Inspection on 14/10/08 for Norfolk House

This inspection was carried out on 14th October 2008.

CSCI found this care home to be providing an Good 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

Similar services:

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

The Shelley

Springfield House

Extracts from inspection reports are licensed from CQC, this page was updated on 05/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Norfolk House 39-41 Sea Road Westgate Kent CT8 8QW     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: Elizabeth Baker     Date: 1 4 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Norfolk House 39-41 Sea Road Westgate Kent CT8 8QW 01843831667 01843836152 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Select Healthcare (2006) Ltd Type of registration: Number of places registered: care home 30 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 30. The registered person may provide the following categories of service only: Care Home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Norfolk House is a large detached building situated directly opposite to the Westgate Pavilion and the sea front. This provides uninterrupted sea views and the opportunity for walks along the sea front. The home can be easily accessed by road and is close to a railway station and local bus routes. There is ample car parking at the front. The home is situated near to local shops and other facilities. Margate is just along the coast. Accommodation is provided on three floors and is mostly single rooms. Some have en suite facilities. A passenger lift provides access between all floors. A Church of Care Homes for Older People Page 4 of 29 Over 65 30 0 Brief description of the care home England service takes place monthly. External entertainment includes weekly exercises and a monthly sing a long. Internal activities currently include arts and crafts and bingo. The latest inspection report is aailable on request at the home. Fees currently range from £320.63 to £542.61 per week. Additional charges are made for chiropody, newspapers, toiletries and hairdressing. 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: 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: Allocated inspector Elizabeth Baker carried out the key unannounced visit to the service on the 14 October 2008. The visit lasted eight hours. As well as briefly touring the home, the visit consisted of talking with some residents, staff and a district nurse. Four residents and three members of staff were interviewed in private. Verbal feedback of the visit was provided to the manager during and at the end of the visit. At the time of compiling the report, in support of the visit, we (the Commission) received survey forms about the service from seven residents. At our request the home completed and returned the Annual Quality Assurance Assessment (AQAA). Some of the information gathered from these sources has been incorporated into the report. Care Homes for Older People Page 6 of 29 Since the last visit there has been one safeguarding investigation. There have been no referrals to the Protection of Vulnerable Adults list. What the care home does well: What has improved since the last inspection? What they could do better: So prospective residents have current and full details of the homes services and facilities, the homes statement of purpose and service user must be reviewed and updated. All records relating to residents must be complete and up to date. Any action which the home takes to protect residents, but which could potentially place the resident at another risk, must only be taken after a full assessment and consultation with other professionals involved in the residents care. The current range of activities and stimulation should be reviewed so that the diverse needs, expectations, preferences and abilities of individual residents are met. Survey respondents and verbal comments included I get bored at times; Days are long with nothing much to do; and I would love to be taken to the shops but there is no one to push me there. The practice of propping open bedroom doors with wedges and the lack of fire detection in the laundry compromises the homes overall fire safety standards for all residents, staff and visitors. For service users protection, gaps in employment histories must be sought and the information recorded. Care staff should receive training so they are able to meet all the assessed needs of current and future residents. Policies and procedures should be reviewed frequently to ensure they reflect current good practice and regulation. Care Homes for Older People Page 8 of 29 There are no requirements but a number of good practice recommendations have been made throughout the body of the report. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 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. Residents are treated equally in that they are all provided with a contract setting out the terms and conditions for staying at the home. Reviewing and updating the homes information would provide prospective residents with more information from which to make an informed choice about the homes suitability for their individual needs. Evidence: As requested the manager provided us with a copy of the current Statement of Purpose and Service User Guide. These documents are important as they inform current and prospective residents of what the home is registered for, as well as details of management, facilities, accommodation and services provided. However a review of both documents identified they are not up to date and in some cases lacking in detail. For example they have not been updated to reflect the departure of both the former Responsible Individual and Registered Manager. It was difficult to establish how to make a complaint and to obtain actual bedroom sizes. To assist providers and Care Homes for Older People Page 11 of 29 Evidence: managers in developing these documents we issued guidance. The guidance is available on our website. Regulation 6 requires the Statement of Purpose is kept under review and where appropriate revised, together with the Service User Guide. Where practicably possible the manager visits prospective residents in their current place of occupation to determine whether the home is suitable to meet their individual needs. Information is also sought from other agencies involved in prospective residents care including local authorities and or primary care trusts. Information gathered at these visits is recorded. Not all prospective residents are able to visit the home prior to admission and in some cases their advocates do so on their behalf. Most residents are admitted to the home with the expectation they will stay there for the rest of their lives. The home is not registered for nursing care. Where it is identified that a residents needs can no longer be met at the home, even with the support of other health professionals, the resident is supported in finding a more appropriate home. The home also admits residents for short stays and or rehabilitation. Sometimes these stays lead to the resident deciding to become a permanent resident. This occurs after a full review is carried out with in put from the sponsoring authority. For equality purposes all residents are provided with a contract. As part of the organisations quality assurance programme, contracts are currently being audited and updated as appropriate. In 2004 the Office of Fair Trading issued guidance on fair terms for care. The manager might find the guidance helpful. The guidance is available from the website of the Office of Fair Trading. Three of the seven returned surveys from residents indicated they had received a contract. The home is not registered for intermediate care. Standard 6 is not applicable. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and personal care needs of residents are met with evidence of good multi disciplinary working taking place on a regular basis. Sadly not all care records reflect this. Evidence: For case tracking purposes the care records of three residents were inspected. Records included signed consent forms and a variety of assessments such as admission details sheet and assessment summary, skin integrity, nutrition, falls, constipation, infection, dependency and bed rails. Body maps are used to record details of pressure sores and wounds. This is good practice. In one file there were two different types of skin integrity assessments in use giving a conflicting outcome score. Some forms were incomplete and had not been signed by the residents. A blank inventory sheet was seen for a resident who has been at the home for three months. The resident has brought some of their own property into the home. Two of the three records contained care plans covering topics such as communication, oral health, hair, social well being, spiritual well being, sleep, personal hygiene, mobility, communication, skin, medicines, Care Homes for Older People Page 13 of 29 Evidence: diet and nutrition. However it has not been the homes practice to compose care plan components for residents who may have additional health problems such as diabetes, seizures, mental health or a learning disability. There are a number of residents in the home who have these conditions. Because of the muddled state of the care records the manager has attempted to compose computerised shorter plans to be used in conjunction with the other care plans. And one was in progress for the resident without a proper care plan. Daily records are kept and generally gave a brief picture of the residents condition and quality of day experiences. Although the form requires staff to record the time of the entry, this is usually left out. Despite the above all seven returned surveys from residents indicated they receive the medical support they need. As well as support from the homes care staff, nursing and medical care is provided by external health professionals. This includes district nurses, GPs, physiotherapists and community psychiatric nurses. During the visit some residents were having their eyes tested. A district nurse spoken with during the visit indicated that despite a recent turnover of staff there are no real issues at the home and things have settled down. A dedicated room is used for the safe storage of medicines and associated sundries. The room is appropriately equipped. Details of the room and drug fridge temperatures are recorded daily. This is good practice as it ensures medicines are stored in accordance with manufacturers instructions so the efficacy of medicines is not compromised. Medication Administration Record charts were inspected and found to be satisfactorily maintained. As part of the homes quality assurance programme, the home manager carries out monthly medicine audits. This has just been supplemented by an external audit which resulted in a number of recommendations being made. The manager said these have been done. Registered nurses are not employed at the home. The home has an insulin dependent resident. The local primary care trust facilitates training so that district nurses can delegate special techniques to unregistered staff such as care assistants, when they are deemed competent to do so. To achieve this, the primary care trust requires care assistants receive specific training, undertake a theory test and have their practice observed. Once signed off as competent, care staff are expected to undertake annual reviews. The manager will be accompanying a number of care assistants on the next course facilitated by the trust. Although the manager has received training in the past she intends to up date her knowledge of this specialised technique. A hairdresser visits the home weekly and residents spoken with indicated they are glad of this service. However not all residents wish to or are able to use the service. One resident has specific behaviour problems with regard to having their hair washed and styled. Sadly Care Homes for Older People Page 14 of 29 Evidence: this information is not included in their care plan. The lack of this recorded information lead in the past to a challenging incident, which could have been avoided. During the inspection a health professional discovered bedrails had been provided to one of her patients because the home feared the resident might fall out of bed. The health professional had not been consulted in this. The resident currently has restriction problems resulting in their legs being in contact with the rails and or the plastic bumpers. The manager did not appreciate the implications of this action. Bedrails must only be used after a full assessment of the residents holistic needs is undertaken, with input from other health and social professionals involved in the residents care, as well as the resident and home. This should ensure that all contra indications are established and considered before a decision is made. Although some funeral details were seen in the records inspected, not all contained meaningful details of residents spiritual and cultural wishes and preferences in respect of death and dying. Whilst appreciating this is a sensitive subject, it is an important aspect of care and needs to be addressed. 