Inspection on 08/12/08 for Greenways

This inspection was carried out on 8th 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greenways 22/03/10

Greenways 24/11/09

Greenways 29/01/08

Greenways 02/08/07

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Greenways Marton Road Long Itchington Nr Southam Warwickshire CV47 9PZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sandra Wade     Date: 0 8 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. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 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 35 Information about the care home Name of care home: Address: Greenways Marton Road Long Itchington Nr Southam Warwickshire CV47 9PZ 01926633294 F/P01926633294 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Carole Mary Webb Type of registration: Number of places registered: Kirkley Limited care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The home is registered to provide care and accommodation for 27 service users over 65 for reasons of old age. Date of last inspection Brief description of the care home Greenways was originally a domestic dwelling and has been converted into a residential care home. It is situated in the quiet village of Long Itchington and can accommodate up to 27 elderly residents. The home offers personal care services only to people over the age of 65 years who are in the category of old age. The home is not registered to take residents in any other categories. Residents needing nursing care receive this from the visiting community nurses. Medical services are provided by local GPs. An extension of 6 bedrooms was completed in April 2003 and further works are imminent for the home to be extended further. There are local shops which are around a 15 minute walk from the home and there are public transport links to Leamington Care Homes for Older People Page 4 of 35 Over 65 27 0 Brief description of the care home Spa, Rugby and Southam within a five minute walk from the home. The bus stop being located by the village pond. There is a door into the home which has level access for wheelchairs and people with mobility problems. Accommodation for residents is provided over two floors, and all bedrooms are for single occupation, several of the rooms have ensuite facilities. There is a communal dining room and one large lounge with two small quiet areas in the home. There is one shower/wet room and four bathrooms with assisted facilities such as bath chairs to support people into the bath. There is currently a large garden with a grassed area where residents can sit in fine weather. The home is set back off the main road through the village. There is parking to both the front of the home and in a car park which is accessed down the side of the garden area. The owners are involved in running the home and there is a full time manager and a team of carers and ancillary staff. At the time of this inspection the fees for the home were up to £475.00. The manager confirmed these are published in the Service User Guide. Extra charges are made for hairdressing and chiropody. Care Homes for Older People Page 5 of 35 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 focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The last key inspection took place on 29 January 2008. This inspection took place between 8.20am and 7.10pm. For the purposes of this report, people who use the service are referred to as residents. Care Homes for Older People Page 6 of 35 This was agreed with the manager following consultation with the people who use the service. A completed Annual Quality Assurance Assessment was received from the service prior to the inspection detailing information about the care and services provided. Information contained within this has been included within this report where appropriate. Quality satisfaction surveys were sent out to ten people who use the service to obtain their views on the care and service they receive, six were returned. Discussions were held with staff and residents during the period of the inspection. Two people who were staying at the home were case tracked. The case tracking process involves establishing an individuals experience of staying at the home, meeting or observing them, discussing their care with staff and relatives where possible, looking at their care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Records examined during this inspection, in addition to care records, included staff training records, staff duty rotas, kitchen records, accident records, financial records, complaint records and medication records. Residents were observed in the lounge to ascertain what daily life in the home is like. A tour of the home was undertaken to view specific areas and establish the layout and decor of the home. What the care home does well: What has improved since the last inspection? The kitchen has been reorganised to make more space for staff to work with new equipment and decoration to allow catering staff to work more effectively. Door wedges have been removed and door closure devices fitted which release in the event of a fire to improve the health and safety of the home. Some of the bedrooms have been redecorated and there have been two new ensuites created. The previous clutter around the home has been removed making the surroundings more homely and pleasant for the residents. Carpets are much cleaner following the purchase of a carpet cleaner and the threadbare areas identified at the last inspection have been replaced improving the environment. Staff work routines have been reviewed with the implementation of a new support worker role allowing care staff to focus more of their time to caring for residents. Care Homes for Older People Page 8 of 35 Extensive maintenance and repair has been carried out to the pipework and radiators throughout the home to ensure the water and heating services are maintained appropriately for the residents. Good systems for monitoring the quality of care and services have been devised with the majority of responses being very positive about the home. 91 per cent of relatives indicated that overall they were satisfied with the homes performance and 94 per cent indicated that they felt this was a happy home. A professional visitor stated quite good approach to equality and diversity and another stated residents always very well dressed and clean and welcoming atmosphere. