Inspection on 17/10/08 for Fosters

This inspection was carried out on 17th October 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

Fosters 17/10/06

Fosters 08/12/05

Fosters 09/06/05

Fosters 06/12/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Fosters Fosters Lane Woodley Reading Berkshire RG5 4HH     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: Helen Dickens     Date: 1 7 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 34 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 34 Information about the care home Name of care home: Address: Fosters Woodley Fosters Lane Reading Berkshire RG5 4HH 01189690630 01189695113 ann.martin@wokingham.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Wokingham Borough Council The registered provider is responsible for running the service Name of registered manager (if applicable) Mrs Ann Martin Type of registration: Number of places registered: care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Fosters is a residential care home that was built in the 1960s and is operated by Wokingham Council. The home provides accommodation and care for up to thirty six older people. Fosters has been organised to provide separate dining, kitchen and lounge areas for 4 distinct groups, one of these areas is registered to provide care for people diagnosed with a dementia related problem. The building is situated in a residential area in Woodley. Local transport services are nearby. There are parking spaces available on site. Care Homes for Older People Page 4 of 34 8 0 Over 65 0 28 Care Homes for Older People Page 5 of 34 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: This key inspection was unannounced and took place over 7 hours. The inspection was carried out by Mrs. Helen Dickens and the Acting Manager represented the establishment. The Registered Manager who is currently working part time due to a secondment, was able to join the inspection for the last hour. A partial tour of the premises took place and a number of files and documents, including three resident’s files and care plans, staff training and recruitment files, quality assurance information, and the annual quality assurance assessment (AQAA) were examined as part of the inspection process. Questionnaires were send out regarding this service but none were returned. The inspector saw most residents who were in the home on the day of the inspection and three residents, one relative, a local Care Homes for Older People Page 6 of 34 GP and three members of staff were spoken with in more detail. The current fees at this home are 575 pounds per person per week. The inspector would like to thank the residents, visitors and staff for their time, assistance and hospitality. What the care home does well: What has improved since the last inspection? What they could do better: New Requirements were made at this inspection in relation to ensuring the nutritional health of residents is assessed and monitored; recruitment checks must be carried out on volunteers; and staff training arrangements need to be reviewed. The home will also need to ensure that there are sufficient senior management resources to run the home efficiently, and to review their current health and safety monitoring arrangements. Care Homes for Older People Page 8 of 34 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 34 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 34 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. No service user moves into the home without having his or her needs assessed and assured these can be met. Evidence: Three residents files were sampled during the inspection, including one recently admitted resident. As stated in the AQAA, returned to CSCI prior to the inspection, residents have a care management assessment from the local authority, and the home also carries out their own assessment during a visit to the potential resident. The homes own assessment is fairly basic (that is, not very detailed) though it covers the personal and health care needs, mobility and the risk of falls, and medication. One file had a risk assessment on self administration of medication. The homes assessment asks about likes and dislikes and social interests. Five staff were spoken with throughout the day and were knowledgeable on residents care needs, and the involvement of relevant family members. Care plans were drawn up using the Care Homes for Older People Page 11 of 34 Evidence: information gathered in the initial assessments. The manager said that the home would only accept residents they could care for, and that they had become known as a home that could take residents who may have been seen as difficult by other homes. Care Homes for Older People Page 12 of 34 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. Residents needs are set out in their care plans, but more work is needed to ensure residents are more involved in their care planning, and that reviews are carried out on a monthly basis. The health needs of residents are promoted at Fosters, though more work must be done in relation to their nutritional health. Medication is well manged at this home and the privacy and dignity of residents is respected. Evidence: Care plans sampled identified residents needs in relation to activities of daily living e.g. mobility, sleeping, continence, washing, dressing, and health care etc. The plans were reviewed regularly, though not monthly as set down in the NMS. Changes made since the previous reviews were highlighted in a different colour to make it easier for staff to see any changes made, and all care plans were clear and well set out; all those sampled had been typed up, as had the reviews. Staff interviewed described the particular support given to one resident whose file was sampled by the inspector. This residents relative later confirmed to the inspector that Care Homes for Older People Page 13 of 34 Evidence: staff had been supportive and described them as Very understanding.....fabulous. There was written evidence that staff had met with one particular resident and negotiated how certain aspects of their behaviour