Inspection on 18/12/08 for Fairlight Manor

This inspection was carried out on 18th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fairlight Manor 13/05/09

Fairlight Manor 14/10/08

Fairlight Manor 30/06/08

Fairlight Manor 10/09/07

Fairlight Manor 04/12/06

Fairlight Manor 18/11/05

Fairlight Manor 22/04/05

Fairlight Manor 25/11/04

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: Fairlight Manor 48 Fairlight Avenue Telscombe Cliffs East Sussex BN10 7BS     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: Judy Gossedge     Date: 1 8 1 2 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 30 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 30 Information about the care home Name of care home: Address: Fairlight Manor 48 Fairlight Avenue Telscombe Cliffs East Sussex BN10 7BS 01273582786 01273582786 ashnazpatel@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Fairlight Manor Ltd care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Date of last inspection Brief description of the care home Fairlight Manor is located in a quiet residential area of Telscombe Cliffs, near to the seafront and local shops and amenities. The property comprises of two large semidetached houses, which have been made into a single building and extended. Residents accommodation is presented over three floors; a passenger lift is available to all floors. The home has a large sitting room with television and stereo, with a smaller dining room situated just off, between the sitting room and the kitchen. Residents have access to the garden at the rear of the premises that is equipped with garden furniture and umbrellas in the summer for them to use during the fine weather. The home provides personal care and support to residents who are both privately funded and those who are funded by Social Services. The homes fees at the time of the Inspection range from £423.86 to £525.00 per person per week. Additional costs are charged for hairdressing; chiropody, newspapers, toiletries and contributions are requested for outside activities. The homes literature states that `the home is committed to working with these individuals, and believe that however impaired they are, they still deserve to be treated with respect and dignity. A Statement of Purpose and Service Users Guide is available to reference. Care Homes for Older People Page 4 of 30 Over 65 0 19 Care Homes for Older People Page 5 of 30 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 reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Fairlight Manor care home will be referred to as residents. This unannounced inspection took place over four and a quarter hours on 18 December 2008 and was undertaken by an Inspector and a Regulation Manager. Mr Patel the Registered Manager and Provider, referred to as Manager in the report was present during the inspection. Mr Patel has appointed a manager, referred to as appointed manager in the report, to be responsible for the day-to-day running of the Care Homes for Older People Page 6 of 30 home with Mr Patel overseeing management matters through her. Both were on duty for either all or part of the inspection and facilitated the inspection. The Manager had been asked to complete an Annual Quality Assurance Assessment (AQAA) for the last key inspection and information from which was updated during the inspection and is quoted in this report. A random inspection was undertaken on 14 October 2008 to monitor compliance with Requirements made at the last key inspection undertaken on 30 June 2008. Following this Statutory Requirement Notices were issued where there had been continued noncompliance relating to staff recruitment procedures, staff training, and activities provided. A focus of this inspection was compliance with these notices. A tour of the premises took place to look at communal areas and a selection of residents bedrooms and care records were inspected. Thirteen residents were resident, and residents were spoken with individually in their bedroom, or in the communal areas as part of the inspection process. The care that four of the residents received was reviewed as part of the inspection process. The opportunity was also taken to observe the interaction between staff and residents in the communal areas. Two care workers, the cook, the domestic and maintenance person, the appointed manager and the Registered Manager and Provider were all spoken with during the inspection. No residents or care workers surveys were sent out on this occasion. A health care worker visiting the home was spoken with during the inspection. What the care home does well: What has improved since the last inspection? The Statement of Purpose and Service Users Guide has been updated. Individual care plans have been developed to detail residents individual care needs and to provide specific guidance for staff to follow, and is devised in consultation with the resident or their representative. A system is in place to review the care plans to ensure that all the care needs recorded are up-to-date. Individual risk assessments that cover residents risk are recorded. The Manager undertakes moving and handling risk assessments in the home and stated he has been appropriately trained and receives the required training updates. Guidelines for medicine prescribed on an as and when required has been developed. A record is kept of staff signatures who administer medication and safe storage has been provided for medication awaiting collection from the pharmacist. The records of individual residents food consumption have been further developed to record all meals taken in the home to protect residents and evidence that an adequate and varied diet is provided. Residents are now able to access a range of social activities to meet their individual social care needs, and the range and the frequency activities are provided should continue to be developed. A number of the residents bedrooms