Inspection on 30/10/08 for Lumley Court

This inspection was carried out on 30th 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lumley Residential Home Portland House Hall Lane Estate Willington Durham DL15 0PW     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: Andrea Goodall     Date: 3 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 31 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 31 Information about the care home Name of care home: Address: Lumley Residential Home Portland House Hall Lane Estate Willington Durham DL15 0PW 01388747698 01388746219 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Joan Lambert Type of registration: Number of places registered: Southern Cross OPCO Ltd care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care Home only Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Dementia - Code DE, maximum number of places 40 Date of last inspection Brief description of the care home Lumley Court is a purpose built care home that shares a site with several other care facilities. It has been operating for around 16 years. In June 2008 it was registered to Southern Cross OPCO Limited which is a national provider of health and social care services. Lumley Court provides personal care for up to 40 older people with dementia care needs. It does not provide nursing care. The home is a single storey unit which shares the building, reception area, catering and laundry service with an adjoining nursing home. All the bedrooms have private ensuite facilities. The home is easy for Care Homes for Older People Page 4 of 31 Over 65 0 40 Brief description of the care home people to get around as it has one main corridor which is wide enough for wheelchairs. In the centre of the home there is an open plan arrangement of dining and lounge areas. All the baths and showers can be used by people with mobility needs. The home also has a garden area and several parking places. It is near the local village where there are shops, pubs and other amenities. The home has a no smoking policy. Care Homes for Older People Page 5 of 31 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: Before the visit we looked at information we have received since the last visit on 18th December 2006. We looked at how the service dealt with any complaints and concerns since the last visit. We looked at any changes to how the home is run, for example since the last inspection a new provider has bought the home. We made an unannounced visit on 30th October 2008. This is the first inspection of this service since it was purchased by Southern Cross Limited. During the visit we talked with people who use the service, relatives, staff, and health care visitors. We joined residents for a meal and looked at how staff support the people who live here. We looked at information about the people who use the service and how Care Homes for Older People Page 6 of 31 well their needs are met. We looked at other records which must be kept by a care service. We checked that staff had the knowledge, skills and training to meet the needs of the people they care for. We looked around parts of the building to make sure it was clean, safe and comfortable. We told the deputy manager what we found. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: Staff must treat every resident with respect, and support their dignity and privacy at all times. The provider should use training and supervision to make sure that staff act towards residents in the right way that makes them valued. Residents must have ways of making an informed choice about meals and be offered additional helpings to meet their individual preferences. It would be better if medication records included the guidance for staff about when people might need extra sedative medication. Residents should be given serviettes (and protective covering where necessary) at mealtimes. Residents should be supported to change stained clothes after meals. Care Homes for Older People Page 8 of 31 The home should review whether all bedrooms need to be kept locked. The home could consider different mealtime arrangements so that everyone gets enough support. Lighting in bathrooms could be better, and the odour in the main corridor could be improved. There should be an extra senior on duty to help the deputy manager when the manager is away. 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 31 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 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents get good information about the service and are fully assessed before they make a decision about moving here so that they know the home can meet their needs. Evidence: People who are thinking about coming to stay here are given an information pack, called a service users guide. This has been fully updated to show the recent change of provider. It is very good practice that the information pack is also available on cassette for people who find it difficult to read. It is good that there is also a promotional DVD that gives some information about Southern Cross and shows the sort of service people might expect from this home. In this way people have very good information about the home while they are making a decision. It was clear from discussions with visiting relatives that they had the chance to look Care Homes for Older People Page 11 of 31 Evidence: around the home before making a decision. One relative said, It was the best one I saw when I was looking. There was good evidence in residents care records to show that this home carries out comprehensive assessments of all prospective residents to ensure that the home can provide the right care that they need. The assessment includes