Inspection on 30/09/08 for Heronswood

This inspection was carried out on 30th September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heronswood 07/08/09

Heronswood 12/09/07

Heronswood 10/07/06

Heronswood 05/12/05

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

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 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Heronswood Heronswood 51 Harestone Hill Caterham Surrey CR3 6DX     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: Jane Jewell     Date: 3 0 0 9 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 35 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 35 Information about the care home Name of care home: Address: Heronswood 51 Harestone Hill Heronswood Caterham Surrey CR3 6DX 01883344645 01883341232 gurl_red19@yahoo.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Susan Jane Bodle Type of registration: Number of places registered: S.E.S Care Homes Ltd care home 21 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 Additional conditions: Date of last inspection Brief description of the care home Heronswood is a converted and developed detached house providing accommodation for older people. The home is provided over three floors and the upstairs accommodation is accessed by a passenger lift. The home has two lounges and a conservatory, which leads from one of the lounges to the rear of the house. The home has a separate dining room. Fifteen of the eighteen rooms have en-suite facilities. There is a well-maintained and accessible garden to the rear of the house and parking facilities are available at the front. The weekly fees range from #514-#595. Extra Care Homes for Older People Page 4 of 35 Over 65 6 1 21 0 0 0 Brief description of the care home charges are made for hairdressing - shampoo and set is charged at #8.30 - Cut, shampoo and set is charged at #14.50 Chiropody is charged at #10.50 per person. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The information contained in this report has been comprised from an unannounced site visit undertaken over six hours and information gathered about the home before and after the site visit. The previous manager had completed an Annual Quality Assurance Assessment form prior to the inspection and the information contained in this document has been used to inform the site visit. Feedback comment cards were sent to the home in advance of the site visit for the home to distribute and six were returned. Two were from residents one from relative and three were from staff. A summary of their feedback is contained in this report. There were eight residents at the home at the time of the inspection. Mrs Devianni Dinand (the person appointed by the provider to manage the home and Care Homes for Older People Page 6 of 35 hereafter referred to as the person appointed to manage) facilitated the site visit. The site visit involved a tour of the premises, examination of the homes documentation and in-depth discussion with four residents and three staff. Five relatives were also consulted about their experiences at the home. The inspector spend time observing a small group of residents during lunch time and in their daily routines and in their interactions with staff. This was in order to assess the well-being of residents who are not able to verbally share their experiences of the home. What the care home does well: What has improved since the last inspection? What they could do better: Variable experiences were noted by residents and their relatives of the home and its practices. Although progress has been made to start providing consistently good Care Homes for Older People Page 8 of 35 outcomes for residents at the home much work is still needed. The requirements made at this inspection and the agreement by the person appointed to manage to improve some areas immediately are designed to promote residents quality of life and improve their safety. Care plans need to accurate reflect residents needs and the risks they face and pose, in order to ensure consistently safe care is able to be provided. The admission procedure needs further action to ensure that new residents needs are properly assessed and that the home only admits residents whos needs can be safely met by living at the home. There are currently limited opportunities for occupation and stimulation. This needs to improve in order to further enhance residents quality of life. A relative commented: activities not aware of a great deal of things to do and not enough of the right encouragement from staff to motivate residents into doing things and there is a generally a programme but my relative does not attend and this is not good for their emotional well being. Although residents have some choices over their daily lives further work is needed to ensure that residents are able to exercise as much control over their daily lives and routines as is possible. Parts of the premises are not fit for purpose and do not enable the home to meet the aims and objectives. Comments included: old house could be spruced up a bit better Environment cant walk outside in the garden as it slopes and wheelchair access is very difficult have to go out the dinning room door and around the side of the building which is not easy as hard to navigate. Variable feedback was received regarding the standards of cleanliness, comments included: Environment kept clean feels like a home, Bedroom carpet is not cleaned shampooed often enough to maintain a clean healthy environment and doesnt smell but it does not exactly feel clean the bathroom is not too nice. Residents benefit from a motivated person in charge who has gradually made positive improvements to practices at the home, and now needs to register with the Commission in order that there is a accountable person in charge of the day to day running of the home. Staff need to be