Inspection on 14/11/08 for Mill House

This inspection was carried out on 14th November 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mill House 16/11/06

Mill House 27/09/05

Mill House 14/04/05

Mill House 29/09/04

Mill House 09/06/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Mill House Salters Lane Faversham Kent ME13 8ND     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: Anne Butts     Date: 1 4 1 1 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 33 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 33 Information about the care home Name of care home: Address: Mill House Salters Lane Faversham Kent ME13 8ND 01795533276 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Heather Karslake Type of registration: Number of places registered: Mrs Renuha Francis,Mr Niranjan Romand Francis care home 24 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 24. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) - maximum number of places 12. Date of last inspection Brief description of the care home Mill House is a large detached property, which is a listed building situated a few minutes from Faversham town centre. Faversham is a town steeped in history with a railway service to most parts of Kent. The M2 motorway is nearby and there is a shop within walking distance of the Home. The Home is registered to provide personal care and support to 24 Service users who are over the age of 65 years. The home can Care Homes for Older People Page 4 of 33 Over 65 0 24 24 0 Brief description of the care home accomodate up to 12 people who have a diagnosis of dementia. Most of the accommodation is provided in single rooms, however there are four rooms available for shared occupancy. All bedrooms have a call bell system, telephone point and television point. The Home has a large rear garden with an ornamental fishpond, bird aviary and seating for Residents. Access to the front garden is restricted as the area is not secure. There is off road parking for several cars. The individual fees range from #370 to #400 per week. Care Homes for Older People Page 5 of 33 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 was a key unannounced inspection that took place over one day and was carried out by one inspector. An unannounced inspection means that the service does not know we are visiting. Key inspections are aimed at making sure that the individual services are meeting the standards and that the outcomes are promoting the best interests of the people receiving the service. Our processes for a key inspection involves a pre-inspection assessment of service information obtained from a variety of sources including an annual self-assessment and surveys. It is now a legal requirement for services to complete and return an Annual Quality Care Homes for Older People Page 6 of 33 Assurance Assessment (AQAA). This was completed and returned to us prior to our visit. Judgments have been made with regards to each outcome area in this report based on the returned AQAA, records viewed, observations and verbal responses given by those people who were spoken with. These judgments have been made using the Key Lines of Regulatory Assessment (KLORA) which are guidelines that enable us (The Commission for Social Care Inspection - CSCI) to be able to make an informed decision about each outcome area. Further information can be found on the CSCI website including details about the KLORA and AQAA. At our visit we spent time touring the building, reviewing a selection of records including service users plans, medication records and other relevant documents. We also viewed a selection of staff records. We had the opportunity to speak to people living in the home and observe how they spent their day. We spoke to two relatives who were visiting on the day and a health care professional. Prior to our visit a number of surveys were returned. This was the first key inspection since the home has changed its category so that they can accept people with a diagnosis of dementia. What the care home does well: What has improved since the last inspection? What they could do better: Pre-admission assessments need to be fully completed so that prospective residents needs are fully known and the client can be assured their needs can be met. In order to make sure that all people living in the home can be confident that they will feel safe and comfortable it is the responsibility of the registered person to make sure of the appropriateness of the levels of dementia of the people who are admitted. There needs to be clearer guidance in the terms and conditions in relation to the replacement of furnishings in peoples rooms in relation to insurance cover. Although the home recognises that people with dementia like to wander at times, there were no robust procedures or care plans in place to make sure people were appropriately assisted to do so safely and safeguarded at all times. Although there are additional members of staff on duty at key times, there are times of the day when there are only limited members of staff on duty. With the newly agreed registration for 50 of the homes residents to require Dementia care the Registered Manager is responsible for ensuring sufficient numbers of appropriately trained staff are available at all times, this needs to be kept under review. The kitchen and laundry area need to be maintained in a manner that meets Environmental Health legislation. Management hours need to be reviewed so that there is sufficient management time available to ensure the smooth running of the home in accordance with standards and regulations. Care Homes for Older People Page 8 of 33 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 33 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 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre-assessment process gives insufficient detail to ensure the prospective residents needs could be fully met. Contracts for residents need to be clearer to ensure all parties are aware of insurance obligations. Evidence: The home has produced a Statement of Purpose, this was reviewed in March 2008 by our Registration Team following a change in registration to provide Dementia Care at that time. The Annual Quality Assurance Assessment (AQAA) confirmed that prior to people moving into the home they are given information in the form of a brochure about the services they can expect. Care Homes for Older People Page 11 of 33 Evidence: In accordance with Standard Two of the Care Homes National Minimum Standards, people should be supplied with a written contract / statement of terms and conditions in order to protect