Inspection on 21/10/08 for Lucerne House

This inspection was carried out on 21st October 2008.

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

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

Other inspections for this house

Lucerne House 21/11/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lucerne House Chudleigh Road Alphington Exeter Devon EX2 8TU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rachel Fleet     Date: 2 1 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. 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 44 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 44 Information about the care home Name of care home: Address: Lucerne House Chudleigh Road Alphington Exeter Devon EX2 8TU 01392422905 01392424636 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Barchester Healthcare Homes Ltd care home 75 Number of places (if applicable): Under 65 Over 65 31 31 31 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 0 0 0 13 The maximum number of service users who can be accommodated is 75. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admision to the home are within the following categories: Dementia - over 65 years of age (DE(E)) - maximum 31 places Mental disorder, excluding learning disability or dementia - over 65 years of age (Code MD(E)) - maximum 31 places Old age, not falling within any other category (Code OP) - maximum 31 places Physical disability (Code PD) - maximum 13 places Date of last inspection Care Homes for Older People Page 4 of 44 Brief description of the care home Lucerne House Care Centre is a purpose-built home which opened in 1995. It provides care, including nursing care and respite stays, for up to 75 people accomodated in three units - Shillingford, Ide and Alphinbrook. The majority of bedrooms are for single occupancy, and all have ensuite facilities. Shillingford provides care for up to 31 people with dementia. Ide provides care for up to 31 people who have needs relating to old age. Alphinbrook provides care for up to 13 younger adults who have physical disabilities. The units share some facilities and services, including a communal reception area. On the ground floor Shillingford, the dementia care unit, is entered via a door with a keypad lock. Here, communal areas are made up of a large lounge with a dining area beyond, and a small lounge. Corridors are wide and long, giving people who like to walk about ample room to do so. Ide, the older persons unit, on the second floor, is accessed by staircase or the lift. Communal space is made up of a lounge and a dining room, with wide and long corridors. Alphinbrook, the younger adults unit, is on both floors. It has communal areas including a bar, lounge, dining room and a private room. Outside the home, there is ample parking and various level-access sitting areas with tables and chairs. Areas for those people who live in Shillingford are secure, for their safety. The home is in the heart of Alphington, with an Anglican church and a pub nearby. It is on bus routes and has its own minibus. Further information about this service, including our reports, can be obtained direct from the home. Current fees range from 527-1253 pounds per week, depending on individuals care packages, and the room size (particularly if someone wishes to have a double room for single occupancy). Fees include the homes physiotherapy services, but do not include chiropody (12 pounds for the homes chiropodist), personal expenses such as hairdressing or newspapers, and outings. Care Homes for Older People Page 5 of 44 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Date of last Key Inspection: 21 November 2007. This inspection took place as part of our normal programme of inspection. It included an unannounced visit to the home, lasting 10 hours on a week day, by three inspectors. Each visited a different unit in the home, including communal facilities and some bedrooms, as well as going to the homes service areas. A CSCI questionnaire (the Annual Quality Assurance Assessment, or AQAA), sent to the home ahead of our site visit, was returned by Paul Courtney, the registered manager. This included the homes assessment of what they do well and any plans for improvement, as well as information about the people living at the home, staffing, Care Homes for Older People Page 6 of 44 policies in place, and maintenance of facilities. We also sent surveys to the home for them to give out. We sent 10 surveys for older people and 5 for the younger adults; 7 and 5 were returned, respectively. Surveys were sent for 10 staff working at the home, and 5 were returned. During our visit, we looked closely at the care and services offered to eight people across the three units. This process of case tracking helps us to judge the services and care offered generally. It also helps to see if peoples individual or diverse needs are being met and to see if issues of equality underpin this. We spoke to and observed some of the care offered to these people. We also spoke to and observed the care of other people at the home, getting views from at least 23 of the 70 people who currently lived at the home, as well as speaking with peoples visitors, a visiting health care professional, staff and the manager. Some of our time was spent in a communal area on Shillingford. A number of people on this unit had difficulty verbally expressing their views on the service, because of mental frailty due to dementia and other conditions. So here we used a particular method for observing activity over time, to help us get a sense of peoples well-being, how they are able to use their environment, and how staff support them. We also looked at records relating to assessment, care planning, medication, staff recruitment, training, and general management. We ended our visit by discussing our findings with Paul Courtney, the registered manager. These various sources of information have been used in this report. What the care home does well: What has improved since the last inspection? What they could do better: More person-centred assessment for every prospective resident would assure people that they will receive the individualised care and support they want, if they move in. Additional detail in some care plans (including peoples likes and dislikes), with more thorough review of such information, will help to ensure everyone at the home receives Care Homes for Older People Page 8 of 44 consistent, person-centred care, even when they cannot express their choices clearly. All care plans should be updated and actioned in a timely way, to ensure they get prompt attention from other healthcare professionals if their needs change. Medication practices must be further improved to ensure safe standards are achieved and maintained throughout the home. A previously set timescale of 31/01/08 has not been fully met. The home should ensure that everyone has access to activities or meaningful occupation that is specific to their life histories or individual interests, to meet their particular lifestyle or psycho-social needs. People who hold a belief or conviction such as a faith, a dietary choice, etc., or who held one when they were fully able to choose how they lived their life, should be supported to continue that practice - showing respect for them as an individual. A suitable supervisory person should monitor how staff actually work with people, and provide guidance or support where necessary, to ensure a person-centred approach to care. Staffing levels and routines should be reviewed on Alphinbrook, to establish that they remain sufficient to meet peoples assessed needs. More timely attention to aspects of maintenance and renewal would ensure everyone has pleasant and safe accommodation with the facilities they need. 