Inspection on 30/07/08 for Heathside

This inspection was carried out on 30th July 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Heathside 26/07/07

Heathside 22/06/06

Heathside 28/12/05

Heathside 30/06/05

Heathside 03/11/04

Heathside 28/06/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Heathside Heathside Coley Avenue Woking Surrey GU22 7BT     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: Patricia Collins     Date: 3 0 0 7 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 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: Heathside Heathside Coley Avenue Woking Surrey GU22 7BT 01483 765046 Telephone number: Fax number: Email address: Provider web address: derek.purchese@anchor.org.uk Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Anchor Trust vacant post care home 51 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The age/age range of the persons to be accommodated will be: OVER 65 YEARS OF AGE The age/age range of the persons to be accommodated will be: OVER 65 YEARS OF AGE 0 2 0 0 Over 65 20 0 21 8 Date of last inspection Brief description of the care home Heathside is a purpose built care home operated by Anchor Trust Ltd, a national care organisation. The home provides personal care and accommodation for up to 51 older people, with increasing physical and mental frailties and varying mental health needs. The home is situated in a residential area close to the centre of Woking town, with its Care Homes for Older People Page 4 of 31 range of shops and facilities. The accommodation is divided into seven living units over two floors. Upstairs units are accessible by passenger and wheelchair platform lifts. Each unit has a combined dining room, lounge and kitchen and all bedrooms are for single occupancy. There is a large communal lounge on the ground floor that can be used for social activities. There is also a small seating area on the first floor as an alternative place to sit. The home has a large enclosed garden with a furnished terrace and fish pond. There are ample parking facilities. 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: 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: The quality rating for this service is 2 stars. This means that the people using this service experience good quality outcomes. Fee levels ranged from £501.87 p.w. to £618 p.w. at the time of this inspection. The date of the last key inspection was 26th July 2007. The unannounced inspection visit formed part of the key inspection process using the ‘Inspecting for Better Lives’ (IBL) methodology. It took place over nine and a half hours and was undertaken by one regulation inspector. The report will say what ‘we’ found as it is written on behalf of the Commission for Social Care Inspection (CSCI). Care Homes for Older People Page 6 of 31 The home manager represented the organisation and was present throughout the visit together with both deputy managers. Judgements about how well the home meets the national minimum standards for older people have been formed on the basis of the cumulative assessment, knowledge and experience of the home since its last key inspection. The Annual Quality Assurance Assessment (AQAA), which is a selfassessment and dataset completed annually by management, also informed the inspection outcomes. We have taken account of all information provided in surveys from seven people using services, a general practitioner, a care manager and two relatives. We also obtained information through discussions with people using services, managers and other members of the staff team. A tour of the premises and garden took place during which we inspected most communal areas, the main kitchen, laundry and some bedrooms. Records, policies and procedures were sampled and care practice and a group activity was observed. Also arrangements for serving lunch and staff assistance with this meal. We wish to thank all who contributed information to the inspection process. Also the people using the home’s services and staff for their time, hospitality and assistance throughout the inspection visit. What the care home does well: The registered manager vacated her post in September 2007 followed shortly afterwards by a number of key staff, including the deputy manager, deputy chef and some team leaders. The new home manager transferred to Heathside in August 2007 from another Anchor care home in Surrey. He has previously held a number of management posts within the organisation and has been registered in the past. He has relevant qualifications and experience and an application for his registration is now in progress. The management team includes a number of recently promoted staff, including the deputy manager and some team leaders. To enable the team to develop and for individuals to adjust to new roles and responsibilities, a deputy manager has been seconded to the home since June to support colleagues and strengthen the senior team. Observations confirmed an enthusiastic and highly motivated management team. People using services were observed to benefit from a management approach providing effective leadership, direction and support to the team. The home was clean and hygienic at the time of the visit. The environment is domestic in character, comfortable and well maintained. The design and layout promotes independence. Health care needs are met by the primary health care team and care practice respects the privacy and dignity of the people using services. There is a rolling programme of staff training which is aimed to provide a suitably skilled workforce. The homes atmosphere was warm and welcoming and staff were professional in their conduct and friendly and supportive in their approach. The people using services who contributed information to the inspection process mostly indicated satisfaction with their care and the running of their home. They communicated feeling safe and had no complaints. A relative commented, over the past nine months Heathside has had a new manager the difference in atmosphere and kindness is quite staggering. All the care staff are wonderful, nothing is ever a problem and my mother is always clean and tidy though having dementia and being doubly incontinent. She is well looked after and I have never had cause to complain. I have complete faith in the home and