Inspection on 12/02/09 for Henwick Grange

This inspection was carried out on 12th February 2009.

CSCI found this care home to be providing an Adequate 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.

Other inspections for this house

Henwick Grange 14/07/08

Henwick Grange 01/07/08

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Henwick Grange 68 Hallow Road St Johns Worcester Worcestershire WR2 6BY     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Dianne Thompson     Date: 1 2 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 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 30 Information about the care home Name of care home: Address: Henwick Grange 68 Hallow Road St Johns Worcester Worcestershire WR2 6BY 01325351100 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Southern Cross OpCo Limited care home 56 Number of places (if applicable): Under 65 Over 65 0 56 0 dementia old age, not falling within any other category physical disability Additional conditions: 56 0 56 The maximum number of service users to be accommodated is 56. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Both Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 56 Physical Disability (PD) 56 Dementia (DE) 56 Date of last inspection Brief description of the care home Henwick Grange Nursing Home is a large Victorian building with purpose built extensions. The home stands in pleasant well maintained gardens, providing seating for residents and relatives to sit outside when the weather permits. The home is conveniently situated within the boundary of the City of Worcester. There is ample parking at the home for visitors and a frequent bus service to and from the City. The home provides a vehicle for transportation of residents, which is suitable for people Care Homes for Older People Page 4 of 30 Brief description of the care home with a physical disability. The home changed ownership last year and is now owned by Southern Cross Op Co Limited. The home is registered to provide nursing care and accommodation for a maximum of 56 residents with dementia, a physical disability or frailty due to old age. There is good access into the home via a touch pad operated automatic door. Accommodation is provided over two floors with a passenger lift providing access to first floor rooms. Up-to-date information relating to the fees charged for the service is available on request from the home. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection to see what the service was like for the residents of Henwick Grange. A key inspection looks at all essential aspects of operating a care home. This type of inspection looks for evidence that shows continued safety and positive outcomes for people who use the service. The last inspection of this service was completed on 01/07/2008. The inspection took place during one day and the manager was present throughout the inspection. The manager, the project manager, operations manager and various members of the staff team provided assistance during the visit. The manager completed an Annual Quality Assurance Assessment (AQAA) and sent this Care Homes for Older People Page 6 of 30 to the Commission for Social Care Inspection (CSCI). The AQAA is where the manager tells us about the service provided at Henwick Grange and how they plan to develop the service. Three residents were identified for close examination by reading their care plans, risk assessments, daily records and other relevant information. This is part of a process known as case tracking where evidence of the care provided is matched to what life is like for residents living at Henwick Grange. Time was spent talking with residents, visiting relatives and some staff working there. We looked to see whether residents were being kept safe and how the service listens to residents views about their life at Henwick Grange. We saw how staff spoke to and supported residents, during mealtime and the administration of medication. We looked around the home to see what the standard of accommodation was like. What the care home does well: What has improved since the last inspection? Full assessments are now completed before anyone moves into the home. This makes sure the service can give people the care they need and that staff have all the information to provide this care. Care plans are in place to show what care and support residents need and how this is to be provided. Care plans are being reviewed and updated regularly. Risk assessments are in place where potential risks have been identified, such as the use of bedrails. Regular resident and carers meetings are being held. There is now a clear audit trail for all medication received and stored by the service, Medication is being given to residents as prescribed. Meals now include more fresh vegetables and more choices for residents. Heated trolleys now keep food hot while it is being served to residents in their rooms. Care Homes for Older People Page 8 of 30 The service now responds to complaints in a timely way according to their complaints procedure, and records are kept to show this. Areas of the home have been redecorated and there are plans to redecorate other parts of the home. All staff are now receiving training in infection control. A new private room has been provided for visitors, professionals and staff to use. Changes to the shared bedrooms have been made so that residents have rooms with enough space for their belongings. The number of staff working at Henwick Grange has been increased since the last inspection of this service, and means that residents are better supported. Staff recruitment procedures are now followed to make sure people who work at Henwick Grange will keep residents safe. Regular training for all staff has begun and more training is planned. Domestic staff are also to complete their NVQ training. Each shift now has a member of staff who is trained in first aid. All residents are being asked to fill in surveys about the service they receive from Henwick Grange. Information from these surveys will help the service plan future improvements. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 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. Henwick Grange gives prospective residents and their relatives up to date information about the service they provide. People can also visit the service to help them decide about their future care and accommodation needs and whether the service can meets those needs. The service does not provide intermediate care. Evidence: Henwick Grange offers a range of up to date information about their service including a copy of their Service User Guide. This information is available to people and their families when considering their future care needs. We saw a copy of the Statement of Purpose on display in the main entrance of the building and this is easily accessible to residents of Henwick Grange and visitors. Information about activities taking place, a copy of the latest newsletter and information about how to complain is also displayed on the notice board in the main entrance. Care Homes for Older People Page 11 of 30 Evidence: Residents and their relatives confirmed they had been given a copy of the Service User Guide and other documents, although one resident we spoke to said they were unsure about the information they had been given. Relatives confirmed they had been able to visit to help their relative making their decision about where they wanted to live. The manager says in the services AQAA that relatives and prospective service users are encouraged to visit the home to look around at the initial enquiry. Brochures about the home are given to or posted to interested parties. The manager said the service is looking to make information about their service more accessible to people by improving their website by keeping it up to date. At the last inspection two requirements were made with regard to Regulation 14, that a pre-admission assessment must be carried out before admission and must be sufficiently detailed to enable staff to formulate a care plan necessary to ensure residents needs are met. The manager confirmed in the services AQAA that pre admission assessments are now in place. A sample of three care records were checked and we saw that detailed assessments had been completed before people moved into Henwick Grange. We saw that a checklist for admissions was completed, and this included individual profiles, completion of the admission register, and medication on admission details. We saw where information about each persons medication was entered onto a relevant medication form. There was a record of medication received on admission. We saw that body mapping charts and weight charts had been completed for each person on admission. The pre- admission assessment now gives sufficient details so that care plans can be developed before people are admitted to the home. This makes sure staff can give the support people need. This meets the requirement of the previous inspection. Residents and relatives spoken with confirmed that pre admission procedures had been followed. Residents said that staff treat me well they are very good here, thats why I came in here. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to care plans and risk assessments so that staff have the information they need to meet residents care needs, but the lack of guidelines for people who are at risk of choking means people are not kept safe. Improvements to medication systems mean that residents can be confident they are being given their medication safely, as prescribed. Evidence: Three residents were identified for close examination by reading their care plans, risk assessments, daily records and other relevant information. This is part of a process known as case tracking where we look at what life is like for people using the service. At the last inspection a requirement was made under Regulations 14 and 15, in respect of care plans. Care plans must be in place and sufficiently detailed to enable staff to understand and meet the health and care needs of residents. And that care plans must be reviewed and updated in light of any change in care needs so that residents can be sure their needs will be met. Care Homes for Older People Page 13 of 30 Evidence: We saw that care plans have been developed from pre admission assessments. We saw that where possible residents had been involved in the planning, development and review of their care plans. We saw information that explained what staff need to do to make sure that residents personal, health and care needs are met. Each plan of care has been reviewed regularly, for example, reviews had been held on 28/10/08, 29/12/08, and 13/1/09. Each residents support needs as in social, medication, communication, death and dying, skin assessment and skin care are included in care plans. We saw information about residents preferred routines, especially the time they like to get up and go to bed. One resident said they like to have a lie in some mornings and that they go to bed when they want to. Residents confirmed they are able to choose when they get up and the time they go to bed. Relatives confirmed that staff give the care that is needed, although one relative said they would like the hairdresser to do their [relatives] hair, and hang some nuts for the birds outside the bedroom window for their relative to watch them feed. Residents indicated in surveys that they were generally satisfied with their care, although one person commented they were not able to choose when to have a bath. Other comments include staff respect my dignity and privacy. One relative said their mother feels secure which I feel is a great thing. The service uses the Malnutrition Universal Screening Tool (MUST) to assess residents on admission and where there are concerns about their weight, residents are weighed weekly until their weight increases or stabilises. Records of all food and fluid intake are kept for all residents so that staff can monitor and assess their well-being. The service maintains records where residents are at risk of or have depression to keep check on their condition. The manager was advised that the form they use when they review residents conditon is called the three monthly evaluation tool, which may limit how often staff make these checks. Such reviews should be done as often as is needed for each resident and agreed in their care plans. The manager agreed to revise this process. We saw risk assessments completed for areas of identified risk. At the previous inspection an immediate requirement was made