Inspection on 22/08/08 for Elm Lea Residential Care Home

This inspection was carried out on 22nd August 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Elm Lea Residential Care Home 01/10/07

Elm Lea Residential Care Home 03/04/07

Elm Lea Residential Care Home 31/05/06

Elm Lea Residential Care Home 27/10/05

Elm Lea Residential Care Home 25/05/05

Elm Lea Residential Care Home 08/11/04

Elm Lea Residential Care Home 24/09/04

Elm Lea Residential Care Home 06/07/04

Elm Lea Residential Care Home 08/06/04

Elm Lea Residential Care Home 04/05/04

Elm Lea Residential Care Home 14/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Elm Lea Residential Care Home 17 Bartholomew Lane Saltwood Hythe Kent CT21 4BX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mark Hemmings     Date: 2 2 0 8 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Elm Lea Residential Care Home 17 Bartholomew Lane Saltwood Hythe Kent CT21 4BX 01303 269891 Telephone number: Fax number: Email address: Provider web address: renuka15@hotmail.com Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Mrs Renuka Oojageer,Mr Mookesh Oojageer Mrs Renuka Oojageer care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 0 Over 65 15 Date of last inspection Brief description of the care home Elm Lea (the Service)is registered to provide accommodation and personal care for 14 older people. Ownership of the home was transferred to Mr and Mrs Oojageer on 18th December 2003. Elmlea occupies detached premises with fourteen single bedrooms, all of which have en-suite facilities. Accommodation is on the ground and first floor and the Home has a shaft lift. There is a well maintained garden for Residents? use. There are two assisted baths, one on each floor. The Residents have a choice of sitting areas, with the main lounge/dining room, a conservatory and a small quiet room for their use. The Home is located on the outskirts of a small sized town, with good access to shops, public transport and other public amenities, some of which are within walking distance. The current scale of charges at the home range between #295-#350 per week. Care Homes for Older People Page 4 of 31 Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We arrived at the Service at nine oclock in the morning and were there for about eight hours. It was a thorough look at how well the Service is doing. It took into account detailed information provided by the Registered Provider in her self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). Further, it considered any information that we have received about the Service since our last inspection. During the inspection, we spoke with the Registered Provider who is also the Registered Manager. We also spoke with the Deputy Manager, with two care workers and with the cook. We spoke with five of the people who live in the Service and with two of their relatives. We saw the lounges, the bathrooms and toilets and some of the bedrooms. We walked around the grounds and we looked at a selection of key records and documents. Before the inspection, we invited people to fill out Care Homes for Older People Page 6 of 31 questionnaires to tell us what they think about the Service. We got 16 of these back. Nine are from people who live in the Service or from their relatives. Seven are from members of staff. When writing our inspection report we have taken into account what these people say. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line – 0870 240 7535. Care Homes for Older People Page 8 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 3 and 6. People who are about to move in are asked about what support they need and how they want this to be done. People who want to stay for shorter periods are helped to go back home. Evidence: The Registered Manager asks people who are considering moving in about what support they need and want. This is done so that everyone can be confident that moving into Elm Lea is the right thing for them. The Annual Quality Assurance Assessment recognises the importance of this process. We looked at the sorts of things that are usually considered. These are practical and relevant. For example, they Care Homes for Older People Page 10 of 31 include the help that is needed for the person to use the bathroom in safety and comfort. Also included, is an account of their general health and the medication they take. The Registered Manager then tells care workers about what she has learnt so that they know what to do from the start. We asked two care workers about how this all works out in practice. They say that the system works well and that they know about the support they will need to provide as soon as someone comes in. We asked one of the people who have moved into the Service since we last called. They say that the Deputy Manager visited them at home and that that she asked all sorts of relevant questions about the help they need. They say that care workers knew what assistance they needed from when they arrived. Some people stay for shorter periods of time. This can be on a planned basis or as a one-off. These shorter stays might be because they have been in hospital and are not yet ready to go home. Or, it might be so that a carer can have time to themselves. The Registered Manager says that careful attention is given to helping people to go back home. This is so that their stays do not last longer than is necessary. We looked at what happened for two people who have stayed recently for shorter periods of time. Both of them went home as had been agreed with themselves and with their care manager (social worker). Care Homes for Older People Page 11 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 7, 8, 9 and 