Inspection on 17/11/08 for Kesteven Grange

This inspection was carried out on 17th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kesteven Grange 15/11/07

Kesteven Grange 09/11/06

Kesteven Grange 21/12/05

Kesteven Grange 11/08/05

Kesteven Grange 09/11/04

Kesteven Grange 06/07/04

Kesteven Grange 11/03/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

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Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kesteven Grange Kesteven Way Kingswood Kingston upon Hull East Yorkshire HU7 3EJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Beverly Hill     Date: 1 7 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 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: Kesteven Grange Kesteven Way Kingswood Kingston upon Hull East Yorkshire HU7 3EJ 01482837556 Telephone number: Fax number: Email address: Provider web address: stevengrange@schealthcare.co.uk Name of registered provider(s): Name of registered manager (if applicable) Southern Cross Care Homes No 2 Ltd Type of registration: Number of places registered: care home 54 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: To admit four named service users, aged under 65. Date of last inspection Brief description of the care home Kesteven Grange is registered to provide personal care and accommodation for 54 people of either gender over the age of 65, some of whom may also suffer from dementia. This also includes up to 4 people under the age of 65. The home is purpose built and situated on a large residential estate on the northern outskirts of the city of Hull. Regular bus services stop near the home and local community facilities are a short drive away. The home has a large car park for visitors. The home has 46 single and 4 double bedrooms. Four bedrooms have en-suite facilities. There is a large lounge and separate dining room on the ground floor and a large lounge/dining room on the Care Homes for Older People Page 4 of 29 Over 65 54 54 0 0 Brief description of the care home first floor. There are a number of bathrooms and toilets throughout the home and a passenger lift to access the first floor for people unable to use either of the two stairways. There is a large garden with a seating area for people to enjoy in the good weather and a secure patio area outside the main lounge. This is the place people using the service go to smoke. Information about the home and its service can be found in the statement of purpose and service user guide available from the manager of the home. The weekly fees range from 348.50 to 475 pounds. Additional charges are made for hairdressing, chiropody, toiletries and newspapers and magazines. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means that the people that use this service experience good quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key unannounced inspection on 15th November 2007 including information gathered during a site visit to the home, which took approximately eight and a half hours. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Kesteven Grange. We also had discussions with the manager, the area manager and staff members. Information was also obtained from surveys received Care Homes for Older People Page 6 of 29 from residents, staff members and a visiting health professional. Comments from the surveys and discussions have been used in the report. We looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. We would like to thank the people that live in Kesteven Grange, the staff team and management for their hospitality during the visit and also thank the people who completed surveys. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? The new manager had settled quickly into the home and staff and residents found her supportive and accessible. The home was well managed and people living and working in the home were able to make suggestions in meetings or day to day chats with management. The service user guide has been updated to reflect the fee scale of the home. The care plans produced were much more detailed and individualised. This meant that care staff had more comprehensive information about the resident and helped to prevent care being missed. The way staff managed medication had improved, which meant that it was recorded and administered safely. An activity coordinator had been employed to ensure people received social stimulation and didnt become bored. Care staff members had received training in dementia awareness and how to safeguard vulnerable adults from abuse. There have been improvements to the environment in line with the homes decoration Care Homes for Older People Page 8 of 29 and refurbishment plan. 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 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. The home only admits people after a full assessment of their needs and provides people with the opportunity to have trial visits. Evidence: The home had updated the statement of purpose and service user guide and ensured that people had information about the home in order for them to make a decision about admission. Both contained good information about the services provided although the statement of purpose could be specific that the home does not provide nursing care and that this service is provided by visiting district nurses. Both documents could be more specific about the range of needs the home is able to support. This is particularly important regarding dementia care needs and the level or severity of dementia the home is able to support. The service user guide could also be clearer about the range of qualifications and experience the staff team have. Both documents are available on audio cassette. Care Homes for Older People Page 11 of 29 Evidence: There was evidence that all residents had their needs assessed prior to admission and the home had obtained assessments completed by care management. This ensured that the home had full information about people prior to admission and helped staff decide if needs could be met in the home. People could also have trial visits and respite stays in order to form an opinion about the home before a final decision about permanent residency was made. The home formally writes to people or their representative following the assessment stating their capacity to meet the identified needs. The home does not provide intermediate care services. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health and personal care needs were planned for and met in the home. Evidence: We examined five care files during the visit and all had care plans in place produced from assessment information. Improvements were noted in the care plans. They gave clear tasks for staff in how to meet identified needs and included information on preferences and how staff were to support the person to remain independent. For example, what the person preferred to have for their breakfast or what their favourite perfume was and which personal care tasks people were able to complete themselves. The care plans prompted staff to promote privacy and dignity and to respect individual choice. There was evidence that health care needs were met via documentation and discussions with people. Residents had access to district nurses, dieticians, dentists, opticians, chiropodists, GPs and consultants. The home documented visits by the health professionals. There had been a recent incident when care staff members had Care Homes for Older People Page 13 of 29 Evidence: not understood how to complete a nutritional risk assessment tool, which had led to a miscalculation of a residents ideal weight. The dietician had since been involved and care staff have received updated training. Risk assessments were undertaken for a range of issues such as moving and handling, pressure areas, falls, bed rails, fire evaluation, night security and specific health issues. The care plans and risk assessments were evaluated monthly and updated when required. The manager audited several care plans per month and identified shortfalls for staff to address. Care plans were signed and dated when formulated by staff but not always signed by the resident or their representative as agreed. This was mentioned to the manager to address in reviews. Care plan reviews were held with the resident, their representative, home care staff and commissioners of the service. People spoken with were happy with the care they received and confirmed care was provided in ways that respected their privacy and dignity. Comments from residents were, they look after us very well, things have got better, Ive been poorly lately, staff are so good and patient with me and Im happy here, everything is done for me. Medication was managed appropriately. Staff maintained good records of medication admitted into the home and when administered to people. Some people managed their own inhaler medication and the manager confirmed this was identified in care plans and risk assessments. The treatment room, store cupboards and medication trolleys were clean and tidy and good stock control was in evidence. Staff members recorded the temperature of the fridge and treatment room. Some readings of the latter were slightly above the required temperature for storing medications. A new thermometer needs installing in the medication room to take closer readings and action will need to be taken if readings are above 25 degrees centigrade. Care Homes for Older People Page 14 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents did not always have a full range of choices available to them as a result of staffing numbers or a lack of knowledge about specific issues. Evidence: People told us that routines were flexible and that visitors were welcomed at any time. The home had a relaxed atmosphere and a visiting health professional commented in a survey, the patients appear happy and the atmosphere is good. One resident told us she was very happy with her new home and joked that her priest came to visit her and that after 87 years she was no longer a practicing catholic but was fully qualified. The manager confirmed that the home had, protected meal times. This meant that all staff were available to support people with meals, and phone calls and professional visitors to the home were limited during this time. The activities provided by the home have fluctuated recently and there have been periods when the home has been without an activity coordinator. However a new activity coordinator had been in post for two weeks and via discussion it was clear they were enthusiastic about their role and had several ideas they wanted to implement. The activities provided consisted of arts and craft sessions, bingo, quizzes, facials and Care Homes for Older People Page 15 of 29 Evidence: nail care, one to one chats with people, visits to local shops, coffee mornings, games, visiting entertainers and reminiscence therapy. The home also had a small pool table and safety darts board set up in the downstairs lounge. The activity programme evidenced there was something on offer each day and the activity coordinator maintained individual records of who participated. To improve in this area occupational activities could be arranged, for example, baking, enabling people to make their own sandwiches for the evening meal or their own drinks, and support with small household tasks. The activity coordinator has applied for a training course with the local authority regarding activities for people with dementia care needs, which will provide them with further ideas. Staff commented in surveys that they would like to complete more outdoor activities with people and one resident felt that the level of activities had decreased during the time they had been in the home. One person told us, there are some activities and another person confirmed they played pool and darts now and again. The employment of the new activity coordinator and the detailed records of participants should address any shortfalls. People generally felt they were able to make some choices about aspects of their lives but staff could be more proactive regarding the limited choices that people with dementia are able to make. For example by providing more visual choice regarding the meals on offer each day and respecting long held personal beliefs about food choices. Staff also advised in discussions and surveys that choices could sometimes be limited regarding routines such as rising and retiring to bed. This was due to staffing numbers at specific times of the day. Staff stated they tried their best to accommodate peoples wishes, but the timing of the shifts meant that there were only two staff members on each floor after 7pm at night so respecting individual choice posed difficulties for them. This was discussed with the area manager on the day and she advised steps would be taken to address the staff shortfall in the evenings. The meal on the day was cottage pie or beef burgers with mashed potato, cabbage, sprouts and gravy. Although presented nicely it lacked colour. However this was perhaps a one off occasion, as people spoken with told us how much they liked the meals provided and that they received plenty to eat and drink. Menus covered a fourweek period and offered two or more choices at each meal. Special diets were catered for although there was limited choice seen for people that preferred not to eat meat. This was mentioned to the manager and cook and addressed on the day. Comments about the meals were, the food is very good and my appetite has gone up, the meals are delicious, very enjoyable and the food is quite alright. Care Homes for Older