Inspection on 05/09/08 for Marwa Nursing Home

This inspection was carried out on 5th September 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 05/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Marwa Nursing Home 27/29 Manor Road Aldershot Hampshire GU11 3DG     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: Christine Bowman     Date: 0 5 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (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 29 Information about the care home Name of care home: Address: Marwa Nursing Home 27/29 Manor Road Aldershot Hampshire GU11 3DG 01252 322980 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Dania Care Homes Ltd Mrs Ethel B Carnay care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 28. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP). 0 0 Over 65 0 0 Date of last inspection Brief description of the care home Marwa Nursing Home is siuated on a quiet residential street on the outskirts of Aldershot and provides accommodation and personal care to persons over the age of sixty five including those over sixty -five with dementia. There are sixteen single ans six shared bedrooms situated over two floors. Communal space includes a lounge and adjoining conservatory andthere is an enclosed garden, which is accessible to the residents. Care Homes for Older People Page 4 of 29 Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection report includes information gathered about the service since it was reregistered as a Limited Company in September 2007 under the Commissions Inspecting for Better Lives (ILB) process. The registered manager completed an Annual Quality Assurance Assessment (AQAA) giving up-to-date factual evidence about the running of the home and informing us of what they think they are doing well, how they have improved the service and of their plans for further improvements. Residents completed six service user surveys, either independently or with support from relatives, giving their views on the running of the home. Five staff surveys were also returned, giving their views on the care and support given to the residents, how they are supported by the management to meet the residents needs and on the running of the home. An unannounced site visit was conducted on 5th September 2008, to assess Care Homes for Older People Page 6 of 29 the outcomes of the key inspection standards for older people with respect to the residents living at the home. The registered manager, Mrs Ethel Carney was interviewed and provided support for the inspection process by making files and documents available to be sampled. A partial tour of the premises was undertaken and some of the residents’ bedrooms and communal areas were viewed. A number of staff and residents were spoken with throughout the day and observations were made of the residents and of staff as they carried out their duties. Residents’ and staff records, maintenance certificates and complaints and compliments records were sampled and the Statement of Purpose, the Service User Guide and policies and procedures were viewed. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line – 0870 240 7535. Care Homes for Older People Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are supplied with all the information they need to make an informed decision about moving into the home. The home ensures that prospective residents individual needs and aspirations are assessed and that a plan of care is made to show how their needs will be met. Evidence: Information about the home is made available to prospective residents and their representatives in the form of a Welcome Pack to enable an informed choice to be made about the suitability of the home to meet their needs and expectations. The Statement of Purpose included in the list of aims and objectives, that it intends to deliver the service, in a non-discriminatory fashion and will ensure the individuals needs and values are respected in matters of religion, culture, race or ethnic origin, Care Homes for Older People Page 10 of 29 sexuality and sexual orientation, political afiliation, marital status, parenthood and disabilities or impairments. The AQAA recorded that the pre-admission assessment is conducted to ensure the home is able to meet the needs of the prospective resident and that the neccessary nursing equipment such as the correct hoist, pressure relieving equipment and specialist bath is in place to enable the staff to provide appropriate care. The assessment documentation of two residents sampled contained a detailed social history, medical history, physical, social, psychological and communication needs and interests to inform the carers and to enable a detailed care plan to be drawn up. Information with respect to equality and diversity was recorded including ethnicity, religious, cultural, sexuality and dietary needs to enable the home to respond appropriately to the individual. The manager stated that, day trial visits are encouraged to make sure the prospective resident feels comfortable that the home is the right place for them. The full assessment of need is carried out by a registered nurse on admission and the resident is encouraged to have as much input into the process as they are able. The AQAA recorded that some of the forms have been reviewed to promote the understanding of nursing terms by the carers and the residents. Five of the six residents who either completed surveys independently or with support from relatives, confirmed that they were given enough information about the home before they moved in so they could decide if it was the right place for them. One resident commented, when I visited, I liked the bedroom and felt the home was friendly and happy. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents care plans contain instructions to the staff on how to meet their personal, health and social care needs. Safe arrangements are in place for dealing with medication to protect the residents and the staff. Efforts are made to ensure the residents rights to privacy and dignity are respected, but the limitations of the premises do not fully promote this. Evidence: Since the previous site visit, some residents care plans had been reviewed by care management and concerns had been raised about the lack of detail in the care planning with respect to health input. Consequently improvements had been made to the structure and organisation of the the care plans and a section had been added to enable healthcare professionals to write a summary of the visit and to record communications with the client. Daily logs are now being completed and care plans updated as changes occur so that those who carry out the caring role are better Care Homes for Older People Page 12 of 29 informed. The care plans of two residents sampled recorded aims and objectives with respect to the residents health and personal care needs. The actions to be completed by the staff were clearly recorded and included the personal requirements of the individual. Care plans were reviewed on a monthly basis and up-dated accordingly. One resident had returned from hospital with pressures sores. Photographs had been taken, body maps completed, a full description of the wound with a record of treatment, dressings and outcome had been retained on the file. The home provided special matresses to prevent the development of pressure ulcers and to promote tissue viability. Nutritional assessments had been undertaken and monthly weights recorded. The manager stated that fluctuations in weight were reported to the GP so that appropriate action could be taken to prevent malnuitrition or dehydration. Regularly, throughout the day of the site visit, drinks were offered to residents. Residents remained with their own General Practitioner where the home was in the same catchment area as the residents previous home, the manager wrote in the AQAA. Records confirmed that residents were visited by healthcare professionals in addition to the GP. Chiropodists, district nurses, community psychiatric nurses, physiotherapists and occuaptional therapists visited when required and the AQAA confirmed access to dental and optical resources in the community. 100 of the residents who completed surveys independently or with support from their relatives, confirmed they always received the care and support, including medical support, they need. Comments included, the manager and the nurses are helpful and caring nothing seems too much trouble, and there are nurses here all the time. They are nice and polite and look after me well. The doctor comes if I need him. A requirement had been made at the previous site visit that all medication must be administered from original labelled containers and not placed in secondary containers, and later administered by another person. Records of any alterations to the dosage of medication must be verified by the residents GP and a record of any alterations must be kept. Residents medication administration records, sampled had been completed appropriately and all medication was stored in original containers. The manager stated that she currently audits the medication regularly and also does spot checks to ensure that any discrepencies would be picked up immediately to safeguard the residents. The medication policy had been signed off by a pharmacist and only registered nurses, who had received medication training administered the medication. Throughout the day of the site visit, the staff were observed interacting with the residents in a respectful and polite manner. The staff showed patience, care and Care Homes for Older People Page 13 of 29 understanding when responding to the residents. The manager stated and provided documentation to show that she was in the process of introducing the Skills for Care Common Induction Standards, which provide an introduction to new staff to the caring role and promote the residents rights to be treated as an individual and to have their equality and diversity needs respected. Some of the residents were accommodated in shared bedrooms, which had been fitted with curtains to provide a certain amount of privacy. However, some curtains were missing and no curtains were provided around the shared washing facilities in two of the bedrooms viewed. When the curtain was pulled across in one of the bedrooms, there was no source of light for other resident. Private conversations with healthcare professionals or relatives, friends or representatives could not be carried out confidentially in such circumstances. The manager stated that when the new build is complete, the double bedrooms would be used primarily for couples and also that care management was happy for confused residents to share bedrooms as it was comforting to have company. There was also no other private space provided in the home for those residents, who share bedrooms, to meet relatives or healthcare professionals in private. The manager pointed out that an area located in the corridor leading to the new wing had been provided with a table and chairs and could be used to provide a certain amount of privacy for entertaining visitors. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy a wide range of organised activities and receive a balanced diet. Social and recreational activities could be more person-centred to meet individuals needs, to promote choice and empowerment and provide more more access to the community. Evidence: The home had a cheerful and enthusiatic activities co-ordinator, who spoke about her work with pleasure. She had been a carer prior to taking on the role and therefore understood the wishes and needs of the current residents very well. She had also achieved a National Vocational Qualification at level three and had completed courses on catering and activities for people with dementia. The activities schedule was posted on notice boards throughout the home and included hand massage, bingo, current topics and newspapers, hairdressing, bread-making, reminiscing, old time music, memory jog quiz, sing-a-long, skittles and board games, reading books and magazines, sherry and chat, relaxing