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 44 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 44 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. Systems in place ensure the home can meet the needs of people who go to live there, although a more person-centred assessment for every prospective resident would provide assurance that they will receive the individualised care and support they want, if they move in. The home does not offer intermediate care. Evidence: The AQAA stated people were admitted to the home on the basis of a pre-admission assessment. This helps to ensure the home can meet the care needs of each individual before they move to the home. People on Shillingford and Alphinbrook were able to confirm that someone from the home had met with the resident to discuss some of their care needs before they moved in. We found the registered manager or other senior staff had undertaken such assessments. Care Homes for Older People Page 11 of 44 Evidence: On Alphinbrook, we saw detailed assessments even for people admitted for a short stay only. This information included their faith, usual bedtime with the time they actually settled down to sleep, the angle they sat at to avoid choking when eating or drinking, any allergies, any advance directives, any preference regarding the gender of carers, what they were able to do for themselves, equipment they would need, and their interests. Someone who had respite stays at the home said their needs and care plan was discussed with them on each occasion. The AQAA said the home always got an assessment of someones needs from a relevant professional before agreeing to admit anyone in an emergency. We saw copies of comprehensive assessment and care plans for people admitted through Social Services care management. These had been obtained for non-emergency admissions also. There was information from somebodys previous care setting in one case. Prospective residents and/or their family or advocate are encouraged to visit, to meet people living there and have a meal if they wish, before deciding whether to make it their home. People we spoke with confirmed that the home had given them ample information about the home before they decided to move in, and the home had lived up to their expectations. We saw the homes brochure that has been produced specifically to help people who are choosing a home for someone with dementia. This explains what a person-centred approach means, and how people can see for themselves if a service for people with dementia is providing good care and support. Information from assessments had been used as the basis of a plan of care. And staff from Ide and Alphinbrook told us they were informed about people and their care needs before they were admitted. However, we found individuals strengths were not always included, or how they could maintain their independence and be supported to lead their lives as they wished. Thus, although care staff were informed what care a person needed, they might not provide individualised, person-centred care. Care Homes for Older People Page 12 of 44 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some care plans are well written, but a lack of detail and thorough review of others creates a risk that some people will not receive consistent, person-centred care and support they need or want. Peoples wellbeing is promoted through respectful attention to their personal, mental and physical needs, although medication practices do not fully ensure their health and safety. Evidence: Staff surveys confirmed they were always or usually given up-to-date information about the people they cared for. On our visit, staff told us they were kept up-to-date through a handover meeting at the beginning of each shift on each unit, when information was shared about individuals living there and any issues or problems that had occurred. Staff we spoke to were able to discuss peoples needs with us and how they were to be met. People we met looked well cared for and appropriately dressed, etc. We did not note any issues with standards of personal hygiene. Care Homes for Older People Page 13 of 44 Evidence: Ide: We looked at three peoples care files in depth. Care plans we saw were based on an up-to-date assessment of all aspects of their health, welfare and social care needs. They were generally informative, well written, and easy to understand. We were told that care plans were developed with each individual, and relatives were involved with the persons consent. Staff we asked said that they referred to them. We looked at a file for someone who had moved into the home in the last week. There was no plan of how their assessed needs would be met, nor assessment and management of any risks. This meant that staff did not have the information to enable them to meet this persons needs in a consistent, person-centred way. We were told that care planning was in progress, and later looked at the care plans that were written during our visit. One did not reflect the persons current needs in relation to continence, stating they were catheterised when this had been removed prior to their admission. We also noted differing information relating to skin care. For example, in one place stating All skin intact on admission, but Sacrum area is a bit red with 2 small breaks recorded in the Skin inspection record on admission. Thus the person was at risk of not receiving appropriate, consistent care to prevent pressure sores. Assessment of potential risks to individuals was undertaken as part of the care planning process, and reviewed regularly. This included the risks of falling and poor nutrition. Care plans were also reviewed regularly and appropriate changes had been made to reflect changing needs. Individuals, and relatives were encouraged and supported to be involved in this review. The daily reports we saw related to specific care plans. The home monitored and organised dental and optician checks for people, and chiropodists attended according to peoples needs. Involvement and advice from health care professionals, such as skin care specialists and nutritionists, were included in peoples plans of care. Senior staff described a good relationship with health professionals such as district nurses, community psychiatric nurse, pharmacist and doctors. Medication was well managed. Records were accurate, up-to-date, and indicated that it is appropriately administered. Details of any changes to a persons medication were recorded in their plan of care. Staff who handled medicines had received training for this. Care Homes for Older People Page 14 of 44 Evidence: People felt that their privacy was respected. Staff were seen to knock on doors and wait to be invited in before doing so. They were also seen offering personal care in a discreet manner. Shillingford: We looked at three care plans - one for somebody who had lived at the home for over a year, and two for people who had moved in more recently. According to the care plans, two of these people had significant communication difficulties, and staff were provided with guidance in how to work with people to bridge the communication gap. However, in one of the files the assessments and guidance appeared to be contradictory. Staff were guided to speak clearly and loudly although it was next stated that the person did not have a hearing loss, for example. The same assessment stated that the person was unable to follow basic requests, but it did not suggest alternative forms of communication - such as gestures or pictures, to supplement verbal communication. A risk assessment for falls stated that the persons ability to comprehend was good, contradicting the previous assessment. Elsewhere a stated goal was to keep the person well nourished. Their record of weight showed that they had lost weight, yet two monthly reviews stated no change when this was clearly not the case. Generally staff were given guidance on how to support people living at the home. However, two staff told us that one person was reluctant to receive help with personal care and screamed when they tried to assist them. The person told us that they felt self-conscious with intimate care, and had not had a bath recently. This, and their distress, was reflected in daily records. However, guidance for staff did not mention that the person screamed and did not provide guidance on how to try to reassure or provide intimate care without causing such distress. We saw that there had been appropriate