People Page 16 of 29 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 home provided an environment where people felt able to complain and were protected from abuse by staff training and adherance to policies and procedures. Evidence: There was a complaints policy and procedure that was displayed in the home. The manager had also set up a file to record any complaints. There was a form for complainants or staff to use to record issues people were unhappy with. Since the last inspection there had been six complaints, all of which were of a minor nature and all had been resolved. People spoken with stated they were happy with their care and felt sure staff would sort out any problems for them, I would tell those doing the medication, I dont have any complaints but I would tell her (the manager), I would report things to the head woman and I know what to do if I have a complaint. Staff were aware of what to do if people made complaints during their shift. There had been nine safeguarding referrals to the local authority since the last inspection. Some of these related to incidents between residents and the local authority responded by completing a monitoring visit to the home after each one. Two related to residents having money missing. The money was reimbursed and better security systems put in place. One referral was received from the dietician regarding Care Homes for Older People Page 18 of 29 Evidence: one residents weight and staff members misunderstanding of a nutritional risk assessment tool. The local authority investigated and the dietician arranged training sessions for the staff team. One related to an allegation of misconduct by staff and although unsubstantiated, retraining was arranged. The last referral related to a staff member being abrupt and rude to a resident. They left the home and all staff have received training in customer care since the incident. The home had access to the local authority multi-agency safeguarding policies and procedures and staff had received training in how to safeguard vulnerable people from abuse. In discussions they were able to demonstrate a knowledge of different types of abuse and the importance of making sure people were safe and reporting any issues to their line manager. The manager and team leaders in charge of shifts had not completed the local authority training regarding referral and investigation. This would help to consolidate their knowledge and practice in this area. The manager was aware of the procedure to follow should she be alerted to any concerns. 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 home provides a clean and safe environment suitable for peoples needs. Evidence: The home is purpose built over two floors accessible by a passenger lift and stairs. The upper floor is a dementia care unit and has a large lounge with a dining area at one end. There are also two small quiet areas within the lounge away from the television. The lounge also has an area furnished as a bar where staff can serve cold, and on occasions, alcoholic drinks. The dining area is set out with individual tables and chairs and doubles as an activities area. There is a room leading from the dining area that the manager hopes to refurbish into a quiet sensory room. The downstairs lounge also has a bar and a small pool table set up at one end. There is a separate dining room downstairs that is light and airy and again set up with individual tables and chairs. Corridors are wide, have hand rails and are suitable for people in wheelchairs. The home is well decorated and particular attention has been paid to decorating the corridors in the dementia care unit. Some display cabinets in the corridors look like the front windows of shops with interesting items in them. Bedroom doors are painted different colours and have a large number and door knocker, reminiscent of front Care Homes for Older People Page 20 of 29 Evidence: doors to houses. The home has a hairdressers room on the ground floor complete with appropriate equipment. People spoken with were happy with their bedrooms and the home in general. Those bedrooms seen were personalised to varying degrees dependent on the choice and taste of the occupant. All bedrooms had lockable facilities and most bedroom doors had privacy locks. Since the last inspection a new shower room had been installed on the upper floor. This meant there were three bathrooms and the shower room upstairs and two bathrooms downstairs. All the baths had hoists to assist people in and out. All the hot water outlets were fitted with thermostats to control the temperature of the water. However two of the outlets in communal bathrooms were checked and the water temperature was above that which was safe for use. This was mentioned to the manager and maintenance staff to address. The home had an ongoing maintenance and renewal plan that evidenced the work completed since the last inspection and the work planned for the future months. The home was clean and tidy and had sufficient laundry equipment to meet the needs of residents. One bedroom carpet required cleaning and another had a malodour that the manager will address. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensured that staff members had access to training to ensure they had appropriate skills to care for older people. A gap in staffing during the evenings means that some residents choices regarding times they wish to retire could be limited. Evidence: Discussions with the staff team and examination of documentation indicated the home usually had one team leader, one senior carer and five care staff on duty between 7am and 7pm and one senior and three care staff between 7pm and 7am. It has been commented earlier in the report that staff members feel residents choices can be limited at specific times due to a gap in staffing. This is between 7pm and 11pm, the time when most people want to retire to bed but the time when staffing is reduced to four to cover both floors. This was discussed with the area manager who confirmed that these important four hours, seven days a week, could be recruited to address the shortfall. We received two surveys from residents and spoke to others on the day. We also received a survey from a visiting health professional. Both surveys from residents had ticked the box stating staff were available and that they listened and acted on what the resident said. Comments about the staff team were, staff are always ready to give me time, the staff are helpful to the district nursing staff, they are very friendly, you Care Homes for Older People Page 22 of 29 Evidence: can have a laugh and a joke with them, very good, they look after us, staff are patient with me, they come quickly when you press the buzzer and they are alright, I have no grumbles. I like living here, its better