might be improved in order to improve their physical and mental well being. A relative and the resident they were visiting were interviewed together and both were very complimentary about the staff and the care given. The resident said 99 of staff were very nice and named two in particular, one who was described a Fantastic and another newer member of staff who delivered personal care very well was described as Brilliant. One of the residents from an ethnic minority background was spoken with and confirmed they were happy at Fosters and and pleased with the support they received from staff. The inspector received no complaints from residents about the current care given and it was pleasing to hear that some residents who had minor issues themselves in the past, had felt confident to raise these, and they knew who they should talk to. However, care plans contained very little information on exactly how residents would like their support to be given and there was little evidence that residents had been involved in their care planning. Whilst it is likely that the residents on the dementia unit are only likely to be able to participate in a very limited way, there are others who are articulate and were very able to express their opinions very clearly to the inspector. The care plan reviews, whilst regular, are not carried out on a monthly basis as set down in the NMS. It was also noted that risk assessments did not always show the date when they were drawn up, or have a date identified for review. A Recommendation will be made in relation to care planning at this home. There were a number of examples from the files sampled that Fosters promotes the health of residents. One resident had been supported by staff to attend therapy sessions outside the home, and another had been encouraged to lose weight. Staff support residents to maintain their personal hygiene and specialist advice is taken as necessary e.g. on skin viability. The AQAA states that the home has a good relationship with the community matron and local district nursing staff. A GP from a local practice was interviewed during the inspection and confirmed the staff asked for advice and GP visits in a timely fashion, and also accepted telephone advice on occasions. He said that staff had been dealing well with the situation in relation to a resident he had come to visit and had sought further advice on how best to support that resident. He said that he has Always been quite happy with the home, and commented particularly on how staff had been knowledgeable on a particular residents social interests, which would be helpful to that residents current health needs. However, the home must review their arrangements for ensuring the nutritional health of residents. Risk assessments sampled on this subject related mainly to assistance Care Homes for Older People Page 14 of 34 Evidence: with eating and drinking, rather than the overall nutrition of residents. The home should seek advice from the community nursing staff regarding the most appropriate risk assessment tool. One risk assessment did not cover the risk of choking, though that particular resident had a health condition that may have increased the risk of this happening. In addition, the homes weighing scales had been out of action for many months so most residents had not been weighed since April on the two units sampled. A Requirement will be made on this subject. Staff were observed on one unit administering medication. There was evidence of good practice including washing their hands thoroughly before they started, and securing the cabinet when it was unattended. Clear records were kept and the manager said that monthly audits were carried out, both on the record keeping of staff and the remaining stocks of medicine. Staff also signed a chart on completion of each session so it could be seen, at a glance, who had been responsible for any session that month. The staff member observed was seen to be sensitive to each residents needs when administering medication. A few unexplained gaps were noted on the medication record on one resident and the cabinet had excessive stocks of one liquid medicine. The staff member said they would attend to both of these matters. The community pharmacist visits the home up to twice per year and though the last report was not readily available, the manager said it would be located and faxed to CSCI the next working day. She said there had been no requirements made, and the report showed the improvements the service had made in regard to medication. Staff were observed to be respectful to residents and there were many examples of this throughout the day. Personal care is delivered in private and on one occasion when this privacy had been interrupted, the resident said it had been reported and satisfactorily dealt with by management and there had been no recurrence. Residents were dressed very individually and this suggests they were wearing their own clothes. Care plans sampled identified which residents were able and preferred to choose what to wear each day. Residents were heard to be called by their preferred names rather than their proper names and there are no shared rooms at Fosters. However, the inspector pointed out that there were a significant number of printed notices in both bathrooms and bedrooms throughout the home which detracted somewhat from the otherwise homely atmosphere that staff were trying to create. It was also noticed that there was very little storage space and therefore continence supplies stored in bedrooms were in full view of any visitors and not conducive to promoting residents dignity. The manager and acting manager both showed a positive attitude to remedying these concerns as soon as possible. Care Homes for Older People Page 15 of 34 Care Homes for Older People Page 16 of 34 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 by a regular programme of activities, and contacts with the local community are promoted. Family and friendship links are encouraged and residents have some opportunities to exercise choice and control over their lives. Residents were happy with