Inspection on 03/07/08 for Harrias House

This inspection was carried out on 3rd July 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

Harrias House 04/07/07

Harrias House 02/02/07

Harrias House 17/02/06

Harrias House 07/11/05

Harrias House 29/03/05

Harrias House 06/12/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 27/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Harrias House Hedgerley Lane Beaconsfield Bucks HP9 2SD     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:     Date: 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 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Harrias House Hedgerley Lane Beaconsfield Bucks HP9 2SD 01494674204 Telephone number: Fax number: Email address: Provider web address: manager@harriashouse.co.uk Name of registered provider(s): Name of registered manager (if applicable): Beaconsfield Housing Society Limited The registered provider is responsible for running the service Name of registered manager (if applicable) Elinasi Bailey Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Harrias House provides care for 17 service users. It is situated on the edge of Old Beaconsfield and is an elegant building with extensive, and well-maintained grounds. It provides a welcoming and homely residence for the older person. Each bedroom is spacious and can be personalised by the occupant. The home requires potential service users to be mobile and personal bathing is undertaken by a visiting qualified carer who visits the home on a weekly basis. The Beaconsfield Housing Trust, which manages the home, has an active board of trustees who take an interest in the home. There is an experienced care team. Fees range from £452 to £579 per week. Care Homes for Older People Page 4 of 31 Over 65 17 0 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. This unannounced key inspection was conducted over the course of a day and covered all the key National Minimum Standards for older people. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion. Information received by the Commission since the last inspection was also taken into account and surveys were sent to people who use the service. The inspection officer was Barbara Mulligan. The registered manager is Elinasi Bailey Care Homes for Older People Page 6 of 31 The inspection consisted of discussion with the registered manager and other staff, opportunities to meet with some people who use the service, examination of some of the home’s required records, observation of practice and a tour of the premises. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. As part of its equalities and diversity work the Commission has established an external stakeholder group made up of people who use services. This group is known as the Experts by Experience Equalities and Diversity Group. On the day of the visit the inspector was joined by an expert by experience, who was asked to join residents for a lunch time meal, menu choice, look at the range of activities available in the home and seek the views of people using the service. Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection, by the CSCI Inspector and the expert by experience. The manager, staff and service users are thanked for their co-peration and hospitality during this unannounced visit. What the care home does well: What has improved since the last inspection? What they could do better: Care plans must set out in detail the action which needs to be taken by care staff and imust be kept under review. Staff must adhere to procedures for the safe administration of medicines. In addition to this it is recommneded that staff update their medication administration training. People who use the service must be enabled to engage in suitable local, social and community activities both inside and outside the home. Facilities for recreation need to be improved. An alternative choice of meal should be prominently displayed on the menu. The home must obtain a copy of the local authorities safeguarding procedure. Once this has been recieved, the home must ammend their own policy and procedure to Care Homes for Older People Page 8 of 31 reflect the local authority safeguarding procedures. Some consideration should be given to making the garden more accesssible to people who have mobility difficulties. All staff should receive up to date mandatory health and safety training. This should include fire training, basic food hygiene training, first aid, infection control and moving and handling training. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Potential service users receive a thorough needs assessment undertaken by staff trained to do so ensuring that the home can meet all the care needs requirements of service users. Evidence: The care of three people who use the service was case tracked, including those most newly admitted to the home. Three completed needs assessments were examined. The home uses their own assessment tool. This includes personal information, past medical history, mental state, history of falls, diet and allergies, medication needs, general health, social care needs and relationships, personal safety and risk. Files examined present good examples of detailed needs assessments. They evidence that people had been visited at home or in hospital prior to their move to the home. These are fully completed and provided sufficient details of the type of support each person requires. All assessments seen are signed and dated. Service users spoken with during the Care Homes for Older People Page 11 of 31 Evidence: inspection confirmed that they had opportunity to visit the home before moving in and were supplied with enough information to help them make a decision about moving in. Encouragement has been given to personalising bedrooms to help people settle in. The assessment documentation demonstrates that prospective service users, family members or representatives are included in the assessment process if this is appropriate. The home does not offer intermediate care. 