referrals to health care professionals, and that concerns had been followed up and reviewed. A care plan contained guidance from a skin care specialist, and showed that staff had sought further advice after picking up on negative changes. Risk assessments were recorded, identifying people whose skin was vulnerable to pressure sores, with relevant guidance in place. We were told that nobody on the unit had a pressure sore but that one person had an ulcer, which they had when they moved in (as records confirmed). Care Homes for Older People Page 15 of 44 Evidence: Staff praised the support and approach of a GP who provided most support to the home. This was echoed by a relative and a younger person living at the home, who described the GP as brilliant. We observed a medication round and saw that the member of staff was focused and calm in their approach. They did not rush people and ensured that they had taken their medication before they signed the records and moved onto the next person. We saw that when personal care was provided, staff knocked on the door and shut the door after entering the room. One persons bedding had slipped off, exposing their lower body. A member of staff noticed this promptly, and rectified this whilst giving reassurance. We were told that people could sleep with the door open or closed, whichever was their choice, which we saw on the day of the inspection. When people were assisted with moving around the home, the staff supported them in a calm and caring manner, explaining what they are doing and going at the persons pace. This reflected guidance in care plans and shows good practice in supporting peoples dignity. We saw that staff maintained eye contact whilst talking to people, and did not become distracted by conversations of other staff members. Care plans recognised that peoples dignity should be maintained. A visitor told us that their relative always looked well cared for, was always wearing their own clothes, and could go to the visiting hairdresser. Other people looked well cared for, and were appropriately addressed. Staff carefully adjusted peoples clothing to ensure their dignity. We saw staff generally communicated in an appropriate manner with people living at the home, changing their approach to suit the individual. They were generally gentle when they woke people or wanted to attract their attention, and picked up on cues when people did not choose to interact. Alphinbrook: We particularly followed up the care of two people living on this unit, although we also met with others. As on the other units, individuals had comprehensive care plans, which had been regularly reviewed. A new staff member said their induction had included learning about person-centred care, an approach we saw reflected in peoples care plans. We spoke with someone at the home for a short stay. They had stayed on the unit before, and said that their discharge from the home after their last visit had gone Care Homes for Older People Page 16 of 44 Evidence: smoothly. They confirmed their current care plan had been discussed and agreed with them, and that staff coming to assist them knew what help they needed. Where someone was unable to be fully involved in planning their care because of a physical condition, we saw that their advocates had been involved in regular reviews of their care plan. Their records included how decisions had been arrived at for the care indicated in their care plan, what care had been tried, and why it had been unsuccessful where relevant. This is excellent practice. Someone living at the home told us the activity staff had agreed goals with them that related to recreation or occupation of their time. Another persons interests were recorded, but we did not find a related care plan to ensure they could continue those interests. We saw peoples faith or spiritual needs were routinely considered along with other needs. We did not see peoples dietary likes/dislikes included in their care plans, although some were on records in the main kitchen. Risk assessments and related risk management plans were in peoples care files. These included consideration of their safety when moving or being moved, and risk of malnutrition and pressure sores. Related records showed staff had contacted a dietitian for advice when someone with complex nutritional needs became unwell. A care plan for prevention of pressure sores reminded staff to ensure the persons pressure-relieving mattress was set according to their weight, which had been monitored regularly. We found the mattress was at the right setting. Daily care notes reflected the state of peoples skin and pressure areas. We saw visiting professionals made entries in peoples care notes, promoting good communication and consistency of care. These showed some people were supported by speech therapists. The home also has links with the Multiple Sclerosis Society, and some people we met were using specialist equipment on loan from them. A professional we spoke with was generally positive about the home with regard to their area of care, although recently they had not been contacted in a timely way by staff when the condition of someone they were already supporting changed. The home employs a physiotherapist, who works mainly with the younger adults. One person told us they benefited from the physiotherapy services, and also that they got medical attention when they wanted or needed it. We were told only one person had pressure sores, which they were admitted with. We saw that staff had fully described someones wounds on their admission, with completion of a body map and a photographic record, giving a proper basis for future assessment of the wounds and effectiveness of any care given. Care plans included Care Homes for Older People Page 17 of 44 Evidence: what specific pressure-relieving equipment people needed, and we found that it was in use or available. We saw daily notes for one person included assessment of their pain. One persons care plan said staff were to contact the pain clinic on their behalf. Although the care plan had subsequently been reviewed, the review did not indicate what had happened with regard to this. The person was unable to speak with us but appeared comfortable. Otherwise, reviews were very detailed. One person had a condition which can require limits on how much they drank, so it was positive to see their care plan included a daily intake target as advised by the persons GP. This amount had been reduced after a review, and staff we spoke with knew this new amount. However, the care plan had not been updated and it was not shown on fluid charts in use. We found these charts were not completed appropriately, showing these to the registered manager when discussing the matter. Daily notes did not reflect whether the target was achieved or not. The person spent time away from the home, and it was not clear in their care plan if or how their intake would be monitored on such occasions. Staff showed us there was written communication between the home and the place the person went to, to address this. There was a detailed plan relating to someones diabetes, with information from a GP about their insulin regime and blood glucose levels to be achieved. Care notes showed staff had contacted the GP when the persons blood glucose was not in this range. People we asked were satisfied with how their medication needs were dealt with by staff. Where one person had medication prescribed for use when needed, care notes included why it had been given, and its effectiveness had been assessed; we did not find any such medication being given regularly. This is good practice. Risk assessments had been written for medication given through a feeding tube, ensuring it was safe practice. There was no evidence that handwritten directions for some medication had been checked by two people for correctness. Occasional signatures were missing on administration records, suggesting some skin creams and other medication were not given as prescribed. We made a requirement about this at our last inspection. Stock levels of two medications did not correspond with quantities