Inspection on 25/09/08 for Furze Hill Lodge

This inspection was carried out on 25th September 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Furze Hill Lodge Furze Hill Lodge Furze Hill Kingswood Surrey KT20 6EP     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: Jane Jewell     Date: 2 5 0 9 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 33 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 33 Information about the care home Name of care home: Address: Furze Hill Lodge Furze Hill Lodge Furze Hill Kingswood Surrey KT20 6EP 01737351023 01737352982 furzehill@mmcg.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Carol Joan Harrigan Type of registration: Number of places registered: Maria Mallaband Care Group Ltd care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 29 The registered person may provide the following category/ies of service only: Care home only - (PC) 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 (OP). Date of last inspection Brief description of the care home Furze Hill lodge is a well established care home that has been operating as a residential home for a number of years. The home is registered to provided personal care for up to twenty-nine older people. The home was purchased in January 2008 by Maria Mellaband care group. This is the first inspection of the home under this new provider. Maria Mallaband are a national company which operate a wide range of registered services across the UK. Furze Hill lodge is a converted large domestic Care Homes for Older People Page 4 of 33 Over 65 29 0 Brief description of the care home property, which has been extended over the years. The home is located on the outskirts of kingswood village and its local amenities. The home is presented across three floors with a shaft lift providing level access to some parts of the building. Residents accommodation consists of twenty-seven bedrooms, including one potential double bedroom, the majority of bedrooms provide toilet en-suite with some also providing bathing en-suite facilities. Communal space consists of a dining room, conservatory and two lounges. There is a patio terrace, which overlooks a well-stocked garden. The homes literature states that the object of Bridge House is to provide care to all service users to a standard of excellence, which embraces fundamental principals of good care practices. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The information contained in this report has been comprised from an unannounced site visit undertaken over seven hours and information gathered about the home before and after the site visit. The manager had completed an Annual Quality Assurance Assessment form prior to the inspection and the information contained in this document has been used to inform the site visit of the home. Feedback comment cards were sent to the home in advance of the site visit for the home to distribute and seven were returned to the Commission. Four from health care professionals, two from relatives and one from a resident. A summary of their feedback is contained in this report. Carol Harrigan (the registered manager) facilitated the site visit and there were Care Homes for Older People Page 6 of 33 twenty-four residents at the time of the site visit. The site visit involved an in-depth discussion with six residents and five staff. The homes GP was visiting at the time of the inspection and was also consulted. Three relatives were also contacted and interviewed about their experiences at the home. The responsible individual for the organisation was contacted following the inspection in order to discuss some of the outcomes from the site visit. A tour of the premises was undertaken and examination of the homes records system. The inspector had lunch with residents and also spend time observing a small group of residents in their daily routines and in their interactions with staff. This was in order to assess the well-being of residents who are not able to verbally share their experiences of the home. What the care home does well: What has improved since the last inspection? This is the first inspection of the home under new providers therefore no previous practices are taken into account prior to the purchase of the service. Since the purchase of the service the home continues to undergo a regular programme of maintenance and repair to ensure that a good standard of decor is maintained Care Homes for Older People Page 8 of 33 throughout the home, this included the fitting of radiator guards. An activities co-ordinator has recently been appointed with much feedback received by the inspector regarding the positive contribution this has had on residents lives. What they could do better: The manager was aware of the need for minor improvements to the range of information provided about the home. This is necessary in order to ensure that prospective residents and their representatives have a wide range of information about the services and facilities at the home to help them make informed decisions. Minor adjustments were identified to the assessment process in order that the assessment documentation is in line with the homes admission criteria and registration. The manager agreed to review these documents. All residents must be provided with a terms and conditions of residency in order that they are aware of their rights and responsibility while residing at the home. Care plans were not always accurate, or provided the appropriate guidance for staff to follow in order to meet residents assessed needs. Risk assessment documentation must be improved in order to promote residents safety. Training needs to be better managed in order to ensure that all staff have undertaken the necessary training to enable them to work safely with residents and that training needs can be easily identified and planed for. The maintenance staff were in the process of fitting window restrictors to reduce the risk of accidental falls and the manager reported that suitable door locks were being fitted to bedroom doors to further promote residents privacy and dignity. A review of staffing levels is required to ensure that residents needs can be met in a timely manner, a sample of comments made about staffing levels included: staff lovely not enough of them, this means they havent got the time to always check on residents who are in their rooms carers are all lovely they could not do more for us they take a bit of bettering , they could do with some more of them however and Staff spoke about having to sometimes rush personal care due to lack of time at the moment. A staff member commented the paper work suffers as we have no time to complete. Although there is a range of regular health and safety checks it is a matter of serious concern that residents were placed at risk of scolding by hot water being delivered well in access of the recommended temperature range. The home was required to rectify this immediately. Some clarity is needed for the manager on the organisations polices and procedures to ensure that they do not conflict with the managers ability to fulfill their legal responsibilities as the registered manager. For example with regard to them being able to increasing staffing levels and adapt locally standardised documentation in order to make relevant to the home. Discussion with the responsibility individual for the Care Homes for Older People Page 9 of 33 organisation confirmed that this would be undertaken with the manager. 