Inspection on 09/01/09 for Moorhouse

This inspection was carried out on 9th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

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 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Moorhouse Tilford Road Hindhead Surrey GU26 6RA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Suzanne Magnier     Date: 0 9 0 1 2 0 0 9 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. that people have said are important to them: They reflect the things 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 34 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 34 Information about the care home Name of care home: Address: Moorhouse Tilford Road Hindhead Surrey GU26 6RA 01428604381 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ashberry Healthcare Ltd. Name of registered manager (if applicable) Ms Sharon Egan Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 36. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Moorhouse was registered with the Commission for Social Care Inspection in August 2008 to provide accommodation with nursing for thirty six service users following the purchase of the registered establishment by Ashberry Healthcare. The property is located in a village setting close to public amenities and other facilities. Accommodation is on three floors accessed by stairs or a lift and comprises of an office, lounges, dining area, kitchen, bathrooms, toilets, a laundry room and bedrooms are either single or shared with some having en-suite facilities. The home has an Care Homes for Older People Page 4 of 34 care home 36 Over 65 36 0 Brief description of the care home attractive garden which is private and secure with wheelchair access. Private parking is available. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The Commission for Social Care Inspection CSCI has since the 1st April 2006 developed the way it undertakes its inspection of care services. This inspection of the care home was the first since the home had been purchased by Ashberry Healthcare and was granted registration by the CSCI in August 2008. The inspector looked at and assessed how well the service was meeting all the National Minimum Standards for Care Homes for Older People and has in this report made judgements about the standard of the service. Care Homes for Older People Page 6 of 34 Ms S Magnier Regulation Inspector carried out the inspection, which lasted for seven hours commencing at 11.00 hours and concluded at 18.00. The registered and deputy manager represented the service. The CSCI Inspecting for Better Lives IBL involves an Annual Quality Assurance Assessment AQAA to be completed by the service, which includes information from a variety of sources. This initially helps us to prioritise the order of the inspection and identify areas that require more attention during the inspection process. This document was received by CSCI and is referred to throughout the report. Thirty seven residents currently receive care and support at the home and as part of the inspection process the pre admission assessment procedures were discussed to ensure that people admitted to the home are assured that the homes staff can meet their needs. The majority of the residents spoken with were able to express their thoughts and feelings about the care they receive. The information contained in this report was gathered mainly from observation by the inspector, speaking with a number of residents and their relatives who were visiting, the care staff and from information contained within the AQAA. Further information was gathered from records kept at the home and written comments received from residents and others associated with the home. The homes staff comprise of the registered and deputy managers who are registered general nurses, registered general nurses who take charge of the shifts, care assistants, catering, maintenance and housekeeping staff. A full tour of the premises was undertaken and documents sampled during the inspection included the homes Statement of Purpose and Service User Guide, care plans, daily records and risk assessments, medication procedures, health and safety records, staff training and recruitment records, and some of the homes policies and procedures. The final part of the inspection was spent giving feedback to registered and deputy manager about the findings of the visit. Since the home was granted registration the commission have been made aware of one concern which was referred by the commission to the service to investigate and one safeguarding vulnerable adults referral identified during the inspection which was reported and concluded satisfactorily by the local authority following the inspection. From the evidence seen by the inspector it is considered that the home would be able to provide a service to meet the needs of clients who have diverse religious, racial or cultural needs. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 Care Homes for Older People Page 8 of 34 240 7535. Care Homes for Older People Page 9 of 34 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 34 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. Well written information regarding the services provided by the home is available and opportunities of visits to the home for prospective residents and their representatives is arranged in order that they can make an informed choice about moving to the home. The admission and assessment procedures ensure that residents needs are appropriately identified and met. Formal written contracts regarding the terms and conditions of residency at the home need to be strenghenned. Intermediate care is offered. Evidence: The homes Statement of Purpose and Service User Guide were well documented to inform prospective residents and their representatives about what the home offers, the management and staffing structures of the home, the accommodation and services available, the staff members level of training and how people could complain if they Care Homes for Older People Page 11 of 34 Evidence: were unhappy with the service provided. The registered manager acknowledged that some minor