Inspection on 01/10/08 for Hay House Nursing Home

This inspection was carried out on 1st October 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

Hay House Nursing Home 02/11/09

Hay House Nursing Home 10/08/09

Hay House Nursing Home 24/06/09

Hay House Nursing Home 05/11/07

Hay House Nursing Home 21/06/06

Hay House Nursing Home 16/12/05

Hay House Nursing Home 26/07/05

Hay House Nursing Home 21/10/04

Hay House Nursing Home 22/04/04

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hay House Nursing Home Broadclyst Exeter Devon EX5 3JL     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: Teresa Anderson     Date: 0 6 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Hay House Nursing Home Broadclyst Exeter Devon EX5 3JL 01392461779 01392460040 info@hayhousecare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Chartbeech Ltd Name of registered manager (if applicable) Ms Rachel Somers Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: On the termination of the placement of the named service user, the registered person will notify the Commission in writing and the particulars and conditions of this registration will revert to those held on the 8th November 2004. Staffing minimum as agreed with the previous registration authority 29/01/2002 and detailed in the variation of registration report of the same date, is observed. The manager, Ms Rachel Somers, must obtain the Registered Manager`s Award by 2005 The maximum number of persons accommodated at the home, including the named service user, will remain at 35 There is a named Registered Mental Nurse as a lead for mental health care at the home. To admit one named person outside the categories of registration as detailed in the notice dated 5th November 2004 Care Homes for Older People Page 4 of 33 care home 35 Over 65 35 35 0 0 Date of last inspection Brief description of the care home Hay House is registered as a care home that provides accomodation with nursing for up to 35 people over the age of 65, with dementia or a mental disorder. The building is Georgian and is set in an elevated position with views to Broadclyst and Killerton. The house has been extended and adapted for use as a care home and provides provides both shared and single bedrooms, 16 of which have en-suite facilities. There is a passenger lift linking the floors aswell as a wide staircase. Communal facilities are made up of a main lounge, a dining room, a smaller lounge and a large entrance hall. There are Registered Nurses on duty throughout the day and night. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place as part of the normal programme of inspection. The visit to the home was undertaken by two inspectors. It began at 10.00am and finished at 7.00pm. During this time, and because the majority of people living here have communication difficulties, we spent some time observing people. We did this formally over a period of two hours using a tool called a Short Observational Framework for Inspection (SOFI), and informally throughout the day. We looked closely at the care and accomodation offered to six people living here. This helps us to understand the experiences of people living here and gives an overview of Care Homes for Older People Page 6 of 33 how the needs of all the people living here are being met. We spoke with some people living here and with a visitor. We also spoke with nursing, care and ancilliary staff working here, and with the manager and the owner. We saw all the communal and service areas of the home and approximately fourteen bedrooms. We looked at records relating to assessment, care planning, medication, the management of peoples personal allowances, recruitment and fire safety. Prior to the visit the owner provided information about this service in the Annual Quality Assurance Assessment (AQAA). In addition questionnaires, asking for feedback and comments, were sent to 10 people living here and 7 were returned, to 6 staff and 2 were returned and to health and social care staff and 1 was returned. Feedback has been included in the report. What the care home does well: What has improved since the last inspection? Since the last inspection the programme of upgrading and redecoration has continued. The manager has succesfuly completed the Registered Managers Award and work continues to help ensure that people with communication difficulties are helped to make choices about how they live. Care Homes for Older People Page 8 of 33 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who come to live here can be assured that they will know what they are paying for and that the service can meet their needs. Evidence: We wanted to know if people had undergone assessments prior to moving here, so that the home could determine if they could meet each persons needs. People we casetracked could not answer this question so we looked at the written records. We found that people have their needs assessed and recorded. Assessments are carried out by the manager and are written in sufficient detail to ensure that the service has the right information upon which to base the decision that they can meet peoples needs. Care Homes for Older People Page 11 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living here are treated with respect but would benefit from improved care planning, from improvements in some aspects of care delivery and from improvements to the way medicines are managed on their behalf. Evidence: We wanted to know that peoples care needs are assessed, are written down for all staff to follow, that staff understand the care plans and that people get the care they need. In surveys people say