Inspection on 02/12/08 for Foresters Lodge Care Home

This inspection was carried out on 2nd December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

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Foresters Lodge Care Home 28/02/08

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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: Foresters Lodge Care Home 46 St Johns Avenue Bridlington East Yorkshire YO16 4NL     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: Eileen Engelmann     Date: 0 2 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 29 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 29 Information about the care home Name of care home: Address: Foresters Lodge Care Home 46 St Johns Avenue Bridlington East Yorkshire YO16 4NL 01262602522 01262609200 richard.hoggart@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Deborah Jayne Creaser Type of registration: Number of places registered: Burlington Care Limited care home 53 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 53. The registered person may provide the following category of service only: Care home with nursing - Code N; to service users of the following gender: Either; whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP; Dementia - Code DE; Physical Disability Code PD (maximum number of places: 8). Date of last inspection Brief description of the care home Foresters Lodge care home is registered to provide care for a maximum of 53 people. The home is situated in the seaside resort of Bridlington on the east coast. Bridlington provides people with ample social and leisure opportunities; the resort has a large leisure world, spa restaurants and some high street shops. The home offers Care Homes for Older People Page 4 of 29 Over 65 0 53 0 53 0 8 Brief description of the care home comfortable accommodation in a mixture of double and single, ensuite bedrooms. There are four lounges, 2 dining rooms and a smoking lounge with a patio and garden to the rear. Information about the home is available in a Service User Guide and this is freely available at the home with a copy in each persons private accommodation. A copy of the inspection report is available on request. Information provided by the manager on 2 December 2008 indicated that the fees range from 350.00 pounds to 451.00 pounds depending on the type of care required and the room facilities chosen. Care Homes for Older People Page 5 of 29 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* stars. This means that the people who use this service experience good quality outcomes. Information has been gathered from a number of different sources over the past 10 months since the service was last visited in February 2008. This has been analysed and used with information from this visit to reach the outcomes of this report. This unannounced visit was carried out with the manager, staff and people using the service. The visit took place over 1 day and included a tour of the premises, examination of staff and peoples files, and records relating to the service. Informal chats with a number of people living in the home took place during this visit; their Care Homes for Older People Page 6 of 29 comments have been included in this report. Questionnaires were sent out to a selection of people living in the home and staff. Their written response to these was good. We received 10 from staff (100 ) and 8 from people using the service (80 ). The manager completed an Annual Quality Assurance Assessment and returned this to us within the given timescale. The Commission for Social Care Inspection has recieved one formal complaint about care in the service, since our last visit to the home in February 2008. This information was passed onto the local authority to investigate. Prompt action from the provider to change practises meant the issue was resolved quickly. The Commission for Social Care Inspection has been notified of three safeguarding of adults allegations since the last visit in February 2008. All were investigated by the local authority and were necessary the provider took appropriate action to ensure people using the service were kept safe. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: 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 29 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 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wanting to use the service undergo a needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met. Evidence: Four peoples care and records were looked at as part of this visit, they each have been provided with a statement of terms and conditions/contract on admission and these are signed by the person or their representative. Checks of the contracts showed these did not have information about giving notice or recieving notice to leave the home, did not have the costs of additional services in them and did not have the room allocated to the individual on them. We discussed this with the provider during our visit and he told us that he would ensure the contracts were updated immediately to meet the criteria of Standard 2 of Care Homes for Older Care Homes for Older People Page 10 of 29 Evidence: People. This was evidenced before we finished our visit. Each person has his or her own individual file and the funding authority or the home, before a placement is offered to the individual, completes a need assessment. The home develops a care plan from the assessments, identifying the individuals problems, needs and abilities using the information gathered from the person and their family. Checks of the homes needs assessment showed that this is very basic and one seen did not have the date it was completed on it. We discussed with the provider and manager the need to improve the overall content of the homes assessment, and good practice would be to ensure risk assessments are included as part of the information gathering process. Those people living at the home who receive nursing care undergo an assessment by a registered nurse from the local Primary Care Trust, to determine the level of nursing input required by each individual. People using the service and relatives are very pleased with the care and support given by the staff, they said we recieve excellent care and great support, and the staff are friendly and there to help you. Information from the Annual Quality Assurance Assessment and discussion with the people living in the home indicates that the majority of the people are of white/British nationality, and there are a number of people with different faiths and religions. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. The employment records show that the manager is using a selective approach to recruitment; ensuring new staff have the right skills and attitude to meet the needs of people in the home. Checks of the information in the Annual Quality Assurance Assessment completed by the manager in October 2008, and observation of the service showed that the home employs seven staff from different countries and cultures. People using the service are able to make a choice of staff gender when deciding whom they would like to deliver their care, as the home has 3 male care staff. Information from the training files and training matrix indicates that the majority of Care Homes for Older People Page 11 of 29 Evidence: staff are up to date with their basic mandatory safe working practice training, or they are booked onto training in 2008. Staff are able to access more specialist training around care of the elderly and care of younger adults. The home does not have any intermediate care beds and therefore standard six does not apply to this service. Care Homes for Older People Page 12 of 29 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, personal and social care needs of people living in the home are being met by the service and staff. Evidence: Information from this visit indicates that the people who spoke to us are satisfied that the staff give appropriate support and care to those living in the home. People said they are able to make their own decisions about their daily lives most of the time; that staff treat them well and listen and act on what they say. One individual said the staff are very caring and understanding, I am well looked after. The care of four people was looked at in depth during this visit and included checking of their personal care plans. The content of the plans is basic, easy to follow and on the whole completed to an acceptable standard. It was discussed with the manager that there are a few areas in the care plans that staff need to take more time over and these include Care Homes for Older People Page 13 of 29 Evidence: All of the care plans looked at during this visit showed a lack of monitoring and evaluation of care from October 2008, the evaluations for November 2008 were overdue. Equality and diversity information about people is not clear on the care plan format. We found that information about religious beliefs, sexuality, ethnicity and peoples preferences regarding staff gender for personal care was not included in all plans. Changes to peoples care and the actions needed by staff to meet their changed needs are not always reflected in the care plan. Instead information is put into the daily notes or jotted onto additional paperwork in the plan. There is a yearly formal review process for the care of people using the service with the funding authorities and family (where the person receiving care consents to this). However checks of the care plans indicate the review process should be extended to include people who fund their own care. The care plans are not person centred and although the four people we case tracked have been in the home for some time, we saw that the plans still say that staff must find out peoples likes/dislikes, hobbies and interests, but no information about this has been recorded. Risk assessments completed by the staff are very basic and need to be more detailed and person centred, to ensure the health and wellbeing of people is protected. There is a specific need for those who have bed rails in place to have a robust risk assessment completed. Positive aspects of the plans include evidence that staff are contacting outside health professionals for advice and visits were needed. Individuals are weighed regularly and dieticains are called if staff have any concerns over a persons nutritional needs. People said that they have good access to their GPs, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Comments from the people using the service indicate they are satisfied with the level of medical support given to them. The medication policy for the home says that individuals can self-medicate if they want to and after a risk assessment has been completed and agreed. All of the people spoken to prefer to have staff administer their medication. Care Homes for Older People Page 14 of 29 Evidence: Checks of the medication records showed these are up to date and accurate, including those for controlled drugs and refrigerated items. As a good practice measure we recommended that two staff sign next to transcribed (handwritten) medication instructions. This is to signify they have checked that the instructions contain the right medication name, strength of medication, route to be given, form of medication (tablets, liquid, cream etc.) and when it is to be administered. Peoples comments show they are very satisfied with the care and support offered by the staff. Chats with people using the service revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Individual comments were that I am happy and well cared for and staff are friendly and helpful. Observation of the service showed there is good interaction between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives. Care Homes for Older People Page 15 of 29 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. People are provided with choice and diversity in the meals and activities provided by the home. Individual wishes and needs are catered for and people have the option of when and how they participate in mealtimes. Evidence: Discussion with the provider indicated that the home has three members of care staff who carry out activities with people living in the home. There is a weekly programme of events and recently the home has had visits from a local gift shop and Thorntons, which gave people a chance to purchase gifts for christmas. People who completed our surveys said they are satisfied with the activities in the home, and the majority felt there was always or usually something going on that they could join in with. Outside entertainers are booked every month and people told us they especially liked musical entertainers. The mobile library visits every six weeks and this provides reading books and audiotapes for people to enjoy. We were shown the christmas related craftwork that people have produced, this will be used to decorate the home this year. Individuals told us that they are looking forward Care Homes for Older People Page 16 of 29 Evidence: to the Christmas Party and other festive activities. Information from peoples files indicates that there are a number of individuals who follow the Church of England faith. The manager said that there is a monthly communion service within the home and people could go to the local church services and religious celebrations as requested. Discussion with the people living in the home indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly was a good relationship between all parties. People spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. There is some information and advice on advocacy and this is available in the service user guide. Discussion with the manger indicated that work is progressing to get IMCAs appointed for those people who do not have anyone to act on their behalf. There are meetings where the viewpoints and opinions of those living in the home can be expressed and the management team will listen and take action were needed. Visitors said they are kept informed of any important issues affecting their friend/relative and felt that staff did a good job of supporting people to live the lives they choose. People who completed our surveys told us that they liked the meals at the home and one person said the meals are excellent. Information from the menus indicated that people are offered a good choice of meals and that special diets are catered for. The provider informed us that the home has recently achieved the local councils Heartbeat Award for producing health meals. We did not observe the lunchtime meal at this visit, but food will be looked at in greater detail when we next visit the home. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system with some evidence that peoples views are listened to and acted upon. Evidence: The home has a complaints policy and procedure that is found within the statement of purpose and service user guide. It is also on display within the home. The policy and procedure is available in a large print format and an audio version. Seven out of eight of the survey responses from people using the service showed individuals have a clear understanding about how to make their views and opinions heard. People told us that we would talk to the staff if we had any problems and I have never had to make a complaint. Checks of the complaints record shows the manager has dealt with three complaints since the last visit in February 2008 and these related to medication, care and laundry. The issues raised were investigated and resolved. We recommended that the home produce a more formal format for the recording of complains showing details of the complaint, dates and times recieved, who investigated the issues and the outcomes or actions taken to resolve them. Any correspondence produced during the investigation should also be kept with the complaint. It was also recommended that complaint forms be provided in the Care Homes for Older People Page 18 of 29 Evidence: communal areas such as the entrance hall so individuals could take one if they needed to make a complaint when the manager was not available. The Commission for Social Care Inspection has received one formal complaint about the service since the last visit in February 2008. This was passed to the local authority to investigate and after discussion with the provider, prompt action was taken to resolve the issue. We have been notified of three safeguarding of adults allegations since the last visit in February 2008, two related to staff actions and one where people who use the service had an altercation. These were investigated by the local authority and the provider offered full co-operation to resolve the issues. One allegation was not proven, one required disciplinary action against a member of staff and the third was resolved with monitoring of the behaviour of the people involved. Safeguarding issues and outcomes areas such as health care, staff supervision, staff training, complaints and safeguarding of adults have been looked at as part of this visit. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of peoples money and financial affairs. The staff on duty displayed a good understanding of the safeguarding of adults procedure. They are confident about reporting any concerns and certain that any allegations would be followed up promptly and the correct action taken. There is an ongoing training programme for staff to attend safeguarding of adults awareness training, and a number of staff have attended in the last 12 months. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of environment within the home is good, providing people with a comfortable and homely place to live. Evidence: Since our last visit in February 2008 the registered person has put a lot of time and effort into refurbishing and redecorating the premises. People living in the home and their relatives told us how satisfied they are with the improved environment, and said they appreciated the hard work and effort that was taking place to make life more comfortable for those using the service. The home has an ongoing maintenance and refurbishment programme and the environment is clean, comfortable and homely. The domestic staff do an excellent job of keeping the premises clean and odour free and people told us that the standard of cleanliness is excellent. Walking around the home we found that since the last visit in February 2008, new carpets have been laid in the entrance area and downstairs corridors of Maple Wing and a disable toilet facility has been created from an old, existing toilet area. Three bedrooms have had carpets replaced with a washable hard floor covering, which is more suitable for these peoples needs, and plans are in place to refurbish two Care Homes for Older People Page 20 of 29 Evidence: bathrooms and another toilet facility. The home has two seperate areas, Maple Wing is the main part of the home and is built on two floors; people can access the upper level using the passenger lift or stairs. There is a ramp to the front entrance to enable people with mobility problems easy access to and from the home and walkways inside are kept clear of any obstacles. The second area is Oak Wing where the majority of the younger adult individuals live. This is single storey and purpose built. Discussion with the provider indicated that plans are being made to connect the two areas of the home with a link corridor, so people do not have to go outside of the home to access one or other of the areas. Discussion with the staff and manager indicates that there is a wide range of equipment provided to help with the moving and handling of the people using the service, and to encourage their independence within the home. This includes mobile hoists, bath hoists, stand aids and handrails. There are a number of specialist nursing beds provided, to aid staff in caring for the people using the service and make life more comfortable for individuals who spend a lot of time in bed. Bed rails are used in some rooms where individuals have been perceived as being at risk of falling out of bed. We observed that on this visit all bed rails were in the down position whilst people were out of bed and bumpers are available to cushion the rails when in use. Discussions during this visit indicate that people using the service are satisfied with the laundry service provided by the home. Infection control policies and procedures are put into practice within the home, and communal bathrooms have paper towel and hand wash dispensers in place. Staff have received infection control training and use personal protective equipment (gloves and aprons) when giving care. The staffing matrix supplied to us on 2nd December 2008 indicates that infection control training took place in October 2008 and the majority of staff attended. Care Homes for Older People Page 21 of 29 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. The staff induction, training and recruitment practices are good, resulting in an enthusiastic workforce that works positively with people to improve their whole quality of life. Evidence: Comments from the people using the service and staff are on the whole very positive about the staffing levels within the home, and individuals feel that there is a high standard of care being given to the people living in the home. People told us that the staff are lovely people who look after us well and you always get the help you need. Staff commented that the home is friendly and we all work well as a team to make sure the people get the care they need. At the time of this visit (December 2008) there were 51 people living in the home, 17 were recieiving nursing care and 34 recieved residential care. The staffing levels were as follows Daytime - 1/2 nurses plus 6/7 care staff. Night time - 1 nurse and 3/4 care staff. Information from annual quality assurance assessment completed by the manager in Care Homes for Older People Page 22 of 29 Evidence: October 2008, about the number of staffing hours provided, and information gathered during the visit about the dependency levels of the people using the service, was used with the Residential Staffing Forum Guidance and showed that the home is meeting the minimum hours asked for in the recommended guidelines. 