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. Care plans are in place for each service user, however these need to include further detail in the action plan to ensure that residents needs are identified and can be met by staff. Healthcare support for people who use the service is good, delivered in a manner that maintains the privacy and dignity of residents and ensures their health and well-being is promoted and protected. Medication policies and procedures are clear but there is no consistent implementation of the policies, that could result in unsafe working practices. Evidence: The care of three people using the service was case tracked and their care plans were examined. The home uses the Standex system for care planning and each one looked at contains identified areas for support. However these lack specific details about how to meet these areas of need. Some examples seen in the care plans include assisted bathing and flaky skin on legs, advised to use creams and can become restless and pace up and down the stairs and corridors. These are vague statements and do not Care Homes for Older People Page 13 of 31 Evidence: detail the action that staff need to take. In one care plan under the section skin integrity the resident is assessed as poor; prone to skin tears. However there was no risk assessment on file regarding tissue viability or guidelines for staff to follow. One file looked at states that the individual is allergic to wasps. However there is no further details informing staff what action to take if the individual is stung by a wasp. This is a serious lack of information and could potentially place the individual at risk. In one file examined the daily notes record that the person using the service is receiving regular baths. However, in this persons care plan under personal cleansing there are only guidelines available to staff for prompting to wash. There is no information about bathing and the support required for this task. Some care plans show evidence of review but others do not. There is little evidence in the three care plans looked at that these are drawn up with the involvement of the person using the service. A requirement is issued for improvement in this area. The daily notes entries are signed and dated but numerous entries lack detail. Many examples state, Mrs X fine today or Mr X had a good day or Mr X had a good morning. These lack detail and do not make other staff aware of how the individual has spent their time, what their mood was like and any other information that may be relevant to the individual and informs the staff how they have spent their day. It is recommended that the daily notes contain more detail to give a full account of how the individual has spent their day. Risk assessments were seen to be in place for bathing, walking off the premises, self administration of medicines and using the stairs. Records show that people who use the service receive prompt attention to their health care needs. Most residents of Harrias House are registered with two local GP Practices. They can register with their own GP if this is practical and agreeable to both parties. All have access to local NHS Services. The home does not admit people who are not independently mobile, however they have recently decided that when people develop mobility difficulties whilst living in the home, the individual can now continue to stay in the home. A moving and handling assessment was seen in files for each person who requires assistance from staff with their mobility. On the day of the inspection the expert by experience noted, At 11.30 a physiotherapist arrived for her weekly session. Eight residents and two care assistants assembled in the large lounge in upright armchairs to take part in the half hour programme. The exercises were quite challenging and included walking up and down the corridor. A handrail had recently been fitted to help residents’ mobility. Since it is a requirement of the home that residents are independently mobile I thought that a higher number would have joined the class. On enquiring of the staff I was told that “they have free choice and choose not to come. These classes take place on a weekly basis and it is pleasing to note that Care Homes for Older People Page 14 of 31 Evidence: these are facilitate by a qualified physiotherapist. A domiciliary optical service visits the home on an annual basis. If additional appointments are needed the resident needs to attend privately. Referrals for a hearing test go through the service users G.P. Weight monitoring was observed in the care plans and this is generally undertaken monthly. Chiropody services visit the home on a six weekly basis and dental services are accessed privately on a needs only basis. The district nurse advices about continence and tissue viability. The systems for administering medicines were discussed and examined. The home uses a monitored dosage system and records were looked at for this. These are fully completed and show no omissions. Following the previous inspection a requirement was issued for all medicines to be transported via an appropriate lockable trolley. It is pleasing to see that this has been complied with. The home uses a local chemist to supply and deliver the homes medicines. There were no out of date medications held in the home and there is a returns procedure in place. There are no controlled drugs in use at the time of the visit. During the lunch time meal the expert by experience noted that the person she had joined for lunch had not taken her tablets. When reminded about them the resident replied, Oh, I put them in my bag and have them later with orange juice in my room. Its much nicer that way. It is unsure how staff know that she has taken her tablets, although the Medication Administration Records are signed by staff to say she has taken them. This is not in line with the organisations medication procedure and is an unsafe practice which needs to be addressed to ensure the safety of the resident is maintained. Training records show that staff have undertaken medication training. However, much of this is outdated and several staff undertook this in 2005. It is important that staff expected to administer medicines regularly update their knowledge and competence in this area and this is recommended. Preferred terms of address are identified at the initial assessment and the inspector saw evidence of this in care plans. People spoken to on the day of the inspection said that staff were courteous and respectful and always willing to help. All bedrooms at the home are single therefore there are no issues with privacy whilst personal care is delivered. 