their right to residency. The registered confirmed that this is in place for people living in the home. We viewed a blank copy and saw that it contained the necessary information in relation to fees payable and the services to be provided. At our visit we spoke to a relative who advised that the family had replaced a carpet in their mothers bedroom through a personal insurance. The statement of terms and conditions states that if a resident requires improved insurance in respect of personal effects, jewelery and money then this should be provided at the residents expense. It also states, however, that basic insurance cover will be provided by the home. The terms and conditions do not state what is covered by the basic insurance and the furnishings which will be supplied by the home. The terms and conditions do state about willful damage but we were informed that the carpet needed replacing through general wear and tear. The Registered Provider must make sure that this information is clear. The AQAA states that prospective service users are only admitted after a full preadmission assessment has been carried out. The home obtains a copy of the Care Managers assessment and uses this to inform their own assessment. The homes assessment covers the areas as identified in the National Minimum Standards for Older People. We viewed three pre-assessments for people living in the home and saw that there was insufficient detail contained in these. For example an assessment stated that the person had poor nutrition and would forget to eat meals, but there was no guidance or evidence on how they support or monitor what meals were eaten. The lack of this could lead to weight loss before the home was aware of a problem. The registered manager stated that they had admitted a gentleman previously whose high dementia needs had been difficult to manage and they had recognised this when he moved into the home. He had displayed challenging behaviour and this had been confirmed by people still living in the home. She stated that they will only accept people whose needs they can meet. In order to establish this they need to make sure that the pre-assessment in completed in more detail so that they fully explore all individual needs and how the home will meet these needs. People are given the opportunity to visit prior to moving in and the terms and conditions confirm that there is a trial period. The home does not provide intermediate care. Care Homes for Older People Page 12 of 33 Care Homes for Older People Page 13 of 33 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 benefit from care plans that take into account their individual preferences and choices. Clearer guidance on assessed needs would further enhance the process. Medication arrangements in the home protect people. People can feel confident that they will be treated with respect and their right to privacy upheld. People can feel confident that they will be treated with respect and their right to privacy upheld. Evidence: We viewed the records for three people living in the home in relation to their care plans and risk assessments. The terms and conditions stated that the four weeks of admission process shall be treated as a trial period. One care plan for a person who had moved into the home four weeks prior to our visit was not yet in place, neither Care Homes for Older People Page 14 of 33 Evidence: were accompanying risk assessments. During this 4 week period it would be expected that the care plan start to be formulated particularly as the pre-admission assessment identified immediate needs. For example that this person had a tendency to become depressed and due to their dementia would also wander. The pre-admission assessment did however give a profile of preferences, likes and dislikes. The registered manager stated that staff would read the pre-assessment to gain an overview of the persons needs and a member of staff confirmed this. Where there are immediate needs, clear guidance needs to be in place. In contrast care plans that were in place were person centered and identified individual preferences and choices. For example one person liked to stay busy and the care plan identified small tasks the person could undertake including laying the tables for meals and folding laundry. Another care plan also identified the individuals preference for their morning routine. There was, however, limited guidance on how to support with any specific care identified care needs. For example one person had limited mobility and required the use of a hoist, but the care plan did not give guidance on how staff were to support with this need. Also where assessments identified that a person had a tendency to wander or may forget why they had gone to their room there was no reference in the care plans to identify how to support and minimise possible distress for this person. There were accompanying risk assessments in place that covered a range of needs including awareness of common dangers, nature of the person, any memory loss and personal care. There was again, however, limited guidance in relation to any movement and handling needs and also how to manage the needs of anyone who had a tendency to wander. Daily records and pre-assessments identified that wandering occurred. The registered manager stated that people had the right to wander if they so chose but she was advised that there was a duty of care to make sure that this was managed safely within the home so as to safeguard the person. The home is strongly advised to ensure all staff are in receipt of appropriate training in the Mental Capacity Act and Deprivation of Liberty legislation. The Annual Quality Assurance Assessment (AQAA) stated that people have access to all healthcare professionals including GP, optician, dentist and district nurses. Records we viewed all contained evidence that people have regular healthcare support and assessments reflected where people needed support in this area. We spoke to a visiting healthcare professional who confirmed that the home acted appropriately if they had any concerns. Peoples weight records are generally maintained with records kept. Although for the newest person who had moved into the home weight records had not yet been Care Homes for Older People Page 15 of 33 Evidence: implemented. There is no nutritional screening undertaken when someone moves into the home. The manager stated that they obtained the information from the care management assessment and also spoke to the person and their relatives. She also stated that if there was any concerns about weight then they implemented food and fluid charts