Inspection on 04/12/08 for Glastonbury Care Home

This inspection was carried out on 4th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Glastonbury Care Home 06/06/08

Glastonbury Care Home 30/01/08

Glastonbury Care Home 11/07/07

Glastonbury Care Home 30/08/06

Glastonbury Care Home 23/02/06

Glastonbury Care Home 23/08/05

Glastonbury Care Home 23/03/05

Glastonbury Care Home 22/09/04

Glastonbury Care Home 29/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Glastonbury Care Home Pike Close Sedgemoor Way Glastonbury Somerset BA6 9PZ     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: Justine Button     Date: 0 5 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Glastonbury Care Home Pike Close Sedgemoor Way Glastonbury Somerset BA6 9PZ 01458836800 01458836809 jwhite@brunelcare.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Brunelcare Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 64 Number of places (if applicable): Under 65 Over 65 0 64 dementia old age, not falling within any other category Additional conditions: 64 0 The maximum number of service users who can be accommodated is 64 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) Date of last inspection Brief description of the care home The Glastonbury Care Home was first registered in July 2000 and is a purpose built Care Home. It is a two-storey building, set in accessible gardens on the outskirts of the town of Glastonbury. Numerous car parking spaces are available in the grounds, close to the building. Care Homes for Older People Page 4 of 30 Brief description of the care home It was previously registered as two separate homes, one on each floor. The registration has recently been combined and the home is now registered as one complte service. The ground floor accommodates service users requiring personal care (formally residential care), with one unit for those with mental health needs. The first floor is for those who require general nursing care. All rooms are single occupancy and have en-suite facilities. The Registered Manager of the ground floor is now also in charge of the nursing care service (first floor) and has recently applied to the Commission to become the Registered Manager of the entire service, i.e. both the ground and first floors. (This process has recently been completed. see main body of the report for more information) The fee range quoted in the service user guide at the time of inspection was from 493 pounds to 572 pounds per person per week; fees are determined by assessment of the persons needs. Additional amounts are charged for chiropody services, hairdressing, daily papers /magazines. Up to date fee information may be obtained from the service. Information regarding the subjects Value for Money and Fair Terms in Contracts can be obtained from the web link: www.oft.gov.uk A report entitled Care Homes in the UK - A Market Study is available on web link http:/www.oft.gov.uk/NR/rdonlyres/5362CA9D-764D-4636-A4B1A65A7AFD347B/0/oft780.pdf Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This Key unannounced inspection was carried out over two days by one inspector. In addition an expert by experience accompanied us for half a day. Their role is to bring a different and independent view to the inspection process by working alongside us observing and gaining the views of people who use the service. We have integrated experts by experiences comments and observations into the report. During this inspection the expert by experience was asked to review the daily life and social opportunities of the lower non nursing ground floor. The Manager Mrs Joy White was available on the day of the inspection. We would like to thank the manager and the duty staff for their time and hospitality shown to us during the visit. Care Homes for Older People Page 6 of 30 The focus of this inspection visit was to inspect relevant key standards under the CSCI Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are:excellent, good, adequate and poor. These judgment descriptors for the seven chapter outcome groups are given in the report. Records examined during the inspection were care and support plans as part of the case tracking process, medication administration records, maintenance records, the homes Statement of Purpose, staffing rosters, menus, the homes complaints file, staff recruitment files, staff training records, quality assurance processes and staff supervision records. The inspector also conducted a tour of the premises. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Following the inspection visit a report is written by us. This is sent to the company in draft form for their comments prior to the report being made a public document. Following issuing the draft report Brunelcare expressed concerns with regard to some of the findings of the report. We have met with Brunelcare on two occasions to discuss these issues. It is clear from these meetings that Brunelcare feel that the overall rating for this home should be two stars good however we, CSCI, feel that the overall rating of one star adequate currently reflects the situation at the home. What the care home does well: What has improved since the last inspection? At the last key inspection, significant shortfalls in the standard of care provided were identified. Following the last inspection additional concerns were raised with us. These concerns have been investigated in conjunction with the local social services office, who have the lead in safeguarding matters. As a result of the concerns raised the home has not been open to new admissions until the care and support provided at the home improved to acceptable levels. As a result of this inspection it is envisaged that admissions to