Inspection on 05/01/09 for Lady Sarah Cohen House

This inspection was carried out on 5th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lady Sarah Cohen House 09/01/07

Lady Sarah Cohen House 17/01/06

Lady Sarah Cohen House 01/08/05

Lady Sarah Cohen House 05/01/05

Lady Sarah Cohen House 16/08/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lady Sarah Cohen House Asher Loftus Way Colney Hatch Lane London N11 3ND     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: Daniel Lim     Date: 0 6 0 1 2 0 0 9 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 33 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 33 Information about the care home Name of care home: Address: Lady Sarah Cohen House Asher Loftus Way Colney Hatch Lane London N11 3ND 02089204400 02089204414 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Jewish Care Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 120 Number of places (if applicable): Under 65 Over 65 0 120 dementia old age, not falling within any other category Additional conditions: 120 0 The Registered Person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs are within the following categories: Old Age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 120 Date of last inspection Brief description of the care home Lady Sarah Cohen House is a care home registered to provide nursing care for a maximum of 120 older people. The home opened in October 1997 and is operated by Jewish Care. Residents in the home are all jewish. The home was previously registered as three different units (first, second and third floors). Following approval of the application for a variation last year, the three floor units are now registered as a single home. The aims of the home are to create a homely, relaxed environment with Care Homes for Older People Page 4 of 33 Brief description of the care home emphasis on treating users with dignity and respect and enabling users to leading a full and active life. The home is a large four storey, detached building. It was purpose built as a hotel style care home. On the ground floor are located the kitchen, laundry, coffee shop and synagogue. The hydrotherapy pool, reception area, clerical and administrative offices are also on this floor. The first floor of Lady Sarah Cohen House was previously registered to provide nursing care for a maximum of forty older people who have dementia. This floor continues to accommodate residents with dementia.The second and third floors of the home accommodate residents with general nursing care needs including some with dementia. The home is situated at the end of a private road (Asher Loftus Way) which leads away from the busy Colney Hatch Lane. It is a short distance from the North Circular Road. It is well served by a variety of shops, restaurants and other community services located along Friern Barnet Road. A new manager has been appointed since the home became one service. He is supported by three floor managers. The fees charged by the home per week, are £1048 for Nursing Care and £1150 for Nursing and Dementia Care. Local Authority charges range from £795 to £1150 per week. Care Homes for Older People Page 5 of 33 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 the people who use this service experience adequate quality outcomes. This inspection was carried out on 5 January 2009 by Daniel Lim, inspector and Jane Shaw pharmacy inspector and took a total of 10 hours to complete. During this inspection we were accompanied by the new manager of the home Mr Rajadurai Sunderalingham. The inspector was able to interview six residents and three relatives. The feedback received from them indicated that they were generally satisfied with the care provided. Some residents were unable to communicate their views due to their dementia. Care Homes for Older People Page 6 of 33 However our observation of staff and residents interaction indicated that positive caring relationships were present and staff were responsive towards residents. Statutory records including six residents case records, the maintenance records, financial records and fire records of the home were examined. The premises including bedrooms, laundry, kitchen, gardens and communal areas were inspected. Eight staff on duty were interviewed on a range of topics associated with their work and staff records were examined. The minutes of residents and relatives meetings were also examined. In addition, the completed Annual Quality Assurance Assessment form (AQAA) was received by CSCI. Information provided in the assessment was used for this inspection. What the care home does well: What has improved since the last inspection? What they could do better: Improvements are needed in kitchen. An immediate requirement was made for the kitchen floor to be kept dry and fully cleaned. This is to ensure the health and safety of residents and staff. This requirement was responded to within the timescale set and we have been reassured by the Assistant Director of Care Services of Jewish Care that an improvement plan is in place. Medicines must be recorded accurately in the home to provide evidence of accurate administration. Robust auditing must be carried out. Individually prescribed medicines must not be shared between residents and the home should discuss the use of bulk prescriptions with the GP and pharmacist so that storage issues can be resolved. Medicines for disposal must be disposed of via a licensed waste carrier. Lancing devices for professional use in sampling blood glucose must be used to prevent the risk of cross infection. There must be witness signatures when Controlled drugs are disposed of. Fridges must be defrosted and the minimum maximum temperature recorded. The temperature must be kept between 2 and 8 degrees centigrade to maintain the potency of the medication. These are necessary to ensure the welfare and safety of residents. Due to the seriousness of deficiencies noted in the administration