Inspection on 10/10/08 for Lauriston Christian Nursing Home

This inspection was carried out on 10th October 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 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lauriston Christian Nursing Home 22/03/07

Lauriston Christian Nursing Home 19/01/06

Lauriston Christian Nursing Home 25/08/05

Lauriston Christian Nursing Home 07/02/05

Lauriston Christian Nursing Home 15/07/04

Lauriston Christian Nursing Home 26/02/04

Lauriston Christian Nursing Home 25/11/03

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lauriston Christian Nursing Home 40 The Green St Leonards On Sea East Sussex TN38 0SY     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: Deborah Calveley     Date: 1 0 1 0 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 38 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Lauriston Christian Nursing Home 40 The Green St Leonards On Sea East Sussex TN38 0SY 01424-447544 01424447522 lauriston@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Trinity Care Limited care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 60. The registered person may provide the following category of service only: Care home with nursing (N) only - to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home The Lauriston Christian Nursing Home is registered to provide care with nursing for a maximum of sixty clients under the category of elderly care. It is owned by Southern Cross Healthcare Ltd. and situated in a residential area of St. Leonards-On-Sea, near to a main bus route. Lauriston is a large purpose built building with level access to the front door and accommodation set out over two floors. A lift provides access to each floor. It is surrounded by well maintained grounds that are accessible to wheelchair users. There are six comfortably furnished lounges and three dining areas to provide communal space for clients and their visitors. All the bedrooms are single rooms and Care Homes for Older People Page 4 of 38 Over 65 60 0 0 60 Brief description of the care home all have en-suite facilities. Lauriston has a Christian ethos although clients with other faiths are welcomed. Care Homes for Older People Page 5 of 38 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 reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at the Lauriston Christian Nursing Home will be referred to as residents. This was a key inspection that included an unannounced visit to the home by two inspectors from the CSCI and follow up contact with residents representatives and visiting health and social care professionals. This key inspection was brought forward as a result of information recieved regarding concerns in respect of care practices and diversity. Care Homes for Older People Page 6 of 38 This unannounced inspection was carried out over 7 hours on the 10 October 2008. There were 59 residents living in the home on the day of which six were case tracked and spoken with. During the tour of the premises six other residents both male and female were also spoken with and two visitors. The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Four members of care staff, three trained nurses, maintenance person, cook and activity coordinator were spoken with in addition to discussion with the regional manager of the organisation and the deputy manager. Telephone contact was made with visiting professionals following the visit and their views and comments are incorporated into the report along with the information received verbally during the site visit. An Annual Quality Assurance Assessment was received from the previous Manager completed in full inFebruary 2008. The Fees charged as from 1 April 2008 range from 600 pounds to 650 pounds, which includes basic toiletries. Additional charges are made for hairdressing, chiropody, and newspapers and outside activities. What the care home does well: What has improved since the last inspection? What they could do better: This was a disapointing inspection visit in that areas found to be good and excellent at the last key inspection had not been sustained. There has been no clear leadership in the home for some months which has impacted on the overall efficiency of the home. Residents and staff would benefit from clear leadership, guidance, direction and Care Homes for Older People Page 8 of 38 management. There are identified shortfalls in care planning meeting of residents social and welfare care needs, risk assessments and in supporting and enabling residents to live a lifestyle based on their individual preferences and choice. The registered manager resigned and then was on sick leave. The CSCI were not informed of this by the organisation. The regional manager also left during this time and therefore the management structure of the home was fragmented. A new management structure is now in place and this will be completed by a new manager who commences employment in November 2008. The Service Users Guide needs to be ammended with the changes to the management structure of the home. The Statement of Purpose and Service Users Guide both need to be dated so as to ensure all the information is correct and current, such as managerial structures, fees and additional charges. The home needs to confirm in writing to the prospective resident or their representative that with regard to the needs assessment completed the home can meet the needs of the prospective resident. This ensures that decisions around admission to the home are informed. The care plans need to be developed in respect of the residents social, mental health and welfare needs so as to be person centred and individual. The risk assessments in place for health needs, safety and well being need to be correctly