appropriately trained, supervised and able to communicate clearly in order to ensure that the range of residents needs can be met. Comments about staff included: At weekends there is not always someone on duty who has the authority to make decisions and always refer on which can delay action Staff fine friendly most of them are usually helpful approachable, English can be limited sometimes A couple of them are ok weekend staff not so friendly and accommodating or say very much, communication can sometimes be difficult if there English is not too good when we first visited there command of English was poor but now things seemed to have improved staff now they are good I like the way they interact and the staff are very helpful. Care Homes for Older People Page 9 of 35 Advice needs to be sought from the fire safety officer regarding some aspects of fire safety at the home. The environment must be risk assessed to highlight any areas where residents could be at potential risk. Medication systems generally protects residents safety with further recommendation made to better protect residents. 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 10 of 35 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 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides both prospective and existing residents, with most of the information about what services are provided and what to expect when living at the home, with minor additions needed to ensure that a wider range of information is available. Evidence: There is a range of information about the home and the services it provides, this includes a statement of purpose and service user guide. These are given to prospective residents, representatives and other interested parties. In line with previous requirements the homes literature had been updated accordingly, however the range of needs the home is able to meet including the different types of placements offered must also be included in this literature. This is to inform interested parties about what level of needs can be safely met at the home. The person appointed to manage agreed to update this immediately. Care Homes for Older People Page 12 of 35 Evidence: The person appointed to manage confirmed that residents are provided with a written contract of terms and conditions of residency with the home. This enables residents and their families to be informed of the placement arrangements and to clarify mutual expectations around rights and responsibilities. Records inspected for a recent admission showed that the home obtains a copy of a care management assessment from the placing authority, and also conducts its own basic needs assessment. Improvements need to be made to the quality of the homes own assessment to ensure that there is sufficient information upon which to base a decision that needs could be met by the home. This is with particular reference to ensuring that any assessment is in line with the homes admission criteria and the level of need that can safely be accommodated. For example in reference to the level of mobility needed to be able to use the facilities at the home. There is a range of needs currently being accommodated at the home including residents who have complex dementia, physical needs and a resident who lives a fairly independent lifestyle. The majority of residents are assessed as having a medium level of need. Variable feedback was received from residents and relatives regarding their overall experiences of the home, which are highlighted throughout this report. A sample of comments included: Overall quite impressed with the place Its not institutionalised Hersonwood is a very comfortable residential home and They dont seem to do very much with the residents as they just seem to sit in the lounge all day with the TV on and The language and cultural difference of some of the staff does present a barrier. Consistent positive feedback was however received regarding the good standard of physical care provided. A sample of comments included: the best thing about the home is they look after residents well happy with standard of care and they always make sure he is psychically well looked after. The current low level of occupancy means that the home is able to focus its resources on the current residents and they were able to evidence that they could meet most needs of these residents. The person appointed to manage was however aware of the improvements needed to the environment, staffing and care planning before full occupancy occurs. Residents and their representatives consulted with spoke of being provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home. Most residents consulted said that it was their families that looked around the home on their behalf. The first six weeks of occupancy is looked upon as trail occupancy. Where social services are the placement authority it is usual practice that within this period a review be undertaken to determine whether the residents wishes to stay permanently or not. Care Homes for Older People Page 13 of 35 Evidence: Intermediate care is not offered at the home therefore this standard is not assessed. Care Homes for Older People Page 14 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans need to accurate reflect residents needs and the risks they face and pose, in order to ensure consistent care is able to be provided. Medication systems generally protects residents safety with further recommendation made to better protect residents. Residents receive the health care intervention they need from a range of health care professional. Personal support is offered in ways, which generally promotes and protect residents privacy and dignity. Evidence: The person appointed to manage had previously identified areas for improvement within the care planning process and were in the process of updating care records. Five plans of care were