to monitor individual people. Improved nutritional screening will further safeguard the people living in the home and it is being strongly recommended that they seek further guidance in this area. We looked at the medication procedures in the home. Medication is stored in a cabinet and there is a designated fridge for those medications which need to be stored below a certain temperature. We looked at a selection of Medication Administration Record (MAR) sheets, and saw that these had been completed appropriately. The manager confirmed that only herself and senior staff on duty administer medication and that they have undertaken training in this area. The home did not have a copy of the Royal Pharmaceutical Guidelines for The Handling of Medicines in Social Care. We have recommended that they obtain this. Care plans clearly respected peoples preferences and acknowledged the importance of respecting the privacy and dignity of people living in the home. Staff we spoke to also confirmed how they would support people in maintaining their privacy and dignity. A visiting relative stated that all the staff are very good they respect the people living here. A resident said they always knock before they come into my room. The Registered Manager is currently reviewing how the home handles issues relating to end of life and death. They currently obtain basic information in relation to this. Staff are attending training on palliative care. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to participate in a range of activities that suits their choices and preferences. People are supported to make choices enabling them to have some control over their daily lives. Evidence: On the day of our visit we observed staff interacting with people who live in the home. They were spending time playing games and talking to individuals. We spoke to visitors and we were told - there is always something happening - I like coming here and another visitor said staff are always so good. Several residents had been to a show the night before our visit. Records are kept of individual choices and preferences. People are able to join in activities as they wish. When we spoke to people living in the home they all stated that they were happy and that they could make their own choices There is no dedicated activities co-ordinator but a member of staff on duty is allocated to activities. We observed people taking part in a sing-a-long on the day of our visit and a relative confirmed that whenever he visited staff were always supporting people arranging different activities. Staff have received training in providing activities for Care Homes for Older People Page 17 of 33 Evidence: people with dementia. Relatives and friends are able to visit when they wish and returned surveys confirmed that people are happy with the arrangements in the home. We spoke to two relatives who confirmed that they are aways made to feel welcome and are offered a drink. Mealtimes are treated as a social event. We observed both a lunch time and evening meal and saw that that people were able to go to their tables when the meal was ready and not expected to sit at the table and wait. Other people who preferred to sit in their chairs to eat their meal were able to do so. There was a cooked meal at lunch time and a choice of hot or cold evening meal. People we spoke to during the course of our visit all stated that the meals were nicely cooked. One person did say that they felt that meals tended to be the same, and more variety would be nice. Care Homes for Older People Page 18 of 33 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. Concerns and complaints raised by people living in the home are taken seriously and acted upon. Staff have received training in adult protection procedures. Evidence: There is a complaints procedure and this is made available to the people living in the home. The manager stated that they take all complaints seriously and will investigate any concerns. The Annual Quality Assurance Assessment confirmed where concerns are raised they are addressed. We spoke to people living in the home and they confirmed that they felt confident about raising any concerns. Visiting relatives also confirmed that they felt able to speak to the staff or the manager if they had any concerns. There is a policy in place for adult protection and staff we spoke to were able to demonstrate a knowledge if any action they should take should they have any concerns about the safety of the people living in the home. Records showed that only a limited amount of staff had completed training in adult protection but a training session had been booked for the following week and the manager contacted us after our visit to confirm that this training had taken place and that all staff who had been booked on this course had attended. Care Homes for Older People Page 19 of 33 Evidence: The manager also confirmed that staff are subject to appropriate safety checks such as a criminal records bureau (CRB) check and protection of vulnerable adults (POVA) check. At the last visit a requirement had been made with regards to making sure all staff have received the appropriate checks and the records we viewed showed that this was now happening. Care Homes for Older People Page 20 of 33 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 benefit from living in an environment that is largely well maintained and reflects their choices and lifestyle. The layout of the home means that people with a tendency to wander may not always be safely assisted. The kitchen and laundry need attention in order to ensure that they meet the Environmental Health legislation. Evidence: The home is situated on the outskirts of Faversham. The rear gardens are enclosed and kept secure at all times. The front gardens are not secure and lead directly onto the main road and as such access is restricted due to the risk of people wandering. The manager stated that the front door is kept locked at all times. Again the home is strongly advised to ensure all staff receive appropriate training in the Mental Capacity Act and Deprivation of Liberty legislation. In February 2008 the home applied for and was granted a major variation to enable them to admit people with a diagnosis of dementia. The number of people who could live in the home with dementia was restricted to 12 due to the layout of the home. The manager confirmed at the time of our visit that they were staying within their registration conditions. Care Homes for Older People Page 21 of 33 Evidence: There are two lounge areas and two dining areas. One of the dining rooms also has a seating