the home will recommence in the near future. The company also known as the provider, Brunelcare, has supported the home and offered additional resources at the home. This has had a significant positive impact on the care provided. Improvements have been observed in safeguarding policy and procedures, some aspects of quality assurance, staff training , care planning and personal care delivered to people living at the home. The number and severity of wounds and pressure damage (pressure sores) has reduced. As has the number of people experiencing weight loss. Personal care is now provided at an acceptable level to people living at the home. Care Homes for Older People Page 8 of 30 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This is the second key inspection in this year. At the last inspection, conducted in June 2008, this outcome group was assessed as good. These standards have therefore not been assessed on this occasion. The report in June 2008 stated People have the information they need to enable them to make an informed decision about moving to the home. The home ensures that people are appropriately assessed before a placement is offered. Evidence: At the key inspection in June 2008 it was reported The home has produced a Statement of Purpose and Service User Guide which details information about the home and services offered. A DVD is also available for people who would find it difficult to access written information. The home have also developed a ‘welcome pack’ which Care Homes for Older People Page 11 of 30 Evidence: is made available to all persons moving to the home. All information, including a copy of the home’s last inspection report by the Commission, is displayed in the main reception area of the home. We have not been advised of any changes to these documents since the last inspection. We sampled four care plans at this inspection and were able to see evidence that people are appropriately assessed by the home before a placement is offered. Care plans contained pre-admission assessments and assessments from other healthcare professionals had been obtained where available. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system has improved with the majority of the plans being specific and person centered although this requires some additional development. Evidence was seen of input from the resident and/or their representative in the plan of care. Staff now ensure that people have access to fluids at all times and that all aspects of personal hygiene are met. The frequency and incidents of pressure damage has reduced. Residents are able to have privacy in their own rooms. Personal support was offered in a way to promote the privacy and dignity of residents. Service users were treated with respect and looked well cared for. The management and administration of medication was good. Evidence: Four people were case tracked during the inspection and their care plans reviewed. An Care Homes for Older People Page 13 of 30 Evidence: additional care plan was viewed for one individual but the care was not case tracked. Case tracking involves identifying individuals at the beginning of the inspection and comparing the care and support they receive with the needs identified in the care plan. The majority of the plans had been completed with the individual and or their representative. All contained a range of appropriate assessments and associated care plans. The majority of the care plans were clear and detailed. Care plans contained up to date assessments, which included moving and handling, reducing the risk of pressure sores & falls. Likes and dislikes were well documented in the majority of the plans seen. This was not consistently completed in all the plans viewed with some containing more detailed documentation than other. Some plans therefore required continued development to ensure that the plans consistently reflect the way in which the individual would like their care to be delivered (person centered) A number of people at the home are frail and as such staff had introduced charts to record such things as amount of fluids taken and frequency of positional change. The majority of the charts viewed had been accurately completed and demonstrated that staff had delivered appropriate care and support. A system is now in place to ensure that the charts are reviewed regularly and any deficits in care are identified and appropriate action taken by staff. There was a good range of pressure reliving equipment, hoists were available. Due to this improvements have been noted in the frequency and occurrence of pressure sores and ulcers. This is a significant improvement on previous inspection findings. It was also noted that people in the communal areas and in their rooms had access to fluids at all times. Drinks rounds are conducted throughout the day and no person appeared to be dehydrated. This again is an improvement on previous inspection findings. It was noted during the case tracking process that staff had supported individuals to meet personal hygiene needs including oral hygiene. One incident in the area providing care and support for people with dementia was observed. This incident involved a person living at the home becoming distressed when the area was being decorated for Christmas. Staff handled this incident in a professional manner using a calm and unhurried manner. This defused what could have been a traumatic experience for the individual concerned. The staff member concerned should be commended for his approach to this incident. The expert by experiences reported that All people I spoke with had nothing but praise for the personal care they received from staff. One said the staff are great, I make little demands but I