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Inspection on 14/10/08 for Michaelstowe Hall Residential and Nursing Home

Also see our care home review for Michaelstowe Hall Residential and Nursing Home for more information

This inspection was carried out on 14th October 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Michaelstowe provides residents with a relaxed and homely place to live. The premises are secure, and have recently been refurbished, are furnished in keeping with the client group and are well maintained. There are regular residents` and relatives` meetings held. There is a wide range of social activities provided both for groups and individuals, with regular entertainment bought into the home. An enthusiastic group of volunteers, led by the home`s activities coordinator, support fund raising events for the Friends of Michaelstowe Hall and arrange weekly outings throughout the summer months with other events also organised. Residents described care staff as friendly and supportive, upholding privacy, dignity and choice where possible. One resident told us `I call them my friends`. The food is homely in type with choices accommodated and special dietary needs also provided for. Residents spoken with said they enjoyed the food and plenty of drinks were offered. The standard of medicines administration that had improved at the previous key inspection have remained good.

What has improved since the last inspection?

The standard of care planning has continued to improve with assessments now covering mental health and cognition and religious, social and cultural needs. Risk assessments are also undertaken and regularly reviewed. Nutritional needs are assessed on admission and closely monitored. Training had been provided on use of the Malnutrition Universal Screening Tool (MUST) tool, a universal screening tool used in care settings for people at risk of malnutrition. Policies and procedures for administration of medicines were available for staff guidance and issues with recording of medicines administration identified at the previous key inspection had been addressed. Staffing levels were satisfactory and no agency staff were employed, however feedback from a resident indicated that more staff hours were needed to ensure some residents with dementia received more stimulation. A manager had been appointed and an application for registration was in progress with the Commission. A range of audits (care planning, medicines administration, health and safety (environment etc) had been introduced to monitor and improve practice. The quality assurance programme had been developed to include consultation with residents and their relatives and an action plan produced to evidence that it was used to improve the service.

What the care home could do better:

One resident had a stoma for which they were self-caring. However, the needs were not identified on the care plan, nor how this was to be monitored. An incident with two residents was noted on the care records during the site visit. However, there was no risk assessment in place to demonstrate how the risk would be minimised, not had it been reported to us as required under Regulation 37 of the Care Home Regulations. This was also a requirement at the previous key inspection.There was no evidence of homely remedies having been agreed with the General Practitioner in writing. Cleaning of baths between use needs to be improved to minimise the risk of infection for residents. The malodorous smell identified in three rooms must be removed. This was also a requirement at the previous key inspection. Recruitment of staff, whilst improved, is still not sufficiently robust to protect residents. Staff would benefit from training in hearing impairment, end of life care and in dealing with swallowing difficulties.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Michaelstowe Hall Residential and Nursing Home Ramsey Road Ramsey Harwich Essex CO12 5EP     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: Diana Green     Date: 1 4 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 30 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 30 Information about the care home Name of care home: Address: Michaelstowe Hall Residential and Nursing Home Ramsey Road Ramsey Harwich Essex CO12 5EP 01255880308 01255880907 Michaelstowehall@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Post Vacant Type of registration: Number of places registered: Handylodge Limited care home 84 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Persons of either sex, aged 40 years and over, who require nursing care by reason of a physical illness/disability (not to exceed 10 persons) Persons of either sex, aged 55 years and over, who require care by reason of dementia (not to exceed 15 persons in woodlands unit) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 15 persons in Woodlands unit) Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 46 persons in Oakland Unit) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical illness/disability (not to exceed 23 persons) Care Homes for Older People Page 4 of 30 Over 65 15 46 23 15 0 10 Staffing levels to be reviewed within 6 months of registration. The registered person must not admnit persons subject to the Mental Health Act 1983 or the Patients in the Community (Amendment) Act 1995 The total number of service users accommodated in the home must not exceed 84 persons. Date of last inspection Brief description of the care home Michaelstowe Hall provides personal and nursing care with accommodation for up to 96 older people and can accommodate 10 service users aged 40 years and above with a physical disability. Michaelstowe Hall is owned by a private organisation named Handylodge Ltd. The home is located in the village of Ramsey, Harwich, Essex. The home was opened in 1995 and is a 3 storey Victorian building. The home is divided into 3 separate units: Oaklands, which provides personal care only, Greenlands, which provides personal and nursing care and Woodlands which provides dementia care. There are 64 single rooms including 60 with en-suite toilet facilities and 14 shared rooms, all with en-suite toilet facilities. There is a passenger lift. The home has large attractive gardens