area. People without dementia tend to use this room. Other residents use the main lounge area. There is a smaller lounge, which is used when people want to sit quietly or meet their visitors in private. At our visit in February we found that the registered manager intended to encourage people with dementia to use one particular lounge and dining area. They have, however, kept this under review and people are free to choose where they prefer to spend their day. We spoke to three people who have been living in the home for a number of years. They expressed some concerns in relation to the needs of people who had moved into the home. One lady told us Things are every different now, people are very different we can see the change. Both a relative and a resident made reference to a particular resident who had moved into the home and had demonstrated high needs, they both reported they had experienced uncomfortable situations involving this person. In order to make sure that all people living in the home can be confident that they will feel safe and comfortable it is the responsibility of the registered person to make sure of the appropriateness of the levels of dementia of the people who are admitted. The home has four double and sixteen single bedrooms, eleven of which are en-suite. Currently all double rooms are being used as singles. We viewed a selection of bedrooms and saw that they were homely and that people were able to bring in their own possessions. The first floor bedrooms are naturally broken into separate areas by fire doors. Overall the home was clean and well maintained. People living in the home said that it was kept clean and that there were no odours. Returned surveys also confirmed this. Two relatives also said that whenever they visited they always found the home to be clean. One person also confirmed that there had been some redecoration and replacement of furniture. There is a range of equipment available in the home including a hoist. There is also a lift to the upper floor. The home maintains the Environmental Health service manual Safer Food, Better Business. This is to ensure that all appropriate safety checks are carried out and a scan of the records showed that fridge and freezer temperatures are maintained appropriately. A visit by the Environmental Health Office had found that work needed to be carried out in relation to the kitchen and they had made requirements in relation to this. It was noted at the time of this inspection that requirements from the EHO Care Homes for Older People Page 22 of 33 Evidence: report had not been complied with. The registered manager confirmed that the registered provider was addressing these and that work would commence in the near future. A recommendation is being made with regards to this. There is a separate area for laundry; this was seen to be clean on the day of our visit. However the walls were not impermeable to aid effective cleaning and the flooring was marked. The registered provider must ensure that laundry facilities are in line with recognised health and safety requirements in relation to infection control. Care Homes for Older People Page 23 of 33 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. People benefit from being cared for by staff who have a good understanding of their needs. The deployment and number of staff needs to be kept under review to ensure that there are sufficient people on duty so as to fully meet the needs of the people living in the home at all times. Evidence: The registered manager stated that staffing levels are allocated in accordance with the needs of the people living in the home. The night staff and the staff working in the morning overlap for a period of time so that people can be assisted out of bed at their preferred times. Following this there are three members of staff on duty in the morning. There are two members of staff on duty in the afternoon, with an additional member of staff between 4.00 and 8.00pm, who is allocated to prepare the evening meal. There are two members of waking night staff. The registered manager participates in the staff rota in a caring role. We viewed rotas for four weeks and these all showed that the registered manager was allocated on duty either on a morning or an afternoon shift on a high proportion of these dates. When on caring duty the registered manager will take the lead role of senior carer. There was Care Homes for Older People Page 24 of 33 Evidence: limited evidence to show that the registered manager had sufficient supernumerary hours allocated for her to fulfill her managerial duties. Evidenced by three of the four periods on the rotas we viewed showed that the manager had been allocated one day a week for paperwork. Feedback from relatives evidenced that they felt that there were occasions when staffing numbers were limited and although the home recognises the busier times, there are other times of the day when staffing numbers are limited. The registered manager stated that staffing was based on the needs of the people living in the home and as such staff numbers were dictated by this. With the recent change to the homes registration to enable them to accommodate dementia clients it is the Registered Providers responsibility to ensure staffing numbers and skill mix is provided to meet the needs of the residents at the home at all times. The registered provider needs to take into consideration not only the dependency needs of the residents but also the layout of the environment. We looked at two staff files and saw that the information as required by the National Minimum Standards for employment checks were in place including references and appropriate safety checks. The application forms, however, had not been fully completed and there was little evidence of peoples previous work history and this had not been fully explored or recorded by the manager. She stated that she had known both the new members of staff prior to their employment and was aware of their work history. She was reminded that records must be maintained in relation to this and a recommendation is being made to this effect. There is a thorough induction programme and this covers all the areas as required by Skills For Care. Staff complete a workbook over a period of time and each section is reviewed by the manager with staff being signed off when they are deemed competent. Training is ongoing and records viewed, confirmation by the manager and discussions with staff showed that staff have participated in a variety of training programmes. Where there are some shortfalls we saw that training has been booked. Following