Inspection on 26/11/08 for Glenmoor House Nursing Home

This inspection was carried out on 26th November 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

Glenmoor House Nursing Home 11/12/07

Glenmoor House Nursing Home 14/12/06

Glenmoor House Nursing Home 07/02/06

Glenmoor House Nursing Home 27/10/04

Glenmoor House Nursing Home 16/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 20/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Glenmoor House Nursing Home Rockingham Road Corby Northants NN17 1AD     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: Kathy Jones     Date: 2 6 1 1 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 31 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 31 Information about the care home Name of care home: Address: Glenmoor House Nursing Home Rockingham Road Corby Northants NN17 1AD 01536205255 01536262662 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southern Cross Healthcare Services Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 59 Number of places (if applicable): Under 65 Over 65 22 37 0 dementia old age, not falling within any other category physical disability Additional conditions: 3 0 20 The maximum number of service users who can be accommodated is 59. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admision to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Dementia - Code DE(E) Physical Disability - Code PD Date of last inspection Brief description of the care home Southern Cross Healthcare owns Glenmoor House Nursing Home. It is a 59-bedded care home with a registration for 48 nursing care beds. It provides care to elderly people (over 65 years of age) and has a further registration category for caring for Care Homes for Older People Page 4 of 31 Brief description of the care home elderly people with dementia related illnesses and younger adults with a physical disability. The home is a purpose built building and is situated on a main route within Corby. It is well situated to access local facilities and amenities with a complex of shops close by and it is on a local bus route. The accommodation offers a range of communal areas including lounges and dining areas on both floors. All bedrooms are single and the majority have en-suite facilities. Level access to the home is via the main entrance and there are stairs and a passenger lift for access to the first floor. Information about fees was not available within the service user guide at the time of the inspection and a requirement has been made to include this information. The following fees were provided by the manager as being current at the time of the inspection in December 2006: Fees range between #331 and #696 dependent on assessed needs. The fees include personal care, accommodation, meals and laundry. Chiropody and hairdressing services can be arranged and are charged separately. Other costs would include personal expenditure such as newspapers, clothing and toiletries. Care Homes for Older People Page 5 of 31 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 quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The key standards under the National Minimum Standards (NMS) were inspected during the course of this inspection. The Commission for Social Care Inspection (CSCI) focus on these standards as they are considered to be the standards, which have a particular impact on the health and welfare outcomes for people using the service. This was an unannounced inspection carried out by one regulation inspector. Judgements reached within each of the outcome areas in the report were based on the Care Homes for Older People Page 6 of 31 drawing together of information from a range of sources such as, the reviewing of care plans, risk assessments, complaints records and safeguarding information about the service, written and verbal communications with the registered provider. We case tracked four people using the service which involved sample checking care records (care plans) held at the service in relation to their health, safety and welfare, and where possible time was spent speaking with people to gain insight into their experience of using the service. In addition general observations of care practices and discussions took place with visitors, staff and the homes management. An expert by experience accompanied us on the inspection. An expert by experience is a person who, because of their experience of using services and/or ways of communicating visits a service with an inspector to helpthem get a picture of what it is like to live in or use the service. Staff files were sample checked to evaluate how the service ensures people are protected through their staff recruitment, training and support and development programmes. We sent out some surveys to a sample of health professionals who visit the service, people who use the service, and staff with the purpose of gathering peoples views on the service provided. In October 2008 we received completed surveys from three members of staff, three health professionals and five people who use the service. The information received provided us with peoples views at that time. We have considered the information received and where more recent information has been received we have included this also. Feedback on the findings of the inspection was given verbally to the manager on the day. What the care home does well: What has improved since the last inspection? What they could do better: More information in the statement of purpose about the range of needs that Glenmoor House is able to meet, would help people to decide if their needs can be met, and would also give some insight into the needs of people they may be living with. Record keeping in relation to peoples care, needs to improve to ensure that care plans which are designed to be working tools to guide staff in the care to be provided contain up to date information. The risk of confusion would be reduced if out of date information was kept separatley. This would also help staff to evaluate more thoroughly the effect of any changes to the plan on peoples health. The feedback we received indicates the need to look at how peoples daily lives can be enhanced in between the organised activities. The mixed feedback relating to meals indicates the need to explore possible reasons for this, particularly in relation to comments about it being cold. We have advised that consideration is given to a possible link with staffing levels. Care Homes for Older People Page 8 of 31 Staffing levels continue to be an area of concern that has been raised and there seems to be a need for review as to how the levels are determined in relation to dependency levels. Our expectation is that there are enough staff at all times to meet the needs of the people who live at Glenmoor in a timely way. There needs to be a more pro-active approach towards refurbishment and redecoration and replacement of equipment which is described in some cases as being old and not the best for the job. 