completed and based on clear criteria and followed with a plan of action for staff to follow. In particular assessibilty to call bells, nutrition, moving and handling and pressure relieving equipment. Whilst there are activities in the home, there is little evidence that those residents in need of one to ones recieve the interaction and stimulation required, also little is documented in the younger persons care files as to how the home will meet their social needs and expectations. The comunication between the catering staff and care staff needs to improve to ensure that the necessary action is taken when residents are nutritionally at risk. Food and fluid charts need to be completed accurately so as to provide the information required to specialist health professionals. The environment of the home appears tired and in need of redecorating and general maintenance. The general cleaning of the home and equipment needs to improve to benefit and protect the residents living in the home. Recruitment practices must improve to ensure the protection of residents. The mandatory training of the staff has not been maintained, which places residents at risk. The supervision of staff has not been maintained for at least eight months and this needs to be recommenced so as to provide staff with support and ensure good practice Care Homes for Older People Page 9 of 38 is maintained. This will ensure staff have the required care skills and empathy to provide appropriate support and care for residents living in the home. 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 10 of 38 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides prospective residents and relatives with a good level of information about the home, its facilities, services and the costs involved. The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission however little information is documented thus not ensuring their needs can be met and people are not assured in writing that their needs will be met. Evidence: There is a comprehensive Statement of Purpose and Service Users Guide in place, which contains clear information about the home and the services it provides. The administrator has updated the Statement of Purpose with the managerial changes, but the Service users guide still needs to be updated. Copies of these are available in the front entrance area of the home. A social care professional that had recently visited the home confirmed that relevant information was provided to a prospective resident. Care Homes for Older People Page 12 of 38 Evidence: It was confirmed whilst talking to residents and relatives that the contract arrangements were clear and understood. A review of the care documentation confirmed that pre-admission assessments are completed by the deputy manager or a senior trained nurse. Six pre-admission assessments were identified for reviewing. The format of the pre-admission document was seen to be thorough and relevant, it consists of tick boxes with a section for free writing the overall thoughts of the assessment. However not all of the assessments were signed and dated and overall the information recorded needs to be more person centred and specific to the individual. The prospective residents are seen either in their home or hospital before admission and the deputy manager confirmed that wherever possible the family or representatives are involved. The deputy manager was able to verbally demonstrate her knowledge and awareness of the different specialities required in the home and acknowledges that the Registered Nurses and carers employed need to attend relevant courses to deal with the needs of the elderly and also specialised courses for certain diseases. Trial visits to the home can be arranged. The deputy manager confirmed that residents are invited to a trial period to ensure suitability of the home this is clearly stated in the Statement of Purpose and in the statement of terms and conditions. It was noted that the last admissions to the home were not sent confirmation in writing that their needs could be met at Lauriston Christian Nursing Home as required. The deputy and regional manager advised that this would be the practice in the future. Intermediate or rehabilitative care is not provided at lauriston Christian Nursing Home Care Homes for Older People Page 13 of 38 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. Although care documentation provides a framework for the delivery of care for health needs it needs to be developed to identify and provide clear guidance to care staff on the mental health social and welfare needs of the residents along with robust systems for risk assessment to ensure individual person centred care is delivered The homes practice at this time do not ensures residents medicines are administered safely Evidence: The care documentation pertaining to six residents were reviewed as part of the inspection process. These were found to include plans of care, nutritional assessments, personal histories and individual risk assessments. On the whole the care documentation demonstrated that the health care needs were reviewed and evaluated, however it was noted that not all the plans of care highlighted all the social and welfare needs of residents. For example one resident who has communication problems did not have any guidance in the documentation to facilitate this vital need the staff though were observed communicating very well with the resident. Another did Care Homes for Older People Page 14 of 38 Evidence: not provide guidance for staff to deal with her isolation and recent confinement to bed. It was also found that social histories and social care plans are not completed on all residents. The review of the documentation