music, dominoes, movie time and catch and throw. The activities were interdispersed with tea and biscuits and lunch. Care Homes for Older People Page 15 of 29 The activities co-ordinator stated that, although at present there is no allocated activities room, plans for the new build include a reminiscence room, a treatment room and a beauty salon as well as an improved sitting room and smaller quiet room for the enjoyment of the residents. Relatives were encouraged to take residents out, but for those without relatives, no transport was available currently and the home was not located on a bus route. However, the operations manager stated that the provider was considering the possibility of allocating transport to the home to enable the residents to access the community. Currently, residents who require transport have to call a taxi. Three of the six residents who completed surveys confirmed there were always activities arranged at the home which they can take part in and one resident commented, I join in everything, I like to sing and play bingo and we are all happy and laughing. Another resident wrote, Sometimes there are activites arranged at the home and when we all join in it makes a nice, pleasant atmosphere for all. A four-week menu was posted on notice boards in the home to inform the residents of the daily choices available. On the day of the site visit, fish, chips and mushy peas was served and ham salad was offered as an alternative choice. Residents asked if they were consulted about the menu stated that it didnt change, but in the completed surveys they had written, the meals are very nice and very presentable and there is plenty of food, I eat everything and look forward to the meals. Care Homes for Older People Page 16 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents know how to complain and are confident they will be listened to, taken seriously and that their concerns will be acted upon. The home protects its residents from abuse by raising staff awareness and by taking appropriate action to safeguard them. Evidence: The homes complaints procedure was displayed throughout the home and also contained in the reviewed Service User Guide to inform the residents and their representatives. Up-to-date information for contacting the CSCI was included should anyone wish to do so. The procedure for dealing with formal complaints informed complainants that, we attempt to respond within seven days. This timescale is too long to leave the acknowledgment of a complaint and too short to ensure investigations can be carried out and an outcomes reached. Complainants had not been given a definite date by which they could expect to be informed of the outcome of a formal investigation. The AQAA recorded that nine complaints had been received over the previous twelve months and that all had been resolved within twenty eight days. The CSCI had recieved no complaints on behalf of this service. Complaints and compliments had been recorded and a sample confirmed that they had been responded to appropriately. The six residents, who completed surveys, confirmed they Care Homes for Older People Page 17 of 29 knew how to make a complaint and knew who to speak to if they were not happy. A copy of the local authority safeguarding adults policy and procedure had been obtained and was available to inform the staff of the action to take, should they become aware of a situation with respect to a resident, which could consitute abuse or neglect. The homes 2008 training programme confirmed regular slots for safeguarding adults training but the staff training matrix indicated that many staff had not been updated. Previous and planned training dates had not been recorded. Two staff, whose development and training logs were sampled, had both received this training in 2007, but the training matrix confirmed one had and the other hadnt. The manager stated that she had completed The Mental Capacity Act train the trainer course to enable her to hand this training on to the staff team and that she also intended to access the local authority Safeguarding Adults training. There had been one safeguarding referral over the previous year, which had prompted the local authority to undertake client reviews. As a result of these reviews, action plans had been completed and improvements made with respect to care planning, record keeping and training to ensure better outcomes for residents. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a home, which is clean and free from unpleasant odours, and plans are in place to improve the design and layout of the home for their comfort and enjoyment. Evidence: The home was located in a quiet residential street on the outskirts of Aldershot and there was nothing to distinguish it from the other large detached houses on the street. There was car parking to the front of the property. Prior to the re-registration of the home as a limited company, the CSCI had been informed that planning permission had been applied for to extend part of the building to provide more communal lounge and dining space and to provide additional bedrooms. The manager stated that the original plans had not been accepted because the council felt they consitituted overdevelopment of the site and that light would be restricted to some parts of the home. Another architect had been commissioned, the manager stated, and new plans had been approved, allowing building work to commence early in the new year. A tour of the premises was undertaken and all the communal rooms, and some of the residents bedrooms were viewed. The communal accommodation comprised of a lounge in which the residents were sitting in easy chairs around the walls facing the Care Homes for Older People Page 19 of 29 centre of the room. The furniture was shabby and the room felt cramped, but efforts had been made to create a homely feel by adding pleasant domestic lighting and framed pictures. A small conservatory was attached, containing more easy chairs against the wall and a dining area. Another dining table was located