Inspection on 06/10/08 for Miranda House Nursing Home

This inspection was carried out on 6th October 2008.

CSCI found this care home to be providing an Poor 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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Miranda House Nursing Home 29/07/10

Miranda House Nursing Home 25/03/10

Miranda House Nursing Home 06/04/09

Miranda House Nursing Home 24/09/07

Miranda House Nursing Home 15/09/06

Miranda House Nursing Home 24/02/06

Miranda House Nursing Home 08/06/05

Miranda House Nursing Home 01/02/05

Miranda House Nursing Home 21/06/04

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Miranda House Nursing Home High Street Wootton Bassett Wiltshire SN4 7AH     The quality rating for this care home is:   zero star poor 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: Sharon Hayward-Wright     Date: 0 7 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Miranda House Nursing Home High Street Wootton Bassett Wiltshire SN4 7AH 01793854458 01793853951 qualitycarewilts@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Gillian Gray Type of registration: Number of places registered: Quality Care (Wiltshire) Ltd care home 68 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: No more than 2 persons not less than 50 years in receipt of day care at any one time. Persons less than 45 years of age may not be accommodated. Date of last inspection Brief description of the care home Miranda House is able to provide personal care and nursing care for up to 68 adults. These may be people with dementia or other mental health problems. Miranda House is in Wootton Bassett, near Swindon, Wiltshire. It opened in 1996, and was extended in 2005. The purpose built accommodation is on two floors, with passenger lifts between them. Most bedrooms have en-suite toilet facilities. Three double rooms are available. The rest are singles. Baths and showers are provided throughout the building. There is also a range of communal space, including lounges, dining rooms and a conservatory. There is a garden and several parking spaces at the front of the building. The fees for this home range from five hundred and twenty pounds and Care Homes for Older People Page 4 of 31 10 10 Over 65 68 68 Brief description of the care home eighty pence to one thousand and two pounds and seventeen pence. These fees include where applicable the Funded Nursing Care contribution (FNC). People are able to request copies of the homes Statement of Purpose and Service Users Guide. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor 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: Two Inspectors carried out this inspection over two days in October 2008. We (The Commission) asked the home to complete an Annual Quality Assurance Assessment (AQAA). It was received on time and was completed in full. It gave us information about what the home considers it does well and the plans they have for improvement. Where possible, people living at the home were spoken with to ascertain their views on the care and services provided and any visitors to the home were also spoken with. Staff were observed interacting with people who use the service and they were also spoken with. Comments received from speaking to relatives and staff during the Care Homes for Older People Page 6 of 31 inspection have been used in the report. We looked at a number of areas to include the admission procedures, care planning, medication systems, activities, the environment, staffing levels and training. The Registered Manager was available during the inspection as were other members of the homes team and the staff spoken with throughout the inspection were helpful and co-operative. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes in to account the views and experiences of people using the service. What the care home does well: What has improved since the last inspection? What they could do better: The home needs to make some additions to the Statement of Purpose and Service Users Guide to make sure people have access to information about all the services offered. The home needs to demonstrate they are meeting the Care Home Regulations in relation to the breakdown of fees. Improvements are needed to the care planning systems used as not all assessed needs had care plans in place and there is inconsistent practice with reviews. Medication practices need to be reviewed to make sure people who use the service are not put at risk. Staff must make sure that they respect the dignity of people who use the service. More stimulation and activities are needed to meet the needs of people who use the service. Relatives of people who use the service said they feel areas of the home need to be redecorated and this includes peoples rooms. A number of other issues were identified during the inspection that must be addressed. The home must make sure that the actions of some staff do not place people at risk. This includes making sure appropriate infection control procedures are followed. Care Homes for Older People Page 8 of 31 All the required recruitment checks must be undertaken prior to any new member of staff starting work at the home. A system must be devised for the supervision of all staff to make sure they can meet the needs of people who use the service. The home must devise an evacuation procedure urgently to safeguard people who use the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their Representatives do not have access to all the required information needed to help make a choice about if this