Inspection on 22/12/08 for New Forest Nursing Home

This inspection was carried out on 22nd December 2008.

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

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

Other inspections for this house

New Forest Nursing Home 19/12/06

New Forest Nursing Home 10/01/06

New Forest Nursing Home 02/11/04

New Forest Nursing Home 22/06/04

New Forest Nursing Home 28/05/03

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: New Forest Nursing Home Fritham House Fritham Lyndhurst Hampshire SO43 7HH     The quality rating for this care home is:   three star excellent 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: Gina Pickering     Date: 2 2 1 2 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. 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 29 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 29 Information about the care home Name of care home: Address: New Forest Nursing Home Fritham House Fritham Lyndhurst Hampshire SO43 7HH 02380813556 02380813920 Bernie.kuropa@sentinel-healthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sentinel Health Care Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 48 Number of places (if applicable): Under 65 Over 65 48 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 48. The registered person may provide the following category/ies of service only: Care home only - Nursing 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 Physical disability - PD Date of last inspection Brief description of the care home The New Forest Nursing Home is a former large country house, which was converted for use as a care home by the previous owners. It is owned by Sentinel Healthcare Ltd, and is one of four nursing homes owned by the company that are located in Hampshire. The home is set in the attractive New Forest surroundings of Fritham village. The accommodation is arranged on two levels with the upper floor beings accessed by passenger lift. There are thirty-eight single and five shared rooms, Care Homes for Older People Page 4 of 29 Brief description of the care home twenty-four of which have en suite facilities. It has several communal areas, with three sitting rooms and two dining rooms. There is also a courtyard garden and large attractive grounds, which are accessible by the residents. Facilities and service provided by the home include assisted baths, a laundry service and full board. Public transport is accessible as the home is located on a bus route, although the service is infrequent because of the homes rural situation. The home has a minibus, which is often in use to provide opportunities for the people living at the home to go on outings and use amenities in the local community. The home is presently without a manager, the previous manager having left employment in the beginning of December 2008. The home is being managed by the Director of Care for Sentinal Health Care Ltd with the support of the Director of the company and staff at the home. Wehave been informed a new manager has been recruited who will commence employment in February 2009. We have been told that the current fees are five hundred and twenty to eight hundred and fifty british pounds per week and are based on the level of care needed and the size of the bedroom that is occupied. Items not covered by the fees include chiropody, aromatherapy, hairdressing and varied amounts for newspapers, toiletries and personal telephone bills. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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 inspection considered information received by the Commission about the service since the last key inspection in December 2006. This includes information provided to the commission in the form of the homes Annual Quality Assurance Assessment in which the manager told us about how the service has developed over the past twelve months and how they propose to continue to develop the service. The manager who completed the AQAA has since left employment at the home and the home has recruited a new manager to commence employment in February 2009. We surveyed people who use the service, staff and health care professionals who have input into the service. We received seven surveys from people using the service and nine surveys from staff members. Information received from these surveys has been Care Homes for Older People Page 6 of 29 used to inform the inspection process. A visit was made to the service on 22nd December 2008. We looked at documentation relating to four people using the service. We had conversations with the Head of Care for the organisation, one of the directors, three staff members, five people who live at the home and four visitors as well as looking at various documentation as part of the inspection process. 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. Care Homes for Older People Page 8 of 29 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 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessment procedures that include the provision of good information about the home mean people move into the home confident that the home can provide the support and care they need and with an understanding about the running of the home. The home does not provide intermediate care. Evidence: The AQAA told us information about the service provided by the home is provided to interested people in the form of the statement of purpose and service users guide and that this information can be provided in large print and on coloured paper. We looked at these documents when we visited the home. The statement of purpose contains all required details and clearly states what services are provided by the home. The service users guide contains a summarised version of the information provided in the statement of purpose, a copy of the summary of the last inspection report by CSCI and sample copies of terms and conditions of residency at the home. The head of care, Care Homes for Older People Page 11 of 29 Evidence: who assisted throughout the visit to the home, provided us with samples of information provided in large print and on coloured paper making informations easier to read. She also confirmed that if needed the information can be provided in alternative formats including audiotapes. Information about the home is also available on the registered providers website. Responses we received from service user surveys and conversations with relatives and people living at the home indicated people obtained information about the home before they moved in form