highlighted that staff need to improve their documentation in certain areas and this was discussed in full with the deputy manager who was to review and address the identified shortfalls. Risk assessments for health needs are included in the care planning format used by the home and the majority of risk assessments were found to be completed, however not all followed through with an appropriate plan of action when identified as required. Those risk assessment completed for nutritional screening, falls and moving and handling need to be based on clear criteria and followed up within the care documentation. This was discussed in full. Shortfalls identified included: urinary continence assessments not completed, bowel assessments not clear as to what is being identified and there was no follow through in the care documentation. Nutritional assessments were not all completed in full, Records are kept for individual residents in respect of fluids and food intake but this needs to be based on clear rationales and followed through. A nutritional assessment is in place and completed in part, but as it is not followed or completed in full is not a useful tool. The home either needs to review the tool used or seek advice from a dietitian in using it to its full potential. The moving and handling assessments needed fuller information regarding the equipment to be used, pressure mattresses were found set at the wrong setting and therefore contra indicated, fluid and turning charts for those that are in need of monitoring were not completed consistently and some had not been completed during the day and there was no risk assessments in place for those residents who can not use a call bell to summon assistance. This outcome area was rated highly at the last key inspection and therefore it is disappointing that the standard has not been sustained Staff spoken with confirmed that they received a full report on each resident daily and read the care documentation that is kept in the main nurses station. They felt that their views were taken into account when planning residents care. The clinical rooms were found to be clean well organised and tidy. Medication trolleys are used for the medicine administration and when not in use are locked to wall. There are clinical fridges available and all eye drops in use dated on opening, temperatures are recorded daily of the fridges and clinical rooms. The Controlled Drug (CD) cupboard was checked and found to reflect the CD register. It was however noted that a deceased residents controlled medicines were still in the CD cupboard although had passed away in May 2008. The Medication Administration Records seen were found to be on the whole to be accurate There are policies and procedures in place for staff to refer to regarding the safe administration, storage, disposal and recording of medication. The home however Care Homes for Older People Page 15 of 38 Evidence: need to develop guidelines for as required (PRN) medication. During the tour of the premises topical creams were found in bedrooms prescribed to a different person than on the label, some had no label on and other creams were also found with out a top. By direct observation poor practice was observed in the direct administration of tablets to a resident which not only contaminates the medication but impacts on the dignity of the resident. This was brought to the attention of the deputy manager immediately. At the last key inspection it was documented that registered nurses wear a red tabard that states do not disturb on it to avoid errors during administration this was not seen at this inspection and would be beneficial to recommence to ensure good practice. Care plans contained information about how a resident might prefer to be addressed and whether they prefer a male or female carer. Staff were observed to be respectful when speaking to residents and good interaction was seen between staff and residents. Feedback from residents confirms that they feel that staff treat them with respect and dignity. Care Homes for Older People Page 16 of 38 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 in the main are supported to maintain a lifestyle of their choice and to maintain contact with their family and friends. They are supported and enabled to exercise choice and control in their lives, there is however a need to develop a more person centred activity programme for those people that are younger or unable to join the group activity sessions. Residents enjoy the nutritious and varied meals provided by the home. Evidence: There is an activity co ordinator that works full time in the home and she stated that her hours are flexible and include the occasional weekends. The activity programme is displayed in the home and showed the weeks planned activities. Every morning there is fellowship session with one of four people who take the group. Every afternoon at 2 pm there is a group activity these include bingo, craft sessions, such as pressed flowers, singing, visiting entertainers and board games. The statement of Purpose states that residents are involved in choosing the activities. From direct observation and from meeting residents, there are not many of the residents that partake in the group activities and there are at this time no records kept to evidence the success of Care Homes for Older People Page 17 of 38 Evidence: activities and whom had attended. There are some younger people living in the home and it was not clear from their care plans how their social needs are being met. There was no recorded evidence of one to one interaction with those residents who are confined to their bed or a plan of how to guide staff in meeting their social needs. Feedback from