Inspection on 19/11/08 for Holmesley Nursing Home

This inspection was carried out on 19th November 2008.

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

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

Other inspections for this house

Holmesley Nursing Home 29/11/07

Holmesley Nursing Home 19/07/07

Holmesley Nursing Home 07/09/06

Holmesley Nursing Home 18/12/05

Holmesley Nursing Home 10/05/05

Holmesley Nursing Home 27/01/05

Holmesley Nursing Home 20/07/04

Holmesley Nursing Home 20/02/04

Holmesley Nursing Home 30/12/03

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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: Holmesley Nursing Home Fortescue Road Sidmouth Devon EX10 9QG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rachel Fleet     Date: 1 9 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Holmesley Nursing Home Fortescue Road Sidmouth Devon EX10 9QG 01395513961 01395519549 holmesley@btconnect.com 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) : Mr Trevor John Gosling,Mr Stephen Robert Barber care home 38 Number of places (if applicable): Under 65 Over 65 38 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 Holmesley is a privately-owned home that provides accommodation and care (including nursing care) for up to 38 people with needs related to old age. Set in approximately 2 acres of grounds and gardens, with views over the Sid Valley and down to the sea, the home is approximately half a mile from the seaside town of Sidmouth. Access to the town centre is via private transport, with ample parking at the home. Facilities include a conservatory, a communal lounge that can be partitioned off to create a second small lounge, and a dining room. Bedrooms are on the ground and first floors, which are linked by a 13-person passenger lift as well as a stair lift. There are two double/twin rooms. Most bedrooms have ensuite facilities, with four of these including a bath or shower. Some rooms have a patio door directly onto a terrace, and others have coastal views. Fees range from 535 - 803 pounds per week, depending on the room and the package of care required. This does not include personal expenditure such as for chiropody, hairdressing, outings, etc. Information about this home, including our reports, is available direct from the home, with information on fees Care Homes for Older People Page 4 of 31 Brief description of the care home provided in their Service User Guide. The homes fax number is now 01395 517981 and not as stated elsewhere in this report. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place as part of our usual inspection programme. Our unannounced visit to the home took place over ten hours on a weekday. Chaslyn Bryant, the new acting manager/matron, and other staff assisted us fully during this time. A CSCI questionnaire (the Annual Quality Assurance Assessment, or AQAA), sent to the home ahead of our site visit, was returned by the proprietors. This included the homes assessment of what they do well and any plans for improvement, as well as information about the people living at the home, staffing, policies in place, and maintenance of facilities. Care Homes for Older People Page 6 of 31 We had also sent surveys to the home three months before our visit, for them to give to 12 people living at the home and to 10 staff. We received surveys back from 11 people living at the home, approximately half of who were were helped by relatives to complete the survey, and from five staff. Three healthcare professionals returned surveys, of four provided. During this visit, we looked at care matters and administrative matters such as health and safety, staff recruitment and training, and quality assurance systems. We spoke with 9 of the 35 people who lived at the home, and met other people who were unable to give their views because of their frailty. We also spoke with three family visitors, and five staff (both care and ancillary staff). We found out what it was like living at the home from them, and by looking around the home. We case-tracked four people, which meant we looked in more depth at their care. They included men and women, people new to the home, and people with more complex health needs. We did this by reading their care records and related information (medication records, personal monies records, etc.). We met them, observed some of the support they received, spoke to staff about their care and other related matters, and looked at the accommodation in relation to their needs. We checked staff recruitment and training information, and records relating to health and safety (such as accident and evidence of maintenance or servicing). We ended the visit by discussing our findings with Chaslyn Bryant. Information included in this report is from all these sources, and from communication with or about the service since our last inspection. What the care home does well: What has improved since the last inspection? What they could do better: More individualised detail in pre-admission assessments and in care plans would help to ensure every person is, from the time that they are admitted to the home, cared for and supported in a person-centred way. Efforts should be continued to ensure all information in reviews or evaluations of care is used to update care plans in ways that promote individualised care. Further improvements to management of medicines are needed to fully ensure peoples wellbeing. People living at the home would benefit in the longer term from a staff training and development programme that ensures staff are safely able to meet their changing or future needs. This includes continuing to work towards the goal that at least half of the care staff hold a National Vocational Qualification (NVQ) in care to level 2 or above. Keeping the homes written policies on safeguarding up-to-date would help to ensure staff can be clear on reporting of any concerns. Robust evidence of recruitment information should be available for staff recruited through an agency, including written explanations for any gaps in the employment histories of prospective staff, to show that people are protected as much as possible from unsuitable staff. Financial Care Homes for Older People Page 8 of 31 protection of people living at the home could be improved if two people had to verify any transactions involving individuals personal monies. Preventing accumulation of dust, etc. behind the laundry machines would avoid a safety risk to the home. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information exchanged before people move into the home helps to ensure it is a suitable home for them if they then decide to live there. However, insufficient detail in some peoples pre-admission assessments means their needs may not always be met in a person-centred way on their admission. The home does not offer intermediate care. Evidence: Surveys returned to us told us one person had visited several times, and people were given sufficient information, before moving into the home. One person we met told us they had looked around the home before they moved in, and also had first-hand information from someone they knew at the home. The homes Statement of Purpose and Service User Guide were also offered to Care Homes for Older People Page 11 of 31 Evidence: prospective residents. We found they gave useful information about the home and the service it offered. The manager confirmed the information could be provided in large print on request. During our visit, the manager went to meet someone in hospital who was considering moving to the home, to give them information and assess their care needs. In another case, we noted an individuals close relative had been involved in such an assessment, where the person was too frail to give much information about themselves. Staff told us they were now informed about new people moving into the home before they were actually admitted, being told their medical diagnoses as well as what care they would need. Generally, assessments of peoples needs that we saw included excellent detail about their individual needs, to help ensure they received person-centred care if they chose to live at the home. They had been asked about their likes and dislikes, interests, etc., as well as what they were expecting from going to live at the home. Some assessments were less informative in places. For example, where someone was said to need aids to mobilise, the type of aid was not always recorded. And a section headed Behavioural traits gave only a small choice of one-word descriptions ranging from sociable to aggressive. It was very positive to see peoples medications were listed in pre-admission assessments although, again, the level of details was variable so not always to a safe standard. We saw copies of letters, sent to prospective residents, that confirmed the home could meet their assessed needs if they chose to move there. Half of the people who returned surveys (which were anonymous) did not think they had a contract. The AQAA stated that all privately funded people had been given a contract. We were unable to look at this further since we were told contracts were in a locked facility the new manager did not have access to at the time. The homes owners have since confirmed that everyone receives a contract, or Terms and Conditions if they are funded through Social Services. We will look at these at our next inspection. We saw a copy of the standard contract, with information on fees, was included in the Service User Guide. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are happy at the home, with their right to respect and privacy upheld. Insufficient detail in some care plans creates a risk that people may not always receive consistent or person-centred care, however. Their health is promoted through involvement of relevant community-based professionals. Although improved, management of medicines does not yet fully ensure their wellbeing. Evidence: Surveys from people living at the home said they were happy with the care provided. Three health professionals surveys said they too were satisfied, one added, A caring service...would be happy to place a relative. People we met during our visit were similarly happy with the care they or their relative received at the home, and felt their health needs were well attended to. They looked well cared for and content. Comments on staff surveys received some weeks before our visit included that one would like a verbal handover for all staff, although another - a part-time staff member - felt they were kept better informed. A care assistant told us on our visit that they Care Homes for Older People Page 13 of 31 Evidence: were now given handover information at the start of their shift. Staff were able to describe the help individuals needed, which was as we observed or as individuals told us. Staff knew less about individuals social histories or past lives, though there were some excellent life histories in peoples care records. The pre-inspection information provided in the homes AQAA was of a good quality apart from a section on Equality and Diversity. We noted during our visit that standard care plans to address certain needs or problems were used for everyone with that need or problem. We discussed this with the newly appointed manager, particularly that such care plans needed more person-centred detail, to ensure peoples diverse needs were met and met consistently. For example, where a standard care plan for preventing pressure sores said Provide appropriate devices and ensure sufficient intake of fluids, detail was needed to clarify what devices were needed, and how much fluid would be sufficient for different individuals. The manager was already planning to address this. People had care plans to address particular health needs or related risks. Two staff surveys