know the care is there when I need it. All said that staff were discrete when carrying out personal care tasks. The new resident was on her Care Homes for Older People Page 14 of 30 Evidence: fourth day and a district nurse, a mobile dentist and the hairdresser had already been organised. This was also confirmed by talking to a number of people on the nursing floor of the home. Staff demonstrated a good understanding of how to promote privacy and dignity and examples of how they do this were seen. Health and social care professionals, through feedback received, confirmed that they see their residents in private and that the standards of care and support people living at the home received had now improved. Staff were seen interacting kindly to residents and were seen knocking on doors before entering. People living at the home spoken to during the inspection confirmed that staff treated them with respect and helped to maintain their privacy when delivering personal care. The homes procedures for the management and administration of medication were examined at this inspection. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). The registered nurse on duty administers medicines. Medicines were found to be securely stored. Creams in use, seen in individuals bedrooms, had been marked with an expiry date and the MAR chart been signed to confirm that the creams had been applied as per the Prescription. On viewing the MAR charts it was evident that at least one person was an insulin dependant diabetic. On one occasion the blood sugar for this individual was low. Staff had taken appropriate action in response to this. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are on offer although these may be limited on occasions. Staff at the home need to ensure that the activities on offer are person centered. People living at the home are able to maintain contact with family and friends. The availability of food has improved over recent months including the availability of snacks and appropriate foods for those on a specialist diet. Evidence: Activities are available to people living at the home. There is an activity facilitator with a designated twenty four hours to organise activities for the whole home. She was away on leave on the day of the inspection but had left a plan of activities for the week which care staff were expected to continue to offer. Two people had been taken out to Clarks village and a trip is organised most Wednesdays. Otherwise groups eg carol singers are bought in to offer entertainment or there are wine and cheese tasting type activities. Communion is offered every week and something would be organised for anyone who is not Church of England, as had been done in the past. Hand massage Care Homes for Older People Page 16 of 30 Evidence: and hair dressing were also on the activity list. However two people told us they did not know about the church services and one person said The activities are not suited for me, I am not interested in cake making and mostly they are aimed at the people with dementia. I thought I would be able to have a game of chess and a decent conversation, but there is no-one here to do that with. This person did do some work in the garden and took photographs of events in the home and used the homes computer to print them off. A few people told us they would like to get out more. Clearly care staff are primarily there to provide care and could only engage in activities for short periods. It would seem that twenty four hours is not really enough time to offer person centred choices of activity to a large number of residents with a wide range of needs. One person did say every day is just like any other. The management at the home need to review the availability and choices of activities on offer. At the last inspection it was identified that meals and mealtimes required improvement in some areas. At this inspection the expert by experience viewed the meals in the downstairs part of the home whilst we viewed the meals in the nursing areas. The expert reported that Everyone I spoke with said the food was very good or excellent. One resident said there is always a choice and if you don’t like that they will do you a light bite - omelettes etc He later told me that he had a particular liking for tripe and onions and black pudding which he had not eaten for some time and the staff had made a point of getting both these foods in for him. Another person said she was fed up with cornflakes, and I had a bacon sandwich yesterday, scrambled egg today and I am having a mushroom omelette tomorrow I am going to try it all. I observed two choices of lunch being offered to people living on the dementia unit. Staff were temperature testing the sausages when I entered the room. Staff served both choices on to two plates which were then offered to those residents who were unable to make a verbal choice. I did notice that on the other unit there were three choices, the sausages and cottage pie that were available on the dementia unit, but also a chicken noodle stir fry which had not been offered to those with dementia. One resident chose not to eat lunch and said he was not hungry when staff made all reasonable attempts to offer him smaller portions or something different. I gather he had got up late and only recently finished breakfast. There was no offer to put back a hot meal for him to eat later. These finding were confirmed in the upper floor of the home. The staff spoke to us during the visits and confirmed that all the food was homemade including puddings and cakes. The staff confirmed that they were aware of people likes and dislikes and any specialist diets required. At the last inspection it was found that a number of people