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. Systems in the home ensure that where appropriate service users are supported to exercise choice and control over their lives. However the opportunities for stimulation through leisure and recreational activities in and out of the home needs to be expanded upon. The presentation and standard of food is good and meets the nutritional needs of service users, however the menu would benefit from an alternative choice of meal. Evidence: The routines in the home are flexible and residents confirmed that they had a choice as to when they get up and when they go to bed. People spoken to on the day said that relatives and friends are welcome at any time. The expert by experience was asked to specifically look at the standard of food and choices available and the activities provided for people who use the service and their accessibility. She noted, I enquired of some residents about the activities provided for them. There was a notice indicating activities on Wednesdays and Fridays. These seemed to consist of colouring in things and playing some sort of scrabble. The equipment was on a trolley in the room. In addition to this there is a store cupboard where equipmewnt is stored. The expert by experience was informed that Friends of Harrias House sometimes took Care Homes for Older People Page 16 of 31 Evidence: residents to a garden centre. This would be a small group as they went in a car. A care staff said: Occasionally we take them out to a garden centre. Another resident said:I had to go to hospital last week, it was so interesting watching the world go by. The expert by experience observed, during my visit of four hours no visitors arrived to visit the residents. The inspector has since been informed that this was because relatives are aware that on a Thursday the hairdresser visits and there is an execise class. New staff did come in and briefly greeted a resident but then became involved with talking with other staff members. It was clearly a routine that after lunch most service users dispersed to their rooms, probably very naturally for a rest. This was probably what they might have done in their own home, but I felt that in general there had been very little stimulation. There did not seem to be much of an activity offered to the residents in the course of the day, let alone in the course of a week. In conclusion, people using this service did on the whole seem contented with their placement in what was their home. However there was very little daily stimulation, conversation or interaction between staff and service users. This assessment was discussed with the registered manager who said that this is an area that she has already identified needs further development. A requirement has been issued for improvement in this area. Examples of involvement in the home by local community groups and individuals are visits by a mobile hairdressers, a visiting library service and a monthly church service. Family and friends are invited to participate in some of the social event organised. Residents and/or their families are encouraged to look after their own financial affairs whenever possible. Details of how to contact the local advocacy service were prominently displayed in the hall. An invitation to bring in personal items of furniture and other belongings is included in the service users guide and this was evident during a tour of the premises. The expert by experience was invited to join a resident at her table for lunch. The dining room was pleasantly arranged with tables for one, two or six reflecting the service users choice. I had noted the menu nicely written out on the wall in the hall but not in a very accessible position. There was no evidence posted of a menu choice. In that the chef was very friendly, and that there were only seventeen residents, it is likely that the chef would know the requirements of the service users. One care staff served everyone in turn. This meant that some were ready for their pudding as others were just commencing to eat their first course. The lady with whom I sat remarked:I hope they give me some gravy, I dont like meat. However she did receive meat as her main course. There was an accompanying sauce with the meal but the lady only ate her pudding. An alternative choice of meal is not offered on the menu and this is strongly recommended. A vegetarian option should also be made available. There was an aura of contentment as the service users ate, and as they finished their meal, Care Homes for Older People Page 17 of 31 Evidence: which was very tasty, they quietly left the dining room. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are effectively handled using the organisations complaints procedure, to ensure that views of people using the service and their representatives are listened to. Policies for Safeguarding Vulnerable Adults Procedures but need some minor revision to ensure people have accurate information to hand and training needs to be completed for all staff. However the recording of concerns needs to be improved. There are adult protection and whistle blowing procedures in place to ensure that the risk of harm to service users is reduced. Evidence: The home has a complaints procedure, which is accessible to service users and their representatives. This is up to date and contains details of how the complainant can contact the Commission for Social Care Inspection. The home has a complaints log that will be completed when a complaint has been received by the home. This was examined by the inspector and shows that no complaints have been received by the home since the last inspection. Each resident has a book in their room where individuals can record any concerns they may have. The inspector observed one book where three concerns or requests were recorded. One of these was a request for the rockery to be cleared so that the new shoots have room to grow and another was a request for a jigsaw to be permanently in place so any one wishing to take part are Care Homes for Older People Page 19 of 31 Evidence: able to at any time. These were seen to have been actioned and this is recorded in each book. This is recognised as good practice and is to be commended. The Commission has not received any complaints about this service. A summary of the complaints procedure is included in the Statement of Purpose and Service Users Guide. There are organisational adult protection and whistle blowing procedures in place. However when examined it was noted that these do