Inspection on 28/10/08 for Northcott House Nursing & Residential Care Home

This inspection was carried out on 28th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Northcott House Nursing &... 06/11/06

Northcott House Nursing &... 04/10/05

Northcott House Nursing &... 17/05/05

Northcott House Nursing &... 12/10/04

Northcott House Nursing &... 13/05/04

Northcott House Nursing &... 30/07/03

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 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Northcott House Nursing & Residential Care Home Northcott Close, Bury Hall Lane Alverstoke Gosport Hampshire PO12 2PP     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: Janette Everitt     Date: 2 8 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 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Northcott House Nursing & Residential Care Home Northcott Close, Bury Hall Lane Alverstoke Gosport Hampshire PO12 2PP 02392510003 02392513110 northcotthouse@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Christine Mirner Type of registration: Number of places registered: God`s Port Housing Society Limited care home 55 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category terminally ill Additional conditions: Only 25 service users in the OP category can be accommodated at any one time who are in receipt of personal care Only a total of 5 service users in the categories TI(E) and TI can be accomodated at any one time Service users in the category TI to be accommodated only between the ages of 55-65 Date of last inspection Brief description of the care home Northcott House is a care home providing nursing and personal care for up to 55 service users over the age of 55. The registered provider is God s Port Housing Association, a charitable organisation, who also manage flats and bungalows on the Care Homes for Older People Page 4 of 33 0 5 Over 65 55 5 Brief description of the care home same site as the care home. The home is situated in a residential area of Alverstoke in Gosport, with easy access to local amenities, health care providers and the coastal are of Stokes Bay. Accommodation is provided over two floors with stairs, a passenger lift and a chair lift giving access to each floor. Residents are accommodated in 53 single rooms and 1 double room. Four of the single rooms plus the double room have ensuite facilities. Bathrooms and toilets are situated close to rooms without en-suite facilities. Residents are also able to access the six lounges situated around the home, the conservatory and a dining room. Many of the rooms have windows that give views of the pleasant, well maintained gardens. At the time of the visit the registered manager stated that current fees ranged from £347 to £460 per week depending on the level of care needs. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 visit to Northcott House on the 28th October 2008 formed part of the process of the inspection of the service to assess the service against the key national minimum standards. The evidence to support the assessed outcomes for people who use the service was gathered from the Annual Quality Assurance Assessment (AQAA), which the manager returned to the CSCI and information received since the last key inspection of November 2006. The manager Mrs. Mirner, assisted with the inspection visit and the chief executive of the charity attended for feedback from the visit. We gathered information in surveys returned to CSCI from people living in the home, Care Homes for Older People Page 6 of 33 staff, GPs, visiting health professionals and two care managers. We also spoke to a number of service users, visitors and staff at the time of this visit. The outcome of the surveys indicated that there was a high level of satisfaction with the service and that generally residents were happy with the services the home provides. A sample of records were viewed and a tour of the building was also undertaken. There were no residents from an ethnic minority group. What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 33 The two dining areas have been made into one large area and has been pleasantly decorated. Many areas of the home have been redecorated and there is a programme in place for redecoration which is an ongoing programme throughout the year. A new disabled toilet has been created near to the main lounge. The training opportunities for the staff has increased and over half the staff are qualified to NVQ level 2 and other staff are undertaking social care apprenticeships to lead to NVQ level 3 qualification. 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 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A care needs assessment is undertaken for all prospective residents, before a place is offered, to ensure the home can meet their care needs. The home has procedures in place for providing intermediate care. Evidence: Pre admission assessments are undertaken on all prospective service users before a place at the home is offered, to ensure that the home can meet their needs. A sample of these assessments were seen in the care plans for the five service users tracked. The assessments seen covered all aspects of care needs and included mobility, personal care, social care, history of falls and were generally comprehensive in information they contained. The manager told us she undertakes all the assessments and she will visit people in Care Homes for Older People Page 11 of 33 Evidence: hospital or in their own homes to do the assessment. She said that relatives are always welcome to be included in this process, if they wish, and if the service user consents to this. The manager told us that care managers organising the persons admission to the home do send in copies of their care needs assessments. The manager reported that the hospitals are also very good at sharing information and allowing the manager to look at hospital notes and care plans.The manager considers she has good communication with the care managers and the clinical areas and gains sufficient information to make the decision if the home can meet the care needs of the potential service user. All prospective residents are invited to visit the home prior to their coming to live there. The manager acknowledged that this can be difficult or not possible, if the person is being transferred from hospital and is in a frail state. Several more able service users spoken to, told us that they had visited the home and had received information about the service before they made the decision to go there to live. Intermediate care is offered in this home and the manager told us that although there is no intermediate care clients currently, there is that facility with the support of the community multidisciplinary professionals, if a room is available at the time of need. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users personal and healthcare needs are set out in individual plans, however, these should be more person centered and acknowledge risk factors as part of the plan of care. Service users are protected by the homes policies and procedures for dealing with medicines. Evidence: The AQAA states that the care plans are updated and risk assessments are completed monthly or with service users changing needs. A sample of five service users care plans was seen. The risk assessments were comprehensive and included nutritional assessments, mobility, falls, pressure care and personal hygiene. The risk assessments identified a score, but there was no indication of what the score meant and what level of risk was identified. There was no actual care plan written to describe what risk had been identified and how this was to be managed. We discussed the system with the manager, who acknowledged that she had already identified that the care planning system needed to be reviewed to be more descriptive and person centered and that Care Homes for Older People Page 13 of 33 Evidence: she is currently auditing and discussing care plans at supervision sessions with the trained nurses to ensure the care plans are reflecting the care service users need. There was evidence that risk assessments were reviewed regularly with the involvement of the service user to reflect the changing needs of the residents. The service users records contained all the necessary information about the service user with a comprehensive history. Daily notes were recorded appropriately and reflected the care that had been delivered during each period of the day. Carers and nurses spoken to during the day told us that they use the care plans daily to inform the care they are giving. Whilst in the staff office, it was observed that staff were regularly visiting it to look at the care plan folders and to document in them. The AQAA states that service users have choices about who they have as a GP and the home has good working relationships with the visiting primary health team. The manager told us the community matron does visit the home and will give advice on any clinical issues that may have arisen. The continence adviser also visits the home to assess the service users needs. The home supplies supplementary equipment for those service users who do not have sufficient continence aids or are not in receipt of them from the continence service. Service users are supported by family or carers if they attend any medical appointments outside the home. The care plans indicated that residents health needs were being met with the involvement of GPs and other health professionals. All medical visits or intervention was observed to be recorded in the care plan. Equipment is in place to meet any healthcare needs such as tissue viability and special mattresses are put in place prior to a person being admitted, if the assessment has shown they are at risk. It was observed that profile beds are in place for those who have nursing needs. The surveys returned from 5 GPs all state that home provides a good service but they feel the nurses skills could be used better as they do not manage what is quite simple medical decisions which result in them calling the GP. They state they are very attentive to service users needs and do well considering the size of home and number of the service users. The AQAA states that medication policies and procedures are in place. Registered Care Homes for Older People Page 14 of 33 Evidence: nurses, who have undertaken medication training, administer all medications. The morning medicine round was observed to be undertaken by the two trained nurses who were seen to be following safe procedures. The home uses the monitored dosage system (MDS) which is prepared in blister packs for each service user for each of the prescribed times of the day. The home has clear procedures in place for dealing with medicines. The manager told us that part of her role is coordinating the ordering and organisation of all medication in the home. She described the process she goes through and this includes checking the prescriptions from the GP before it is taken to the pharmacist for dispensing. This is seen as good practice and should prevent unwanted medication being dispensed and delivered and medication errors. The storage of medication was viewed. The cupboards were clean and tidy. It was observed that there were quite large stocks of as needed(PRN) medication and topical creams in the cupboards. The manager told us that this is the the consequences of having a large number of service users, most of whom have some medication prescribed on a PRN basis. The stock of these medications was large and in some cases there was evidence of poor stock rotation. It was suggested to the manager that more attention be paid to the ordering of these drugs to prevent the home carrying large stocks. The drugs fridge was clean and temperatures of this were recorded daily. It was observed that some of the eye drops currently being used were out of date and this was discussed with the accompanying nurse. Records seen for controlled medicines were seen in the controlled drugs register. These were checked and the stock held in the controlled drugs cupboard matched the balance in the register. The controlled drugs cupboard was noted to meet the standard set in the Misuse of Drugs Regulations (1973). The medication recording sheets (MAR) were viewed by us and there was evidence of some gaps where signatures should have been or a code to indicate why the person has not had the medication. This was discussed with the manager who told us she would check the recording of the MAR sheets as part of her monthly audit and discuss this with the appropriate nurse as part of supervision. Procedures were in place for residents to self administer their medication should they wish and were assessed as able to do so safely. At the time of this visit no service users were choosing to manage their own medication. Care Homes for Older People Page 15 of 33 Evidence: Up to date information on the medicines used in the home was available for staff and the nurse said that staff receive training in the administration of medicines. Training records confirmed that staff had received the training. We observed the training work book supplied by Boots, who supply the training. The service users spoken with told us that they consider their privacy was respected and the staff cared for them well. Staff were observed to interact well with service users and spoke to them in a respectful manner. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to exercise choice and control over their daily lives, participate in a range of suitable activities, receive visits from relatives and friends as they wish and enjoy a varied and nutritious diet. Evidence: The AQAA states that social activities do take place and a programme is displayed on the notice board and service users have the choice of whether they participate. The AQAA describes various outings that take place during the year and the home hosts various fetes and sales to boost funds for the residents comfort fund. The home employs an activities organiser to arrange appropriate activities. She attends the home three days a week. Other outside entertainers attend the home on a regular basis. The activities programme is displayed on the notice board and this evidenced that there is a variety of activities taking place if the service users wish to participate. At the time of this visit the organiser was having a musical band morning with service users who wished to participate and be involved in playing an instrument. The Care Homes for Older People Page 17 of 33 Evidence: manager told us this was enjoyed by many of the service users, particularly those with a level of dementia. The activities organiser was spoken with and she told us that she has worked at the home for some years and she has a good idea of what the service users enjoy and it is mostly music. She maintains records of what activities have taken place and who has attended and their level of participation. Service users social histories are recorded at the pre admission assessment. Those viewed contained little information but the manager said it is sometimes difficult to obtain information at that time. The activities organiser said she tries to obtain further information about their lives and preferences as they settle into the home life. The service users preferences for participating in daily living and social activities are recorded in their care plans and include their preferences for how they wished to undertake their daily activities of living. Service users religious needs are met by the visiting clergy from the local church and the times of visits and church services are displayed on the notice board. The manager said that the local church is involve with the home and some service users were going to attend a social evening, in the coming week, at the church hall. A service user spoken with told us that she would be going and was looking forward to the evening. The manager told us that the home has many visitors during the day and that they are made welcome to the home. There is no restriction on visiting relatives and friends if the service user wishes to see them. The visitors book evidenced that a number of people do visit the home each day. A relative spoken to said she comes a long way twice a week to see her mother and she is made welcome and offered tea and biscuits. Outings into the community do take place. A mini bus is available to the home and care staff support the outings. The manager told us that the service users favourite outing is visiting the fish and chip shop and eating their tea on the seafront overlooking the harbour. The service users reported that the food is very good. The menus, which are on display in the dining room, indicate that choices are offered at every mealtime. The chef creates the menus. is familiar with the service users likes and dislikes and does take into account any suggestions from the service users. The lunchtime meal was observed and this looked well presented and wholesome. The kitchen was visited and the chef spoken with. The kitchen is a large well equipped area and the chef takes pride in maintaining systems for monitoring and managing a well organised, clean kitchen and a number of staff. Care Homes for Older People Page 18 of 33 Evidence: The chef told us that he has been at the home for some years and is familiar with the service user group and is able to provide alternative diets for those with special dietary needs. Breakfast is served in service users rooms if they wish and the main meals of the day are taken in the large bright dining room, which most service user choose to go to at meal times, which can be quite a social occasion. There is an area in the dining room designated for those who need assistance with their feeding and we observed that this was being undertaken by staff in a quiet respectful manner. Nutritional assessments are undertaken for all service users. Weights are recorded in the care plans. There are a number of service users who are taking supplementary drinks to improve their nutritional status. It was observed that regular beverages were being offered to the service users with biscuits or home made cakes. Service users spoken with told us that they have autonomy over their lives. One gentleman told us that he can go out independently and does so often. Observation throughout the visit confirmed that staff interact well with service users and are familiar with their preferences of how they wish their care to be delivered. The home has a designated smoking room for the two service users that smoke and this allows them the freedom to go to this room as and when they wish. The manager said that there is an advocacy service available to service users should they need this service at any time. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents feel that any complaints will be taken seriously and acted upon as necessary and staff training and awareness in the protection of vulnerable adults protect them. Evidence: The AQAA reports that the home has received two complaints in the past twelve months. One of these was an adult protection issue that has been investigated by social services and the police, with no evidence found to substantiate the allegation. The other complaint was dealt with by the manager satisfactorily. The CSCI was informed of the procedures taken and records are in place. The home has a complaints policy in place that indicates complaints would be taken seriously and investigated promptly. The complaints policy is included in the Statement or Purpose. Service users spoken with at the time were confident that their complaints would be listened to and acted on. The manager said that she is available at all times to service users and relatives to discuss any issues or concerns and she is generally able to resolve these quickly. This was supported in the surveys returned to the CSCI from service users and staff. The service user surveys returned to CSCI told us that service users are aware of the complaints procedure and would know who to go to if they had concerns. Staff surveys Care Homes for Older People Page 20 of 33 Evidence: returned to CSCI say that if there was a complaint they would complete a complaints form and see the manager. The homes policies and procedure for dealing with safeguarding issues around protection of vulnerable adults is available to all staff. The manager told us that staff receive regular supervision and during this supervision POVA and abuse are discussed and procedures reiterated. This was evidenced on the supervision records. Staff training is offered regularly on this subject. The manager told us that the last training held for the Protection of Vulnerable Adults (POVA) was not well attended, but feels confident that staff are aware of their role if any concerns are raised. Currently the home has another Safeguarding investigation in progress, which was recently reported to the manager. Staff spoken with at the time of this visit and the staff surveys returned indicate that they are aware of adult protection issues and what they should do if abuse or alleged abuse is reported. The recruitment files evidenced that all appropriate recruitment checks such as Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks are undertaken before the staff member commences employment, to ensure the safety of the service users. No form of restraint is used in the home. If bed rails are deemed necessary to be used following a risk assessment, consent is sought from the service user or their relatives for their use. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Northcott provides a clean, comfortable and homely environment for all who live, work and visit there. Evidence: We looked around the home and visited all areas. The home looked bright, clean and homely. All residents spoken with at that time said that they liked their rooms and found the communal areas comfortable. Many of the service users rooms have windows that give views of the well-maintained grounds that surround the home. The home also has a pleasant enclosed courtyard area that has been maintained and nurtured by a member of staff and has resulted in an attractive area for service users to sit or walk in. Residents rooms seen looked homely and contained many personal items such as pictures, ornaments and small pieces of furniture. The manager said an inventory of all furniture and other personal possessions bought into the home, is recorded. The laundry area was visited. A designated team undertake all the laundry. The room was clean and well organised. The machines were fit for purpose, although the manager said that she was putting forward to the board that more robust machines Care Homes for Older People Page 22 of 33 Evidence: are needed. Service users said they were satisfied with the laundry service and that it was returned promptly. The AQAA states that over the past year there have been improvements and refurbishment to the dining room and the office and smokers lounge has been relocated. The disabled toilet has also been relocated. The main corridors have been redecorated and medical cabinets have been put into residents rooms for toiletries. The home is well maintained and decorated to a good standard. The charity employs a team of three maintenance people to maintain the site. The manager said that the home receives a quick response from any faults or ongoing repairs that are needed. She, with the chief executive of the charity decide on what improvements are needed for the coming year and a plan of improvements is in place. The AQAA says the home has an infection control policy in place and all staff have received training in the prevention of infection. Hand washing facilities were observed in toilets and bathrooms and protective clothing is provided for staff. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users needs are met by the number and skill mix of staff employed at the home and are protected by the homes robust recruitment procedures. Staff receive the training required to do their jobs. Evidence: The AQAA said that the duty rota evidences a good skill mix of staff on duty each shift. One trained nurse is on at night with two during the day and the manager says when she allocates the work she considers the skill mix and gender mix in each area to ensure high standard of care. The rota was viewed and demonstrated that 2 trained nurses and between 7 and 8 carers are on duty during the day and 1 trained nurse and 5 care workers on duty during the night. The manager has used available hours innovately and has employed a twilight carer to work between the hours of 7.PM and 10.PM, this being a busy period of the day. The staff were observed giving time to service users in a calm and unrushed manner. Call bells were sounding throughout the busy period in the morning, it was observed that this did not indicate a slow response to the call bell. The system is that as one call alarm is deactivated and cancelled, this then activates another call bell waiting in the Care Homes for Older People Page 24 of 33 Evidence: queue. From observations throughout the visit and speaking with staff and service users, it was concluded that the home has sufficient staff on duty each shift to meet the needs of the service users currently in residence. A survey returned from a care manager said that Staff are friendly and approachable and very visible in the home. Service users said the staff are usually available when you need them but understand that there can be a delay due to pressure of work. Other surveys indicated that staff are always available when they are needed. Separate staff groups are employed to undertake the cleaning, maintenance, laundry, kitchen and administration duties. The home does use agency staff to maintain staffing levels to cover sickness and annual leave. The manager told us that she uses one particular agency who will send a carer who is familiar with the home to ensure continuity for the service users. The home has a recruitment procedure in place. A sample of four recruitment files were viewed and these contained the information required, including two references and proof of identity. Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks had been completed. The manager said that new recruits cannot work in the home until all checks have been received. The Manager told us that the home promotes equality and diversity and that the home employs a mixed gender staff group and nurses from other countries. English courses are provided for foreign staff to improve their communication skills. All new staff undertake an induction programme which is based on the Skills for Care induction programme. The manager said that the induction programme is a pathway to the staff undertaking the NVQ level 2 but some staff commence employment already having achieved this qualification. One such new member of staff was spoken with who had commenced at the home in the previous week. She told us that she was not giving any care but was undertaking her induction and mandatory training and was in an observational role only until her induction to the home was complete. A number of staff are undertaking the NVQ level 3 in Social Care. The home has over 50 of staff with NVQ level 2 or 3. There was evidence in the personnel files that various training has been undertaken by the staff. There was evidence of the mandatory health and safety training, moving and handling, infection control, abuse awareness, first aid and food hygiene. Other training Care Homes for Older People Page 25 of 33 Evidence: appertaining to the client group has been made available, this being palliative care, dementia care and continence care. The manager said that sometime the training is poorly attended owing to many of the staff undertaking NVQ training whilst others are doing social care apprenticeships and that staff do not always have the capacity to attend other training sessions. Staff told us that they receive regular supervision and appraisal. This is undertaken by the manager and some senior staff who have been trained to do this. Evidence of records of these meetings were observed in staff files. It is at these meetings that staffs training needs are discussed and identified. Staff surveys returned to CSCI and staff spoken with at the time of this visit, told us that there are more training opportunities available to them since this manager has been in post and that they are well supported and encouraged by her to undertake training. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of the residents. Residents financial interests are safeguarded by the homes clear procedures for handling money and their health and safety is protected by the supervision of staff and the safe working practices operated in the home. Evidence: The manager has been in post for over four years and is a registered nurse and has gained her registered managers award. She is currently undertaking further education to achieve a business qualification. The home is a large nursing home with service users who have complex needs. The home employs a big staff group that the manager oversees. The managers role is wide ranging from managing the ordering and coordination of medication to working in a clinical role when she is needed, and being constantly on call. Care Homes for Older People Page 27 of 33 Evidence: Her managerial role was discussed as there was evidence that she undertakes many tasks that could be delegated to a deputy manager. The chief executive of the charity told us that he agrees that a deputy manager should be employed to support the manager in her role and that this will be discussed with the board and he anticipates that action will be taken in the near future to recruit a person into this role. The AQAA states that the home promotes an open culture with good communication between all parties. The manager is always available to staff, service users and relatives. This was evident during the visit which demonstrated the managers good relationships with service users and staff and those staff spoken to said the manager is always available and they have a high regard for her. The manager told us that she is involved with the management committee to undertake audits for various aspects of the service. There was evidence of a quality audit for infection control, kitchen and food audits, questionnaires distributed to the service users. The manager also audits the care plans with the link nurse at each supervision session. Staff meetings are held as well as inter department meetings and records of these are maintained. Staff surveys and speaking with staff say that there is good communication between all members of staff and the other departments and that they work well as a team. The home does keep small amounts of monies for some service users. These were observed to be stored in a locked environment in separate containers with receipts and records of all transactions. These records were being audited at the time of this visit by the administrator and the manager. The home has risk assessments in place for the environment and a fire risk assessment of the building. The fire log was viewed and this is maintained by the maintenance manager. All records of tests and checks on equipment were appropriately documented at the suggested intervals. The staff fire training records were also documented in this log and were observed to be up to date. A sample of servicing certificates for the gas boiler, lift and hoist were seen to be current. The home has a clinical waste policy and contract and appropriate storage for clinical waste was identified. Care Homes for Older People Page 28 of 33 Evidence: The accident book was viewed and completed appropriately. The manager audits these regularly to identify any emerging themes and she told us she follows up any reoccurring accidents and puts an action plan in place to manage any identified risks. These records were seen by us and demonstrated clear procedures for managing risks. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must give details in how risk identified risk factors are to be managed. Care plans must describe the action to take if a risk has been identified. 31/12/2008 2 9 17 A record must be kept of all medication administered to service users on the date it was administered and a signature must be replaced by a code for reason the medication has not been given. MAR sheets must be signed by the nurse administering the medication at the time of administration and a signature replaced by a coding of reasons why medication has not been administered. 31/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards Care Homes for Older People Page 31 of 33 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 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - 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!