Inspection on 02/12/08 for Houndswood House

This inspection was carried out on 2nd December 2008.

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

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

Other inspections for this house

Houndswood House 03/06/08

Houndswood House 13/02/08

Houndswood House 11/04/07

Houndswood House 09/11/06

Houndswood House 18/04/06

Houndswood House 05/01/06

Houndswood House 22/06/05

Houndswood House 20/10/04

Houndswood House 04/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta 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: Houndswood House Harper Lane Radlett Hertfordshire WD7 7HU     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: Jeffrey Orange     Date: 0 2 1 2 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 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Houndswood House Harper Lane Radlett Hertfordshire WD7 7HU 01923856819 01923853509 houndswood.manager@craegmoor.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Michelle Whitmill Type of registration: Number of places registered: Speciality Care (REIT Homes) Ltd care home 65 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 48. This home may accommodate 4 older people who require personal care. This home may accommodate 4 older people with physical disability who require personal care. Date of last inspection Brief description of the care home Houndswood House is a care home providing accommodation, nursing and personal care for older people as set out above. The home is owned by Craegmoor and registered under Speciality Care (REIT Homes) Limited. Houndswood House was opened in 1997 and is situated in a rural area between London Colney and Radlett. It is a period house with modern extensions, set in extensive parkland gardens with Care Homes for Older People Page 4 of 32 Over 65 23 48 4 0 0 0 Brief description of the care home pathways a large patio area and a sensory garden area all accessible to people living in the home. The home is divided into two areas, identified by staff as the `main house and the `extension. The older part of the house has one large ground floor lounge and a small sitting room. The `extension has communal areas all on the ground floor, which include dining, lounge and conservatory areas. All bedrooms in the new area have en-suite facilities with toilets. A lift serves each end of the home and a wheelchair lift is in place to enable improved access to one part of the older building. The premises are reached via a driveway from Harper Lane. Car parking facilities are provided to the front and rear of the building. Houndswood House is not served by public transport, but is close to Junction 22 of the M25 Motorway. The service user guide includes contact details for the Commission for Social Care Inspection (CSCI) and copies of the latest inspection report are available in the home. Current fees range from £525 - £1100 (As at December 2008). Additional charges apply for newspapers, hairdressing, personal toiletries, chiropody and private dentistry. Care Homes for Older People Page 5 of 32 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 last inspection on this service was completed on 03/06/2008 This unannounced inspection was carried out by two inspectors and started early in the morning, lasting approximately eight hours. This provided an opportunity to observe the morning routine of the home as people were being helped to get up and have their breakfasts in preparation for the activities of the day ahead and also to see the late morning, lunchtime and early afternoon routines including any planned activities organised by the home. One inspector spent two hours of this inspection conducting a Short Observation Framework for Inspection (SOFI) observing the care experience and outcomes of a Care Homes for Older People Page 6 of 32 small group of people who live with dementia. The care records of some of those observed were looked at in depth and comparisons made between what was observed and the homes records and the knowledge of those care staff involved with their care. Throughout this inspection we were able to observe care, speak to people who live in the home and to any visiting relatives, we also spoke to the manager and members of the care staff team. We looked at some key records, including those for the administration of medication, the recruitment, training and supervision of staff and care plans for people who live in the home. This report also draws on information provided to us by the home in their annual quality assurance assessment or AQAA. The AQAA is a self-assessment document that looks at how well care outcomes are being achieved for people living in Houndswood House and it also includes some useful statistical information. We have also drawn on the views expressed to us about the home contained in surveys returned from or on behalf of people who live in Houndswood House. Since the key inspection of February 2008, Houndswood House has received a further key inspection in June 2008 and a random compliance inspection in September 2008. There have also been a series of meetings held during this period under Hertfordshire County Councils safeguarding adults procedures. Information provided during that process has been taken into account in drawing up this report as have the action plans submitted by Houndswood House in response to those inspections and meetings. What the care home does well: What has improved since the last inspection? It is a different home, There have been a lot of improvements and The home is much better are all recent comments received about Houndswood House from people living there, staff working there or from relatives. This view is not an isolated one, as health and social care professionals who are familiar with the home and who have spent significant time there since the last key inspection in June 2008 have all identified improvements in Houndswood House. The standard and spread of staff training and supervision has improved and is, in both cases on track to deliver a well-trained and supported care staff team provided that the current programme is delivered and then continues as scheduled. The poor outcomes identified at the previous report were in part the result of poor or inconsistent staff training, particularly in respect of dementia care training and led in turn to poor care practises. It is no coincidence that as