a bedrail risk assessment must be done prior to use to ensure the safety of the resident. We saw that the deputy manager had completed risk assessments for the use of bedrails, for example we saw one dated 5/2/09. We also saw that bumpers were in place where bed rails were being used. Care Homes for Older People Page 14 of 30 Evidence: In daily records for one resident it was noted that the use of bedrails had been refused. The record did not show what action had been taken (if any) to make sure the resident was kept safe. The record was also unsigned so it was unclear who had recorded this information. This was discussed with the manager who advised that a temporary mattress had been placed on the floor by the bed for protection and that crash mats had been ordered. The manager agreed that all records should be signed, they should reflect the decision making process and any action taken. The moving and handling assessment explained the type of support people need. The use of equipment such as a profile bed and pillow, hoists and slings including the size and type of sling to be used was specified. This makes sure staff use equipment in an agreed, safe and consistent way. We saw that equipment was being used in residents rooms as advised in their care plans. It was recorded that a person who is at risk of choking had more than one episode. There was no written evidence to tell us what action had been taken or if this was followed up to reduce this from happening. This means that residents are not being kept safe from harm. From the care plans we could see that residents are well supported by their doctors, district nurses and other health care specialists as required. The manager states in the services AQAA that service users are registered with local GP of their choice, health care professionals include social workers, district nurses, audiologists, dentists, chiropodists, physiotherapists, dieticians, speech and language therapists and the tissue viability nurse. A medidose system for storage and administration of medication is used by the service. Prescribed medication and records were checked for the residents being case tracked. There is now a clear audit trail. Medication Administration Record Sheets (MARS) were checked. We saw that all medication had been given as prescribed and signed for, and that records were up to date linking with residents care plans. Residents confirmed they were given their medication on time and safely. Observations were made for two medication rounds completed during the inspection visit. Medication is stored safely and correctly in a lockable medical cabinet that is stored in the nurses office. The manager states in the services AQAA that we employ both RMNs and RGNs. All trained staff are having accredited medication training at present. We have dignity in care champions who regularly attend training. At the last inspection a requirement was made under Regulation 13. Medicine records for the administration of medication must document what has been administered or record a reason why it was not administered in order to ensure the residents who use Care Homes for Older People Page 15 of 30 Evidence: the service are safeguarded. The records show that information is now recorded. This requirement has therefore been met. Time was spent talking with residents. They said they were treated with respect and that staff were kind to them. Some residents said they thought staff are kept busy and they have lots to do. Staff were seen to be kind and patient when speaking to residents, and that residents were not rushed. Staff appeared gentle and keen to make sure residents needs were being met. We observed friendly interaction between staff and visiting relatives. Care Homes for Older People Page 16 of 30 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. Residents are supported to take part in activities, maintain their interests and their religious beliefs. Residents are encouraged to keep in touch with family and friends, and visitors are welcome to visit at any time. Residents are offered a varied choice of meals and snacks to maintain a wholesome diet. Evidence: The service employs two activity co-ordinators who between them arrange activities seven days a week. Time was spent with one of the activity co-coordinators talking about their job, current activities and future activity plans. The coordinator was very enthusiastic about her role and the ways of promoting daily living skills for all residents including frailer residents who spend most of their time in bed. The coordinator explained that she was currently supporting residents to complete the quality assurance surveys for the service. Residents confirmed the service provides good activities and they really enjoy taking part. Feedback from the previous evenings relatives meeting was very positive about the activities on offer and taking place. Care Homes for Older People Page 17 of 30 Evidence: We saw as copy of the services newsletter displayed in the entrance hallway and in residents rooms. This gave reports of recent activities that had taken place, such as gardening in the area of garden that has been made available for growing vegetables and some flowers. There is a weekly plan of activities that includes Bingo on Fridays. There is a computer in the lounge that residents use if they wish to. Some residents help in the production of the weekly newsletter. The coordinator talked of plans to offer music and movement sessions involving gentle stretching exercises for residents wishing to take part. We saw pictures on display and available for sale that had been painted by one of the residents. Activity plans record details of activities residents have taken part in. The manager states in the services AQAA that there have been more in house entertainment and external outings since the last inspection. Residents confirmed this. The activity coordinators are developing individual profiles for residents as they learn more about their interests. This will help to develop and plan activities in a more person centred way. We met with visitors who said they were able to come and go as they pleased and there were no restrictions on the number of times or the time of day that they visited. Relatives said they are made welcome to the home