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 10 of 33 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 11 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides both prospective and existing residents, with most of the information about what services are provided and what to expect when living at the home, however all residents must be provided with clear terms and conditions of residency. There is a process in place to ensure that residents needs are assessed prior to them entering the home, with minor adjustments needed to ensure that the assessment process is in line with the homes admission criteria and registration. The home is able to meet most needs of residents. Evidence: There is a range of information about the home and the services it provides, this includes a statement of purpose and service user guide. These are displayed in resident’s bedrooms and given to prospective residents, representatives and other interested parties. Minor additions are needed to these documents to ensure that they contain all of the legally required information in order to help inform prospective Care Homes for Older People Page 12 of 33 Evidence: residents about the home. This includes the full terms and conditions of residency at the home and the range of needs the home is able to meet. It was discussed that this information under represented the wide range of services and facilities actually being offered at the home and further improvements would only seek to help inform prospective residents about the home. Relatives confirmed that they received information in advance of visiting the home. Not all residents had been provided with a full copy of the terms and conditions, this is with particular reference to residents receiving short term care. The home has been required to provide all residents with a full terms and condition to ensure that they and their families are aware of their rights and responsibilities, the placement arrangements and receive clear information on additional charges. The assessment process for a recently admitted resident was viewed, this included information obtained from a relative and previous GP. The documentation used to assess residents although comprehensive was in the main clinical based and did not provide all of the necessary social care information needed for the manager to make an informed judgement as to whether the home could meet the needs of residents in need of residential care. The manager agreed to review the assessment documentation to ensure that all none essential clinical based information was replaced with information necessary for residential based care. There is a wide range of needs being accommodated at the home including four residents who have high physical needs, the majority of residents are assessed as medium to low needs. There is some evidence that the home is able to meet most needs of current residents, however a review of staffing levels and care planning is needed to ensure that the full range of residents needs are able to be identified and met. This is discussed further under standard 7 and 27 of this report. Residents in the main spoke positively about their experiences and a sample of their comments include, Lovely home I am very happy here, Havent got a bad word to say about the place. A sample of feedback from relatives included: it provides a caring and comfortable home for my mother and its a lovely home. A health care professional feedback: Overall care of residents is excellent. Several residents and their relatives were not clear that the home provided residential care and not nursing care, with one relative believing that they were paying for nursing care. This situation was exacerbated by the language used at the home, for example Matron. The manager agreed to ensure that this situation was clarified immediately. Residents and their representatives consulted with spoke of being provided with the Care Homes for Older People Page 13 of 33 Evidence: opportunity to visit the home in advance to assess the quality, facilities and suitability of the home. A relative said: we were able to look around the home several times before we made a decision we had looked at many other homes and Furze Hill felt right. The first four weeks of occupancy is viewed as a trail period, which is followed by a review to establish whether the resident wishes to stay at the home permanently and whether the home is able to continue to meet the residents needs. Intermediate care is not offered at the home therefore this standard is not assessed. Care Homes for Older People Page 14 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans were not always accurate, or provided the appropriate guidance for staff to follow in order to meet residents assessed needs. There is a need to improve the standard of risk assessments in order to promote residents safety. The medication systems are generally well managed promoting good health. Residents receive the health care intervention they need from a range of health care professional. Personal support is offered in ways, which promotes and protect residents privacy and dignity. Evidence: The manager reported that they are in the process of introducing new care planning documentation. Five individual plans of care were inspected, including two new formatted care plans. Not all of the care plans viewed contained sufficient information about the individual’s needs and the guidance necessary for staff on how to meet them. Staff consulted with have worked at the home for a number of years and were however knowledgeable on residents needs and preferences. A staff member described the care plans as not user friendly. The manager has been required to ensure that care plans provide clear guidance for staff on all aspects of the health, personal and Care Homes for Older People Page 15 of 33 Evidence: social care needs of