their meals but more work needs to be done to ensure menus are well balanced, and evidence of residents input into the choice of food on offer should be available. Evidence: The AQAA states that the home employs an Activities Co-ordinator for 20 hours per week. Training records show that this person has completed a total of 6 different courses in dementia, some of which covered provision of activities for clients with dementia. There is a dedicated room The Gallery which is used for group activities and exercise classes, as well as religious services. There is access to the courtyard from this room which has tables and chairs, wind chimes, and raised flowers beds with some tomatoes and herbs. There is a separate large garden with bird tables, a summer house and more tables and chairs. Two residents were seen to be out walking with a member of staff at the start of the inspection and the acting manager said the garden and summer house were popular with residents. A staff member brings their Care Homes for Older People Page 17 of 34 Evidence: little dog in to work and the inspector was told that he is popular with residents, many of whom had known him since he was a puppy. Volunteers are being used to assist with some activities and provide extra opportunities for social interaction with residents. A record is kept of activities and there is a programme of forthcoming events. Religious and faith based activities take place including regular church services and Communion. A few residents attend outside day centres. One off events and outings are also organised and staff were knowledgeable on residents social interests. There were photographs around the home showing events and activities and one resident who was spoken with showed the inspector some of the artwork done by themselves and fellow residents and which staff had displayed on the walls in that particular unit. Family and visitors are made welcome at Fosters and notices in the entrance area encouraged them to feel free to use the Unit kitchens to make a drink, or to take residents they are visiting into the garden or summerhouse. One relative who was interviewed complimented staff and said they had been very understanding and fabulous. A resident who had moved to Fosters from elsewhere in the country was interviewed by the inspector and confirmed that their visitors were made welcome when they visited. Others confirmed family had been invited to attend reviews at the home. Staff spoken with were knowledgeable on family and friendship links of individual residents. Residents have opportunities to be part of the local community for example they can attend local day centres, and as already mentioned, religious and community groups visit the home. Residents are given some opportunities to exercise choice and control over their lives, for example some care plans noted that staff should ask the service user what they wanted to wear each day. There was evidence of residents being able to exercise choice in relation to meals and activities. Residents bedrooms visited had been personalised with photographs and pictures, and some had brought in items of their own furniture. As discussed earlier under care planning, it is recommended that the home find more ways of involving residents in planning their own care, and making choices about how they wish to receive support, and their input should be clearly documented. There is a written menu in place which changes weekly and offers two choices of main course per day. On the day of the inspection the choice was fish and chips or sausage roll. The inspector asked to sample a small piece of the fish which was served in homemade batter, and it was very tasty. All residents spoken to commented positively on the food and one relative said the food was always presented nicely. Two staff have been on a training course entitled Food, drink and dementia which should ensure the Care Homes for Older People Page 18 of 34 Evidence: needs of residents with this condition are better met in relation to meals and mealtimes. Residents are offered cooked breakfasts on two mornings per week, and otherwise the choice of porridge, cereal, toast and juices are on offer. There is a roast on Sundays which was roast lamb on Sunday of the Week 1 menu. Meals are served on individual Units and offered a pleasant mealtime experience to residents. The manager said that there is a regular meeting with the cook whereby a resident from each Unit can bring forward any suggestions regarding the food and menus. It was noted that one Unit did not have space for a table (or tables) big enough to accommodate all the residents. Staff said several residents preferred to have their meals in their armchairs, and those who needed support with eating were also given their meals sitting in their armchair. It is recommended that this is kept under review to ensure ALL residents who would prefer to sit together with fellow residents can have the opportunity to do so. Following the inspection, the inspector looked in more detail at the Week One menu, details of which had been collected on the day. It was noted that there were several days when either high fat choices, or cheaper meat options such as mince or sausages were on the menu. For example Lasagne and garlic bread or cheese and onion pasty on Thursday, fish and chips or sausage rolls on Friday, and sausage and mash with onions or fish fingers in batter with croquette potatoes on Saturday. Puddings appeared to be mainly shop bought with the exception of rice pudding on one day. Angel delight, fruit jelly and cream, cheesecake, and gateaux featured on 4 other days in that week. It is recommended that the home seeks advice from a dietitian on the current menu options to ensure residents are receiving are a balanced and healthy diet. Nutrition is also discussed under health care earlier in the report and a Requirement has been made in that regard. Care Homes for Older People Page 19 of 34 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 can be confident their complaints will be listened to and acted upon and they are protected from