of medication, immediate requirements were issued. We have been reassured by by the Assistant Director of Care Services of Jewish Care that these have been responded to and an improvment plan is in place. The recent complaint made in December 2008 by a relative regarding staffing Care Homes for Older People Page 8 of 33 arrangements in one of the main lounges must be fully investigated. This is ensure the safety and welfare of residents. A review of staffing levels must be undertaken so as to ensure there is sufficient staff to meet the needs of residents. A report following this must be forwarded to the CSCI. This is necessary to ensure that the needs of residents are attended to. The manager must apply for his registration with the CSCI. This is to ensure that he is suitable for the management of the home. The policies and procedures in the home must be updated annually. This is to ensure that residents are well cared for and staff are well informed. The home must have a detailed evacuation plan. This plan must detail the manner and stages in which evacuation is to be carried out, equipment to be used, and the individual responsibilities of staff. This is to ensure the safety of residents and all those in the home in the event of a fire. A detailed evacuation plan was provided after this inspection. 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 33 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 33 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. Prospective residents are given the necessary information and opportunity to spend time in the home. On the whole, admissions are not made to the home until a full needs assessment has been undertaken by the manager or a sufficiently skilled member of staff. This ensures that the home is able to meet the needs of residents. Evidence: We were able to interview six residents and three relatives. The feedback received from them indicated that they were satisfied with the care provided. Comments made by them included the following I am satisfied with care Staff help me when needed Care Homes for Older People Page 11 of 33 Evidence: and My father is well cared for We observed that residents in the home were clean, appropriately dressed and appeared well cared for. The homes AQAA stated We have a comprehensive admissions process which includes information for potential service users and their relatives or representatives and assessments. This includes written information, new brochure, planned and comprehensive viewing visits to the home and a comprehensive and detailed assessment form that enables the manager to accurately evaluate the needs of potential service users, and ensure that only those whose needs can be met in the home, are offered a place A sample of six residents case records which was examined contained evidence of appropriate pre admission assessments and plans of care and details of how residents needs had been met. With one exception, all the preadmission assessment contained the required information. One of these assessments did not contact a pressure area risk assessment. This was discussed with the manager who explained that the staff concerned said she had done the assessment but had not yet completed the form. The required assessment form was promptly completed. The manager reassured us that he will ensure that all future assessments are fully completed. The manager stated that the home does not provide intermediate care. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to healthcare services both within the home and in the local community. There is evidence in the care plans of healthcare treatment and intervention. The views of residents or their representatives are sought regarding how care is to be delivered. However, there are serious deficiencies in the arrangements for the administration of medication. These put people who use the service at risk and must be rectified. Evidence: Feedback from residents and the relatives interviewed, indicated that residents healthcare needs had on the whole, been met. Comments made included, I can see the doctor if I need to I have been attended to by the chiropodist The staff assist my father with his meals Care Homes for Older People Page 13 of 33 Evidence: I have been given my medication Individual care plans had been prepared for residents following their assessment. The AQAA stated, All our service users have an up to date person centred care plan in place which is currently being reviewed and up dated with the introduction of additional sections to improve the care delivery to maximise our intended outcome for each individual service user The sample of six case records examined were up to date and contained plans which were individualised and person centred. These plans of care had been reviewed. Records of medical and healthcare appointments, including appointments with the chiropodist, dietitian, optician and physiotherapist were documented. The record of doctors visits indicated that residents prescribed medication had been subject to reviews. Staff interviewed were knowledgeable regarding the care to be provided to residents. The pharmacy inspector report is as follows We noticed that on the Medication Administration Records, MAR, that there were frequent omissions in recording. We looked at the monitored dosage system and noticed that sometimes the medicine was not in the cartridge so we assumed that it had been given and not signed for. On other occasions we found tablets in the monitored dosage system and these had been signed as given. We counted medicines in their original containers and frequently could not reconcile the balances with the signatures for administration or endorsements for not giving. On one floor it was difficult to carry out any auditing because there were incomplete records of receipts of medication. We noticed that there was double recording of one medicine on this floor and the home investigated this after the