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get Care Homes for Older People Page 9 of 35 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 35 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. Detailed information about the home is available to ensure residents can make informed decisions on whether to stay. Prospective residents are assessed prior to their admission to ensure their needs can be met. Evidence: There is a detailed Service User Guide in place which has been updated since the last inspection. This gives information about the care and services provided to enable prospective residents to make a choice on whether to access the service. Three care files were viewed including files for people who have more recently accessed the service. It was evident that full assessments of their needs had been undertaken by the manager prior to their admission to the home. Care plans had been devised using Care Homes for Older People Page 12 of 35 Evidence: this information so that staff knew how to meet their needs. Care Homes for Older People Page 13 of 35 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. Residents have plans of care in place but gaps in recording mean they cannot be confident that their needs will be met consistently or promptly. Evidence: Residents looked well kempt and well cared for and all those spoken to were positive about the care and support they receive. One person said the home was very good, they look after you and they leave you alone to do what you want. Another resident said all good here, nothing to complain about, very good. Although each person who uses the service had a plan of care in place, these were found to be insufficiently detailed to show the staff support required and being given. It was therefore difficult to be sure that the needs of the residents are being met consistently or promptly when identified. For example, the daily records for 16 November 2008 for one resident stated that staff had noted a sore area on their hip. It was not evident from records that that a request Care Homes for Older People Page 14 of 35 Evidence: was made for the district nurse to see this until 3 December 2008. There was no care plan in place for the management of this in this residents file. It was therefore not clear if staff were monitoring this or providing any treatment. When the district nurse visited on 3.12.08, she also noted the resident had sore heels and gave instructions for staff to continue to cream these which would suggest this advice had previously been given. It was not clear from records that this previously was being done. The resident said that their sore area was very sore and that they could only lie on one side. It was not clear from records that this was the case to ensure staff did not lie them on the side with the sore. The resident did however say that staff knew this and did put them on the side not affected by the sore. It was evident that a new specialist mattress was in place to help provide some pressure relief for the resident and to help prevent further deterioration of the sore. The GP visit sheet showed that on 17 November 2008 a second resident also had sore heels and the district nurse had visited to apply dressings. Again there was no care plan in place showing how this was to be managed or monitored by staff. The daily records of 17 November 2008 also made no reference to staff having identified the sore heels. A nutritional assessment for this resident had been completed in June 08 but this did not state whether the persons appetite was good, fair or poor. It did identify that the person had problems with swallowing and needed help with eating. The dietary plan contradicted this by stating no assistance/aids required for eating and drinking. On speaking to the resident they said that staff managed their diet very well and they had no concerns regarding how staff were managing this. The daily records for one resident showed that they suffered from periods of confusion, were challenging towards staff and would wander around the home at night. Although the doctor had been contacted in regards to this, there was no care plan in place stating how staff should manage this behaviour. The policy on Aggression for the home also was not clear on actions staff should take when dealing with residents who may display challenging behaviour. Risks associated with the care of each resident were listed on the same sheet making it difficult for staff to review and amend these as changes in the condition of the residents occur. Assessments were not person centred. For example the risk assessment for falls did not identify how many falls the person had sustained, any medical conditions that could impact on them falling, specific equipment that should be used to help prevent this. There were no instructions for staff to support or observe