mental health and dementia care needs as this is the primary care service that the home offers.The deputy manager was able to describe occasions where people were reassessed if their health care needs changed, and they were offered alternative placements at one of the nursing homes on the same site. It is good practice that the assessment forms include details of peoples spiritual and cultural needs. The home also uses social care assessments to get information about each persons individual preferences, hobbies, and interests. Care Homes for Older People Page 12 of 31 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 residents have satisfactory support with their care needs, they are not always treated in a way that upholds their dignity. Evidence: Care plans are records that are used by all care services to show what sort of help each person needs and how staff will provide that care. For example how to help people with their mobility, diet, and dementia care needs. The care plans at Lumley Court have good information to guide staff in how to support each person with their individual needs.The care plans are sufficiently detailed, easy to follow, and are kept up to date on a monthly basis. The care records also show that peoples health care needs are assessed and regularly checked. The home has clear assessment records of peoples mobility, nutrition, risk of falling, and risk of skin pressure. These are reviewed every month to check any changes. Lumley Court does not provide nursing care so the home supports people to access community health care services such as GPs, district nursing services, and Care Homes for Older People Page 13 of 31 Evidence: psychiatry services. A visiting health care professional said, The home makes appropriate referrals where needed. They also felt that care records had improved since the new provider took over. Senior care staff take responsibility for managing medication. Medication is stored securely and safely, and records of the administration of medication were up to date. It is good practice that where a medication is given covertly there is documented agreement of the pharmacist involved, and that there is clear guidance for staff about this. Some people are prescribed anti-anxiety and sedative drugs that are to be given as and when required. However at this time there is no guidance for staff about how to decide when these should be given to an individual person. The inspector was very concerned by the attitude of staff, especially towards one resident. When the resident was leaving the dining room a staff had twisted the waistband of their pyjama trousers round and was pulling the person along the corridor by this. This persons care plan clearly states that they need assistance with dressing, but the staff cannot then have supported the person to change because even later into the morning the resident still had pyjamas on when walking along the main corridor. The pyjamas were clearly the wrong size for them and were very loose fitting so would not stay up. At times the resident lost grip of the pyjama bottoms which fell down leaving the person in a semi-naked state in the main corridor in front of visitors and other residents. Rather than support the person to change into appropriate clothing, several staff raised their voices at the person and chastised them for their dilemma in front of other people. One staff even told another elderly resident to help her pull her pyjamas up from the floor, which placed both residents at risk to their safety and to their dignity. This is an unacceptable attitude for staff to have towards vulnerable people who have high dependency needs. One health care professional said, The staff do their best but their approach can be a bit brusque. It must be a very frustrating job but their attitude can be non-valuing towards residents. At the end of this visit in the early evening at least one person still had a stained top on from breakfast and badly stained trousers on since lunchtime. They had not been sufficiently supported at those mealtimes to protect their clothes, but had also not been supported to change their clothes. During the lunchtime meal several residents used their sleeves or other parts of their clothing to wipe spillages, as they had not been provided with serviettes. Care Homes for Older People Page 14 of 31 Evidence: One relative said, They are very nice with her, but sometimes I see her sitting with stained clothes on and none of her own clothes in her wardrobe. Several ladies would benefit from assistance to remove facial hair to support their dignity. Care Homes for Older People Page 15 of 31 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. People do not have good opportunities to make choices so they do not lead a lifestyle that supports their individual preferences. Evidence: The home benefits from an activities co-ordinator who organises daily activities and social events for the people who live here. These include reminiscence sessions, dominoes, skittles, hand massages, and pamper sessions. An organist is a regular entertainer at the home. Some residents also talked about occasional walks out and trips out on a minibus. At the time of this visit some people from the three homes on this site were attending a religious service in a room in the foyer, one person was going out for lunch with a relative, and some people were having their hair done by the visiting hairdresser. Most people spent the day sitting in the central lounge/dining area or walking up and down the corridors. It was clear that care staff had little time to spend with residents other than in essential tasks such as washing, toileting, and mealtimes. The home