and are offered drinks and meals if they are there for long periods of time. A local minister provides communion each month and staff spoken to said they were aware of the religious needs of the residents being case tracked. There is a four-week rolling menu that offers of a choice of meals and deserts. For example, there are two choices for the dinner menu, with further options such as omelettes. For tea, there is a cooked meal option or soup and sandwiches. One comment about the food from residents surveys thought food served was baby food. The manager said they have changed the menu several times to improve the meal choices. Menu sheets are shared with all residents by the activity coordinator who confirmed that residents are happier with the menu now. Residents comments include more fresh vegetables now, I like the food and there is a good choice of meals. At the last inspection it was recommended that the manager reviewed the service of meals to residents upstairs to make sure that food temperatures are maintained whilst staff are serving and assisting residents to eat their meals. The manager stated in the services AQAA that they now have heated trolleys on both floors and a hot water heater in the kitchen. The heated trolleys were seen on both floors and this meets the recommendation. Care Homes for Older People Page 18 of 30 Care Homes for Older People Page 19 of 30 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. Henwick Grange follow their procedures to make sure that any complaints or allegations of suspected abuse are taken seriously and that residents are protected. Evidence: The service has a complaints procedure that explains how complaints can be made and how the organisation will respond to these. The procedures confirm that all complaints will be responded to within a maximum of 28 days. We saw a copy of the complaints procedure made available to everyone in the main entrance hallway. A log of all complaints is kept. The service has clear information about local safeguarding policies and how to make contact if needed. Staff are aware of their responsibilities, the whistle blowing policy and precedures to follow should they have any concerns. Residents spoken to said they were aware of how to complain, and said they would talk to their family if they were worried about anything. Two residents indicated in surveys that they did not know about the complaints procedure. Visitors confirmed they were aware of the complaints procedure and visitors spoken to said they had not needed to make any complaints. Information supplied in the services AQAA shows that 12 complaints have been Care Homes for Older People Page 20 of 30 Evidence: received and one safeguarding investigation has taken place since the last inspection. The manager said that all complaints were responded to within 28 days. The Commions for Social Care Inspection has received no complaints or adult protection referrals since the last inspection. Staff spoken to say they would know how to respond should they have any concerns, and they would report any concerns they may have to the nurse on duty or the manager. Residents confirmed that they felt well cared for and that they are happy at Henwick Grange. Comments include its a nice home. Relatives and residents are supported to share their views and give feedback on the service through their regular meetings. A residents meeting was planned and took place on the day of the inspection visit. The manager says that meeting regularly with residents and relatives maintains good communication, this helps with early responses to concerns and monitoring of standards. Staff training records show that staff received training in the Protection of Vulnerable Adults (POVA), and staff were very clear about the action they would take if they suspected a resident may be at risk. Care Homes for Older People Page 21 of 30 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 of Henwick Grange enjoy a comfortable and homely environment. The home is spacious and is kept clean and well maintained. Evidence: Henwick Grange Nursing Home is a large Victorian building with purpose built extensions. There are pleasant well-maintained gardens, providing seating for residents and relatives to sit outside when the weather is good enough. There is good access into the building via a touch pad operated automatic door. Accommodation is provided over two floors with a passenger lift giving access to first floor rooms. We looked at parts of the building that included some residents bedrooms. The home is well maintained, attractively furnished and has a pleasant atmosphere. There were no odours noticeable during the inspection visit. Time was spent talking with residents in their rooms about the service they receive. We saw that residents are encouraged to have their own furniture and personal possessions to furnish their rooms and make them more homely. Residents and relatives commented that rooms are comfortable, rooms are warm, there is a Care Homes for Older People Page 22 of 30 Evidence: pleasant smell in the home and they are able to move about freely. The laundry room is located in a separate building in the grounds. All cleaning materials are locked in the laundry room. Staff were seen using personal protective equipment suitable for the work they were doing. The manager said that all staff complete infection control training and records confirm this. Routine repairs are carried out in-house and maintenance records are kept. The manager states in the services AQAA that improvements carried out in the past twelve months have included a new private room for visitors, visiting professionals and staff. Plans for the coming year are to create a new clinical room, redecorate in many areas, and refurbish several areas of the home. The manager said that changes to the use of shared bedrooms has been made, so that residents have bedrooms with enough space to have their own possessions around them. The communal areas of the building are comfortable and well maintained. Dedicated staff are employed to keep the environment clean and welcoming. Care Homes for Older People Page 23 of 30 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. Training is planned to help staff provide the care and support people living at Henwick