indicated by administration records, which we showed to the registered manager. One controlled drug was out-of-date, which had not been identified in a recent audit Care Homes for Older People Page 18 of 44 Evidence: carried out by staff. Another controlled drug had not been dated on opening, so its shelf-life as indicated by the manufacturer could not be properly monitored. Staff told us appropriate procedures for disposal of unwanted controlled drugs, a kit used for this being kept in the home. People had care plans for maintaining their dignity. Those we spoke with felt staff were respectful, using their preferred name, and ensuring their privacy. Care plans showed who would be responsible for opening someones post if they couldnt do it themselves, which one person confirmed staff adhered to in their case. We saw staff knocked before entering peoples rooms. We discussed with the manager whether a Do not disturb/privacy sign on bedroom doors might be useful for people who, for various reasons, might not give a response to anyone knocking on their door. Where someones door was kept open (so that staff could monitor them), their care plan showed this had been agreed through multidisciplinary decision-making on behalf of the person, with regard for the Mental Capacity Act 2005. Care Homes for Older People Page 19 of 44 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. People are generally supported to make choices and retain their independence, promoting their quality of life. They benefit from new and continued links with the community outside the home. Planned activities do not fully reflect the varied needs and abilities of individuals, so peoples lifestyle or psycho-social needs are not always met. They enjoy the food provided, which is nutritious and takes into account their preferences. Evidence: Ide: All those spoken with said that there was always something going on at the home that they could take part in if they wished. We saw people being encouraged and supported to take part in gentle exercises. A group of people were chatting, with the involvement of staff, reading, listening to music or watching TV. Some people went out with relatives or friends. The great majority of surveys from the whole home were positive about the suitability of activities provided. The home has an Activity Team, consisting of two members of Care Homes for Older People Page 20 of 44 Evidence: staff - who have recognised care qualifications also - who organise activities. One-toone and group meetings are held to discuss any issues or suggestions people living at the home may have. We asked staff how they protect people who prefer to stay in their room from the risk of social isolation. We were told that staff visit them frequently, talk to them about daily events, their interests and what activities are taking place so that they could change their minds. We saw care staff visiting people in their rooms, to make sure they were comfortable and did not need anything. Several people told us their visitors were offered drinks, and were made to feel at home. The visitors book showed many people received visitors and they came at various times of the day. People moving into the home are encouraged to bring personal possessions and small items of furniture, to make their rooms feel homely. Most of the rooms we saw were personalised, and people spoke about the pleasure having their own things around them gave them. Most people told us that the food served was very good, with surveys also showing that people enjoyed the meals. People could choose to have their meals in the pleasant dining room, in the lounge, or in their bedroom if they wished. The meal served during the day of this inspection was well presented, hot and nutritious. More information on catering arrangements at the home can be found at the end of the next section below. Shillingford: A visitor told us that they felt their relative would benefit from more stimulation. When we looked at three care plans, we saw that few activities were recorded. However, people do benefit from musical therapy according to staff, a visitor, and records that showed that group work and one-to one work is provided. Staff told us that someone we met had spent time with the musical therapist, who gave one-to-one support; records confirmed this, with positive comments about the persons reactions. We were told that they were looking for songs in the persons first language. Outside entertainers also visited the home. We saw that some people appeared to enjoy being part of the life of the home and took part in making their bed, laying the tables and folding napkins. For one person, who took little interest in others around them, these tasks seemed to give them a Care Homes for Older People Page 21 of 44 Evidence: sense of purpose. Staff encouraged them and supported them in this role. We looked to see if care plans promoted person-centred activities in order to meet peoples individual needs. We found peoples life histories, written by relatives. But this information had not been used to inform care planning so that activities would meet peoples identified needs and interests. For example, one person used to enjoy dressmaking according to their life history. We saw this from their actions, as they appeared to be sewing throughout much of our observation time. However, their care plan did not reflect how this interest would be met. We spoke with staff about how they could meet this social need, and they told us that the organisation is due to implement a programme called Memory Lane to provide more meaningful occupation and more person centred activities. Interest and hobby sheets had not been completed in any of the three files we saw. These should be developed to work alongside the new programme. One persons file indicated that they had a Christian faith, and used to regularly attend church. However, there was not indication as to how this need was met, apart from through music therapy. One person showed obvious enjoyment caring for a doll, appearing relaxed and focused on caring for it. Staff told us that this person had previously been restless and unsettled. They discussed their care of the baby with the person, but this meant that the person received far more attention than others. Of a group of people we saw in the morning, four were reading a magazine, sewing or talking animatedly. The remaining five either slept, or drifted in and out of sleep, but generally responded positively if staff interacted with them. We observed five people specifically to help us make a judgment about peoples well-being. Nobody showed any sign of negative well-being. Staff generally interacted with them in a gentle and caring manner, but were usually performing a task - such as helping with a meal - when they did spend time with people. However, one staff member acted as a positive role model by taking time with a number of people in a meaningful way, and told us that they recognised that quieter people needed equal time spent with them. Some staff sat with these people later in the day during some entertainment. During the morning, we saw visitors arriving and spending time with people either in their rooms or in communal areas. Staff were friendly and welcoming. Later, some visitors joined their spouses or relatives to watch the entertainer, in a friendly and relaxed atmosphere. Care Homes for Older People Page 22 of 44 Evidence: We noted that peoples relatives had attended care reviews to discuss the persons care and care plan. We saw favorable comments about the standard of care. A letter from a relative said they were always made to feel welcome, that the staff had shown every consideration to meet their relatives needs, and that the care was excellent. We looked to see if the environment supported people with making choices. People generally looked relaxed in their surroundings. Some people had good mobility and moved around freely, using all communal areas of Shillingford as well as their rooms or the garden. They could thus choose to participate in communal activities or opt to spend time elsewhere. We looked to