in the wide corridor leading to the new wing, which was also referred to, by the manger as, the visitors room. The dining furniture was of poor quality and there were insufficient spaces around the tables to accommodate all the residents should they wish to dine there. The space set aside for residents to meet with visitors was not private as it was located in a corridor and this meant that the residents in shared bedrooms had no private space, where they could speak confidentially with visitors. New building plans showed, that the new dining area would be located where the present lounge areas is currently, and that the conservatory would be extended and a second quiet sitting area provided. Other improvements planned for the comfort and enjoyment of the residents were separate treatment, reminiscence and beauty rooms in addition to an extension of the kitchen facilities and additional bedrooms. The two shared bedrooms viewed were large and curtains divided the spaces to afford the residents some privacy. In one of the bedrooms, one of the residents was afforded no natural light from the window when the curtain was drawn across the bedroom. Curtains were missing from around the washing areas, the furniture was of poor quality and the soft furnishings were lacking in any kind of colour co-ordination. The conflicting patterns on some of the soft furnishings would not have a calming effect on residents with dementia. One of the bedroom doors did not have an automatic closing mechanism to ensure the fire door would give some protection to the residents, should a fire break out. The manager stated that the maintainance person would attend to this as a matter of urgency. Other doors had been fitted with door guards to enable them to be left open safely. The manager also stated that maintainance was carried out as required, but that the older part of the home would be completely refurbished when the new plans were put into operation. Two of the single bedrooms viewed had been personalised and the residents had private washing facilities and the bedroom in the new wing was comfortably furnished, colour co-ordinated and had en-suite facilities for the convenience of the resident. Furnishings, although obviously recently purchased, were not solid or of high quality. The home was clean and free from unpleasant odours on the day of the site visit. Five of the six residents, who completed surveys, confirmed that the home was always fresh and clean and one thought that it usually was. One resident commented, it always smells nice. Infection control training was included in the training programme and the staff, whose training records were sampled, had received this training. The Care Homes for Older People Page 20 of 29 manager wrote in the AQAA that her intention was to introduce the Department of Health Essential Steps with respect to infection control and to ensure that all staff attend this training. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents needs are met by a caring staff team, who access a variety of training courses, to support them and they are protected by the home’s recruitment procedures. The availability of more staff at busy times would promote a more individual approach to meeting the residents needs. Evidence: The AQAA confirmed that there were four carers on duty from 8.00am to 8.00pm and two overnight. The manager stated that there was a registered nurse on duty at all times, that an administrator was employed and that an activities organiser provided stimulation and encouraged socialisation for the residents. In addition, the home provided staff for catering, laundry, housekeeping and maintainance. 100 of the residents, who completed surveys, confirmed that the staff listen and act on what they say and that the staff were always available when they needed them. Comments included, they are all very nice and patient with me, I feel comfortable with them and they do what I ask, and the staff are always willing to help you when you ask them and I cannot praise them enough, they are very good indeed. Residents spoken with on the day of the site visit stated they didnt go out because there were not sufficient Care Homes for Older People Page 22 of 29 staff on duty to accompany them. One resident said they had been out for a meal in town, but had to pay for the taxi and for the staff time. When the manager was asked about this, she stated that the time had not been allowed for and another staff member had to be brought in, but the resident did not have to pay for the staff time. Residents also stated that, tea is early, 5.00 pm because the staff have to start putting them (referring to the people with more advanced dementia) to bed at 6.00 pm to get everything finished in time. Records confrimed that at least 50 of the care staff had achieved a National Vocational Qualification (NVQ) at level 2 and that three stff were working towards the qualification at level 2 or 3. The manager wrote in the AQAA that, most of the carers have a nursing degree equivalent to higher education. Staff personnel files sampled confirmed that recruitment had been carried out prior to the offer of a post and full employment histories, with gaps explained and reasons for leaving former employment had been completed, to ensure only those suitable to work with vulnerable people would be considered for employment, to safeguard the residents. A programme of staff training and development was in place and the manager was in the process of introducing the Skills for Care Common Induction Standards, which emphasise the residents rights to be treated with dignity and respect and to be treated as an individual and have their needs with respect to equality and diversity met. 50 of the staff, who completed surveys thought their induction covered everything they needed to know about the job when they stated but the other 50 stated it mostly or partly did. One staff member wrote, new care staff need to spend more time on induction with trained staff and have more basic training in lifting and handling