changes needed to be made to the documents with regard to the recent changes to the homes ownership. Five residents care plans were sampled and it was noted that four of the care plans did not contain formal contracts to describe the arrangements for payments of fees and what the costs are regarding the care and accommodation provided at the home including any additional fees. The registered manager showed the inspector documentation which confirmed that one resident had recently been admitted to the home and for another resident there had been involvement by the homes management regarding the formation of the residents contract. The residents contract in place which was sampled during the inspection described the arrangements for payments of fees and what the costs are for the care and accommodation provided at the home including any additional fees. It was evidenced that the home were aware of the shortfall with regard to residents contracts and had developed a short term contract for individuals receiving respite care at the home. It has been required that all residents at the home are provided with a standard form of contract for the provision of services and facilities by the registered provider. All the care plans sampled during the inspection contained good information to confirm that the individuals needs had been assessed prior to being admitted to the home. The registered manager and deputy manager confirmed they undertook the assessments and demonstrated that they have the appropriate ability and qualifications to undertake the assessment prior to an individuals admission to the home in order to ensure that the homes staff could meet the individuals care and support needs. The registered manager advised that the home work closely with other health care professionals with regard to the pre admission assessments and as much information is gathered about the individuals need prior to the moving into the home. Visitors to the home confirmed that they and prospective residents had been offered the opportunity to visit the home prior to admission. A trial period, which includes the ongoing assessment of the residents needs is arranged following admission to the home and every effort is made to help the resident feel settled in their new environment and feel included in their admission to the home. Intermediate care is currently offered by the home. The AQAA completed by the home identified improvements within the documents, which includes updating and changing the format of the pre admission assessment to Care Homes for Older People Page 12 of 34 Evidence: include a wider range of questions. Care Homes for Older People Page 13 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are offered a good provision of health care and personal support by the home. Care is administered in way that protects the individuals privacy and dignity and the monitoring of risk assessments is maintained to ensure the safety of people in the home. Care planning and medication procedures are robust. End of life choices and preferences are promoted to respect residents wishes. Evidence: The five care plans sampled had been developed from the pre assessment documentation and included the residents care and support needs. The care plans were well written to allow the reader to gain an overview of the residents cultural and ethnic diversity, medical, social and personal care needs, lifestyle preferences and included the individuals complexities in communication and behaviours which may test the service. The registered manager was aware to ensure that all care plans are signed by the Care Homes for Older People Page 14 of 34 Evidence: resident or their representative, that care plans are dated, and the plans kept under review to reflect any changes in the residents care and support needs. The care plans were developed from a person centred approach and included each residents health profile, nursing and dietary requirements including screening tools, body weight charts which are monitored regularly to indicate weight loss or gain, skin integrity, safe moving and handling procedures, the residents current mobility, communication and sensory abilities, medication requirements, specialist care, and day and night time choices and preferences. There was clear documented evidence that regular and appropriate health care appointments including visits by the General Practitioner or by visiting the local health care services had been attended. Whilst speaking with residents it was evident that the home maintains good working partnerships with health care professionals which include visits from the chiropodists and physiotherapists to ensure that residents health care needs continue to be met. Written omments received by the commission from health care professionals included The care service provides a pleasant dignified environment for residents to enjoy and live in. The staff are kind and freindly and form meaningful relationships with residents. They monitor each client regularly and will ring if anything outstanding or they are concerned. They work closely as a team and the GP and my requests are carried out appropriatly and in a timely response. The care plans are constanly being updated. Verbal and written reports are detailed with helpful input across the multi disciplinary team. Care records were professionally written and well maintained to reflect the individuals needs and care provided by staff. The risk assessments sampled were robust in identifying hazards in individuals lives and detailed what actions staff would take to minimise the risk of harm in order to keep the individual safe. The risk assessments were reviewed in order to reflect any changes in the residents care and support needs to ensure their safety and welfare. Other risk assessments were seen and considered to be appropriate in order to promote independence whilst ensuring the individuals safety and wellbeing. The home has a medication policy and procedure in place and has been supplied with a monitored dosage system. The nurse in charge showed the inspector that the home has good, clear procedures in place for the monitoring