overlook public areas and for the privacy and dignity of residents net curtains have been provided to the homes windows. Staffing numbers have been increased during the waking day. Recruitment procedures have been reviewed to ensure the receipt of a satisfactory Criminal Records Bureau and Protection Of Vulnerable Adults (POVA )First check and two written references prior to new members of staff commencing work in the home to protect residents. Induction training to meet the requirements of Skills for Care has been introduced in to the home. The quality monitoring of the care provided has been developed to enable other stakeholders such as health and social care professionals who visit the home to comment on the care being provided. The outcome has been collated and should also be available in a format which can be made available to interested parties. Care Homes for Older People Page 8 of 30 Recorded visits to meet the requirements of Regulation 26 have been maintained. Further guidance has been sought from Environmental Health and the Health and Safety Executive as required and polices and procedures are in the process of being updated. Unguarded pipe work following work undertaken to fit thermostatic valves at hot water outlets accessed by residents has been guarded. Infection control procedures have been reviewed in the home and improvements made to the supply and accessibility of liquid soap and disposable paper towels. Requirements made following the random inspection, that a risk assessment is put in place for the garden area and fire checks are maintained were evidenced to have been addressed. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 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 30 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. There is detailed information available for residents and their representatives to view. Potential new residents are individually assessed prior to an admission to ensure that their care needs can be met in the home. Intermediate care is not provided in the home. Evidence: A copy of the Statement of Purpose and Service Users Guide are available to reference in the home. Both the documents were read during the random inspection, and had been updated to ensure prospective residents and their representatives have accurate information to refer to. Staffing information in both the documents did not reflect current practice in the home and was discussed with the appointed manager at the time. The appointed manager stated this has now been addressed. The AQAA details that a copy of the last inspection report is available to reference in the home. Care Homes for Older People Page 11 of 30 Evidence: The AQAA detailed that no resident is admitted to the home unless a thorough assessment is undertaken prior to any admission, to ensure individual residents care needs can be met in the home and to provide staff with information on the care to be provided. For the one new resident admitted to the home since the last inspection there was detailed pre-admission information viewed, which had been completed. A letter is sent to the prospective resident or their representative with regard to the needs assessment completed and to confirm that the care needs of the prospective resident can be met in the home. Intermediate care is not provided in the home. Care Homes for Older People Page 12 of 30 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. Care planning has improved with residents individual care plans detailing choices and preferences and providing guidance to staff as to the care to be provided, health care needs, and with supporting risk assessments in place. Further guidance on the management of any challenging behavior and risk of pressure sores should now be put in place. Medication practices have been reviewed, but it should be ensured that the recording of administration of medication is maintained. Evidence: The appointed manager stated that further work has been undertaken to improve the information contained within all the individual residents care plans. A selection of four of the residents individual care plans was viewed and there was evidence of significant improvement in the care planning. The documentation was well structured and presented and storage of this information has been reviewed to ensure confidentiality. Each resident had an initial assessment from which the care plan was developed. The care plans are pre-written and then adapted to detail individual residents care needs. These provide a good rationale to identify the care to be provided, and have been Care Homes for Older People Page 13 of 30 Evidence: developed to detail residents individual care needs, preferences and choices. All had records of regular checks of the residents weight. All the residents had an up-to-date photograph in place. One resident was described as having challenging behavior, but there was no guidance for staff as to how to manage this. This issue was also highlighted at the last key inspection and was discussed with the Manager who stated and evidenced that a risk assessment ifor the management of challenging behavior is in the process of being introduced in the home. An assessment for pressure sores has also been developed and again is due to be implemented in the home. A Requirement has been made to address these issues. Risk assessments include nutritional screening, mobility and the risk of falls, and all of the four residents documents had risk assessments in place. The care documentation recorded regular contact with health and social care professionals and a visiting community nurse confirmed that they are involved as necessary with the residents care. The AQAA details that medication policies and procedures are in place. The home has a designated locked cupboard for the storage of medication and a sample of the storage and recording of medication administered was viewed. At the time of the