their change in registration staff have undertaken training in dementia and also in activities for people with dementia. Both the manager and the registered provider have also completed training in dementia. There has been a limited amount of training undertaken with regards to the Mental Capacity Act. At the time of our visit the registered manager informed us that there were seventeen staff working in the home and records showed that seven of these had attended training for this. Staff have not yet received Deprivation of Liberty training and the registered provider is strongly advised to make sure that this is implemented. This new legislation comes into effect Care Homes for Older People Page 25 of 33 Evidence: on 1st April 2009. Supervision is now occurring on a regular basis. People living in the home and visitors all spoke highly of the staff working in the home. Care Homes for Older People Page 26 of 33 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. Whilst people can be confident that the quality of their care is promoted by the philosophies of the home. The effectiveness of the overall management of the home is reduced because of the lack of time allocated to enable the manager to fulfill her management role. Evidence: The registered manager has been in place for a number of years. She has completed training in National Vocational Qualifications (NVQ 4). At the time of our registration visit the registered manager was advised to take some additional training in relation to dementia and she has undertaken this. She was also booked to attend a health and safety risk assessment course for managers but this had not happened and at the time of our visit and it had not been rescheduled. As we identified earlier in this report the risk assessments were not as robust as they could be and we are therefore strongly recommending that this course be completed. The registered manager and registered provided need to ensure that training in Mental Capacity Act and Deprivation of Liberty Care Homes for Older People Page 27 of 33 Evidence: legislation is undertaken by all staff at the home to ensure they can meet the needs of all client groups now accommodated. We identified at our last visit that more support was needed within the staff structure to enable the registered manager to carry out the management responsibilities and daily running of the home. We saw at this visit that the registered manager continues to work a large proportion of her time on the rota as a member of the care team. The registered person needs to ensure that there are sufficient management hours available so as to fully ensure the smooth running of the home. The registered manager, however, was able to demonstrate a commitment to ensuring that people were cared for in a manner that promoted their privacy and dignity and enabled them to have the opportunity make choices. People we spoke to all spoke highly of the manager and staff. The Annual Quality Assurance Assessment (AQAA) stated that all policies and procedures are in place including one for the home to accommodate and care for people with dementia. We viewed this policy and saw that it recognises the needs of the all people living in the home including those without a diagnosis of dementia. The registered manager stated that they had recently carried out a quality assurance survey and she was currently collating the information and intended to produce a report with the findings. Regular residents meetings are held. The AQAA confirms that health and safety checks are in place to ensure that the building and its facilities are well maintained. Staff confirmed that there are fire drills and there are environmental risk assessments in place. The AQAA also confirms that all safety checks are up to date. The arrangements for managing peoples finances was not inspected but the AQAA states that people have control over their own money. Care Homes for Older People Page 28 of 33 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 29 of 33 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 3 14 The Registered Person shall not provide accommodation to a service user at the home unless the needs of the person have been fully assessed. In that the assessment must make sure that peoples needs are fully explored and recorded in sufficient detail so the home can be confident they will meet all their needs. 31/01/2009 2 7 12 The Registered Person shall 31/01/2009 ensure that the care is conducted so as to promote and make proper provision for the health and welfare of service users. In that where people have a tendency to wander then there must be clear guidance to ensure that they are safeguarded at all times Care Homes for Older People Page 30 of 33 3 7 15 The Registered person shall prepare a written plan as to how the service users needs in respect to their health and safety are to be met. In that staff are given clear guidance in the care plans and all people living in the home are provided with a care plan in a timely manner. 31/01/2009 4 27 18 The registered person shall 28/02/2009 having regards to the size of the care home the statement of purpose and number and needs of the service users ensure that at all times there are staff are employed in such numbers as are appropriate for the health and welfare of the service users. In that the deployment of staff including management hours meet the size, layout and purpose of the home at all times. 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 5 The registered person must ensure that there is a standard form of contract for the provision of services and facilities. In that there should be clear guidelines and accountabilities for the replacement of any furnishings. The home are strongly advised to seek further guidance in relation to nutritional screening processes. That a copy of the Royal Pharmaceuticals Society of The Handling of Medicines in Social Care is obtained and made 2 3 8 9 Care Homes for Older People Page 31 of 33 available to staff. 4 26 The Registered Person should ensure that requirements made by the Environmental Health Office should be addressed. It is strongly recommended that any gaps in employment history are explored and records maintained. The home are strongly advised to ensure all staff receive appropriate training in the Mental Capacity Act and Deprivation of Liberty legislation. It is strongly recommended that the registered manager completes her training in the health and safety risk assessment for managers course. 5 6 29 30 7 31 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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