and recording of all medicines administered and those entering and leaving the home. Records of controlled medication were sampled and checks made were accurate. Some medication Care Homes for Older People Page 15 of 34 Evidence: administration charts were seen which were well documented and were clear to ensure that residents received their prescribed medicines. It was confirmed that only qualified staff administer medication in the home. It was noted that some residents were prescribed medication to be given as required. Whilst speaking with the deputy manager it was confirmed that there are clear protocols to indicate that all reasonable and safe measures have been taken before the medication has been administered to safeguard the resident and staff from any allegations of harm and abuse. The nurse in charge explained that residents have a right to refuse their medication and told the inspector that the home promotes peoples rights to independence and where possible following assessments people would be supported to manage their own medication. Visitors to the home stated that staff members are very caring, kind, welcoming and friendly to residents and visitors. It was observed that residents responded favourably to staff and the staff demonstrated a knowledge and understanding of the residents welfare and support needs. Throughout the day the inspector observed that residents were addressed in a polite and courteous way by staff. The home have a policy regarding death and dying and the registered manager and deputy confirmed that residents and their representatives wishes regarding the residents final affairs are addressed sensitively. The managers demonstrated that they are aware of the Gold Standard Framework Programme in order to support residents and their representatives in the well planned provision of end of life care within the home. Care Homes for Older People Page 16 of 34 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 able to make choices about their daily routines and enjoy and choose from a range of activities offered by the home. Visitors are welcomed to the home to maintain contact with their family members. The home provides a healthy and balanced diet in a pleasant spacious dining area. Evidence: The home promotes an activities programme which includes a range of activities and entertainment for residents and it was evident through observation that residents are asked if they wish to attend activities demonstrating preference and flexibility of the homes routine. Records of the activities or meaningful engagements of residents were well documented in a diary and there was evidence by speaking with residents that they were informed of the homes daily and weekly activities. Visitors to the home confirmed that there are a variety of activities available in the home and that staff are flexible in allowing residents to choose the level of activities they attended. All the visitors spoken with during the inspection spoke highly of the home and the staff and confirmed they were welcome to come and go in the home as Care Homes for Older People Page 17 of 34 Evidence: they chose. Several residents told the inspector that the activities included physical exercises, visiting places of interest, using the local Hoppa bus and local transport hire firm for group outings, and attending local day centres. Residents confirmed that staff were involved in arranging the activities and social events within the home and enjoyed the visits from the hairdresser and having a beauty therapist available if they would like to have a pampering session. Written comments received by the commission about the purposeful activities provided in the home stated People are encouraged to go out on trips and visits out. Choice of meals and activities are given. The pianist who came l;ast week was very good. Things like Bingo and quizzes are not my cup of tea. Various activities take place on weekday afternoons and are only missed when the relevant member of staff is away. Sometimes there is a shortage of activities or things to do which you can be interested in. Activities are available but I choose not to take part because I cannot see or hear very well. Im quite happy no complaints. The AQAA advises that wireless internet access is available for residents who have computers and links have been maintained with the clergy who are free to visit the home and support residents spiritual and religious needs. The midday meal served at lunch time was well presented with each resident, where able, being supported to sit up to a dining table to have their meal. The dining room was bright and spacious with appropriate crockery,condiments, napkins and centre piece available on each table. A menu was available in the home for residents to see what was on the days menu. Several residents said that they enjoyed the food served yet felt that the standard and quality of food had gone down following the change of the ownership of the home. Written comments regarding the quality of the meals served were varied with most of the thirteen surveys received stating the the meals were good. Several residents confirmed that the evening meal was invariably cold and this had been raised with staff. The AQAA advises that the service are planning to make further changes as a result of listenning to people regarding updating the menu to make meal times a little more interesting and enjoyable for residents and it is recommended that attention be given to residents comments regarding the standard of the evening meal. Staff were attentive to residents during the meal time and meals were served courteously. Residents were observed to be given choice to have their meals in their bedrooms if they wished to. It was confirmed that residents food intake is monitored and measured where necesarry in order to ensure that individuals nutritional needs were met. Care Homes for Older People Page 18 of 34 Evidence: Care Homes for Older People Page 19 of 34 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. The residents rights to protection must be strenghenned by the homes complaints and safeguarding adults