Grange need. All checks are now completed to make sure that suitable staff are employed to keep residents safe. Evidence: Staff levels at Henwick Grange have been increased since the last inspection. The manager said that they have successfully recruited to the team and are planning to enhance the staffing levels further. Residents commented in surveys that they were generally satisfied with the service and the staff. Staff appeared to be enthusiastic and well motivated. Staff confirmed they are well supported by the management for the service and by the organisation. Comments include the nursing staff make sure things happen. They help to support communications and teamwork is good here. The manager says ther are plans to improve the continuity of care by creating two staff teams who will work to each floor of the home. Additional staff are to be recruited for this and residents have been asked to choose names for each floor. This will make sure that continuity of support is improved for all residents. Recruitment procedures are now in place and followed to make sure suitable people are employed. Records for four members of staff were checked, including two nurses Care Homes for Older People Page 24 of 30 Evidence: and two care staff. All required information was seen including confirmation of address and identity. All applicants complete an appropriate application form and Henwick Grange make sure that suitable references are obtained including one from most recent employers. Appropriate criminal records and other checks such as checking nurses are registered with the Nursing and Midwifery Council (NMC), are done before employment is confirmed. All staff are required to work a probationary period. The manager confirms that all new staff complete training to make sure they can meet the needs of people they support. We saw the training programme for all staff for the coming year. Mandatory training such as Health and Safety, Fire Safety, Food Hygiene, Moving and Handling, Infection Control, Nutrition, Dementia Awareness and Vulnerable Adults is planned. First aid training is arranged for 28/2/09 and 14/3/09. The manager said that improvements to the service since the last inspection has included implementation of regular training, the recruitment of all grades of staff, and staff files audited. First aiders are on every shift now including kitchen staff, cleaners and laundry. A staff register is now being kept which gives details of staff, job role, qualifications, hours worked, start dates and leaving dates with reasons where appropriate. Records were seen to confirm this. According to the information recorded in the services AQAA, 14 permanent staff have NVQ qualifications from a staff team of 36 care workers. This does not include 18 staff employed in non-care roles. The manager plans to increase the number of staff doing NVQ training and maintain the training programme for all staff this year. Care Homes for Older People Page 25 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the service has improved and staff receive the leadership and support they need. Southern Cross makes regular checks to ensure people living and working in Henwick Grange are kept safe. Evidence: The manager, Jeanette Bedford has many years experience working in care and is a qualified nurse (RMNH). Jeanette has achieved her Registered Managers Award (RMA) and was previously a registered manager for another home with Southern Cross. Jeanette is also an NVQ assessor and has a current first aid at work certificate. Jeanette regularly completes training relevant to her position and said she is currently completing her registered manager application to send to the CSCI . Jeanette is supported by a deputy manager and has recently recruited an administrator to the service. The Annual Quality Assurance Assessment (AQAA) was completed and sent to the Care Homes for Older People Page 26 of 30 Evidence: CSCI prior to the inspection visit. The AQAA is where the manager tells us about the service provided at Henwick Grange and the ways they plan to improve the service. The manager states in the services AQAA, that she operates an open door policy of access to all. Surveys confirm that people are made welcome and are able to talk to the manager and staff at any time. Staff confirmed the manager is approachable and available to talk to. The provider regularly visits Henwick Grange as one of the ways to monitor the service and how it is being run. At the time of the inspection Jeanette was being given support from the Project Manager and Operations Manager to put systems and procedures in place to help develop the service. The Project Manager said that work is progressing to complete the transfer to Southern Cross formats as soon as possible. There is a structured support network in place to help Jeanette in her position as manager, and for staff to develop the service and adapt to the Southern Cross ways of working. The manager states in the services AQAA service user surveys will be completed and the results analysed and actions identified from this will be part of the continued development of the service. Policies and procedures are in place to protect residents finances. The manager says the service carries out regular financial audits to make sure that records and receipts of all financial transactions are kept. Health and safety is generally well managed and there are good operational systems in place. We saw records show that monthly checks of the fire safety system and equipment, water temperature and storage, fridge, freezers and electrical appliances are completed. Staff training in mandatory health and safety topics and generic risk assessments is being arranged and completed. Monthly health and safety meetings are held with minutes available. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 4 (c) Unnecessary risks to 13/04/2009 the health or safety of service users are identified and so far as possible eliminated. Guidelines and records must show how risks are to be reduced and managed. This will help staff support residents in a consistent way and keep them safe from harm. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 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. 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