Inspection none of the residents were self-administering their medication. A list of staff sample signatures for those administering medication is in place. There were several gaps in the administration records, which was discussed with Manager on the day who stated this would be addressed. Where residents are on medicines on an, as required basis further guidance to staff on when to give this medication has been put in place. Staff confirmed that a pharmacist regularly visits; the records were not viewed on this occasion. The appointed manager also stated she was aware of the new requirements in relation to the storage of any controlled drugs and that an appropriate cupboard and a control drugs register has been ordered with delivery expected within six weeks. So a Requirement has not been made on this occasion. Facilities have now been provided to ensure that all medicines are stored securely when awaiting collection. The Manager stated medication training facilitated by himself and has been provided to staff. Medication training was discussed with the Manager, who has agreed to look in to further medication training facilitated by an external provider to supplement the training already provided. There were no training records available to view to evidence which staff had undertaken medication training. The care worker spoken with during the inspection confirmed they had attended medication training. Care workers were seen to be respectful to residents and visitors. Net curtains have now been provided at windows in residents bedrooms. Care Homes for Older People Page 14 of 30 Care Homes for Older People Page 15 of 30 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. Residents benefit from opportunities to participate in social and recreational activities, residents are encouraged to maintain contact with family and friends as they wish and a varied diet is provided. Evidence: The AQAA, Statement of Purpose and Service Users Guide all detail that individual and group activities are facilitated in the home. Care workers facilitate the activities in the home and the Manager stated that he was still advertising for an activities co-ordinator to work in the home. An activities plan is in the lounge to reference and details of actives that individual residents have taken part in are available to reference. On the day of the inspection ten residents were going out to a local garden centre for a visit and a Christmas dinner. Additional staff had been brought in to assist residents. The three residents who did go on the outing had their own Christmas dinner with the staff remaining in the home. Care plans detail residents individual social care needs. Staff was seen to be welcoming and residents can see their relative or friend in private if they wish. Care Homes for Older People Page 16 of 30 Evidence: A cook was spoken with, who with a second cook work in the home seven days a week providing the residents meals. Training records viewed evidenced that both of the cooks have a basic food hygiene certificate. The menu was read, which the cook stated she had drawn up and that improvements of food deliveries to the home has lead to less changes from the stated menu. Choices were documented to be available at all meals. The three residents who did not go out had roast turkey, mashed potatoes, broccoli and cauliflower followed by minced pies and cream. The cook stated that fresh fruit is regularly ordered and available in the home, and a bowl of fruit was in the sitting room. Special diets are catered for. Residents were observed eating part of their lunch with staff in the dining room and it was a relaxed environment taking into account the different length of time that individual residents would need to finish their meal. Records viewed detailed what individual residents had eaten during the day to ensure that residents have had an adequate and varied diet. Care Homes for Older People Page 17 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures are in place to enable residents or their representatives to raise any concerns about the care being provided, also to ensure that residents are protected from abuse. Care workers should receive training and guidance on the policies and procedures in relation to protecting vulnerable adults. Evidence: The AQAA details that there is a complaints policy and procedure in place and a copy of the procedure was available to view in the entrance of the home. The Manager stated that no complaints have been received since the last inspection. The CSCI has been made aware of two concerns in relation to the care provided at Fairlight Manor, investigated under safeguarding adults procedures. The AQAA detailed that there are policies and procedures in place in relation to the protection of vulnerable adults. A copy of the East and West Sussex County Council, Brighton and Hove safeguarding adults procedures is available to reference in the office. The Manager stated that he has completed training on facilitating training for staff in safeguarding adults procedures. Training records viewed detailed that not all staff has received training and guidance on the safe guarding of vulnerable adults. A Requirement has been made to address this issue. Care Homes for Older People Page 18 of 30 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. Fairlight Manor provides residents with a homely and pleasant environment. Evidence: A tour of the building was made. The home has a light and airy feel to it and provides a pleasant environment for residents. There are seventeen single bedrooms and one double bedroom situated on all floors in the home. A number of bedrooms were viewed and had been personalised with pictures and ornaments. The appointed manager stated that further work has been undertaken to help facilitate more bedrooms to be personalised with residents and their representatives or by the staff where there are no relatives. All