home can meet their needs. Evidence: Copies of the homes Statement of Purpose and Service Users Guide were examined. Several additions are needed to the Statement of Purpose to meet the Care Home Regulations 2001. These are; to include the Registered Managers relevant qualifications and more details about her experience. The number of relevant qualifications of staff needs updating as it is dated August 2007. A copy of the homes full complaint procedure that includes timescale for a response. The arrangements for respecting peoples privacy and dignity is missing. The complaints procedure needs to have our (The Commission) address altered to the Bristol Regional office. Included in the Statement of Purpose is a heading that is very concerning to us it is called Care Homes for Older People Page 11 of 31 Evidence: Methods of control and discipline. When reading this heading it would indicate that the home is using punishment for peoples behavior and the home needs to consider altering this heading. The homes Service Users Guide does not contain a summary of the Statement of Purpose, however if the home provides people with a copy of both guides then this would not be necessary. A copy of the homes terms and conditions and standard contract need to be added to the Service Users Guide. Information about services that are extra to the fees is included but more information is needed about how people pay for these services and if this would be different if the person is funded by another source other than themselves. This guide does contain a lot of very useful information about the routines of the home for people and their Representatives. The pre admission assessment for one person who has been admitted to the home since the last inspection was examined. This assessment contained information about this persons medical history, medication and their assessed needs. This assessment was not dated or signed by the person who completed it but evidence was seen to prove that this was completed prior to the person being admitted. Two letters were seen that the home sends to peoples representatives, one is about how the home can meet the assessed needs of the person and the other provides information about the home and asks if they would like to be involved with care planning. This is good practice. Three visitors to the home that were spoken with confirmed that they had chosen this home on behalf of their relative. Standard 6 does not apply to Miranda House as it does do not provide intermediate care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is mostly based on their individual needs, however care records are not always reflecting peoples current needs. The principles of respect, dignity and privacy are not always put into practice by all staff. People living in the home are at risk from poor procedures and a lack of consistency in the management of medicines in the home. Evidence: Four people who use the service were selected at random to have their care examined in detail. This includes reading care records, speaking to the person if able and observing them interacting with staff, speaking to their relatives if they were visiting and speaking to care staff. Some people were found to have different records to others for example one person had a front sheet that contained personal information and a photograph but the others did not. None of the four people had an ongoing assessment of need in place, therefore the home is not always able to make sure they have identified all peoples current care needs. However the company that manages Care Homes for Older People Page 13 of 31 Evidence: the home have devised an ongoing assessment form that the home must now implement. Care plans for all four people were examined, some were found to be very personalised and contained detailed instructions for staff to follow and others did not contain as much detail. Reviews of care plans were also inconsistent with some being reviewed monthly and others not being reviewed since July 2008. One person did not have a care plan in place to manage their wandering despite it being recorded a number of times in their daily records, care staff mentioning it happens every day and being observed during the inspection. Another persons care plans mentioned they get out of bed, and have a weekly shower but when discussing the care with staff they said they do not get out of bed. This needs to be updated. In one care plan it was written that the temperature of the bath should be checked using the staff members elbow, this is out dated unsafe practice and an appropriate thermometer must be used. One persons social activity care plan said they are on 24 hour bed rest but they were observed sat in the communal area with their family. Some care plans need information adding for example how many care staff are needed to meet peoples personal care and if they have continence needs, what aids are require. Care staff spoken with did demonstrate good knowledge of the four peoples care needs but care plans are not always reflecting what care is being delivered. The home has a key worker and named nurse systems in place. Risk assessments were in place for falls, moving and handling, pressure sores and nutrition. Reviews were seen of these but again it was inconsistent with some being reviewed monthly and others not since July 2008. One person had a care plan in place for a wound but it was not completed and no other records were in place to state how the wound was progressing or if it had healed. This is poor practice. A care plan