staff stated that there are no organised trips out for residents and this might be something some residents would enjoy. At the last key inspection the home received an excellent for this outcome and therefore it was disappointing to see that it had not been sustained. It would benefit the people who live in the home if there was further activities planned for small groups in other communal areas and structured one to one sessions for those who are unable to attend. Discussions with residents confirmed that they joined in activities only if they chose to do so some residents prefer their own company and often spent their time in their own rooms. Residents rooms were found to be individual and personalised and each resident has their preferred term of address recorded in their care documentation and this preference was respected. Residents were seen to have their choices respected through out the day with decisions being responded to. Visitors spoken to were all happy with the visiting arrangements and how staff, who were said to be very welcoming, received them. During the inspection visit it was noted that the reception area was always manned during the day and visitors were greeted with assistance being provided if needed. The staff said residents are encouraged to make choices about all aspects of their day to day lives, this however needs to be reflected in the individual care plans and there is a need to evidence the choices regarding meals and activities. The care plans of residents unable to make choices need to demonstrate how the staff enable and support residents in making choices. There was a choice of meal available on the day of the inspection and the food was seen to be well prepared and attractively presented. One visitor commented the food is always tasty, I join my relative for a meal once a week and always enjoy it. The menus are displayed in the home and rotate 4 weekly and change according to the season. The communication between the chef and staff needs to be improved as he was not aware that there were residents that needed fortification in their meals due to weight loss. Records are kept for individual residents in respect of fluids and food intake but this needs to be based on clear rationales and followed through. The Environmental Health Organisation visited the home 13/06/08 and the comments included Premises maintained to a high standard in general. Recommendations were made regarding the floor and a deep clean, as yet this has not Care Homes for Older People Page 18 of 38 Evidence: been fully actioned. The hot food trolleys were unclean , the deputy manager had identified this and highlighted it at the recent staff meeting (a week a go), but no action had been taken. Staff were seen assisting residents with their meal in a respectful manner, however some residents found it difficult to reach the table in the main dining area and staff need to be vigilant when serving meals. Care Homes for Older People Page 19 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a formal complaints system which is easily accessible and displayed in the home. Whilst records are not being held in the home at this time due to the absence of a manager, the registered providers are involved. Evidence: There is a comprehensive complaint policy and procedure in place and it is displayed in the home. It is also in the Service Users Guide and Statement of Purpose documentation. However the complaint file seen on the day of the site visit, dating over the past six months did not evidence clearly that when a complaint was received that it was acknowledged, investigated or responded to and did not state what action had been taken. One complaint received was clearly not fully investigated at the time of receiving it, and the response was not appropriate. It was sent to CSCI and referred again to the manager to re investigate. It is acknowledged that the manager was off sick and then left the organisation and a new regional manager had picked up the complaint. It is now resolved. The Annual Quality Assurance Assessment stated that there have been 21 complaints recieved in the last twelve months. It was stated at the last key inspection that regular meetings are held that residents can attend if they wish to raise any issues and the manager holds an open surgery each month for relatives, staff or service users to discuss any issues. There was no evidence that Care Homes for Older People Page 20 of 38 Evidence: these had been held for some time, at least six months, however the deputy manager confirmed that these have been recommenced and the last meeting was minuted and provided for review. There is a procedure for the protection of vulnerable adults in the home that staff are made aware of during their induction The staff handbook contains a copy of the whistle blowing policy. The training matrix evidenced that staff have attended training in safeguarding vulnerable adults, however the planned update sessions for many staff are now overdue and this needs to be addressed. The deputy manager acknowledged that this will be a priority. There has been one safeguarding alert alert raised by the home, which is currently being investigated. The organisation need to keep the CSCI informed of Safeguarding issues. There has been one safeguarding alert investigated by Social Services that was unsubstantiated at the time of the investigation. Care Homes for Older People Page 21 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lauriston Christian Nursing Home provides residents with a homely and comfortable environment with a variety of communal rooms and a shaft lift that enables them to have access to all parts of the home, however the residents would benefit