inspection. On another floor there were numerous gaps in the MAR and we were told that it was because residents were refusing medication. Unless this is recorded on the MAR with the correct endorsement, we and other professionals do not know this. Records must be accurate and made at the time of administration or refusal to avoid error. Accurate record keeping provides evidence that medicines are given as prescribed. On one floor we noticed that individually prescribed medication was being shared between residents because there was insufficient space on the trolleys. We looked at the records of disposal and saw that it was recorded that medicines were being returned to the pharmacist for disposal rather than a licensed waste carrier. Care Homes for Older People Page 14 of 33 Evidence: We looked at the protocol for feeding a resident who was unable to swallow and noticed that it was comprehensive and recently reviewed by the dietician. We noticed that staff were not using professional lancing devices for sampling blood glucose in residents with diabetes. The use of professional lancing devices prevents the risk of cross infection of blood borne diseases. There were inconsistent practices on the safe recording and management of an anticoagulant drug. When we looked at the controlled drugs we noticed that storage was good and balances were correct, but that there was a witness signature missing for a medicine no longer needed. Fridge temperatures were recorded accurately except on the first floor where staff were not recording the minimum and maximum temperature. Some fridges needed defrosting and one temperature reading was too low. Storage was tidy in all units with the exception of one floor. Overall, we were disappointed at the careless recording in the home. Accurate recording provides evidence of accurate administration which maintains the health and welfare of the residents. Audits need to be carried out more robustly throughout the home to identify poor recording and ensure all medicines are administered safely. Immediate requirements were issued. We later received the outcome of the investigation and the home provided evidence that the resident had received the correct medicine and action is being taken to address the double recording. The manager stated that he had carried out regular medication audits and he refuted 60 percent of the findings. We do not agree with his view. He nevertheless acknowledged that there had been errors made and he provided us with an action plan aimed at addressing the deficiency noted. Prior to this inspection, we had also been notified by the manager of a medication error. This was discussed again with the manager. We note that appropriate action had been taken in response. Care Homes for Older People Page 15 of 33 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 daily life and routines of residents are on the whole, well organised. The views of residents and their relatives are being sought when planning the homes activities and routine. People using the service are given the opportunity to take part in activities that are imaginative, appropriate and varied. They also have opportunity to maintain important family relationships. Evidence: The homes AQAA make the following statements: We believe in creating a homely atmosphere and familiar surrounding as much as possible, this will we feel help our service users who are mainly suffering from dementia and physical disabilities and Each service users ability and willingness to take part in multitude of varied activities being offered are assessed and continually monitored and reviewed by key worker activities co-ordinator, service user, relatives and volunteers at regular intervals. In Care Homes for Older People Page 16 of 33 Evidence: addition to this we also have a sensory room operated by the holistic specialist therapist to assist service users to enjoy relaxation and calmness. Both activities coordinators, volunteers and holistic therapist will have their own comments to make in each service users care plans about their progress and the set goal each are working towards achieving An example of good practice was noted in the provision of activities for residents. The home has an activities organiser and several volunteers on each floor and there is a comprehensive and varied programme of daily activities organised. Activities provided included various art, music and movement sessions, Bingo, Stroke Club, Discussion Group, Orientation Group, manicures, card games, entertainment sessions, Film Club and outings to theatres and museum. In addition, there are religious activities such as Talks on the Torah, Shabbat Blessings on Fridays and a synagogue on Saturdays. These activities have been carefully tailored to suit the needs of the client group. Individual social care plans had been prepared for residents which reflect their preferences. Residents interviewed were of the opinion that the home had activities which were appropriate to them. The home has a complimentary therapy room where hand massage, aromatherapy, music and light therapy are provided. Three of the volunteers who were also interviewed confirmed that they assisted with activities in the home and they were of the opinion that residents in the home have access to a range of acitvities suited to their personal, cultural and religious needs. We further note that there are links with local synagogues and the local Jewish community. This enables residents to maintain their links with the community and feel part of it, despite having moved into a care home The bedrooms inspected had been personalised by residents with their personal items such as photos and souvenirs. Staff informed us that residents are given a choice of main dish at meal times. This was evidenced in the menu examined. Residents are encouraged to have their meals in the main dining room but if they wish to eat in their own bedrooms or are too ill to join others