never worry about my mother when I go away. We were unable to verbally communicate with all people using services due to their specific needs and conditions. Judgements about their care and welfare have been made on the basis of direct observations that focused on their appearance, behaviours and general demeanour; also on information obtained from records, care plans and discussions with staff. The homes management and operation demonstrates good awareness and understanding of equalities and diversity in meeting needs and promoting antidiscriminatory practices. Recruitment practice ensure the safety of people using services and new staff receive an appropriate induction. Effort is made to establish the interests and hobbies of people using services. This information is used, as far as practicable, in the development of the activities programme. The home has a small shop and hairdressing salon. The hairdresser was providing a service for people using services at the time of the inspection. It was Care Homes for Older People Page 8 of 31 evident that they were benefiting from her input and very much looked forward to her visits. What has improved since the last inspection? What they could do better: It is recognised that the significant staff turnover since the last inspection has had an adverse impact on the NVQ care qualification programme. At the time of this inspection none of the permanent care staff had NVQ qualifications in care and only two bank staff had attained the same. Work was noted to be continuing to achieve the minimum ratio of qualified care staff. Other areas for improvement include record keeping practices specific to care and the need to ensure regular review of risk assessments and care plans. We must be notified of all serious injuries and hospital admissions for people using services. One requirement was made for compliance with the regulation for monthly visits to be undertaken on behalf of the responsible individual and reports produced. 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. Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using services and their representatives receive the information they need to enable an informed choice about the homes suitability to meet their needs. Admission decisions are based on the findings of comprehensive needs assessments to be sure that needs can be met. Evidence: The home has a comprehensive statement of purpose stating who the home is for. The service users guide describes how it operates and is specific to the needs of the people for whom the home is intended. This information is available in suitable formats to meet their needs and that of their representatives. Both documents are included in an information pack which is available in each bedroom. The pack has been professionally produced, providing details about Heathside and other Anchor Care Homes for Older People Page 12 of 31 services. It is stated to be available in a range of languages and comes with a large text /audio DVD disc. The admission procedure is underpinned by Anchors equal opportunities policy. Preadmission assessments are carried out by a skilled and experienced senior member of staff. It involves the individual and their family or representative, as appropriate. Assessments are carried out in the homes of prospective people using services, in hospital or during a day visit to Heathside. Since the last inspection new assessment tools and an improved care planning format have been implemented. The assessment focuses on achieving positive outcomes for people. This ensures the homes facilities, staffing and specialist services meet the ethnic and diversity needs of the individual. The service is efficient in obtaining a summary of any assessment undertaken by care management. Emergency admissions will be accepted on the basis of receiving sufficient information from purchasers to enable an informed decision about the homes suitability to meet individual needs. Though evidence was found of significant time and effort spent planning admissions to make these personal and well managed, observations during the inspection highlighted this area of practice could be further developed. Care Homes for Older People Page 13 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and personal care delivery is based on individual needs assessments and set out in a plan of care. The principles of respect, dignity and privacy are put into practice. Medication policies and procedures ensure the health and welfare of people using services. Evidence: A new assessment and care planning system has been implemented at Heathside and across all Anchor homes since the last inspection. Two experience staff were seconded to the home for two weeks in February this year to support staff in transferring to the new system. Observations confirmed that the approach to assessment and care planning using the new system is inclusive, involving people using services within individual levels of capacity, also their relatives or advocates where appropriate. The new care plans were Care Homes for Older People Page 14 of 31 found to be overall clearly written and easy to navigate. As part of this system a new alert mechanism has been put in place. This informs team leaders and management of significant information and concerns about the health and welfare of individuals. Alerts raise awareness to problems to ensure an appropriate response, generating a care plan specific to this problem which is then follow up by team leaders. A comprehensive range of risk assessments form part of the new system. The manager advised of the intention to transfer from the old assessment tools and documentation to those in the new system specific to supporting people in managing their own medication. Areas of discussion with the manager included the need for improvement in care records relating to care practice to ensure an adequate audit trail. A file examined showed that the care plans had not been evaluated since being written in April and the need for more frequent evaluation was discussed. Records of baths and showers and of monthly weight monitoring, in accordance with this individuals care plan, were incomplete. The importance of ensuring adequate records are maintained so that care plans can be monitored and reviewed was also discussed. The