looked at and although the format would enable sufficient information to be recorded about a residents needs this had not always been completed satisfactorily. Where there was clear guidance for staff to follow on meeting Care Homes for Older People Page 15 of 35 Evidence: residents needs an example was noted whereby this was not being followed. The home has been required to review the care plans to ensure that they provide clear accurate and up to date information on residents needs and how these can be met to ensure a consistent approach by staff. Not all of the risks faced and posed by residents were assessed or the actions needed to reduce or manager risks recorded. The manager has been required to ensure that as part of care planning process, comprehensive personal risk assessments are completed which are reviewed regularly. This is with particular reference to mobility, use of steep stairs within the home and any complex or challenging behavior. There was evidence of involvement of appropriate healthcare professionals including a General Practitioner, district nurses, community psychiatric nurse, and chiropodists. Residents and relatives confirmed that the home acts quickly for requests for medical intervention. The system for the administration of medication was generally adequate with suitable arrangements in place to ensure residents medication needs are able to be safely met. However to further ensure residents safety it is recommended that additional instructions are provided for staff on the administration of As required medication, which make clear the individual requirements for when these medications are prescribed. In order to fully eliminate the associated risk when copying prescribed instructions onto medication administration records, it is recommended that these records should be checked and countersigned for accuracy by a second member of staff. Examples were noted whereby staff had forgotten to record when some medications were received. The person appointed to manage agreed to remind staff of the importance of completing this to provide an audit trail of all medication. Staff consulted with showed an understanding of good practices in preserving residents rights to privacy and dignity. Staff were able to give examples of how they promote these rights in their every day care practices. A relative spoke of how incontinence issues have been dealt with in a dignified manner. Some bedroom doors currently do not have locks fitted, the person appointed to manage confirmed that residents are offered the opportunity of locks being fitted. Some care information is displayed in residents bedrooms, this does not promote residents privacy and the person appointed to manage agreed to remove them immediately. Care Homes for Older People Page 16 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are currently limited opportunities for occupation and stimulation necessary to enhance residents quality of life. Links with the local community are limited and links with family and friends are generally supported. Although residents have some choices over their daily lives further work is needed to ensure that residents are able to exercise as much control over their daily routines as is possible. Evidence: Variable feedback was received on the opportunities for occupation and stimulation. A sample of comments included: activities not aware of a great deal of things to do and not enough of the right encouragement from staff to motivate residents into doing things there is a generally a programme but my relative does not attend and this is not good for their emotional well being and aware that they do some nice activities such as music. Staff spoke of undertaking dancing, exercise session and manicures with residents. At the time of the inspection a group of residents were observed Care Homes for Older People Page 17 of 35 Evidence: undertaking a game of indoor bowls. It was not clear what opportunities are provided for residents to go out and access local community. The person appointed to manage had identified this as an area that needed further action. It has been required that residents social needs and preferences are identified and suitable opportunities for social engagement and meaningful activities are provided based on these identified needs in order to further enrich residents lives. There is a homes cat which residents clearly enjoyed watching and caring for. Relatives and residents said that their visitors could visit them at any reasonable time. A sample of comments included: go any time usually welcoming My relatives can pop in whenever they want and when we first visited we received coffee and biscuits in the lounge now when I visit I only get tea or coffee if it coincides with residents tea and coffee. A relative spoke of the good level of communication between the home and themselves and how they were kept informed of any significant changes in needs. It was clear that residents are given some choices in their daily lives for example times for rising and going to bed. Once up however the vast majority of residents remain in the lounge until going to bed in the evening. Residents limited access to their private accommodation is largely due to the layout of the building as access to the majority of bedrooms required the assistance of staff to use the lift. It was not clear what arrangements are in place to ensure that those residents whos level of dementia means that they are unable to make a independent choice to go to their bedrooms are given the opportunity to during the day for either personal time or for a sleep in their bedrooms. On the day of the inspection all residents had the same meal despite it stating on a care plan that a resident did not like aspects of this particular meal. A sample of comments made about the food included: my dad has a very good diet quite good