they always or usually get the care they need and that they always or usually get the medical care they need. A healthcare professional said they thought the home met peoples healthcare needs even though people cannot always communicate what their needs are. Everyone living here has a plan of care and we looked at four. In them we found lots of records to show that doctors are called to see people if they are unwell or if staff are Care Homes for Older People Page 12 of 33 Evidence: concerned. We also saw that none of the care plans we looked at addressed all the aspects of each persons physical and/or mental health needs. Whilst we saw that care plans contain assessments relating to each persons nutritional, skin and moving and handling needs, we also found that these assessments do not always form the basis of a plan of care and that equal risks result in different actions. For example two people have been assessed as being at high risk of skin damage (developing pressure sores). Neither has a plan of care instructing staff on how to prevent skin damage in the light of the risks identified. One of these people has a pressure relieving mattress on their bed and a pressure relieving cushion on their chair. The second person does not sit or lie on any pressure relieving equipment. Two care plans show that the people they relate to are losing weight. Records do not include a plan of care which informs staff about how to manage this to help ensure that people get a nutritious diet. When we spoke with staff they told us how they help both these people to eat. One member of staff demonstrated an in-depth knowledge in relation to what helps one person to eat. They say that this person can feed themselves but that they dont do this because this is a time they like to be helped and be given attention. The carer says that if they are given this help they will eat lots because they have a really good appetite. This is not written in the plan of care meaning that other staff may not have this information or may not give this help. Records of what and how much this person actually eats are not kept. This person was observed during the observational exercise (SOFI) for two hours. During that time they were asleep. Although teas and coffees were served, this person was not offered a drink. Another care plan records that the person it relates to has diabetes and should have a diabetic type diet. When we spoke with staff they did not know this person had diabetes and told us that they love their puddings. Although the cook does prepare puddings especially for people with diabetes, if staff do not know who has diabetes, they might not be given the right foods. Another care plan identifies that the person is at risk of choking. There are very detailed instructions from the Speech and Language Therapist about what actions staff should take to reduce the risk of choking, including the need for a pureed diet. During the SOFI observation we saw this person being given and eating biscuits. We spoke with staff about this persons dietary needs and were told this person has a normal diet. Care Homes for Older People Page 13 of 33 Evidence: When we spoke with care staff about care plans and their general access to and knowledge of them, they told us that they would like to read them but that they do not have the time. They say that the nurses write in them and that carers have written information that tells them for example what types of pads people wear. They also use this record to record who has had a bath and who has had their bowels open. This is not a person centred way of planning or delivering care. Staff told us that one person has chronic constipation. We looked in the records and found that there is no plan of care saying how this, and the associated discomfort, should be managed. Daily records show that some inappropriate actions have been taken by staff and this information was passed to the owner and the manager on the day of the visit to this home. Because this home is registered to provide care to people with dementia we also looked at how care planning and delivery supports people with this disability. The information sent to us prior to this visit told us that the home provides person centred care and reduces inappropriate behaviours which are seen as challenging. We looked in care plans to see how this is achieved for the people we case tracked. Although reference is made to some behaviours that challenge this service, the care plans we looked at do not have a plan of care about how such behaviours could be anticipated, reduced and managed. For example, a member of staff told us that one person refuses their medicines in the morning. However, this repeated behaviour has not been taken into account in the planning and delivery of this persons care. Staff have continued to try to give the morning medicines to fit in with the time that medicines are administered and not at a time that would suit this individual. Staff told us that one person becomes agitated when they want to go to the toilet. However, this behaviour observation has not been included in the plan of care as a way of trying to ensure that this person remains continent and which addresses their individual need. During our conversations with care staff they gave us a lot of important information about people and their needs. However when we looked in peoples records we could not find evidence that this information is taken into account when peoples care plans are reviewed or further developed. For example the daily records relating to one person record that this person has been experiencing frequent falls. We spoke