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 31 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 31 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. There is a thorough assessment process which helps to determine if peoples needs can be met. Information about the service is up to date, however more detailed information would enable people to make more informed choices. Evidence: Information is available to people considering using the service and their families in the form of a statement of purpose and service user guide. A copy of the documents and a copy of the most recent inspection report are also available in the foyer. We made a requirement at the last inspection that the fees must be included in the service user guide. This information is now included which helps people to make decisions about the financial aspects of their care. Up to date information and contact details for the operations manager and operations director were also correct at the time of the inspection. Care Homes for Older People Page 11 of 31 Evidence: The statement of purpose and service user guide, are corporate documents with some information specific to Glenmoor House. The specific information is however very limited and does not give people information about the range of needs catered for and the type of needs that can be met. For example Glenmoor House care for people with dementia, however there is no information about the types of dementia, range of needs or the approach to dementia care. This is important in helping people to decide if their needs and expectations can be met. Responses from three out of four people who use the service about the information they received prior to admission to Glenmoor house confirmed that they felt they had enough information to make a decision about moving in. One person said that their wife had lived in the home and that they were more than happy to move in. Review of the records for someone who had recently been admitted confirmed that a thorough assessment had been carried out prior to admission. Information gathered included medical history,consideration of any risks such as developing pressure ulcers or falls. In this case the person was admitted from hospital and information was received about treatment and care required which was incorporated into the care plan. Information is also gathered about peoples social interests, religion and friends and families. It is important that this information is gathered from all sources to help ensure that the required care and support can be provided. Discussion with the manager indicated that consideration is given on an ongoing basis as to whether peoples needs can continue to be met at Glenmoor House and that where necessary a request for re-assessment is made. Standard 6 is not applicable as intermediate care is not provided. Care Homes for Older People Page 12 of 31 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. People are happy with the care that they receive, however they are at risk of their needs not being met as the care plans which guide the care are not being kept up to date. Evidence: Three people who use the service stated in surveys that they always get the care and support that they need and two that they usually do. One person stated that they feel the care and support is right at this time. During the inspection someone who uses the service told the expert by experience that the quality of nursing care is excellent. We asked people in the surveys if they get the medical support that they need. Two said always, two usually and one sometimes. The people we spoke with during the inspection and review of care records indicated that referrals are made to health professionals for advice and treatment as and when required. We also saw advice given by health professionals relating to feeding for people who are fed via a Percutaneous Endoscopic Gastrostomy (PEG) feeding tube was available on the care Care Homes for Older People Page 13 of 31 Evidence: files. One record of a visit by a General Practitioner stated wishes to be put on the waiting list for surgery. There needs to be clearer information as to the reason for the visit and the outcome to help ensure people receive the correct care. It would appear that a lot of information is passed between staff verbally and this is confirmed by comments made in staff surveys. Staff report that nursing staff are very good at making sure carers are kept fully informed. Staff appeared knowledgeable about peoples needs and feedback from people who use the service was that they were getting the care that they need. We were however concerned that it would be very difficult for a new member of staff, someone who has been away for a while or agency staff to establish what peoples current needs are. There are care plans in place, which are documents to guide and instruct staff in the care provided to meet peoples needs. We would expect these care plans to be working tools. Some of the care plans were very detailed and contained clear information about the care required to meet peoples needs. However it was difficult in some cases to establish what the current needs were. Out of date documentation is kept alongside current information and new care plans are not always developed as peoples needs change. For example care plans and risk assessments relating to a catheter which the person had not had in place since approximately 18/12/06. We also found through that discussion with staff about someones care, that a care plan didnt match the current care in respect of someone fed via a PEG feeding tube being given pureed food. There were also records of evaluations of the care plans which had been carried out approximately monthly which contained very generalised comments and did not demonstrate effective monitoring of the persons needs or health. For example following a review in July 2008 changes were made to someones diet. We noted that there was a care plan for a condition which can be affected by diet for this person and would have expected that the evaluations would have considered the effect of the changes. The