Inspection on 03/12/08 for Glebe House

This inspection was carried out on 3rd December 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Glebe House 05/06/09

Glebe House 05/02/07

Glebe House 10/01/06

Glebe House 27/07/05

Glebe House 15/02/05

Glebe House 28/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Glebe House 5 Sundays Hill Lower Almondsbury South Glos BS32 4DS     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: Grace Agu     Date: 0 3 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 33 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 33 Information about the care home Name of care home: Address: Glebe House 5 Sundays Hill Lower Almondsbury South Glos BS32 4DS 01454616116 01454616118 angela.ryan@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Avonedge Limited care home 53 Number of places (if applicable): Under 65 Over 65 53 0 old age, not falling within any other category physical disability Additional conditions: 0 5 Manager must be a RN on parts 1 or 12 of the NMC register. May accommodate one named person aged 32 years or over. The registration wil revert to 50 years and over when the person leaves the home. May accommodate up to 5 persons between 50 and 65 years of age. May accommodate up to 53 persons aged 65 and over, who are receiving nursing care. Of the total 53 persons, the home may accommodate up to 3 persons (who must be 65 years or over) requiring personal care only. Staffing notice dated 19/3/1998 applies Date of last inspection Brief description of the care home Glebe House was first registered as a Care Home providing nursing in 1996. It is one of three homes in the same ownership. The other homes are Field House in Horfield and Beech House in Thornbury. Glebe House is in part a converted older building with a purpose built annexe. The home is situated in wooded grounds that are well Care Homes for Older People Page 4 of 33 Brief description of the care home maintained and accessible to residents and visitors. Accommodation is of a high standard and is arranged on three floors providing forty-one single bedrooms and six rooms for double occupancy. The majority of rooms have en-suite facilities and others have a washbasin and a toilet within a short walking distance and there are two large lounge areas and two smaller ones for quiet occupation if wished. There is access to all parts of the building provided by two passenger lifts. The fees for staying at the Home range from £585- £970 a week. 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 peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: The reason for this visit was to review the requirements made at the last inspection that was undertaken on the 5th and 6th February 2007. In addition we also followed up the complaint we received from an ex member of staff about alleged incidents in the home concerning several residents. To enable the inspector to confirm that the requirements have been met the following records were reviewed, they included eleven residents care files, the staff rota, and residents activities record and staff training records and staff recruitment. We also looked at several health and safety records and the complaint record to help Care Homes for Older People Page 6 of 33 us determine how the home handles complaints made by the people living in the home or their relatives. We met with the acting manager Angela Ryan and the homes administration manager. Whilst touring the building we had the opportunity to speak with seven residents and seven staff members, and one relative. What the care home does well: What has improved since the last inspection? What they could do better: At the last inspection a requirement was issued in relation to lack of appropriate care planning, it was disappointing to note that this requirement had not been met. We are therefore issuing a repeat requirement for the home to ensure that all identified residents have specific care plans in place to ensure that their needs are met. Those needs are identified in the body of the report under Standard 7. The home is reminded that failure to meet the requirement may result in enforcement action being taken by the Commission. It is also required that the home rewrite some of the care plans dating as far back as 2000 to support staff in meeting the current needs of the residents. It could be better if a risk assessment was in place for an individuals aggression in order to protect their health and safety and that of others around. Care Homes for Older People Page 8 of 33 Residents would be protected if risk assessments are in place and reviewed following accidents to individuals living at the home. Furthermore to ensure that individuals are adequately protected and minimise/prevent falls it could be better if the generic risk assessment includes the bedrooms and corridors. To ensure that residents needs are met it is required that staff attend training on Tissue Viability, Challenging behaviour, Wound Care Management, Infection Control and Dementia Awareness. Staff would perform their duties effectively if they receive regular supervision and in particular registered nurses who have a lead responsibility in relation to care of the residents. The provider must ensure that monthly visits (Regulation 26) are regularly undertaken to monitor the quality of the services provided as required by the legislation. It must ensure that copies of reports of visits are sent to the Commission for Social Care Inspection for review. 