training and supervision have improved, so too, quite significantly have the care outcomes for people living in Houndswood House, including those people living with dementia. The management of the home has been strengthened by the appointment of unit managers under the deputy manager and registered manager and during this period, the manager has received additional support from the area management team of Craegmoor. Again, this strengthened management can be directly linked to the Care Homes for Older People Page 8 of 32 improvement in standards observed. The new care plans are a significant improvement and providing the current standard of completion is maintained, they will help the home to meet its expressed aim of providing genuinely person-centred individualised care for the people who live in the home. Any requirements made following the key inspection of June 2008 have either been met or are being addressed within the required timescale and in line with any improvement plans submitted by the home to the commission. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Care Homes for Older People Page 10 of 32 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 32 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. People considering moving to Houndswood House can be assured that their needs will be assessed before they do so to make sure that they can be met. People considering Houndswood House as a home for themselves or someone they are responsible for can be confident that they will be able to visit the home to satisfy themselves that it is somewhere they will feel happy, safe and well cared for. The personal care needs of people living with dementia are now met well and recent improvements in the standard of dementia care in Houndswood mean that their need for appropriate stimulation and activity is now also more consistently met. Evidence: When we looked at the information that is available for people considering Houndswood House as a home for themselves or someone they are responsible for we found that it was adequate and included details about costs and what services are included in basic fees and which are not, so that they could make a reasonably wellCare Homes for Older People Page 12 of 32 Evidence: informed decision about a move into the home. When we spoke to relatives and people living in Houndswood House or when they returned surveys to us, they told us that they had opportunity to visit the home before a final decision was made about living there and that they were supported and encouraged by the home to reassure themselves that Houndswood House was a place that could meet their needs and where they could be happy. When we looked at care plans for people who have recently moved into Houndswood House we found that they included detailed pre-admission assessments of their needs and how they were to be met effectively and in a way that recognises their individuality. When we spent two hours sitting and observing in detail the care outcomes for a small group of people living with dementia we found that there were many examples of good staff interaction with them that resulted in generally positive care experiences including opportunity for some level of activity or stimulation. Care Homes for Older People Page 13 of 32 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. People living in Houndswood can be increasingly confident that their health and personal care needs will be met appropriately in a way that reflects their personal preference and wishes and which maintains their health, safety and well-being. Evidence: When we looked at care plans, including those for people living with dementia or who had particular pressure care needs we found that the standard of record keeping and person centred information had greatly improved since the last key inspection of June 2008. The care plans now enable care staff to identify care needs much more readily and they are now better able to record how care needs have changed and to review on a regular basis if the persons care needs are still being appropriately met. This means that people living in Houndswood House can be far more confident than was previously the case that their care needs will be met appropriately and effectively. Because the care plans now contain more personal detail, for example a detailed life history, care staff are able to provide care and activities in a way that more closely Care Homes for Older People Page 14 of 32 Evidence: matches the persons individual wishes, requirements and preferences. When we spoke to one member of care staff about a person they are the key worker for they had an impressive knowledge of the persons history and life, what their current care needs were and how they could best be met. When we looked specifically at care records for people assessed as being at particular risk from pressure ulcers we found that risk assessments were well-completed and maintained, that appropriate records for monitoring their condition were in place and were being well-completed. When we spoke to the manager and looked at training records we found that the home have made increasing use of specialist tissue viability services and that training has been enhanced. This is important as pressure care has been an area of concern in the past. One person noted that since her relatives arrival in the home from hospital where they had lost weight, the weight just seems to have gone on. People are looked after brilliantly and Its OK, its good were some comments from relatives or people living in the home about the standard of care received or provided. When we watched the care being provided to people who require help in moving or walking, we saw that they were supported and assisted appropriately, with reassurance and information being given to them. In recent visits to Houndswood, some less satisfactory moving and handling techniques have sometimes been noted and it is positive that on this occasion with only one exception when a persons dignity was temporarily compromised whilst being hoisted, the standard seen was very much better. This benefits all those who rely on care staff to help them move and mobilise and it is of course imperative that any poor practice or lapses in good moving and handling are identified and addressed by training so that the improvements seen during this inspection are maintained. When we checked the medication