care plans for eating and drinking and the particular condition had not been updated to include the dietary changes and the evaluations contained entries such as care plan remains effective, which from review of other care plan evaluations appears to be a standard entry. The annual quality assurance self assessment completed by the manager identifies that three monthly reviews are held with people who use the service and their relatives to discuss care issues. It is important that people are involved in decisions about their care and there was evidence of the reviews being carried out on the care files. We spoke with someone who had requested some dietary changes and they Care Homes for Older People Page 14 of 31 Evidence: confirmed that the changes to their diet had been made indicating that peoples views are taken into account. We carried out a sample check of the management of medication on the first floor as this had been an area of concern at our last inspection. We found that there had been an overall improvement. Medication was appropriately stored, prescribed medication was available and stock levels not excessive. Medication is supplied in twenty eight day cycles and where medication is carried forward to the next cycle this was clearly recorded establishing an audit trail. This helps any discrepancies to be easily identified reducing the risk of errors and shortages of medication occurring. We saw that staff were having difficulty in accurately splitting a tablet where half a tablet was prescribed. We advised that if the pharmacist is unable to supply the medication in the prescribed dose, then they should seek advice from the pharmacist about a tablet splitter to ensure the correct dose can be given. The manager has identified in the annual quality assurance self assessment the need for training updates for staff in the management of medication which will help to ensure safe practices continue. People were observed to speak to and treat people with dignity and respect and those spoken with during the inspection and who responded in the surveys had no concerns about how they were treated by staff. Care Homes for Older People Page 15 of 31 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. Visitors are encouraged and welcomed into the home, people have different views about the activities and food provided, though most are generally satisfied. Evidence: Information received in surveys from people who use the service identified that one person feels that there are always activities to take part in and two said there usually was. One person said they enjoy the activities and dont want any more than they already have. Another said that due to their age they are difficult to take part in as they have difficulty concentrating. People we spoke with on the day of inspection had mixed views about the activities. Some felt they would like more, while others were either happy with what is provided or didnt want to take part anyway. Several people told the expert by experience that they would appreciate an occasional outing, some saying in the better weather. We noted that a Christmas shopping trip was advertised on the notice board and one of the people we spoke with was aware of this trip. Some people were happy that their families are able to take them out for such trips. The annual quality assurance self assessment identifies that plans for the future include raising money for a mini bus to Care Homes for Older People Page 16 of 31 Evidence: enable more outings to be provided. One person we spoke with told us they were quite lonely and said The door is always open but no one comes in to see me. People have a wide range of needs and interests and the comments indicate the need to look at how this range of needs and expectations can be best met. We spoke with the activity organiser who has been in post since August 2008 and recognises the need to divide her time between the two floors and group activities and some one to one time with people. Activities and stimulation appear from observations to be largely carried out by the one person, as care staff appear to be rushed in meeting peoples basic care and hygeine needs. The activities organiser told us that she has made contact with two churches in the area to try and arrange for some religious services to assist those people who can no longer go out to church. One person told us that a priest visits them and others that family take them out to church. People spoken with were satisfied with the arrangements in place to help support them with their faith. Visiting arrangements are flexible and people are made welcome, this was confirmed by people who use the service and a visitor. Several people spoke of the importance of visitors in their daily lives. The level of choice and control people have over their life varies. We identified at the last inspection that staff would benefit from training on the Mental Capacity Act 2005 to enable them to understand more fully their responsibilities for ensuring that residents rights are fully protected. Staff spoken with have not yet had this training, therfore given the importance of this, we are repeating this recommendation. Out of five surveys received from people who use the service, two people said they always like the food, two usually do and one sometimes. Similar responses were received by the expert by experience when they asked people about the food. A choice of menu is given, however someone told us that they make the choices tthe day before which may explain why some people told us they dont have a choice as not everyone will have been able to remember making the choices. Someone told us that their request for more salads had been listened to and staff confirmed that they try to act on individual requests and preferences. Two people told us that their meal is often cold. These were people on the nursing floor. We noted that a high number of people require assistance with their meals and the comments highlight the need to monitor staffing levels at meal times. Care Homes for Older People Page 17 of 31 Care Homes for Older People Page 18 of 31 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 taken seriously and are referred to other agencies for investigation where appropriate helping to safeguard people who use the service. Evidence: Comments received from people who use the service confirm that although some people cant remember the actual complaint procedure they have someone they feel comfortable with that they can raise any concerns with. Comments from