see if peoples care plans promoted choice. For example, we looked to see if they had details of their likes or dislikes with regards to food. One person told us that they did not like a particular soggy cereal but preferred crunchy cereal. And they only liked coffee, which they confirmed was always served to them. However, such information was not recorded in their care plan. Another persons life history said that they were vegetarian, but staff confirmed that the person was given meat at lunch during our visit. This does not show respect for, or recognition of, the persons identity and how they chose to live their life in the past. Records showed that they had lost weight and needed encouragement with eating. A senior staff member told us that they were trying to promote an ethos where peoples abilities were promoted rather than the focus being on what they could not do. We saw that one person was assisted with their meal but was given a set of cutlery also. As they started feeding themselves, the staff member withdrew, promoting the persons independence. However, we noted staff took a jug away from a table, even though one person was able to serve themself. On several occasions, they lifted their empty glass to their lips, but had to wait until staff noticed and filled up their glass. On the day of the inspection, some people were offered a choice of hot drink. This could be improved by allowing people to choose using visual prompts, to maximise their independence. No choice was offered to people regarding their drink at lunch, although the manager told us that this normally happened. One person told us that they liked to sleep in late and that they were able to do this, adding that they had been able to eat their breakfast later in the morning. They also told us that they preferred their own company; staff were seen respecting this and providing meals in their room. We saw other people also choosing to get up at different times of the day and having their breakfast provided then. During lunch, we noted some people chose where they sat and then decided to move around the room, Care Homes for Older People Page 23 of 44 Evidence: eating different courses of their meal in various places, which staff accommodated. The units luncheon club provides people with one-to-one support from staff in a smaller group. Staff provided support at lunchtime in a discreet and calm manner. Tables were set in an attractive manner with tablecloths, napkins and flowers. Generally, staff told people what the meal was, and where people ate little, they were given a supplement drink. Two surveys from older people mentioned that cutlery put on tables was sometimes handled by other people before it was time for it to be used. We mentioned this to a senior manager. See, also, the end of this section for more information on catering arrangements at the home. Alphinbrook: The AQAA said there was a computer with internet access and a games machine for people living at the home. We found this was in Alphinbrooks lounge, and people living on the unit told us they were helped to use it. Activity staff had arranged access to a literacy class, and people we met were pleased with their developing skills. Someone said the staff were also helping them to consider whether to take up a longdistance learning course. Another person went out to a community centre, during our visit, clearly keen on going there. Somebody told us they usually preferred to stay in their room, but went on the homes minibus outings. They didnt know that the home had a video library as well as a book library. Care records included consideration of peoples spiritual needs, and we saw some people were enabled to attend communion services at the home despite their complex needs. People said their visitors were made to feel welcome, and they could stay late if they wished. One person said their family went with them to the functions put on by the home. Someone who had no relatives locally told us that the Activities staff had visited them when they were hospitalised. They appreciated greatly a card sent to them by the manager and others to mark the anniversary of their admission to the home, saying they had few other occasions or anniversaries to celebrate. One person said they were only really interested in certain sports that they used to take part in, which were not available to them now, but added that they were always invited to whatever was being offered by the home. They felt they were benefiting Care Homes for Older People Page 24 of 44 Evidence: from Tai Chi classes held at the home. They enjoyed going out for meals, and the home organised local outings making this possible. Others told us they got out to the cinema, with support from the activities staff, paying for their own ticket and a fixed charge for the homes transport. People had been to the aquarium at Plymouth quite recently, and went to the Eden Project after they said they would like to go there. One person thought outings were less common at week-ends, and said week-ends could feel very long, especially if they didnt have any visitors. Another thought that people from Shillingford did not go on outings, but the manager confirmed that they went on outings separately. We saw photos of various occasions and events out on display. Someone we met had limited verbal communication. There was an excellent personal history in their care records, so staff would be able to understand and appreciate this persons personality as well as their achievements to date. Their care notes showed they had been to the cinema, a garden centre, and two other places of particular interest to them in recent months, despite their more complex needs. We noted monthly activity records showed very variable levels of one-to-one time spent with them by staff, however. People we asked generally said the food provided was satisfactory, with one saying it was excellent. One person knew what the days lunch was to be, adding that people could have something like an omelette instead if they wanted. At lunchtime, six people sat individually around the dining area. Other people chose to eat in their own room, and we saw meal trays taken to them were nicely set. Regarding the whole home: People chose from the options on the daily menu, with individual preferences accommodated. We saw the kitchen had a request for someones curry to be extra hot, for example. The great majority of all surveys were positive about the meals provided. Menus we saw included traditional dishes - fish on Fridays, roasts twice a week, cottage pie, etc. A hot meal was available at teatime also. A vegetarian alternative was always available, and the chef told us menu dishes were adapted to make them suitable for people with diabetes to eat. Menus were displayed. Some of these were in ordinary print where some people might have benefited from larger print. Care Homes for Older People Page 25 of 44 Evidence: The AQAA said wine was available on request, fruit was available throughout the home, and finger food (which was fruit, crisps and cheese) was available regularly. On our visit, we were told fruit was available on request as well as being taken to the units every day at lunchtime and teatime. One person said they could have a hot drink at anytime, but wasnt aware that snacks were offered or available apart from fruit segments they had seen on the tea trolley. The bar is located on Alphinbrook. We did not see anyone use it, but one person who lived there confirmed that people living on other units occasionally did. The chef told us that whole milk was used (in accordance with good practice guidance for older people) unless staff were advised otherwise, as in the case of advice from the Multiple Sclerosis nurse specialist. Care Homes for Older People Page 26 of 44 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 homes systems and safeguarding practices help to ensure peoples concerns are heard and that they are also protected from harm. Evidence: Surveys from people living at the home said most knew how to complain or that they would tell their families; two surveys from older people said