manager confirmed a recent directive from senior management specific to this same point and confirmed this area would be reviewed and improved. People using the homes services receive personal and healthcare support using a person centred approach. Personal support was found to be based upon the rights of dignity, equality, fairness, autonomy and respect. Personal healthcare needs including specialist health, nursing and dietary requirements were clearly recorded in the care plans sampled. Mostly they contained a comprehensive overview of health needs. The managers attention was drawn to the omission to repeat a pressure sore risk assessment for a person using services further to a significant change in mobility. This was after discharge from hospital following treatment for a serious injury sustained during a fall. Consideration could be given to routinely notifying district nurses of pressure sore risk assessment scores that possibly indicate the potential for an individual to develop pressure sores. The need for a more pro-active approach to pressure sore prevention was discussed. It is acknowledged that referrals are made to district nurses for assessment for pressure relieving equipment however staff sometimes delay this until after signs of tissue damage appear. It was evident from another file sampled that district nurses had directed staff to maintain turning charts for a another person at risk of developing pressure sores. This was being maintained by night staff. It was suggested these be used by day staff also on observing this person on bed-rest for a number of hours after lunch. Managers described receiving excellent support from district nurses. Their records for people receiving their services were confidentially stored in a central area of the Care Homes for Older People Page 15 of 31 home. They visit daily to administer insulin and were providing treatment to a number of people, based on individual needs. The home has an efficient medication policy supported by procedures, practice and daily audits. Improvement has been made to the system for medication stock control following a complaint. This related to the home twice running out of prescribed medication for the same person. Medication records were sampled and found to be complete, containing required entries and signed by appropriate staff. Staff have completed and passed an appropriate medication training course. They had their competence assessed to ensure they handle, record and administer medication properly. The home is compliant with statutory requirements for the storage, recording, administration and disposal of controlled drugs. Personal support was observed to be responsive to the varied and individual needs and preferences of people using services. Observations and information obtained from surveys and through discussions with people using services and staff, confirmed an individualised, flexible approach to meeting personal care needs. Good practice was observed by staff in moving and handling and assisting people with personal care, ensuring respect for their privacy. A carers confirmed a key worker system was in operation and she was keyworker for two people. She confirmed that each carer is allocated to a living unit and work on their unit at least two shifts per week. At other times they work across the whole home, enabling them to get to know all the people using services and their needs. This is important to enable good continuity of care and for equitable distribution of workload. Care Homes for Older People Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of social activities are available and people who use the homes services can make choices about their lifestyles. A balanced and varied diet is offered. Evidence: An agency chef manager was covering the absence of the chef who is currently on long- term leave. Discussion took place with the agency chef manager whilst working in the kitchen with a kitchen assistant. Both were observed to wear clean protective clothing and to have current food hygiene certificates. The deputy chef post had been vacant for some time and recruitment to this post stated to be in progress. Meanwhile a chef from another Anchor home covered when the agency chef had a day off. The agency chef has reviewed and improved the menus since working at the home. This was in consultation, as far as possible, with people using services. Some of their suggestions had been incorporated into the new menus. Nutritional assessments are carried out by staff and where indicated general practitioners and dietitians are consulted. Special dietary needs are accommodated and at the time of the visit Care Homes for Older People Page 17 of 31 diabetic and high calorie meals were provided, also soft and pureed foods. The people using services that we consulted were mostly satisfied with the food provided. The kitchen was clean and organised for the time of day and all kitchen appliances stated to be working. The chef manager confirmed having sufficient budget to enable the menus to be followed. The menus include a choice of meals and provide three full meals a day. Home baked cakes and deserts were available and fresh fruit and some fresh vegetables. Care staff serve the meals from a heated trolley in the dining area of the living units or if preferred, in bedrooms. Practice observations were carried out over lunch in all units. Menus were prominently displayed and the dining tables nicely laid with clean table cloths and napkins. Carers wore protective tabards whilst handling food. Since the last inspection the home has introduced Anchors dining with dignity policy and staff had received appropriate training. People using services are no longer expected to pre-order meals and can choose from two meal options. These are plated up by care staff who were noted to show people the choices as well as verbally informing them. If neither option is liked then an omelette, jacket potato or salad is offered. Staff assisting people with their meals were patient and helpful, allowing the time needed to finish the meals comfortably. The meals served on the day of the visit were well presented and enjoyed by the people consulted. Throughout the day hot and cold drinks were being served and drinks dispensers were available on units. The