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 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 10 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The process of admission is well planned with clear information to enable the resident or their representatives to make decisions about the services provided at the Home. Evidence: The Homes Statement of Purpose and Service Users Guide remains in place and provides information to prospective residents in relation to services provided to enable them to make a decision about the Home. Evidence from two newly admitted residents records showed that one of the residents was assessed at the hospital before admission, this was to ensure that the needs would be adequately met. The Manager stated at a discussion that the Home has Terms and Conditions for all categories of residents. The Terms and Conditions document has information in Care Homes for Older People Page 11 of 33 Evidence: relation to services provided. Care Homes for Older People Page 12 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. The home offers care and support to residents throughout their life and towards the end. Residents needs are assessed before admission, and their right to privacy is respected. However, it fails to provide specific care plans for residents identified needs. The process of medicines administration recording and disposal is satisfactory. Evidence: On the days of the site visits we looked at eleven care files as part of a case tracking process in relation to the complaint we received about poor quality care that these people are receiving. There was evidence of pre-admission assessment in all the care files viewed including that of one new resident to the home. This assessment was to determine whether the home is suitable and able to meet the residents need. The resident was reassessed following admission before care plans were provided detailing how the assessed needs Care Homes for Older People Page 13 of 33 Evidence: are to be met. This was to be followed up by monthly reviews and intervention as needs change. However while reviewing other care files we noted that one resident admitted on 1/02/08 and had entries on 25/08/08, 26/08/08 and 16/11/08 for aggression towards other residents and staff and trying to leave the building had no care plans in place on how this behaviour was being managed. There was no risk assessment seen in the care file on how to reduce this risk. Furthermore another individual whose notes from the previous home clearly states the person has difficulty in swallowing so drinks are thickened has no specific care plan to indicate that this individual is at risk of choking due to poor swallowing reflex. There were entries on 3/11/08 and 16/11/08 that the persons relative gives him food that he is unable to tolerate, there was no care plan seen in the file on how staff were to deal with this situation in order to protect the resident. We also noted that the same person has a pressure sore on the right buttock which is looking quite nasty tonight (2/12/08) had no wound care plan nor body map to enable staff to monitor the wound in terms of healing. On reviewing other care files records indicate that there are considerable number of residents with pressure sores one dating back to 2006 with no care plan to support staff in caring for this person. There was no evidence of any professional advice for example (Tissue Viability Nurse) to advise the home on strategies to prevent/minimise pressure sores and appropriate wound management to use if a pressure sore occurs. There was no evidence that staff have received training on ways to prevent pressure sores. While we acknowledge that an individual with several entries of distress and anxiety had a care plan that set out how staff were to support this person, there was no care plan developed on how staff were to monitor the pain being experienced by the person as indicated on the entry on 6/03/08. This person was also experiencing severe constipation which could account for the distress and discomfort that this individual was experiencing, there was no care plan on how this condition was being monitored and managed in order to make the resident more comfortable. Observation on the day of the visit led us to believe that this persons distressing Care Homes for Older People Page 14 of 33 Evidence: condition impacts on the persons health and the health and safety of other residents around the person. We have issued a requirement for the home to put a risk assessment in place followed with a care plan to protect this person and those around them. We have also issued a requirement for the home to ensure that care plan is in place to meet the residents identified need. We noted that the care files have a document known as Daily Accountability Record which the registered nurses use to monitor care provided for residents on a daily basis. The entries on this document were vague and failed to give a clear account on how care was provided to the residents. We recommend that these documents are reviewed to ensure that care given is well monitored and documented. At a discussion, the acting manager stated that the registered nurses are aware that care plans need to be developed to reflect the changing needs of the resident. She would ensure that this is implemented. An ex staff member told us that two residents were supposed to have a bath on 19/10/08 but were given a wash instead. The acting manager could not give a satisfactory reason why this was the case. There was no written evidence seen in the care notes that the individuals were given explanations why they could not have a bath on the day or that they were offered an