Inspection on 10/12/08 for Ivydene Nursing Home

This inspection was carried out on 10th December 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ivydene Nursing Home 12/12/06

Ivydene Nursing Home 24/05/06

Ivydene Nursing Home 17/01/06

Ivydene Nursing Home 12/10/05

Ivydene Nursing Home 09/02/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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: Ivydene Nursing Home Staniforth Drive Ivybridge Devon PL21 0UJ     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: Wendy Baines     Date: 1 1 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. 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 29 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 29 Information about the care home Name of care home: Address: Ivydene Nursing Home Staniforth Drive Ivybridge Devon PL21 0UJ 01752894888 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sanctuary Care Ltd Name of registered manager (if applicable) Mrs Fiona Cartlidge Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Old age not falling within any other category (OP) 20 Both One Service User under the age of 65 years (named elsewhere) Physical Disability over 65 years of age (PD(e)) 37 Both Terminally Ill over 65 years of age (TI(e)) 5 Both Date of last inspection Brief description of the care home Ivydene is a purpose built care home, situated in the town of Ivybridge, providing nursing and/or personal care for up to 57 persons over the age of 65 years of age of either gender. The home is designed to care for persons suffering with varying degrees pf physical disability/frailty or illness. The accommodation is located on 2 floors with 2 passenger lifts providing access to the Care Homes for Older People Page 4 of 29 care home 57 Over 65 20 57 0 0 Brief description of the care home 1st floor. All the bedrooms have the benefit of en-suite WC and wash hand basin. 7 bedrooms are dedicated to persons receiving short term nursing care funded by the NHS. Ivydene has large communal areas including dining room and large lounge and 2 smaller lounges. There is a pleasant patio area with flower- beds; the town centre is a short distance away. Ivydene was first registered in 1994. Information about the home was found in the entrance hall and this asks readers to request a copy of the latest inspection reports from the administration office. Information given to the Commission by the provider indicates the current fees range from £400 to £733 per week. Care Homes for Older People Page 5 of 29 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 Quality rating for this service is one star. This means that people using the service experience adequate quality outcomes. The Inspection was unannounced and took place over two days on the 9th and 10th December 2008. The Registered Manager was present during the first day of the Inspection. Prior to the inspection the Commission had sent surveys to people living in the home to ascertain their views regarding the quality of the services provided. Some of the feedback within these surveys are included in the main body of the report. Care Homes for Older People Page 6 of 29 The Inspector completed a tour of the premises and was able to meet with residents on an individual basis and group settings. Staff on duty were spoken to and the Inspector was able to spend time with and ask the views of people visiting the home. This included family, friends and health care professionals. A sample of records were examined, and the care notes of 10 residents were looked at in more detail. Other documentation such as staff files, residents meeting minutes, quality assurance questionnaires and medication records were also examined. What the care home does well: What has improved since the last inspection? What they could do better: The homes care plans must be sufficient in detail to reflect the level of care being provided. Care records should include clear guidelines for staff to ensure that care and support can be delivered in a consistent manner. Residents should be involved in planning their care and information should be documented about their preferences about how care is delivered. All care plans should include information about End of Life Care. This information will ensure that the wishes and views of the individual and their families are followed in the event of a death. Staffing levels in the home must be reviewed to ensure that the number of staff Care Homes for Older People Page 8 of 29 available is sufficient to meet the assessed needs of all people living in the home. Consideration should be given to having sufficient staffing levels to deliver Person Centered support. Staff working in the home must be sufficiently skilled and trained to meet the needs of the people they care for. All staff must undertake regular training in First Aid, Infection control and Manual Handling. Staff who have been away from the home and return to work must receive a adequate Induction to ensure they are aware of any changes. Information about the agreed arrangements to support people with their finances should be recorded as part of the service user plan. 