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. Residents enjoy a choice of meals. The current range of activities does not ensure all residents experience what they want to do. Evidence: External entertainers provide activities including a weekly exercise session and a monthly sing a long. A Church of England service takes place at the home monthly. Other faiths and beliefs are catered for on request. Birthdays are celebrated with a present, card, cake and tea party. Some residents are able to take themselves or with support from their friends and relatives to the nearby shops and venues. Other residents prefer their own company and have their own interests to keep them occupied. A number of residents were seen sitting in their bedrooms watching the TV or listening to their radio. And quite a few residents were in the middle lounge watching the televisions. Six of the seven returned surveys from residents indicated there are activities arranged by the home that they can take part in. However other residents are not of the same opinion. During the visit residents comments included Days are long with nothing to do and, I would love to be taken to the shops but there is no one to push Care Homes for Older People Page 16 of 29 Evidence: me there. The manager has recently changed the function of the front lounge so that it can also be used as an activities room. Two care assistants now endeavour to provide some in house stimulation such as drawing and painting. Indeed a small number of residents were seen engrossed in their work during the visit. The National Association of Activity Providers for Older People might be a good reference point for the manager to contact. The organisation may be able to provide guidance in the provision of meaningful activities, so that the diverse needs, preferences and choices of individual residents can be met. The home encourages residents to personalise their rooms and those visited had been individualised to the residents own preferences. Although no visitors were seen on the day of the visit, residents said when they do receive visitors they are made welcome and offered refreshments. The home has a large dedicated dining room on the ground floor for residents to use if that is their wish. Residents spoken with said the meals are good and offer choices. Indeed one resident said I live for mealtimes now and am offered two choices every day. Other comments included good food here and always like the meals. All seven of the returned comment cards from residents indicated they always like the food. Two respondents added I really like the food at this home and There is always of choice of food at mealtimes. Meals were not sampled during the visit but the lunchtime meal was presented in an appetising manner. Special diets are catered for and care records evidenced residents are regularly weighed. Care Homes for Older People Page 17 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. Residents can be satisfied their concerns are listened to and acted upon. Evidence: A complaints procedure is displayed in the reception hall. The procedure includes contacts details of the provider, Social Services and us. Residents spoken with knew what to do if they have a complaint. All seven returned surveys from residents indicated they know how to make a complaint and who to speak to if they are not happy. A record is kept of formal complaints. Non-formal complaints are usually recorded in the residents individual files. However it has not been the homes practice to keep a record of all niggles and adverse comments. Recording this information centrally would help the home monitor trends for quality assurance purposes. The training matrix provided at the visit shows that most staff have received adult protection training. The returned AQAA records the home has a current Safeguarding Adults and the Prevention of Abuse policy and procedure. The AQAA also records the home has made one safeguarding adults referral and has not made any referrals to the Protection of Vulnerable Adults List. We have not received any complaints about the service. However we were contacted by a relative about the care afforded to a resident. This matter was dealt with under the countys multi agency safeguarding procedures. The investigations did not substantiate the allegations. Care Homes for Older People Page 18 of 29 Evidence: Arrangements are made for residents to exercise their civil rights by voting in elections if they wish to. Care Homes for Older People Page 19 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. Residents live in a clean and homely environment Evidence: An environmental health inspection of the kitchen was recently undertaken at the home by the local council. Two contraventions were identified. The manager has confirmed these have been attended to as required. The environmental health officer added to the report that cleaning of the kitchen is carried out to a good level. Areas visited were fresh, clean, warm and odour free. Indeed residents spoken with indicated the home is kept clean. And all seven returned surveys from residents indicated the home is always fresh and clean. Bedrooms and communal rooms are furnished and decorated to a good standard. A number of bedrooms are in the process of being redecorated. Since the last visit a number of bathrooms and toilets have been refurbished. Residents spoken with said they like the new splash shower rooms very much. The home has recently acquired a hospital type adjustable bed for a resident whose dependency has increased. Other beds in the home are divan type and most have been provided with a static type pressure preventative mattress. The home has two of its own airflow mattresses. Where the need for airflow mattresses exceeds this Care Homes for Older People Page 20 of 29 Evidence: number, the primary care trust has loaned these. However the home may like to consider increasing its own provision as during the visit the district nurse informed the manager that the trust will no longer be in a position to automatically provide this type of equipment. If they do it will only be for the highest dependency. It is the providers responsibility to ensure the home has the appropriate equipment for residents current and future needs. For residents with mobility problems the home has two hoists comprising of one Oxford (sling type) and one stand aid. The home has a laundry in which residents personal clothes and general linen is washed. Bed linen is contracted out. Good quality bed linen was seen in the bedrooms visited. Residents were complimentary about the laundry service. The home has a range of sitting rooms in which residents can choose to spend their time, one of which provides extensive views of the sea. Fire detection was seen in various parts of the home as is required. However during the visit to the laundry room in which the washing machine is kept no fire detector was seen, although there were three holes in the ceiling, where such a detector may have been fitted in the past. The home tries to accommodate all residents lifestyle wishes and preferences and this includes propping open bedroom doors, where this has been requested. A wooden wedge was seen for this purpose. Whilst not wishing to deny residents their choice, for the protection of all residents living at the home, as well as staff working there, it is the providers responsibility to ensure that only approved devices are in place. To promote good hand washing practices and minimise infection control risks, paper towels and liquid soap are