a variety of sources including the information the home supplied to them, visiting the home, by accessing information about the home on the CSCI website and information provided by social services. The AQAA told us an assessment of a persons needs is completed before they move into the home, so the home can make the assessment as to whether the persons needs can be met at the home. We looked at documents belonging to five people living at the home. These all contained an assessment of the persons needs that was completed prior to the person moving into the home. The assessment included details about personal care and well being, diet and dietary preferences, sight, hearing & communication, oral health, foot care, mobility & dexterity, skin care, history of falls, continence, equipment needed & mental health needs. Responses we received from service user surveys and conversations with relatives and people living at the home confirmed that assessments were completed by a member of staff from the home prior to the person moving into the home. There was one exception to this. One relative told us her mother/father had moved into the home from out of the local area which meant nobody from the home had been able to visit to assess her mothers/fathers needs. However she confirmed that information was sought from social and health care professionals by the home, and there has been no concerns about the homes ability to meet the needs of her mother/father. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Excellent care planning processes that include in depth assessments and individualised details about how a persons care should be delivered means that people living at the home receive the care and support in the way they like and need. People living at the home have their health care needs met by a work force that has a good understanding about health care issues, by effective monitoring and by prompt referral to health care professionals when needed. Good medication practices mean that people using the service have their wellbeing protected. Good practices and the provision of equipment means that a persons privacy and dignity is protected. Evidence: The AQAA told us the home is effective at assessing the needs of people living at the home and developing the results of these assessments into informative care plans. We looked at the care plans for five people living at the home. Completed assessments are in place in each persons care plan for eating and drinking, elimination, personal care Care Homes for Older People Page 13 of 29 Evidence: and hygiene, sleeping, breathing, pain control, mobilising, risks, motivation, spiritual fulfilment, senses, memory, cognition and orientation, communication, behaviour, social relations, sexuality, personal fulfilment and emotions. For each assessed a need a detailed care plan is in place describing the actions to be taken to meet that need. Each assessed need details the reference number of the care plan that describes the actions needed to meet the need. Professionally recognised tools are used to assess risks about skin integrity and malnutrition. Again the results from these risk assessments are developed into a care plan that can be cross referenced to the assessment. Moving and handling risk assessments result in detailed instructions about how a person must be supported to move in many different situations for example moving up and down the bed, turning in bed, getting into and out of the bed, sitting and standing and walking. Details are given of the type of aids that are required to assist an individual, for example the type of hoist and size of slings to be used with the hoist. The AQAA told us care plans and assessments are reviewed every month. We saw documented evidence that care plans and assessments are reviewed on a monthly basis and amended as required. Care plans are kept in the individual bedroom so they can be easily accessed by care staff and by the person that the care plan belongs to. It was very clear from conversations that we had with staff, people living at the home and their relatives that the care plans are a working document with staff referring to them to ensure each person living at the home receives the care they want and need. Some of th people living at the home that we had conversations with were able to tell us about their involvement in the development of the plan of care, they understood what was in the plan and that they receive care and support from staff in the manner they like to meet their needs. All care plans we looked at had a signature of either the person living at the home or their representative, usually a relative, evidencing involvement and awareness of the plan of care. Assessments of peoples needs that could contain confidential information are stored in the office area but are accessible to care staff when needed. It was concluded that because of the in depth detail in care plans and assessments a member of staff commencing employment or an agency member of staff would be able to deliver the relevant care in the manner preferred by a person living at the home after reading the relevant care plan and assessments. To ensure care plans and assessments are all completed in the same manner and have the depth of information required to provide people with the care and support they need, the Director of Care told us she completes monthly audit checks of a sample of the documentation. The team of trained nurses working at the home facilitate the health care of people living at the home. Documentation evidences the contact people have with doctors and other health care professionals. Examples of the contacts people have are dietitians, Care Homes for Older People Page 14 of 29 Evidence: physiotherapists, dentists and continuing care nurse assessments. Instructions from health care professionals about a persons health care are recorded in the relevant area in the care planning document as well as being incorporated into the care plan and medication administration record sheet if needed. People living at the home told us in surveys they always or usually receive the medical care they need. Relatives that we spoke with during our visit to the home spoke highly about the health care provision at the home. One visitor spoke about how the care provided by staff at the home had promoted the healing of a pressure sore her relative had that she has been advised had a very poor chance of healing by other health professionals. Policies and procedures are in place for the safe management of