independence of people using services is recognised in the daily running of the home. Their wishes are identified and documented through the care planning process. This includes how they wish to partake in their life style choices. Since the last inspection a full time activity co-ordinator had been recruited butwas no longer in post. Care staff were designated responsibility for coordinating the social care activities programme on a daily basis. An activities programme was displayed on a notice board and various social and recreational events take place. The people using services consulted appeared mostly satisfied with the interim arrangements for leisure and social activities. A person-centred approach to meeting peoples social care needs was being actively promoted by management. The focus is on involving people using services in all areas of their life. A carer commented that she preferred the recent change to social care provision. She recognised her responsibility in this area of care as part of her role. She said the new arrangements were an improvement because carers dont have to hurry people using services with activities of daily living in order to be ready at a set time for activities in the morning. She confirmed that mostly the activities were in the afternoon and at weekends movies are shown on a large screen television with DVD in the large lounge on the ground floor. We were told that sometimes she takes people using services out in wheelchairs for a walk to the town which is nearby. Care Homes for Older People Page 18 of 31 A care assistant who is new in post was observed to be very attentive and caring in her approach. She was providing assistance and encouraging people using services at their own pace, to sit in the garden to benefit from and enjoy the sunshine. On handing a person using services a book of puzzles that individual was noted to express surprise that the carer was aware she enjoyed passing her time in this way. She asked the carer how she had known and appeared very pleased when the carer had evidently taken an interest in her and noted her completing the crossword everyday in her newspaper. People using services maintain contact with family and and friends if they wish to. Visitors can visit at any reasonable time. The local clergy provides regular religious services at the home. Individuals who attend day centres on admission had been encouraged to continue these arrangement. On the day of the visit an activity took place in the garden after lunch. A group of people using services and staff enjoyed a quiz whilst listening to background music. The manager confirmed plans to develop the activities programme and to encourage community involvement. The home held a successful garden fête on the weekend preceding the inspection visit. The home has a small shop that is open for a short time on set days and can be opened at other times by request. This sells items such as toiletries, sweets, stationery and biscuits. There is a hairdressing salon and the hairdresser was providing a service to people during the visit. It was evident that people using services greatly benefited from her input and looked forward to socialising with her. The homes large garden is completely enclosed. Security of this area has been improved following an incident earlier this year in which a person using services left the grounds unobserved. A part-time gardener is a new development. Comments from people using services, their visitors and staff, confirmed their appreciation of improvements in the garden. This affords an attractive outlook, with a safe, wellmaintained fish pond, shaded patio area with seating and colourful flower beds and planters. Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and have access to a robust, effective complaint procedure. They are protected from abuse and their rights are respected by staff. Evidence: The complaints procedure is displayed. A compliments, concerns and complaints leaflets is accessible to the public and included in the information pack. This leaflet invites completion of a short questionnaire enabling expression of views about the home and staff at any time. These can be completed anonymously and sent to the home’s management or external management. People using services who participated in our surveys were informed of the complaint procedure. They were aware of who to speak to about any concerns or complaints. A care manager told us that the manager promptly responds to any complaints or concerns. Complaints are logged in a complaint book, with details of the concerns, action taken and outcome and this cross–refer to correspondence. There had been one complaint received and investigated since the last inspection. This was upheld and the outcome resulted in improvement to medication systems. Care Homes for Older People Page 20 of 31 Safeguarding adults and whistle blowing procedures were in place. Those staff consulted were clear of what action they would take in response to a suspicion or report of abuse. The manager stated that all current staff had received training in safeguarding adults and rights and responsibilities. This training is provided by an external trainer and by the organisation. The homes training records needed to be updated however to reflect recent training in this area. Staff induction records sampled confirmed adult protection awareness had been covered. Safeguarding training was booked for newly appointed staff. Two safeguarding adults incidents were both recorded in the complaint book, with information about action taken and outcomes. On both occasions management had followed the local protocol for safeguarding adults referrals. Staff recruitment procedures ensure new staff are fully vetted. This includes checks against the national register of people unsuitable to work with vulnerable adults and those with criminal records. Systems are in place for the safe storage of money and valuables belonging to people using services. Care Homes for Older People Page 21 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. The physical design and layout of the home enables people who use the service to live in a safe, hygienic, well maintained and comfortable environment, which encourages independence. Evidence: There is an ongoing upgrading and redecoration