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Inspection on 22/11/08 for Heatherdene Nursing Home

Also see our care home review for Heatherdene Nursing Home for more information

This inspection was carried out on 22nd November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service provides nursing care for twenty two older people. It provides a clean, well maintained and pleasant home for residents. The standard of care planning, the care given and the medication administration is good. Staff receive on going training in the care of the older person, and the registered nurses have opportunities to update their knowledge and extend their practice. This is one of the few homes in which all the care staff have attained their National Vocational Qualification in Care, and the home encourages them to study for higher levels in this qualification. Staff turnover is low. Residents spoke highly of the food: `Lovely food and plenty of it`, ` The food is always good and you can always have snacks in the evening before you go to bed`. The home provides a varied programme of activities which includes outings.

What has improved since the last inspection?

Requirements made at the last inspection, which included care planning, staff recruitment and enlargement of communal space, have been complied with. The provider is in the process of extending the home, and building work has commenced to ensure that communal space is enlarged. This is being done with minimal disruption to the residents.

What the care home could do better:

The staff must continue to work on the care plans to ensure that each care plan is person centred. Management should keep staffing levels under review, with a view to changing staffing levels depending on the needs of the residents in the home.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Heatherdene Nursing Home The Highlands Bexhill on Sea East Sussex TN39 5HL     The quality rating for this care home is:   two star good 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: Elizabeth Dudley     Date: 2 2 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. 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 29 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 29 Information about the care home Name of care home: Address: Heatherdene Nursing Home The Highlands Bexhill on Sea East Sussex TN39 5HL 01424224518 01424212800 heatherdene01@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Stianand Baichoo Type of registration: Number of places registered: Zeenat Nanji,Tasneem Osman care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: That rooms 5 and 15 are the only rooms used as shared rooms. That the bathing facilities are improved by June 2005. That the care home provides general nursing care to older people over the age of 65. That the communal space is improved to meet the pre commission Heath Authority standard by June 2005. The maximum number of service users to be accommodated is 23. Date of last inspection Brief description of the care home Heatherdene was originally a family home and has been greatly extended and adapted to its present use over the last 20 years. Heatherdene is registered to provide personal and nursing care for older people up to a maximum of 23. The home has 21 bedrooms 2 of which can be used for sharing and 6 of the single rooms have en-suite facilities. Heatherdene Nursing Home is situated on the outskirts of Bexhill on Sea, in a private Care Homes for Older People Page 4 of 29 Over 65 23 0 Brief description of the care home residential road in an elevated position facing towards the sea, with attractive gardens on all sides. Heatherdene is owned by a family partnership that also owns and manages another care home in East Sussex. Care Homes for Older People Page 5 of 29 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: two star good 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 key unannounced inspection took place on the 22nd November 2008 over a period of eight hours and was facilitated by Mr S Baichoo, the registered manager. Methods used to inform the judgements made in this report included a tour of the home, examination of documentation and discussions with staff, residents and visitors to the home. Documents examined included care plans, medication records, catering records and menus, health and safety and staff recruitment and training records. During the day all residents were seen and spoken with, and four residents were Care Homes for Older People Page 6 of 29 spoken with in depth. Residents said that the staff answer bells promptly and Its the best home Ive been in, no bad points at all, food is good , the staff are good and we can have a laugh and you can get a cup of tea when you want one, just ring your bell and they will get you one. Discussions were also held with three visitors and six members of staff. . Visitors comments about the home included We are very pleased with the care given, attitude of staff and the general ambiance of the home. Prior to the inspection surveys were sent out to ten residents and five staff. All surveys were returned and the comments made were generally positive. However two staff surveys said that the numbers of staff on duty were not always sufficient given the dependency levels of the residents.Staffing is not always sufficient, given the high needs of some residents, for us to give the care we wish to give and that the residents deserve. The Annual Quality Assessment tool (a document required by legislation, which tells us what has been happening in the home, what improvements the home has made and its planned improvements and changes for the coming year), was received when we asked for it and accurately reflected the current status of the home. This was used as part of the inspection process. The last inspection took place on th 5th December 2006 and the home had an annual service review (desktop review) on the 7th March 2008. Current fees for the home range between five hundred and thirteen pounds and six hundred pounds a week. Extra services such as hairdressing and chiropody are charged separately. Details of these are available from the home. What the care home does well: What has improved since the last inspection? 