for another person who uses the service was looked at in relation to their diabetes, it contained limited details about the management and the member of staff was using medical terms that not all staff would understand. Another person who was diabetic had their care plan examined and it contained full instructions on how to manage this. The Registered Manager said that the home has an information sheet that should be in peoples care plans if they are diabetic but this was only seen in one persons care records. One person had a Care Programme Approach (CPA) in place which details the care they required and the support they should have from external mental health professionals. This is good practice. Records were in place of external professionals that have visited people in the home and they include GPs, Chiropodists and reviews from peoples funding authorities. A number of visitors to the home were spoken with and some said they did not have any concerns about the care their relatives receive where as others said things had improved over the last couple of months. Our Pharmacist Inspector looked at the arrangements for medication in the home. We found that the medication administration records were generally clear and any changes to the original record were checked by two members of staff. Records were kept of all Care Homes for Older People Page 14 of 31 Evidence: medicines received into the home and sent for disposal. The medicines prescribed for people were all available. The medication that was given on the morning of the inspection was not signed for on the appropriate medication administration record and staff were seen to give medicines without reference to these records which increases the chance of errors. We saw some clear care plans to support staff in the administration of medicines prescribed as required, however these had not been written for all the people with these medicines. The recording of medication given on an as required basis was also not consistent. Some appeared to be given regularly without any evidence for its increased use being recorded. There was evidence that staff were not always fully aware of the appropriate use of some as required medicines. One medicine was seen to be given regularly, or omitted due to the person being asleep, when it was prescribed as required for anxiety. As there was no record of why this medicine was being given in this way, it was not clear as to whether it was being given in accordance with the prescribers instructions. The storage arrangements for medicines are not ideal for the size and type of home that Miranda House is. The cupboards are situated in the middle of a busy area with no escape from the distractions of staff, visitors or residents. The controlled drugs cupboards require appropriate bolts to ensure they comply with current legislation. Staff were observed speaking to people respectfully, however several mealtimes were observed and two members of care staff were feeding people whilst they were stood up. One of these members of care staff was feeding one person then started to help another person. This is poor practice and does not respect peoples privacy and dignity. It was also found during a tour of the home that seat covers used to protect seating in case a person is incontinent were placed on a number of communal seats. This is institutional poor practice and does not respect peoples privacy and dignity. With proper management of peoples continence needs they are not required and they can be an infection control risk if they are soiled and not removed immediately. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most people who use the service are able to make choices about their daily lives. However people are not being provided with adequate stimulation or activities to meet their recreational and social needs. Evidence: The home has 2 activities coordinators that work along side each other and cover different parts of the day. During both days of the inspection activities were provided but with group activities they are only able to include a small number of people due to peoples needs. Observations of the majority of people was that they are sat in communal areas with the television on and no other stimulation. No individual activities were witnessed. Visitors to the home said that the activities staff are very good but there is little stimulation for people when they are working due to the number of people in the home, and when they are not working. The homes Statement of Purpose states Our aim is to provide high quality nursing care that will, together with a day to day programme of agreed meaningful activity, enable the residents to maximize their independence, pursue personal development, meet their religious needs and to ensure that individual requests are met as much as possible in a shared living environment. The homes Annual Quality Assurance Assessment (AQAA) states Care Homes for Older People Page 16 of 31 Evidence: that activities is an area they want to improve on and they have some ideas they are looking to implement. The Registered Manager said that the home has a Church service every month that people from all religions can attend. A Catholic Church is in the same grounds as the home and if people or their relative request then the home can look at arranging a visit or for someone from the Church to visit the home. A number of visitors to the home were spoken with and all said there are no restrictions placed on what time they can visit. they also said the staff in the home always make