than being on your own. The home had a training plan which included mandatory and service specific training for the next year. The team leaders had completed, train the trainer courses with the company in some areas such as, safeguarding adults from abuse, dementia awareness, customer care and how to respond to behaviour that could be challenging. They cascade the training to the rest of the staff team. This training consists of presentations, watching DVDs and questionnaires for participating staff to complete. Maintenance staff facilitate practical fire and bed rail safety training and an external facilitator provides first aid training. A community dietician recently provided training for all staff regarding the use of a nutritional risk assessment tool. Staff training is facilitated via various routes, for example company trainers, in house, external facilitators, distance learning and through the local authority. New staff members completed induction in line with skills for care standards, which means their competence is assessed during the first few months of their employment. Fifty percent of the care staff team had completed a national vocational qualification in care at level 2 and 3. This is a good achievement and means the required standard had been met. The home had good recruitment practices. Staff completed application forms and were employed via an interview process. References and criminal record bureau checks were sought prior to employment. 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 home is well managed and is a safe place for residents to live in and staff to work in. Evidence: The new manager has been in post since April 2008 and is to apply for registration with the Commission. She has completed the Registered Managers Award and has a General National Vocational Qualification in Health and Social Care. She has completed various training courses relevant to her role. Some of the residents knew the managers name, which told us they were not office-based all the time but went out and about the home. Staff described the manager as supportive and approachable, you can go to her with any problems, if I raise concerns they will be dealt with and I wouldnt feel silly in asking questions. Two staff members in surveys indicated they would like to have more contact with the manager, now and again we are asked if we are ok and thats it. One person also suggested that the way information is passed on about residents when staff have been on holiday or off sick could be improved. Care Homes for Older People Page 24 of 29 Evidence: Records indicated that some staff have received formal one to one supervision. People had between 2-5 supervision sessions in the last year and the standards are that care staff should receive a minimum of six sessions. At present the manager is supervising all staff and a structured plan has not been devised yet with delegation to team leaders. When this is organised it will make the system more manageable and provide staff with regular supervision in line with national minimum standards. The company has a management structure in place to offer support to the home manager and the area manager visits the home on a regular basis to meet with the manager and to have discussions with residents and their families who may be in the home at the time of the visit and staff members on duty. The company has a quality assurance system that consists of monthly audits and six monthly questionnaires to residents and their families, staff members and professional visitors. Action plans are produced to address identified shortfalls and a process of ongoing monitoring via monthly reports to senior managers helps to keep track of progress. Meetings are held with residents and their families and staff to ensure consultation takes place. The home has gained both parts of the local authority quality development scheme award for having in place care planning and quality monitoring mechanisms. Finances were not examined during this visit but the administrator confirmed the company policy. On admission residents completed a personal allowance contract and decided whether they would like to control their own finances or have support from staff. The home has a computerised accounts system for personal allowance deposited for safe keeping. Receipts are maintained for all transactions on the personal allowance account and two signatures obtained. The home is a safe place for people that live there and staff that work there. Equipment is serviced regularly and any maintenance repairs completed quickly. Staff receive training in health and safety, fire prevention and first aid. Fire safety checks are carried out and drills completed to ensure staff are aware of what to do in emergencies. The home has policies and procedures for staff to follow and records are held securely. 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 9 13 Medication must be stored below 25 degrees centigrade. This will ensure it is stored in line with manufacturers instructions and will be safe to use. 31/12/2008 2 14 12 Residents choices regarding nutritional preferences must be respected and adhered to. This will reassure people that when they are no longer able to make decisions their wishes will be respected. 31/12/2008 3 27 18 The home must have 31/12/2008 sufficient staff on duty in the evenings. This will ensure peoples needs are met and choices are not limited. Care Homes for Older People Page 27 of 29 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 1 The homes statement of purpose and service user guide should be more specific about the level or degree of dementia care needs the home is able to support. Staff should increase the range of social stimulation afforded residents by investigating occupational activities they can participate in. Staff should offer people with dementia care needs a visual choice of the meals and drinks available each day. Catering staff should expand the options available to people that choose not to eat specific food groups. The manager and senior staff in charge of shifts should complete the local authority training on referral and investigation to consolidate their knowledge of local safeguarding procedures. The thermostatic controls on the sinks in two of the communal bathrooms should be adjusted to ensure a safe and ambient temperature of the hot water outlets. The manager should apply for registration as soon as possible to ensure stability for the home. Care staff should receive a minimum of six formal supervision session a year. This will enable them an additional forum to discuss their work role and provide them with support as required. 2 12 3 4 5 14 15 18 6 25 7 8 31 36 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. 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