alternative day. Furthermore, it was noted that some care plans were dated 2000 and 2001 and staff were writing over the documents making it difficult to find information about the person on the file. All the care plans need to be rewritten and tailored to reflect the current individual needs. We discussed these issues with the acting manager and we have issued requirements in relation to the above and would be monitoring the care planning system before and during the next inspection. Other information seen in the care files reviewed was detailed and up to date. Some residents interviewed confirmed that staff treated them with respect and knocked at the doors and waited for an answer before entering to attend to their personal hygiene needs. One resident interviewed stated I like it here, staff are kind, I couldnt fault this home. The home has introduced the provision of wheelchairs to its residents. They are assessed by a professional physiotherapist and mobility team and are provided with wheelchairs that meet their individual needs funded by the home. Care Homes for Older People Page 15 of 33 Evidence: There was evidence of General Practitioner (GP), Dentist, Chiropodist visits to residents. There was evidence in the care files viewed of details of residents wishes in the event of death. Staff interviewed were aware of policies and procedures for dealing with a dying resident and at the time of death. Records show that two registered nurses have attended End of Life training to enable them to support residents and their families at a time of imminent death and bereavement. Three staff members spoken with are aware of the importance of keeping information about residents confidential. A local pharmacy provides medication using a monthly monitored dosage system. A check of the blister packs indicated that medication had been administered as recorded. All medication seen was stored securely. Medicines trolleys are used to transport medication around the home and staff were mindful not to leave the trolley open and unattended when giving out lunch time medication. There is a medicine fridge and temperatures are recorded daily. Two areas in the home where oxygen cylinders were stored had statutory warning notice on the doors for easy identification in the event of fire emergency. Controlled drugs were stored correctly and recorded in a register. A policy is available to enable staff to provide safe service to residents. The pharmacy supply printed medicines administration record sheets each month. Records of administration of medicines were clear. Records indicate that no resident was self administering their own medication. Records are kept of medicines ordered and received by staff into the home. Care Homes for Older People Page 16 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. The home enables residents to maintain contact with family, friends and community. It also provides meaningful activities and choice in respect of meals and meal times. Evidence: Evidence of discussion with residents, staff and entries in the visitors book showed that the home actively supports the residents to maintain contact with families, friends and advocates. One service user spoken with told us that her family visits very regularly and that the Home would contact her family anytime she wanted them to. One relative spoken with on the day stated that there are no restrictions to time of visiting and that they visit their relative almost everyday. They are satisfied with the Home and the services provided, staff are very welcoming I cannot fault them.The home provides meaningful activities for the people living in the home. The manager told us in the Annual Quality Assurance Assessment that residents are assessed on an individual basis to enable the home to plan activities tailored to individual residents. The activities organiser consults with the resident/relatives on admission to obtain information on the activities preferences and regularly undertakes Care Homes for Older People Page 17 of 33 Evidence: reviews to ensure it is still appropriate.The families also complete a social history form to enable the activities coordinator to plan activities suited for the individual. The manager also stated that the home has employed an Activity Coordinator who works 30 hours a week and whose responsibility is to provide appropriate activities based on individual capabilities. All new residents are assessed by the homes Activity Coordinator for example likes and dislikes, their cognitive awareness and previous hobbies. The information obtained in this way would be used to plan activities suitable for this individual. During a discussion, the manager stated that there is a list of monthly activities for special events, weekly planned activities that include outings and trips. The home has a minibus and a car used for outings and trips. Recorded trips include Weston-Super-Mare 19/11/08, sightseeing in Bristol, Wye Valley, Serven Beach, Leighwoods and Downs. The activities book contained lists of all the residents and activities they had participated in. This is to enable the home to monitor participation and to plan other ways to encourage those who are reluctant to participate in any activity. Activities recorded in each residents file include music and movement, Keep fit, Target the Rings, Ball Game and monthly entertainment. There were also records of interaction on an individual basis with residents who prefer to be in their rooms or declined or were unable to attend the general planned activities. The acting manager stated that the Activity