abuse, though more frequent staff training is needed on this matter. Evidence: A central record is kept at the home of all complaints made to the service. They have received 5 in last 12 months and the record shows these had been clearly recorded together with the actions taken. According to the AQAA, the complaints procedure is given to all residents and their families, and is displayed in the entrance to Fosters. Residents interviewed knew how to complain and who to go to if they had a problem. One confirmed to the inspector that once he raised an issue, management had dealt with it in a timely way. No complaints have been made to CSCI about this service since the last inspection. The AQAA states that all staff are trained in adult protection procedures and two issues have been raised by the home since the previous inspection. Neither related to staff at the home and the manager said they had co-operated fully with the local authority safeguarding team. The AQAA stated that there is a safeguarding adults policy in place but not the date when it was last reviewed. On the day of the inspection the acting manager said a policy was in place and was available on the computer. It is recommended that a paper copy of the homes policy, and the local authority multiCare Homes for Older People Page 20 of 34 Evidence: agency procedures should be readily available, and the summary leaflet from the latest Berkshire procedures could be given to all staff as training records showed that some staff had not had refresher training since 2004. The frequency of safeguarding adults training needs to be reviewed to ensure all staff have up to date knowledge of the latest thinking and multi agency procedures. Care Homes for Older People Page 21 of 34 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. Staff work hard to ensure Fosters, a 1960s building, is made as homely as possible, and that there is a continuing programme of maintenance and renewal. The new toilet, bathing and showering facilities on the first floor provides superb facilities for residents to enjoy. The home is clean and hygienic throughout and there were no unpleasant odours in any part of the building. Evidence: Fosters is a 1960s building which is in need of continued maintenance and renewal. Despite this, staff work hard to make Fosters as homely as possible. The entrance hall carpet has been replaced as requested at the last inspection and a fine wooden sideboard and cabinet, together with plants and a welcoming notice for visitors greets those who enter. Since the norovirus outbreak the home now has hand gel and a notice to visitors to use this when they are signing in. The acting manager said there is an ongoing 5 year plan regarding maintenance and renewal and this included the first floor bathrooms and toilets which are just being finished. There are also plans for the Unit kitchenettes to be replaced, and there is ongoing replacement of furniture and floor coverings. There is a gardener who is also responsible for day to day maintenance and the grounds around the home. Care Homes for Older People Page 22 of 34 Evidence: The inspector noted that some of the old furniture was left outside waiting to be collected, and inside some mattresses were waiting to be properly stored or collected and had been left in stairwells. The acting manager said she would have the mattresses moved as soon as possible. There seemed to be a general lack of storage space as stairwells and bathrooms were used to store wheelchairs and hoists, and some residents bedrooms had continence supplies stored under basins and in various corners. The home has now met the Requirement from the previous inspection in relation to replacing the bathrooms and toilets on the first floor. These rooms have now been totally refitted and provide superb toilet, bathing and showering facilities on that floor. The grey marble effect decor is stunning and level surfaces allow complete disabled access. One room is a wet room with wheel in access to the shower, and there are is also a special bath. The home should be congratulated on providing such first class facilities for residents to enjoy. Bedrooms visited were personalised with residents own photographs, pictures and furniture. All three residents spoken with said they liked their rooms, one describing it as A nice bedroom. Most residents who had rooms on the ground floor did not have nets or any privacy screening on the windows. This was discussed with the acting manager who said she would double check with residents whether this was their choice. One resident spoken with definitely did not want anything which might restrict the sunlight coming in, and another suggested having a net which covered the bottom half of the window only. The acting manager was asked to ensure responses from residents in relation to their choices were clearly documented on their files. The home now employs domestic help for 8 hours per day over 7 days per week. The home was found to be clean and pleasant throughout with no unpleasant odours. There were prominent hand washing facilities as well as hand gel throughout the home, including in the entrance area for visitors to use. Following the norovirus outbreak earlier in the year an audit was carried out by the Health Protection Agency and advice was given, in the form of a report to the home. The manager said the report had only been received in September and they were already making good progress on the recommendations. Residents spoken with had no concerns about the cleanliness of the home and two residents and one visitor particular commented on how clean and pleasant the home is, one saying Fosters is a Nice, clean environment. Some shortfalls were noted such as no hand washing soap at one basin, and a bin with no lid. The acting manager said she would deal with these issues as soon as possible. The advice from the Health Protection Agency regarding staff training on infection control is discussed under staff training below. Care Homes for Older People Page 23 of 34 Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are met by the numbers and