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 8 of 29 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 9 of 29 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. Prospective residents receive sufficient information to enable them to make a decision about whether the home can meet their needs and expectations. The manager, or a senior member of staff, undertakes an assessment on each individual to ensure that the home can meet their needs, and prospective residents and their representatives are encouraged to visit the home to meet the residents and staff.. Evidence: There is a Statement of Purpose and Service User Guide which give clear and accurate information about the home. Residents receive a copy of the Service User Guide on their admission to the home and the Statement of Purpose is available in the office. All residents receive a copy of the homes Terms and Conditions of Residence and a Care Homes for Older People Page 10 of 29 Evidence: contract following their admission to the home. Prospective residents are assessed by the manager or a senior member of staff to ensure that the home is able to meet their needs and expectations. Three preadmission assessments of recently admitted residents were examined, these were comprehensive and included sufficient information about the person to enable staff to have a clear knowledge of the initial needs of this resident. The assessment forms the basis of the care planning. The home encourages prospective residents and their representatives to visit the home before making a decision over whether they wish to live their. Prospective residents are informed in writing of whether the home can meet their needs and accept them for admission. The home admits residents for respite and permanent care but not for intermediate care. Care Homes for Older People Page 11 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of care planning is good, and reflects the care required and given to the residents. Care plans could be more detailed to promote person centred care. The standard of medication administration and recording safeguards the residents. Evidence: During the course of this inspection three care plans were examined in detail. The standard of care planning was generally good, had been reviewed regularly and there was evidence that where possible, the care plans were formed in consultation with the resident or their representative. However, the care plans are computer generated and require more detail to become completely person centred. Care plans should include times of rising and retiring, details of continence aids required, and the sizes of the hoist slings to be used when the moving and handling plan includes requirements for use of a hoist. Care Homes for Older People Page 12 of 29 Evidence: The information on mattress pressures is kept separate from the care planning and there was evidence that these were checked regularly and pressure was according to the weight of the resident. The infection control policies need to include a policy regarding Clostridium Difficile but there was evidence of good infection control procedures within the home. Care plans included nutritional, continence and wound care plans, and residents are weighed on a monthly basis. In one care plan examined, the risk assessment for bedrails had not been completed, this was completed during the inspection. The manager should continue to ensure that staff complete all risk assessments. There was evidence of visits from other health professionals including community psychiatric Nurses and the wound care nurse becomes involved in residents care as necessary. Nursing charts used in the care of residents, were up to date and showed evidence of suitable fluid intake and turning and moving of residents. The residents appeared well cared for and relatives and residents spoken with said that they were pleased with the care given. My (resident) always looks clean and well cared for. I am very pleased with the standard of care. They look after me very well. Four of the residents were sitting in the lounges or in their rooms with stained clothing from recently spilled drinks or food, this was seen three times during the day and staff should be aware of the need to maintain residents dignity by ensuring their clothes are always clean and fresh. Many of the residents living in the home showed a high level of need and dependency. Staff surveys received prior to the inspection said that The level of dependency is high, whilst we are meeting the needs of the residents we feel highly pressurised to do so, and it is difficult to move the hoist around some of the small rooms. The manager should consider the dependency levels of existing residents when assessing prospective residents and also consider the mental health needs of both existing and prospective residents. Several of the residents, whilst having a need for general nursing care also had Care Homes for Older People Page 13 of 29 Evidence: associated mental conditions of old age. One member of staff had to sit continually with a resident to