medications which includes procedures for people who wish to manage their own medication. We were not made aware of anybody living at the home who presently manages their own medications. All medications are ad mistered by one of the trained nurses. We looked at the Medication Administration Record (MAR) sheets evidencing that medications are signed for, detailing the time and amount of medication administered. A record is kept of all medications ordered, received and destroyed. Staff confirmed they see the individual prescriptions before medications are ordered. This ensures people living at the home are given the medications that have been prescribed to them by their doctor. The home complies with regulations about the safe disposal of medications. medications are stored in a safely in appropriate locked cabinets. For people that require additional aids such as bed rails or belts to ensure their safety whilst sitting in wheelchairs, relevant risk assessments are undertaken and evidence is available detailing that the persons next of kin or legal representative has been involved in the decision to use restraint. Throughout the inspection process information was obtained evidencing the privacy and dignity of people living at the home is promoted and protected. Care plans detail peoples wishes about how they like to be supported whilst receiving personal and health care and people told us they receive the support and care in the manner they like. Staff members were observed talking with and assisting people at the home in a friendly and pleasant manner. No breaches of privacy were observed during our visit to the home, staff were seen to always knock o a persons bedroom door and wait for a response before entering the room. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home have opportunity to take part in meaningful activities and maintain contact with family and friends. People living at the home are able to exercise choice and control over their daily life. People living at the home benefit from a varied and healthy diet. Evidence: The AQAA told us that an in-house activity coordinator has responsibility for coordinating activities at the home. Details about a persons interests and hobbies and a history of their life is gathered during the assessment process and from ongoing discussions with the person and their family after moving into the home. From this information the activity organiser plans an activity programme that aims to include something of interest to all people living at the home. People living at the home told us in surveys there are usually activities taking place they can choose to join in if they want to. This was confirmed in discussions we had with people living at the home. Details about activities are provided to people when they move into the home within the service users guide and a weekly programme of activities is on display on the notice board in the entrance hall. Activities arranged for the week we visited the home included sing a longs, Christmas shopping trips, crosswords and quizzes, carols by Care Homes for Older People Page 16 of 29 Evidence: candlelight, visits by entertainers and room visits where the activity coordinator spends time with those that chose not to or cannot join in with group activities. Whilst we were visiting the home groups of people were joining in with games and quizzes in one of the lounge areas. People living at the home have access to a library of books, videos and board games that can be used for entertainment. Visitors that we spoke with during our visit told us their relatives have a good choice of activities they can take part in. One visitor told us herself and her relative chose the home because of the good provision of varied activities. Details in the homes own quality auditing surveys indicate a high level of satisfaction from people living at the home with the provision of activities. Spiritual needs of people living at the home are met with the local Church of England minister visiting to conduct holy communion or hymn services and visits from the local Catholic Priest. The service users guide details that the home assists in arranging visits from other religious backgrounds as requested by people living at the home. The AQAA told us that there are no limitations on visiting times; people at the home can choose when to receive their visitors. Visitors that we spoke with during our visit told us they can visit their relative any time of day and have a choice of where their relative receives them, either in one of the communal areas or on the privacy of their own bedroom. One visitor told us the home always invites the relatives of people living at the home to any special events at the home. She told us she was going to spend Christmas day at the home, having Christmas dinner with her relative at the home. The visitors logbook detailed that people receive visitors at various times of the day. Throughout the inspection process evidence was gathered confirming that people living at the home are able to make choices in their daily lives. Examples of these include being able to make choices about involvement in activities, where and when to take their meals and their wishes regarding care support being included within the care planning process. People were observed being able to move freely or with assistance around the home, choosing whether to use the communal areas or sit in their bedrooms. People living at the home told us they choose what they want to do. The service users guide tells people at what times meals are served and provides a menu sample so people moving into the home have an idea of the meal provision at the home. This sample menu indicates there is a choice of menu at meal times. This was confirmed in conversations we had with both people living at the home and their representatives who were visiting at the time of our visit to the home. People confirmed to us that it is their choice where to take their meals. People living at the home told us they generally enjoy the food provided. The AQAA told us that changes have been made to the way people living at the home order their food. Different methods for ordering food are used to meet the different needs of people living at the Care Homes for Older People Page 17 of 29 Evidence: home. Some people order their meals the day before, others order them a week at a time. We were told this has been done so that people can have more support from their relatives to order meals they will like. One visitor told us this method is resulting in her relative who has communication difficulties and is a fussy eater receiving the food he likes and will eat. We observed a meal time with people being supported to move into the dining room, choose where to sit and for those that required it support with feeding being given in a sensitive manner. Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to enable people living at the home and their representatives to express complaints about the service. People living at the home are protected from the effects of abuse by a staff team that has a good understanding of safeguarding procedures. Evidence: The AQAA told us there is a complaints procedure in place and the service had received twenty complaints in the past twelve months. Details about the complaints procedure are included in the service users guide. Surveys we received from people living at the home indicated people living at the home are confident to raise concerns or complaints and are confident the home will respond promptly and appropriately to complaints raised. We looked at the log of complaints. This evidenced that concerns whether received verbally or written and whether a concern or complaint are managed effectively, an investigation is undertaken and the complainant receives a response to the complaint within twenty eight days. Details within the complaints log book also evidence that the service treats the receipt and investigation into complaints as part of their quality auditing process, with the attitude that the result of a complaint will lead to the improvement of the service. Staff we spoke to and all surveys we received back from staff told us they know how to respond to any complaints made about the service. We have received no complaints about the service in the past twelve months. This information and details documented in the complaints logbook indicates that Care Homes for Older People Page 19 of 29 Evidence: complaints are addressed to the satisfaction of the complainant. The AQAA told us policies and procedures are in place for the protection of vulnerable adults and staff have recieved training about this area. Staff records evidenced that staff have received training about safeguarding and discussing with staff members evidenced a good understanding about safeguarding procedures. The AQAA told us two safeguarding referrals had been made in the past twelve months. These referrals were not relating to the conduct of staff members and were made appropriately evidencing the service takes the relevant action to protect the well being of people living at the home. Information provided to us details the safeguarding referrals have been concluded to a satisfactory outcome ensuring the protection of the relevant people to whom the referral was regarding. Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live at the home benefit from living in a safe and comfortable environment, which is suitably furnished and maintained. Evidence: The AQAA told us in the past twelve months improvements have been made to the home with the home being rewired, decoration of communal areas, catering areas and fifteen bedrooms along with the installation of a new fire alarm system and a loop system in the main lounge for those who are hard of hearing. However the head of care told us that the loop system is presently not being used frequently by people living at the home. She discussed that people need reminding and encouragement to use the system. Details about the environment are included in the service users guide that describes the service provided at the home. As part of the inspection we toured the building looking at a sample of bedrooms, bathing areas, the kitchen and the laundry. Communal areas consist of a large lounge, a library and a conservatory as well as two dining rooms. During our visit all communal areas were being used by people living at the home. From the seating area in the conservatory people can enjoy the view of a sensory garden and in the warmer weather can enjoy sitting out in the sensory garden. At the time of our visit the sensory garden had been decorated to represent a Care Homes for Older People Page 21 of 29 Evidence: Christmas grotto which was being enjoyed by people sitting in this area. People living at the home also benefits from the use of a large garden area that is well maintained. Resident meeting minutes detailed thoughts that people living at the home have had about further development of the garden areas. The head of care and one of the directors of the service told us these wishes are being taken into consideration in the development plan for the service. The bedrooms we looked at evidenced that people are able to bring in personal belongs such as small items of furniture and ornaments to personalise their bedrooms. All were furnished and decorated in a homely manner. For people who required assistance of moving and handling equipment there was sufficient space in their bedrooms to enable the safe use of such equipment. A team of housekeepers are employed to maintain the cleanliness of the home. At the time of our visit the home was clean and tidy with no malodours. People that we spoke to who live at the home and responses in surveys sent to us detail the home is kept clean and fresh. These views matched those received fomr people living at the home in the homes own quality auditing processes. We were told the home only undertakes personal laundry for people living at the home, the sheets and towels are sent out to an industrial laundry. The laundry has sufficient washing machines and driers and is accessed from the corridor so dirty linen is not taken though the kitchen or food preparation areas. The laundry was clean and tidy at the time of our visit, but one of the walls had areas of peeling paint which could pose problems with maintaining the cleanliness of the area. We were told by the head of care and one of the directors of the service that this area is going to be attended to in January 2009. Policies and procedures are in place about the prevention of infection and records detail staff have received training about the prevention of infection. Care Homes for Older People Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good staff development and training provision ensure that people living at the home are cared and supported by a highly skilled and knowledgeable work force in suitable numbers. Robust recruitment procedures mean that people living at New Forest Nursing Home are supported and cared for by staff suitable to work in the caring profession. Evidence: A staff rota details the numbers of staff on duty at any one time and in what capacity they are working. The rota we looked at detailed that in the morning there are two nurses and six care staff on duty, in the afternoon two nurses and four care staff on duty and at night two nurses and three care staff on duty. A separate ancillary rota details there are two housekeeping staff on duty each day, one member of staff working in the laundry and a cook in the kitchen. Also detailed are the two activity staff one who works two days a week and the other who works five days a week and the mini bus driver who works across the four homes owned by Sentinel Care Ltd. People living at the home, thier relatives and staff working at the home told us in surveys and conversations that there are usually sufficient staff on duty to meet the needs of people living at the home. The AQAA told us the home follows a robust recruitment procedure that includes the Care Homes for Older People Page 23 of 29 Evidence: receipt of two written references and checks against the Criminal Records Bureau ( CRB) and protection of Vulnerable Adults (POVA) list being recieved prior to a person commencing employment at the home. Staff told us in surveys and conversations that checks were completed prior to them commencing employment at the home. This was confirmed by looking at the records of two recently appointed members of staff. Staff told us in conversations and surveys they receive training to enable them to do their job. One member of staff told us training is both formal and informal. There are formal training sessions every couple of weeks which staff take turns to attended and training videos to watch. We have moving and handling trainers within the group who induct and update all staff in both theory and practical sessions. We looked at the 2008 training records for four members of staff. Training included all health and safety training as well as courses such as stress management, management of challenging behaviour, role of the care worker, basic life support and pressure ulcer prevention. The training programme has already been planned which an includes the compulsory trainings such as moving and handling, fire safety and whitleblowing and safeguarding people and other care topics such as management of diabetes. The AQAA told us that over 50 of care staff members have NVQ level 2 or above in care. Care staff records contained copies of certificates evidencing that NVQ qualifications had been achieved. The AQAA told us that they are aiming to improve the period of induction by having new staff complete the induction programme within three months of commencing employment at the home. One recently appointed member of staff told us she is in the process of completing her induction training which should be completed within three months of her commencing employment at the home. We saw evidence in staff files they complete induction training that meets the Skills for Care common induction guidelines. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is effectively managed and seeks the views of those using the service to influence the development of the home. Robust procedures ensure that the finances of people using the service are protected. Good health and safety practices protect all people at the home. Evidence: At present the home is without a registered manager, the previous registered manager having resigned in September 2008. A manager had been recruited for the home but left employment at the beginning of December 2008. The head of care and director of the company informed us that a new manager has been recruited and is due to commence employment in February 2009. The registered provider has kept us informed of the management of the home and at present the head of care for the organisation and the director are managing the service with the support of the deputy matron of the home. It is clear from conversations with staff members, people living at the home and their relatives that although the home is presently without a manager Care Homes for Older People Page 25 of 29 Evidence: the management arrangements at the home mean staff have the skills and abilities to run the home. Both staff and people living at the home speak highly of the providers management of the home. Comments from a staff member include, the Directors take an active daily interest in the home. The Directors are very approachable, supportive and helpful to staff, residents and their relatives. Staff told us they receive regular supervision and support from the management at the home. One staff member told us monthly supervision is usually based on a topic for example, abuse, privacy and dignity or infection control. We saw details of the dates that staff have received supervision in their personal files. The AQAA told us the views of people living at the home are sought by the use of annual surveys, residents meetings, monthly reports about the running of the home and by general conversations. a summary of the most recent residents survey is included in the service users guide which include views about the environment, provision of care, food, social contact and activities and management of the home. Minutes are kept of all residents meetings and these are made accessible to everybody living at the home as well as their relatives. Examples of changes made to the running of the home as a result of listening to the views of people living there include changes to the menu, changes in how people request their menu choices, care plans being returned to individual bedrooms so the individual can access their own care plan without difficulty, the inclusion of key worker photographs in individual bedrooms and the provision of a new minibus to replace what people thought was an uncomfortable bumpy mini bus. As discussed in the section about environment consideration is being given to comments about the garden area in the development plan for the home. Procedures are in place about the handling of money for people who live at the home. People can make use of a safekeeping facility if they wish. Records are kept of monies held for people including details of income and expenditure. We looked at a sample of service certificates evidencing that services and equipment are maintained at manufacturers recommended intervals. This protects the wellbeing of all at the home. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 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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