them feel welcome. A number of rooms belonging to people were seen as part of the tour of the home and their personal belongings were on display. Staff were observed offering people choices and these included at mealtimes and when giving out hot drinks. Since the last inspection the home has appointed a new chef who has only been at the home for a number of weeks. He is still using the old menus devised by the previous cook but has plans to implement new menus very soon that will offer people more choices. Alternatives are offered and this was seen at one mealtime. Therapeutic diets are catered for. Health and safety checks are taking place but the home needs to maintain more detailed food records for example if it says on the menu cooked breakfast a record needs to be maintained of what was offered to people. Two mealtimes were observed one lunchtime and one evening mealtime. In the downstairs dining room people were brought to the table in wheelchairs but the footplates were not folded back and a person could potentially injure themselves on them. Staff were observed to quickly de-escalate any challenging behavior between people. The puddings were brought into the dining room not covered. The Registered Manager said they have ordered plate covers for mealtimes. Staff were observed assisting people with feeding, one member of care staff sat and explained to the person she was feeding what the meal was and gave them time to eat. This is good practice. However 2 members of care staff were observed assisting people stood up as mentioned in the previous outcome group. This is poor practice and must be stopped. People were observed eating and enjoying their meals. At the evening meal it was a concern that people were only offered a hot piece of quiche and a slice of bread. No vegetable or salad was offered and people who require a soft diet were given soup. The new chef said that more choices will be offered once the new menus are in place. Staff were observed offering people drinks at mealtimes and in between meals. Visitors to the home that were spoken with said the food provision is good. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People and their Representatives have access to a complaints procedure that makes sure they are listened to and acted upon, however not all records held in the home support this. The home has systems in place to help safeguard people who use the service. Evidence: The home has received 7 complaints since the last inspection. Four of these were investigated within the 28 day timescale. The home did not have records in place of all of the outcomes to these complaints and this must be addressed. The Registered Manager said that the home is about to display an updated complaints procedure. Visitors to the home that were spoken with all said that if they had any concerns or complaints they would approach the Registered Manager and they all felt she would take their concerns seriously. Most of the staff have completed the in-house POVA training. The home has plans to provide more sessions for staff with one being planned for in a couple of weeks time. The home has a copy of the local Councils No Secrets that has information about the local reporting procedures and copies of their referral forms were found in the office. Staff spoken with said they had received training and knew who to report any suspicions to. This inspection was brought forward to follow up on an anonymous allegation received Care Homes for Older People Page 18 of 31 Evidence: by the local Councils Adult Protection Unit. The allegation was that people in the home were being over sedated. We were not able to substantiate this allegation. The home has made two safeguarding referrals to the local Council. At the last inspection the home was required to have clear guidance for the management of people with challenging behavior. The Registered Manager said the home has a policy but they were not able to locate this during the inspection. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service do not live in a well-maintained environment and the actions of some staff could place people at risk. Evidence: A tour of the environment took place with the Registered Manager and a number of rooms belonging to people were seen. The home is set over 2 floors and is secure to enable people to wander safely. All rooms have en-suite facilities and three rooms are classed as double rooms. Each floor has several communal rooms and on the top floor the home has made a laundry area where people can hang clothing and fold items and an ironing board. The Registered Manager said that a number of people use this area. The main entrance to the home was very odorous on both days of the inspection however from speaking to two visitors they said this is not normally the case. The corridor that leads to the bedrooms and conservatory from the main entrance is uneven and the home is in the process of addressing this and they are also fitting a new fire door at the other end of this corridor. The carpets in the main corridors are heavily stained in places which does not make a good impression of the home. The Registered Manager said they are due to be replaced but this needs to be done very soon. On checking a number of bathrooms and toilets some items were found that had been left which could potentially place people who use the service at risk. These included Care Homes for Older People Page 20 of 31 Evidence: bars of soap, a razor and jar of one persons prescribed cream. A bag of soiled linen was found left on the