in the dining room they can have their meals in their own rooms. The AQAA stated that kosher food is provided and effort is made to consult with residents and their representatives. The AQAA states Food committee, a forum of residents, relatives and staff will meet regularly in order to discuss improvement to the food served. This will include menus, choice of dishes, cultural references and recipies and nutritional factors. The contractors who provide the food at LSCH will be present at the forum Care Homes for Older People Page 17 of 33 Evidence: The provision of meals was discussed with residents. Some were satisfied while others were not fully satisfied. We noted from the minutes of meetings at the home, that some residents had expressed dissatisfaction with the meals provided. This was discussed with the manager. He provided documented evidence from the minutes of meetings that effort is being made to improve the provision of meals. In addition, the AQAA states There is a complaint comments book available in each dining room for service users or their relatives/friends to register their comments or concerns. This will be noted and acted upon by the catering manager and the floor care manager The kitchen was inspected on the first day and we noted that it had not been fully cleaned as there was debris on the floor and a significant amount of water under the sink. This was brought to the attention of the chef in charge and the home manager. The kitchen was inspected again on the second visit to the home the next day. We noted that there was again debris on the floor including two pieces of paper, a glove, 3 slices of tomatoes under a sink and a significant amount of water under another sink. This was brought to the attention of the hotel services manager and manager of the home. An immediate requirement was made for the kitchen floor to be kept dry and fully cleaned. Following this inspection, the assistant director of care services of Jewish Care has responded to the immediate requirement issued and an action plan was provided to ensure that the kitchen is kept clean and dry. Care Homes for Older People Page 18 of 33 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 arrangements for responding to complaints and for adult protection are on the whole, satisfactory. The required policies and procedures for safeguarding residents were in place and give clear and specific guidance to staff. Evidence: Residents and the relatives who were interviewed stated that they had been well treated by staff and staff had been respectful towards them. The home had an adult protection procedure. It included guidance to staff on reporting allegations of abuse to Social Services and The CSCI. Staff who were interviewed were aware of the policy and procedures for the protection of vulnerable adults. There was evidence that staff had been provided with the required training. The homes AQAA states We welcome complaints and use these complaints to revise, introduce corrective actions, review our approaches and plan our future care practices to avoid similar mistakes happening again. No matter how good our standard is there is always room that could be found for improvement. We feel that complaints and comments are the vital pointers towards achieving further higher standards The complaints record was examined. There was documented evidence that the Care Homes for Older People Page 19 of 33 Evidence: complaints recorded since the last unannounced inspection had on the whole, been promptly responded to. We noted that one of the complaints documented in the complaints book did not have the dates when the complaint was responded to. This is necessary to provide evidence that the complaint mentioned had been responded to within the required timescale. The manager agreed to ensure that the date is provided. One recent complaint made in December 2008 by a relative stated that there was a lack of staff in one of the main lounges when the relative was present. There were no details in the complaints book to indicate that it had been responded to. The manager explained that he had been on holidays. He however, reassured us that it is being responded to and he had contacted the complainant concerned. A requirement is made in this report for the manager to inform us of his findings. The home manager provided us with letters and cards expressing appreciation and gratitude for staff and the care provided at the home. Comments made in them by relatives included the following. My family wish to thank you all for the wonderful, kind and considerate way you cared for my dear wife She was only with you a short time, but your care helped her such a lot A big thank you to all the nurses and carers I was amazed by the way everyone knew her and made her feel so comfortable Thank you for the care you took of my mother Just a big thank you for all your care Care Homes for Older People Page 20 of 33 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 physical environment that is appropriate to the specific needs of people who live there. All bedrooms have ensuite facilities. Overall, the home was well furnished and well equipped, therefore providing a pleasant environment to live in. Residents interviewed were satisfied with the accommodation and facilities provided. Evidence: The AQAA states The home is in good decorative order and the bedrooms are decorated on a rolling programme and as and when a room is in need of decoration. All electrical equipment, lifts, call bells, fire alarm system equipments and utility supplies are serviced as required We note that some areas of the home had been refurbished and new furniture had been provided. Attention had been paid to ensuring that the environment is specially adapted for those with dementia. Two smaller lounges had been created on the first floor. This provided a more cosy atmosphere. The courtyard garden was attractive and seating had been provided. Care Homes for