will get you something else if you dont like it and no complaints very good. There was no clear record of the meals provided therefore it could not be clearly identified the level of choices provided to residents. The meal served at inspection was appetising with discrete assistance offered to those residents that needed support however staff did not always show an awareness of good food practices in the care of people who have dementia. This is with particular reference to the encouragement needed, presentation and orientation at meal times. The practice of staff wearing disposal gloves when assisting residents to eat did not promote residents dignity and the person appointed to manage said that this was not the homes usual practice and would cease this practice immediately. Care Homes for Older People Page 18 of 35 Care Homes for Older People Page 19 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaints system with evidence that residents and relatives feel that they are able to raise any concerns, however not all concerns were reported to be acted upon swiftly. Staff have the guidance necessary to show them what to do if abuse is suspected, however this needs to be supported by training so all staff are clear on their roles and responsibilities. Evidence: There is an accessible complaints procedure for residents, their representatives, and staff to follow should they be unhappy with any aspect of the service. Variable feedback was received on the effectiveness of the home responding to complaints and minor concerns made to the persona appointed to manage and provider. However all person consulted with felt confident to approach the person appointed to manage with any concerns that they might have. There has been one formal complaint raised to the provider, which at the time of the inspection the provider stated they were in the process of investigating. The home has written policies covering safeguarding adults and whistle blowing. These identify the vulnerability of people in residential care, and the duty of staff to report Care Homes for Older People Page 20 of 35 Evidence: any concerns they may have to a responsible authority for investigation. Not all staff had received current training in safeguarding adults and the prevention of abuse and this was evident in their level of understanding of their roles and responsibilities.The person appointed to manage stated that all staff were due to undertake this training shortly. It was further discussed that the person appointed to manage should undergo managerial training in this area to ensure that they were also clear on their roles and responsibilities under safeguarding guidelines. Care Homes for Older People Page 21 of 35 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a homely environment, however parts of the premises are not fit for purpose and do not enable the home to meet the aims and objectives of the service as stated in the homes statement of purpose and homes registration. Evidence: The home is in an elevated position on the outskirts of a town centre, access to local facilities involves a short journey or walk which involves a steep inclines. Variable standards of maintenance and repair were observed throughout the home, with newly decorated areas completed to a good standard while other areas were in need of refurbishment and upgrade. Comments about the environment included: old house could be spruced up a bit better and Very homely. The person appointed to manage had developed a plan of refurbishment and was in negotiation with the provider to ensure that these works were done in a timely manner. It was reported that delays in addressing maintenance issues can occur due to having to seek the budget to complete the work from the organisation. The home employs a part time maintenance staff who at the time of the inspection addressed immediately a serious trip hazard noted by the inspector. Bedrooms were observed to have been individualised with residents personal effects. Care Homes for Older People Page 22 of 35 Evidence: The home is presented across three floors with the vast majority of residents accommodation above ground level. The stairs to the second floor were noted to be particularly steep and required considerable mobility to use them safely. It was reported to the inspector that no residents use the stairs all use the lift and have to be accompanied by a member of staff. Concern was noted regarding this situation especially in the event of a fire. Due to the reliance on the lift the person appointed to manage reported that the lift is regularly serviced and that they have access to emergency call out should the lift break down. A relative commented: when the lift broke down she remained in her room for 24 hours. Communal space consist of a lounge, dinning room and small conservatory, much effort has been made to create a homely feel to these areas. There is a rear garden, which is set to lawn with flower beds and although well maintained is slopping and not accessible to residents to use safely and independently. It was previously required that the external security arrangements be reviewed to ensure the safety of the residents. A wire fence has been put around part of the garden but there remains a need for a gate in order to secure the garden. The person appointed to manage said that a gate is due to be fitted in the near future. There is sufficient number of toilets and bathrooms located around the home, including the majority of bedrooms providing en-suite facilities and assisted bathing facilities. Several relatives commented on how some restrictions of the building impacted on their relative, their comments included: Environment cant walk outside in the garden as it slopes and wheelchair access is very difficult have to go out the dinning room door and around the side of the building which is not easy as