to care staff about this and they told us that this person gets agitated at certain times and under certain conditions. They say that despite this persons lack of mobility they then try to move around the home and tend to fall. We expected this information would be recorded and used when the registered nurses reviewed this persons care plan. Care Homes for Older People Page 14 of 33 Evidence: However, although one review states that there had been an increased number of falls, it also states that nothing can be done. And in another part of the care plan covering the same period of time, the review states that there had been no significant or no incidents relating to falls. We looked at the way that medicines are managed to see how peoples medication needs are met and to check if practices are safe. We found that medicine sheets completed by staff are not always signed to say they have been checked by two people, which would reduce the risk of mistakes being made. We found that records of what medicines are received into the home are not kept. This means that medicines cannot be audited and accounted for. We found tablets in a pot with the persons name written on a piece of paper in the same pot. We spoke with staff about this and they explained how this had come to happen. This practice is not safe. We found that some people are prescribed anxiety reducing medicines to be given when they are needed. There were not written instructions for staff relating to the circumstances that would result in this medicine being used for individuals and there were no directions for staff about what measures might be taken to reduce a persons anxiety before this medicine is given. There were no records relating to the effects this medicine has had on individuals and therefore this information could not be included in any review undertaken of peoples care. Another person is prescribed a strong pain killer. There is no written record as to why this has been prescribed or of the effect this medicine is having. When we asked staff about why this medicine is being used, we received different reasons. When staff open creams and lotions they are not recording the dates this happens. This means that some creams and lotions might be used after they have reached their use by date. We also looked at the way controlled drugs (which have to be managed in a special way) are managed and recorded. We found that these are well managed. The stock matches written records, records are complete and up to date and these medicines are stored securely. We observed staff during the SOFI and at other times. We found that mostly staff treat people with respect and support their right to privacy. We saw that personal care is given in private and a healthcare professional told us that people are taken to their bedrooms when they visit, so they can have privacy. We saw some staff are very skilled at treating people as value individuals by for example making eye contact and Care Homes for Older People Page 15 of 33 Evidence: speaking with people respectfully. We also saw some staff are not so skilled in this area and may need further support. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The provision of activities, opportunities to make choices and the ways of engaging people who live here continues to develop and improve. People benefit from the good relationships the home has developed with peoples relatives and representatives and from a varied and nutritious diet that can be imaginative and is based on peoples likes and dislikes. Evidence: In surveys people told us that there are usually or always activities arranged that they can join in with. The AQAA told us that the home encourages a form of community living not just individuals living under one roof. We observed some very good practice. For example people do not have their movements around the home restricted. We observed people walking around as they please and with whom they please. Only areas that pose a risk to them or belong to someone else (other peoples bedrooms) are restricted areas. We saw that people seem to have developed attachments with staff and/or with some of the people they live with. This means that people are making choices, are having their social needs attended to and are exercising, meaning they are likely to remain mobile for as long as Care Homes for Older People Page 17 of 33 Evidence: possible and are more likely to sleep at night because they are using energy. The AQAA told us that the activities arranged offer variety and experiences away from the home. We saw that this had included trips to the zoo and the seaside, and that themed evenings have taken place and have become a regular feature about every three months. We saw photographs of these events and could see from these that the events had included some very disabled people showing that people living here have equal opportunities in relation to activities. The home has an activities co-ordinator who has received training in person centred care and in providing activities for older people and people with dementia. Rummage boxes have been put together which people can rummage through and take things from. We saw some people taking things and we saw staff taking things from here and giving them to people because they thought the person might be interested in it. Some people have memory boxes that contain items that are important to them, which they might identify with or which might encourage happy memories or feelings. This is being further developed. In addition to the above, the home is visited by a drama therapist who works with people and from whom the activities