32 of care staff at the home have an NVQ 2 or above in care and the home has a mandatory staff training programme in place. Discussion with the manager indicates that the majority of the staff are up to date with this or are booked onto refresher training for 2008/9. Nurses are supported in maintaining their own professional portfolio of practice in order to keep their Personal Identification Number (PIN) from the Nursing and Midwifery Council (NMC) up to date. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of four staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Nurses at the home undergo regular registration audits with the Nursing and Midwifery Council to ensure they are able to practice. Four staff files were looked at and they contained evidence of a variety of training events attended over the past year including safeguarding of adults, moving and handling, fire management, infection control, diabetes, equality and diversity and safe handling of medication. The provider has introduced training DVDs for challenging behaviour, dementia care, health and safety, moving and handling and food hygiene. Care Homes for Older People Page 23 of 29 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. The management of the home is satisfactory overall and the home regularly reviews aspects of its performance through a good programme of audits and consultations, which includes seeking the views of people using the service, staff and relatives. Evidence: The registered manager of this service is Deborah Creaser and she has been in post since August 2007. The manager is a registered nurse who is in the process of completing her registered managers award, she hopes to have completed this by the end of June 2009. She has experience of caring for older and younger adults and keeps her skills and knowledge up to date with regular training sessions pertinent to her role. The home has achieved the Local Councils Quality Assurance Award (QDS parts I and II). Care Homes for Older People Page 24 of 29 Evidence: Policies and procedures within the home have been reviewed and updated to meet current legislation and good practice advice from the Department of Health, local/health authorities and specialist/professional organisations. The manager and senior staff complete in-house audits of the home and its service on a monthly basis, and the registered individual does spot checks and completes the regulation 26 visits. Feedback is sought from the people living in the home and relatives through regular satisfaction questionnaires, and the manager has produced a development report as part of this process to highlight where the service is going and/or indicate how the management team is addressing any shortfalls in the service. Checks of the finance systems within the home found that computerised and handwritten records are kept for peoples personal allowances; the administrator on a daily basis up dates these. Information from the Annual Quality Assurance Assessment indicates the majority of people have their families looking after their financial affairs, and checks of the system show their relatives top up the persons individual allowance account on a regular basis. People who have asked the home to look after their personal allowances are able to access their money on request, and receipts are kept for any transactions. All monies are kept safe and secure within the home and only the administrator or manager has access to the funds. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling and daily activities of living. We found during our visit that bed rail risk assessments needed to be more robust (see comments in health area of the report), and further checks showed that the staff or handyman needs to ensure regular checks of the bed rails are carried out. This is to make sure that the bed rails are fitted correctly and in full working order. Care Homes for Older People Page 25 of 29 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 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must 02/03/2009 make sure that the care plans are detailed and individual to the person they are about, putting the person at the centre of it, and giving a picture of who they are as well as what their needs are and how to meet them. The plans must also include robust risk assessments around bed rails, moving and handling, falls, pressure sores and nutrition. This will make sure that staff have access to information that will help them to provide person centred care and support, and protect people from risk of harm. 2 38 13 The registered person must 02/03/2009 make sure that risk assessments are completed for bed rails and that regular safety checks are carried out Care Homes for Older People Page 27 of 29 on the equipment and recorded. So that people can be confident that any hazards to their well being are identified and action taken to reduce any risk, and that equipment in use is correctly fitted and safe to use. 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 The registered manager should ensure that the home has its own robust needs assessment for self funding individuals, which includes risk assessments as part of the information gathering process. The manager should carry out regular audits of the care plans; to ensure staff are completing these in full and that risk assessments are reviewed on a monthly basis. The manager should make sure that where staff are hand writing medication onto the sheets (transcribing), there should be two staff signing the entry to indicate they have both witnessed that the information on the sheet (name of medication, strength and administration methods) is correct. The manager should ensure that there is a formal complaints format for recording of any issues raised within the home, and a complaints form should be made freely available to anyone who needs one, especially when the manager is not available. The manager should ensure that 50 of care staff achieve an NVQ 2 in care by the end of December 2009. The manager should achieve her registered managers award by the end of June 2009. 2 7 3 9 4 16 5 6 28 31 Care Homes for Older People Page 28 of 29 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. 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