skill mix of staff and the home is committed to promoting NVQ qualifications for care staff. Recruitment arrangements are well developed for paid staff but more work is needed in relation to volunteers. Staff training continues to improve and all new staff follow the recommended Common Induction Standards. Evidence: There is a staff rota in place and there appeared to be sufficient care staff on duty during this inspection, for example bells were answered, staff were available to walk residents in the garden, and to support them with personal care and at lunchtime. However, shortfalls identified in the inspection for example in relation to care plans not being reviewed frequently enough, was discussed with the manager and acting manager at the end of the inspection. The manager put these shortfalls down to staff shortages at a senior level. The manager is herself on a secondment and working only 2.5 days at the home until December. The AQAA identifies these senior staff shortages and, whilst it is not appropriate to list them in this report, more thought must be given to how the staff shortages are having an impact on the management of the home and the care of residents. This will be the subject of a Requirement under the management Standard in the next section. Domestic staff funding is now available for 8 hours per day, 7 days per week and the manager said this has now freed up care staff time that Care Homes for Older People Page 25 of 34 Evidence: can be spent with residents. The AQAA states that 60 of staff at this home now have NVQ 2 or above. When this was discussed with the acting manager it became clear that any agency and temporary staff used at the home had not been included in this figure. The acting manager was asked to check on the qualifications of any agency staff they were using, so that they could be included in this figure. Recruitment arrangements are shared between the home and the companys HR department. The Requirement from the last inspection that evidence of a POVA check be available was met in that the HR department faxed across proof of the one staff file requested during the inspection. Therefore the home meets the previous Requirement on this subject but should look to having a proforma with all the relevant details kept in the home. Checks on volunteers however have not been as stringent and the activities co-ordinator was only just in the process of getting CRBs filled out for some of the newer volunteers. A discussion was held with the inspector, acting manager, and the activities co-ordinator, and a copy of the latest Regulations (Schedule 2) was given to staff to assist them. They agreed that no volunteer would return to the home until the appropriate recruitment checks had been completed. A Requirement will be made in this regard. Training arrangements are well developed at Fosters and there is a staff training matrix on their computer which was demonstrated to the inspector. It was easy to identify which staff had done which training courses. New staff now follow the Common Induction Standards format according to the acting manager. Most staff have done some form of dementia training and the activities organiser has done 6 different courses on this subject. The notice board in the hall sets out the principles of the Mental Capacity Act and the acting manager said most staff had now been trained on this. All but two staff had done moving and handling training within the last 12 months and the other two were waiting for a refresher course. Further work is needed on training. For example the deputy manager said infection control is not mandatory in this home though it was a recommendation from the Health Protection Agency following their audit. The training database shows 17 staff plus the manager have now completed this course but no further staff are booked to go on it. This is the subject of a Requirement under Standard 30. The database also showed that some staff had not attended safeguarding adults training since 2004 and this was discussed under the Complaints and Protection section of this report. Care Homes for Older People Page 26 of 34 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. More work needs to be done to ensure the current management arrangements and quality assurance processes are sufficient and appropriate to manage the home effectively. Health and safety arrangements are well developed but need to be reviewed and further improvements made. Evidence: The registered manager is qualified and experienced and several positive comments were made about the manager and management of the home when speaking with residents. She is supported by a senior team who are also competent, and three are working towards their NVQ Level 4. The acting manager had a very positive attitude to the inspection process and took seriously suggestions made and the shortfalls highlighted during the inspection. There are clear lines of accountability within the home. However, shortfalls identified during the inspection for example in relation to care Care Homes for Older People Page 27 of 34 Evidence: plans not being reviewed frequently enough, were discussed with the manager and acting manager at the end of the inspection. The manager put these shortfalls down to staff shortages at a senior level. The manager is herself on a secondment and working only 2.5 days per week at the home until December. The AQAA identifies these senior staff shortages and, whilst it is not appropriate to list them in this report, more thought must be given to how the staff shortages are having an impact on the management of the home and the care of residents. There are quality assurance processes in place at this home including Regulation 26 visits by the provider, and feedback is sought from residents, families and others who are involved with the home. There is an annual business plan and a five year maintenance and renewal plan for the home. Care plans are reviewed regularly (though not yet frequently enough) and families are invited to formal reviews. A number of audits take place to look at the quality of the service provided, and