co-ordinator is gaining more skills. We observed the activities co-ordinator and staff frequently engaging with people living here. However, we also observed that some people were not engaged with unless a member of staff was delivering care to them. In general terms the SOFI shows that the very disabled people living here respond positively to staff interactions with them. However, these interactions are infrequent, giving people few opportunities to feel that engagement and the associated feelings of well being. The quality of interactions also varied. For example one carer was very skillful at engaging someone they were attending to, giving them their full attention and using the time to make that person feel special. Another carer responded to someone who did not like their drink by immediately getting them a different one. Another carer looked through CDs and books whilst assisting someone with their drink, another referred to one person as a good girl which is demeaning, and another took someone from the lounge to the dining room without explaining what was happening. When in the dining room for lunch, people were very well attended to and seemed to enjoy the food they were served. Those people who eat slowly have their meals served in specially designed plates which keep food warm. However, some people who cannot see their food due to sight problems were not told what was on the plate and what Care Homes for Older People Page 18 of 33 Evidence: they were eating. In surveys people told us that they always or usually like the food. One person told us it could be a bit bland and someone else that they had asked for extra salt as the food lacked seasoning. We talked to the owner about this and he said that this had been something that had been recognised during one of the themed evenings when spicy food had been served. Staff were concerned that it would be too spicy. However the owner reports that people really enjoyed the extra flavour and this had led to changes being made to the menu. He was also able to show us that those people who did not like spicy food were given an alternative of their liking. Visitors to the home say that there are no restrictions on visiting, that they can see the person they are visiting in private if they want to and that they are kept up to date with developments and changes. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living here are listened to and are kept safe through safeguarding procedures. Evidence: In surveys people told us that they know how to make a complaint and who to speak with if they are not happy. We observed people during this inspection showing mild displeasure or that they werent happy and saw staff responding to this. For example one person made it clear they did not like their drink and this was immediately replaced. A member of staff told us that someone who cannot walk was restless in their chair, so staff had changed it. These are forms of complaints made by people who cannot communicate, which are well dealt with. The commission have not received any complaints about this service since the last inspection. The home has received some complaints since the last inspection and all have been dealt with in the timescale set. One complaint related to wheelchairs having parts missing. The records in relation to this show that this has been dealt with. However, we found many wheelchairs that did not have foot plates (see environment). The home has had cause to deal with one safeguarding alert. They followed the appropriate procedures and took appropriate action. People living here, who can talk with us, say they feel safe and well cared for. Those Care Homes for Older People Page 20 of 33 Evidence: who cannot communicate with us verbally appeared relaxed in the company of staff and other people. We saw in staff records that staff have received training in safeguarding people from abuse. We spoke with some staff about what abuse is and they have a good knowledge of the types of abuse. They also demonstrate that they would know what to do if they suspected or observed abuse. In the information provided by the home in the AQAA, we were told that the home does not restrict peoples movements. However, we saw during our visit that some people are cared for in recliner chairs and one person is kept in their chair using a lap belt. We have no reason to believe that these actions are inappropriate. However, there were no records relating to how these decisions came to be made and how long and in what circumstances they should be used. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and homely environment. Ongoing upgrading is enhancing the overall ambiance of the home. Evidence: In surveys people told us that the home is always or usually clean. The owner told us there is a cleaner on duty every day and that one cleaner starts work at 6am so that communal areas and carpets can be cleaned without disturbing people. We looked at some bedrooms and found that they had all been personalised for use by the person occupying that room. We saw that a system has been set up to help people to recognise their bedrooms and the owner reports this is working well for some people. We looked in the bathrooms and toilets and found them to be clean. We saw that there is some equipment to help those people who are less mobile to have a bath. We also saw that none of the toilets have seat raisers, which would help people with mobility problems to use the toilet more easily. We noticed that staff are recording the temperature of peoples bathing water at 37C. We could not find a thermometer to check this. However, the owner reports that