floor in one bathroom, which is poor practice and an infection control risk. The staff toilet upstairs had no soap and the hot water tap was not working. The maintenance man had left his tool box unattended in one room, where the person was sat, again this could have placed this person at risk. Room 28 the door closure was not working properly and in room 29 the reset button for the call bell was hanging off the wall which was exposing the wiring. The screening in room 16/17 is not sufficient to maintain the privacy of people who live in this room. The home appeared to have limited storage space as hoists were being stored in peoples rooms and bathrooms. However their Statement of Purpose says the home is generously provided with store rooms. Some baths were not working and were waiting to be repaired. The home has a snoozelen room however a visitor said they have never seen it used. Some relatives spoken with feel there are areas in the home that need re-painting to include peoples rooms. Staff were observed wearing protective clothing when required. The laundry area was also seen and one of the assistant explained that the home has a policy and procedure for the management of soiled linen. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is confident that their staffing numbers meet the assessed needs of people who use the service and staff have access to a training programme to improve and maintain their skills. However some staff are not always putting this training into practice. Evidence: The staffing levels were discussed with the Registered Manager who said she is confident that the needs of people who use the service are being met. Ancillary staff are available to support the care staff. The home does use agency staff when the need arises. Relatives of people who use the service who were spoken with all felt that the staff are caring and very good. They also felt that the staffing levels have improved in the last few months as there has been times when no staff were in the communal areas and people have been left unsupervised. Staff spoken with all said they enjoy working at the home and the staff team work well together. The Registered Manager said that the home has just over the recommended 50 of care staff with an NVQ 2 or above in Health and Social Care. The personnel files of three staff that have been appointed since the last inspection were examined. The home had obtained all the required recruitment checks except in Care Homes for Older People Page 22 of 31 Evidence: the case of two members of staff where a full employment history was not in place. The systems the home has in place for induction training were examined. All new staff start their induction training on the homes e-learning and this covers a number of topics in theory. The home has an in house moving and handling trainer and the maintenance person trains the staff in fire and health and safety. Once completed the member of staff then undertakes the induction training based on the common induction standards devised by Skills for Care. All new staff are mentored by the qualified nurses. One qualified nurse confirmed she mentors new members of staff. The home has a training matrix in place that lists when all staff have completed training and when an update is due. The Registered Manager or training manager book staff onto courses. Each member of staff has their own training folder that contains copies of their certificates and several were seen. The home has a training board that contains details of the next training courses and staff can put their names down. The Registered Manager said that once the mandatory training has been completed dementia training in yesterday, today and tomorrow will start. Staff spoken with confirmed they have access to training and were able to list a number of courses they have recently completed. One qualified nurse confirmed that training specifically to help maintain their registration is provided. All qualified nurses are appointed first aiders. Even though staff have access to training some of their actions witnessed during the inspection could potentially place people who use this service at risk and does not always promote peoples dignity. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is undertaken by a competent person, however the home is not always run in the best interest of the people who use the service. Evidence: The Registered Manager has been running this home for a number of years. She is a Registered Mental Health Nurse and has completed the Registered Managers Award. She undertakes training along with the other staff and said she has recently attended a conference about dementia. Relatives and staff spoken with all said she was approachable and would listen and act upon any concerns they might have. The systems the home has in place for quality assurance were examined. The company that manage this home complete 6 monthly audits and the Registered Manager is due to complete the next one. The audit that was completed in January this year was seen. Monthly auditing of certain areas was also seen. Regulation 26 visit Care Homes for Older People Page 24 of 31 Evidence: reports were read. The Registered Manager said that on a yearly basis questionnaires are sent to people who use the service where able, their relatives, staff and other stakeholders to obtain their views on the services provided by the home. Last years results were seen and the home is due to send out questionnaires for this year. Since the last inspection the home has put in place a safe