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 29 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 29 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 Ivydene are provided with sufficient information to help them make an informed choice about where they live and the services they receive. Peoples needs are assessed prior to them moving in, however a clear distinction between how people are assessed for nursing or residential care will further ensure that the home only admits people whos needs they are able to meet. Evidence: There is a Statement of Purpose and service user Guide for the home. This contained information about the home and the services it can provide. These documents were available in the main reception area and were given to new residents and their families. All the people who completed surveys felt they had had enough information prior to Care Homes for Older People Page 11 of 29 Evidence: moving into the home to help them make a decision as to whether they wanted to live there. Sanctuary Care Ltd has a standard form, which is completed for all new admissions. This form is used to help the home collect as much information about the individuals needs before they move in. A sample of these pre-admission assessments were looked at and where appropriate included information from family, GPs and other relevant agencies. Where possible the person who may be considering moving to the home and their family are invited to visit so that they can see the environment and meet other residents and staff. This pre-admission process ensures that the home and the individual are sure that the placement is appropriate before they move in. The Manager said that on completion of the pre-admission assessment a letter would be sent to the individual and/or their family advising them whether or not the home can meet their needs. If a decision is made to move in a trial placement would be agreed followed by a review and completion of a full care plan by the home. The Manager for the home said that she was in the process of reviewing the admissions policy and procedure with a view to ensuring that their is a clear distinction between how people are assessed for Nursing and Residential Care. This will further ensure that people are only admitted if the home is certain that their needs can be fully met. A District Nurse who was visiting the home felt that the manager was very clear about ensuring people are not admitted to Ivydene if their needs cannot be met. Care Homes for Older People Page 12 of 29 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. Residents needs are set out in an individual plan of care, but these do not always provide enough detail to ensure that staff are able to consistently meet all of the needs of some residents. The homes current care plan process does not always demonstrate the involvement of the resident, and care plans are not always written in a way that recognizes the individuals preferences and choice about how care is delivered. Systems are in place to promote and maintain peoples health and to ensure that access to health care services are available. Residents are treated with respect and their rights to privacy is upheld. In some cases insufficient information is recorded to ensure that end of life care is provided in a way that the individual and/or their families choose. Care Homes for Older People Page 13 of 29 Evidence: Following admission to the home a number of assessments are completed, which provides the basis for the care to be delivered. Records confirmed that these assessments include, Manual Handling, risk of falls, skin integrity, continence and nutrition. A sample of care plans were looked at for people in the home who were receiving either residential or Nursing care. Although the forms used to assess and document peoples needs were the same for both these units the quality and detail of information varied considerably. In several cases the amount of detail did not reflect the level of care being provided. Some of the care plans had good information about peoples individual preferences and described how they liked and chose to be supported. Others looked at had written statements about peoples needs such as Mrs X needs to be washed and dressed to a standard that she finds acceptable, however the plan did not describe how the individual likes and prefers to be supported. Within the Residential unit there were several examples of residents requiring monitoring of food and fluid, and forms were available to show how this was being monitored. However, some of the records of people receiving nursing care did not as clearly evidence how needs were being met and monitored. Two members of staff spoken to said that they did not feel that the information provided to them was sufficient to enable them to provide care in a consistent way. One staff member said that they felt they had to guess how the person needed supporting and did not feel this was appropriate. The Inspector met with several residents during the inspection. Most wanted to praise the staff, and said that they were well cared for and never rushed when being supported with personal care needs. Some of those spoken to said that the care provided can at times vary depending on the staff member and number of staff on duty. Records are kept of all visits to the home by Social or Health care professionals, all residents are registered with a GP. As well as visits from General Practitioners, district and specialist nurses, residents are also supported to access Chiropody, Physiotherapy and dental services. Records of outpatient appointments show that visits to community and health resources are enabled. The Inspector was able to talk with a visiting Healthcare professional during the Inspection. The feedback was very positive describing recent care to residents as exemplary. They said that in their view the staff had a good understanding of the care needs of residents although the care being provided is not always reflected in the written information. Care Homes for Older People Page 14 of 29 Evidence: The homes systems for the administration of medications were examined. The Inspector looked specifically at how information about medication is recorded and how medication is stored. When someone is admitted to the home a record is made of all prescribed medication. The home uses a monitored dosage system, which is well organized and easily audited and administered by trained staff from four purpose built trolleys directly to the resident on a 1:1 