staff always check bathing water temperatures and that these are always comfortable. Care Homes for Older People Page 22 of 33 Evidence: There are gloves, paper towels and liquid soap around the home, to promote good basic hygiene, and we saw staff using these. The laundry is well equipped and appeared to be well organised. We looked in the lounge and dining room and saw these are furnished with domestic furniture of good quality. The majority of chairs in one lounge and in the hall are quite low. We heard some people asking for help to get in and out of chairs which means they cant be as independent as they might be. We talked to staff about equipment which helps them to move people with mobility problems and they told us they had enough to this safely. We looked at the wheelchairs that are stored in the hall area. We found that of the 9 stored there 6 did not have foot plates. We were told that 2 people prefer this as they like to move themselves around the home in wheelchairs using their feet, and foot plates would restrict this. However, we saw staff moving people around the home using wheelchairs without foot plates, meaning that these people are at risk of injury. This problem had previously been recorded as a complaint by a visitor to the home and had been recorded as being dealt with. We saw that people have easy movement around the home and that they do this at their leisure. There is a garden at the rear of the property with raised beds and the owner is in negotiation with local planners to try and get approval for easier access (from the rear of the property) for people living here. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from being cared for by a staff group who are experienced and caring. Some improvements to the recruitment procedures and support/supervision procedures would help to ensure that people are kept safe from inappropriate staff or actions. Evidence: We looked at the staff duty rota which shows that there are usually two registered nurses and five carers on duty during the day and one registered nurse and two carers on duty at night. The manager works office hours and is supernumarey to those figures. In addition, there are usually two cleaners, a cook, a kitchen assistant and a laundry assistant on duty during part or all of the day. On the day of this inspection there were 33 people living here (the home can accomodate 35) and there was one registered nurse on duty as the other was on leave. We looked at what training staff have received and saw that 19 of the 22 staff received training in providing person centred care in 2007. However, although staff have an annual appraisal there are no records to show how staff competence following this training has been assessed, measured or built upon. Records also show that a dementia care mapping exercise had been undertaken in August 2007. However, there are no records to show if/how the recommendations made have been addressed. Care Homes for Older People Page 24 of 33 Evidence: In addition it is reported in the information supplied to us prior to the inspection that 11 care staff working at the home have successfully achieved a National Vocational Qualification (NVQ) in care to level 2 or above, and that a further 4 care staff are working towards acheiving this. During the SOFI we observed staff attending to people who cannot communicate verbally, who appeared uncomfortable. Staff made real efforts to help these people to settle by for example talking with them and giving extra blankets in case they were cold. We saw a carer gently talking with one person as they helped them to have a drink, and we saw a carer explaining what they were going to do with that person before they did it. These are all examples of good practice. However, we also saw some staff ignoring people who were making attempts to attract attention or who appeared to need assistance. Records show that staff have received other training, including induction, fire drill and moving and handling training. In surveys staff say they feel well supported and that the owners are very quick to provide help and support. People living here say the staff are very caring and always pleasant and willing to help and are compassionate and caring and credit must be given to the younger staff who carry out sometimes difficult duties with such cheerfulness and good humour. Staff are truly dedicated. We looked at three staff recruitment files. We found that all checks recommended to help keep people safe have been carried out. Staff have had their name checked against the list of those people barred from working with vulnerable adults (POVA list) prior to starting work and all had a police check before working unsupervised. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further improvements in the way this home is managed would help to improve the experiences of people living here and would help to ensure that people are safe. Evidence: The manager of this home is a registered nurse and has recently completed the Registered Managers Award (RMA). She has many years experience of managing a care home and working with older people. In surveys people living here and the staff say they feel the manager is approachable and easy to talk with. The manager holds regular staff meetings and staff say these are a time when they can discuss issues and offer up ideas. There are comprehensive quality assurance processes in place that are designed to gain feedback from people living here and their representatives. Records we were shown demonstrate that satisfaction levels have increased and are generally good. Care Homes for Older People Page 26 of 