hard to navigate. The restrictions that the building imposes in being able to meet residents needs who have mobility restrictions must be incorporated as part of the homes admission criteria. This is to ensure that only those residents whos mobility needs can be safely met are accommodated and to identify the point at which residents mobility needs have gone beyond that which the home can continue to safely meet. It has been required that the premises are suitable for the purpose of achieving the aims and objectives of the service as set out in the statement of purpose and the physical design and layout of the premises meets the needs of the people for whom the service is intended. It has also been required that a qualified person makes an assessment of the premises, in relation to the suitability of premises including equipment and environmental adaptations. The parts of the home visited were observed to be clean with any melodious odours confined to a few areas. Variable feedback was received regarding the standards of Care Homes for Older People Page 23 of 35 Evidence: cleanliness, comments included: Environment kept clean feels like a home Bedroom carpet is not cleaned shampooed often enough to maintain a clean healthy environment and doesnt smell but it does not exactly feel clean the bathroom is not too nice. The manager was being proactive in addressing the malodorous odours noted at the time of inspection but acknowledged that a more proactive approach is necessary to ensure consistent standards. Care Homes for Older People Page 24 of 35 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. There was sufficient staff on duty who were observed to be hardworking and enthusiastic, however staff need to be appropriately trained, supervised and able to communicate clearly in order to ensure that the range of residents needs can be met. Residents are protected by a good recruitment practices. Evidence: Variable feedback was received regarding staffing, comments included: At weekends there is not always someone on duty who has the authority to make decisions and always refer on which can delay action Staff fine friendly most of them are usually helpful approachable, English can be limited sometimes A couple of them are ok weekend staff not so friendly and accommodating or say very much, communication can sometimes be difficult if there English is not too good when we first visited there command of English was poor but now things seemed to have improved staff now they are good I like the way they interact and the staff are very helpful. Staff member said that at the weekends bank and part time staff have historically been employed. It was clear that staff on duty at the time of inspection were enthusiastic and hardworking but language did in one case present difficulties. Staff felt that at the Care Homes for Older People Page 25 of 35 Evidence: moment due to low occupancy there was sufficient staff on duty to be able to meet the needs of residents. A staff member was observed to have a good rapport with residents, which promoted a relaxed atmosphere in the home. The persons appointed to manage said that all three permanent staff have a National Vocational Qualifications. The personal files of three staff were inspected and these showed that a satisfactory recruitment process is followed which includes the use of an application form, interviews, Criminal Records Bureau (CRB) checks and written references prior to employment commencing. It was previously required that all staff receive mandatory training, the person appointed to manage said that they have obtained a training grant to assist them in the training needed and plans are in place for this to be completed in the immediate future. Staff must also undergo specialist training in dementia in order to aid a further understanding and awareness of people who have dementia. A staff member said that the area in which the home does not do so well in is staff training. In light of the above concerns regarding ongoing staff training, communication and weekend staffing arrangements it has been required that at all times the staff on duty are appropriately trained, supervised and can communicate clearly. Care Homes for Older People Page 26 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a motivated person in charge who has gradually made positive improvements to practices at the home, and now needs to register with the commission in order that there is a accountable person in charge of the day to day running of the home. A range of regular health and safety checks generally helps to promote the health and safety of residents and staff, however advice needs to be sought from the fire safety officer regarding some aspects of fire safety at the home and the environment risk assessed to ensure that it is safe. Evidence: The home has been without a registered manager since 2006. It was previously required that a manager be appointed and an application to register a manager be made to the Commission. There have been several people appointed by the provider to manage the home with applications returned due to their inadequate completion. The Care Homes for Older People Page 27 of 35 Evidence: current person appointed had not at the time of inspection applied to become registered with the Commission and both the provider and person appointed were written to outside of the inspection process. The person appointed to manage has subsequently confirmed that an application is in the process of being made. It was clear that the person appointed to manage was making a positive contribution towards improving practices at the home and had developed an action plan of areas for further improvement. Although they have limited managerial experience they were receiving additional support from the area manager and external training organisation. A sample of comments