staff confirm that they are sufficiently aware of complaint procedures to be able to guide people who use the service or their relatives in how to make a complaint. Records show that all staff received training in safeguarding vulnerable adults between May and September in 2008, this helps them to understand their responsibilities in relation to the people they care for. A sample check of the complaints records confirmed that complaints are taken seriously, investigated and where appropriate, concerns are referred to other agencies for investigation. For example allegations of abuse are referred to social services for investigation through safeguarding vulnerable adult procedures. Details of who to contact in the case of complaint are detailed in the statement of purpose. In addition to the home manager, contact details are given for senior Care Homes for Older People Page 19 of 31 Evidence: managers within Southern Cross. This is important for people who do not feel able to approach people in the care home directly. Complaints have been received about changes to the smoking policy which mean that people can no longer smoke on the premises. The manager advised that they have involved people who use the service, their relatives and Northamptonshire County Council in discussions and decisions about smoking arrangements. Care Homes for Older People Page 20 of 31 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A more pro-active approach to re-decoration, refurbishment and replacement of equipment is required to enable people to live in a pleasant and well maintained environment with appropriate equipment to meet their needs. Evidence: A sample of shared areas and peoples bedrooms on both floors were seen during the inspection. We were concerned at the last inspection about the condition of the environment in terms of cleanliness and the need for some refurbishment. It would appear that little has changed since that inspection. Review of the complaint record identifies that people have raised concerns about the need for some re-decoration, there is also a need for some replacement carpets, furnishings and equipment. This need is acknowledged within the annual quality assurance self assessment and also the operations managers monthly report. Staff have also told us in surveys that the equipment such as hoists and beds are old and not the best for the job. The new manager has identified and obtained quotes for the carpets and equipment that need replacing but at the time of inspection had not received authorisation to purchase them. Various other equipment has also been requested such as profile beds, dining chairs, lounge chairs, a dishwasher and a freezer. The annual quality assurance self assessment identifies that an extensive refurbishment and re-decoration schedule Care Homes for Older People Page 21 of 31 Evidence: is planned and that the gardens will be attended to and improvements will be made in standards of cleanliness and the management of odour. All five people who responded to the surveys were satisfied that the home is fresh and clean and it was positive to note that the majority of staff have received training in infection control. Care Homes for Older People Page 22 of 31 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. There is a caring staff team, however staffing levels and staff training need to be more firmly based on peoples needs to ensure their needs are met in a timely manner. Evidence: A health professional commented that staff appear to know the individual patients well and can communicate their individual needs. Another states that overall staff on the nursing floor are caring. Four out of five people who use the service told us in surveys that staff listen and act on what they say. One person commented staff always try to help. We received positive comments during the inspection about the staff team and observed staff to be caring in their approach to people. For example the expert by experience who accompanied us on the inspection observed a carer assisting someone with a drink and noted that the interaction was very good and that they were very patient and caring. One person commented that staff come most of the time when they are needed and another said that they are slightly understaffed. We also asked staff in the surveys if there were enough staff to meet peoples individual needs. Several comments were made about the inadequacy of staffing levels. One comment made indicates that staff mistakenly beleive that the Commission for Social Care Inspection (CSCI) set the staffing levels and state We are a high dependency floor and the levels set by CSCI Care Homes for Older People Page 23 of 31 Evidence: are totally innapropriate to allow quality of care of people. We raised concerns and made a requirement about the sufficiency of staff in relation to the needs of people at our inspection in December 2007. Care files contain individual dependency assessmnets, however there was no evidence of how this information linked to the calculation of staffing needs. Review of one dependency assessment identified that the person was considered to be medium dependency, however review of the care plans and risk assessments and discussion with staff identified that this person had significant care needs. The annual quality assurance self assessment submitted by the manager acknowledged the need to look at dependency levels in the home. We discussed the staffing issues with the manager who just came to Glenmoor House in August 2008. The manager confirmed that she had identified the need for more staff to meet the high dependency needs of people and has started by increasing the number of nurses to two in the mornings and some afternoons. The number of care staff is currently being reviewed but she beleives with the current dependency needs more care staff are needed on the nursing floor. The manager advised that she was due to meet with her line managers to discuss staffing requirements. There is clearly a need to demonstrate that the sufficiency of staff is being reviewed on a practical level through talking to people who use the service, relatives and staff and checking on a regular basis if peoples needs are being met. Surveys from three members of staff confirm that pre-employment checks such as criminal record bureau checks and references were carried out before they started work. A sample check of staff files confirmed that this was the case which is important in helping to safeguard people who use the service. Staff confirmed that they receive