procedures. Peoples legal rights are protected. Evidence: The home has an established complaints procedure. The manager advised that all complaints received by the home are fully investigated and that records are kept by the home to evidence this. One concern had been reported to the commission since the home was granted registration and the commission advised that the matter should be raised with the homes management. Whilst speaking with several residents they confirmed they were unsure what the procedures were to raise a formal complaint and that they rarely had resident meetings in which to raise their concerns and views. It was evident during the tour of the premises that the homes complaints procedures were not displayed within the home. The manager confirmed that residents receive the complaints procedures with the Statement of Purpose and the Service User Guide yet agreed it would benefit residents and other people visiting the home to have access to the complaints policy and procedures in order that any concerns, complaints, opinions and views of the homes services could be addressed by the home. The inspector was assured that the complaints procedures would be displayed within the home and that Care Homes for Older People Page 20 of 34 Evidence: residents meetings were under discussuin to be arranged in order to ensure that all people associated with the home are given opportunities to raise their concerns or complaints which can then be addressed promptly. The home has a copy of the Surrey County Council Multi-agency Procedures for Safeguarding Vulnerable Adults. The home has an in house protection of vulnerable adults policy and procedure which it was noted did not clearly detail the lead responsibility of the local authority multi agency safeguarding team. During the sampling of one residents care plan it was noted that an incident which involved an allegation had not been reported at the time to the local authority safeguarding team. The manager was proactive in reporting the incident during the inspection and following the inspection the CSCI have received confirmation from the local authority that the matter would not be progressed. Three staff files sampled indicated that safeguarding vulnerable adults training is included within the homes induction programme and several staff spoken with during the inspection confirmed that they would report any allegations of abuse or harm to the manager. The manager assured the inspector that arrangements will strengthenned to ensure that safeguarding policies and procedures are updated and clear lines of accountability and reporting procedures are in place in order to safeguard residents from abuse and harm. The manager demonstrated an awareness of the Mental Capacity Act and the home recognise residents rights to participate in the political process if they choose to. The home have a cause of concern form and there are policies regarding not using any form of phyiscal intervention or restraint. There are clear guidelines regarding the documented agreed use of bed rails in order to ensure the safety and welfare of residents. The home have a whistle blowing procedure and records sampled indicated that Criminal Record Bureaux checks CRB and Protection of Vulnerable Adult POVA checks are carried out on all new staff. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical layout and indoor and outdoor communal of the home enable people who use the service to live in a safe and well maintained environment. Residents independence is promoted and maximised using specialist equipment. Individual bedrooms suit residents needs and the communal bathrooms and toilets are adequate in number. All areas of the home are clean and hygienic. Evidence: The homes environment creates a pleasant home for residents and is equipped to support people who use wheelchairs or other mobility aids. All rooms are fitted with a call bell system in order that residents can summon assistance from staff. The homes indoor areas are well maintained and furnished to a high standard. The lounge areas and small annexes include armchairs, settees, which are assembled into small clusters to enable residents to meet in small groups if they chose to. Attractive soft furnishings of carpets, curtains and homely ornaments had been tastefully considered. The lounge area offers leisure and recreational facilities for residents and includes a television, books, magazines, daily papers and facilities for residents to listen to music. Care Homes for Older People Page 22 of 34 Evidence: An area within the home is also available for residents and their representativies to make beverages. The dining areas are well equipped and offer a comfortable and attractive area for residents to enjoy their meals. Written comments received by the commission regarding the homes environment included They create a homely environment with welcoming atmosphere. The home is clean and well presented. One bathroom was out of order and there was evidence to support that the defect had been reported. The manager explained that arrangements were underway for a new specialist bath to be installed and residents had access to other bathing facilities within the home. The laundry and lavatory facilities were viewed as suitable for the current needs of the residents. The AQAA advises that improvements are planned for toilet and sluice facilities on the ground floor which will benefit residents. Outdoor communal areas include an accessible garden, which contained wide pathways, objects of interest, bird feeders, sensory and aromatic plants and attractive sturdy garden furniture which residents could use. The corridors of the home are wide and suitable for residents who use wheelchairs. The facilities are well equipped with aids and adaptations and are clean and spacious to provide support and care for residents. The home have a stairlift and also a shaft lift. Residents spoken with said that they liked their bedrooms, which were viewed during the tour of the premises to be clean, well decorated, furnished with a high standard of furnishings and were personalised. Prospective residents are encouraged