Older People Page 21 of 33 Evidence: The bedrooms were clean and well furnished. Residents interviewed stated that they were happy with their bedrooms and their rooms had been cleaned. Various specialist equipment for the care of residents was available. These included hoists, assisted baths, toilet handrails, wheelchairs, and a call bell system. The hoists had been serviced within the past six months. The relevant inspection records were available for inspection. The home had safety inspection certificates for the gas and electrical installations. The portable appliances had been checked. Bedlinen which had been laundered were examined. These were found to be clean and neatly folded. Laundry staff were aware of the need to wash soiled linen in a special prewash sluice cycle. Care Homes for Older People Page 22 of 33 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. Residents care needs are generally met by the numbers of staff available. The service has a good recruitment procedure that is followed in practice. There is a good team spirit. The manager recognizes the importance of training and tries to deliver a programme that meets statutory requirements. Residents and their representatives are well treated by staff. Although residents needs are generally met by the numbers of staff available, concerns raised indicate that a staffing review is needed. Evidence: Residents and relatives who were interviewed indicated that they had been well cared for by staff and staff were respectful and polite towards them. They further indicated that staff were responsive towards them. The homes AQAA states The staffing mix is well balanced to care for people with various degrees of dementia. In each twelve hour day shift we have three qualified nurses and seven residential care workers on duty and during night shift we have two qualified nurses and four residential care workers on each floor. In addition to this there is one care manager on each floor covering 8.00am till 4.00 pm shifts and an overall manager for the home on Care Homes for Older People Page 23 of 33 Evidence: duty covering mainly 9.00 am till 5.00pm Monday to Friday. Both care managers and the home manager from September 2008 are on a rota to cover Sundays and occasional Saturdays. The home manager occasionally covers evening shifts to provide support to staff team when it is required Staff who were on duty were interviewed on a range of topics associated with their work. They were noted to be knowledgeable regarding their roles and responsibilities. The records of five staff, including three new staff were examined. These indicated that the required recruitment standards and procedures such as obtaining satisfactory CRB disclosures and references had been followed. Nurses employed in the home had up to date PIN numbers. There was documented evidence of regular formal staff supervision. This was also confirmed by staff interviewed. The supervision notes indicated that staff had opportunity to discuss any work related problems, issues related to the care of residents and their training. The issue of equalities and diversity was discussed with the home manager and his staff. Staff were aware of the Jewish culture and demonstrated an understanding of the need to treat all residents sensitively and with respect regardless of disability, gender, race, religion or sexual orientation. They were aware that they must not discriminate against residents. A total of eight care staff were interviewed. Two of them stated that the staffing levels were not always adequate and they had difficulty attending to residents. They explained that residents in the home have high needs and require a high level of care. They said that a large number of residents require assistance with feeding and the situation was exacerbated when some staff go off sick at short notice. This finding was discussed with the manager who was of the opinion that the overall staffing levels were adequate. He explained that the ratio of staff to residents was quite good for a nursing home, especially when the home was not completely full. Although the general feedback received from residents and their representatives regarding the staffing arrangements was positive, a small number, including a relative were of the view that staffing levels were inadequate. A requirement is made for staffing levels to be reviewed. This review must be carried out in consultation with staff and residents and their representatives. A report following this must be forwarded to the CSCI. This is necessary to ensure that the staffing levels are adequate. Three of the staff interviewed stated that a relative and a resident had sometimes Care Homes for Older People Page 24 of 33 Evidence: been abusive towards them. This had occured over a period of time. This was discussed with the manager. He provided evidence that the abusive behaviour concerned had been dealt with. Care Homes for Older People Page 25 of 33 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 the required qualifications and experience and is working continuously to improve the service. There is a focus on equality and diversity issues and on person centered care. The quality of care is being monitored to ensure that residents are well cared for. Evidence: Feedback received from residents and their representatives indicated that managers and staff had been successful in fostering a caring and welcoming environment where residents are cared for with respect and dignity regardless of their background, race, religion, disability or sexual orientation. The AQAA indicated that the home manager and floor managers on each floor are well qualified and have the necessary experience for caring for residents in the home. It further states Care Homes for Older People Page 26 of 33 Evidence: Consultation with service users, relatives and staff helped the management team to reduce the number of wheel chair usage, introduction of food forum