Inspection on 28/11/08 for Ivybank

This inspection was carried out on 28th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ivybank 18/11/09

Ivybank 24/01/08

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ivybank 73-75 Middleton Hall Road Kings Norton Birmingham West Midlands B30 1AG     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: Lisa Evitts     Date: 2 8 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. 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 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Ivybank 73-75 Middleton Hall Road Kings Norton Birmingham West Midlands B30 1AG 01216243006 01216243581 ivybank@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Southern Cross BC OpCo Ltd Type of registration: Number of places registered: care home 58 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 58 The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Old Age, not falling within any other category, Code OP - maximum number of places 58 Date of last inspection Brief description of the care home Ivybank Nursing Home is a large traditional property, which has been further extended to provide accommodation for 58 older people who require nursing care. The home is located in a residential area of South Birmingham and is close to local amenities. The home is conveniently situated for public transport and off road car parking is available for several cars. The home has been established for a number of years however was acquired by Southern Cross Healthcare in November 2007. Accommodation is provided Care Homes for Older People Page 4 of 30 Over 65 58 0 Brief description of the care home in both single and double rooms. En-suite toilets are provided in 24 rooms, and two en-suite shared rooms are available. The bedrooms are on two floors and a passenger lift is available to all floors. Sufficient communal space is provided with lounges and dining rooms and there is a large garden to the rear of the home, which is accessible to people via a ramp. A smoking room is available for people who choose to smoke. The home has a number of hoists and pressure relieving equipment available to meet the assessed needs of the people living at the home. There are assisted toilets and bathrooms available and corridors are wide and spacious and enable people to move around the home freely with any aids they require. Inside the home, there are various notice boards, which display information about forthcoming events and other articles that may be of interest. The last inspection report is available in the reception area and this enables people living at the home or visitors to the home to access this information easily. The current scale of charges for the home are not included in the service user guide but can be obtained directly from the home. Additional costs include, hairdressing, toiletries, chiropody and newspapers. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Since the last key visit to the home in January 2008, We, the commission have completed two random inspections at the home. The first visit was in May 2008 following concerns being raised about care and documentation. This visit resulted in two Statutory Requirement Notices being issued in order to improve outcomes for the people living at the home. The second visit took place in July 2008 and was to monitor Care Homes for Older People Page 6 of 30 the progress and to check if they had met the requirements. We found that the home had made significant improvements to documentation and had met the requirements to improve the standards. There had been a number of adult protection concerns raised and the police are taking the lead on a number of these cases. Due to the concerns Adults and Communities had placed a suspension on the beds in May and this meant that the home was not able to take any one else to live there. This suspension remained in place at the time of this visit. The pharmacy inspector visited the home on the 24th November 2008 and the report is included in the main part of this report in the healthcare section. Two inspectors undertook this visit to the home over eight and a half hours and were assisted throughout by the operations manager and project manager. The home did not know that we were visiting that day. There were 25 people living at the home on the day of our visit. Information was gathered from speaking to and observing people who live at the home. Three people were case tracked and this involves discovering their experiences of living at the home by meeting or observing them, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of the people using the service. Staff files, training records and health and safety files were also reviewed. We also looked partly at one other file. We spoke to three people who live at the home, three staff and four relatives. Prior to the inspection the project manager had returned the Annual Quality Assurance Assessment (AQAA). This gave us information about how the home think they are performing, information about staff and people who live there along with improvements and plans for future improvement which was taken into consideration. What the care home does well: What has improved since the last inspection? Care plans have improved so that staff are provided with detailed information about how people should be assisted to meet their needs. An extensive redecoration programme has been put in place to provide a clean, homely and comfortable environment for people to live in. New equipment has been purchased to meet the needs of the people living at the home. Bathrooms have been upgraded to provide people with a choice of bath or shower, which meets their mobility needs. Care Homes for Older People Page 8 of 30 Staff training has increased so that staff have up to date information about how to meet peoples needs. This is an ongoing programme to ensure that all staff receive the training. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have some information about the home so that they can make an informed decision about whether they would like to live there. Evidence: The organisation has produced a service user guide and statement of purpose. These documents had been taken off display and out of bedrooms as they were in the process of being updated to ensure they provided current information about the home. These documents are available in large print and can be made available on audiocassette upon request. This ensures that people with visual impairments can access this information. Fee rates were not included in the service users guide and this was recommended so that people know how much they will pay to live at the home. The certificate of registration and the last inspection report were displayed so that Care Homes for Older People Page 11 of 30 Evidence: people could read this information if they chose to. It was not possible to review the pre admission assessment process, as the home has not been able to admit people to live at the home since May 2008. This standard will be reviewed at the next visit to the home. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provide staff with information so that they can assist people to meet their needs in a way they like. People may not receive their medication as prescribed which may impact on their well being. Evidence: Each person has a written care plan. This is an individualised plan about what the person is able to do for themselves and states what assistance is required from staff in order for the person to meet their needs. We completed a random inspection at the home in May 2008 following concerns being raised about care and documentation. We looked at care records and found that some people had not got care plans, some provided conflicting information and staff were not following instructions in the plans to ensure that peoples needs were met. Following this visit the home had two Statutory Requirement Notices to improve the care and documentation for people living at the home. The organisation responded very quickly with an action plan about how they were going to put things right. Care Homes for Older People Page 13 of 30 Evidence: In July we visited the home to check that they had met the requirements in the two Statutory Requirement Notices. The home had made significant improvements to care plans and documentation and staff were following instructions from the plans to ensure that peoples needs were being met. During this visit we looked at three files in detail and one file was partly reviewed. Care files were detailed with peoples likes and dislikes and gave staff instructions to follow to meet peoples needs for example wears Tena comfort supa pad and net knickers and ensure pillow is placed between knees and ankles. The plans were updated as changes happened and plans were evaluated each month to ensure they gave current information. One person had a problem with their skin and staff were able to tell us about this but there was no care plan written and this may mean that not all staff would know what to do. There were risk assessments in place for nutrition, sore skin and risk of choking. Moving and handling assessments were detailed with type of equipment to use such as full body hoist with yellow medium sling. This means that staff know what equipment to use to move people safely. One file showed that staff at the home had made a decision not to take any action regarding weight loss of one person in the home due to their condition. There was no evidence that this was a multi disciplinary decision and was discussed with the operations manager and project manager at the time of our visit. Wound care plans for one person had been updated following a visit from the tissue viability nurse and this means that staff have current information about how to manage the wounds effectively. There was evidence that people were seen by the GP, optician, tissue viability nurses, dietician, chiropodist and speech and language therapist. This should mean that people receive specialist advice about their healthcare needs. People were observed to be wearing clothing, which reflected individual choices. One relative said mom can go to bed when she wants and if she is ill they let us know straight away. The pharmacy inspector undertook a visit to the home four days before we visited. The medication is kept in two designated medication rooms. The room on the ground floor Care Homes for Older People Page 14 of 30 Evidence: was 25C at the time of the inspection. Concern was raised that this temperature would exceed this in the summer months and so the medication would not be stored in compliance with their product licences which may affect their stability. Both medication rooms had their own medication refrigerator. The upstairs refrigerator was too cold to safely store medicines in as the temperature was 1C. This must be between 2C and 8C at all times to guarantee the medicines stability within. The prescriptions are seen prior to dispensing but the copies of these are not kept alongside the medicine chart for reference. Nursing staff are not checking the prescriptions to ensure that only what they need is prescribed. One medicine was available for use that was not needed. It had not been returned nor had it been recorded as received on the medicine chart. Another medicine had run out mid cycle and nursing staff were awaiting the doctor to assess whether a further supply was needed. This had not been done in a timely fashion and resulted in a break in the medication whilst this decision was made. The nurse on duty was finishing off the medication round when the inspection took