residents concerned within the risk assessment. Actions for each falls risk assessment Care Homes for Older People Page 15 of 35 Evidence: viewed were the same and included items such as ensure bedroom is clear from clutter, ensure call bell is within reach. Although these actions are important, each person should be considered individually to assess specific risks in relation to them. It was not clear risk assessments were being reviewed when changes occurred. A risk assessment for falls for one person was dated 10 June 2008, the accident book showed this person had fallen in November 08 but it was not evident the risk assessment had been revisited for review to ensure the actions listed remained appropriate. Records viewed showed that residents were accessing specialist services such as chiropody, opticians and specialist medical appointments. A review of medication was undertaken, this was found to be well managed with records being accurate in terms of medication received, remaining and given. The only exception was the Ibuprofen for one resident which showed there were three tablets missing when calculating those given and remaining. There was also one record where it was not clear how many tablets were available at the start of the medication period so that the medication could be effectively audited. The storage of controlled drugs was found to be sufficient and a separate record of controlled drugs given was in place and had been accurately completed. The privacy and dignity of the residents was respected throughout the inspection. The only exceptilon was that one resident was responded to inappropriately, this was discussed with the manager who agreed to address this. Care Homes for Older People Page 16 of 35 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. Some social activities are being provided to satisfy the social interests of residents. Meals are provided which residents enjoy although it is not clear these are always varied or that the timings of meals and drinks are in accordance with resident choices. Evidence: Social activities are provided by care staff when possible. Staff said that if they are not too busy they will ask residents what they would like to do. They confirmed that sometimes they do musical bingo which the residents like, or dominoes. They said that social activities are not provided every day. There had been some actions taken to develop and implement activity schedules but it was not evident these have been followed consistently. On the day of inspection there was a bean bag floor game in the lounge which staff said the residents enjoyed. The manager advised that they had bought a large countdown game recently and the provision of social activities was an area they were hoping to improve. During the inspection residents were noted to chat amongst themselves and read the daily newspapers. One person went around the lounge and dining areas helping to tidy up. The atmosphere was a happy one with occasional bouts of laughter and residents Care Homes for Older People Page 17 of 35 Evidence: were observed to be at ease to make requests of staff. The home receives regular visits from the church and Holy Communion is organised for those residents who request this. Documentation in the care files confirms each residents wishes in regards to this support. The lounge area has two large screen televisions, one at either end for residents to watch if they choose. One person said they were quite happy just to watch television and receive visits from their family. Comment cards received by us from residents show that two out of six people feel there are always social activities they can take part in and four feel there usually are. One person has commented I am still able to fill my day in activities carried out on my own, however if I wish to join any home activity I am always welcomed. There were various pressure cushions, blankets and little tables around the lounge to ensure residents were comfortable and there was a large Christmas Tree in the corner. There was a period of time during the morning where a discussion took place amongst the residents about which chair belonged to who as some people were considered to be sitting in the wrong chairs. This resulted in some residents swapping seats to make sure all residents were happy. All residents spoken to said they were happy with the food. One person said it took some getting used to at first but they were ok with it now. Comment cards received by us show that three people always like the meals at the home and three people usually do. On the day of inspection the meal was fish either plain or breaded with tartare or parsley sauce with vegetables followed by jam sponge and custard. Residents spoken to said they enjoyed their meal. At teatime staff were seen to prepare tomato soup with a selection of sandwiches including cheese, cheese and coleslaw and ham and tomato. The manager said that they had made hot choices available at tea time but the residents had not wanted them so they tended to provide soup and sandwiches each day. She said this was their choice. The records in regards to meals the residents had eaten had not been completed consistently to demonstrate a nutritious diet is being provided at all times. During the morning one resident was seen to be sitting in the lounge area for some time waiting for their breakfast. They complained to the resident sitting beside them that they were still waiting. This person was given some porridge at 9.44am and Care Homes for Older People Page 18 of 35 Evidence: when they had finished this was then given toast at 10.05am. Another resident