made about them included: Helpful very good, very adjustable has made lots of positive changes since previous manager left standards much better at the home now The manager at the moment is lovely seams a bit inexperienced and used to be a member of care staff this manager is more sympathetic and gentle and good with the residents how much power she has there is questionable not sure if she can make decisions manager pleasant enough a little inexperienced but approachable and listens. There are some mechanisms in place for the home to obtain feedback on the quality of the services provided and whether it is achieving its aims and objectives. This includes feedback surveys being sent to residents and relatives, monthly visits by the providers representative to monitor standards at the home and some yearly reviews of residents placements with social services. Changes to menus and activities have resulted in feedback received from residents. Residents are encouraged to retain control of their own finances for as long as they are able to do so and if unable then this responsibility is taken on by a relative or another responsible persons external to the home. The person appointed to manage stated that they do not manage the personal finances for any residents. Records submitted by the manager prior to the inspection stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. Systems were in place to support fire safety, which included: regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. The person appointed to manage reported that they had undertaken a fire risk assessment, however this did not assess how residents would exit the building safely when unable to use the lift in the event of a fire. In order to address this it has been required that the home consult with the Fire Safety Officer to ensure that adequate fire safety arrangements are in place. The home has been required to ensure that an environmental risk assessed has been undertaken with particular reference to the stairs and garden in order to identify their Care Homes for Older People Page 28 of 35 Evidence: suitability and how to manage eliminate any identifiable risks. Care Homes for Older People Page 29 of 35 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 30 of 35 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 3 14 That a written format for the 30/12/2008 assessment of prospective service users is developed in line with the homes admission criteria and that of the National Minimum Standards That a written format for the assessment of prospective service users is developed in line with the homes admission criteria and that of the National Minimum Standards 2 7 15 That care plans provide clear 21/12/2008 guidance for staff on all aspects of the health, personal and social care needs of service users and which make explicit the actions needed to meet these needs and which include personal risk assessments for all service users, which are reviewed regularly and records the Care Homes for Older People Page 31 of 35 actions to manage or reduce any identified risks. To ensure that staff have the guidance they need to work with residents. 3 12 16 That service users social 21/12/2008 needs and preferences are identified and recorded on individual care plans and opportunities for social engagement and meaningful activities are provided based on these identified needs. In order to help enrich residents lives. 4 19 23 That the premises are 25/12/2009 suitable for the purpose of achieving the aims and objectives of the service as set out in the statement of purpose and the physical design and layout of the premises meets the needs of the people for whom the service is intended. To ensure that residents needs can be safely met at the home 5 22 23 That the registered person demonstrates that a qualified person has made an assessment of the premises, in relation to the suitability of equipment and environmental adaptations. To ensure that service users have all of the equipment and adaptations necessary to meet their needs and that 30/12/2008 Care Homes for Older People Page 32 of 35 the premises are assess to establish the suitability of the environment for whom the service is intended for. 6 26 16 That robust procedures are in place to ensure effective and consistent cleaning standards and the management and eradication of offensive odours throughout the home. In order to provide a pleasant dignified environment in which to live. 7 27 18 That at all times staff are on 30/12/2008 duty who are competent, appropriately trained, supervised and who are able to communicate clearly with residents, relatives and interested parties. To ensure the health and welfare of service users and to meet the assessed care needs of service users 8 38 13 That a written risk assessment is carried out of the environment and that significant findings are recorded, and action taken to eliminate or manage any risks with particular reference to the stairs and garden To ensure that any areas of risk are identified and actions taken to manage the risk 21/12/2008 21/12/2008 Care Homes for Older People Page 33 of 35 9 38 23 That the registered person 21/12/2008 consult with the Fire Safety Officer within one month to ensure that adequate fire safety arrangements are in place to protect the health and welfare of service users. To ensure that there are adequate fire safety precautions at the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 That additional instructions are provided for staff on the administration of As required medication, which make clear the individual requirements for when this medications was prescribed. hat hand written Medication Administration Records (MAR) are checked and countersigned by a second member of staff for accuracy 2 9 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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