place. This was at 11.30am. Concern was raised that there would be insufficient time between the next round scheduled at 2pm. Without an adequate break between medication rounds the risk of potential overdose increases. We, the commission, was assured that this was unusual but on further questioning there was only one nurse on duty for the 25 residents that live in the home and her duties were compounded by one care assistant who was off sick that morning. Audits indicated that not all the medication had been administered as prescribed at all times. Many gaps were seen in the records. In some instances the medication had been administered but staff had failed to record what they had done, in others not administered and staff had not recorded the reasons for non administration. Some codes had been recorded for some medicines that had been refused but there was no consistent code used resulting in the records being unclear as to whether the medicine was destroyed or not. Concern was raised where one person should have had their blood glucose levels monitored on a monthly basis. This had not occurred and no further action had been taken when the level exceeded the recommended range. Scabies had been diagnosed in the home in October. Treatment was poor. No medicine charts could be found to demonstrate the receipt and application of the treatment. In addition despite a detailed care plan written for each person sampled only one Care Homes for Older People Page 15 of 30 Evidence: application was recorded as applied. Two bottles of the scabies treatment were found in the cabinet for four residents, dispensed one week apart. It could not be demonstrated whether they actually had any applied at all despite the care plans recording one application. A further 13 unused bottles were found for 13 other people. The home has installed a quality assurance system to assess the nursing staff practices in the safe handling of medicines. Assessments were undertaken on a monthly basis. This though had failed to address some of the issues found during the inspection. All controlled drug balances were correct and they were stored in line with current regulations. Care Homes for Older People Page 16 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities offered may not meet all the needs of the people who live at the home. People are offered a choice of meals to meet their dietary, cultural needs or preferences. Evidence: The activity coordinator had recently left employment and the home were in the process of recruiting someone for this vacancy. Minutes of the service user meeting in November said that activities were generally good but people would like more variety and more trips out of the home. One staff member said We did have a coordinator but they left. There is nothing really going on, we do puzzles and drawings but dont have time We did not see any activities taking place on the day of our visit and one person told us that there was no one for them to talk to. External entertainers/activities visit the home, for example a clothes show, a violinist and a school choir were booked for December. A hairdresser visits each week and vicar visits the home so that people can continue to follow their religious beliefs if they choose to. Exercises to music are offered each week and someone comes in to complete general knowledge quizzes. Care Homes for Older People Page 17 of 30 Evidence: A relative told us that staff had taken his mom Christmas shopping and staff were taking another person out shopping the day after our visit. Staff were taking people out on their days off and one staff member said they did this because they didnt like to take staff off the floor. One persons care plan stated that they liked to have scriptures read to them daily, however the records showed this had only happened twice during November and means that this persons religious needs were not being maintained. This suggests that activities offered do not meet the needs of all people living at the home and the manager should review how people will be stimulated until the activity coordinator post is recruited to. People can go out of the home as they are able to and this encourages their independence and enables them to maintain links with the community. The home has an open visiting policy, which enables people to see their visitors as they choose and maintain relationships that are important to them. One relative said staff always make you welcome. The home has a four-week menu in place, which offers a variety of choices. On the day of our visit the menu had been changed as some people had requested fish and chips. There were comment books in the dining room and these indicated that generally people enjoyed their meals. Staff were observed to assist people to eat their meals in a dignified and discreet manner. People were offered sauces with their meals and drinks were available. Tables were nicely presented and the menus were on the table so that people could see what was being offered. There was a blackboard on the ground floor, which showed the change in menu for the day. People sat at the dining table or stayed in their chairs as they chose to. Staff were observed to encourage people who were not eating their meals and offer alternatives. One person and his wife who was visiting sat together at a table on their own and this assists people to maintain relationships and a homely environment. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a comprehensive complaints procedure so people know how to make a complaint if they want to. There are systems in place, which should protect people from harm. Evidence: The complaints procedure is displayed in the home and is in the service users guide so that people should know how to make a complaint if they want to. Minutes of the service users meeting at the beginning of November stated that some people did not know how to complain so the procedure was explained again. Since our last visit to the home we have received three complaints about the home and these were concerning staffing levels and tidiness of the home. These were referred to the provider to investigate using their own complaints procedure. We looked at the complaints records held in the home and they had recorded nine complaints in the last twelve months. There were good records of the complaint details, investigations, outcomes and actions taken. One relative said We have no complaints and another said its more organised since Southern Cross took over The home has an adult protection policy, which incorporates the Department of Care Homes for Older People Page 19 of 30 Evidence: Healths, No secrets policy and has a copy of the local multi agency guidelines so that staff have guidelines to follow in the event of an allegation being made. There have been a number of adult protection concerns raised by external professionals and by staff at the home. The police are taking the lead in a number of the investigations and there has been a suspension on placements at the home by Adults and Communities since May 2008. This means that the home have not been able to admit new people to come and live at the home as social services would not pay for them to live there. Staff have received training in protection of vulnerable adults and staff spoken to during our visit were able to give good verbal accounts of action they would take in the event of an incident occurring to ensure that people are safe. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A comfortable, homely and safe environment is provided to meet the needs of the people who live at the home. Evidence: There has been an extensive refurbishment programme actioned since the organisation took over the home in November 2007. This has included redecoration of the communal areas and bedrooms, including new carpets. New beds have been purchased and bathrooms and shower rooms have had new equipment to enable people to use the facilities more easily. The project manager told us in the AQAA that the kitchen has had new storage facilities and equipment and a new washing machine and iron had been brought for the laundry so that peoples clothes were treated and kept in the best condition. We looked at areas of the home, which were relevant to the people we case tracked. Communal areas were pleasantly decorated and handrails are available in the corridors to assist people to mobilise around the home. The lounge was arranged so that people could talk to each other if they chose to. While sitting in the lounge we noticed that a number of cushions were missing from the chairs. Staff did place cushions on the chairs before they assisted people to sit down however people may have come into the Care Homes for Older People Page 21 of 30 Evidence: lounge and sat down without being aware of the missing cushions and this would place them at risk of developing sore skin. This was brought to the attention of the operations manager and project manager on the day of our visit. Bedrooms seen were personalised and reflected individual tastes, gender and preferences. People are encouraged to bring in their own possessions, which helps to provide a familiar environment and make their room as homely as possible. Bedroom doors have nameplates and doorknockers so that people know which room is theirs. People told us: The home is clean and spotless I have a call bell to call the staff when I need them The new decoration is much better One person told us that they had moved from the first floor to the ground floor so that they had more room due to the amount of equipment they required. Another person said that they were unhappy with their room and this was discussed with the staff on the day who were going to discuss alternative rooms with her. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate 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 staff who receive training to ensure they have the knowledge to help them meet their needs. The recruitment procedure should ensure that people are safe guarded from harm. Evidence: There are five care staff and one trained nurse on duty throughout the day and three care staff and one trained nurse at night. There was a manager and activity coordinator vacancy, which the home was in the process of recruiting to. In addition to care and nursing staff the home also has domestic, laundry, administrative and maintenance staff. Two staff have completed National Vocational Qualification Level 2 (NVQ) in care and the remaining staff are enrolled and working towards this qualification. This should ensure that staff have the knowledge and skills to meet peoples needs individually and collectively. People told us: If staff are unsure of things they always try and find out Care Homes for Older People Page 23 of 30 Evidence: There is one staff I dont get on with, the others are ok Im looked after Sometimes there are less staff at the weekends, but they are alright There are no staff at night, there are temporary carers who come in and help There was a pleasant atmosphere in the home and staff were observed to interact well with people living at the home. We observed one person who asked two different members of staff to move her away from the table, wait for fifteen minutes before staff were able to do this. We spoke to staff who told us that they felt there needed to be at least one more carer on duty as a number of people required hoisting and two staff. With one person supervising the lounge this meant that one person was left waiting for someone to come and help them, which meant that people had to wait longer. We discussed this with the operations manager