they did not know how to complain. Those that we spoke to during our visit said that if they were unhappy about anything, they would not hesitate to raise any matter at any time and they were sure that it would be dealt with to their satisfaction. Staff surveys confirmed staff knew what to do also, if someone complained. One said that this was covered in new staff induction and in annual updates for staff. Staff we spoke with said if it was something that they were able to sort out themselves then they would, but they would also report complaints to the manager or senior person on duty. They were confident that no issue raised would ever be ignored. The manager had told us there was a rapid response system for addressing complaints, and that the home would always respond, however small a concern is. Staff we spoke with on Alphinbrook were not aware of this new system, but we saw relevant forms freely available on the unit. We saw a Suggestions box in the homes entrance also. Care Homes for Older People Page 27 of 44 Evidence: People we spoke with on Ide told us that staff were very helpful, respectful and that nothing was ever too much trouble for them. We saw during a meal on Shillingford that some people indicated that they did not want to eat their meal. Staff were heard responding to this and offering extras from another course. On Alphinbrook, one person felt staff fitted in with people at the home, rather than people having to fit in with staff. People named Paul Courtney, the manager, when asked about making suggestions or complaints, describing him as approachable; one person, however, added that sometimes they felt their concerns were trivialised. We have not received any complaints about the home since our last inspection, and the AQAA said the home has not received any complaints either. Copies of the Complaints procedure that we saw did not include our current contact details, which Mr Courtney said would be rectified. He told us that all staff have received training in Adult Protection issues. Staff were able to describe differing types of abuse, including rough handling and not attending to peoples continence problems. They were aware of the homes Whistle-blowing policy and that it would support them in reporting bad practice. They felt confident that they would be listened to if they raised any such concerns, saying they would report concerns to senior managers at the home. However, some staff were less clear about outside agencies who could be contacted about safeguarding matters if necessary. The AQAA suggested that the physical intervention policy and safeguarding policy had not been reviewed since 2006. We were shown versions that had been reviewed in 2007. We found they were readily available to staff. We saw that it had been identified in someones pre-admission assessment that they might not be able to use a call bell. The care plan subsequently written said that staff were thus to check on them every half-an-hour. The person confirmed that staff did do this. We saw evidence that others were similarly visited regularly. Staff, when asked about the matter of restraint, said this meant they needed to assess carefully if it was appropriate for someone to have a lap-belt or bedrails, for example. Someone said in their previous care setting they had bedrails, but now did not, having been assessed by staff as not needing them. The person was happy with this situation. Where a care plan stated that someone was to have a lap belt when in their wheelchair, we found this had been decided through multidisciplinary decision-making Care Homes for Older People Page 28 of 44 Evidence: on behalf of the person, with regard for the Mental Capacity Act 2005. Staff said they had had training on the Mental Capacity Act, but had difficulty describing how it related to their work or its practical application. We discussed with the manager that refresher training might be helpful. Care Homes for Older People Page 29 of 44 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. People living here benefit from a homely environment that is designed to meet diverse needs. Timely attention is not always given to aspects of maintenance and renewal, adversely affecting the facilities that some people have. Evidence: Decoration, fittings and fixtures such as furniture, curtains, carpets, pictures, lamps were of a good quality throughout the home. The home has wide corridors, with handrails to enable people to move around the building without staff. Ample space was available for social activities, for those who liked to walk, and for people needing use of a wheelchair. People we spoke with on Alphinbrook felt repairs were dealt with in a timely way; however, a survey from someone on this unit had said maintenance issues could take a long time to be resolved. Maintenance logs on Shillingford showed some matters had been addressed in a timely way, but others had not been (for example, 14 days to replace a headboard, and 3 days for a new lamp). We looked at these logs with Mr Courtney. There was a good supply of disposable protective clothing and hand-washing facilities for staff at the home, to promote good hygiene standards. The laundry also had Care Homes for Older People Page 30 of 44 Evidence: equipment that should reduce the risk of cross-infection, through thorough cleaning of washing. There were two distinct areas, one where staff left soiled laundry and one where clean items were placed, again reducing risk of cross infection. We noted there was much dust behind machines and under worktops, however, which was both a safety and a health hazard. Ide: This had a large lounge, two dining rooms, and a hairdressing room. People living there commented positively on the cleanliness of the home, as observed on the day of our visit. There was one area with an offensive odour but other areas were fresh. Shillingford: Peoples doors to their rooms were personalised to help maintain peoples independence by making their rooms more recognisable. The corridors were attractively decorated with pictures and reminiscence objects, and had various places for people to sit. There was a large communal area with a variety of comfortable chairs and a sofa. The dining room included a kitchen area that staff and a relative told us is used for baking with people living at the home. People were seen using all communal areas of the home, apart from the quiet lounge, which is currently being re-decorated. Staff told us that there are plans for a new piano to be bought for this room to enable the room to be used for music therapy. The garden is secure and not overlooked by neighbouring houses. We met someone who enjoyed being in the fresh air. Staff supported their wish by ensuring they were dressed appropriately and had a rug over them. They told us how much they appreciated the fresh air and the flowers. We were told that there were plans to provide a wheelchair-accessible greenhouse. A relative said that it would be useful to have a sun house, and a person living at the home agreed that an undercover place outside would benefit them. All the rooms we looked in were clean, including bathrooms and communal areas, but throughout the day there was an odour in the unit. The manager told us some carpets were being replaced in two months time. Alphinbrook: Care Homes for Older People Page 31 of 44 Evidence: People we asked were happy with both their own and the shared facilities on the unit. Some bedrooms were very personalised, reflecting peoples varied interests, lives and individuality. Each bedroom had its own shower, which some people particularly appreciated. Adapted baths were also available, made accessible for people with physical disabilities. A survey from a younger adult said they would like a new carpet. On our visit, one person told us their bedroom carpet was new, but we found two stained bedroom carpets (- one in a room that was also very odorous). We showed these to Mr Courtney. People living here confirmed staff followed infection control practices such as using disposable gloves and aprons, and handwashing. We noted staff wore tabbards when serving