overlooking open countryside and a courtyard garden accessible to wheelchair users. Michaelstowe Hall is accessible by road and has good bus links. Parking is available in the car park. CSCI inspection reports are made available to prospective service users at their request to the manager. The fees range from £383.00-£484.00 for nursing care with other costs indicated by individual needs. Additional costs apply for hairdressing, newspapers and chiropody. This information was provided to CSCI on 14/10/08. Care Homes for Older People Page 5 of 30 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: This unannounced inspection took place on 14th October 2008. All of the Key National Minimum Standards (NMS) for Older People, and the intended outcomes were assessed in relation to this service during the inspection. The report has been written using accumulated evidence gather prior to and during the site visit, including the homes Annual Quality Assurance Assessment (AQAA), a selfassessment that focuses on how well outcomes are being met for people using the service, was completed by the home and returned to us prior to the visit to the home. Information received in the self-assessment provided us with some detail to assist us in understanding how the registered persons understand the services strengths and weaknesses and where they will address these. Care Homes for Older People Page 6 of 30 The inspection process included reviewing documents required under the Care Home Regulations. A number of records were looked at in relation to residents, staff recruitment and training, staff rosters and policies and procedures. Time was spent talking to residents, visitors, the staff and the manager. What the care home does well: What has improved since the last inspection? What they could do better: One resident had a stoma for which they were self-caring. However, the needs were not identified on the care plan, nor how this was to be monitored. An incident with two residents was noted on the care records during the site visit. However, there was no risk assessment in place to demonstrate how the risk would be minimised, not had it been reported to us as required under Regulation 37 of the Care Home Regulations. This was also a requirement at the previous key inspection. Care Homes for Older People Page 8 of 30 There was no evidence of homely remedies having been agreed with the General Practitioner in writing. Cleaning of baths between use needs to be improved to minimise the risk of infection for residents. The malodorous smell identified in three rooms must be removed. This was also a requirement at the previous key inspection. Recruitment of staff, whilst improved, is still not sufficiently robust to protect residents. Staff would benefit from training in hearing impairment, end of life care and in dealing with swallowing difficulties. 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 30 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 30 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. People planning to live at Michaelstowe Hall can expect to have full information to enable them to make a decision and to have their needs fully assessed prior to admission to ensure they can be appropriately met. Evidence: The home had a statement of purpose and service user guide that were viewed at the site visit. Both documents had been reviewed since the previous key inspection and were confirmed to meet regulatory requirements. A resident and relative spoken with confirmed they had sufficient information about the home prior to admission to enable them to make a decision. Six residents care files including those of two residents that had been admitted since the previous inspection were viewed at the site visit. All had a pre-admission assessment form that had been completed detailing all care needs prior to agreeing admission. A full assessment was recorded in all the care files following admission and Care Homes for Older People Page 11 of 30 Evidence: detailed all elements of needs (including mental health and cognition and religious needs) as recommended to meet this standard. An agreement form had been signed by each individual resident and or their relative in all the files sampled. This home does not provide intermediate care. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Michaelstowe Hall can expect the majority of their health and personal care needs to be met but care planning is not sufficiently robust to ensure this is always the case. Evidence: Six care plans were viewed during the site visit including those of two residents admitted since the previous key inspection. All included a pre-admission assessment detailing care needs and completed prior to admission and used to develop care plans. Additional individual risk assessments had been completed in regard to specific needs (e.g. nutritional risk, risk of falls, continence, skin integrity, moving and handling etc.) and had been regularly reviewed. However for one incident where a resident was aggressive towards another, there was no risk assessment review following the incident to evidence action had been taken to minimise the risk. Neither had CSCI been notified as required under regulation 37. A range of care plans were seen on the care files viewed and were detailed with specific care needs of residents. However one resident with a stoma was assessed as being self caring for personal care, yet there Care Homes for Older People Page 13 of 30 Evidence: was no guidance for staff as to how this was to be monitored. The same resident had been admitted to hospital with an obstruction and cellulitis (inflammation of the tissue). This had also not been reported to CSCI. The manager stated that the resident was now being seen by district nurses. The records showed residents had access to GPs and health professionals (for example district nurses and nurse specialists for continence, tissue viability, diabetes, chiropodists etc.) as indicated by need. A resident spoken with said they look after me and they are very kind to me, I consider them my friends and another resident, when asked what the service does well? told us looks after most for my needs. A relative also told us Each person has the well-being of my x at