from an maintenance and redecorating programme and improved cleaninless of the communal areas and equipment. Evidence: The home was purpose built and meets it stated purpose in respect of communal areas and good sized bedrooms with ensuite facilities. The maintenance person is well organised and keeps up to date records of his responsibilities in maintaining a safe environment. The overall decor in the home was in need of tidying and general maintenance issues attended to. It is a requirement that a plan of maintenance and redecoration is developed to ensure that the home meets the needs and expectations of those living there and visiting. It is a large home and consideration should be given to the size against the size of the maintenance team. All the bedrooms are single and have ensuite facilities, high/low nursing beds are provided in most bedrooms, however some are old hospital beds with the old marble mattresses are still in use and a number of divan beds in use. The beds in use need to be audited and risk assessed as to their use and replaced as necessary. Care Homes for Older People Page 22 of 38 Evidence: Residents who expressed an opinion spoke positively about the home, many have decorated their rooms with their own possessions, pictures and ornament. The gardens are accessible and attractive. There are adequate communal bathrooms and shower rooms in the home with specialist equipment, which enables frail residents and those with a physical disability to enjoy the facilities available. However as identified during the site visit, the moving and handling equipment had been serviced last week and this resulted in two baths being taken out of use and a number of slings being condemned. It was advised that further slings had been provided to ensure the needs of residents are met. The baths are being repaired and replaced as necessary. Specialised equipment to encourage independence is provided e.g handrails in bathrooms hoists, wheelchairs and lifts to all areas of the home. There were also specially ordered chairs for some residents and the dining tables were seen to be adjustable. However some residents were sitting in a difficult position to eat their meal and this needs to continually monitored by staff. Whilst the home has a call bell facility, there were a large number of residents that did not have access to this facility and no alternative or plan of action put into place to ensure that residents are reassured that staff can be alerted if they require attention. This was discussed in full during the site visit. The lighting in the home is of domestic quality and there are above bed lights as well as the main ceiling lights. Water temperatures are controlled and monitored monthly and a record kept. Random temperatures were taken and were of the recommended level. The heating of the home was discussed and there were portable heaters in use with a guard in a few rooms and in some rooms the radiator could not be altered and the resident had a portable fan to cool down the room. The heating in the home needs to be continually monitored and reflected in the environmental risk assessments. There is a team of domestic staff that work in the home and overall the communal areas and bedrooms were clean, however the equipment in use for residents was not clean: bed frames in some rooms were unclean as was the furniture in communal areas, the food trolley in use on the ground floor was dirty and though this had been identified the week previously by the deputy manager, action had not been taken. It is not clear from viewing the cleaning schedules and talking to various staff where the responsibility lies for the cleaning equipment and furniture and this needs to be developed and cleaning schedules devised to protect residents from possible cross infection. The laundry area was clean and organised and there were no concerns raised regarding the quality of the laundry service, towels in some bedrooms were frayed and there needs to be systems in place for staff to recognise this and replace them as Care Homes for Older People Page 23 of 38 Evidence: necessary. There are sluice facilities in the home, one macerator was out of use and some catheter stands and other equipment were found rusty and the plastic covering rotted, these need to be replaced to avoid cross infection risks. Gloves and aprons were found in most areas and staff were seen using them appropriately. Care Homes for Older People Page 24 of 38 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. A review of staffing levels based on residents dependency levels ensures there are sufficient staff to meet the residents needs. The training matrix evidenced that staff are not receiving the necessary training at this time to perform their job competently and thus place residents at risk. Evidence: There are always 3 nurses on duty during the day with 11 carers and 2 nurses at night with 4 carers. On the day of inspection there was one carer off sick and she was not replaced. In addition to care and nursing staff there is a domestic team, headed by the housekeeper a maintenance man, an activities co-ordinator, administration staff and a kitchen team. Care staff spoken with said that the levels of staff on duty were sufficient to give the care required they also said that the trained staff always helped out. Residents also confirmed that they had no complaints regarding the amount of staff. It was confirmed by the deputy manager that there is flexibility of the staffing levels and they are adjusted according to the changing needs of the residents. Staffing levels need to be reviewed regularly against the dependency levels of the residents, the residents dependency is high with many of the residents