food, and we saw them washing their hands before moving to another room. They described appropriate practices for handling soiled laundry and use of disposable gloves. Care Homes for Older People Page 32 of 44 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. People living here benefit from a staff group generally employed in sufficient numbers, who are recruited and trained in a way that helps to ensure peoples safety and welfare. Evidence: The great majority of surveys from people living at the home were positive about staff, staffing arrangements and their support. One anonymous staff survey said they felt some colleagues lacked patience and therefore didnt respect the needs and wishes of people. We did not observe such behaviour during our visit, however. We looked at the files for six staff employed since our last inspection. They included application forms, details of past employment and training, evidence of identity, and police checks. All but one had two positive references; this one staff member had only one reference. The manager said he would look into why the second reference wasnt available, confirming two are always sought. Information confirmed the nurse in charge of Shillingford was a Registered Mental Nurse. There was evidence that both nurses whose files we checked were currently registered, enabling them to practice legally as nurses. A staff survey said there was flexible working between units to cover any shortages, if Care Homes for Older People Page 33 of 44 Evidence: other cover could not be found; two surveys indicated this was an unusual occurrence, with shortages not due to poor planning, but due to sickness, etc. The section for Alphinbrook below includes further reference to this matter. The AQAA showed agency staff were used, mostly in the role of care assistants. However, the homes nurses also take the place of care assistants if necessary, rather than employing agency staff to cover a staff shortage. Five staff surveys indicated generally communication was good, staffing levels were usually appropriate, and they received relevant training. Comments included This is the best place Ive worked in for training and courses. Our trainer is good. The training given and available is very robust and easily accessible. The home trainer and general manger are extremely proactive with regard to a diverse range of training, mandatory, clinical and otherwise. Training includes all levels and categories of staff, not just nurses. Obviously occasionally something comes up that you dont know about, but being a large company, there is always someone you can talk to and advice is available on the company intranet. One staff member felt that the homes trainer was mindful of new staff, including staff who were moved to a different unit, so that individuals training needs for their new place of work were followed up. The home has a suite for staff training, which staff we spoke with said they had used. Computer-based learning was available - such as on fire safety, food hygiene, and communication with or support for visitors. One staff survey said new staff induction included all mandatory issues (i.e. health and safety matters), local policy, and supernumerary shifts to familiarize staff with the people living at the home. A new staff member we spoke with told us their induction included learning about person-centred care, and shadowing colleagues. Senior staff confirmed that of 44 care assistants (including bank staff), 14 had the care qualification we recommend (NVQ in Care at Level 2 or Level 3), and 20 had an equivalent qualification. Five staff were undertaking the course currently. The two activities staff also had NVQ Level 3 in Care. Ide: People living there felt there were always or usually enough staff on duty to care for them. The unit can accommodate up to 31 people. We were told that intended staffing levels on the unit were a first level nurse on duty at all times, with 6 other members of staff (both care assistants and nurses) on duty in the mornings, and 6 in total during the afternoons and evenings. An extra person was on duty when the homes GP conducted their weekly round. Care Homes for Older People Page 34 of 44 Evidence: People spoken to during our visit said that staff responded to their needs promptly. We saw most staff responded promptly to peoples needs in a kindly manner. Throughout the day they asked people if they wanted a drink or were comfortable, they reassured people, visited those who wished to stay in their rooms, and engaged people in conversation. However, we noted one member of staff served someone their lunch without speaking to them or even acknowledging them. Shillingford: The unit can accommodate up to 31 people. A relative told us that staffing levels were good. During our visit, there were 3 nurses and 4 care assistants on duty, who appeared to work well as a team. We saw that the majority of the team were skilled in their approach, which they changed depending on the person. The atmosphere in the morning and lunchtime was calm with a friendly atmosphere. In the afternoon, there was an external entertainer, which meant the atmosphere was busier and more lively. Staff had time to sit with people during this event or dance with people who chose to, while other staff were still able to support people who chose not to be involved. We spoke to staff about their training. One member told us that they had attended a two-day course on dementia training approximately two years ago, and that they were due to attend a challenging behaviour refresher training. We saw from their approach that they had translated their training into practice. We saw that most staff were gentle in their approach, ensuring that they maintained eye contact with people and explaining what they were doing if they were supporting people with tasks. One staff member was more task orientated, concentrating in getting things done rather than taking time to interact with people - as they tucked peoples blankets in, for example. This left some people unsettled, or searching for reassurance. Sometimes staff walked away after supporting people with their meal without explaining what they were doing. But generally the staff approach respected people, and support was carried out at the individuals pace rather than at the staffs pace. Alphinbrook: The unit can accommodate up to 13 people. Staff told us there were usually 5 staff in the morning, 4 in the afternoon, and 2 staff from 8pm overnight. One of these was always a nurse. Care Homes for Older People Page 35 of 44 Evidence: One person living on the unit felt staff had no time to chat, conscious that by talking to them they were stopping them from working. Someone felt that when the respite room on the unit was being used, staff were occupied more fully, adversely affecting the persons usual routine; staff we spoke with agreed with this. Asked if their bell was answered quickly enough if they rang it, the person said they organised themselves so as to avoid having to use it, because the response could be slow. When we asked if the relatively low staffing level for evenings affected peoples opportunities to be out or go out later in the day, staff said the activities staff made themselves available to assist people with this if necessary. Care Homes for Older People Page 36 of 44 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. People benefit from living in a home that is well managed and being run in their best interests. This aim would be promoted further by additional staff supervision to ensure people do receive person-centred care. Evidence: Mr Courtney became the homes registered manager in April 2008. He is a Registered General Nurse, who has undertaken an additional course on Elderly Care Nursing for Registered General Nurses. He has the City & Guilds NVQ Assessors award, and the Certificate in Management Studies. He is currently undertaking a leadership course relating to a dementia care initiative that the home intends to follow, and a Diploma in Management Studies. He told us he has, since our last inspection, had updating in medication management