heart and I know x is being well looked after and another relative told us I am very happy with the care my x is getting. I could not wish for better. The medicine administration systems for the home were inspected. The home had policy and procedures for staff guidance that were personalised to the home and additional guidance from the Royal Pharmaceutical Society of Great Britain (RPSGB). Medication is received from a supplying pharmacy in a medicines dosage system (MDS) and in individual containers. Appropriate arrangements were in place for receipt and disposal of medicines. Medication was managed independently in Greenlands and Oaklands Units. The medication system for Greenlands only was inspected. Medication was administered by registered nurses and records of the name, signature and initials were maintained to enable appropriate follow up in the event of an adverse incident. Medicines were stored in a locked trolley that was secured to the wall in a locked cupboard and within a locked clinical room. There was a drug refrigerator and monitoring of room and refrigerator temperatures was undertaken and recorded twice daily. A controlled drugs cupboard was used for storage of controlled drugs (CD). The medicines administration records and supplies for four residents were inspected. All medication was available as prescribed. The medicines administration records were well recorded and there were no omissions evident. Arrangements for administration of prescribed creams were detailed on the care plan and confirmed by the signature of staff who had applied the cream. Regular audits had been undertaken by the manager ensuring safe standards of medicines administration were in place. However it was evident that some staff needed further training as one resident told not all staff will do my eyedrops and so I have to wait. Care staff were observed to treat residents in a friendly and respectful manner during the site visit. One resident spoken with said they do everything they can for me. They are very kind and make me laugh. Another resident told us staff always knock and do show respect. Care Homes for Older People Page 14 of 30 Care Homes for Older People Page 15 of 30 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 living at Michaelstowe can expect to receive a nutritious diet and to have a lifestyle that satisfies their cultural needs and expectations. Evidence: A weekly programme of social activities was seen displayed in both Greenlands and Oaklands units. A wide range of group and individual activities were offered comprising quizzes, board games, use of a computer, bingo etc. Weekly outings in the minibus were also provided for residents who were able and supported by volunteers from the Friends of Michaelstowe. A resident said they sometimes took part in activities but also liked some quiet time reading in one of the lounges. Entertainment was provided regularly and the records confirmed that some residents liked to also take part in a sing a long session with someone playing the piano or organ. A wide screen TV was provided in each of the large lounges in both Oaklands and Greenlands units which some residents were seen to enjoy watching. The records viewed detailed residents social preferences that had been discussed with them on admission and confirmed that efforts were made to meet their needs. The statement of purpose detailed the homes visiting arrangements. Several visitors were seen to come and during the site visit and the visitors book in each of the two Care Homes for Older People Page 16 of 30 Evidence: units confirmed they attended the home at various times throughout the day. One relative told us they could visit at anytime and were always welcomed into the home. Another relative told us the home would always ring me if they are at all concerned. The manager said that a regular church service was held in the home and arrangements were made for representatives of different faiths to visit residents as indicated by them. A resident confirmed that this had been offered to them. Various groups were invited into the home, mainly at Christmas and residents also said they were taken on outings for visits to the seaside and other places of interest throughout the year. Residents were observed to have choices in their daily lives especially in what they ate, where they ate their meals, taking part in activities. One resident told us I am quite happy in my room to eat, watch TV and films and do all I have to in my own time. A number of the rooms were well personalised with residents own belongings, such as photographs and pictures and one resident room had their own curtains and furnishings. The menus were discussed with residents in both units and all said they enjoyed the food provided. The meals consisted of mainly homely type food with an alternative at each main meal. The lunch offered during the site visit comprised liver and bacon, boiled potatoes, peas and broccoli, followed by pears and custard. A resident told us the food was always very good and another said the liver was very well cooked and tender. A relative told us they often had a meal at the home and always found it enjoyable. A resident also told us they were offered an alternative choice of meal and if they did not like either, they could have something else. Residents appeared well nourished in the main. The records confirmed that staff had received training in use of the Malnutrition Universal Screening Tool (MUST) to identify their needs and ensure their nutritional intake met their needs. This was evident from the monitoring forms in use and supplements being provided to some residents. Care Homes for Older People Page 17 of 30 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. People living at Michaelstowe can expect to have their complaints listened to and acted upon and to be protected from abuse by policies, procedures, staff training and practices. Evidence: The home had a complaints procedure that was included in the statement of purpose and service user guide. The procedure included timescales within which complainants can expect a response. Residents spoken with said they knew who to complain to and a resident told us that the manager deals with any issues and that a recent