bedrooms have an emergency call bell system, but one bedroom did not have an extension lead. It must be ensured that the emergency call bell system is fully accessible. One bedroom was being used to store the homes mobile hoist and it should be ensured that appropriate storage is available for equipment in the home. Another vacant bedroom will need redecoration before being used by a new resident. Five of the single bedrooms have en-suite facilities of a shower, wash-hand-basin and toilet. Communal bathroom facilities are provided throughout the home. One bathroom was not accessible to residents during the inspection as is being upgraded. Heating is Care Homes for Older People Page 19 of 30 Evidence: provided by a central heating system. The homes records of checks of the hot water supply were viewed and did show that there was some recording of temperatures lower than the recommended safe temperature of 43 C. This was raised at the last key inspection and so a Requirement has been made on this occasion to address this. A passenger lift is available from the lower floor to the second floor. The main staircase now has stair gates from the ground to second floor. The communal area is attractive and allows for flexible use and provides a sitting room and dining room. The room and adjoining corridors and have been decorated and personalised with photographs of residents and activities they have participated in. This is where the majority of the residents congregate during the day. There is a garden to the rear of the home, which has been made secure. The Manager stated further improvements to the garden area are still planned in 2009 to make it more suitable for the residents in the home. Access to the garden is via the patio doors off the lounge by steps leading onto a patio area adjoining a sharp drop to the lawn. The Manager stated that as part of the improvements it is planned to fix railings to protect the residents. A risk assessment to protect residents until this work has been completed has been put in place. The AAA details that there is a policy in place for managing infection control and that the Department of Health Guidance has been used to assess current infection control management. The appointed manager has previously stated that infection control procedures in the home have been reviewed to ensure that staff has an adequate and an accessible supply of liquid soap and disposable paper towels for their use. There was evidence in the home of these supplies in the home. One communal toilet had a fabric hand towel for residents use and this was discussed with the Manager to review its use to ensure infection control procedures were being met. A part-time domestic and maintenance person works in the home five days a week. The home was clean and free from offensive odours at the time of the inspection. The domestic and maintenance person has previously stated he has received training and guidance in infection control or the control of substances hazardous to health regulations (COSHH.) The Manager stated that infection control training had been facilitated in May 2008. The one care worker spoken with on the day confirmed attendance at this training, but training records viewed did not evidence all staff have received this training. The care workers undertake all the laundry duties in the home. The laundry room is very small and plans to provide a larger laundry in the home have not yet been implemented. Care Homes for Older People Page 20 of 30 Evidence: Recording was viewed and the maintenance person was spoken with to confirm routine fire checks have been carried out in the home. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels have been increased and must be continually kept under review to ensure the care needs of the residents continue to be met. Recruitment procedures are in place to ensure residents are in safe hands at all times. Care workers should be provided with the required training to ensure they can meet the care needs of the residents and training records should continue to be developed. Evidence: The appointed manager works supernumerary in the home, with a deputy manager to provide further management cover. Staffing levels have been reviewed since the last inspection and three care workers were working in the home during the day of the inspection and at night the home was due to deploy two waking night, staff. Staff rotas viewed and staff spoken with during the inspection also confirmed the increased staffing levels in place. Staffing levels should be kept under review, especially with any increase in the number of residents in the home to ensure that all the residents care needs continue to be met. The times the Registered Manager is on duty in the home is still not recorded on the rota. This was discussed with the Manager and further clarified why this is required. The Manager stated that this would now be addressed, so a further Requirement has not been made. The AQAA detailed that of the thirteen care workers working in the home five hold an Care Homes for Older People Page 22 of 30 Evidence: NVQ Level 2 in care and four further care workers are working towards this qualification. The documentation was viewed for three new members of staff, who had been recruited since the last inspection. All demonstrated the completion of an application form, and had two written references in place prior to commencing work. A new member of staff spoken with on the day confirmed they had been interviewed and two written references requested. All had had a Criminal Records Bureau (CRB)/and a Pova First check which had been requested and received prior to staff commencing work in the home. The Manager stated that induction training for new members of staff is now in place and that this meets the requirements of the General Skills for Care induction standards, and that it is planned to retrospectively take staff who have been recruited