33 Evidence: Prior to the inspection the service gave us information about the home. However, when we checked some of this information, particularly in relation to health and personal care we did not find evidence to support some of the statements. As demonstrated in this report, improvements are needed to how care is planned and how this is delivered. Improvements are also needed in how the medicines are managed. In addition, although staff have received comprehensive training in caring for people with dementia, their competencies and practice in relation to this have not been adequately monitored, and we saw varying degrees of ability during this inspection (see health and personal care and staffing). We saw records that show staff receive an annual appraisal but do not always receive regular supervision. Records also show that a dementia care mapping exercise had been undertaken in August 2007. However, there are no records to show if/how the recommendations made have been addressed. We looked at how monies are managed on behalf of some of the people living here and found this to be in order. Records are kept of all monies, cheque books and payment cards found in peoples possession and these are kept safely locked away. The home does not manage anyones personal allowance. Instead records are kept of monies spent on behalf of and for people, and a monthly account is sent to the persons supporter for checking and payment. We looked in the kitchen and found it clean and tidy. All open food is labeled and dated as is appropriate. Freezer and fridge temperatures are recorded and staff were observed following good hygiene practices. During the inspection we noticed that some fire doors did not close properly. We told the owner and when we checked these again we found they had been dealt with and were closing. Care Homes for Older People Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15(2) You must keep each persons 31/12/2007 plan under review and ensure that revisions to the plan are appropriately made. Where possible the person should be involved in planning their own care this will ensure people get the care they want in a way that is acceptable to them. Care Homes for Older People Page 28 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 (1) (2) (b) Each person 13/02/2009 living here must have a plan of care that details how that persons needs relating to health and welfare are to be met, in a way that addresses these needs for each individual and which is based on their preferences. Care plans must be reviewed meaningfully, using all the information available. Changes to the way care is planned and delivered must be made accordingly. In this way people will receive person centred and consistent care based in their individual needs and preferences. Care Homes for Older People Page 29 of 33 This will help to ensure that care planned and given is appropriate to that persons changing needs. 2 8 12 (1) (a) Each person living 30/01/2009 here must have proper provision made to meet their health and welfare needs. This includes making provision to meet needs relating to tissue viability and preventing skin damage, nutrition, hydration, diabetes and mental health needs. This will help to ensure that people remain healthy for as long as possible. 3 9 13 (2) Medicines must be 13/02/2009 managed safely. This includes making sure that records are up to date and accurate, that medicines are stored securely and that medicines are in date. This will ensure that people get the medicines they need in a dose that is appropriate to their needs, that all medicines are in date and therefore effective and that all medicines recieved into the home can be accounted for. 4 18 13 (7) (8) All records relating to 13/02/2009 the use of restraint (e.g lapbelts) must relate to the Mental Capacity Act and Care Homes for Older People Page 30 of 33 helping people to make decisions. Where restraint is used there should be clear guidance about the circumstances in which this is to be used and for how long. This will help to ensure that restraint is only used in exceptional circumstances and is used appropriately for as short a time as possible. 5 22 23 (2) (n) An assessment of the 13/02/2009 home must be made to determine if the equipment and adaptations available to people (such as toilet raisers, seat raisers and wheelchair foot plates) are sufficient to meet their mobility and comfort needs, and to help them remain independent. This will help in identifying individual and collective adaptation and equipment needs and to meet those needs for the people living here. 6 38 23 (4) Adequate precautions must be taken to ensure that if a fire were to break out that it could be contained appropriately. This includes carrying out regular checks to ensure that all fire doors close. This will help to ensure that the people living here are kept safe. 13/02/2009 Care Homes for Older People Page 31 of 33 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 25 You should ensure that water available for bathing comes out of the taps at close to 43C (and that fail safe devices are provided and checked regularly) as this is the temperature considered appropriate to prevent scalding and ensure that people can have a comfortable bath. Records should be kept of this each time a person has a bath. Staff should receive regular supervision to ensure their competencies and learning needs are assessed, helping to ensure that people living here will benefit from being cared for by competent and able staff. 2 36 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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