and infection control, but the constraints of staffing does not always make this possible. The staff training and development files sampled showed that the homes own induction training had been signed off as completed. The staff-training matrix confirmed that mandatory training, including manual handling, fire training, food hygiene, health and safety and infection control had been accessed by the majority of staff. Dementia, medication administration and adult protection were also included on this list. Other more specialist training such as Understanding and Managing Cognitive impairment, Difficult Disturbing and Dangerous Behaviour, Managing Challenging Behaviour in Older Adults with Dementia, Dietary Requirements for People with Dementia and Assertiveness for Managers were included in the training calendar for specific staff to attend to support the staff with respect to the needs of the residents. Nursing staff, whose files were sampled, had accessed clinical training to support their Care Homes for Older People Page 23 of 29 professional development, including wound management, the management of dysphasia, nutrition and the older adults and medicine administration. Four of the five staff, who completed surveys confirmed they were given training which was relevant to their role, helped them to understand the individual needs of the residents with respect to equality and diversity and keeps them up-to-date with new ways of working. A staff member commented, we have very good care staff and registered nurses, who are very good with our residents. They are very caring and help each other especially when there are shift changes. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a well managed home, in which their opinions are sought and which has effective systems are in place to promote their health, safety and welfare. Evidence: The registered manager, who was a Registered General Nurse, holds a nursing degree and a degree in education and has many years of nursing experience. She had recently returned from planned leave and had completed all the work for the Registered Managers Award. However, the organisation responsible for verifying the work had gone into receivership, so she was in the process of seeking an alternative. Care Homes for Older People Page 25 of 29 She stated that a deputy manager had recently been appointed to support her, who was also a trainer and had experience of Mental Health practise. Recent investment in IT equipment also facilitated learning for the manager and the staff. A staff member commented on the homes management, I think line management could do better rewarding staff with positive praise and for good tasks well done as they are under pressure to complete duties. Systems were in place to ensure the views of the residents, their relatives and representatives contributed to the running of the home. Quality assurance questionnaires had been completed and the results confirmed satisfaction with the standard of care at the home and there were many positive comments including, I have always found the staff to be caring and helpful, I couldnt ask for better care for my mum, and the staff are always friendly and polite and the manager and the staff nurses make you feel welcome when you visit. Letters in the compliments file included, thank you for the professional care and attention that you and your staff give to the residents at Marwa Nursing Home and especially to my dear wife. There is always a pleasant and caring feeling in the home when I visit. The AQAA recorded that the home do not hold bank accounts for residents, and the manager stated that small amounts of cash held in safekeeping for the residents are well-documented. The health, safety and welfare of the residents was promoted by regular staff training in moving and handling, fire safety, first aid, food hygiene and infection control. Certificates were viewed on a sample of staff personnel files to confirm this. The AQAA recorded that policies with respect to health and safety were in place and that equipment had been serviced or tested as recommended by the manufacturer or other regulatory body in a timely way to protect the residents and the staff. A sample of certificates seen on the day of the site visit confirmed this. Accidents had been recorded appropriately with records kept of actions taken to reduce risks. One staff member thought that the management were good at ensuring training updates in particular with respect to individual client needs and that the home had a friendly and caring atmosphere. A resident wrote in the survey they completed, My family and I are very happy with the very caring staff. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 10 10 Suitable arrangements should be made to enable residents to meet with their relatives, representatives and health professionals in private accommodation which is separate from their bedroom. This is particularly necessary for those residents who share bedrooms as confidential issues cannot be discussed in private. A more individual approach to providing social and recreational activities including more opportunities for community access would empower residents and meet their needs in a more person-centred way. The complaints procedure should be reviewed to include a realistic timescale to report investigation findings back to the complainant. The proposed plans for the improvement of the physical design and layout of the home and the complete refurbishment of the bedrooms in the older part of the building should be carried out promptly so that residents can enjoy and benefit from an environment which meets their needs in a comfortable and appropriate way. Additional staff should be available at busy times to promote a more individual approach to meeting residents needs, including their recreational needs in order to enhance their lives and empower them. Page 28 of 29 11 13 12 16 13 19 14 27 Care Homes for Older People Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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