to the home during the past two-three months through this induction. There were induction records to view for one new care worker who had completed a part of the required induction, and one new member of staff spoken with confirmed it was the first day they had worked in the home and that they had had an induction the previous day, which included being made aware of fire procedures and had had a resume of the individual residents care needs. Care Homes for Older People Page 23 of 30 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. Fairlight Manor is run in a friendly manner. The current management arrangements have enabled significant work to address issues highlighted, but there are still shortfalls in respect staff training and health and safety practice in the home. Systems are being further developed to monitor the quality of care provided. Residents financial interests are safeguarded. The health, safety and welfare of residents and staff are not well protected in all areas. Evidence: Although Mr Patel is the Registered Manager and Provider of the home the responsibility of the day-to-day management continues to be allocated to an appointed manager. A new appointed manager has been put in place since the last key inspection and is currently working towards the Registered Managers Award. The Manager stated that an application for a new Registered Manager specifically to work in the home will now be made to the CSCI in January 2009. Care Homes for Older People Page 24 of 30 Evidence: Although there was evidence of improvements in the identified shortfalls, there are still areas which need to be addressed for example staff training. Mr Patel needs to ensure the management arrangements are appropriate and that the Manager has the skills and time to manage the home effectively. Observation and feedback confirmed that the appointed manager had a good rapport with staff and residents. The Manager evidenced a quality assurance plan, which has been drawn up for 2009. He stated that feedback has been sought from residents and their representatives, and extended to enable other stakeholders such as visiting health and social care professionals to comment on the care provided. Some of this information has been collated and the Manager agreed this would also be detailed in a format that can be made available to residents, their representatives and other interested parties. The AQAA detailed policies and procedures are in place. Not all had recently been reviewed, and the Manager stated and evidenced that all the homes policies and procedures continue to be in the process of being reviewed and updated as required and this will be completed by January 2009. Records of visits made by Mr Patel to the home to meet the requirements of Regulation 26 were viewed for October and November 2008. The Manager confirmed that the home has no dealings with residents monies and that any extras costs incurred are paid by the home and then individually invoiced on a three monthly basis. The AQAA detailed that regular supervision and team meetings are facilitated to meet requirements, and staff spoken with a sample records viewed confirmed these forums occurred. Training records were viewed, but these were still not fully up-to-date and it was not possible to evidence if all staff had received training in moving and handling, basic food hygiene, first aid and infection control within the required timescales. The Manager stated he was in the process of collating all this information and acknowledged not all staff had received the required training. A plan has been drawn up to address this with the intension of accessing more external training providers to facilitate the required training. The Manager evidenced that further advice and guidance has been sought in relation to health and safety. Policies and procedures are all in the process of being updated, where required. Risk assessments of the environment had been completed, and were viewed. Evidence that all the maintenance of equipment and services in the home had all been Care Homes for Older People Page 25 of 30 Evidence: carried out was not available to view during the inspection. This was discussed with the Manager stated that he was aware this was an area which needs to be improved, and that records are in the process of being compiled to evidence this and will be available to view at any future inspection. So a further Requirement has not been made on this occasion. A fire risk assessment is in place and should be kept under review. Records were viewed of regular weekly and monthly checks undertaken in the home. Records were viewed that evidenced that some staff had attended fire drills and fire training provided. The Manager stated that training was also due to be completed for a fire marshall for the home. A sample of the recording was viewed of incidents and accidents. Care Homes for Older People Page 26 of 30 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 27 of 30 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 13 That guidance is now in 31/01/2009 place for the management of challenging behavior and pressure sores. To protect residents. 2 9 13 That systems are reviewed 31/01/2009 to ensure that the administration of medication is always recorded. To protect residents. 3 18 18 That all staff receive training 31/01/2009 on safeguarding vulnerable adults and this is updated as required. To protect residents. 4 25 24 That hot water is provided close to recommended safe temperature of 43C at outlets accessed by residents. To protect residents. 31/01/2009 Care Homes for Older People Page 28 of 30 5 38 18 That the staff training matrix 31/01/2009 is kept up-to-date, to inform management of staff training needs. To protect residents and staff. 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 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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