administration records on two units we found that they were generally satisfactory and provide a good level of protection for those people living in the home who rely on care staff to help them with their medication. Although we found two minor discrepancies in recording practice, overall the standard was satisfactory and we were informed following the inspection that an enhanced system of stock checking on a daily basis has been re-introduced to ensure that stock balances are correct and that any discrepancies are promptly identified and addressed. It is for this reason that a requirement has not been made. Where people living in the Care Homes for Older People Page 15 of 32 Evidence: home are able to self-medicate, they are supported to do so within a risk assessment framework and these risk assessments were seen. This maintains both the independence and safety of those who are assessed as capable of dealing with their own medication. When we spoke to people who have lived in, worked in or have regularly visited the home over the past year, there were several who told us that things have noticeably improved. It is a different home was how one person put it. Care Homes for Older People Page 16 of 32 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. People who live in Houndswood House can be confident that they will be given realistic opportunities to engage in relevant and meaningful activities, in line with their individual preferences and that they will be encouraged to maintain family and other social contacts that are important to them. People who live in Houndswood House can be assured that their nutritional and dietary needs will be monitored and met in line with their individual tastes and preferences and that they will be offered genuine choice as to what, where and when they eat. Evidence: When we looked at the newly introduced care plans, we found that they each contained a life history that enables care staff, including those who are responsible for arranging activities in the home, to understand the background, significant life event, hobbies, interests and preferences of people who live in the home. This helps activities staff to try and ensure that the activities provided for them are suitable and appropriate. When we spoke to care and activities staff we found that they had a good understanding of the needs and personal preferences of people living in the home and Care Homes for Older People Page 17 of 32 Evidence: this suggests that they have taken note of the information provided in those life histories. Surveys we received directly from people living in the home, and also information provided in the homes own annual survey suggests that people feel that there are adequate activities provided. Reports from health and social care professionals confirm that; During the review, lots of activities were going on in the home When we observed the care provided specifically for people living with dementia, we saw good levels of interaction from care staff which in turn resulted in positive care outcomes for the people concerned. We saw that new menus have been devised, in pictorial form to assist people to make choices about what they want to eat. Brilliant new menus was the comment of one relative. Finger food was available for those who find that easier to cope with and there were snacks and fruit available throughout the home. When we looked at care plans we found that they included nutritional assessments, weight records and showed evidence of the involvement as appropriate with specialist dietary and nutritional advice services where that was needed to address particular concerns about weight gain or loss. When we observed the lunch time routine in the home, we saw that where people require assistance with their meals it was given sensitively and that people living with dementia and others were offered choices about what they would like to eat at the time and not just having to keep to choices they had made the day before. When we observed mealtimes we found that the use of music and the improved decor in the dining area of the unit where people who live with dementia have their meals has greatly enhanced the experience for them. The home informed us in their AQAA that there are now monthly your voice meetings for relatives and people who live in the home and this was confirmed by visitors to the home that we spoke to. It was noted by the home that attendance at these meetings is sometimes disappointing which is a shame as they provide a good opportunity for the improvement of communication between the management of the home and relatives and people living in the home which should in turn improve the care experience and outcomes achieved for all concerned. We did note that it appears that televisions are routinely put on and left on during the day, whether or not anyone is actually watching them or indeed could see or hear Care Homes for Older People Page 18 of 32 Evidence: them in all cases even if they wanted to. This was fed-back to the manager at the end of the inspection to enable her and her staff to consider if some change in this practice might be beneficial for people living in the home. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Houndswood and those who are responsible for them can be assured that there is a thorough complaints procedure in place that is followed when a complaint is received and that people who live in the home are protected from abuse through training provided to staff and policies and procedures being followed that should ensure that any abuse is recognised promptly and appropriate action taken to address it. Evidence: When we looked at the summary of data from relatives surveyed by the home, provided to us by the manager, it indicated that only forty six percent of relatives were aware of the complaints procedure. As part of the action plan arising from the survey, the home have sent a copy of the complaints procedure to all relatives together with a copy of the homes welcome pack, which also includes the complaints policy and procedure. This should mean that all people in the home and their relatives are now aware of the complaints policy and procedure and how to make a complaint. By contrast, when we asked in our own surveys Do you know how to make a complaint? everyone that responded indicated that they did and one person noted; Staff availability means this is not necessary