stop them shouting. There was evidence of visits from other health professionals including community psychiatric Nurses and the wound care nurse becomes involved in residents care as necessary. All of the staff spoken with were aware of the needs of individual residents, and registered nurses are trained in extended roles, including venepuncture and various methods of catheterisation. The standard of medication administration was good, with all medication records up to date. Drug rounds were observed and the administration of medication safeguards the resident. The majority of the medications are in blister packs but there were many medications in individual packaging. Where possible the pharmacist should be asked to convert these to blister packs. The clinic room should be kept in a clean condition to avoid cross infection. Some maintenance issues which could lead to spread of infection were seen in the clinic room and discussed with the manager. Staff have received training in end of life care including the Liverpool Care Pathway and Gold Standards Framework (nursing tools to ensure that recognised end of life care and sufficient pain control is given to residents). Thanks and compliments received from relatives of deceased residents were seen in the home Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a varied range of leisure activities for residents, although there is scope to provide more activities to meet the varying abilities and interests of the residents. There is a varied and nutritious menu and meals are well presented. Residents were very complimentary about the standard of catering provided. Evidence: The home provides leisure activities which are facilitated by the homes administrator for around an hour a day during weekdays, Monday to Friday. Activities include reminiscence therapy, exercises, visiting entertainers and some outings. Library books are brought to the home and changed monthly. A programme of the planned activities is given to all residents. This inspection took place on a Saturday and there were no activities taking place, some residents were sitting in the lounge with the television on and a member of staff was sitting with another resident in the lounge, but there was little interaction taking place with residents and this member of staff. Residents were not interested in the Care Homes for Older People Page 15 of 29 Evidence: television. More emphasis needs to be placed on staff interaction with those residents who are not so cognitively able. Subsequent to the inspection the manager stated that There is interaction between staff and the service users throughout the day. Also at weekends we usually engage service users with games on Saturday afternoons. The majority of the residents were in their rooms and were either reading or watching television. The inspector had spent around half an hour in the lounge mid afternoon and then gone back to the lounge to wish residents good bye at the end of the inspection One resident said that I tried the activities but they didnt appeal. Whilst another said The activities provided are quite amusing. Other residents were complimentary about the activities saying they really are very good at this sort of thing. Staff join in and its quite jolly. The manager should ensure that the types of activities provided relate to all of the residents abilities and where possible take into account their past interests. There were several visitors in the home and those spoken with said they said that they could visit at any time and were always made welcome. The staff are so welcoming and you do not feel a stranger in here. Both the staff and the manager were very up to date on residents needs and quick to contact us if there is anything wrong. The home goes that step beyond, both in caring for the residents and for the visitors. Links are maintained with local churches and schools, religious services are held, and a local school visits and is providing a carol concert at Christmas. Currently there are no residents with ethnic religious needs in the home, but the manager said that he could contact ministers of specific faiths if required. Residents said that they could rise and retire at times their choice, and staff said that when a resident could not make this choice, relatives were contacted for advice on preferred times. Residents also said that they had choices around all activities of daily living and one resident said that when she went out a lunch had been kept for her until her return They are very accommodating here. Care Homes for Older People Page 16 of 29 Evidence: The home provides a nutritious and varied menu, two choices are available at lunchtime and residents can make individual choices at supper time. Breakfasts are currently served between 8 and 9 am in residents rooms. Meals were well presented and portions were large. Pureed meals were of a good consistency, and equally well presented. Residents were complimentary about the meals the meals are lovely, very big though and lunch is a bit difficult as I eat more at breakfast. Standard of catering very good, very good indeed and plenty of it. They give us huge meals and then go round and offer more food before you go to bed, no wonder we all put on weight. Visitors commented on the good size of all meals and those visitors who had meals at the home said the standard of catering was very good, they also said that fruit was always available. One relative said I was so surprised that they serve fresh grapefruit at breakfast, not the tinned sort and also commented There is not much to criticise in the home but one criticism I will make is that suppers are not as hot as they could be. The home has a four weekly rolling menu and staff make daily options known to the residents and record their choices. Records as required by the Environmental Health Authority were in place and all catering staff have the Food Hygiene Certificate. Most residents take their meals in their rooms or in the lounge with small tables provided. There is a pleasant dining room, but only a few of the residents choose to use this. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents generally feel comfortable about making complaints and are confident that these would be addressed in an open and fair manner. Staff are aware of their responsibilities in the safeguarding of the residents in their care. Evidence: The home has a complaints procedure which is displayed in the hallway and included in the Service Users Guide. Residents said that they were aware of how to make a complaint, but would probably talk to the manager before going through the formal procedure. The majority of the residents said that they would feel comfortable making a complaint, although one resident said that there was an issue that they were not happy with and did not feel comfortable about reporting this. The manager said that he would address this with the resident concerned. Records of complaints are kept in a confidential manner and include evidence of the ways that these have been addressed. There have been no complaints in the past twelve months. There have been two adult safeguarding issues in the past twelve months, both of which were unsubstantiated. Care Homes for Older People Page 18 of 29 Evidence: Both the staff and the manager have updated adult safeguarding training, and staff spoken with were aware of their responsibilities towards the safety of the residents in their care. Care Homes for Older People Page 19 of 29 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. Residents live in a clean and comfortable home. Current building work to provide an extension of the home is being undertaken in a manner which is not disturbing residents. Evidence: Building work is currently taking place in the home which will result in an extension to the lounge area, dining rooms and some bedrooms. It is planned that all bedrooms, apart from four, will have en suite bathrooms. Currently the home has nineteen single rooms and two double rooms, one of the double rooms is used as a single room. The standard of maintenance in the home was generally good, although areas in the clinic room require attention and some curtains were off their runners in residents rooms. Residents rooms were comfortable and made homely with their personal possessions and most residents have a lockable drawer for their use. One double room only had one lockable drawer and the manager said that he would address this. Care Homes for Older People Page 20 of 29 Evidence: Some of the rooms are very small, Staff have identified that it is difficult to have a hoist, wheelchair and two members of staff in these rooms, but the new extension should address this. Hot water temperatures to residents rooms are checked regularly and temperatures were within recommended parameters. There are two assisted bathrooms and two assisted shower rooms. These were clean and well maintained. There are varied aids and equipment to enable residents to maximise their independence, and all rooms have variable height nursing beds. The home provides electric pressure relief mattresses, and records of the required pressure according to residents weight were seen. There is a good range of moving and handling equipment available. The home was clean and visitors to the home said the home is always clean and comfortable. The standard of cleanliness is good and it is always fresh in here. Infection control policies and procedures are in place and recently reviewed and staff were seen following recognised infection control practices. Care Homes for Older People Page 21 of 29 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. There are sufficient staff on duty for the numbers of residents living in the home, but this may not always be sufficient to meet the needs of the residents currently in the home. The standard of staff training is good and all care staff have their National Vocational qualification in care. Staff recruitment practices safeguard the residents. Evidence: The duty rota shows that there are sufficient staff on duty for the numbers of residents currently living in the home.The manager works supernumerary to the rota but staff said that he often helps with the daily care routine. Whilst current staff numbers per shift is sufficient for the number of residents in the home, this may not be sufficient given the dependency of the residents. Staff surveys and discussions with staff identified that: We have a lot of residents with complex needs so the staffing levels are insufficient. we need to be adequately staffed to meet their needs. There are insufficient staff to do everything to the standard we would like, although I believe that we provide an excellent service. This was the current theme of the surveys returned and conversations with staff. Care Homes for Older People Page 22 of 29 Evidence: However staff turnover is low and the home benefits from a staff stability which does not necessitate the use of agency staff over long periods, and few are used. Care staff are supported by full time cleaning and catering staff. All care staff have the National Vocational Qualification level 2 or 3 in Care. Staff and management are to be commended on this. Newly employed care staff undertake the Skills for care recognised induction training. Registered