available around the home. The home has a passenger lift so residents can access rooms on the first and second floors. The home has a call bell system in place and residents said staff generally respond quickly when this is used. Care Homes for Older People Page 21 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. Residents receive care and support from an enthusiastic and caring workforce. Evidence: As well as care staff, staff are employed for cooking, cleaning, laundry, maintenance and administration. The home is staffed 24 hours a day and a roster is maintained. Staffing levels generally comprise of four care assistants in the morning, three in the afternoon and two awake at night. The manager is not included in these figures but would be available to work on the floor if there was a need. Four of the returned surveys from residents indicated staff are always available when they are needed. The other three respondents indicated staff are usually available. Staff were seen carrying out their duties in an unhurried manner. The returned AQAA indicates that 62 of untrained staff are qualified to NVQ level 2 or above in care. Staff spoken described the training they had recently received relevant to their roles. This included health and safety, loss and bereavement, palliative care, food hygiene, moving and handling and a three month MRSA course. One senior health care assistant is eagerly waiting to commence her NVQ level 3 care course. Staff commented on the availability and range of training, which is available and additional to their mandatory training. Ancillary staff are also encouraged to undertake NVQ training relevant to their roles. Care Homes for Older People Page 22 of 29 Evidence: New staff are required to complete an induction programme. During this period they are required to read and familiarise themselves with policies and procedures, shadow trained staff and complete an induction book. It is expected that the initial induction, once successfully completed, leads into NVQ level 2 training where this has not already been achieved. The home is registered for personal care to older people. During this visit it was identified that some residents have other needs in addition to the personal care support they require. Conditions include diabetes, epilepsy, learning disability, mental health, challenging behaviour and dementia. The training matrix supplied for this visit indicates not all care staff have not received training for these conditions. For residents safety, this must be addressed. Two staff files were inspected. As part of the homes vetting practices, references are sought and obtained and Criminal Record Bureau (CRB) checks undertaken. CRB clearance is obtained prior to new staff commencing. Indeed one member of staff interviewed said their start date was put back because the form was incorrect and had delayed the whole process. The organisations application form now requires applicants state their full employment histories. However both files had unexplained employment history gaps. In one case it was also difficult to establish whether the reference provided for the last care position, actually was sent to the care homes address and indeed whether it was returned from there. The applicant had indicated on their application form they wanted the reference to be sent to a former colleagues house. To assist home managers and providers in developing robust recruitment procedures and practices, in 2006 we published guidance on our website. These are in the form of two InFocus publications. Details have subsequently been provided to the home manager. Care Homes for Older People Page 23 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. The manager has a good understanding of what needs to be done to improve the home for the benefit of residents and is activitely striving to bring this about quickly. Evidence: Since the last visit a new manager is in post. Although this is the managers first home manager position and she has yet to attain the Registered Managers Award, she has achieved the Access to Social and Health Care qualification. The manager has worked with the elderly for about 15 years. The registered manager was open and frank about her opinions and aspirations for the home. Residents and staff spoke openly during the visit about their experience of living and working at the home. Staff said they feel supported by management and the manager is always accessible. Staff receive regular supervision and records are kept of matters discussed. Staff Care Homes for Older People Page 24 of 29 Evidence: interviewed said staff meetings are held and they find them useful in that they are able to express their views about the service. Policies and procedures are kept in the managers office. A staff member said these are always available for reference, even when the manager is not at the home. The returned AQAA indicates that just over half of the policies and procedures have been reviewed in the last twelve months, with many having a review date of April 2006. Policies and procedures should be reviewed more frequently to ensure they reflect current regulation and good practice. In the absence of residents and relatives meetings, the manager endeavours to seek the views and opinions of the service by the use of questionnaires. The results will then be analysed and fed back to residents and other stakeholders. Two plaques displayed on the outside wall indicate the home is affiliated to care home associations. The area manager visits the home and provides the manager with written monthly reports. The organisation has recently undertaken a review of personnel files to ensure that all proper documents are in place and appropriate checks have been carried out for staff from overseas. As indicated previously, care records did not provide a coherent picture of each residents individual assessed needs, care to be delivered and ultimate goal or outcome to be achieved. This could present the home with problems if it was reliant for evidence purposes to produce records as part of an investigation. The provider and or manager are responsible for ensuring that all records are complete and up to date. While most records were held with due regard to confidentiality, a bath list was seen displayed on a notice board in the dining room. This is institutional practice and should cease. The AQAA records the homes equipment is serviced and or tested as recommended by the manufacturer or other regulatory body. The home maintains personal allowances for the majority of residents. Records, receipts and cash balances are held individually. The area manager audits these records as part of the regulation 26 visits to the home. Some care managers also audit these records as part of their clients care reviews. Care Homes for Older People Page 25 of 29 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. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!