as concerns can be discussed as they arise. Care Homes for Older People Page 20 of 32 Evidence: When we spoke to staff about how to raise any concerns they may have with external agencies when they felt unable to do so within the home, they all had a good understanding about how that could be done. They also confirmed that they had received recent training on safeguarding vulnerable adults. When we looked at the training matrix provided by the manager, it showed that training had been provided to most staff currently working in the home and gave details of further training planned, including protection of vulnerable adults training the week following this inspection. This suggests that people who live in the home are protected by being provided care by a staff team that are aware of how to recognise abuse and what action to take if it is seen or suspected. Since the last key inspection in June, Houndswood have been the subject of a serious concerns process undertaken by Hertfordshire County Council Adult Care Services. The home and company have co-operated fully in this process and have put in place action plans to address any concerns arising from it, including an undertaking to us to ensure that staff training in safeguarding is maintained at a satisfactory level and frequency. When we looked at one recent complaint we found that it had been dealt with within the agreed timescale, had been recorded satisfactorily and that the issue raised had been addressed and appropriate action taken. Care Homes for Older People Page 21 of 32 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 living in Houndswood House can be assured that the home is clean, safe and well-maintained and that it provides a pleasant and comfortable environment for those who live and work there. Evidence: When we asked people in our surveys Is the home fresh and clean every one who replied said that was always. When we saw the summary of comments from relatives provided to us by the home, again everyone indicated that the home was clean and free from unpleasant smell. On the day of the inspection we saw that there were cleaning staff in action and that the home provided a clean, tidy and pleasant environment for people to live and work in. Over recent months work has been done to improve the physical environment for people living in the home with dementia, for example improved signage and a more attractive and practical layout and themed decor in the dining area. We also saw that enhanced access to the garden area is also now in place. Care Homes for Older People Page 22 of 32 Evidence: When we looked at some of the exterior paintwork we noted that in places it is badly flaking. The manager informed us that this is due to be addressed in the planned refurbishment due to commence in early 2009. Care Homes for Older People Page 23 of 32 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 who live in the home can be confident that they will receive care from care staff who have been recruited through a robust and thorough process and that care staff will receive the training they need to enable them to meet their care needs safely and appropriately. Evidence: When we spoke to people who live in the home and to their relatives, we found that they had a very positive view of the care staff and the standard of care that they provided for them. People are looked after brilliantly and They have been amazing were some of the comments received. This view was supported by comments sent to us by people who completed our surveys about Houndswood House. Care is excellent and always supportive to family as well All of the surveys returned to us answered always to the question; Do you receive the care and support you need? When we spoke to the key worker for one person who lives in the home we found that she had an excellent knowledge of their background, their care needs and how they were to be met and demonstrated a refreshing enthusiasm and commitment to her role. When we looked at staff training records and spoke to staff we found that significant Care Homes for Older People Page 24 of 32 Evidence: progress has been made to address the serious concerns identified following our previous inspection in June. Provided this progress is sustained, it should mean that people living in the home will receive care from people who have received the necessary training to enable them to do so effectively, safely and appropriately. Both at this inspection, and recently during the visit of a health care practitioner, isolated instances have been noted where for example moving and handling practice and consideration for respect and dignity have been less satisfactory than we would expect. These are acknowledged to be increasingly atypical, however that they have occurred underlines the need for constant vigilance, monitoring and supervision, together with regular training for staff at all levels to consolidate and entrench good practice at all times. When we looked at staff recruitment files we found that in general they were satisfactory and should provide adequate protection to people living in the home from the recruitment of unsuitable people to care for them. When we looked at induction records for new staff we found that whilst they all receive an immediate short induction to the home to meet their immediate induction needs, it can take several months in some cases for the funding to be secured and put in place to undertake the more significant in depth induction that is also required. Any unreasonable delay in this process does not meet the needs of the care staff concerned and could potentially impact on their ability to provide care as effectively as might otherwise be the case. This was discussed with the manager. We discussed with the manager the practice of working twelve hour shifts on consecutive days. From records provided to us of shifts actually worked, we saw that the usual pattern is for three days, although it was accepted that on occasions this could exceptionally be for four days. We were informed that no care staff work consecutive day and night shifts. We asked the manager to keep the staffing rotas and patterns of work under constant review to ensure that she is satisfied that the safety and well-being of people living in the home is not compromised by staff shift patterns. In their AQAA the home identify the improvement of the awareness of good dementia care