programme since the last inspection. This has substantially improved the environment. Thought has gone into the use of colour to provide orientating cues that people with dementia can easily understand. This is intended to improve their ability to find their own way around their home. If doors are not meant to be used by people using services, for example leading to sluice rooms or cleaning cupboards, they have been decorated so that they blend in with background walls. And if people using services are encouraged to use a door, for example, leading to toilets, these are highlighted through the use of colour coding as well as use of signage. The building design provides small-group living units where people using services can enjoy maximum independence in a discrete, non-institutionalised environment. This type of design is not only of benefit to people with dementia but also individuals with problems affecting mobility, hearing and eyesight. The living units are individually Care Homes for Older People Page 22 of 31 named and new signage stated to be on order. The building is fully accessible throughout to people with physical disabilities. Adaptations and specialist equipment is designed to fit with the domestic characteristics of the environment. The refurbishment programme has included new furniture in the reception area and large communal lounge and improvement in lighting in lounges. Some kitchenette facilities have also been upgraded in the living units and two baths have been replaced. Other bathrooms have been redecorated, enhancing their appearance and creating a more relaxing atmosphere. All living areas were comfortable and suitably furnished. There is a selection of communal areas, both inside and outside of the home. This enables a choice of places for people using services to sit quietly, to meet with family or friends or to actively engage socially with other people using the service. All bedrooms promote good levels of privacy and the people using services we consulted confirmed that room temperatures were satisfactory and there was always access to hot water. Every effort is made to provide a safe environment for people using services who would be vulnerable if they left the home unaccompanied. External fire doors are alarmed and the front door is fitted with a coded lock for their security and safety. People using services can safely access the enclosed garden which has been significantly improved this year since the appointment of a part-time gardener. The homes management has a proactive infection control policy and ensures a high standard of odour management and hygiene. We spoke with housekeeping staff who confirmed they had received relevant training. Excellent deep cleaning systems were in place and a housekeeper observed to move all furniture in a bedroom whilst cleaning this room. He confirmed that bedrooms were deep cleaned in rotation, carrying out this activity on each unit over a seven week cycle. There had been improvement in housekeeping staffing levels since the last inspection. A housekeeper confirmed his experience of good team work which ensured efficiency and created a happy atmosphere. The laundry room was clean and functional and laundry organised to provide a personal laundry service. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using services are protected by robust staff recruitment practices and their needs are met by the number and skill mix of staff.There is a staff training and development programme for staff to gain the required skills and competencies. The home is working towards compliance with relevant workforce training targets. Evidence: There has been substantial staff turnover since the last inspection for various reasons. This appears to have been managed in a way that has minimised disruption to the homes daily operation and maintained continuity of care . The staff recruitment procedure covers equality and diversity and has the needs of people who use the service at its core. The recruitment process includes new recruitment documentation and ensures robust vetting procedures are followed for their protection. The staffing structure is based around the delivery of outcomes for people using services. Day and night staffing levels for carers have increased since the last inspection as a result of management listening to staff. The rotas sampled demonstrated creative delegation and deployment of staff. This ensures the needs of people using services are met and adequate observation levels are maintained. Care Homes for Older People Page 24 of 31 Throughout the duration of the inspection visit at least one carer was on duty in each unit at all times. Consultation with individual staff members confirmed regular staff meetings take place. These are used for consultation, communication and training purposes. All staff have opportunity to attend these meetings and contribute to the agenda; also engage in discussions influencing the homes development. The content of the staff induction and probationary periods is robust, detailed and service specific. A carer who was relatively new in post expressed opinion that her induction had adequately equipped her for her role and responsibilities. Most of the statutory training had been undertaken during this period and the few outstanding courses had been booked. Records were seen to evidence Anchor BTEC induction training is received by all new staff. A master training plan for the whole team has been put in place. On sampling training records however it was evident that this was not being maintained up to date and excluded recent training events. The manager acknowledged that staff training is an area where improvement needs to be made. Currently none of the permanent care staff have attained a national vocational qualification in care (NVQ). It was positive to note however that nine carers are currently working towards NVQ Level 2 qualifications. The training plan demonstrated that the staff training programme is relevant, targeted and focused on improving outcomes for people using services. Feedback from people using services and relatives was mostly complimentary about staff. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the home is effectively managed and run in the best interest of people using services. Whilst there are areas for improvement that we are confident the provider can manage, there are no significant weaknesses in areas relating to health and safety issues. Evidence: The home manager submitted an application for registration during the course of this inspection. The former registered manager vacated the position in September 2007 and was replaced in August 2007 by the current manager, who transfered from another Anchor home. The manager is appropriately qualified and experienced and Care Homes for Older People Page 26 of 31 has been registered in the past. The management team is new, the deputy manager having left around the same time as the former manager. The current deputy manager was recently promoted to this post and intends to study for the Registered Managers Award qualification. Though the homes management structure has one deputy manager post, at the time of the inspection visit a second deputy manager had been seconded to the home since June 2008. This was for the purpose of strengthening and supporting the management team which also has a number of newly promoted team leaders. Though initially the turnover in key staff had been challenging, the new management team has risen to the same. Positive feedback was received from people using services, relatives and staff about changes and improvements under the new managers leadership and direction. Discussions with managers and other senior staff confirmed a clear vision for the home. This is based on the organisations values, corporate priorities and objectives for achieving quality outcomes for people using services. The annual quality review assessment (AQAA) completed by the manager with input from senior staff, contains clear, relevant information supported by a wide range of evidence. It let us know about changes that have been made and where management still need to make improvements and how these will be achieved. All requirements from the last inspection have been met. The manager fully recognises the importance of the AQAA and has used the content to inform corporate quality assurance systems. These provide continuous self-monitoring and involve consulting people using services and their representatives. Records of visits carried out on behalf of the responsible individual evidenced these had not been undertaken monthly in accordance with statutory requirements. Records were only available to evidence visits carried out in April and July 2008. The findings of the visit in July were recorded on the same record as those of the April visit, in the column for recording responsibility for action points. The manager produced a report of a visit carried out by the regional trainer in June 2008 however this did not cover all statutory areas for compliance with the regulations. A requirement has been made for compliance with Regulation 26 of the Care Homes Regulations 2001(amended). The homes management team is working towards continuous improvement of services. There is a strong focus on equality and diversity issues and an understanding of person centred care. A supervision tracker system had been implemented since the last inspection. Improvement was noted in the frequency of staff supervision meetings. Care Homes for Older People Page 27 of 31 Discussions with the manager and the homes administrator confirmed their knowledge of the organisations financial planning systems. The personal money of people using services is managed using a new corporate financial management system. Weekly audits of finances are a recent development. The home has a comprehensive range of policies and procedures that promote and protect the health and safety of people using services and employees. The management team has a good understanding of risk assessment processes which is underpinned by promoting independence, choice and autonomy. Fire safety is diligently managed and further fire training for the team is imminent. Effective personal emergency evacuation plans (PEEP) have been put in place for each person using services, including respite users. These detail dependency and mobility needs and contain clear instructions on use of SKI sheets if required. Health and safety and other safety audits are regularly carried out. Areas of discussion with management included the need for risk assessments for garden ornaments that could potentially be trip hazards. Statutory records were mostly satisfactory though attention is required to records relating to care. These need to be sufficiently detailed to provide an audit trail of care so that care plans can be evaluated. The need to date all assessments and ensure regular review of care plans and risk assessments was discussed, particularly in response to changes in needs. A more proactive approach is necessary in the area of pressure sore prevention. It was suggested that photographs be placed on care files in addition to the medication administration records. Omissions found in notifications of all significant events was drawn to the managers attention. It was agreed that the system for notifications would be reviewed and strengthened. The homes management is aware that the area of staff training needs to be more robust to ensure all staff receive statutory training and updates. Also for a minimum ratio of 50 trained members of care staff (NVQ Level 2 or equivalent) to be achieved. The intention to complete all personal development discussions with staff was noted. Also for the manager, who is an NVQ Assessor, to attain the Internal Verifiers Award. Care Homes for Older People Page 28 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 29 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 1 33 26 For monthly visits to be 25/09/2008 carried out to the home by an employee of the organisation on behalf of the responsible individual in accordance with this regulation, preparing a report on the outcomes and supplying a copy to the manager which must be available for inspection. To ensure effective quality assurance and monitoring systems based on seeking the views of people using services by a manager external to the homes management. 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 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 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. 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