who also had been sitting in the lounge area for some time was not given porridge until 10.19pm. As these residents had been up for some time, this is a long time for them to wait for breakfast. It was also observed that as the morning progressed, residents wanted a mid morning drink. One person said they were going to get up and go to a member of staff to ask for a drink. The member of staff said she would be there in a minute and drinks were eventually served at 11.20am. As some residents had been up early this was a long time for them to wait for another drink. The manager said that drinks are usually served earlier than this but she felt staff were conscious of the inspection process and this had had impacted on their timings. During the last inspection this same issue was noted with residents wanting drinks earlier than provided. This matter should be followed up accordingly. Menus viewed showed one choice of main meal but there was a note on the bottom of the menu saying an alternative could be prepared if people didnt like it. The menus did not show what is served for breakfast or tea. On the day of inspection it was observed that residents had cereal, toast and cooked items of their choice. The manager agreed to reproduce menus showing the full choices of menus and drinks available so that residents are clear what choices are available to them. This also helps to demonstrate that varied meals are being provided consistently. Since the last inspection the kitchen area has been improved by moving out the fridges and freezers into a room off the kitchen to create more space. New worktops have been fitted and the walls painted. Care Homes for Older People Page 19 of 35 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. Procedures for managing complaints and abuse are in place but records are not fully clear in demonstrating these are being followed to promote the safety of the residents. Evidence: There is a complaints procedure in place and this has been updated since the last inspection to show all appropriate contacts, telephone numbers and addresses. We have not received any complaints since the last inspection and the home has only received one concern. This had been in relation to the behaviour of one resident towards another resident. The manager had made contact with the relative to discuss this and had taken action to ensure this was recorded in a diary and monitored. The appropriate form for recording concerns and complaints had not been fully completed in accordance with the homes procedure. The manager agreed to do this. Since the last inspection action has been taken to implement policies and procedures in regards to the management of aggression, staff whistleblowing and management of abuse. Since the last inspection there has been one incident whereby a member of night staff was accused of hitting a resident. This was investigated as appropriate and the member of staff concerned no longer works at the home. It was not evident that all staff have completed training on abuse. Staff spoken to who had not done this training said that if they should observe this they would report it to Care Homes for Older People Page 20 of 35 Evidence: the manager and knew it also had to be reported to us. Care Homes for Older People Page 21 of 35 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 is pleasant, comfortable and homely and is subject to ongoing refurbishment to improve the facilities and environment for the residents. Evidence: Greenways has plans to extend the home to accommodate an additional seven bedrooms with ensuite facilities. It is also planned to fit a disabled toilet and change the configuration of the dining area. The provider explained that there have been ongoing problems associated with the plans which have prevented this work going ahead but they were hopeful they would soon be resolved. There have been ongoing improvements made to the garden area and staff reported residents use the garden frequently in finer weather. There is a comfortable lounge and dining area with varied seating which is well utilised by the residents. Accommodation for residents is provided over two floors and there is level access within the home for wheelchair access. Bedrooms seen had been personalised with residents own possessions and were clean, tidy and homely. Since the last inspection cluttered areas have been cleared and the threadbare carpet replaced making the appearance of the home more pleasant and homely for the residents. The only exception was one small threadbare area of carpet outside the Care Homes for Older People Page 22 of 35 Evidence: laundry which the manager said she was aware of and would be addressed. There is one shower wet room and four bathrooms which have bath chairs to assist people into the bath and there are 8 communal toilets situated around the home. Handrails are available to aid mobility and there are wheelchairs and hoists to support the care needs of the residents. Upstairs there is a wooden ramp which is used in front of a step in the corridor. Due to the wooden surface and steepness of this, it could present a slip or fall hazard to the residents. There is also no handrail present in this area. The manager confirmed there was no risk assessment in place for the use of this and advised she would complete one and take any actions necessary to ensure residents were safe. Since the last inspection a new staff room has been developed on the first floor so that staff do not need to use the area off the kitchen. The kitchen was viewed and has been improved since the last inspection with additional work surfaces and space to