group, change of meal times, senior staff weekend working, setting up structured staff supervision sessions and reviewing of activities co ordinators roles and the holistic therapists structured approach to care planning. Residents, relatives and staff interviewed expressed confidence in the management of the home. The manager had been in post since September 2008. He is a qualified nurse and was noted to be well qualified and had many years of experience in the care field, including experience of working in a care home. He indicated that he is working towards providing care that is individualised and of a high quality. The manager had not yet applied for registration with the CSCI. He reassured the inspector that this would be done soon. There was evidence that residents are consulted regarding the management of the home. Residents and relatives meetings had been held. The minutes of these meetings indicated that residents and relatives were informed of progress in the home and their concerns had been responded to. A consumer survey had been carried out recently and there was evidence that the respondents were satisfied with the management of the home. Several of the policies and procedures in the homes folder had not been updated in the past twelve months. This was also noted in the details provided in the AQAA received. These included the medication procedure and the adult protection procedure. To ensure that residents are well cared for and staff are well informed, these policies and procedures must be updated. The fire logbook examined indicated that the required fire drills and weekly checks of the fire alarm had been carried out. These included drills carried out after dark. Fire training had been arranged for staff. When questioned, staff were knowledgeable regarding the fire procedure. The detailed evacuation plans specific to the home in the event of a fire was not seen by us during the inspection. The manager was not able to confirm that the home had such a plan. Recent guidance by the LFEPA advises that such a plan be provided and staff be made familiar with it so that evacuation can be started prior to the arrival of the fire service. The home is therefore required to have a detailed evacuation plan. This plan must detail the manner and stages in which evacuation is to be carried out, equipment to be used, and the individual responsibilities of staff. A detailed evacuation plan was provided after this inspection. The emergency call bell cords in two of the bedrooms on the first floor had been tied Care Homes for Older People Page 27 of 33 Evidence: up and shortened. this is unsatisfactory as they may be out of reach of someone who may have fallen to the floor. This was brought to the attention of the floor team leader. He explained that this was because the cords sometimes get entangled with the fixtures. He immediately rectified the matter and had them untied. The home has a current certificate of insurance. The financial records of four residents were examined. These were noted to be well maintained by the admin staff of the home. Receipts had been obtained for transactions made on behalf of residents. We were also informed by the manager that relatives are involved in assisting residents manage their finances and appointeeships and power of attorney had been arranged for residents who needed these arrangements. This was also confirmed in the AQAA. Care Homes for Older People Page 28 of 33 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 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 We require evidence through 10/04/2009 robust auditing that medicines are being managed safely in the home. This is to ensure the health and welfare of the residents is maintained. Medicines must be recorded 10/04/2009 accurately in the home to provide evidence of accurate administration. If not given then the correct endorsement must be used. This is to ensure the health and welfare of the residents is maintained. 2 9 13 3 15 16 The registered person must 10/04/2009 ensure that the kitchen floor is kept clean and dry. This is to ensure the health and safety of residents and staff. 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 Individually prescribed medicines must not be shared between residents. 10/04/2009 Care Homes for Older People Page 30 of 33 This is to ensure the health and welfare of the residents is maintained. 2 9 13 Medicines for disposal must 10/04/2009 be disposed of via a licensed waste carrier in accordance with the Waste Regulations. This is for Health & safety reasons. 3 16 22 The recent complaint made in December 2008 by a relative regarding staffing in one of the main lounges must be fully investigated. A report following the investigations must be submitted to the CSCI. This is to ensure the safety and welfare of residents. 4 27 18 A review of staffing levels 10/04/2009 must be undertaken so as to ensure there is sufficient staff to meet the needs of residents. This review must be carried out in consultation with staff and residents or their representatives. A report following this must be forwarded to the CSCI. This is necessary to ensure that the needs of residents are attended to. 5 31 8 The new home manager must apply for his registration with the CSCI. 10/04/2009 17/04/2009 Care Homes for Older People Page 31 of 33 This is to ensure that he is suitable for the management of the home. 6 37 10 The policies and procedures in the home must be updated annually. This is to ensure that residents are well cared for and staff are well informed 10/04/2009 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 9 The home should discuss the use of bulk prescriptions with the GP and pharmacist for laxatives so that storage issues can be resolved. Care Homes for Older People Page 32 of 33 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). 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. 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