to bring their own small items of furniture if they choose to. The home has an infection control policy in place and staff are trained and aware in infection control procedures and were observed adhering to infection control measures for example wearing protective clothing, washing their hands and using hand gels to prevent the spread of infection in the home. There is a daily cleaning schedule in place and the home was clean and odour free throughout, which also included the homes main kitchen. Visitors and residents commented that the standard of cleanliness and hygiene was very good. A handy person is employed to ensure that the home is well maintained. Care Homes for Older People Page 23 of 34 Care Homes for Older People Page 24 of 34 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. Staff are in sufficient numbers to support the people who use the service. The homes recruitment, training and induction programmes need to be strenghtenned to ensure that residents are protected from harm and abuse and their needs are met appropriately and safely. Evidence: The home is currently supporting 35 residents and have a total of 30 care staff which include several registered general nurses, care assistants, bank staff, catering staff, a handy person and the housekeeping staff. The staffing numbers on the day of the inspection were observed to meet the current needs of the residents and staff were at hand promptly to support residents who required immediate assistance. Visitors to the home on the day of the inspection spoke highly of the staff and how friendly and welcoming the home was. Written comments received by the commission regarding the staff were varied and incliuded There are attentive and experienced staff and a good number of staff on duty Staff always listen but sometimes need several reminders before action is taken. Quite often seem to be short staffed particularly at weekends. I only have to ring my Care Homes for Older People Page 25 of 34 Evidence: bell and someone attends even in the middle of the night. The staff are very friendly. There are one or two foreign staff that I find very difficult to understand. I think that more training is needed for junior staff or recent arrivals on how to clean thoroughly, particularly the bathroom, and how to bath an elderly person. Laundry is not always back quickly enough after cleaning. My hearing aids are not always put in for me. Overall the staff are always polite and very patient. It was observed that the home employs a multi cultural workforce and equality and diversity issues are addressed within the homes polies and procedures and induction programmes. The inspector sampled three staff recruitment files. Two of the three staff files evidenced that the homes management need to strenghten the safe vetting practices concerning the recruitment of staff in order to ensure the safety and protection of people living in the home. The shortfalls identified included the lack of robust references, no statement as to the applicants mental and physical health and on one file scant information on the application form. It has been required that the homes management of the recruitment of staff be more robust in order to ensure the safety and protection of residents. The three staff mandatory training records were sampled and evidenced that there was a lack of evidence to support that two of the senior staff had undertaken some mandatory training courses and one staff member had not undertaken the homes induction programme. It has been required that all staff undertake a full induction and necessary statutory training in order to ensure they have the necessary skills and knowledge in order to ensure that they are suitably trained and competent in their duties. The AQAA advises that the service staff have achieved a fifty percent achievement level of the National Vocational Qualification NVQ in Level 2 or above. The home had a relaxed atmosphere and staff were observed to undertake their tasks in a quiet and orderly manner. The inspector observed staff interactions with residents all of which were supportive and friendly. Written comments received by the commission from staff about the home included The care plans are an excellent way of accessing information, Training days are always available. There is a very caring atmosphere with a right blend of informality with service users and relatives to make all feel comfortable and able to discuss problems, feelings at any time without comprimising acring aspects. We are constantly being offered the opportunity to attend courses and are encouraged to do Care Homes for Older People Page 26 of 34 Evidence: so. We work well as a team when anyone is off work at short notice. We provide a warm friendly environment for residents, staff and visitors. We serve good meals and cater for residents needs. I have worked here for many years because I am happy with my job, treating all residents like family and feel the service does everything it can to make residents feel at home. Matron and the sister in charge always make sure there is enough staff to cope with the work. Matron is always very good about updating us with any information. We can talk to our manager at anytime with concerns or questions regarding our committment of care to service users. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The day to day management of the home is robust. Residents are consulted regarding the running of the home and their financial interests are safeguarded. The health and safety of residents needs to be more consistent in order to ensure their safety and well being. Documentaion of senior staff supervision needs to be implemented. Evidence: The registered manager demonstrated competency and knowledge in the running of the nursing home and of her role and responsibilities as a registered manager. The manager has fifteen years management experience and holds the NVQ Level 4 Registered Managers Award qualification. During the inspection a discussion was held regarding the additional responsibilities the registered manager has acquired since the new ownwership and registration of the home in August 2008. The manager acknowledged that some of the shortfalls identified during the inspection were in areas of management that she had not been previously involved in and would as a matter of priority address the shortfalls without delay. Care Homes for Older People Page 28 of 34 Evidence: During the inspection she discussed the needs of the residents and demonstrated a good understanding of differing needs of older people and the support and care required through a person centred approach to care planning. It was observed that her management style was open and approachable and acknowledged that all peoples views and opinions associated with the service should be listened to and acted upon where appropriate. The manager confirmed that quality assurance processes within the home need to be strenghtenned and are part of the service plan for the coming year. The inspector was informed that the Regulation 26 visits take place and any shortfalls in the quality of the service would be noted by the organisation during the Regulation 26 visits, so that appropriate action could have been taken to rectify the shortfalls. There were clear lines of management accountability during the day of the inspection and staff demonstrated an understanding of their roles and responsibilities. All persons spoken with during the inspection spoke highly of the abilities and knowlegde of the manager and her open approach and the staff morale was good. Written comments received by the commission regarding the management of the home included I regularly discuss situations with our manager who is always accessible either in house or by phone. There is a very good atmosphere in the home. As far as it is possible individual preferences of the service users are implemented to make the nursing home as comfortable and homely as possible. A high standard of care is maintained and access to the manager is available at all times. I was very apprhensive before coming here and I am a relative new comer but I am very happy living here. The care service identifies and respects the individual needs of their residents and makes their friends and relatives welcome but does not compromise their privacy. An improvemnt would be to get a secrectary or a telephone receptionist. As far as I can see this nursing home would be very hard to find anything that could be improved. If I were to go into a nursing home this is the one I would choose. Some residents financial records were sampled and these were well recorded and clear in evidencing that appropriate safekeeping and regular auditing of the accounts was undertaken in order to safeguard residents from financial abuse. The policies and procedures of the home and organisation were sound, and kept under review. Staff demonstrated that they were aware of the core policies and procedures of the home, which included the health and safety policy to ensure that the welfare Care Homes for Older People Page 29 of 34 Evidence: and safety of all persons in the home is promoted. The manager confirmed that staff receive formal supervision yet agreed that improvements in the recording of supervisions need to be implemented as two of the senior staff files sampled contained no documentation to evidence that formal supervision had been undertaken. Records indicated that fire safety equipment and records were documented and equipment serviced. The sluice and laundry areas were noted to be clean and tidy. The home have maintained records relating to water temperature checks and it was noted that in several bathrooms the water temperatures exceeded the required levels which was also confirmed by the deputy manager. The home took prompt action to report the shortfall and it has been required that the homes staff must make more robust arrangements to ensure that residents are protected from harm when using the bathing facilities. During the tour of the premises it was noted that in a sluice room chemicals had been left on the window ledge and not stored correctly and were removed promptly by staff. It has been required that all chemicals must be stored in compliance with the Control of Subtances Hazardous to Health COSHH guidance in order to protect residents from harm. The home has the required gas safety and electrical certificates available in the home and a current insurance indemnity certificate. The inspector re affirmed the procedures that the home must report any incidences to the CSCI under Regulation 37 notifications of any event that affects the well being and welfare of residents in the home. Care Homes for Older People Page 30 of 34 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 31 of 34 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 2 5 Arrangements must be made that all residents are provided with a standard form of contract for the provision of services and facilities by the registered provider. In order to ensure that residents or their representativies are fully informed about their rights and services provided by the home. 14/03/2009 2 29 19 Arrangements must be made to strengthen the homes management of the recruitment of staff. 14/03/2009 In order to ensure the safety and protection of residents. 3 30 18 Arrangements must be made that all staff undertake a full induction and necessary statutory training. 14/03/2009 Care Homes for Older People Page 32 of 34 In order to ensure they have the necessary skills, knowledge and are suitably trained and competent in their duties. 4 38 13 Arrangements must be made that all chemicals must be stored in compliance with the Control of Subtances Hazardous to Health COSHH guidance. In order to protect residents from harm 5 38 13 Arrangements must be made to ensure that safe bathing procedures are robust. 14/03/2009 14/03/2009 In order to protect residents from harm when using the bathing facilities. 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 15 It is recommended that attention be given to residents comments regarding the standard of the evening meal. Care Homes for Older People Page 33 of 34 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. 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