allow staff to work more effectively. There were no unpleasant odours noted during the inspection. Comment cards from residents show that all six residents that replied feel the home is always fresh and clean. The laundry area was viewed. This has three washing machines and two driers to support the laundry needs of the home. Sufficient systems were in place for the collection and management of the laundry. This included the use of red bags for the collection of heavily soiled items. A handwash sink was available in the laundry for staff to wash their hands and there were disposable aprons and gloves also available for staff to maintain good hygiene practices. No concerns were raised by residents regarding the management of their laundry during the inspection. Care Homes for Older People Page 23 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents feel their needs are met by the numbers of staff on duty but not all staff are receiving the training required to ensure they are competent to manage residents effectively. Recruitment systems are generally well managed but records do not always show that procedures are being followed to ensure staff are deemed safe and suitable to care for the residents. Evidence: On the day of inspection there were 25 residents within the home. The manager confirmed that she aims to have three or four carers on the early shift, three carers on the late shift and two waking carers on the night shift. There are also specific staff to undertake laundry, cleaning and catering duties. Since the last inspection the manager has introduced a member of staff known as a Gordon. This person is listed on the duty rota as a support worker. The manager said this person does the laundry, helps feed residents, makes beds and completes some cleaning. Both the staff and the manager said this had made a big difference to how the home operates with carers having more time to dedicate to the residents. Duty rotas for the home show that there are three carers on duty during the morning plus the support worker. The support worker sometimes works six days a week and Care Homes for Older People Page 24 of 35 Evidence: sometimes seven days a week. In addition to this the manager works full time in a supernumerary capacity. There is a person dedicated to do the cooking seven days per week with the help of a kitchen assistant six days per week. This would inevitably mean the care staff would pick up on the kitchen assistant duties on the other day. Staff spoken to acknowledged that they noticed the difference when there was no kitchen assistant on duty. There is no cleaner cover indicated at the weekends which again would mean care staff would need to undertake any emergency cleaning. Throughout the inspection staff were noted to be busy with their duties, there was in particular limited time for them to spend with residents in the lounges during the morning. Residents were observed to wait for staff to walk by to make requests of them but their requests were always carried out by staff as soon as they could. In the afternoon some of the staff were able to spend time with the residents doing social activities. Comment cards received by us from six residents show that they all felt staff listened and acted upon what they say. Five always felt staff were available when they needed them and one person felt they usually were. Residents spoken to during the inspection were positive in their comments about the staff. One stated the staff are very good. Another said staff are friendly and helpful. One person said that if they use the call bell it usually takes a couple of minutes but the staff always come. Thank you cards retained by the home contained such comments as I would like to thank all the staff for the care and kindness they have shown X over the last 2 years and especially over past few days. A letter from a professional visitor stated I would like to thank you and your staff for the help and co-operation shown to our clinical team which enabled the day to run smoothly. It was established that there are only two senior carers employed by the home which means there are times when there is no senior carer on duty to ensure the home continues to be managed effectively. The manager acknowledged this and said this was something that was being reviewed. The list of staff provided by the manager shows there are 14 carers employed. Of these she confirmed that seven have completed a National Vocational Qualification (NVQ) II in Care which means the home are achieving the standard for 50 of staff to complete this. This training helps staff to provide more effective care to the residents. Care Homes for Older People Page 25 of 35 Evidence: Staff files were viewed for three people to confirm the recruitment practices carried out. Two out of the three had two written references as required. One only had one reference on their file. The start date for one person was not clear from records in place to check that the Criminal Records Bureau (CRB) check had been obtained before they had started. Criminal Record Bureau checks had been obtained for all staff to ensure staff were deemed safe to work with the residents. It was not clear from records that all new staff had completed induction training. It was not evident from those records that were in place that the training was being undertaken in line with the Skills for Care Common Induction Standards. This training is completed in modules over a number of weeks to ensure staff build up their competences to care for residents safely and effectively. Some of the induction records that were in place had not been signed off by