crisis had been dealt with by him with tact and understanding. Discussions were held with the manager regarding the homes safeguarding procedures during the site visit. It was confirmed by him that Michaelstowe had safeguarding procedures in place and a whistle blowing policy and procedure and that Essex safeguarding procedures would be followed in the event of any allegations made. There had been no allegations made since the previous key inspection. However the manager stated that an allegation reported as being under investigation at the previous key inspection remained under investigation by Essex Social Services. Records viewed at the site visit confirmed that staff had received training in safeguarding procedures and recent updated training had been provided for all but three staff members since the previous key inspection. The staff recruitment records viewed at the site visit confirmed that appropriate checks Care Homes for Older People Page 18 of 30 Evidence: had been made prior to appointment to minimise the risk to residents. Care Homes for Older People Page 19 of 30 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. People living at Michaelstowe can expect to live in a comfortable, homely and generally clean and well maintained environment but some infection control practices may place them at risk. Evidence: A tour of the premises was made during the site visit that included both Oaklands and Greenlands units. Woodlands unit was closed. A number of residents rooms, communal rooms, several bathrooms, the clinical room, the sluice and the laundry were viewed. Oaklands Unit had been recently redecorated and carpets replaced in corridors and stairs. The furnishings were comfortable and in keeping with the client group. New dining chairs had also been provided in the Oaklands Unit dining room. The surrounding gardens were large and gardens to the front of Oaklands were attractively maintained, accessible to wheelchairs and provided with seating and gazebos for residents use. The gardens to the rear of Greenlands and the quadrangle garden adjacent to Woodlands were untidy and in need of maintenance. The home had stairs and a passenger lift to enable access in Oaklands Unit which was linked by a corridor to Greenlands Unit, a single storey building. The laundry and kitchen facilities were shared between the units. Call systems with portable units were seen to be provided throughout all communal and individual rooms. A range of specialist pressure relief equipment including seating was provided to meet Care Homes for Older People Page 20 of 30 Evidence: the needs of residents. The records confirmed that equipment was serviced as per manufacturers recommendations. However two recommendations made at servicing on 26/06/08 for two baths and a bath hoist to be replaced had not been actioned. It was also noted that some slings were worn and additional purchase was required to ensure there were sufficient to enable laundering between use. The home was generally cleaned to a satisfactory standard. However during the site visit three rooms were noted to have a malodorous smell. The records confirmed that continence assessments had been undertaken and advice sought. The manager stated that the carpets were shampooed daily. However as the smell was still present, this presents a risk of infection and the carpets may therefore need to be replaced. The records confirmed that care staff had received infection control training, however staff practices did not always reflect this. For example a non-slip mat was found covered in mould and had evidently not been cleaned between use. Once brought to the attention of the manager, the mat was disposed of and confirmation given that a replacement had been ordered. Care Homes for Older People Page 21 of 30 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 at Michaelstowe Hall can expect to be cared for by staff employed in sufficient numbers and who are in the main robustly recruited, well trained and well supervised. Evidence: Discussions were held with the manager who informed us that there were 18 residents in Oaklands Unit and staffing levels comprised 1 senior care assistant and 2 care assistants. There were 17 residents in Greenlands and staffing levels comprised 1 registered nurse and 5 care assistants. We were also informed that Woodlands Unit was closed. From inspection of the staff duty rota and discussion with staff and residents it was evident that staffing levels were well maintained. Ancillary staff comprised the administrator, the activities coordinator, the cook, kitchen assistant, laundry assistant, 2 domestic assistants on each unit. A relative told us this is the best care home x has been in. The management and staff are really nice here and I am happy with the care. A resident also told us they do everything they can for me. They are kind and make me laugh. However one resident when asked how do you think the care service could improve? told us to spend more time with people with dementia. etc. to try to get them interested in life, not to be on their own. The AQAA stated that the home employed 35 care staff of which 13 had NVQ level 2 qualifications or above. This is below the 50 needed to meet the standard. However Care Homes for Older People Page 22 of 30 Evidence: the home also employed registered nurses and a further 7 care staff were working towards achieving NVQ level 2 training. The recruitment files for 4 members of staff who had been employed since the previous inspection were viewed. These included evidence that the required checks had been obtained for three of the staff (two satisfactory references, CRB/POVA checks) and evidence of identification and photographs obtained before the individuals commenced employment at the home. However for the remaining person there was only one written reference and one verbal reference. Although the person is employed in an ancillary capacity rather than a care position, it still does not ensure that residents are fully protected by the homes recruitment procedures. The files also contained evidence that homes induction had been provided to Skills for Care Standards. The records confirmed that training had been provided in fire safety, manual handling and health and safety as is required under health and safety regulations. The home had a training programme in place. Records were viewed during the site visit and confirmed that since the previous key inspection training had been provided in manual handling, fire safety, safeguarding adults, whistle blowing, infection control, food hygiene, dementia care, care planning, catheter care, medicines administration and Control of Substances Hazardous to Health (COSHH). Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements are beginning to show improved outcomes for people living at Michaelstowe but without a registered manager, effective leadership cannot be assured. Evidence: The manager has been in post since May 2008 and is an experienced registered nurse and registered mental health nurse with experience of nurse prescribing, also confirmed from the records viewed. We were told that the manager had experience in management of care homes and prior to being employed at Michaelstowe had worked at another care home owned by the same Provider. Residents spoken with said they found the manager very approachable. One told us the manager handled a crisis with tact and understanding. He is popular and always cheerful. The manager had submitted an application for registration as manager under the Care Standards Act 2000. However the application was incomplete and CSCI are waiting to receive further information (identification, CRB check) before this can be progressed. The home has Care Homes for Older People Page 24 of 30 Evidence: now been without a registered manager for more than a year and it is essential that a registered manager is in place to ensure the home has effective leadership and supervision of staff. The quality assurance system was discussed with the manager. He explained that audits had been undertaken in medication, health and safety and care planning, also confirmed from the records. Surveys had been distributed for surveys and relatives and a report produced with an action plan to ensure continued improvement to the service. The manager stated that there were plans to also distribute surveys to health and social care professionals in future. All sections of the AQAA were completed. However more supporting evidence from where the service had improved would have been helpful and there was limited detail in the areas identified for improvement. The arrangements for handling residents monies were discussed with the manager and administrator. Most residents managed their own personal monies or had a relative or advocate to manage their finances on their behalf. Personal allowances were held in safekeeping for some residents. Four residents monies were checked and records and receipts were confirmed to be appropriately maintained and accurate with transactions confirmed by residents signatures. Records held on behalf of residents were kept up to date and were stored safely in secure facilities. Records viewed at this inspection comprised the statement of purpose, service user guide, assessments/care plans, medication, complaints, staff recruitment records, fire safety, health and safety record and training records. The home had a health and safety policy statement with procedures in place for staff guidance. The AQAA stated that regular health and safety checks were undertaken and this was also confirmed from the records viewed. The training records confirmed that staff had undertaken heath and safety training, fire safety, manual handling. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 29 13(6) To ensure the protection of residents: Two satisfactory references must be undertaken prior to appointment. 31/12/2007 2 37 37 Regulation 37 notifications 31/12/2007 must be forwarded to the CSCI for all events that adversely affect the wellbeing or safety of a resident. Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 29 9 Two satisfactory written 30/11/2008 references must be obtained for all staff prior to appointment. Without satisfactory written references it cannot be assured that residents are protected by appropriate checks being made. 2 31 9 The manager must be registered under the Care Standards Act 2000. Without a registered manager effective leadership and supervision cannot be assured. 31/12/2008 3 38 37 Notifications must be submitted for any event which adversely affects the well-being or safety of any service user. Without notifications being submitted it cannot be assured that residents are protected by the management arrangements of the home. 30/11/2008 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 Care Homes for Older People Page 27 of 30 1 7 15 Care plans must include 14/11/2008 clear guidance for staff to monitor and review residents ability to self care. Without clear guidance for staff residents may not be monitored and their personal and health care needs may not be met. 2 8 37 Notifications of serious 21/11/2008 illness and adverse incidents must be reported to the CSCI without delay. Incidents not reported to CSCI do not ensure close monitoring of residents care nor represent an efficient and effective management. 3 22 23 Baths and hoists must be upgraded as indicated in the servicing reports. Without a safe system for bathing residents they may be a risk of accident or injury. 31/01/2009 4 26 13 The malodorous smell must be removed from the rooms identified at inspection. Malodorous smells pose a risk of infection that places residents at risk. 30/11/2008 5 26 13 Non-slip bath mats must be appropriately cleaned between use. Bath mats that are not appropriately cleaned between use pose a risk of 21/11/2008 Care Homes for Older People Page 28 of 30 infection to residents and staff. 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 All care staff who administer medication should received updated training in administration of eye drops to ensure they are competent. Homely remedies should be agreed with general practitioners annually and confirmed by their signature. Additional hoist slings should be provided to ensure they are sufficient to meet residents needs and to enable regular laundering. 2 3 9 22 Care Homes for Older People Page 29 of 30 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). 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