basis. Records inspected were found to be in good order and up to date. Throughout the inspection staff were observed knocking on residents bedrooms before entering and speaking to residents in a respectful manner at all times. One resident said that staff are always very respectful and discreet when offering support with routine personal and medical procedures. Not all of the care plans seen included information about end of life care. In some cases this area of the care plan had no comments so it was not evident if the individual and/or their families had been asked questions about the care and arrangements they may wish to have in place in the event of a residents death. At the time of the inspection the Commission had received a complaint regarding the procedures followed by the home at the time of residents death. The Provider was in the process of investigating these issues and any outcome will be reported within future Inspections of the home. Care Homes for Older People Page 15 of 29 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. The home provides a good choice of daily activities, and relatives and friends are welcomed into the home at any time. The food is enjoyed by most residents and the environment allows for people to eat their meals where they choose. Evidence: The home employs an activities coordinator who has a specific role to organize and provide social activities to meet the needs of people living in the home. Some of the care plans seen included information about peoples interests but in some cases this information was limited or not recorded. The Inspector met with the activities coordinator who said that a getting to know you form is now being completed for all people admitted to the home and this aims to encourage staff to gather as much information as possible about the individual and the things they enjoy. Throughout the visit the atmosphere in the home was warm and welcoming. The layout and size of the home allows for people to spend time sitting quietly on their own or with others if they choose. During this visit the Inspector saw that some residents Care Homes for Older People Page 16 of 29 Evidence: were socializing in the lounges or watching television, others were spending time in their rooms, reading and listening to music. On the second day residents enjoyed a visit from the staff of a local chocolate shop and were able to sample some of the Christmas Items for sale. The house was decorated for the Christmas celebrations and prizes for a Xmas raffle were on display in the main reception. Information about local events and visitors to the home such as the hairdresser and chiropodist were displayed clearly on notice boards. Residents who completed questionnaires said that there was a good mix of activities available and that they were able to choose whether or not to join in with them. Staff were observed chatting with residents and on the second day a game of countdown was being organized. Some of the staff spoken to said that they felt if there was more staff available they would be able to spend more time getting to know the residents and joining in with their activities. Visitors spoken to during the inspection said they are encouraged to come and see their relative or friend and are always made to feel welcome. The menu seen on the day of the inspection was varied and nutritionally balanced. The kitchen staff said that homemade cakes, drinks and fresh fruit are available throughout the day. There were separate dining areas, and residents were also able to have their meals in their own rooms if they preferred. The dining area in the residential unit of the home had a microwave on a side table. The staff said that this had occasionally been used as residents said that their meals were not hot when they arrived. It was suggested to the staff member that this could be unsafe because of the way food is heated in microwaves and could result in burning a resident. The feedback from residents who were spoken to and completed questionnaires was that the food was usually good. Care Homes for Older People Page 17 of 29 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. The Registered manager has a good understanding about the recording and management of complaints and safeguarding issues. Any complaints made are taken seriously and arrangements made to address any of the issues upheld. Evidence: A complaints procedure was available within the main reception and included in information provided to people about the home. The people who completed questionnaires all said that they knew how to make a complaint. A record of complaints received by the home is maintained and was looked at during the visit. The information recorded confirmed that the home listens to the concerns and complaints raised by people who use the service and puts in place an action plan to address them. The Commission has received three complaints since the last key Inspection, which was undertaken in December 2006. The issues raised involved the monitoring of a residents diet and procedures followed by staff at the time of a residents death. Earlier complaints have been addressed by the home and information about the outcome provided to the Commission. The Commission has received a more recent complaint regarding the procedures followed by the the home at the time of a residents death. Care Homes for Older People Page 18 of 29 Evidence: The Registered Manager was not employed in the home at the time the incidents occurred, but has undertaken a thorough investigation, following the organizations complaints procedure, and a substantial amount of the issues raised have been upheld. The manager has provided an action plan to the Commission outlining how the concerns raised will be addressed. The Commission will continue to look at these issues as part of the on-going