the manager to confirm that they had been assessed as competent in regards to the training they had completed. The training records were not fully up-to-date to be able to confirm all staff have completed statutory training as required. This includes food hygiene, first aid, moving and handling and fire training. Dates for training to be updated or completed were not available. The manager said these were to be confirmed by the training organisation. The manager advised that five staff had completed training in health and safety and seven had completed training in infection control. She also advised that new records had been developed for recording training but these now needed to be completed. Care Homes for Older People Page 26 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is of good character and is suitably trained to manage the home. Quality monitoring systems are in place in regard to care and services provided but there are gaps in health and safety management which could impact on the safety of the residents. Evidence: The manager has worked in the home for approximately 11 years and therefore has extensive experience of working with older people. The manager also has attained a National Vocational Qualification (NVQ) IV in Care and the Registered Managers Award (RMA) so is suitably qualified to manage the home. Since the last inspection the manager has continued with training incorporating Food Safety in Catering and Fire Safety. On the day of inspection both the manager and provider were available in the home. It was evident that the manager and provider have taken actions since the last Care Homes for Older People Page 27 of 35 Evidence: inspection to address the requirements and recommendations made to improve the quality of service and care being provided. Discussions with the manager and provider confirmed there continues to be a strong commitment to ongoing improvements to raise standards further within the home. It was evident that the manager shares a good rapport with the residents and has a caring approach when talking with them or carrying out their requests. Since the last inspection a quality monitoring system has been introduced. Questionnaires had been forwarded to residents and relatives asking questions about the care and services provided. Questions to residents included If you need help in washing and bathing, how well is this given and Do the staff answer the nurse call system as quickly as can reasonably be expected. Residents were asked to score answers from one to ten with ten being the highest score of satisfaction. Outcome scores ranged from 83 to 100 satisfaction to 16 questions asked. The provider had published the outcome results and had identified areas for improvement which included the garden. Overall the scores indicated that residents were satisfied with the care and services provided. The areas that relatives scored slightly lower were the physical environment, parking and the provision of social activities for the residents. 91 per cent of relatives indicated that overall they were satisfied with the homes performance and 94 per cent indicated that they felt this was a happy home. A GP who had completed a questionnaire for the home gave positive responses as follows The quality of homes personal and social care is very good, Health care provision is very good, Freedom of movement and choice for residents is very good, Never had concerns on how residents looked after, Manager always gets things done when asked, Staff always polite and helpful, The GP had indicated happily put my parents there. Another professional visitor stated Quite good approach to equality and diversity and another stated residents always very well dressed and clean and welcome atmosphere. The provider confirmed that the proposed extension works to the home continue to be delayed due to unforeseen problems with the planning proposals. The provider did Care Homes for Older People Page 28 of 35 Evidence: however confirm it is still planned for these to go ahead which will significantly improve the environment for the residents. Since the last inspection it was evident a staff meeting had been arranged in March 08 and a resident meeting in October 08. The notes of the residents meeting stated that discussions had taken place about having a shop, whether to have fireworks and arrangements for the Christmas party. Residents had also been asked to name the homes four new goldfish. A review of service user monies and personal allowance records was undertaken to confirm these were being managed by the home appropriately. All records checked were found to be accurate in accordance with the funds available. Receipts for any transactions carried out were in place as required. It was found that some resident medication records were being stored in an open area on the first floor which means confidentiality could be breached. Any records relating to residents are required to be stored securely in the home. Health and safety records were viewed to confirm checks carried out. Electrical Portable Appliances contained stickers stating they had been checked in March 2008. Hoists and slings had been recently checked and the Legionella water check had been done in April 08. Records showed that there was some work required in regards to the lift which was last checked in April 08. It was not clear this work had been completed. Hot water temperature records were requested for resident rooms and communal areas to confirm these are being maintained at safe levels. These could not be provided to demonstrate they are regularly monitored to comply with recommended