and first aid as well as training in the Mental Capacity Act. Someone living on Alphinbrook unit told us they found the manager made himself available to people and was very approachable. They said, The alterations he has Care Homes for Older People Page 37 of 44 Evidence: made have been super. A staff member commented Mr Courtneys door is always open, and he is happy to talk about any problem or give advice if requested. The home had been asked to provide an improvement plan after our last inspection. We saw action had been taken in line with this - for example, some staff told us they had had training on person-centred care planning, we saw meeting of peoples social needs were linked to their interests and personal histories, relevant risk assessments had been carried out with individuals as well as care plan reviews, and mental capacity assessments were being used to inform care planning. Staff told us the manager had sent a letter of thanks to staff, for their help whilst the home was recruiting more staff. Those we spoke with confirmed there were staff meetings for individual units and the whole home, with minutes kept. One person told us there were now daily multidisciplinary meetings, which had significantly increased awareness and communication between departments. During our visit, we observed that some staff supported people well and others - some of whom had more senior roles - had a less person-centred approach (see section on Staffing). All but one survey told us staff often had opportunities for one-to-one supervision, meeting with their manager to discuss their work, and get support; related records were seen in staff files. One survey said they had not had any meeting with the manager, although he came onto the unit to make sure everything was alright. The AQAA confirmed that external managers carry out inspection visits to the home, and stated that other audits are carried out in-house, for quality assurance purposes. On this visit, we found evidence that one such audit (for medication) had not been robust, however. Residents/relatives meetings are used by the home to seek the views of people living there, as well as surveys, which are also sent annually to visiting professionals. We were told that feedback about the quality of life on the unit, staffing, meals, cleanliness and activities is sought from people on Ide on a daily basis, by senior staff. Mr Courtney confirmed that Barchester staff do not act as appointee for anyone living at the home, leaving people free to choose who helped them with their finances. Most people were billed in arrears for any personal expenditure they made. A small number of people had money held in the office on their behalf. There was a dedicated bank account for residents monies, so it was kept separate from the homes affairs. A monthly print-out of individuals computerised accounts was given to them or their Care Homes for Older People Page 38 of 44 Evidence: representative, and we saw receipts were kept in case they wished to see them. We were told an external Barchester business manager had carried out an audit of systems in September 2008. People living at the home confirmed they heard the fire alarms being tested at intervals. The AQAA said individual evacuation plans were available for each person, and we saw these included the support individuals would require in the event of a fire. No immediate hazards were identified during our visit. There was evidence on electrical items we saw in peoples bedrooms that they had been tested for safety in July 2008. This was reflected in the AQAA, which showed certain equipment and facilities had been serviced in the current year. The manager told us that although staff from the Health & Safety Executive had visited the home in May 2008, the home had not received anything in writing from them as a result of the visit. An Environmental Health Officer had visited twice since our last inspection, and all but one of their recommendations had been addressed. Staff we spoke with confirmed they had had updates on various health and safety topics, including fire safety. They felt they had a safe working environment, and were aware of their responsibility to report any hazards. The AQAA showed a majority of care staff had had training in basic food hygiene, and all had had training on infection control. It also stated that all staff were fully trained in fire safety and manual handling, and received regular training on all health and safety matters. Care Homes for Older People Page 39 of 44 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 40 of 44 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 You must have effective systems for determining the correct current stock levels of medication As part of medication administration audits to monitor if people living at the home have had medication as prescribed. 11/03/2009 2 9 13 You must have robust systems for monitoring the shelf-life of medication So that people living at the home are assured that their medication is safe to take and will be effective. 11/03/2009 3 9 13 Staff must sign to say they 11/03/2009 have given any and all prescribed medicines. This includes the application of prescribed creams So that people living at the home are assured that their medicines are handled safely and they will receive the medication they need. Page 41 of 44 Care Homes for Older People Timescale of 31/01/08 not fully met. 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 3 The pre-admission assessment for every prospective resident, and any subsequent care plan, should be sufficiently detailed (including individuals abilities or strengths, etc.), to ensure they receive fully person-centred care and support. All care plans should be updated and actioned in a timely way, to reflect peoples changing needs and ensure they get prompt attention from other healthcare professionals. Guidance in care plans should be reviewed regularly to ensure information is not contradictory. All care plans, related daily care records and reviews should be sufficiently detailed and individualised to reflect peoples differing needs, how their needs are to be met in a personcentred way, and whether those needs are met. It is recommended that you evidence that handwritten directions on medication administration records have been checked by two people for correctness. The home should ensure that everyone has access to activities or meaningful occupation that is specific to their life histories, individual interests or hobbies. People who hold a belief or conviction (whether a faith, a dietary choice, etc.), or who held one when they were better able to choose how they lived their life, should be supported to continue that practice, with relevant guidance for staff in the individuals care plan. Peoples likes and dislikes should be listed, to ensure staff provide person-centred care even when people are unable to express their choices clearly. You should ensure timely attention is given to all repairs and maintenance matters, so that people have the equipment, furnishings or fittings that they need. You should have an effective programme of routine maintenance (including special cleaning if necessary) and 2 7 3 4 7 7 5 9 6 12 7 12 8 14 9 19 10 19 Care Homes for Older People Page 42 of 44 renewal, to ensure that the home is free of lasting unpleasant odours, stained carpets, etc. 11 12 19 27 You should ensure the laundry is kept free of accumulated dust, to remove associated health and safety risks. Staffing levels and routines should be continually reviewed on Alphinbrook - including consideration of the purpose of the unit, the service offered, and the units layout - to ensure they are kept sufficient to meet peoples assessed needs. Staff practice should be observed by a suitable person as part of supervision arrangements, to monitor how staff work with people and provide them with guidance or support where necessary, to ensure a person-centred approach to care. 13 36 Care Homes for Older People Page 43 of 44 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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