shares the site with two other care homes and a day centre. It is close to Care Homes for Older People Page 16 of 31 Evidence: the centre of a local village and a some people talked about going for occasional walks there. Some people have also visited a nearby working mens club. Religious services are held at the main reception area home by various denominations, and occasionally school children perform events at the home. In this way the home offers residents some opportunities for continued contact with the local community. There are limitations to residents opportunities to make their own choices and decisions. For example only a small number of people have keys for their bedroom, but bedroom doors are kept locked. This means that most people have little or no choice about using their own rooms for privacy (unless they have the ability and communication skills to ask staff.) Some people express a desire to leave the building but the exit door is fitted with a keypad lock to prevent people from going out. At this time there are no assessments of peoples capacity to make their own decisions about whether they are restricted in this way. People are verbally asked for their main lunchtime meal choices the day before. Given that all the residents have dementia care needs it is likely that most people would have forgotten their choice by the next day. It was stated that people are asked just to give the cook an idea of the quantities but that people can change their mind at the table if they prefer the alternative dish. Several people are provided with a softened diet, which has to be specially prepared, so it unlikely that they have the chance to change their minds. It is good practice that each of the foods, including the meat, is individually softened and presented in the same way as the regular meals so that it is more identifiable for residents. Meals are transported to the large dining area in a hotlock trolley by a cook. The care staff and activities co-ordinator then serve each resident. Several people need assistance at mealtimes, from full physical support to verbal prompts. Care staff did spend time sitting next to individual residents providing full physical support with their meals. This was generally carried out in a sensitive manner and at the residents own pace. However there was little time for staff to provide verbal prompts to other people so this was done quickly when passing by a table, and as a consequence was not always successful. Throughout the meal one resident was very agitated and made continuous loud cries, even when being supported to eat their meal. It was evident that several people found this distressing and were put off their food. This not only meant that they unable to enjoy the mealtime experience, but also that their dietary intake was reduced and this could affect their health. The quality of the meal was good. However there was no choice of dessert, and staff Care Homes for Older People Page 17 of 31 Evidence: stated that there is only one dessert offered at each main meal. During this mealtime no-one was offered second helpings. One very tall resident ate all their meal and dessert, and when passing another table reached down to pick up more food. The resident was loudly told off by staff for pinching and was led away to an armchair. All resident have dementia care needs and this significantly affects their communication skills. It is possible that the resident was actually showing a desire for more food and might have enjoyed a second helping of a dessert. Care Homes for Older People Page 18 of 31 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. Residents and their representatives have clear information so they would know how to make a complaint. The staff team have had suitable training so they should know how to protect residents from abuse. Evidence: People have good information about what to do if they are not happy with the service. People or their relatives are provided with an information pack that includes details of how to make a complaint. There is also a copy of the complaints procedure on display in the hallway where visitor sign in. Residents and their relatives also have opportunities to discuss concerns at the Residents Meetings or individually with the manager. The homes complaints records show that there have been no formal complaints received about the service. It is good practice that there is a record of informal comments and concerns, e.g. missing laundry, as it demonstrates the home has listened and acted on these matters. All staff have previously had training in protection of vulnerable adults. Most staff have also had updated training in safeguarding adults protocols, and arrangement have been made for the manager to receive training in the management of safeguarding adults alerts. Care Homes for Older People Page 19 of 31 Evidence: The home is contracted to follow the Durham local authority Safeguarding Adults procedures. At the time of this inspection a copy of the procedures was not available in the home for reference, but this was to be sent to the home in the near future. Care Homes for Older People Page 20 of 31 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. Overall the home provides safe, well maintained accommodation for the people who live here. Evidence: Lumley Court is a purpose built care home that has been operating for 16 years. There is level access into a reception area at the front which it shares with its sister home within the same building. Lumley Court is a single storey unit that provides 40 places along one main corridor. In the centre of the unit there is an open plan arrangement of a large lounge/dining room and two annex