had said care plans were muddled or it was difficult to find information. Having read some care plans, we found them to be comprehensive and relatively well ordered. But we suggested that more cross-referencing between health-related risk assessments and related care plans would ensure staff were alerted to relevant information noted elsewhere. Care plans had been regularly reviewed and evaluated, as is good practice. We saw evidence that individuals or their relative had also been involved in these. It was very positive to see that evaluations of peoples social care plans included whether they had enjoyed the recreation offered to them. But some information had not been used to update the care plan. For example, fluid intake (where daily charts were kept) had not always been reflected in care notes to inform ongoing care planning. However, the people concerned looked hydrated, as though they were having enough fluid intake. An evaluation said someone disturbed others at night and a relevant professional had been consulted, but we did not see guidance as to how staff should respond or manage the situation at night. Such detail would help promote individualised and consistent care. Some people we case-tracked had communication and swallowing difficulties. We saw GPs had been contacted about these problems, with cross-referencing of information to help ensure staff read all information available. Staff we spoke with could describe appropriate care and support for these people - such as allowing time, and not rushing the person. They felt staffing levels allowed them to take the time needed. Care Homes for Older People Page 14 of 31 Evidence: A dietitian had been contacted for someone else on a special diet who said they felt hungry, to try to resolve this problem. Someone with a particular physical condition that could be worsened by the wrong diet told us that the kitchen staff were aware of this, providing food that wouldnt disagree with them. They said the nursing staff had advised them of the right diet to have, and were arranging a GP review. However, the nutrition care plan for someone else with the same condition and who had lost some weight in the last year did not mention their condition, nor include their likes/dislikes. Some visitors told us their relative was given a hospital type bed as their needs changed and they were cared for in bed more. We saw adjustable beds were being used in several bedrooms. People we spoke with were generally not self-medicating, but were happy for staff to manage their medication for them and were satisfied with how this was done. We noted one person had a prescribed preparation in their room, which they told us they self-administered. Their care records did not include this as they should have. We observed medication given out by a nurse at lunchtime was given out in an appropriate, safe way. A care assistant confirmed they were not asked to give out medicines. The home had written instructions about homely remedies, and written confirmation that a particular medication could be crushed for one person. A GP had been informed when someone hadnt taken their prescribed medication. Stock levels were correct where we checked them at random. Records for medication that had been disposed of included signatures of two staff to verify the disposal details. There was a lockable fridge solely for storage of medications. Temperature records showed it remained within recommended ranges for such storage. We advised temperature records were also kept for the room medication was kept in, since this had electrical equipment in it that generated heat. One person we case-tracked was on digoxin, but there was no record that staff checked their pulse before administering it as is good practice. The manager said she would address this. A medication chart had been hand-written, without evidence to show two people had verified the accuracy of the directions on it. Two bottles had not been dated on opening, so its shelf-life (as recommended by the manufacturers ) could not be determined. One person we case-tracked was prescribed medication to thin their blood. A care assistant was not aware of dietary items that should be avoided in such cases. Care Homes for Older People Page 15 of 31 Evidence: We saw admission checklists included asking people about the preference of their carers gender. People we asked felt their privacy was respected. One person said there was always a female carer present if they were attended by a male carer. People confirmed staff addressed them as they wished to be called, and did not talk over them to each other. When we asked staff about ensuring peoples privacy, they said this included confidentiality. They said they were told what people wanted to be called, adding this was also in peoples care plans. A shower room had a door lock and a Do not disturb sign, although we noted there was no curtain or screen for privacy should the door from the corridor be opened. One bathroom had no such sign or lock, which the manager said she would follow up. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Work is ongoing to help ensure that the diverse social needs of the people living here are met. People are assisted to make choices, and have easy contact with their visitors and good contact with the local community. People benefit from a diet which is varied, nutritious, and which they enjoy. Evidence: The AQAA included that the activities staff had been to a relevant conference to develop their knowledge and service. The majority of people who returned surveys were satisfied with the activities provided, but we received two surveys said activities not always accessible to everyone because of sight problems or incapacity. We discussed development of person-centred activities, and were told the Resident Coordinator now provides or enables one-to-one activities and occupation of peoples free time. People were being consulted about their social interests. One person said they enjoyed playing Scrabble before moving to the home, and they had had several games since going to live there. Someone who lived at the home told us the home organised events of interest. There was information on the local churches in Sidmouth freely available. A Care Homes for Older People Page 17 of 31 Evidence: communion service was held at the home during our visit, for anyone wishing to attend. Visitors told us they were always made welcome and offered refreshments. We saw some peoples relatives had been invited to care plan reviews. There is a hotel style phone system offering direct phone lines to each bedroom, as well as a portable pay phone, enabling people to make a phonecall in private if they wished. Some people living at the home told us they felt the residents, rather than the staff, were in charge at the home and that they were taken notice of. People felt they were given enough choice in their daily lives, and staff fitted in with what they wanted. Care notes reflected somebody had told staff they preferred a shower to a bath, and their care plan had subsequently been updated to reflect this. The manager said she would ensure someones care plan reflected the time they wished to have their early morning cup of tea, in response to a comment made to us. Surveys from people living at the home included one person who found the food variable; other people said they usually or always liked it, with choice or alternatives offered, and allergies catered for. People we met told us they were happy with the food provided, having enough choice and enough to eat. Some told us the food had improved. We asked staff about peoples dietary likes/dislikes. They said a record of these were kept in the kitchen, and they knew about individuals food allergies. People were given breakfast as they got up, at the start of our visit. This included a cooked breakfast in some cases. Later,we saw a buffet-style tea being prepared, which included warmed cheese scones and fresh fruit salad. Provision had been made for those on special diets such low fat or a diabetic diet. One person we case-tracked had a particular digestive problem, and the cook explained how this persons meals were made more suitable for them. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples concerns are listened to and they are protected from abuse, safeguarding them and promoting their rights. Evidence: Some people told us that they had no complaints but added that management were about daily, should they wish to make a complaint. Others said they also felt able to complain, one saying that they could get things thrashed out. Care staff said they would report any concerns voiced to them to senior staff. Since our last inspection, we have not received any complaints about this service. The home had received three complaints which they looked into promptly and upheld, with appropriate action then taken. The manager agreed to review the written complaints procedure, which needed to include that we could be contacted at any stage of a person making a complaint. She was beginning to review the homes policies and procedures, which included the safeguarding policy that needed attention - it didnt include current guidance on reporting concerns, for example. People told us they felt safe living at the home. The AQAA stated all staff have had safeguarding training, and staff surveys said they had clear guidance on this matter. Care Homes for Older People Page 19 of 31 Evidence: Staff we spoke with were able to describe practices considered to be abusive (such as ignoring people), and were clear that they would report to senior staff if they observed such behaviour. They also knew of outside agencies to whom they could report concerns if necessary. One confirmed they would report any allegations made by people living at the home, even if the individual was someone who was usually confused. A staff member told us they had been given the homes written policy on gifts offered by residents. We saw a best interests check list was being used, to ensure people were protected as indicated by the Mental Capacity Act 2005. Where someones medication was given in their food, the persons GP and a pharmacist had been involved in the decision that medication would be given covertly in this way. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from accommodation that is clean, homely and adapted for older people with physical disabilities. Evidence: Most people we asked were satisfied with their private facilities as well as the communal ones. One person, who was otherwise very positive about their accommodation, said they had just asked to have the heating on again in their room, since they felt cold. Decor and furnishings were to a high standard, although a small number of shared bathrooms and toilets looked less homely than the rest of the accommodation. One toilet was being converted for other use; no-one we spoke with said that loss of this facility caused them a problem. We saw many homely touches elsewhere, such as paintings, pictures, plants and flowers. At lunchtime, we saw tables in the smaller dining attractively set with napkins, etc. There was a variety of furniture and equipment for people of different physical abilities. Corridors had handrails, and there was a specialist sink for the hairdresser to use, for example. Dining chairs had their legs set into gliders for easier independent movement to or from the tables. Care Homes for Older People Page 21 of 31 Evidence: At our last three inspections, we recommended that all people had easy access to call bells. During this visit we saw people had callbells available. Someone who used the lounge said they always had a callbell in reach, although we noted during our visit that staff were also in the room regularly, available to assist people. A care assistant spoke about