Coordinator offers dementia group stimulation on one to one basis every morning. There was evidence of personal possessions in the rooms viewed. One relative stated in the survey returned to us This care home is light, fresh smelling and warm. The rooms are large and spacious with appropriate furniture and because pictures and photos are allowed to be placed around the rooms look personalised. The menu on the day contained a choice of two nutritional meals and a choice of pudding. One of the puddings tasted by the inspector was delicious. The meal was relaxed and residents were given the meals based on the choices they made after consultation on the meals available to them. In order to promote equality and diversity at the home vegetarian meals are provided Care Homes for Older People Page 18 of 33 Evidence: for the residents who are vegetarians and kitchen and other staff are aware to avoid giving one particular individual resident any pork dishes. Residents who were unable to feed themselves were given appropriate support; staff approached the residents in a sensitive manner and treated them with dignity and respect. All Residents spoken with after lunch stated that they enjoyed their food. The kitchen was found clean and tidy. The chef stated that staff working in the kitchen have attended basic food hygiene training and Control of Substances Hazardous to Health (COSHH) Training. Some certificates were displayed in the kitchen area.There was a regular record of the fridge and freezer temperatures. The food in the fridge was labelled. Laundry room was clean and had two industrial washing machines and two industrial tumble dryers available to provide better laundry services for the residents at the home. Staff showed knowledge of their role and responsibilities about ensuring that the home is free from any form of infection epidemic. The Acting manager told us that there are risk assessments of both laundry and kitchen. 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. Residents are enabled to complain and are confident that the home is able to protect them from harm and abuse. Evidence: The Home has appropriate and robust procedures in place for management of complaints. The complaints procedure was noted displayed in the hallway at the entrance. However the acting manager stated that this document is given to all the residents or their relatives at the home on admission. This document contains information about the Commission for Social Care Inspection to enable individuals to contact the Commission if they were not satisfied with the outcome of their complaint to the organisation. This inspection was also undertaken to follow up a strategy meeting held about a serious complaint received from a concerned ex member of staff in relation to care practices at the home. Although this complaint was not recorded at the home, the acting manager confirmed that they were aware of the serious nature of the complaint. The acting manager, the administration manager along with the Managing Director will be attending the second scheduled strategy meeting in relation to this complaint on 8 December 2008. Care Homes for Older People Page 20 of 33 Evidence: Other recorded complaints were satisfactorily investigated and the outcomes were fully recorded. Residents spoken with and responses noted on the comment cards evidenced that residents are aware who to complain to. One resident stated, I know where to go if I have any reason to complain.The manager stated that new residents/ families are informed about the complaints procedure on admission and that this is also included in the Service Users Guide. Staff are aware of the Whistle Blowing policy and would report any bad practices to the Manager without fear of reprisal. There is evidence of staff training in relation to Protection of Vulnerable Adults from Abuse. The acting manager is aware of the South Gloucestershire Councils policy on the Protection of Vulnerable Adults from Abuse to ensure that the protocol is followed if incidences of abuse occur. A copy of this guidance was noted at the home. It was agreed that relevant details should be made available to staff to access in emergency to enable them to contact the Safeguarding Adult Team at the Council. Evidence from the records showed that Registered Nurses working at the home had their own Personal Identification Numbers verified by the Nursing and Midwifery Council (NMC) before commencement of employment and periodically to ensure that residents are adequately protected. 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. The home provides a homely and comfortable environment for the service users. Evidence: Glebe House was first registered as a Care Home providing nursing in 1996. It is one of three homes in the same ownership. The other homes are Field House in Horfield and Beech House in Thornbury. Glebe House is in part a converted older building with a purpose built annexe. The home is situated in wooded grounds that are well maintained and accessible to residents and visitors. Accommodation is of a high standard and is arranged on three floors providing fortyone single bedrooms and six rooms for double occupancy. The majority of rooms have en-suite facilities and others have a washbasin and a toilet within a short walking distance and there are two large lounge areas and two smaller ones for quiet occupation if wished. All residents are provided with televisions and telephones with external lines. No major changes to the building had occurred since the last inspection. The home remains suitable for its stated purpose. The acting manager told us during a discussion that a second passenger lift has been installed with more room capacity for Care Homes for Older People Page 22 of 33 Evidence: transportation of residents and to ensure that there is no disruption of services if one lift breaks down. The Home was found clean tidy in a good decorative order. The communal areas, bathrooms and the toilets were found to be clean and tidy to meet the needs of the individuals living in the home and to protect them from potential infection. The home also has a policy on infection control. Whilst the home has a system to extract foul air it was noted during the inspection that one persons room smelled of urine. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes recruitment process demonstrates safeguards are in place however it fails to provide adequate numbers of care staff at times and training to ensure that residents receive adequate care. Evidence: The inspection followed up the concerns raised by an ex member of staff in relation the length of time that residents have to wait to be assisted to the toilet due to insufficient numbers of staff at the home. A number of comments were received from individuals who live in the home about staffing levels. Comments included: When I ring the bell it takes long for staff to attend to me. Another comment was when I ring the bell they tell me I have to wait for my turn, they havent got enough carers. A random review of the rota showed that the home had adequate numbers of staff mix on most of the dates, however, was one care staff short on 22/11/08 morning shift, one staff short 23/11/08 morning and afternoon shifts, one staff short on 28/11/08 moring shift and one staff short on 30/11/08 afternoon shift. The manager stated that the home contacted an agency on the 30/ 11/08 but they were unable to supply any staff to cover and this was recorded in the diary. On other occasions the acting manager was unable to provide a satisfactory reason why the shifts were not covered. Care Homes for Older People Page 24 of 33 Evidence: The manager must ensure that adequate numbers of staff with suitable skill mix are working at the home at all times to ensure that the residents needs are met. In relation to allocation of staff on the floors for assisting the residents the manager stated that this is based on the numbers of residents on each floor. For example on the day of this visit a senior care staff with NVQ level 2 and 10 years experience was paired to work on the ground floor with two care staff who had been at the home for two and three months. There were two senior staff members with NVQ level 2 and 3 and over ten years experience working with care staff with combined experience of eighteen months. The home has a robust recruitment procedure to ensure that suitable staff are employed to meet the residents needs.The records of recently recruited staff members contained two satisfactory references, Criminal Record Bureau (CRB) disclosures and relevant qualification to ensure that the residents are protected. However the ex member of staff that complained to us felt that the homes induction was unsatisfactory. Two staff members we spoke with stated that they had one week induction /observation and one week working on the floors with an experienced senior staff member. We were unable to verify the homes current policy on induction however the acting manager and the administration manager showed us the newly purchased induction portfolio from Red Crier publications which is a comprehensive programme with similar topics from Skills for Care Induction programme. The acting manager stated that this programme will be introduced in January 2009. Training records provided by the home showed that staff had received the required training specifically moving and handling and fire safety. At the time of this inspection nine staff had achieved National vocational Qualification (NVQ) level 2, 3 care staff have achieved NVQ level 3 qualification, one care staff is working towards NVQ 2 and three staff are working towards NVQ 3. We also noted that all staff have attended training on abuse awareness, four staff members including the Activity Coordinator have attended training on dementia awareness on 27/11/08 and three staff attended training on challenging behaviour on 27/5/08.There was no evidence in the records that staff have attended training on Tissue Viability to enhance their knowledge in recognising the causes of pressure sores and how to prevent them from happening. It was also unsatisfactory to note from trained staff members and from the records Care Homes for Older People Page 25 of 33 Evidence: that only one registered nurse out of twenty one working at the home has attended wound care management training. This led us to believe that a lack of knowledge and training contributed to inadequate wound management noted on one of the residents care file. We have issued a requirement for the training to be arranged to ensure that registered nurses acquire the skills required to provide appropriate care for the residents. Care Homes for Older People Page 26 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. The home has no registered manager but current leadership and management arrangements on the day of the visit were satisfactory. Some practises fail to offer full protection to the health and safety of residents. Evidence: On the day of inspection there was a good, friendly interactive atmosphere at the home. Residents looked well care for and were talking to staff in an informal way. Staff and residents spoken with were