plan for the coming year should be developed in line with information gained from staff supervisions and appraisals and knowledge of residents needs. It should include mandatory training with updates and service specific areas such as conditions affecting older people and particular residents in the home. The manager should apply for registration with the Commission. Accidents should be included in the audits to check that all measures have been taken to minimise them. The quality assurance system developed should be implemented as planned. Care staff need to have a minimum of six formal supervision sessions in line with national minimum standards. It is acknowledged that the supervision system has been started. Care files should be held securely when not in use in line with data protection legislation, and the manager needs to forward, to the Commission, any future information 6 14 7 15 8 27 9 27 10 11 27 30 12 13 31 33 14 36 15 37 Care Homes for Older People Page 31 of 33 regarding incidents that affect the wellbeing of residents. 16 38 Fire alarm checks and drills should be re-started to ensure that staff are kept up to date in how to deal with fire emergencies. Care Homes for Older People Page 32 of 33 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. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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