providing call bells as part of their responsibility for health and safety. The AQAA stated a new gardener/handyman had been employed, giving extra hours for the upkeep of the home. People living at the home felt repairs were dealt with in a timely way - You just mention it and they come and do it, one told us. The AQAA confirmed fire equipment and the utilities had been checked or serviced in the last year or as appropriate. We looked at the fire log. All checks and drills had been carried out. Someone in a bedroom with an automatic door holder confirmed it shut when the fire alarms sounded. Other routine maintenance or safety checks had not been recorded recently. The manager said she would ensure these records were re-established as a matter of urgency, confident the checks had been carried out. We noted a delivery of items being placed under a staircase - an area that should not be used for storage in order to maintain safe fire exit routes. The manager was aware of this and said the items would be cleared away promptly. Surveys from people living at the home were positive about the cleanliness of the home. Those we spoke with said their bedrooms were cleaned daily, and that this regularly included moving furniture for thorough cleaning. Staff had a good knowledge of how to prevent the spread of infection, including appropriate handling of soiled washing and continence products. We saw linen skips, disposable gloves and aprons were freely available. People living at the home confirmed that staff used them regularly, one adding staff were very particular about that. Sluice rooms had handwash facilities. The laundry was away from food preparation areas. Washing machines had appropriate programmes for thorough cleaning of soiled linen, which staff on duty were familiar with using. Handwashing facilities were available. We noted an accumulation of dust, fibres, etc. behind the machines, which is both a health and a safety issue. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by sufficient numbers of staff who are trained to meet their current needs, but who would benefit from further training to promote peoples welfare in the longer term. Recruitment processes have improved, meaning that people are safe from being cared for by unsuitable people. Evidence: When we arrived, the new matron/manager and assistant manager (both nurses), another nurse, and five care assistants were on duty, with 35 people living at the home. Care staff were supported by cleaning staff, laundry staff (who were employed for every day of the week including weekends), a cook, a handyman, and an activities organizer who worked at least 30 hours each week. Both proprietors are also at the home every weekday, providing administrative support required for the home. We were told the manager worked in a supernumerary capacity. Usual staff levels for 35 residents were two nurses with six care assistants in the mornings, one nurse with four carers in the afternoon/evening, and one nurse with two carers overnight. There were occasionally extra staff in the evening, rostered for a twilight shift. No agency staff had been required in recent months. Surveys from people living at the home said staff were usually or always available, and Care Homes for Older People Page 23 of 31 Evidence: they listened to people, acting on what they asked or said. People we spoke with told us their call bells were answered quickly enough. They described staff - on all shifts as very good, very pleasant, helpful, or like friends. They felt there was a stable staff team. Visitors we spoke with were positive about staff, including the catering staff in this because they helped with drinks. A survey from someone living at the home said it was a first class home, well run, with caring staff. Visitors and somebody living at the home told us there had been communication difficulties with staff in the past but this was no longer a problem. One person in their bedroom felt staff didnt have time to chat. But another person also in their bedroom said they occasionally had to wait for help because of staff shortages, but that staff still found time to pop in to chat. New staff we met had relevant previous experience. We looked at the recruitment files of three people recruited since our last inspection. We discussed with the manager that two documents for one person - employed through an agency before the manager was appointed - appeared to be copies rather than originals; the person also had a gap in their employment, which appeared from other information to be due to a period of training but without a written explanation for the gap recorded. She agreed to follow these matters up. The other two staff had been employed recently (including one also employed through the agency). We found that they had required information including proof of identity, two written references and a full police check obtained before they started work. We looked at the induction records of one person who had been newly appointed. We saw they had undertaken the homes previously-used induction programme as well as a new one, which was based on nationally recognised standards. A newly employed nurse told us she had shadowed another nurse for a week, then had her practice observed before working on her own. A care assistant told us they had watched training videos, and undertook some practical training such as manual handling, before working with colleagues to learn to provide care to people at the home. The AQAA stated that of 17 staff, five have a recognised care qualification, and eight were undertaking it. Although other training was not mentioned here in the AQAA, staff surveys said they were getting training now, and better supervision. A nurse told us she had had recent updating on use of syringe drivers and venepuncture. Another staff member, who had been employed in the previous three months said they had watched training videos to date. The homes programme for regular training and Care Homes for Older People Page 24 of 31 Evidence: updating had lapsed, which the manager was mindful of. We were told that two staff members had recently been appointed with training responsibilities, to ensure all staff received necessary training. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is run in their best interests, promoting their general health and welfare. Evidence: Chaslyn Bryant had only been appointed recently to manage the home, and so was yet to be registered by us as the manager. She is a Registered General Nurse with experience of managing similar care homes, who has also undertaken a relevant recognised management qualification. She has had further training that enables her to assess care staff undertaking certain care qualifications, as well as to teach staff how to move people safely and how to care for people with dementia. The manager had a system of one-to-one supervision with individual staff, to help identify training needs, etc. Staff said there were staff meetings and they felt they could speak about any issues if they wished to. Care Homes for Older People Page 26 of 31 Evidence: People living at the home felt their views and opinions were sought, although there hadnt been any residents meetings for some months. The manager told us she had met with people recently to discuss having such meetings. A questionnaire was currently being sent out to peoples relatives, staff and visiting professionals. An action plan would be drawn up based on the responses, which would be shared with people at the home and participants. Our last inspection report was available by the visitors signing in book. We looked at records kept for personal monies held by the home on behalf of people we case-tracked. We were told people were offered, on their admission, the alternative option of using a lockable drawer in their own room. Cash balances for each person matched the written records, with receipts available, and transactions appearing appropriate. Copies of these records were sent to the persons representative when the account needed topping up. Transactions were only signed by one person, and there was no system for external auditing; it is good practice to have two signatures to verify the entries. Most radiators were covered to prevent burns from hot surfaces; others were concealed behind furniture. A record was kept of water temperatures but other health and safety checks - such as for bedrails, wheelchairs and window restrictors - had not been recorded recently (- addressed under the section on the Environment). Where we checked at random, windows were restricted. Fixed bath hoists and portable hoists had labels showing they were serviced, appropriately, within the last six months; electrical items had also been tested for safety recently. Signs were in use where oxygen was kept in peoples rooms, to alert people to this potential fire hazard. Current food safety guidance was available in the kitchen, with food portions covered, dated and kept in the fridge. We saw accident records were kept, which the manager intended to audit shortly. Staff we asked generally felt they had a safe working environment, one commenting that health and safety was everyones responsibility. They confirmed repairs were carried out quickly, and felt they had enough equipment. Staff confirmed that people needing adjustable-height beds had them; one thought that some rooms were relatively small if hoists were needed to move people. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 9 13 There must be safe systems for the safe administration of medicines, including effective systems for monitoring the shelf-life of medication, and that all relevant staff are aware of contraindicated foods To ensure peoples health is not compromised by problems caused by their medication. 20/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 All prospective residents should have a pre-admission assessment which is sufficiently detailed to ensure that their needs can be met in a person-centred way if and when they then move into the home. All information in reviews or evaluations of care should be used to update care plans in ways that promote individualised care. 2 7 Care Homes for Older People Page 29 of 31 3 7 Everyone who lives here should have a care plan that is sufficiently detailed, regarding how their health and welfare needs are to be met (including arrangements for medication), to ensure that they receive person-centred care. There should be effective systems in place to ensure the accuracy of handwritten directions on medication administration charts. It is recommended that the homes written policies on safeguarding (reporting, whistleblowing, etc.) are kept upto-date. It is recommended that effective systems be put in place to prevent accumulation of dust, etc. behind the laundry machines. It is recommended you continue to work towards ensuring that 50 of care staff hold a National Vocational Qualification (NVQ) in care to level 2 or above to ensure that the people who live here will have their needs met. It is recommended written explanations are kept for any gaps in the employment histories of prospective staff. It is recommended you ensure you have robust evidence of recruitment information available for inspection, especially where staff are recruited through an agency. It is recommended that there is an effective staff training and development programme, to ensure staff are able to meet the changing needs of people living at the home. It is recommended that you ensure that there are robust financial safeguards in place, including evidence that transactions involving the personal monies of people living at the home are verified by two people. 4 9 5 18 6 26 7 28 8 9 29 29 10 30 11 35 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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