required staff support at meal times. This remains the case however staff now serve the meals in two sittings. This allows staff to ensure that they have the time to spend with people during meals Care Homes for Older People Page 17 of 30 Evidence: and ensures that meal times are a pleasant experience for all. This time also allows staff to monitor dietary intake more effectively which will promote the general health of people living at the home. At the last inspection it was reported that Afternoon tea was observed. Cakes and biscuits were available at this time however a number of people living at the home have difficulty in swallowing or require specialist diets, for example if they have skin damage or have experienced weight loss. There were no specialist snacks available for these people on the drinks trolley. This had been addressed at this inspection with a range of snacks now being available for all people at the home. Milk shakes and smoothies had also been introduced for those people who have experienced weight loss or required a high protein diet. It was noted however that on the day of this inspection that a number of people had not been supported to have breakfast until late in the morning and were then offered snacks. This resulted in people not being hungry when their main meal was served at 12:30. Staff need to ensure that the provision of snacks does not compromise the intake of the main meal. This could be achieved by offering the snacks at different times eg in the evening or saving the main meal until a later time. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are dealt with in line with the homes policy and procedures. People living at the home are aware and comfortable in expressing any concerns. People living at the home are protected by the homes policies and procedures. Staff have received recent training in the prevention and recognition of abuse. Evidence: Feedback from people living at the home when asked do you know who to speak to if you are not happy? All people stated that they would speak to a staff member or the manager if they had any concerns. Comments from relatives included A wonderful home no complaints. The Home has a complaints procedure that is clearly written and contains the contact details for CSCI. All the complaints are dealt with in line with the homes policy and procedure. The policies and procedures regarding protection of residents are of a good standard, which include complaints,recognising signs of abuse and whistleblowing. These policies have been reviewed and up dated. The home has copies of the local abuse polices and procedures. Abuse training is included in the staff induction programme. The training matrix was viewed as part of the inspection process and this showed that staff had Care Homes for Older People Page 19 of 30 Evidence: received abuse training. Staff spoken to during the inspection all now have a increased knowledge of the action to be taken should issues be identified. The management of Brunelcare have been involved in reviewing and investigating the recent safeguarding issues that have been raised with home. The management have been proactive in resolving, investigating and informing the relevant authorities the outcome of these concerns. Since the last inspection the manager and the staff team have been proactive in adressing the complaints and suggestions about the service, using these positively and learning from them. Staff recruitment files were viewed during the inspection. These contained all necessary checks. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This is the second key inspection in this year. At the last inspection, conducted in June 2008, this outcome group was assessed as good. These standards have therefore not been assessed on this occasion. The report in June 2008 stated People live in a comfortable and well maintained environment. People are able to personalise their bedrooms. The home is fitted with an appropriate range of aids and adaptations. The standard of cleanliness is good and the home has systems in place to reduce the risk of the spread of infection. Evidence: In the report in June 2008 it was report that The home is purpose built and is situated over two floors Grab rails are conveniently sited throughout the home. The gardens is accessed from the ground floor and provides level access for people in wheelchairs/mobility difficulties. There is a passenger lift which is accessible for people in wheelchairs. A call bell is installed and people were noted to have access to appropriate mobility aids. Care Homes for Older People Page 21 of 30 Evidence: Each unit has a large bathroom with assisted bathing facilities. All bedrooms are for single occupancy and are fitted with en-suite toilet and shower facilities. The home employs a maintenance person. At the time of this inspection the home appeared comfortably furnished and well maintained. We sampled a few bedrooms and it was evident that people are encouraged to personalise their private space. In the dementia unit, signs/pictures are in place to assist people with orientation. The home employs domestic staff. The standard of cleanliness on the day of this inspection was good and there were no malodours. The home takes appropriate steps to reduce the risk of the spread of infection. Liquid soap and paper hand towels are appropriately sited throughout the home. Staff have access to a good supply of protective clothing. A sluice facility is available on each unit. Doors to these areas were found to be secure. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels appear appropriate to the needs of people currently at the home but these should be kept under review. The home promotes NVQ and ongoing training training for staff and ensures that all staff received training appropriate to their role. The home follows robust procedures for staff recruitment. Evidence: Staff rotas were viewed as part of the inspection. These demonstrates that currently adequate numbers of staff are available to meet the needs of the people living at the home. The home however has reduced occupancy due to not taking any new admissions over the last few months. The management need to ensure that as the level of dependency at the home increase that they keep the staffing levels under review and increase these if necessary. This will ensure that the hard work at improving the care and support afforded to people living at the home is not compromised. As part of the ongoing review and improvements at the home staff training has been reviewed and up dated training provided to staff. Some deficits in the training matrix Care Homes for Older People Page 23 of 30 Evidence: were seen however training had been organised to complete this. Staff spoken with during the inspection confirmed that they had been provided with the training needed to care for people at the home including NVQ. Staff indicated that they felt confident in their skills and they stated that they were never asked to undertake a task that they didnt feel trained to carry out. Staff confirmed that, in addition to the mandatory training, they had received very good’ training. Staff confirmed that clinical responsibilities had been delegated to named individuals and that this in their opinion had improved the quality of the care provided at the home. Staff stated that they enjoyed this new responsibility. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not currently have a manager registered with the CSCI. Staff are appropriately supervised and feel well supported. The homes procedures for ensuring the health and safety of persons at the home are generally good. One issue with regard to safety of one individual was report to us prior to the inspection. Evidence: The current home manager is Mrs Joy White. Mrs White has submitted an application to become registered with us. This application is currently pending. Mrs White is not a registered nurse and therefore Brunelcare have recruited a clinical lead for the nursing part of the home. This individual had recently commenced employment at the home. Care Homes for Older People Page 25 of 30 Evidence: Mrs White has undertaken and achieved a Registered managers award. In addition she has achieved a Management Diploma. Following the inspection we have met with the providers, Brunelcare. It has now been confirmed that Mrs White has been successful in her application to become registered with us. We have written to Brunelcare separately from this report to detail additional action required in response to this application. All records seen were stored appropriately and safely. Accident forms are completed and these are audited on a monthly basis. These were reviewed during the inspection. A system of staff supervision has continued to be developed and is being rolled out to all staff. Servicing and maintenance records were sampled these were found to be in good order. The sluice and laundry area have now been fitted with locks COSHH (Control of Substances Hazardous to Health) advisory sheets are held at the home. Prior to the inspection one issue was raised with us by the home relating to the safety and well being of one person living at the home. Following this incident appropriate action was taken by the home management to ensure the on going safety of this individual. However it was clear from viewing the care records of this individual that this had previously been identified as a potential issue. The care plan for this issue was not specific and it could not be confirmed that necessary action had been completed to ensure the safety of this person. Mrs White and the management of Brunelcare need to ensure that their on going monitoring of the home, via regulation 26 visits and quality assurance systems, identify as much as possible potential issues relating to the deterioration of the health needs of individuals at the home and how this may impact on their health and safety. At the meetings following the inspection BrunelCare, the providers, do not agree with our findings in this area. Brunelcare feel that staff knew the needs of the individual well and were delivering appropriate care. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 38 12 The ongoing monitoring arrangements such as regulation 26 visits, quality assurance and reviewing of care needs should identify potential health and safety issues relating to people living at the home.Consideration should then be given as to how potential health and safety issues relating to the individual are going to best managed. Areas such as increasing staffing levels, changing of equipment or referral to specialist care should be considered. This will ensure that the health and safety of people at the home is not compromised. 03/03/2009 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 Care Homes for Older People Page 28 of 30 improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 7 It is recommended that all the care plans are consistently completed in a person centered way. This should include the likes and dislikes of the individual, their strengths and weakness and how they would like their care to be delivered. It is recommended that the management at the home review the availability and choices of activities on offer to ensure that they meet the needs of the people living at the home. 4 12 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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