not accurately reflect the local authority Safeguarding policy. Updating is needed to amend the homes policy and to make sure that staff are aware of the correct procedures. Staff were unable to locate a local authority Safeguarding Adults procedure. A requirement is issued for improvement in this area. There has not been any adult protection referrals made in the past year, according to information supplied before the inspection. On the day of the inspection training records supplied demonstrated that twelve care staff had completed Safeguarding Adults training in May 2008 and reflected that ten people still needed to complete this training. The Registered Provider has since provided up to date training information that shows twelve staff had training in May 08, 1 in Jun 08 and 3 in Oct 06, and only 4 not undertaken yet. The registered manager does not act as appointee for any people using the service. There are systems in place to look after small amounts of personal allowance or for the safekeeping of service users valuables. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A clean, comfortable and homely environment has been created for people who use the service, ensuring that they have appropriate surroundings in which to live. Some thought needs to be given to making the garden more accessible to residents who have mobility difficulties. Evidence: Harrias House provides care for seventeen older people who need to be independently mobile. The home is a large country residence located amongst walled grounds in Old Beaconsfield. The home is approached by narrow roads on which currently major building work is taking place. Accommodation is on the ground and the first floor and all bedrooms are single and vary in size. Some have direct access to the gardens via a door and several have large bay windows overlooking the gardens. The local amenities include a village store, public house and an attractive green. The second floor of the home is accessible via a passenger lift. The front entrance of the home includes a reception area and this is welcoming and homely. Just past the reception there is a small seated area for the use of residents and visitors. Communal space consists of two lounge areas and a bright spacious dining area, which Care Homes for Older People Page 21 of 31 Evidence: are both set in a homely and attractive fashion. The internal decoration of the home is of a good standard and there are personal touches around the home such as flowers, plants, books and pictures. The main kitchen is clean, spacious and well looked after. Following the previous inspection it was strongly recommended that the smaller kitchen is replaced. This has been completed and the new kitchen area is clean, spacious and more suited for its purpose. The furnishings observed in communal areas are of good quality and suitable for the range of interests and activities preferred by service users. The gardens are large and well maintained. The expert by experience enquired from some residents as to their ability to access the beautiful gardens which had crazypaved paths. I was told very firmly that;I would not feel safe outside as I might fall over. After this I went out of the building, negotiating the doorstep and a small change of step down. One resident, who had returned for respite care, came and walked a little way down the garden. The gardens are not accessible to all residents, and there are several people living in the home that require assistance to make use of the gardens. Level tarmac paths rather than crazy paving and ramps in place would definitely help accessibility. There are accessible toilets available for service users throughout the home and several are close to the lounges and dining area. Laundry facilities are very spacious and sited so that soiled articles, clothing and infected linen are not carried through areas where food is stored, prepared, cooked or eaten and do not intrude on service users. The home has an infection control policy and the inspector observed this. Instructions are in place for the washing of soiled linen. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing numbers and skill mix is adequate to meet the needs of the people using the service. Recruitment procedures are undertaken to ensure staff have the right skills and competencies to support the people who live there. Evidence: The home’s staff rota demonstrates that there are adequate numbers of staff on duty at all times to ensure the needs of the service users are always met. This includes sufficient numbers of ancillary staff. The registered manager is extra to these numbers. There are no staff working in the home who are aged under 18 years of age and there are no members of staff under the age of 21yrs left in charge of the home. Progress is being made with NVQ training. At the time of the visit there was five staff who had completed NVQ level 2 trainng, two have completed NVQ level 3 training and the registered manager has achieved NVQ level 4 training. The registered manager said that a further two staff were registered to commence NVQ training. Four staff recruitment files were viewed at this inspection including those new to the service. All files looked at contain the necessary documentation as detailed in schedule 2. There is evidence that all staff have CRB checks and two references have been obtained before they commence work. One file looked at did not contain a recent Care Homes for Older People Page 23 of 31 Evidence: photo of the applicant and the registered manager is reminded that proof of identity is required for all staff. There is a staff induction programme that covers the Skills for Care Common Induction Standards. Two of these were looked at and fwere detailed and comprehensive. They cover the following areas; 1) understand the principles of care; 2) understand the organisation and the role of the worker; 3) maintain safety at work; 4) communicate effectively; 5) recognise and respond to neglect; 6) develop as a worker. In addition staff are given key policies and procedures. Copies of certificates from courses attended have been collated for each person working at the service. There is specialist training available for staff, an example of this is falls prevention and dementia care trainng. Staff spoken to on the day confirmed that there are regular staff meetings. Care Homes for Older People Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. However some updating of mandatory health and safety training needs to be undertaken by care staff. Evidence: The Beaconsfield Housing Trust, which manages the home, has an active board of trustees who take an interest in the home. The chairman and three of the trustees visit the home regularly. On the day of the visit the inspector was able to meet with the chairman and one member of the board of trustees who were visiting the home. The manager is competent and sufficiently experienced to manage the home. She has completed her registered managers award. Further training includes first aid, fire training, health and safety training and infection control training. The inspector was informed that residents, family and friends receive service satisfaction questionnaires on an annual basis. The results are collated and sent to the Care Homes for Older People Page 25 of 31 Evidence: board of trustees. In addition to this there is a book in each service users bedroom where they can record their comments and concerns. These books are collected and looked at by the manager who will respond to each concern. The registered manager said that she seeks the views of residents, informally on a daily basis. Monthly Regulation 26 visits are undertaken by the Registered Person. The manager does not undertake the role of appointee for any people who use the service. Residents are encouraged to look after their own financial affairs where at all possible. The home was not managing the finances of anyone living at the home. Some residents manage their own money and others have arrangements with families and sponsors. There are locked storage facilities in residents rooms if they wish to keep valuables with them and each person has a key to their room door, which can be locked if they wish. At the previous inspection a requirement was issued for staff to receive formal supervision at least six times a year. The inspector was informed that this now takes place on a more regular basis. Dates seen for staff supervision show that this took place in December 2007, March 2008 and May 2008. Records were seen for fire safety. The last visit received from the Bucks and Milton Keynes Fire Service was on 25/06/08. No requirements were made. Testing of the homes fire alarm system is undertaken on a weekly basis and evidence was seen of this. There is a fire based risk assessment that is reviewed annually and is dated May 2008. Training records provided on the day of the inspection show that eleven staff completed fire training on 23/05/08 and four staff in April 2007. However there appears to be seven staff that have not received up to date fire training. From records seen on the day of the inspection it was apparent that eight staff have not received up to date basic food hygiene, eleven staff have not received up to date moving and handling training. The registered provider has since provided more up to date information about training which shows this training is considerably better than assessed on the day. However there still remains a small number of staff who need to update their mandatory training and the registered provider has acknowledged that with many part-time staff who have other commitments to family or other jobs, the home do find it difficult to keep all staff up-to-date at all times as they cannot always attend the organised training. It is strongly recommended that all staff undertake mandatory training. The registered person is reminded that all records must be kept up to date and made available for inspection purposes. Service reports are in place for PAT testing dated 30th and 31st January 2008, Fire Alarm and servicing of fire equipment dated 09/12/07 and Electrical installation 27/04/07. A new gas boiler was installed on 11/12/07. There are two gas cookers and the inspector asked when these had last been serviced. The registered manager said she was not aware of when this Care Homes for Older People Page 26 of 31 Evidence: had been completed and there were no service certificates available. The Registered Provider has since provided information the cookers were checked for leaks in Aug 07 as part of the checks when replacing the gas boiler. They were found by National Grid to be OK. The inspector looked at Infection Control guidelines that are available for all staff. 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 The registered person is required to ensure that care plans set out in detail the action which needs to be taken by care staff and is kept under review. To ensure all aspects of the health, personal and social care needs of the service user are met. 30/09/2008 2 9 13 The registered person is 30/10/2008 required to ensure that staff adhere to procedures for the safe administration of medicines. To ensure people who use the service are protected by the homes policies and procedures for dealing with medicines. 3 12 16 The registered person is required to ensure that people who use the service are enabled to engage in local, social and community 30/12/2008 Care Homes for Older People Page 29 of 31 activities and provide facilities for recreation. To ensure the lifestyle experienced in the home matches residents expectations and preferences and satisfies t their social, cultural, religious and recreational interests. 4 18 13 The registered person is 30/09/2008 required to ensure that the home obtains a copy of the local authority Safeguarding policy and updates their own adult protection policy to reflect this. To ensure that people who use the service are protected from abuse, neglect and self-harm. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 It is recommended that the daily notes contain more detail to give a full account of how the individual has spent their day. It is recommended that care staff expected to administer medicines complete up to date medication training. It is strongly recommended that an alternative choice of meal is prominently displayed on the menu. The registered person is required to ensure that all staff receive up to date mandatory health and safety training. This must include fire training, basic food hygiene training, first aid, infection control and moving and handling training. 2 3 4 9 15 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 © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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