and project manager on the day of the visit and they felt this was due to lack of organisation with the routine. It is of concern however that we have raised concerns about staffing both at the last key visit and two following random inspections. After our last visit in July the home told us about a number of things they were doing to improve the provision of staff, however this needs to be reviewed again to ensure that peoples needs are met in a timely manner. We looked at three staff files and these were found to contain all the required information to ensure that people were safe from harm. The exception was that gaps in employment history had not been explored and this is recommended. Some staff had received training in fire safety, food hygiene, moving and handling, control of substances hazardous to health (COSHH), health and safety, protection of vulnerable adults, infection control, customer care, dementia awareness, challenging behaviour and dementia awareness. There were still some staff who required some of this training but the manager was aware of this and was working towards further improving this so that staff have the knowledge and skills to meet peoples needs. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has not benefited from a registered manager who is able to provide leadership and direction to ensure that the home is run in the best interest of the people living there. Evidence: Since our last visit to the home there have been a number of managers and project managers who have been in charge of the home. There has not been a registered manager of the home since the organisation took over in November 2007 and no consistent manager to provide continuity to the people who live at the home. This lack of consistency may have contributed to the number of adult protection concerns that have been raised at the home regarding healthcare needs. Care staff told us that they feel there are not enough staff to always meet peoples needs in a timely manner and this may be as a result of lack of consistent leadership. On the day of the visit there was a new project manager at the home and the senior Care Homes for Older People Page 25 of 30 Evidence: managers have told us that he will stay at the home until a permanent manager is appointed and has received an induction into the home. People who live at the home, their relatives and staff were very complimentary about the project manager and it is disappointing that there will be another management change.The project manager has a number of years experience as a registered home manager. He has a National Vocational Qualification Level 4 (NVQ) in care and has the Registered Managers Award. The manager has worked for the organisation for a number of years and therefore is aware of the policies and procedures. Meetings are held with people who live at the home, relatives and staff and minutes were available from these. This gives people the opportunity to discuss any ideas or concerns about how the home is run. External managers visit the home and write reports about the quality of service being offered. The manager has to complete a number of audits each month to monitor quality. The home had sent out satisfaction questionnaires in August but there was no analysis available from these yet. Prior to the inspection the project manager had completed and returned the Annual Quality Assurance Assessment (AQAA). This gave us information about how the home think they are performing, information about staff and people who live there along with improvements and plans for future improvement which was taken into consideration. The home is able to hold small amounts of personal money for people. There is a computerised system, which enables the administrative staff to keep individual records of money coming into and out of the account. People receive interest on the money held in the bank. Receipts were available for all monies spent. Health and safety and maintenance checks had been undertaken in the home to ensure that equipment was in safe and full working order. Maintenance checks are completed on the fire system and equipment and staff receive training and fire drills, which should mean that people are safe in the event of a fire occurring. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 All medicines must be stored 23/01/2009 in compliance with their product licences. This is to ensure that all the medicines stability is maintained and will not compromise treatment. 2 9 13 The medicine chart must record all the medicines received into the home and be administered as the doctor intended. Records must reflect practice. All medicines must be administered at least four hours apart. This is to ensure that the correct medicine is administered to the correct resident at the correct dose and time as the doctor prescribes and to minimise the risk of potential overdose. 23/01/2009 Care Homes for Older People Page 28 of 30 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 2 3 1 7 8 Fee rates should be included in information about the home so that people know how much they will pay to live there. Care plans should be written for all needs so that staff know how to assist people to meet their needs. Decisions relating to care delivery should involve the multi disciplinary team to ensure the best outcomes for the people at the home. Provision of activities should be reviewed to ensure people have an interesting and meaningful lifestyle. Staff availablility should be reviewed so that peoples needs are met. Gaps in employment history should be explored to safeguard people from harm. A manager should be appointed to ensure continuity for the poeple who live at the home. 4 5 6 7 12 27 29 31 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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