inspection process. The policies and procedures seen in the home included information about the safeguarding of people who use the service. This included the procedures to be followed if an incident of abuse or suspected incident should occur in the home. At the time of the key inspection safeguarding procedures were being followed regarding the care of a resident who had recently left the home. The manager had made an alert to the relevant safeguarding agencies and the home was cooperating fully with the investigation. The manager had provided the Commission with information to confirm that in relation to this situation the home had taken appropriate action to ensure that all people living in the home were safe. Care Homes for Older People Page 19 of 29 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. The environment is safe and adequately maintained. The home is clean and hygienic. The manager recognizes where improvements in the layout of the environment could be made to further meet peoples needs. Evidence: During the visit the Inspector was able to complete a full tour of the building. This included visiting several residents in their bedrooms and inspecting all communal parts of the home. The bedrooms seen were attractive and had been decorated to reflect individuals personal taste. Residents had been able to bring some personal belongings with them when they moved in and much effort had been made to help residents display family photographs and many other personal items. The home was found to be clean and tidy throughout and had been organized in a way that allowed residents enough space to either sit quietly on their own or with visitors or to sit and enjoy the company of other residents. The dining areas were tidy, but did lack a feeling of homeliness. The garden area has been landscaped to include, accessible pathways, a covered area Care Homes for Older People Page 20 of 29 Evidence: and raised flower beds. Access to the garden is sufficient for people who may require the use of a wheelchair. One relative spoken to during the visit said that their had been recent improvement in the environment, particularly the reception area that was now more welcoming. Posters were displayed around the home reminding staff of tasks that needed doing during the night to ensure that the environment remains clean and well maintained. The manager said that although the home currently provides nursing, residential, and short term NHS care, the future plan was to ensure a clear distinction between these units, which may also involve environmental changes to these areas to ensure that peoples care needs are appropriately met. Information provided by the home prior to visit confirmed that there is an on-going maintenance and renewal programme. In addition to general decor and replacement of furniture a new bath has been installed and the purchase of four more specialist profiling beds. Care Homes for Older People Page 21 of 29 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 using the service are generally satisfied with the care they receive to meet their needs. However, information provided concludes that the current staffing levels are not sufficient to ensure that peoples daily care needs are being appropriately met. If staffing levels are not reviewed as peoples needs change this could severely restrict the ability of the service to deliver person centered support. The homes thorough and robust recruitment process protects people who use the service. Several staff members demonstrated a wish to provide good care to residents, however gaps in training and Induction could result in a staff team who do not have the necessary skills and knowledge to meet the assessed needs of residents. Evidence: During the visit the Inspector was able to meet with and speak to staff within both the Residential and Nursing parts of the home. Discussion confirmed that within the residential unit two staff are available to provide care for residents during the morning. However, discussion with staff and residents suggested that these numbers are not sufficient to meet the needs of residents during Care Homes for Older People Page 22 of 29 Evidence: this busy time of the day. Staff said that the care needs of people within the residential unit had increased, and there were now more people requiring assistance with their daily personal care needs. Although it seemed that staff organize themselves in the morning so that they can fulfill as many tasks as possible, discussion with residents suggested that some had to wait a significant amount of time between getting up and getting dressed, as some residents required the support of both the staff members on duty. Staff spoken to recognized this as a problem and the residents spoken to felt that staff were doing their best and that they didnt want to complain. A sample of recruitment records for staff recently appointed to work in the home were inspected. The records contained evidence that all required checks had been completed to ensure that prospective staff are suitable to work within a care setting. Other evidence of good practice included a full application form and checks of employment history, and a interview questionnaire, which included scenarios, which a staff member may face within the work place. Throughout the Inspection staff were observed responding sensitively and respectfully to the needs and requests of residents. Residents spoken to generally gave good feedback about the staff and said that most were kind and caring. The homes training plan was seen for 2007/08. It was noted that there were lots of gaps particularly in areas of training such as First Aid, Infection control, and food Hygiene. Two of the staff members spoken to during the inspection said that they did not feel they had sufficient training opportunities to fulfill their role. Although records confirmed that the organization has a full Induction process in place for new staff one staff member spoken to said that they had not received an Induction after not working in the home for some time and felt that that the information available about residents did not provide sufficient detail to ensure that needs were met. These issues were discussed with the manager during the Inspection who said that training was being reviewed as a matter of urgency, and several training courses had been planned, including Dementia Care of the Elderly. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has a good understanding of the areas in which the home needs to improve. Information provided during the inspection confirmed that the manager has a clear development plan and vision for the home. The home regularly reviews aspects of its performance through a programme of selfreview and consultations, which include seeking the views of, service users, staff and relatives. Evidence: At the time of the Inspection the Registered Manager had only been working in the home for a two months. She has many years experience as a home manager, is a Registererd Nurse and also has a Diploma in Management. She has obtained a number of Nursing post graduate qualifications, which include; care of terminally ill patients and care of the elderly. In discussion she stated that there are also plans for her to Care Homes for Older People Page 24 of 29 Evidence: undertake training with Sanctuary Care, which would include The Mental Capacity Act. The manager described parts of the service where she believed improvements and change were needed. This included the review of the admissions procedure and a clear distinction between Residential, Nursing and NHS funded short stay beds. The main focus of this change would be to provide a dedicated staff team to each unit to ensure that care needs are being adaquatly met. The manager stated that priority was also being given to staff training, staff supervision and support. Records confirmed that staff and residents meetings were taking place to inform people of any changes. A visiting professional, two relatives and several residents said that they felt their had been a noticeable improvement in the environment and the way that care is delivered since the new Registered Manager had started working at the home. Some of the staff spoken to said that the home had gone through several changes of management, which was making change very difficult. The home has an administrator who deals with any of the finances held in the home on behalf of residents. A random selection of actual balances were checked against the documentation and found to be correct. It was advised that any arrangements relating to the management of residents finances are documented as part of their individual care plan. Internal auditing processes are in place. An external company manager visits the home on a monthly basis and completes a report regarding systems and procedures in the home. Questionnaires are also given to residents and their families to gather their views on the quality of the service and to assist in developing an action plan for the year. The Provider demonstrates a responsible attitude to health and Safety, and the home has a designated staff member to deal with all maintenance and Health and Safety issues. The manager confirmed that the home has a up to date Fire Risk assessment and that regular Fire training, and checks of fire equipment take place. Risks to residents are individually assessed and documented with an agreed plan in place to minimise risks where possible. Discussion took place with the manager of the residential unit about the need to consider any risks to residents when using microwave appliances to re-heat food. Care Homes for Older People Page 25 of 29 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 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The home must ensure that care plans contain sufficient information to reflect the care needs of the individual concerned and to allow for the staff to provide care in an appropriate and consistent manner To ensure that the specific care needs of each resident are met in a consistent and appropriate manner 10/04/2009 2 27 18 The Registered Person must ensure that their are staff employed in sufficient number to meet the assessed needs of people living in the home. Consideration should be given particularly to the busy times of the day and the preferred routines of residents. To ensure staffing levels are appropriate to meet assessed needs and to 10/05/2009 Care Homes for Older People Page 27 of 29 deliver person centered support. 3 30 18 The Registered Person must ensure that staff receive sufficient training to meet the assessed needs of people living in the home. This must include all mandatory training and Induction. To ensure that the home has a team of staff suitably qualified and skilled to meet the assessed care needs of people using the service. 10/05/2009 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 7 The home should demonstrate how they involve residents in planning their care and care plans should be written in a way that is Person Centered and takes the individuals personal wishes and choice into account. Care plans should include information about peoples likes and interests, this information should be reviewed as part of the homes on-going care plan process. The home should consider ways of making the main dining area a more welcoming and comfortable room in which people can enjoy their meals The use of a microwave oven within the residents dining area should cease to ensure that residents are protected from the risk of scalds and burns. 2 12 3 20 4 38 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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