having complex needs. The Annual Quality Assurance Assessment stated that 79 per cent of staff have an National Vocational Qualification and a further six are enrolled on a course. Care Homes for Older People Page 25 of 38 Evidence: The recruitment procedures were seen to have been followed for the majority of the new staff employed and additional staff files were sampled to support that good practice is followed. However as discussed the recruitment file for the deputy manager did not follow the good practice normally seen. The application for recommencing employment with the organisation had not been completed, there were no interview notes in place and no job description for either her role as registered nurse or as deputy manager. The Criminal Record Bureau check had been applied for, but not yet received. These issues were discussed with the Regional Operations Manager and would be addressed. All staff undertake an induction when they start at the home staff are issued with a handbook outlining their responsibilities and key polices of the home. The training matrix was reviewed and identified that the training programme is very behind and therefore places residents at risk from uninformed staff. Many staff have not received the necessary training and updates to perform their job competently and safely This includes fire safety fire drill infection control and moving and handling This must be addressed to ensure that the staff can meet the needs of the residents living in the home. Care Homes for Older People Page 26 of 38 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and staff would benefit from a consistent managerial approach that provides leadership and promotes the health and safety of the residents. Staff must be appropriately supervised to ensure good care practices are consistent throughout. Evidence: Since the last key inspection the registered manager has resigned and at present the newly appointed deputy manager is running the home on a day to day basis with support from the new regional manager from the organisation. A new manager has been recruited to the post and commences employment on the 11/11/08. She is an experienced manager and has been registered as manager by the CSCI for her current job in a large care home. She is a registered nurse and has the necessary experience to run a home. The deputy manager worked in the home as registered nurse for 7 years before having two years away and returned to work on the 22 July 2008 as a RGN on the 3 Care Homes for Older People Page 27 of 38 Evidence: September 2008, she was promoted to the deputy managers post and took on the role of running the home on a day to day basis. This process has been difficult as the previous manager was off sick for her 3 month resignation and therefore the deputy manager received no handover. The support systems also were irregular as the regional manager also left during this time and the new regional manager had no experience of the home. It was acknowledged that there has been a lapse in the efficient running of the home in areas that have been identified throughout this report since the last key inspection. Audits have been recommenced by the deputy manager and she is already putting into place improvement strategies. The deputy manager has recommenced the lapsed meetings with residents and relatives to gather their views about the service provided. These meetings have not been happening in the home for some time and there were no records available. There have been formal quality visits carried out each month by a representative from Southern Cross, the last one available for review was July 2008. It was confirmed that they had been undertaken, but no record was available in the home. This is especially important at this time as the home is in the need of strong leadership. There have been regular monthly audits undertaken, but there were gaps and were difficult to track since the last key inspection however these have been recommenced by the deputy manager. Customer surveys are sent to residents at least annually. The home does not generally deal with financial issues on behalf of residents but will hold small amounts of cash securely for them if requested. A system is in place for supporting residents to pay bills for hairdressing or toiletries etc and the records relating to residents money were seen to be accurate and robust. Residents have lockable drawers in their rooms for personal belongings. Staff supervision was discussed and staff supervision has not been undertaken for some time. The deputy manager is aware that these need to be recommenced to ensure that staff are supported through the changes of management. At present as identified by the training matrix supplied not all staff have received the mandatory training in moving and handling, infection control,POVA, health and safety and fire safety, however it was confirmed that this will be addressed Environmental risk assessments still need to be developed for the individual residents, the premises to ensure the safety of residents is promoted. The accident book was viewed and was correctly completed, however these need to be Care Homes for Older People Page 28 of 38 Evidence: signed and audited by the management team to ensure that residents well being and safety is promoted by preventative measures. Care Homes for Older People Page 29 of 38 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 38 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 1 4 That the registered person ensures that the Service Users Guide is up to date and gives service users the correct information. To ensure that the service user is informed. 