lounges. Overall the home is well maintained and decorated. The home benefits from the input of maintenance staff who carry out routine checks and repairs. All the bedrooms have ensuite facilities. The rooms that were viewed were comfortable, well decorated and maintained. Another visitor described the home as clean, modern and comfortable. At this time the bedroom doors have names, numbers and some doors have photographs of the person, to help people find their room. Otherwise there are few visual clues for people, e.g. all doors including cupboards are the same colour and there are no directions from one end of the long corridor to the other. However the Care Homes for Older People Page 21 of 31 Evidence: new provider, Southern Cross, has plans to improve the environmental orientation for people with dementia. For example the home is looking to introduce memory boxes for each persons room that will be significantly familiar to that person. There are sufficient bathrooms for the number of people, all of which are equipped with specialist baths to support people who may also have significant mobility needs. One resident said that she did not mind using the specialist bath even though she could manage a standard bath like she had at home. There is also a shower room but the shower was awaiting repairs to a leak on this day. The lighting to two bathrooms was very dim at the time of this visit so it would be difficult for some people to see their way around the room. Overall the home was clean and it is clear that domestic staff work hard to keep all areas of the home clean, particularly bedrooms. One relative said, Shes got a nice room. Its warm and kept clean. It is good that domestic staff were able to describe an in-depth training course that they had completed in infection control. Despite the hard work of staff there are small pockets of odour within the home, mainly at the entrance into the main corridor and around the two main bathrooms. Air-fresheners have been fitted in these areas but these are not fully resolving the odour problem at this time. The laundry service is shared by both homes within this building. In this way up to 100 peoples clothes are managed by the laundry service, which may account for some relatives comments about missing laundry and lost clothing. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides suitable, trained staff to meet residents primary care needs. Evidence: The staff team consists of the manager, a deputy manager, five senior care staff, 16 care assistants, an activities co-ordinator, an administrator and four domestic staff. There are also a team of laundry staff and a team of catering staff who cover both Lumley Court and its sister home within the same building, Brancepeth Court. At the time of this visit there were 32 people accommodated in the home (one of whom was staying here for a short break). The daytime staffing level is 5 care staff (this includes one senior or the deputy manager). Staff stated that care staffing levels have reduced by one care staff throughout the day since the new provider took over. It was clear that many of the people living here have a high level of dependency due to their dementia care needs and they need a lot of support with all aspects of their personal care. Staff time with residents was spent in physical tasks as washing, dressing, toileting, serving meals and clearing up. As a result there was little time for care staff to spend on supporting the social or emotional care of the people who live here. There are three care staff on night time duty (including one senior staff). There are Care Homes for Older People Page 23 of 31 Evidence: sufficient domestic and catering staff to provide a satisfactory service to the people who live here. This was evident from the cleanliness of the home and the catering service. The home has enjoyed a low turnover of staff over the last year. One staff retired and two others have transfered to other care homes within the Southern Cross organisation. There have been two new appointments. Southern Cross is an equal opportunities employer and has robust recruitment and selection procedures to make sure that only suitable staff are employed. It was clear from personnel records that no staff starts work until satisfactory checks, references and police clearance (called a CRB disclosure) have been received. Records of staff training show that around 17 of the 22 care staff have attained a qualification in care (called NVQ level 2). Around two-thirds of the staff team have had training in understanding dementia care needs. This is essential training for staff as all of the residents come to live here because they have dementia care needs. It was stated that Southern Cross is also planning to provide more training for staff in this area. Staff also commented that they have requested training in how to manage challenging behaviour as around 10 residents need support in this area. It was evident that staff receive training in mandatory health and safety matters including fires safety, food hygiene and first aid. It is good practice that the deputy manager is a moving and assisting trainer so she is able to provide in-house training to any staff as and when they require it. In discussions staff said that they have very good opportunities for training. Care Homes for Older People Page 24 of 31 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. Overall the home is well run so that the safety and welfare of residents is supported. Evidence: The registered manager has several years experience at a senior level in care services for older people. She has attained a care qualification (called NVQ level 3) and the Registered