practise throughout the home as something they could do better and indicate that over the next twelve months they will train all staff on the dementia unit in the Alzheimers Society training programme called Yesterday, today and tomorrow. The home informed us in their AQAA that of 23 permanent care workers 13 have achieved an appropriate national vocational qualification in care at level 2 or above. Care Homes for Older People Page 25 of 32 Evidence: Care Homes for Older People Page 26 of 32 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. People living in Houndswood House or responsible for them, can be increasingly assured that the home is being well managed and that their interests, health, safety and welfare are being promoted and protected by the homes management and administration. Evidence: When we spoke to people who live in the home, their relatives and members of the staff team, we were told in each case that they had noticed significant improvements recently; Home is much better, Its a different home, there have been lots of changes were some of the comments recorded. One relative, whom we contacted to discuss a complaint she had made to the home nonetheless said; I am very happy with Houndswood and My relative is happy there and would tell me if they were not. The complaint itself had been resolved although at the time we contacted the relative concerned they indicated that they had not been Care Homes for Older People Page 27 of 32 Evidence: notified of the outcome. Health and social care professionals who have visited the home on several occasions since February 2008 have also told us that they have noticed improvements in many areas of record keeping and health care practise in the home. The manager of the home has been registered by the commission as a fit person to manage a registered care service and has a good level of experience in care settings for older people in particular, as well as a nursing background. The management team of the home has also been enhanced by a number of recent appointments, with separate unit managers for both units in the home now in place, most recently the appointment of a registered mental health specialist nurse as unit manager for the dementia care unit. We have seen that the area management team for Craegmoor have also been instrumental in supporting the registered manager, with a significantly enhanced presence within the home on a regular basis. Houndswood has experienced a number of management changes in recent years and this has unavoidably led to some lack of consistency for staff and people living in the home. It is recognised that Craegmoor are aware of the challenges that management changes bring to people who live or work in the home and have attempted to minimise the adverse affect where possible. We were told both by the home in their AQAA and by relatives that we spoke to or contacted that regular residents and relative meetings are now being held, which should provide all people associated with the home additional opportunity to raise and discuss any issues of concern they may have. When we spoke to the manager and to members of the staff team and looked at staff supervision records, we found that although supervision has not yet reached the required level over a full year, it is now on track to do so provided the current frequency and planned sessions are maintained. This will provide staff with the regular, sustained supervision support they need to help them achieve good care outcomes for people living in the home. When we spot checked financial records for transactions carried out by the home on behalf of people living there, we found that they were accurate and that a robust system of checks is in place to appropriately protect their interests. When we spoke to some people who have regularly visited the home either as relatives or as health and social care professionals, some concern was raised about the visibility and profile of the registered manager within the home. The manager is office bound was one observation. It is accepted that in recently carrying out additional evening Care Homes for Older People Page 28 of 32 Evidence: checks in the home at varying times and through sharing in daily walk through checks with other management staff, all of which are fully recorded, the manager is attempting to address this perception. It is important that as and when the enhanced support currently being provided into the home by the area manager and others is scaled down, that the manager is sufficiently visible in her leadership role in the home to maintain the clear progress achieved, that benefits all those who live and work within the home. When we looked at the routine system of quality assurance in operation, we found that it is very thorough and should provide confidence that the recent difficulties and failures in care that were highlighted in our report of June 2008 would now be identified and addressed at an early stage. It is perhaps too early yet to be entirely confident that all concerns have been fully and permanently addressed as there have been a few, if isolated instances where we have seen less than ideal moving and handling practises, some minor failures in medication recording and lapses in consideration for the dignity and respect for people living in the home. This is not to detract from what has, as noted above, overall been a significant improvement in many areas of the homes operation or the consequent benefits to people living in Houndswood House. Care Homes for Older People Page 29 of 32 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 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 36 18 Staff must receive suitable formal supervision, which in the case of care staff should be at least six times a year. This is to make sure that all staff receive guidance and support in all areas of practice, are kept up to date with any changes to policies and procedures and so that their training and personal development needs can be identified. 31/03/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 30 The manager should try to make sure that funding is in place to enable all care staff receive full induction training at the earliest possible opportunity as this will benefit both them and people living in the home that they care for. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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