10. People are provided with the personal and health care they need. Medicines are dispensed in the correct manner. People are treated with respect. Evidence: The people who live in the Service say that the care workers offer them all the assistance they need. There is a written individual plan of care for each person. These are important because they are one of the ways that people can say what assistance they want to have and how they want it to be done. Also, the plans give information to staff so that they know what to do. We looked at four of these plans. They give a clear account of who needs to do what and why. For example, there is useful information about things such as helping people in the bathroom, about health care and about keeping people safe. We asked two care workers about some of these Care Homes for Older People Page 12 of 31 requirements. This was done to check out their understanding of what the plans say. They have a good knowledge. For example, they know about how one person needs to be helped in the bathroom. They also know about another person who likes to be kept specially warm. We saw this person sitting in the conservatory. They were wearing a shawl and seemed to be very comfortable when everyone else only needed light clothes. The plans are kept up to date so that they are accurate. This includes a monthly review. At the moment, these monthly reviews do not actively involve each of the people who live in the Service. The Registered Manager is going to look into this so that people are more clearly invited to take part. There is an annual review to which relatives are invited. This more directly involves each of the people who live in the Service. They are asked for their views about all sorts of things to do with the assistance they receive and their everyday lives. Care workers complete a daily record of how things are going for each person. This is done so that staff can keep up to date with developments. Also, it means that the Registered Manager can keep a check that things are being done in the right way. There is an arrangement whereby care workers every now and then quietly look in on everyone at night. We looked at some of the records they keep and we found that these checks are being done in the way described to us. Sensible steps are taken to ensure that people do not have any avoidable accidents. For example, one person likes to go out on their own. They dont want to have a care worker with them. The Registered Manager has tactfully discussed this with them to make sure that they are confident about dealing with things such as road traffic. People are helped to keep healthy. Care workers keep an eye open so that medical assistance can be sought if someone is becoming unwell. Since our last inspection, a number of people have seen their doctors, some on more than one occasion. There have also been consultations with professionals such as district nurses, a specialist nurse and chiropodists. No one manages their own medication at the moment. The Registered Manager says that people will be assisted to do this if this is their wish. There is a system to check that the correct medicines are received from the chemist. Once in the Service, they are stored securely. There is a procedure for administering medicines that is designed to double check that the right medicines are given to the right people at the right time. There is a record that is completed on each occasion that a medicine is dispensed. We examined three sets of these records. They are correctly completed. We looked at three medicines in more detail to see if the remaining stock matches Care Homes for Older People Page 13 of 31 what should be there. Again, we found things to be in order. We asked people what they think of the care workers. Without exception, they praise them. They say that they are courteous and attentive. One person summarized the general mood when they say, the staff are just right here. You get to know them and to know that they are always around and ready to help. They dont rush you about, just leave you to what you like at home. I really wouldnt change anything about the place. the staff are really like family. We spoke with a relative and they repeated this view. They say that they are confident that their mother is treated with kindness and affection. We noted how the care workers are relaxed and informal in how they are. For example, one person was doing a crossword. There was alot of friendly competition between them and several of the staff about who would get the clue first. We also noted how people are assisted to use the bathroom in a private manner. They are quietly helped to leave their armchairs. Once in the bathroom the door is closed to give them privacy. People are helped to wear neat and clean clothes so that they can present themselves as they wish. People are give their post promptly and they have the use of a telephone. Care Homes for Older People Page 14 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 12, 13, 14 and 15. There are social things for people to do. However, some people would like to do more. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. Evidence: There is a lively atmosphere in the Service. When we were there, people were chatting in the lounge, receiving visitors, watching television and reading the newspaper. No one appeared to be on their own too much or seemed to be bored. There are various social activities that people can do if they want. For example, they can play a game of bingo, do arts and crafts and watch films. Until recently, the Registered Manager has kept a record of what activities have been held and who has taken part. She stopped doing this because of the paperwork involved. Therefore, we cant be quite sure who has been doing what in the past few weeks. Its important for Care Homes for Older People Page 15 of 31 the Registered Manager to have a rough idea of this just in case someone starts to get overlooked. The Registered Manager says that the record will now be kept again. We asked people if there is enough going on. They say that there is plenty to do. However, we also looked at what people said when they completed a questionnaire for the Registered Providers. Only about two thirds say that there is enough to do, so at least some people would like to have more social opportunities. We think that the Registered Providers need to take another look at this. The Registered Manager says that she is now going to have a chat with each person to see if they would like to have more social opportunities. She is going to do this by 1 October 2008. People are helped to keep in touch with members of their families, if this is necessary and if it is their wish. Family members and friends are welcome to call to the Service at any reasonable time. The Registered Manager keeps in touch with family members so that they know how things are going. One relative told us, the staff always keep in touch with me if something happens like mum needs to see the doctor. I feel that I know whats going on and thats how I like it. The Registered Providers do not become involved in the financial affairs of people who use the Service. We think that this is a good idea because it helps prevent there being any conflicts of interests. In most cases, relatives help with managing peoples bank accounts so that they have enough money to pay all of their bills. The Annual Quality Assurance Assessment says that people are encouraged to make their bedrooms their own. For example, they can bring personal things in with them like small items of furniture, ornaments and photographs. We saw examples of all these in the bedrooms we looked at. People say that they receive good quality meals and that they have enough to eat. They consider meal times to be a relaxed and pleasant affair. The Registered Provider and the cook say that there is a choice of dish at each meal. Breakfasts are normally things like cereals, toast and porridge. The main meal of the day is lunch. The cooks says that there is a set dish and then people can have something else if they dont like it. We asked people if they do have a choice at lunch in practice and they say that they do. At the moment, there is no record of the alternatives provided and so we cant be sure about how this choice arrangement works in practice. The Registered Manager says that the necessary record will now be kept. The tea time meal usually is a choice between a light cooked dish and things such as a selection of sandwiches. There are records of the teas provided. These show that people do indeed choose different things. The overall menu provides people with a normal healthy diet. The cook has a good knowledge of the sorts of dishes that are going to be popular. She varies the food she prepares according to the season. She says that experience has shown that things like fish on Fridays is important to people. We looked at the menu Care Homes for Older People Page 16 of 31 for a Friday and saw that it was fish. People can dine in their bedroom if they want to. Special diets can be met. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 16 and 18. There is a system for sorting out complaints. People are kept safe. Evidence: There is a written complaints procedure. This explains how the people who live in the Service and other people can go about raising a concern. Most concerns can be sorted out locally without things being too formal. However, people can always speak to us first if they dont feel comfortable about talking with a member of staff. The procedure does not explain this option. The Registered Providers are going to put this right by 1 October 2008. We asked people about how free they feel to raise a concern with the Registered Providers or with other members of staff. They say that they are confident to approach them. They also say that there was no need to do so at the moment, because they do not have any concerns. The Registered Providers have a written statement of their commitment to keep people safe. For example, from being bullied or from not being taken care of in some Care Homes for Older People Page 18 of 31 way. Since our last inspection, a concern was raised about the wellbeing of someone living in the Service. The matter was investigated by Kent County Council. This agency is responsible for ensuring that these sorts of concerns are quickly sorted out. We understand that there is no real evidence to support the concern. We looked at how the Registered Providers have responded to the investigation. We found that they cooperated fully with the Council. We also note that they did their own investigation. This involved the Registered Manager speaking individually with each of the care workers to see if there was any truth to what was being said. She did not find anything. We asked two care workers about things that are done in the Service to keep people safe. They say that they have read the Registered Providers written policy on the matter. They also say that they will not hesitate to speak up if something is not right. They have both worked in the Service for a while. Neither of them says that they have ever seen or heard of anything that has worried them. The people who live in the Service say that they feel safe in Elm Lea. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 19, 22, 25 and 26. The accommodation in general is homely and comfortable. However, bathrooms and toilets are rather bare. There are things to help people get around. Evidence: On the outside, the building is generally well maintained. Some of the woodwork is a little discolored with age. There are stone chippings on the front drive that might be difficult for some people to walk on. At the back there is a walled garden. It is well kept, secluded and pleasant. On the inside, most of the accommodation including the bedrooms is homely. The decoration and the furnishings are of a good standard. However, the bathrooms and the toilets are clean but rather bare. Much more could be done to make them into welcoming spaces. In two of the bedrooms the atmosphere is not that fresh. The Registered Providers are going to wet wash the carpets to see if this sorts out the problem. This will be done by 1 October 2008. In one bedroom, the double glazed window is cracked and this has caused the middle space to mist up. The Registered Providers are going to replace the window. In one of the bedrooms private toilets there is a door missing off the vanity unit. In another, the vanity unit is made of laminate. Over time it has got wet and the laminate has Care Homes for Older People Page 20 of 31 peeled away of the edges. The Registered Manager says these units will now be repaired or replaced. The premises are fitted with an automatic fire detection system. This provides a high level of fire safety protection. It is understood that the Kent Fire and Rescue Service says that the system meets the national standard. The Registered Providers have prepared a fire risk assessment. This has been done to make sure that there is nothing that might reduce the level of protection in place. We looked at the assessment. It says that eight improvements needed to be made. The Registered Manager says that all of them have been done. We looked at one of them to check this out. The improvement was about not wedging fire doors open. This is important because if they are open they cant stop a fire from spreading. There was a record dated the next day after the completion of the assessment that says that the matter was raised with all members of staff. We asked two of the care workers and they say that they have been reminded about the need to close fire doors behind them. We did not see any fire doors wedged open when we were in the Service. The assessment has not yet been sent to the Kent Fire and Rescue Service. This needs to be done. This is so that it can check that fire safety system remains okay. The Registered Providers are going to do this by 1 October 2008. The local Department of Environmental Health last inspected the kitchen towards the end of 2007. It says that things are good standards of food hygiene. We looked in the kitchen. It is clean and neat. We asked the cook about how she runs things. She has a good knowledge of the importance of hygiene. She also knows about how food should be stored. So for example, she checks that the fridges are cold enough. If a packet of food is opened and some of it is not used straight away, she covers it and writes the date on it. This is done so that it doesnt get forgotten and then hang around too long. The cook says that the kitchen is well equipped. We think that the chip fryer looks a bit small. This means that chips will have to be done in batches and then there will be the problem of keeping things hot. People who need it are helped to get about. There are banister rails in corridors. At key places there are assistance poles. These are fitted to the wall and they are there for people to hold onto for extra support. Help is also given in the bathroom. The baths are fitted with seats that rise and fall. There is a passenger lift between the floors. This means that most parts of the accommodation are step-free. There is a short flight of stairs on the first floor that lead off to a couple of rooms. The Registered Manager says that only people who can manage these use this part of the accommodation. We asked people how warm the accommodation is kept. They say that they are always comfortable even during the coldest weather. Some of the radiators are fitted with guards. This has been done so that there is less chance that their heated surfaces Care Homes for Older People Page 21 of 31 might burn someone if they have a fall. The guards are not painted yet and they look unsightly. The Registered Manager says that the remaining radiators are less of a problem. For example, their location makes it less likely that someone will fall against them. However, a proper assessment now needs to be done to make sure that this is indeed the case. The Registered Provider says that this will be done by 1 October 2008. The hot water taps are temperature controlled. This has been done to reduce the chance that someone will be scalded. We checked two hot water taps and found them to be okay. The laundry has a commercial grade washing machine. This has an extra cycle for items that need an especially hot wash. There is also a large dryer. The laundry is organised and clean. The Registered Providers are going to check that the laundry complies with new regulations about preventing used water from leaking back into the main pipe-work. This will be done by 1 October 2008. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 27, 28, 29 and 30. There are just enough staff around. There is a shortfall in the recruitment system. Care workers know what they are doing. Evidence: From early in the morning until the early afternoon there are two care workers and sometimes three on duty. At night, there is a waking staff presence. There is a cook and on some days there is a housekeeper. There is no laundry person. We looked at the written roster for several days before out visit. All of the shifts described to us had been filled. There is always someone senior who can be called for advice. This is usually the Deputy Manager who lives nearby. The night care workers do the breakfasts and the afternoon care workers do the teas. When we were last in the Service, we raised questions about whether or not more care workers are needed on duty, especially at busy times. We thought that care workers might be having to rush around helping people in the bathroom, doing the laundry and then having to go into the kitchen. This time, we carefully looked at this Care Homes for Older People Page 23 of 31 whole matter again. The Registered Manager says that there are enough care workers on duty. She says that the current staffing level reflects the fact that some of the people who live in the Service at the moment dont need that much help. We asked two care workers about staffing levels. They both think that there are enough staff around. One of them summarized their joint view when they say, I know it looks like not much but you have to remember that we know the clients and what they need and so we can time out work accordingly. We have Sam (the Registered Manager) and the Deputy Manager to help and they are hands on. All I can say is that with two on we get through our work. Most of the laundry is done at night because nights are very quiet here, I know because I work some nights. As we have said earlier, we did not see care workers rushing about in particular. Also, we saw call bells being answered quite quickly. Two of the people who live in the Service commented about the matter. One said, We get the help we need when we need it. If you ask for something it arrives without having to wait. The other said, I dont ask for much but if I need help I get it and things run smoothly. If someones unwell it can cause more work for staff but they can cope or seem to. Having said all of this, we still think that the Service is only adequately staffed. If someone becomes unwell, more care workers might quickly be needed. The Registered Providers will need to keep this matter under careful review so that the staffing level can be increased should it be needed. The Registered Providers complete a number of security checks on new care workers. These include things such as confirming their identity and doing a police check. This is done to ensure that they are trustworthy people who are suitable to have unsupervised access to the people who live in the Service. We looked at the records for two of the care workers who have been appointed since our last inspection. Most of the checks have been completed. However, for both of them the employment histories do not give a full account of what work they have done. The Registered Providers are going to put this right by 1 October 2008. New care workers receive introductory training before they work on their own. We asked two care workers about their introductory training. They say that it was very useful. They say that they were introduced to the people who live in the Service and that they were told about each persons needs for support. After their introduction, care workers are provided with ongoing training. This is designed to develop further their ability to provide a high quality residential care experience. We couldnt look at all the records of this training because the Registered Manager had left them at home. She has been told that in future they must be kept in the Service. This is because we need to see them. In their absence we asked two care workers what courses they have done. They say that they have done training on important things such as how to help people move about safely, on first aid and on Care Homes for Older People Page 24 of 31 giving medication. We double checked this by looking at some the training certificates in one of the personnel files we looked in. There are a number of certificates there to show that the person in question has done courses in the sorts of subjects described. The Registered Providers are going to start a new system. This will involve the Registered Manager reviewing the skills and knowledge of each of the care workers. This will be done using a model that we think is helpful. This is because it checks what people actually know and do rather than relying too much on which courses they might have attended. The Registered Provider intends to finish this review by 1 January 2009. There is a total of 12 care workers. Ten of them have completed a National Vocational Qualification at Level 2 in health and personal care. This qualification is important because it helps care workers deliver high quality residential care services. We spoke with two care workers to find out about their knowledge and skills. They know a lot about how each of the people who use the Service like to be supported. They also know about important points of detail. For example, they know about helping older people to take care of their skin and about the important contribution good hygiene makes to health and safety. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 31, 33, 35, 36 and 38. Things are well managed. People are asked what they think, but this needs to be a little more organised. People are helped to buy what they want. A part of the fire safety regime needs to be strengthened. Evidence: The Registered Manager takes care of things. She is a qualified nurse. Also, she has a management qualification. She is in the Service most days and she has a detailed knowledge of how things are going. For example, when you ask her a question about Care Homes for Older People Page 26 of 31 one of the people who live in the Service, she knows the answer straight away. She doesnt have to fiddle about looking for bits of paper or ask someone else. Care workers feel that they can talk to her without being formal or wary in any way. The care workers say that there is good team work between them. There are handover meetings at the beginning and end of each shift. These are held so that care workers can be kept up to date with developments. Care workers say that they get on well together. They also think that the small size of the team helps because people meet each other quite regularly and talk about things to do with the Service. One person summarized the overall mood when they say, its really good to work here. I knew that I wanted to work here as soon as I walked in the door. You can just feel the relaxed atmosphere. I like the way all of the residents are treated like theyre your own Nan. Its really like a large family here and not at all like what youd imagine a care home to be. There are team meetings every now and then. The records of the most recent ones werent available for us to see. The Registered Providers will need to make sure that in future they are. We looked at the records of one held towards the end of 2006. They show that important subjects were considered. For example, the need to be alert to things such as scratches and bruises. This is so that they can be reported to someone senior who can then looked into them and if necessary call a doctor. Several things are done to ask people what they think about their home. These include informal discussions as part of daily life. The people who live in the Service or their relatives are invited to complete questionnaires about once a year. When they are returned the Registered Provider adds up all the responses to get a general picture of how things are going. We looked at the most recent summary. As we have noted earlier, the scores give a mixed account. Most people are satisfied with most aspects of the Service. However, the results show that some people want improvements to be made. So far the Registered Providers have not really looked into the results to find out what these improvements might be. Also, people arent told what has been said and what improvements the Registered Providers are going to make. There is no system to ask staff what they think. The Registered Manager says that the system will now be changed to sort out these problems. This will be done in time for us to be told about it when the Registered Providers send us their next Assessment in 2009. The Registered Providers help most of the people to manage their personal spending monies. They have been asked to do this by the people concerned. The arrangement usually is that relatives leave some money with the Registered Manager. She puts it into safekeeping and then uses it for things like paying the hairdresser. There is a record kept of the various transactions. We looked at one set of these. The amounts Care Homes for Older People Page 27 of 31 spent are for reasonable things and the sums add up. There are receipts to show that the money has been spent on what the records say was done with the money. The cash balance matches what the records say should be there. The Registered Manager and the Deputy Manager meet with each care worker on a regular basis to see how things are going. We asked two care workers about this. They say that the sessions are useful because they can speak freely about things are going for them. Also, they can ask for advice. Regular checks are completed to ensure that the Services fire safety equipment remains in good working order. This includes a weekly test of the fire alarm bells. More detailed periodic checks are completed by a contractor. There are regular fire drills. There is a system of an annual fire safety lectures. However, the last one was held in January 2007 and so the arrangement is considerably overdue. The Registered Providers are now going to strengthen this arrangement by making sure once every six months that all members of staff know how to use the Services fire safety procedure. This is important because the level of fire safety protection in the Service largely depends whether or not members of staff do the right things at the right time. The Registered Manager says that the improved system will be up and running by 1 October 2008. In the mean time, we asked two care workers about fire safety things. They know about what the fire bells sound like and what to do if they ring. There are up to date reports from engineers about the gas appliances and the passenger lift. These say that they are safe to use. We could not see the report that should say about the condition of the electrical wiring installation. The Registered Manager says that the electrician has not sent a copy to her yet. She says that no improvements were required by the electrician. We have asked her to send a copy of the report to us as soon as she gets the copy. We looked at the record of accidents that have occurred in the Service since the last inspection. There is nothing in the frequency or in the nature of the accidents that causes us concern. The Registered Manager says that she checks the premises and the accommodation to ensure that there are no hazards that might cause someone to have an accident. We looked at the records of the most recent checks. These show that sensible things are being looked at. For example, she looks at things such trailing leads and wet floors that might cause someone to have a fall. She says that there are no obvious hazards. We didnt notice any. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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