service users and which make explicit the actions needed to meet these needs. Not all of the risks faced and posed by residents were assessed or the actions needed to reduce or manager risks were recorded or reviewed following a significant accident. The manager has been required to ensure that as part of care planning comprehensive personal risk assessments are completed. The home has a retained GP, who holds a surgery once a week at the home and visits if needed in-between. Much positive feedback was received from residents about the high standard of medical support and the promptness in receiving medical intervention. A visiting health care professional said Overall care of residents is excellent and Care staff always asks me to check on residents they think needs attention or will phone for a GP visit. Records also showed the home works closely with other health care professionals including District and specialist nurses, chiropodists, opticians and dentists to ensure residents receive a range of good health care intervention. The system for the administration of medication was generally good with suitable arrangements in place to ensure residents medication needs are able to be safely met. The Manager recognised the need to incorporate self medication risk assessments for any residents who self mediate as part of the improvements needed to document risks at the home. It is recommended that additional instructions are provided for staff on the administration of As required medication, which make clear the individual requirements for when this medications was prescribed. This is necessary for staff to know when to administer these medicines. Staff consulted with showed a good understanding of good practices in preserving resident’s rights to privacy and dignity. Staff were able to give examples of how they promote these rights in their every day care practices. This was supported by the inspectors own observations of the interactions between staff and residents and the experiences of visiting relatives and a health care professional. Some bedrooms did not have a suitable door locks fitted in order to promote residents privacy. The manager said that that this was in the process of being addressed by the homes maintenance staff. The manager spoke of the support they had received in the past from Health Care professionals during the care of residents who were dying. Staff also spoke sensitively about the care and support provided to residents and their families when residents have become terminally ill. Care Homes for Older People Page 16 of 33 Care Homes for Older People Page 17 of 33 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. Social activities and meals are very well managed, creative and provide daily variation and interest for people living in the home. Residents are helped to exercise choice and control over their lives with flexible routines being an integral part of daily practice at the home. Links with families and friends are valued and supported by the home. Evidence: It was evident, during the inspection that the routines of daily living are flexible to suit residents individual needs e.g. rising going to bed, taking meals in their private rooms and entertaining visitors. For a few people living at the home, being able to exercising their choice was difficult due to their level of needs. Staff were seen in these instances to use their acquired knowledge of the person to help them make choices with regard to food and personal care. An activities co-ordinator has recently been appointed who overseas the organising and running of a varied programme of activities based at the home. A relative feedback the presence of Julie as activities co-ordinator has made a huge difference Care Homes for Older People Page 18 of 33 Evidence: to my mothers daily life. Residents spoke of undertaking a wide range of activities including craft sessions, poetry reading and quilling. A resident described the activities as superb, I like to join in we do all sorts of things and everyday there is something on and she changes the programme if you dont like something. A staff member said: Best thing is we look after the residents well and now even better with a new activities coordinator. Much positive feedback was received from residents on how much they enjoyed exercise sessions held at the home and were concerned that these were due to end because of the departure of the session leader. This was feedback to the manager who said that they were currently recruiting a new leader. Visitors commented upon how welcomed they are made to feel during their stay, this included being offered beverages or meals and staff being friendly and approachable. Some residents have a private telephone line in their bedroom and they spoke of how this enabled them to keep in regular contact with their relatives and friends. The inspector had lunch with residents, which was served in a relaxed environment with discrete assistance offered to residents who needed some support. The meal was presented to a high standard with residents individual preferences being observed. Residents comments about the food included: meat and fish choice every day, all home cooked cakes excellent and Food excellent they bring a choice of menus around in the morning we have a very good chef you can have a chat with him whenever you want. Care Homes for Older People Page 19 of 33 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. There is an effective complaints system with evidence that both residents and relatives feeling that their views are listened to and acted upon. The homes practices are designed to protect residents from abuse, however staff training and their understanding of their roles and responsibilities under safeguarding adults guidelines must improved in order to further increase residents safety. Evidence: There is an accessible complaints procedure for residents, their representatives, and staff to follow should they be unhappy with any aspect of the service. Without exception all residents and relatives consulted with said that they felt able to share any concerns they had with the manager and that where they have done so their concerns have been addressed promptly and satisfactorily. Records of complaints showed that the homes complaints procedure was followed and the matters dealt with in a timely manner. The home has written policies covering safeguarding adults and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. Not all staff consulted with had undergone safeguarding adults training or were clear on their roles and responsibilities under safeguarding adults guidelines. The manager has been Care Homes for