Inspection on 21/10/08 for Fazakerley House Residential Care Home

This inspection was carried out on 21st October 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

Fazakerley House Residential... 21/05/07

Fazakerley House Residential... 31/08/06

Fazakerley House Residential... 18/10/05

Fazakerley House Residential... 27/04/05

Fazakerley House Residential... 16/12/04

Fazakerley House Residential... 26/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Fazakerley House Residential Care Home Park Road Prescot Knowsley Merseyside L34 3LN     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: Daniel Hamilton     Date: 2 1 1 0 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 32 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 32 Information about the care home Name of care home: Address: Fazakerley House Residential Care Home Park Road Prescot Knowsley Merseyside L34 3LN 01512899203 Telephone number: Fax number: Email address: Provider web address: fazakerleyhouse@meridiancare.co.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Cathrine Joan Atkinson Type of registration: Number of places registered: Meridian Healthcare Ltd care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care home only- Code PC To people 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 Physical disability- Code PD The maximum number of people who can be accommodated is: 45 Date of last inspection Brief description of the care home Fazakerley House Care Centre is registered to provide personal care and support for up to 45 older people, including older people with a physical disability. The premises is well maintained and furnished and decorated to a very good standard as a new 15 bed extension has recently been built and the existing building was completely refurbished in 2005. The care centre is located in the Prescot area of Liverpool and is easily Care Homes for Older People Page 4 of 32 Over 65 45 45 0 0 Brief description of the care home accessible from the M57. Local shops, bank and public transport are situated approximately half a mile away. A smoking lounge and an air-conditioned conservatory is provided on the ground floor along with the office, kitchen area, dining room and a selection of bedrooms. The upper floor, which can be accessed by a passenger lift, comprises of the rest of the bedrooms. Twenty-nine of the rooms are equipped with en-suites and toilet and bathing facilities are located throughout. A call bell system is fitted in all areas of the care centre. Off road parking is available at the front of the premises. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The quality rating for this service is 2 star. This means that the people who use the service experience good quality outcomes. This unannounced inspection took place over one day and lasted approximately 10 hours. A partial tour of the premises took place and observations were made. Five care files were examined and a selection of staff and service records were also viewed. The manager, three care staff, three relatives and twelve residents were spoken with during the visit. Survey forms were distributed to a number of residents or their representatives prior to the inspection in order to obtain additional views and feedback about the service. All Care Homes for Older People Page 6 of 32 the core standards and previous recommendations from the last inspection in May 2007 were reviewed. The Care Home Fees for this service range from 357.00 to 385.00 pounds per week. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 32 Some assessments viewed provided basic information on the needs of residents and a number of omissions were noted in one assessment. Staff responsible for undertaking pre-admission assessments should therefore receive appropriate support or training, to ensure they understand how to undertake an holistic assessment of needs. Some medication administration records viewed had not been signed to confirm the administration of medication. It is recommended that all staff designated with responsibility for administering medication undertake an assessment of competency periodically, to confirm they understand the organisations medication policies and procedures. This will help to safeguard the health and welfare of the people using the service and ensure a clear audit trail. Some progress had been made in the development of in-house activities for residents however a large number of residents remained dissatisfied with the lack of community based options. The range of activities should be kept under review and include community based activities geared towards the needs and expectations of the people using the service. This will ensure the ongoing development of the service and help to satisfy the needs and expectations of all the residents. Overall, areas viewed during the inspection appeared well-maintained and clean. At the time of the visit the furniture and decoration in the lounge area used for smoking was in need of cleaning and refurbishment. This issue should be addressed to ensure the comfort and dignity of the people using the service. Some residents reported that they did not always receive a choice of meal at lunch time. It is recommended that a copy of the menu plan be displayed for residents to view in large print. This will help the people living in Fazakerley House to read the information and understand the meal choices more easily. The registered provider (Meridian Health care Limited) had developed induction booklets for staff to complete as part of their induction. The documentation should be reviewed to confirm it meets the requirements of the Skills for Care Common Induction Standards as previously recommended. All outstanding staff should be supported to access training and development opportunities beyond the basic requirements, in order to increase staff awareness of care related topics e.g. dementia, palliative care, nutrition, equality and diversity, diabetes etc. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have access to information on Fazakerley House and undergo an assessment of their needs prior to admission, to enable them to determine whether the service is able to meet their needs. Evidence: Since the last visit the Registered Provider (Meridian Healthcare Limited) had produced a combined Statement of Purpose and Service User Guide in a standard format. A copy of the document was made available to prospective residents or their representatives via a Welcome Pack which contained a brochure on Fazakerley House, marketing information, a copy of the complaints procedure and details of staff training. The manager had also produced the Statement of Purpose and Service User Guide in large print and a Contract had been developed to outline terms and conditions of residency. Information on Fazakerley House was displayed in the reception area of the Care Homes for Older People Page 11 of 32 Evidence: care centre for people to view and feedback received from the people using the service confirmed that they had received enough information about the service before deciding whether to move in. The files of five residents were viewed during the visit. Three assessments were for residents that that had moved into Fazakerley House since the last visit and two were for residents who had been living in the care centre for over one year. Each file viewed contained a Pre-Admission Assessment that had been completed by the home before each resident had moved in. The assessment form had been designed to enable staff to undertake a comprehensive assessment of needs, however the information on some assessments was basic and a number of omissions were noted in one. Since the last inspection, the assessments had been updated to include information on equality and diversity issues. Copies of social work assessments had been obtained for residents referred through care management arrangements and residents spoken with confirmed that they had been given the opportunity to visit the care cenre to assess the quality, facilities and suitability of the service prior to admission. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that residents receive is based upon their individual needs and the principles of respect, dignity and privacy are put into practice. Evidence: The Annual Quality Assurance Assessment (AQAA) for Fazakerley House detailed that policies and procedures had been developed for individual planning and review and for the control, storage, disposal, recording and administration of medicines. The files of five residents were viewed during the visit in order to review care planning processes. Three care plans examined were for residents that that had moved into Fazakerley House since the last visit and two were for residents who had been living in the care centre for over one year. Each file contained a plan of care that outlined the individual needs, goals and action required by staff to meet the health, personal and social care needs of residents. Care plans had been signed by residents or their representatives and a system had been Care Homes for Older People Page 13 of 32 Evidence: established to ensure each plan was kept under monthly review. Systems had also been established to ensure the records were audited periodically. Care Plans had been completed to a satisfactory standard however the service was recommended to clarify in more detail the particular needs of residents as part of the ongoing monthly review process. A range of supporting documentation was also available for reference as previously noted. This included life history and personal information, a range of individualised risk assessments, daily reports, medication consent forms, weight and health care records. Records of personal care provided to all residents were maintained in a log book. Feedback received from residents via surveys and examination of the AQAA and medical intervention records provided evidence that the people living in Fazakerley House had access to a range of health care services subject to individual need. Medical intervention records viewed confirmed residents had been in contact with general practitioners, community nurses, opticians, chiropodists, consultants and audiologists etc. Fazakerley House continued to use a blister pack system that was dispensed by a local pharmacist on a monthly basis. A record of staff authorised to administer medication and a system to check the identity of residents prior to administering medication was in place. Previous inspection records confirm that staff designated with responsibility for administering medication had undertaken medication training and this was verified with a member of staff who was administering medication during the visit. Risk assessments had been completed for two residents who self-administered medication. Advice was given on how to further develop the assessment process. Medication was appropriately stored in a locked air-conditioned room within a medication trolley. A fridge was available to store medication requiring cold storage and suitable storage was in place for controlled drugs. A sample of Medication Administration Records (MAR) were viewed during the visit. Records confirmed that medication entering the care centre had been checked, signed in and dated on MAR. Overall, MAR viewed had been correctly completed to account for the administration of medication however there were three occasions when staff had failed to complete MAR, to account for medication administered. Furthermore, the recorded balance of one type of medication in the controlled drugs register did not correctly correspond with the actual balance. This issue was addressed by the manager during the visit. Care Homes for Older People Page 14 of 32 Evidence: Systems were in place to account for medication returned to the pharmacist and stock levels were satisfactory at the time of the visit. Staff spoken with demonstrated a good understanding of the needs of the people living in Fazakerley House and were observed to be attentive to the residents needs and support requirements. Staff were observed to provide care and support in a dignified and caring manner and residents were complimentary of the care provided. For example, comments from three residents included: They [staff] have all been very good to me; I couldnt complain about the care provided. The staff and manager are brilliant and The girls [staff] are very helpful and kind. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Community based activities are in need of ongoing development and review in order to satisfy the social and recreational needs and expectations of the people using the service. Evidence: Since the last visit, the range of activities available in Fazakerley House had been expanded and notices had been developed to provide information for residents on the range of activities organised in the care centre. Three notices were displayed throughout the care centre which detailed that dominoes, board games and cards were organised during the afternoon on a Monday, Tuesday, Thursday and Friday. Bingo sessions were also coordinated on a Wednesday and each weekend when old time music and sing-a-longs was also available. Some residents also reported that they had accessed the local community independently or with occasional support from staff. Records viewed highlighted that there had been no external trips as previously noted and feedback received from residents via surveys and discussion confirmed this remained an issue of concern for many people. For example, comments received from Care Homes for Older People Page 16 of 32 Evidence: three residents included; Would like to have if possible (myself paying) some activities maybe cinema, theatre or pub away from home; The only comment I would like to make is we are in this home 24/7 unless we are lucky enough to be taken out by relatives or friends. There is no mini-bus so we never go out as a party either to a shopping precinct or as a day trip which is very sad and There are not many activities. It would be nice if someone would take us out on trips. The manager reported that the range of activities on offer was continually reviewed with residents via resident meetings and the Annual Quality Assurance Assessment (AQAA) detailed that the continued expansion of the range of activities, especially outdoors, was an issue that the service aimed to improve on in the next 12 months. Three outside entertainers had also visited Fazakerley House since the last visit and representatives from the local roman catholic, church of england and methodist churches continued to visit residents in the care centre subject to their individual religious beliefs. Residents were observed to receive visits from family and friends at different times of the day and people spoken with confirmed they were able to follow their preferred routines. A three-week rolling menu was in place which had been kept under review and developed in consultation with the people using the service. The manager was recommended to display the menu in large print and to make the meal choices more clear as some residents spoken with reported that they did not always receive or understand the choices on offer. For example, a resident reported; The only meal we dont get a choice for is dinner but the food is good Menus viewed detailed that a choice of wholesome and nutritious meals was provided to residents at each sitting. Meals were served in the homes dining room which was decorated and furnished to a pleasant standard. Although meals were served at set times, arrangements were flexible to accommodate individual needs and additional refreshments were served throughout the day. Information on the dietary needs and preferences of residents had been obtained as part of the assessment process and the manager confirmed that the home would meet the dietary needs of current and prospective residents as required. Mealtimes were observed to be unhurried and care staff were observed to be available to provide assistance to residents who required support at mealtimes. Care Homes for Older People Page 17 of 32 Evidence: Feedback on the standard of catering was generally positive. Comments included; The food is very nice and The meals are very appetising. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives are able to express their concerns via a complaints procedure and systems are in place to protect residents from abuse. This protects the rights of residents and ensures an appropriate response to suspicion or evidence of abuse. Evidence: Meridian Healthcare Limited (Registered Provider) had a corporate complaints procedure in place which detailed that complaints would be responded to within 28 working days. Information on the complaints procedure was included in the Statement of Purpose and Service User Guide and a copy of the procedure had been displayed in residents rooms. The service maintained a record of all concerns and complaints received. Records showed that three complaints had been received by the manager since the last visit. Two of the complaints concerned the conduct of the night staff and records detailed that both the complaints were retracted by the complainant. The third complaint concerned discrepencies in the management of medication for one resident. Records viewed provided evidence that the complaints had been acknowledged and acted upon by the manager. The Commission for Social Care inspection had received no formal complaints about Care Homes for Older People Page 19 of 32 Evidence: the service in the last twelve months however two concerns regarding the staffing levels in the care centre at night time were received. The concerns were discussed with the manager of the home and the staffing levels have been kept under review. One relative expressed concern regarding the temperature in the home during the visit. The manager reported that that this issue had been fully investigated and rectified by a heating engineer. Feedback received from residents via care home surveys and through discussion confirmed that the people living in the home knew who to speak to if they were not happy and how to make a complaint. Likewise, residents reported that they felt listened to by staff and that their comments were acted upon. For example, a resident stated; I know that if I have a problem I can speak to the manager. Policies and procedures had been developed to provide guidance to staff on how to respond to suspicion or evidence of abuse. The annual quality assurance assessment for the service detailed that safeguarding adult training had been organised for the manager and deputy manager and cascaded to all levels of staff since the last visit. Staff spoken with during the visit demonstrated a satisfactory awareness of how to recognise and respond to suspicion or evidence of abuse. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is generally well maintained and clean. This provides residents with an attractive, safe and comfortable home. Evidence: Fazakerley House was suitable for its stated purpose and areas viewed were accessible, safe and generally very well maintained. A part-time handyperson was responsible for keeping the premises in a good state of repair and contractors were hired for specialised maintenance work as and when required. The care centre has received substantial ongoing investment by the Registered Provider (Meridian Healthcare Limited). Since the last inspection, a new extension had been built in order to accommodate 15 additional residents. This included the development of a secure courtyard, patio area and car park. The exisiting building was completely modernised, refurbished and redecorated during 2005. Residents spoken with were complimentary of the standard of accommodation. Feedback received from three residents included; Ive been to four homes before this and this is the best; Its nice and very homely. The place is well-decorated and furnished and Its wonderful. Coming here is the best thing I ever did. Care Homes for Older People Page 21 of 32 Evidence: The front entrance of Fazakerley House was accessible and the care centre was equipped with a call bell system and passenger lift. Assisted bathing and toilet facilities were available for residents to use. Handrails were fitted along corridors and hoisting equipment was in place. Service users had access to personal mobility aids and grab rails were fitted in each room and ensuite, subject to individual needs. (Please refer to the Brief Description of the Service section for more information on the premises). The annual quality assurance assessment for the service confirmed policies and procedures were in place for communicable diseases, infection control and the control of substances hazardous to health. The laundry was sited away from food preparation areas and sluicing facilities were available on each floor. Domestic staff were employed to ensure the care centre was kept clean and hygienic as previously noted. Areas viewed during the inspection (with the exception of one lounge area) were generally clean and hygienic. One lounge area used for smoking was in need of redecoration, cleaning and refurbishment. Records confirmed that the premises had been visited by the fire officer and the environmental health department since the last visit. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are appropriately recruited and have access to training that is relevant to their role and responsibilities. This protects the welfare of the people using the service and helps to develop the competence of staff working in the care centre. Evidence: Changes had been made to the staffing levels in Fazakerley House since the last visit in order to respond to the increased number of residents accommodated following the completion of the new 15 bed extension. Examination of rotas and direct observation confirmed there were five care staff and a senior carer on duty through the day from 8.00 am to 8.00 pm. During the night, three waking night staff were on duty. The manager was supernumerary and continued to work Monday to Friday each week or as required by the needs of the service. Feedback received from residents and their representatives confirmed the people living in the home received the care and support they required and that staff were available when needed. Staff were observed to communicate and engage with residents in a respectful manner and were attentive to the needs of the people using the service. The Annual Quality Assurance Assessment (AQAA) for Fazakerley House confirmed Care Homes for Older People Page 23 of 32 Evidence: that corporate policies and procedures had been developed for recruitment and employment by the Registered Provider (Meridian Health care Limited). The manager reported that six staff had commenced employment at Fazakerley House since the last inspection and the recruitment records for the six employees were viewed. Files viewed contained all the necessary records required under the Care Home Regulations 2001. Advice was given regarding one application form which did not include details of any referees and a Criminal Record Bureau check which had not been processed via the Registered Provider. The manager agreed to address these issues. Examination of training records and discussion with staff confirmed staff had access to induction and ongoing training as part of their employment. The Registered Provider had developed induction booklets for new employees and evidence of inductions was available for the six new staff that had started since the last visit. Two of the records had not been dated or signed off by the employee. The manager agreed to check that the Meridian Induction package was fully compliant with the Skills for Care Common Induction Standards as recommended at the last visit. The manager reported 25 care staff were in post at the time of the visit. Records detailed that 13 staff had completed a National Vocational Qualification (NVQ) in Care at level 2 or above (52 ). An additional 5 staff (20 ) were working towards the NVQ level 2 award and two staff who already had a NVQ level 2 were working towards a higher award. Once the remaining staff members have completed the training, 72 of the care staff will have attained the qualification. Since the last visit the manager had established a training matrix which was recorded on a white board for reference. Discussion with the manager and examination of records highlighted that some of the information recorded was not up-to-date. The manager agreed to address this matter. The manager reported that staff received a range of in-house training which consisted of Fire, Health and Safety, Moving and Handling, Protection of Vulnerable Adults and Basic Food Hygiene. The training was delivered via company videos or by senior staff who had received training in the subject area. Some minor gaps were noted and the manager confirmed that these related to staff who had been absent from work. Other training offered by the company included nutrition, control of substances hazardous to health, mental capacity, medication, diabetes, palliative care, dementia, continence awareness etc. A number of gaps were noted in these training subjects which should be addressed. The manager agreed to update the records and to review staff awareness of equality Care Homes for Older People Page 24 of 32 Evidence: and diversity issues as staff spoken with lacked awareness of this topic as previously noted. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to ensure the care centre is appropriately managed. This ensures the service is run in the best interests of residents. Evidence: The Registered Manager of the home (Mrs Catherine Atkinson) is registered with the Commission for Social Care Inspection and has managed the care centre for several years. Since the last visit, the Registered Manager had completed the National Vocational Qualification (NVQ) level 4 in Health and Social Care Qualification and previous records confirmed the manager had also attained the (NVQ) level 4 in Management and the D32/D33 care assessors award. Examination of records confirmed the manager had undertaken a range of additional training in the past twelve months that was relevant to her role and responsibilities. Care Homes for Older People Page 26 of 32 Evidence: The Registered Provider (Meridian Health care Limited) had an external management structure in place and there were clear lines of accountability within the service. The manager demonstrated a commitment to the ongoing development of Fazakerley House and systems had been established to ensure the management and operation of the care centre was open and transparent. Feedback received from the people using the service, their representatives and staff was also generally positive. Records showed that the Operations Manager had continued to undertake regular visits to Fazakerley House on behalf of the Registered Provider and produced a monthly report in accordance with Regulation 26 of the Care Home Regulations 2001. A Residents and Representatives survey had also been completed during May 2008. This involved distributing questionnaires to residents or their representatives to seek their views on a range of issues. Records detailed that twenty seven (78 ) of the thirty-six questionnaires distributed were completed and returned. A summary of the survey and the findings is available in the care centre for reference. Minutes were also available to confirm that meetings with residents and staff had been coordinated. Staff spoken with confirmed they had access to formal staff supervision and records were available on files viewed. The Registered Providers head office was responsible for invoicing residents or their representatives for fees and a system was in place to enable payments to be made by standing order. The manager did not act as an appointee for any of the residents, as the people living in the home received support to manage their finances from either family members or personal representatives. At the time of the visit the manager looked after the personal finances for approximately 15 residents. Records of transactions were in place and receipts had been obtained to account for expenditure. Since the last visit a declaration form had been developed to confirm authorisation had been received from residents or their representatives for money handled on behalf of the people using the service. Additional advice was given on this matter. The Annual Quality Assurance Assessment for Fazakerley House confirmed that Health and Safety policies and procedures were in place and that maintenance and associated records had been kept up-to-date for all key areas. Fire records were viewed during the visit. Records confirmed the fire alarm system had been tested on weekly basis and that fire safety equipment had been visually inspected, tested or serviced periodically. Care Homes for Older People Page 27 of 32 Evidence: Risk assessments had been completed for safe working practice areas including Fire, Catering, General Cleaning and Care Practices and health and safety audits were undertaken to identify and control potential risks. Staff spoken with confirmed they had received in-house training in a range of health and safe topics to promote safe working practices. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 3 Staff responsible for undertaking pre-admission assessments should receive appropriate support or training, to ensure they understand how to undertake an holistic assessment of needs. Staff designated with responsibility for administering medication should undertake an assessment of competency periodically and medication administration records should always be signed to confirm the administration of medication to residents. This will help to safeguard the health and welfare of the people using the service and ensure a clear audit trail. The range of activities should be kept under review and include comunity based activities geared towards the needs and expectations of the people using the service. This will ensure the ongoing development of the service and help to satisfy the needs and expectations of all the residents. A copy of the menu plan should be available for residents to view in large print. This will help the people living in Fazakerley House to read the information and understand the meal choices more easily. Action should be taken to clean and refurbish the lounge area used for smoking, to ensure the comfort and dignity of the people using the service . Page 30 of 32 2 9 3 12 4 15 5 26 Care Homes for Older People 6 30 The Organisations induction documentation should be reviewed to confirm it meets the requirements of the Skills for Care Common Induction Standards. All outstanding staff should be supported to access training and development opportunities beyond the basic requirements, in order to increase staff awareness of care related topics e.g. dementia, palliative care, nutrition, equality and diversity, diabetes etc 7 30 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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