Managers Award, and is working towards a management qualification (NVQ level 4). These are suitable qualification for the manager of a care service. The manager is supported and supervised in the management of the home by an Operations Manager of Southern Cross. The staffing structure of the home includes a deputy manager and senior carers who are responsible for supervising the care of residents. In this way there are clear lines of accountability within the organisation and the home. At the time of this inspection the manager was on planned leave. The deputy manager Care Homes for Older People Page 25 of 31 Evidence: was acting as manager but there were no additional staff rostered to replace her role. In this way she was responsible for the many administrative and managerial tasks involved in a care service, and so was unable to also supervise the delivery of care to the residents. Southern Cross quality assurance processes include a number of audits of the home and at least monthly visits by a representative of the organisation to check on its operations and progress. The home also seeks the views of the residents and their relatives. There are Residents Meetings every couple of months where residents and their families are invited to comment on the service. People also have opportunities to discuss the service with the manager during their visits. If requested the home will support residents to keep their personal monies safely. Their monies are keep in a group bank account. Using computerised statements, the home can then debit their account for services and purchases, such as hairdressing, chiropody and toiletries. Receipts are kept for each transaction. Any interest accrued is proportionately paid to each resident who uses the bank account. An amount of cash is securely stored in the home so that any resident who wants to withdraw money for trips out can do so. This system also provides clear printed statements for residents or their representatives. Staff are well trained in health & safety matters, for example there were clear records of recent fire drills and fire safety training. The maintenance staff carry out and record routine health & safety checks of the building and equipment, for example water temperatures and fire alarm systems. These were in good order and up to date. There were no health & safety issues noted during this inspection. Care Homes for Older People Page 26 of 31 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 27 of 31 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 10 12 The Provider must ensure, 01/01/2009 by the training and supervision of staff, that each resident is supported in an acceptable manner that upholds their dignity. This is to ensure that staff treat every resident with respect, and support their dignity and privacy at all times. 2 15 16 Residents must be 01/01/2009 supported to make an informed choice about meals and be provided with sufficient foods to meet their individual preferences, for example offered second helpings. Staff must not chastise residents who show a desire for more food. This is to ensure that residents receive support that values their individuality and respects their needs. Care Homes for Older People Page 28 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 There should be written guidance for staff about when and why to support a resident with when required anti-anxiety and sedative medication so that all staff can be clear and consistent in this. A copy of that guidance should be kept with the persons MARs records. Residents should be provided with serviettes (and protective covering where necessary) at mealtimes. Residents should be supported to change stained clothes after meals. The reason for locking all bedroom doors should be reviewed as it actively discourages and prevents people from choosing to use their own room for privacy. The home should now be developing assessments about peoples capacity to make their own decisions, for example why they are restricted from leaving the unit. Consideration should be given to ensuring that residents enjoy a relaxed, enjoyable mealtime experience, whilst still meeting the individual needs of each resident. This might be achieved by separate sittings or individual dining arrangements for those with the greatest support needs. The deputy manager should also have training in how to manage safeguarding adults alerts so that she is familiar with the procedures in the absence of the manager. The new provider should continue with plans to develop environmental orientation for the people who live here so they have visual clues around the home. The lighting to the bathrooms should be upgraded so that it does not present a tripping hazard for the people who live here. Greater attention is needed to odour control at the entrance to the unit. The provider should review the staffing levels to ensure that residents receive a service that supports their social and emotional needs, not just their physical needs. Plans to provide more training for staff in dementia care needs should continue so that staff understand the needs of the people who live here. Page 29 of 31 2 10 3 14 4 14 5 15 6 18 7 22 8 25 9 10 26 28 11 30 Care Homes for Older People Also staff should be provided with training in managing challenging behaviour so that they are sufficiently equipped to support people with behavioural needs. 12 31 When the deputy manager is acting as the manager (during planned leave) there should be additional senior staff on duty to cover the deputy managers role. Care Homes for Older People Page 30 of 31 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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!