the manager gave the example of monthly audits of medication. However, the number and nature of Requirements and Recommendations made during this inspection suggests further worth needs to be done by the home to ensure they maintain a good quality of service. Service users money was not checked on this occasion as the staff member who manages these arrangements had left before the inspector reached this Standard. However, the acting manager confirmed they do keep some money for residents and relatives who wish them too, and these accounts are audited by Wokingham Borough Council. The AQAA states that there is now a dedicated member of staff responsible for health and safety at the home. It also states that the relevant equipment has been tested for example portable electrical equipment, hoists and fire equipment, and that there are polices in place on issues such as infection control, fire safety, first aid and health and safety. Training records showed that all but two staff had done moving and handling training within the last 12 months. Floor coverings had been replaced in some units with washable, non-slip and cushioned flooring. Staff said this flooring is softer to land on if any resident should have a fall. The manager said the requirements made at the last Environmental Health Inspectors visit had now been met. However, recommendations made by the Health Protection Agency earlier in the year had not yet been met in full, including all staff needing to have infection control training. Whilst many pipes were noted to have insulation to prevent injury to residents from hot pipes, not all pipes in two bathrooms had been insulated. It was not clear if there was a reason for this, e.g. some pipes may not be carrying hot water. The acting manager was asked to have this checked and ensure that all pipes which Care Homes for Older People Page 28 of 34 Evidence: may get hot and cause a hazard to residents are properly insulated. As identified earlier in the report, more work is needed on risk assessments e.g. the format of nutritional risk assessments needs to be reviewed, and some risk assessments sampled were not dated and not been given a date for review. Staff meeting minutes showed the manager had asked staff to be more alert in relation to health and safety matters after coming on duty and finding cleaning materials had been left out. However, on the day of the inspection other potential hazards e.g. hoists, wheelchairs and mattresses were being stored in stairwells. One mattress had been left leaning against a radiator and the acting manager removed this immediately. One bathroom waste bin had no lid, and one handbasin had no hand soap. Given the number of residents at this home with dementia, staff should also ensure there are written risk assessments where personal toiletries, especially liquids, are left out and on view in residents bedrooms. Care Homes for Older People Page 29 of 34 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 30 of 34 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 8 12 A review of arrangements 20/11/2008 for promoting the nutritional health of residents must be carried out. An appropriate nutritional risk assessment tool must be used and the means to weigh residents as regularly as their risk assessment requires must be available. This is to promote the health and welfare of residents. 2 29 19 As with paid staff, all 22/11/2008 volunteers must have the appropriate recruitment checks as set out in Regulation 19 and in Schedule 2 of the Care Homes Regulations. Records should be available for inspection as agreed between the Provider and CSCI. This is to protect service users. Care Homes for Older People Page 31 of 34 3 30 18 Staff training arrangements must be reviewed to ensure all staff have up to date training in all the relevant areas deemed necessary by the Provider and this should include infection control. To ensure all staff are suitably trained for the work they are asked to perform. 22/11/2008 4 31 18 A review of senior staffing 17/11/2008 levels must be carried out to ensure that there are sufficient senior staff available to meet the needs of the home and its residents. To ensure the health and welfare of service users. 5 38 13 A review of health and safety arrangements must be carried out to ensure shortfalls are identified and dealt with in a timely fashion. To ensure the health and welfare of service users. 17/11/2008 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 7 Risk assessments should be checked to make sure they always contain the date when the assessment was carried out, and a date for the next formal review. The care planning arrangements should be reviewed to ensure that care plans are reviewed on a monthly basis. Residents should be more involved in their care plans, and special consideration should be given to user friendly formats for those residents with dementia whose cognitive Page 32 of 34 2 7 Care Homes for Older People ability may be impaired. 3 10 The number of signs and notices in bathrooms and bedrooms should be reviewed, as should the lack of storage space for continence supplies, to ensure that these issues do not impact negatively on the privacy and dignity of service users. It is recommended that a dietitian be asked to look at the current menus and advise the home on whether any changes need to be made to ensure residents receive a nutritious and balanced diet. The frequency of safeguarding adults training should be reviewed to ensure all staff have up to date knowledge on the latest thinking and the new Berkshire procedures for protecting vulnerable adults. In the meantime, all staff could be given copies of the summary leaflet from the local authority to ensure they are clear on what action to take. Storage arrangements should be reviewed to ensure stairwells and bathrooms are not cluttered with hoists, wheelchairs and mattresses. 4 15 5 18 6 19 Care Homes for Older People Page 33 of 34 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 © (2008) Commission for Social Care Inspection (CSCI). 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