09/01/2009 2 3 14 That the registered provider ensures that the preadmission assessment has sufficient detail and information to ensure the home has the necessary facilities and skills to meet the prospective needs. That no service user moves in to the home without their needs being assessed in full. 09/01/2009 3 4 14 That the registered person 09/01/2009 ensures that it is confirmed in writing that having regard to the assessment made on any prospective service user that the home can meet those needs. Care Homes for Older People Page 31 of 38 That no service user moves in to the home without their needs being assessed and agreed. 4 7 15 That the registered provider 09/01/2009 ensures that care plans accurately reflect the specific mental health, social and welfare needs of the service users. To ensure the safety and well being of the service users. 5 8 14 That the Registered Provider 09/01/2009 ensures that all risk assessments are accurately and fully completed and include a clear action plan for staff to follow. That accurate records pertaining to nutrition, wound care, continence and communication are further developed and accurately reflect the service users changing needs. That risk assessments for the use of call bells are in place and a plan of action in place for those that can use a call bell. To ensure the safety and well being of the service users. 6 9 13 That the registered person 09/01/2009 ensures that medication practices are safe and follow the homes policies and procedures. Care Homes for Older People Page 32 of 38 To ensure the safety and well being of the service users. 7 12 16 That the registered person 09/01/2009 ensures that all service users have a social care plan that is designed to meet their interests and preferences. That service users isolated in their bedrooms have a plan of care to ensure that they receive interaction and stimulation. To ensure that all service users lifestyle meets their wishes and expectations. 8 15 16 That the Registered Provider 09/01/2009 ensures that a formal monitoring of service users appetites and amount consumed is kept. That the staff communicate special diets and dietary needs with the cook. To ensure the service users dietary needs are met. 9 16 17 That the registered person 09/01/2009 ensures that the complaint records are kept in the home and evidence the investigation, the outcome and the action taken by the home. To ensure that service users are confident that their complaint is taken seriously and acted upon. Care Homes for Older People Page 33 of 38 10 18 17 That the registered person keeps a record in the home of any incident affecting the service users well being. That service users are protected from abuse. 09/01/2009 11 19 23 That the registered person ensures that the home meets its stated purpose and is well maintained and in good repair. This pertains to the internal decoration and the maintenance of the equipment such as baths. That a plan of maintenance and redecoration is developed. To ensure the service users safety. 09/01/2009 12 22 16 That the Registered Provider 09/01/2009 ensures that the specialist equipment in the home is maintained and in good working order. This pertains to: Air flow pressure relieving mattresses - daily check. The beds in use need to be audited and risk assessed as to their use and replaced as necessary. Call bell facility to be in reach of service users, staff and visitors. To ensure the service users safety. 13 25 23 That the registered person ensures that the heating facility in the home is 09/01/2009 Care Homes for Older People Page 34 of 38 apppropriatly risk assessed and adjustable to suit individual needs of the service users. To ensure the service users well being. 14 26 16 That the registered person ensures that the equipment in the home is clean and hygenic. This pertains to lifting equipment, catheter stands, meal trolleys, bedframes and communal furniture. To protect the service users well being and health in respect of cross infection. 15 27 18 That the registered person 09/01/2009 ensures that there are suitably trained staff on duty at all times to meet the assessed needs of the service users and the purpose of the home at all times. To ensure that the service users needs are met by the skill mix of the staff. 16 30 12 That the registered person ensures that staff receive the training to perform their job competently and receive the necessary updates. That the registered person ensures that staff receive the training to perform their job competently and receive the necessary updates. 09/01/2009 09/01/2009 Care Homes for Older People Page 35 of 38 17 31 12 That the registered person 09/01/2009 ensures that there are suitable managerial structures in place to ensure the home is run efficiently and in the best interests of the service users. To ensure the management of the home is suitable and competent in order to protect the service users. 18 33 24 That the registered person ensures that the monitoring systems in place are completed regularly. that the registered person ensures that the monitoring systems in place are completed regularly. 09/01/2009 19 36 18 hat the registered person ensures staff are appropriately. supervised. That staff are appropriately supervised to ensure good practice. 09/01/2009 20 38 23 That the registered person 09/01/2009 ensures all staff receive the necessary training to protect and promote the health, safety and welfare of the service users. To ensure the service users continued safety and well being. 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. Care Homes for Older People Page 36 of 38 No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 37 of 38 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. 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