system for managing peoples monies. Two were randomly selected to be checked against the records and all was correct. The systems the home has in place for supervision of staff were examined. The Registered Manager said she undertakes the supervision of the qualified staff and they undertake supervision of the care staff. None of the qualified staff have received training in supervising staff. Several randomly selected staff files were examined and it was found that in some cases care staff had not had supervision since April 2008. There were no records of any supervision taking place for ancillary staff. This area needs to be addressed urgently following this inspection due to the actions of some of the staff. Records relating to ongoing maintenance, servicing and checks of equipment in the home were seen. The home is about to implement their fire risk assessment and they must devise an evacuation procedure immediately to safeguard people who use the service. Care Homes for Older People Page 25 of 31 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 7 15 Each service users plan of 31/10/2007 care and associated records must set out the actions to be taken to meet all their needs, and must be updated to reflect changes. Service users must have all healthcare needs fully assessed, with suitable guidance to address any identified risks. 31/10/2007 2 8 12-11415 3 16 17-2Sch41117-3b Records must be kept of all 08/10/2007 complaints and the actions taken by the persons registered in response. Such records must be kept in the home and available for inspection at all times. 31/10/2007 4 18 12-113-6,7,8 There must be clear, objective guidelines for staff management of potential disturbed behaviour from service users. Care Homes for Older People Page 26 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5 The home must update their 05/01/2009 Service Users Guide as listed in this Standard. This will help to provide people and their representatives with information about the services offered by the home. 2 1 4 The home must update their 05/01/2009 Statement of Purpose as listed in this Standard. This will help to provide people and their representatives with information about the services offered by the home. 3 2 5A The home must provide people with the information required in relation to the breakdown of fees. This will help to make sure that people and their representatives have access 05/01/2009 Care Homes for Older People Page 27 of 31 to information about the fees charged by the home. 4 9 13 Staff giving medication that has been prescribed on an as required basis must follow relevant guidance for its use and record the use appropriately. This will ensure that all medication is given safely and in accordance with the prescribers instructions. 5 9 13 All medication must be 10/11/2008 signed for on the medication administration record at the time of administration. This will ensure that an accurate record is available at all times of all medication given. 6 9 13 Rag or Rawl bolts must be 15/12/2008 used to secure the controlled drugs cupboard to a solid wall. This will ensure that it complies with The Misuse of Drugs and Misuse of Drugs (safe custody)(amendment) Regulations 2007 7 10 12 The home must make sure that the actions of staff do not impact on people who use the service. This will help to make sure that people who use the service have their privacy, dignity and respect maintained by staff. 28/11/2008 28/11/2008 Care Homes for Older People Page 28 of 31 8 15 16 The home must make improvements to their activities provision to make sure all people are provided with stimulation and activities. To make sure all people in the home have access to meaningful recreational activities. 31/12/2008 9 19 23 The home must address the environmental issues identified in the report. This will help to make sure that people live in a well maintained environment. 17/01/2009 10 19 13 The home must make sure that the actions of staff do not place people at risk. This will help to make sure that people live in a safe environment. 28/11/2008 11 26 13 The home must make sure 28/11/2008 that staff have an awareness of infection control procedures to reduce any risks to people who use the service. This will help to make sure that people who use the service are not put at risk by the actions of staff. 12 29 19 The home must make sure that all the required recruitment checks have taken place prior to a new member of staff starting work at the home. 19/12/2008 Care Homes for Older People Page 29 of 31 This will help to safe guard people who use the service. 13 36 18 The home must devise a system to make sure all staff are appropriately supervised. This will help to make sure that the staff are competent to meet the needs of people who use the service. 19/01/2009 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 1 The home should remove the following heading in their Statement of Purpose methods of control and discipline as it could indicate they use punishment for people who have challenging behavior. The home should consider providing people with written information about how they manage the Funded Nursing Care contribution (FNC) payment. Consideration should be given to the arrangements for the storage of medication so that they allow staff to work in an environment that is both secure and free from distraction. All staff that supervise other staff should receive training in this area. 2 2 3 9 4 36 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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