Older People Page 20 of 33 Evidence: required to ensure that staff undergo all of the necessary training in order to work safely with residents, staff training is further discussed under standard 27. Care Homes for Older People Page 21 of 33 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. Residents live in a clean, well-maintained homely environment, which has been decorated and furnished to a high standard with their bedrooms furnished and decorated according to their individual lifestyles. Evidence: The home is set in its own well-maintained grounds on the outskirts of a small village. The home was decorated and maintained to a high standard with maintenance staff on site. A resident said Very good maintenance man if a problem just ask him. Relatives described the environment as lovely very pleasant attractive surroundings and maintain a clean and friendly environment. A staff member said : One thing we do need is a bigger car park or the parking restrictions lifted from the surrounding roads. All residents consulted with said that there private space provided everything they needed. Residents bedrooms were observed to have been individualised to reflect their individual lifestyle and preferences with many of the residents saying that they were able to bring small items of furniture and personal belongings with them. Communal space is spacious and consists of lounges, conservatory, hairdressing room and dinning room. Much effort has been made to create a homely environment throughout the home. Care Homes for Older People Page 22 of 33 Evidence: A passenger lift provides level access to the first floor and parts of the second floor, a chair lift then provides access to the remaining part of the second floor. Although the home does not provide level access throughout much thought has gone into ensuring ease of access for residents who need assistance, for example with regard to fire safety, room allocation and in the use of mobility aids such as ramps and grab rails. Fitted throughout the home are call points, which enable assistance to be summoned when pressed. Variable feedback was received on the timely response of staff for calls for assistance, with several residents stating that in the afternoons staff can take some time to answer. A staff member said that staffing levels were not always sufficient for them to be able to respond to calls for assistance in a timely manner. There is sufficient number of toilets and bathrooms located around the home, including the majority of bedrooms providing en-suite facilities. All areas inspected were observed to be cleaned to a high standard. The home employs sufficient domestic staff to ensure that standards of hygiene and cleanliness can be maintained. Care Homes for Older People Page 23 of 33 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. Although Residents clearly benefit from a stable, enthusiastic and robustly recruited staff team a review of staffing levels must be undertaken to ensure that residents needs can be met in a timely manner. Training needs to be better organised in order that staff receive the training necessary to enable them to work safely with residents and for the home to meet their aims and objectives. Evidence: Consistent feedback was received, from residents staff and relatives regarding the kindness of staff and that there was not always sufficient staff on duty to be able to meet residents needs in a timely manner. A sample of comments included: staff lovely not enough of them, this means they havent got the time to always check on residents who are in their rooms, staff great fun most seem to have been here a long time and I enjoy their company carers are all lovely they could not do more for us they take a bit of bettering , they could do with some more of them however and the nursing staff are all very good the girls are very busy most of the time but they do try and find the time for you if you need some help. Staff spoke about having to sometimes rush personal care due to lack of time at the moment. A staff member commented the paper work suffers as we have no time to complete. The manager spoke of some current staff shortages and that they are in the process of recruiting further staff. Staffing levels must be based on residents level of needs and the Care Homes for Older People Page 24 of 33 Evidence: manager has been required to review staffing levels to ensure that residents needs can be met in a timely manner. There was some confusion as to whether the manager was able to increase staffing as these had been fixed by the organisation. Discussion with the responsible individual for the organisation confirmed that the manager is able to request to head office for an increase staffing levels and this would be dealt with within twelve hours. The home has been proactive in ensuring that the majority of staff have undergone National Vocational Qualification (NVQ ) in Care. Although the manager demonstrated much commitment towards ensuring that staff receive the necessary training, evidence of what training had been undertaken and outstanding was difficult to confirm or for the manager to identify training needs, as training records were difficult to navigate. Staff confirmed that they had not all undertaken all of the necessary training to work safely with residents, this includes safeguarding adults, dementia, manual handling updates. The manager has been required to ensure that staff undergo the training necessary for them to be able to undertake their work with residents in a safe manner and to be able to meet the range of residents needs currently accommodated. It is recommended that a training and development plan also be developed in order to identify the training necessary to meet the homes Statement of Purpose, service aims and service users needs and individual plans. The manager reported that skills for care induction documentation, which are industry recommended minimum inductions standards has been obtained but there has not as yet been any new staff to complete the programme as yet. The personal files of the newly appointed staff were inspected and these showed that a robust recruitment process is followed which includes the use of an application form, interviews, Criminal Records Bureau (CRB) checks and written references prior to employment commencing. Care Homes for Older People Page 25 of 33 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. Residents benefit from an experienced and established manager who ensures a clear ethos and values of the home that enables staff to provide good quality care to residents. Although there is a range of regular health and safety checks it is