complimentary about the managers ability to manage the home. Whilst the home has no registered manager the acting manager, Ms Angela Ryan showed professionalism throughout the inspection. Ms Ryan stated that she was leaving the home and organisation to go back to hands on nursing. Staff stated that the acting manager and registered nurses were approachable and would listen to their comments and acted accordingly. Care Homes for Older People Page 27 of 33 Evidence: One staff member stated in the comment card the home provides a home from home environment which makes residents and staff happy on the whole. The level of care is very good. The staff work very hard as do the management and they are all very caring people. In relation to health and safety measures, there was a nurse call system check on 28/8/08, all the hoists were checked on 15/10/08. Portable appliance checks were in date. The liability insurance is current. The home had a generic risk assessment in relation to various areas of the home to include Staircase, dining area, kitchen, laundry, wardrobes and bathrooms. It was agreed that the individual bedrooms needed to be risk assessed following recent falls to residents. The fire logbook was found to be up to date and well maintained and there was evidence that staff have attended regular fire drills. Accidents were recorded however some care files lacked risk assessments and care plans and reviews to minimise further occurrence. Statutory Notifications (Regulation 37) in relation to serious incidents at the home were received at the Commission for Social Care Inspection at the time of occurrence. The administration manager stated that the five yearly Periodic Inspection of the Electrical Installation safety test had been carried out on 11/11/08 and the list of work to be done was given to the home which she had authorised to be carried out. The home would send the certificate to the Commission when the work is completed and a certificate is issued. The homes Quality Assurance systems were reviewed. The manager stated that the home assesses the quality of its services through feedback from residents, relatives, visitors and health professionals visiting the home. The chef consults the residents on a daily basis regarding the menu and any concerns raised are acted upon as soon as possible as a way of auditing the catering services and residents satisfaction. The home has an open door policy that enables residents relatives and visitors to come in at anytime to see the manager or senior staff members for any issues that they may have. However we noted that the last statutory providers visit (Regulation 26) took place in May 2008. The registered provider is reminded that the care home must be visited monthly to inspect the premises, its records of events and records of any complaints and prepare a written report on the conduct of the care home and send a copy to the Care Homes for Older People Page 28 of 33 Evidence: Commission for Social care Inspection. We have followed this reminder with a requirement and will be monitoring it to ensure that this is regularly undertaken. The home has policies and procedures to include recruitment of staff, Complaints, Moving and Handling, Protection of Vulnerable Adults, Missing Persons and Grievance. There was documentary evidence that some care staff at the home have received regular supervision, however review of the records and discussion with registered nurses show that they have not been receiving supervision to enable them to raise concerns on any area of practice that affect the health wellbeing of any resident living at the home. The acting manager told us that the home is aware that staff supervision should be more regular. We have issued a requirement for the home to put systems in place that would ensure regular supervision of all staff. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15(1) All residents care plans must 05/03/2007 be reviewed and updated on a regular basis Care Homes for Older People Page 30 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 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be in place for identified residents. To ensure that their needs are met. 31/01/2009 2 8 15 Consult Tissue Viabilty Nurse. To give advice for the prevention and management of pressure sores. 16/01/2009 3 8 13 Ensure that risk assessment and care plan are in place for identified individuals aggression and challenging behaviour. To protect the individuals safety and safety of others. 31/12/2008 4 8 13 Risk assessment must be in place after a fall. To prevent/minimise falls. 16/01/2009 5 27 18 Ensure that adequate 15/01/2009 numbers of staff are on duty at all times. Care Homes for Older People Page 31 of 33 For residents to receive good care. 6 31 8 Ensure that a registered manager is appointed at the home. To provide leadership and direction at the home. 7 33 26 The registered provider must undertake statutory monthly visits. To monitor the quality of its serrvices. 8 36 18 Staff supervision must include registered nurses. To ensure quality care to is given to residents. 03/03/2009 26/02/2009 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 improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Review the Daily Accountability Record to ensure that how care is given is well documented. 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. 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). 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. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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