temperatures. One tap was found to be too hot but others tested were found to be comfortably warm. It was evident that the home were no longer using door wedges which do not meet with fire precautions and where needed door retainers had been fitted which release in the event of a fire. The manager confirmed risk assessments are now in place in regards to the use of window restrictors. The wooden ramp in front of a step on the first floor could present a slip of fall hazard to the residents. This is due to the wooden surface and steepness of this. There is also no handrail present. The manager confirmed there was no risk assessment in place for the use of this and advised she would complete one and take any actions necessary to ensure residents were safe. There were some areas identified for action in the kitchen. Fridge and freezer Care Homes for Older People Page 29 of 35 Evidence: temperatures had not been monitored and recorded since the beginning of November to ensure the food within them is stored at the appropriate temperatures. The microwave was found to be food stained and in need of cleaning. The cupboard where the glasses are stored is paint scuffed and therefore not appropriately sealed to maintain good cleanliness. Care Homes for Older People Page 30 of 35 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 13(4) Risk assessments must be reviewed when care needs change to show how risks to the resident are to be managed safely. This includes risks of developing pressure sores. 31/01/2009 2 8 13(1) Specialist support such as 31/01/2009 the advice of GPs/District Nurses must be sought promptly to ensure resident health care needs are managed effectively. Records are to demonstrate any specialist support sought and given. Care Homes for Older People Page 31 of 35 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 16 A further review of care 28/02/2009 plans is to be undertaken to ensure all resident needs are clearly documented as well as details of staff actions required to meet these needs and the care being provided. This is to demonstrate that residents are receiving the care and support they need consistently. 2 7 12 Risk assessments must be 31/01/2009 person centred and show that all risks have been considered with appropriate actions to help manage these. These also need to be reviewed as when care needs change. This is so that the care of residents can be managed appropriately and safely by staff. Care Homes for Older People Page 32 of 35 3 27 18 Sufficient numbers of senior staff need to be available at all times. This is to ensure the home can be managed effectively at all times. 13/03/2009 4 30 18 Staff must complete 19/03/2009 statutory training within the required timescales. Records need to demonstrate this is happening. This is to ensure staff are suitably trained to care for residents safely and appropriately. 5 38 13 A risk assessment is to be completed in regards to the use of the wooden ramp on the first floor. Actions need to be taken to ensure residents have safe access within this area at all times. This is to ensure residents can mobilise around the home safely. 12/02/2009 6 38 13 All kitchen equipment must 31/01/2009 be maintained in a clean condition consistently. This is to ensure there is no cross contamination of food for the residents which could impact on their health. 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 15 It is advised that menus make clear all choices of meals Page 33 of 35 Care Homes for Older People and drinks available to residents so they know what is available to them on a daily basis. 2 15 It is advised that the timings of drinks and breakfast served to residents who sit in the lounge is reviewed to ensure they are receiving these at times when they wish. Any concerns or complaints received need to be clearly documented with actions taken to address or resolve these. This is to demonstrate complaints are being managed effectively to safeguard residents. It is advised that all staff complete training in abuse to ensure they are up-to-date with procedures in order to safeguard residents. Some consideration should be given to reviewing the availability of kitchen assistants and cleaning staff so there is a consistent service and these duties do not impact on care staff time. All recruitment checks need to be completed prior to staff being employed by the home. This includes clear information on start dates and the receipt of two written references so that it is clear staff are deemed safe and suitable to work with residents at the home. Staff induction training should be reviewed to ensure staff work to the Skills for Care Common Induction Standards. Records should demonstrate that staff are competent in training modules completed relating to these standards. All records relating to residents must be kept locked in a secure location to prevent any breach of resident confidentiality. Fridge and freezer temperatures need to be monitored each day. This is to ensure food is being stored at appropriate levels and is safe for resident consumption. It is advised that appropriate actions are taken in regards to addressing the maintenance work to the lift to ensure this continues to be fully operational and safe to use. It is advised that regular checks are carried out and recorded of all hot water outlets in resident and communal areas. These should not exceed 43 degrees centigrade to protect residents from scald risks. 3 16 4 18 5 27 6 29 7 30 8 37 9 38 10 38 11 38 Care Homes for Older People Page 34 of 35 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. 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