a matter of serious concern that residents were placed at risk of scolding by hot water being delivered well in access of the recommended temperature range. Evidence: The manager has considerable experience in working with older people and became the registered manager in 2007, prior to this they were the deputy manager of the home for nine years. The manager is clearly respected at the home with many positive comments received, these included: Matron is excellent lovely lady helpful alright and easy to approach. The manager was clearly extremely busy on the day of the inspection as they were undertaking care duties as well as managerial duties, answer Care Homes for Older People Page 26 of 33 Evidence: the phone, meeting with relatives an organisations representatives, this meant by their own admission that much of the administration has suffered lately including the care planning process. Concern was noted at inspection regarding the managers apparent inability to meet their legal requirements as a manager due to the organisations practices and polices. This was with particular reference to staffing levels, maintenance issues and the use of standardised organisations documentation. Discussion with the Responsible Individual following the inspection confirmed that the organisations ethos is for managers to have autonomy regarding the services they manage and that this issue would be discussed directly with the manager and their line manager therefore it is the commission view that no requirement is made regarding these concerns. Since the change of ownership of the home the consensus of those consulted with was that there have been no adverse effects on residents of the sudden change of ownership, which is to be commended. There are several mechanisms in place for the home to obtain feedback on the quality of the services provided and whether it is achieving its aims and objectives. Changes to activities and in the provision of toilets have resulted in feedback received from residents. The registered providers representative also visits the home monthly to monitor services and facilities and produces a detailed report, which included some residents and staffs views. The chef reported that food surveys are sent out every six months to residents, however there was no evidence that significant findings had been acted upon. The manager agreed to look into this. The manager reported that the home does not manage finances on behalf of residents. Staff are in the main supervised by the manager working along side them each shift and all staff consulted with felt well supported. Care staff spoke of also receiving formal supervision and appraisals. Records submitted by the manager prior to the inspection stated that the necessary servicing of health and safety equipment has been undertaken. It was noted however as a matter of serious concern that hot water was not controlled to outlets accessible to residents. This is necessary in order to prevent the risk of scolding. Outlets checked showed that hot water was delivered well in excess of the safe temperature range. The home was immediately required to rectify this situation and ensure that in the interim residents are not placed at risk of scolding. The home has been required to ensure that hot water in the home is delivered to hot water outlets accessible to residents within the recommended safe temperature range. The manager and responsible individual subsequent to the inspection confirmed that mixer values the type unaffected by changes in water pressure were in the process of being fitted in order to delivery hot Care Homes for Older People Page 27 of 33 Evidence: water close to 43 oc.Systems were in place to support fire safety, which included: regular fire alarms and emergency lighting checks and maintenance of fire equipment and fire drills were reported to have been undertaken. The manager reported that a fire risk assessment had been undertaken by a fire safety expert, which recorded significant findings and the actions taken to ensure adequate fire safety precautions in the home and that recommendations made from this risk assessment have been actioned. At the time of the inspection the maintenance staff were in the process of fitting window restrictors in order to reduce the risk of accidental falls. 13(4)(a) That hot water in the home is delivered to hot water outlets accessible to residents within the recommended safe temperature range at around 43oc. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 33 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 1 38 13 That hot water in the home 24/11/2008 is delivered to hot water outlets accessible to residents within the recommended safe temperature range at around 43oc. To ensure residnets safety 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 3 5 That service users or their 23/10/2009 representatives are provided with a full copy of the terms and conditions of residency, in order that they are aware of charges and their rights and responsibilities whilst residing at the home. To ensure that service users have the information they need to make informed decisions 2 7 15 That care plans provide clear 21/11/2008 guidance for staff on all aspects of the health, personal and social care needs of service users and which make explicit the actions needed to meet Page 30 of 33 Care Homes for Older People these needs and which include personal risk assessments for all service users, which are reviewed regularly and records the actions to manage or reduce any identified risks. To ensure that staff have the information they need to gudie them on the needs and preferences of residents 3 27 18 That at all times adequate staffing levels are maintained. To ensure the health and welfare of service users. 4 30 18 That staff undergo the 23/11/2009 training necessary to be able to undertake their work with service users in a safe manner and to be able to meet the range of residents needs currently accommodated. To ensure promote residnets safety and ensure that their needs can be met at the home 21/11/2008 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 9 That the prescribed instructions for medication is followed at all times and that only medicines are administered to the individual for whom it is prescribed to. That a training and development plan be developed which identifies the training necessary to meet the homes Statement of Purpose, service aims and service users 2 27 Care Homes for Older People Page 31 of 33 needs and individual plans. Care Homes for Older People Page 32 of 33 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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