induction and one commented I work primarily on the nursing floor and find carers fully informed and nurses fantastic at this element of the job. They also confirmed that they have training needed to do their job, though one commented that they do not receive regional cooperation with training. Another felt that more specialised training in behaviours and side effects of medication would be helpful. Comments made in a survey from a health professional refer to a lack of encouragement for staff training. It refers to requests being made for training to help meet peoples specific health care needs and then poor attendance at the training with nutrition training being given as an example. Review of the staff training matrix identifies various shortfalls in training which includes training to meet peoples health Care Homes for Older People Page 24 of 31 Evidence: care needs which includes pressure area care and nutrition. A health professional made a comment that Glenmoor House have a better understanding of dementia care than some other homes in the area. It is stated that there is a good skill mix, with a mix of younger staff and those with life experience. They also noted that staff tend to stay at Glenmoor House which is really important in helping to provide consistent care. Training records show that the majority of staff have received dementia awareness training, however only three members of staff have received the more in depth dementia care training which took place in November 2007. This more in depth training would help staff build on existing skills for the benefit of people who use the service. Care Homes for Older People Page 25 of 31 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. Consistent management supported by the organisation will help to improve and maintain the quality of care for people who live at Glenmoor House. Evidence: Standard 31 has not been assessed as this specifically applies to a registered manager. However as the management of any service is key to residents well being, the arrangements have been taken into account as part of this inspection. A comment in a staff survey highlights the problem of the lack of consistency with several changes of manager. A health professional also identified the need for consistent management. It is too soon to comment on the ability of the current manager to drive and sustain improvements as she has only been working at Glenmoor House since August 2008. However discussion with the manager during the inspection indicated that she was Care Homes for Older People Page 26 of 31 Evidence: aware of her responsibilities in relation to the management of the home and of the actions required to make improvements. An application for registration will be required as part of the legislative requirements which place legal responsibilities on managers for the management of the home. An annual quality assurance self assessment was submitted to CSCI which had been completed by the current manager. This showed that the manager had identified areas where improvements need to be made and actions required. This acknowledgment is an important part of the quality assurance process. The organisation has audit systems in place to check specific aspects of the service provided and an operations manager from the organisation conducts monthly unannounced visits to review and report on the quality of care provided. In addition relative meetings are held every three months with weekly surgeries when people can arrange to see the the manager. Review of peoples care files also identified that opportunities were provided in the service user reviews to raise any issues or discuss areas where improvements to the care could be made. The staff training matrix identifies that training is provided in safe working practices such as movement and handling, fire safety, health and safety and infection control. Records do show that some staff require refresher training in areas such as movement and handling. It was of concern to note that records show that only one member of staff has received first aid training. Updated training is important in ensuring that staff have the necessary knowledge and skills to meet peoples needs and to deal with emergencies that may arise. We noted that although cleaning products are locked away when not in use, while staff are cleaning they use an open trolley to transport the various products. We were concerned about the vulnerability of people on the dementia unit and advised that consideration is given to having an enclosed trolley to reduce the risk. We gave advice at the last inspection about the need for signage where oxygen is stored and during this inspection found that the advice had been implemented. This helps people identify areas of risk in the event of an emergency. Care Homes for Older People Page 27 of 31 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 28 of 31 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 and care records must clearly identify peoples current needs and the care to be provided. This is to ensure peoples needs are fully met. 20/03/2009 2 19 23 A full review of the premises 26/03/2009 must be undertaken, and a plan for re-decoration, refurbishment and replacement of equipment developed with timescales for implementation. To enable people to live in a pleasant environment. 3 27 18 Staffing levels must be reviewed in relation to the dependency and monitored in consultation with people who use the service and sufficient staff provided to meet their needs. This is to ensure peoples needs are met. 24/04/2009 Care Homes for Older People Page 29 of 31 4 28 18 Staff must receive training appropriate to their role and the assessed needs of people who use the service. This is to ensure that they have the necessary knowledge and skills to fulfil their responsibilities and meet peoples needs. 24/04/2009 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 1 More information should be included within the statement of purpose about the range of needs that can be met and the type of care provided. This is to help people to decide if their needs and expectations can be met. The way care plans are evaluated should be reviewed and changes made to ensure that they can be effective working tools in supporting peoples care. Arrangements for the safety of cleaning products should be reviewed when staff are cleaning on the dementia unit. 2 7 3 38 Care Homes for Older People Page 30 of 31 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. 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