nurses and staff with the National Vocational training undertake a local induction training. Management recognises the importance of staff training and training records showed that all staff have undertaken mandatory training and various training related to the care of residents in the home. Many staff have undertaken training on the mental capacity act and have received training for end of life care. Staff said We are so lucky here, we are encouraged to take training and we get plenty of training opportunities. Following the adult safeguarding issues raised recently, staff have identified a need for both Dealing with Challenging Behaviour training and training of Awareness of Sexual Behaviour in the Older Person. They expressed this need in surveys sent to the CSCI and this was discussed with the manager. Subsequent to the inspection the manager stated that, due to a change of circumstances in the home, We did not feel at this time such a course was a priority. Instead we had a course on End of Life with Gold Standard and Liverpool Care Pathways Six personnel files belonging to both recently employed and established staff were examined, these contained all information and checks as required by regulation. Care Homes for Older People Page 23 of 29 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. There are systems in place to ensure that the services provided by the home meet the residents expectations. The safety of the residents and staff is upheld by robust health and safety systems and training. Evidence: The manager is a registered general nurse and has attained the Registered managers award. He is registered with the CSCI and has been managing this home for four years, and regularly attends training to update his skills, which includes being the moving and handling trainer for the home. Residents, relatives and staff said that the ethos in the home was good, turnover of staff is low, and all staff spoken with said they enjoyed working in the home and that it is a good place to work. They praised the manager for being approachable and willingness to help and listen to them. Residents and relatives said The staff are so Care Homes for Older People Page 24 of 29 Evidence: kind, anything you want they do. The home goes that step beyond to make sure everything is alright, All the staff are really good, they answer my bell very quickly and are so kind and polite, very nice atmosphere in the home and I feel at home here. The home has a quality monitoring system and regularly sends surveys to residents and relatives, using the results of these surveys to inform and improve the services offered. This could be improved by surveys being sent to staff, health and social care professionals and other stakeholders. The Annual Quality Assurance self assessment (a document required by legislation which informs us of way the home is run and improvements that have taken place over the past twelve months and planned improvements) was received when we asked for it. It accurately reflected developments and practices in the home. Policies and procedures have been reviewed regularly, were up to date and contained evidence of recent research and practice. All other records in the home were up to date. Residents and relatives meetings are held three monthly and staff meetings are held two monthly. Staff said that feedback given at these meetings is acted upon by the management. The home does not act as appointee for any resident or deal with any of the money belonging to residents. Regulation 26 visits (monthly visits by the provider and required by regulation) have taken place regularly and records of these were seen in the home. These accurately reflected any issues in the home and actions taken to address these. Staff are receiving supervision six times a year as required by the National Minimum Standards. Records of accidents and incidents were seen and the home sends Regulation 37 reports (reports required by regulation of any incidents affecting residents) to the CSCI. Records showing regular servicing of utilities and equipment were seen and there was evidence to show that all staff have received mandatory training which is refreshed as required by legislation. During the tour of the home it was noted that all doors are held open with devices that Care Homes for Older People Page 25 of 29 Evidence: respond to the fire alarm. One of these required a new battery and this was replaced during the inspection, a resident had put a chair in front of another door guard which would impede its ability to close in the event of fire. The manager addressed this, but must ensure that this is not allowed to reoccur. One window restrictor was broken and the manager gave assurances that this would be addressed and actions taken to minimise risk until it could be mended. Subsequent to the inspection information was received that all window restrictors have been checked and repaired as required. Care Homes for Older People Page 26 of 29 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 27 of 29 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 27 18 That staffing levels be kept under review To ensure that the needs of all residents can be met. 30/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 10 Staff should ensure that residents clothing is changed as required during the day to uphold residents personal dignity That the planning of activities takes into consideration the varying abilities of the residents and their current and past interests. 2 12 Care Homes for Older People Page 28 of 29 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. 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